What the NHS vaccination strategy means for PCNs and practices

NHS England has recently published its NHS Vaccination Strategy. While there are clearly vaccination-specific implications for general practice, the wider implications for practices and PCNs may actually be much more significant. In fact, it may be that it tells us more about the future plans for general practice than the recent contract letter.

The vaccination strategy reinforces the status of PCNs. It proposes, quite forcefully, that all vaccination activity should be directed through integrated neighbourhood teams. 

‘The Fuller stocktake proposed that PCNs evolve into integrated, multidisciplinary teams, delivering to communities at home, neighbourhood, place and system level. We believe that vaccination across the life course should be at the heart of these teams, as an integral part of a cradle-to-grave prevention approach based on population health need…An integrated team should be adaptable and work across the vaccination delivery network. It should flex according to type of vaccination and of provision… When not vaccinating, the team should be capable of delivering other healthcare interventions.’ [See 3.3.3/4]

Here what we have is yet another example of a service that has historically formed part of the core business of individual practices now being shifted to the remit of the PCN (now neighbourhood team). 

The document is actually explicit about this, ‘We will also explore with government partners whether and how we can maintain and extend the ability of primary care organisations to collaborate within a PCN’ [4.2.5]. The direction is clearly less into individual GP practice contracts, and more via the PCN.

This does not mean a wholesale move of vaccinations away from general practice. The expectation remains that some (but not all) vaccinations will still be carried out within general practice, and in fact the document specifies which vaccinations it expects to occur where: vaccinations for infants and pre-school children within general practice; vaccinations for school-aged children in schools; adult seasonal vaccinations at a ‘range of locations’ that is ‘likely to include general practice and/or community pharmacy’; and adult routine vaccinations also at a ‘range of locations’ [3.1.13].

But it means not only will the funding for vaccinations come via the PCN but the service will also be commissioned locally rather than nationally. ‘We intend to delegate responsibility for commissioning NHS vaccination services to ICBs… Our provisional timetable is that all areas should be engaged in formal joint working across ICBs and regional teams from April 2024, with delegation to all ICBs completed by April 2025.’ [4.1.3 & 4]

The rationale for this is that ‘this is in line with the Fuller Stocktake recommendation to amalgamate existing primary care funding where possible and maximise system decision-making on discretionary investment’ [4.2.11]. So not only is the funding for vaccination being shifted to local systems, but we can expect more of this to occur in future.

Further, it is clear that integrated neighbourhood teams really is going to be the unit of delivery of choice moving forward. While many of us still struggle with pinning down exactly what an integrated neighbourhood team is (we know it is more than a PCN, but what does that mean?), the strategy does provide some clues as to how the system is thinking about these teams.

First, it seems it is an entity with its own workforce, and that ‘systems’ (one assumes integrated care boards) have responsibility for workforce planning in these teams, ‘Systems should ensure their workforce planning includes clear opportunities for progression within and beyond the integrated team’ [4.3.8].  Second, they require collaborative working arrangements across organisations, with sharing of workforce across providers, and the ‘best arrangement may differ from the lead employer model used during the pandemic’ [4.3.9]. I am not sure it is pushing it too far to say this is pointing towards these teams becoming entities in their own right.

This leaves us with some very important questions.  How can individual practices remain sustainable if funding and services continue to be stripped from the core contract?  What will be the relationship between these new integrated neighbourhood teams and the current PCNs. Do they evolve into these teams or are they part of them?  And what does this mean for the future of independent general practice?

What does now seem extremely likely is that further change is coming for general practice and that working together at a PCN level is going to be front and centre of this change.

Ben Gowland is director and principal consultant at Ockham Healthcare, a think tank and consultancy. He was an NHS chief executive for eight years and has also been a director of Croydon Health Services NHS Trust. He established Nene Commissioning, first as a PBC organisation and then as one of the largest clinical commissioning groups (CCGs).