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NHS England should start from scratch on PCN specifications

Lack of two-way engagement over ‘laudable but overly prescriptive’ specifications threatens GPs’ trust in PCNs

Louise Prime

Thursday, 16 January 2020

NHS England and Improvement should start again from the beginning in determining the service specifications for primary care networks (PCNs) to ensure that they do not impose unrealistic expectations, and to allow patients, GPs, and the wider system to reap their benefits, the Royal College of GPs (RCGP) has told the head of the NHS. It warned that the lack of two-way engagement risks the profession’s trust in PCNs and could undermine the “laudable aims” of the “overly prescriptive” specifications.

As NHS England closed engagement on the five draft service specifications for PCNs yesterday, it insisted that it had “heard the views expressed” and “will now carefully consider how to respond adequately, balancing the ambition to improve services for patients across England and the need to stabilise general practice, with what can realistically be delivered by PCNs in 2020/21”.

The RCGP said that it supports the establishment of PCNs and believes they offer a real opportunity to do things differently; and that, if given the chance to develop properly, they will increase support to practices by facilitating collaboration, pooling resources, enhancing services and ensuring that funding reaches the frontline. However, it said it is “deeply concerned that the rapid process of consultation and implementation of these five service specifications has been counterproductive to realising these aims”.

In his letter to NHS chief executive Sir Simon Stevens, College chair Professor Martin Marshall warned: “The service specifications as they stand are overly prescriptive, and our members have raised concerns that they would place significant pressure on networks before overstretched practices have begun to feel the benefits of additional staff and funding. If adopted in their current form, the specifications will inevitably impact on practices’ ability to maintain the accessibility and services they are currently providing and take away the freedom for professionals to truly improve care for their patients. This is particularly acute for places that are finding it challenging to recruit to the new PCN roles and for areas with significant deprivation that are already managing excessive workloads.”

He called for PCNs to be given the time and space to recruit to the new roles, integrate new staff into established teams and ensure they are properly trained to work in primary care, to enable them to address excessive GP workload – and ultimately improve patient care.

Professor Marshall warned Sir Simon that mandating the specification without broad agreement from the profession “would have a detrimental effect, undermining the development of emerging networks, and potentially destabilising services in some areas”.

He warned: “We are therefore calling on NHS England and Improvement to take urgent steps to further engage with professionals in general practice to make changes to the service specifications, to ensure that they do not impose unrealistic expectations and allow a flexible approach to local delivery. This will help to ensure that we build on the early successes of the PCN policy and will mean that local systems empower clinicians to deliver the best possible services to patients. We would be happy to be part of these discussions and recommend beginning the process again for developing the specifications with a new approach.”

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