1) Additional funding allocations

The Government published an additional allocations schedule on 30 September 2024 to supplement the 2024/25 ICB primary medical care baseline allocations and are focused initially at an ICB level.

The publication outlines that the GP contract has been amended to uplift the pay elements of the contract by 6%, backdated to 1 April 2024 (a further 4% in addition to the 2% already included in contract funding at the start of 2024/25). ICBs and NHS England regional primary care finance leads were emailed with further information about this change on 15 August 2024 => so, the news should be filtering down to GP level in the near future….

The pay uplift, referred to as the “DDRB pay uplift”, has been implemented through an increase to the global sum, with payments backdated to 1 April 2024 in the September Primary Care Support England (PCSE) payment runs. The new global sum for 2024/25 is £112.50.

So, the advice is to work with your PCN to understand when this will flow through to GP and practice level. Practical bit to be aware of is that as with the additional funding provided for contract updates at the start of 2024/25, these allocations are based on each ICB’s share of total recurrent primary medical care allocations for 2024/25. There are tables on the NHS website which show how funding is split across ICBs. Where an ICB is already in deficit, this makes it even harder for them to allocate spend across the whole system.

2) Enhanced services

Up until April 2023, the investment and impact fund (IIF) was the principal enhanced service operating at PCN level. Since then, domains were reduced from 36 to five – and now two from April 2024, with the additional funding moving to the capacity and access DES, of which 70% was paid up front in 2023/24. This amounted to £2.77 per patient, and has been increased in 2024/25 to approximately £3.25 per patient. In many PCNs the funding flows directly to GP practices, however some PCNs have utilised the funding to develop additional services instead. There is a reward element of 30% as well which is for achievement of various provisions PCN-wide at approximately £1.39 per patient for 2024/25. This is linked to delivery of modern general practice access model, and as yet, we havent seen how ICBs will monitor or seek evidence.

The enhanced access scheme has been operated at PCN level since October 2022. Managing it successfully could generate a profit, or surplus, as current funding levels allow for this eventuality.

3) Additional funding allocations

The Additional Roles Reimbursement Scheme (ARRS) is the largest area of funding, though it doesn’t flow into GP practices directly. However, with the expansion of roles eligible for funding, it is imperative that any practice decisions regarding either the replacement of outgoing staff members or further investment in staff levels take into consideration what is available and practicable from the PCN. It is in this area where increases to the primary care budget since 2019 have largely manifested.

The Government has recently announced that newly qualified GPs can be employed at PCN level. Originally this was planned to be from October until March, but it has since been confirmed that this arrangement will now continue past 31 March 2025. The level of funding available for this new role is £92,462 WTE salary (£95,233 with London Weighting) including employer on-cost, which equates to approximately £8,200 per clinical session p.a. (£8,450 inside London). This is considerably below average annual sessional rates for salaried GPs so careful consideration should be given on the basis of affordability. In addition, the provisions for this new role are as follows:

• They are within their two year anniversary of qualification as a GP;
• They have yet to be substantively employed within primary care; and
• They are not being employed on a temporary i.e. locum basis

4) General advice for GP practices

Practices need to actively engage with their PCN, with a partner responsible for liaising with them to ensure that there are no missed opportunities, and your practice receives a ‘fair deal’. Resources and funding should be allocated fairly and be commensurate with individual practices’ list size, patient needs and services provided on behalf of the PCN.

As an alternative to “fair shares” allocation, some more advanced PCN’s are considering their ARRS teams as a “service” across the full PCN. This can lead to more cohesive service delivery, the ARRS team feeling less nomadic and can assist with the supervision required.

It is also important to adhere to appropriate financial transparency and good governance, with annual PCN accounts being distributed amongst member practices. There should also be a conversation with regards to funds being retained at PCN level, either for working capital purposes or for the funding of any future projects being operated by the PCN.

Linked to this is cash flow – specifically the flow of funds via the PCN to member practices. This is especially important if there are local enhanced services that are being delivered by member practices but the funding is distributed at PCN level. With a high inflationary period in the recent past, and national budget increases over that period struggling to meet spiralling costs GP practices have had to face, it is essential that funding that is ultimately destined for individual GP practices does not get unduly held up at PCN level for administrative reasons.

5) Support from Redmoor Health

We work with a great cross section of GPs, PCNs and ICBs across England, supporting with digital transformation, implementation support and procurement support. If ever you are worried about how to interpret these financial questions then please reach out to us and we can help you.