The following support article summarises the requirements for the Network DES contract for 2021/22 and offers guidance around how Ardens can help you achieve these requirements. Please see NHS England guidance here.

Enhanced Health in Care Homes

For a PCN's patients who are living in the PCN Aligned Care Home(s), its suggested clinicians to deliver a weekly 'home round'. Please see pages 45 to 47 of the NHS England guidance for further information.

Ardens have provided searches to help practices identify patients within care homes, using the correct coding as required by the PCN DES.

To locate the searches, navigate to the Population Reporting module > Ardens Searches >  5.3 Ardens National Cntract Reports > Network Contract DES (NCD) > Care Homes folder.

The Care home data quality search folder identifies patients who have a 'care home' code in their record which is not recognised by the Network DES business rules. You may wish to re-code these with 'Lives in residential home' or 'Lives in nursing home' (or 'living temporarily in care home') as these are the recognised codes.

The Network Contract Requirements - work to do folder identifies outstanding work to be done. Once the searches have been run, click on the Population Included tab to review the list of patients.

There are further care home searches in the same suite of searches, within the 'Network Contract DES Indicators > Management Information searches:

To support practices with capturing  consistent ward round data for care home patients, the Ardens Care Home template is available, please see further details of this template here along with other supporting templates.

Early Cancer Diagnosis 

Our understanding of the service specification is that practices should work together to achieve the QOF QI Early Cancer diagnosis. 

The Quality Improvement for Early Cancer Diagnosis requires practices to improve participation in the national cancer screening programme, and also improve referral and safety-netting practices for patients suspected of having cancer.

Ardens have a number of resources to support these requirements.

The Ardens Cancer screening searches (which can be located in the Population Reporting module > Ardens Searches > 5.6 Ardens Cancer Searches > Cancer screening searches folder), identifies uptake for bowel and breast screening for those patients eligible. 

The Cervical screening uptake and call/recall folder contains searches to identify eligible patients that are yet to have cervical screening and due either a 1st, 2nd or 3rd invitation.

The Ardens Fast Track Safety Netting Tools allows practices to keep track of patients referred for a 2WW fast track referral. The tools include alerts to warn clinicians if a patient is yet to be seen within 3 weeks. Further information of the Ardens Fast Track Safety Netting tools can be found here.

To monitor achievement of cancer activity and identifying work that still needs to be done relating to PCN DES. Access the Population Reporting module > Ardens Searches > 5.3 Ardens National Cntract Reports > National Contract DES (NCD) > Cancer folder.

The Clinical Activity folder (once run) will report on the diagnosis, referral and screening activity recorded for this fiscal year.

The Work to do folder identifies work to be done. This is mainly patients that have not had screening advice recorded in this fiscal year. The practice also have the option to narrow down to specific groups of patients, such as Learning Disability, Transgender and BAME. 

To complete the work to do, access the patients displaying in the Population Included tab, check if a patient has been given advice and code appropriately.

The Ardens Cancer Template includes Cancer Care Review pages to complete the review for the patient.

For further information on the different Ardens cancer resources, please see the following support article

Additional Roles Reimbursement Scheme (ARRS)

Each PCN may employ Allied Health Professionals to work with GP Practices. 

Social Prescribers and Clinical Pharmacists may wish to use the Ardens Social Prescribing and Health Coaching Template to record activity. This template can be located in the Ardens > Other templates > Social folder

Physiotherapists may wish to use the Ardens Musculoskeletal Template to record activity. This template can be located in the Ardens > Other Templates > Musculoskeletal folder.

Ardens has created a suite of searches to help practices and PCNs to monitor the activity of the Allied Health Professionals. To access the searches, navigate to the Population Reporting module > Ardens Searches > 5.3 Ardens National Cntract Reports >  Network Contract DES (NCD) > Network Contract DES Indicators > Management information folder.

The folder contains searches broken down by role:

Run the searches individually or by entire folder to view the results.

Structured Medication Reviews (SMR)

PCNs should identify specific groups of patients who need a SMR. To support practices to identify target populations, Ardens have created a suite of searches.

To access the searches, navigate to the Population Reporting module > Ardens Searches > 5.3 Ardens National Cntract Reports > Network Contract DES (NCD) > Structured Medication Review folder.

The  Target populations folder breaks down the target population by groups (care home residents, patients recorded as having a fall or admission in last 6 months, housebound, medication associated with errors, severe frailty patients and those patients on 10 repeats or more.

The Work to do folder identifies work to be done and patients requiring a structured medication review. Click on the Population Included tab to identify the patients. Please note - the Ardens Structured Medication Review includes standardise coding of this activity.

To standardise coding of this activity, Ardens have provided a Structured Medication Review template and Pharmacist Review Template, both can be searched for via the Run Template option in the consultation screen.

Please see the following support article, for further information on the Structure Medication Review template - click here.

Investment Impact Fund (IIF)

The Network DES Investment and Impact Fund (IIF) has been revised for 2021/22 and 2022/23.  A summary is below and more information can be found here.

Improving Prevention and tackling health inequalities

  • CVD-01: % patients not on QOF hypertension register as of 30 Sep 2021 with BP > 140/90 (recorded before 31 Mar 2022) for whom there is evidence of clinically appropriate follow-up to confirm or exclude a diagnosis of hypertension by 31 Mar 2022 (53 points).
  • CVD-02: % of patients on QOF hypertension register (27 points).
  • VI-01, VI-02, VI-03: Offer seasonal influenza immunisation to eligible patients (142 points).
  • HI-01: Identify and include all patients with a Learning Disability on the LD register, and make all reasonable efforts to deliver an annual LD health check and action plan for at least 75% of these patients aged over 14 (36 points).
  • HI-02: Record the ethnicity for all patients registered with the PCN (45 points).

Support better patient outcomes in the community through proactive primary care

  • PC-01: % of patients referred to social prescribing (20 points).
  • EHCH-01: Number patients recorded as living in a care home as % of care home beds eligible to receive the Network DES Enhanced Health in Care Homes service (18 points).
  • EHCH-02: % of care home residents with a Personalised Care and Support Plan (PCSP) agreed or reviewed (18 points).
  • EHCH-03: % of care home residents who have received a structured medication review (18 points).
  • EHCH-04: Average number of patient contacts as part of weekly care home round per care home resident (13 points).

Support improved patient access to primary care services

  • ACC-01: Confirmation that all practices in PCN have mapped all active appointment slot types to the new national appointment categories (27 points).
  • ACC-02: Number of online consultations per 1,000 registered patients (27 points).
  • ACC-03: Analyse and discuss the implications of data on Type 1 A&E attendance rates for minor conditions with the local ICS, making a plan to reduce unnecessary attendance and admissions (56 points).
  • ACC-04: Work with local community pharmacists to increase referrals to the Community Pharmacist (56 points).
  • ACC-05: Make use of GP Patient Survey results for practices in the PCN to identify patient groups experiencing inequalities in their experience of access to general practice and develop and implement a plan to improve access for these patients (56 points).

Help create a more sustainable NHS

  • ES-01: Metered Dose Inhaler (MDI) prescriptions as a percentage of all non-salbutamol inhaler prescriptions issued on or after 1 October (27 points).
  • ES-02: Mean carbon emissions per salbutamol inhaler prescribed on or after 1 October (27 points).

Ardens has created a suite of IIF searches to support practices and PCNs to achieve these requirements. To access the searches, navigate to the Population Reporting module > Ardens Searches > 5.3 Ardens National Cntract Reports > Network Contract DES (NCD) > Investment and Impact Fund (IIF) folder.

Each sub folder includes a defined register of patients, activity achieved and indication of work still to be done. 

Please see the following support articles for further supporting resources for the IIF requirements:

PCN DES Template

The Ardens PCN DES template includes the required coding (only) for payment for each area, more detailed information can be found within the templates mentioned above.

If you require any further assistance on the process above, please contact Ardens support on: