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Is the game up for PCNs?

Hard-wired GP

Luke Koupparis

Thursday, 16 January 2020

Dominos_AdobeStock_290218561_v2.jpgI gave my feedback on the draft PCN specification document this week which Chris Preece has helpfully summarised in a recent blog post. I wanted to tell them in no uncertain language how terrible it was and explain that going down this line will simply result in practices pulling back from the contract. However, I couldn’t quite believe how the questions do not allow you to give any negative feedback. Take the first question below, which was followed by subsequent ones with a similar vein:

Is there anything else we should consider for inclusion as a requirement for this service? For example, are there approaches that have delivered benefits in your area that you think we should consider for inclusion?

So, I tackled the whole survey by not answering their questions, but bluntly giving feedback that expresses the sentiment of the vast majority of the profession, that this is simply an unworkable car crash. I pointed out that the document they hurriedly sent out just before Christmas, is going to result in a significant increase in workload for general practice and not in GPs suddenly being released to take on other work (who thought that this could ever have been the outcome?).

Moving on to the issue of funding and workforce, the document states the following:

Page 5 (1.11) states Funding is not allocated directly for delivery of the service specifications; rather, the largest portion of network funding (£257m in 2020/21, rising to £891m in 2023/24) provides reimbursement for additional workforce roles that PCNs can engage to support the delivery of the specifications and alleviate wider workforce pressures.

Their idea that GPs will simply use staff employed under the PCN contract to release them to take on additional workload is just unworkable. In our PCN so far, we have one pharmacist (who is not an independent prescriber) and one social prescriber both who are shared across practices. Don’t get me wrong, they are both lovely people, but I don’t see them taking workload away from our GPs any time soon.

There appears to be a view nationally from many PCN directors and LMCs that they will refuse to sign up to these specifications. They fly in the face of the original mandate for the contract that was supposed to stabilise general practice. Some LMCs are suggesting that GPs withdraw from the network contract entirely. PCN directors are threatening to resign from their posts. A recent petition has also been set up from the GP survival group who vehemently oppose the document contents.

This should be a real warning for the authors of the specification document, but I have heard that it is likely to be broadly the same as was published, with only some minor “tweaks”.

What is even more concerning is that where there is potential overlap with local contracts and the new service specifications, funding will be removed and “reinvested”.

Page 8 (1.24) states: Funding previously invested by CCGs in local service provision which is delivered through national specifications in 2020/21 should be reinvested within primary medical care and community services in order to deliver the £4.5bn additional funding guarantee for these services.

We all know what “reinvestment” means in NHS England speak, as we have seen this happen countless times before. It either means that the funding will be used to pay off deficits or it will be recycled to get us taking on more box-ticking work with no evidence base. There is widespread concern that CCGs have emerging plans to start to terminate local contracts, where there is any potential overlap, but with little detail about where the money will flow.

So not only do we have to cover the work required in the specifications by simply using the new PCN staff, but we also lose investment that was made via historical local agreements. A double whammy, extra work and less investment. Hardly the basis of a new contract aimed at stabilising general practice and preventing the haemorrhaging of vital clinical staff.

I fear that we may see a domino effect of practices disengaging and PCNs starting to topple over if there is not a pull back from this poorly considered specification document. The game will most certainly be up for PCNs with them going in the same direction as the document should…directly to the shredder.

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Luke Koupparis

Luke is a general practitioner in the Bristol area with interests in men's health, child health, minor surgery, online education and medical information technology. He is the IT lead for Bristol clinical commissioning group, LMC representative and chair of the locality provider group. He also works as the medical editor to OnMedica helping to deliver high quality, peer reviewed information to the wider medical community. In his spare time he is a keen road cyclist and likes to ski with his children.
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