Draft specifications published by NHS England before Christmas outline requirements for five services set to be added to the £1.8bn network contract DES from April 2020 - covering structured medication reviews, support for patients in care homes, anticipatory care, personalised care and early cancer diagnosis.
But the document has been met with widespread dissatisfaction from doctors, who say that the draft specifications create workload ‘vastly in excess of what is credible’ for GPs. They have also criticised a lack of separate funding to carry out additional duties, such as fortnightly care home visits.
This had led to a number of senior GPs and leaders of mature networks, including the 2018 winners of the NAPC Primary Care Home of the Year, threatening to pull out of the PCN DES unless it is altered ‘radically’.
PCNs at risk
GPonline reported last week that the unfunded care home responsibility for GPs within the draft specs could trigger the collapse of the PCN model.
However, the BMA has moved to assure the profession that it is listening to GPs' concerns over the draft specifications.
Sharing his views on the draft specifications on Twitter, Dr Mark Spencer - clinical director of Fleetwood Neighbourhood PCN and the award-winning Fleetwood Primary Care Home - said: ‘Unless the draft PCN service specs are radically changed in order to reduce general practice workload and allow us to address local priorities then we’re out.'
Dr Spencer - a former chair of the NHS Alliance - added that PCNs had to be allowed to ‘opt out of delivering some or all of the services specifications’, with the agreement of their local commissioners, in order ‘to concentrate on delivering local priorities’.
GPs opting out
He said that if the draft specifications were not changed, his PCN would revert to its previous status as a primary care home and would do this ‘without NHS England PCN funding or status’.
Fleetwood; winners of @NAPC 2018 Primary Care Home of the Year & Primary Care Network of the Year at 2019 GP Awards. Unless the draft PCN service specs are radically changed in order to reduce General Practice workload and allow us to address local priorities then we’re out. https://t.co/FuZTPjKU07— Mark Spencer (@markspen9999) January 8, 2020
Meanwhile, Dr Hugh Reeve - a senior GP partner who was until recently a CCG chair in Cumbria and who leads a GP federation in the area, said the service specifications were ‘overwhelming’. He predicted practices would start to pull out of PCNs without a ‘radical change of direction’ from NHS England.
In his response to the NHS consultation on the network DES plans, Dr Reeve wrote: ‘Considered individually they might be achievable, if it was only one specification a PCN had to deliver. But the five together create a massive package that even a mature and sophisticated primary care organisation would struggle with, let alone new partnerships made up of struggling GP providers who are under enormous pressure and are struggling to recruit core staff.'
CCG clinical lead and Sheffield GP Dr Anthony Gore also anticipated a widespread withdrawal of practices from PCNs if service specifications went unchanged.
‘New work in new specs far outstrips the maturity of new PCNs to deliver and exposes how small the real level of new investment has been,' he wrote on Twitter this week. 'Risk practices will pull [out] of PCN DES en masse very real.’
Responding to the concerns expressed by GPs and LMCs about the draft specifications, BMA GP committee chair Dr Richard Vautrey, said: 'General practice continues to be under a huge amount of pressure and we hear the concerns raised by the profession in recent weeks about these draft specifications, the workload implications and the need for a qualified workforce to deliver them, loud and clear.
'While the content of negotiations is confidential, the profession should rest assured that we are listening to doctors on the ground, reviewing their feedback and this will form the basis of talks with NHS England to ensure that the specifications are fair and appropriate before they are agreed.
'In turn, we would urge as many clinical directors, GPs, practices and LMCs as possible to raise concerns directly with NHSE to ensure their voices are heard.'
Just finished online feedback for PCN draft spec. I predict that without a radical change of direction NHSE will start to see practice resignations from PCNs. This is not what we signed up for. Comments too detailed for twitter but DM me if you want a copy to read and share.— Hugh Reeve (@hugh_reeve) January 6, 2020
Speaking to GPonline, Devon GP and former NHS Alliance chair Dr David Jenner vowed to pull his practice out of the PCN DES if other partners agreed. If not, he said he would resign his partnership.
'These specifications are just so crazily out of sight, for example the fortnightly visits to nursing homes. If we did that properly, it would be 15 minutes a patient… we have 100 patients in care homes, so that would be 1,500 minutes or 27 hours a fortnight of GP time. And then there's the bit about giving out of hours to PCNs in future.
‘I just think the workload is vastly in excess of what is credible - most practices are struggling to deal with the day-to-day workload. New staff hired by PCNs would potentially help us support our core contract, but we can't do a whole load more as well.
Additional NHS staff
Dr Jenner also questioned the suitability of additional staff PCNs are being supported to hire. He said these staff would need additional primary care training to bring them up to speed; something which would have to be provided and paid for by GP practices.
'In regard to these new people coming on board, I think the assumption is that they would free up GPs to do all this extra work around the specifications. But, to be honest, they are not qualified to do this, they can only do a bit of what a GP does in a consultation. They will also need supervision and backup.
BMA GP committee chair Dr Richard Vautrey has said recruitment of additional roles staff would be the acid test for PCNs in 2020. But PCN leaders have warned that networks could lose additional staff if they did not receive adequate funds to train them.
The draft specifications are currently out for consultation, which closes on 15 January. Click here for full details on how to respond.
An NHS spokesperson said last week: 'We published the draft service specifications, aimed at stabilising general practice and reducing health inequalities, to provide the opportunity to feedback views through the survey. GPs are getting significant extra funding through their agreed multi-year contract and this feedback will shape the final agreement with the BMA GP committee.'