Many PCNs are considering incorporation, which is forming a company to employ staff and to provide DES services as a subcontractor of the PCN practices. There are indications that PCNs will become the preferred vehicle for delivering other local services from 2022/3, so having a separate legal entity may make it easier. Also, limited liability as a PCN is much bigger than most practices, and being able to shelter surpluses from the taxman, is attractive.
Consideration needs to be given before incorporating to matters such as:
There is no formal link between existing GP federations and PCNs. However, in many areas of the country, existing federations are working closely with PCNs.
In some cases, existing federation membership corresponds to the membership of a PCN or a number
of PCNs and the federation is evolving its governance structures to support the PCNs. Where the federation itself holds a primary care contract, it might be a core practice member of a PCN in its own right. Many federations have been appointed as subcontractors of PCNs or as employment vehicles for PCN staff, particularly where they already have NHS employing authority status and CQC registration.
However, where a federation’s employing authority status is by virtue of a time limited contract, there is a risk this might not be a long-term solution.
As PCNs are not legal entities, they cannot employ staff in their own right. There are three main options for employing PCN staff:
No single option is ideal. Joint employment arrangements can be unwieldy, and a separate partnership could be created inadvertently between the employing practices. If one practice or a third party (e.g. a company or the GP federation) employs staff on behalf of the PCN and supplies the staff to the PCN practices (rather than providing a managed medical service), there is a risk that the employing body could be acting as an employment business (which requires compliance with certain legal requirements) and the supply could be subject to VAT. Whatever employment arrangements are put in place, it is important that the PCN’s network agreement covers matters such as:
A number of template schedules were issued around the time that PCNs were introduced and many PCNs understandably took advantage of using these in the run up to the initial registration deadline.
However, we strongly advise that you review these if you have not already done so. This is for six main reasons:
A key objective of PCNs is to ensure that general practice engages with the wider health and care system in order to achieve more integrated health and social care.
PCNs need to work collaboratively with other providers of community, mental health and social care services. If you are delivering services jointly with other organisations, you should have a collaboration agreement setting out your respective responsibilities.
Going forwards, primary care providers will need to work together at place level (generally, based on city or town boundaries and surrounding areas covering populations of 250,000 to 500,000) as well as participating in ICSs (populations of 1 to 3 million). A place is likely to involve multiple PCNs and you should be planning now with other PCNs so that general practice will effectively represent primary care at “place” level. This is another area where existing GP federations might have an important role to play, as many of these cover areas which could be defined as “place”.
NHS England has published useful FAQs which can be found on their website.
Our frequently asked legal questions supplement those published by NHS England.