The Network Contract Directed Enhanced Service – why does it matter?

Physiotherapists have provided services into primary care for many years. However the introduction of first contact physiotherapy (FCP) roles has pushed the boundaries of historical provision. One challenge for these new roles has been their integration into the primary care team. Some of these challenges and their possible solutions can be explained by considering the Network Contract Directed Enhanced Service (DES) contract.  

by Abi_Hend

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The 2022/23 specification, recently published in England, is part of the annual NHS GP Contract.  It empowers general practice to improve the range of services it offers to its populations working in primary care networks (PCNs). Most FCPs in England are funded through the Additional Roles Reimbursement Scheme (ARRS). The contract sets out the detailed requirements for reimbursement of all staff contracted or recruited under the ARRS.  It sets clear expectations around the level of practice and role of an MSK FCP, the embedding of FCP in primary care and access to appropriate supervision and training.  Understanding the funding and contractual framework, which PCNs operate in, is crucial when negotiating both local FCP contracts and working within FCP services.

The DES represents more than just the contractual framework for FCP.   It illustrates key drivers and priorities for general practice and contains the nuts and bolts of how NHS primary care policy is translated for delivery in practice.  For example, all PCNs will be now be required to offer ‘enhanced access’ to patients in the evenings and weekends, utilising the full MDT.  This recognises the contribution of these roles and it could create further opportunities for FCPs.  However, it may also raise contractual questions and knock-on effect to how these roles are recruited, vital aspects for service leads and the CSP to consider. 

It details requirements relating to shared-decision making, social prescribing services, targets for incentive payments, such as cardiovascular disease prevention and diagnosis, tackling neighbourhood health inequalities and many other areas of care.

Strengthening the case for FCPs 

The ambitions of the DES are welcomed by the CSP.  However, it illustrates the breadth and extent of demand placed upon primary care.  With ever-growing requirements, the case for implementation of FCPs at a higher density becomes even stronger. The CSP has long advocated that to see the true value, there needs to be one FCP for every 10,000 people.   We are actively looking to influence workforce development through a national integrated approach to workforce planning, which will in turn support the needs of FCP services. 

By understanding the broader context of primary care and recognising wider pressures, FCPs can fully evaluate where their contribution fits into the bigger picture of general practice and the patient pathway, both within primary care and beyond.  FCPs must work collaboratively with general practice to ensure their services are utilised optimally to support the population health ambition of this contract. 

Rachel Newton, head of policy at the CSP, co-authored this blog with Abi Henderson, head of FCP implementation 

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