BMA seeks to allay GP fears over formation of primary care networks

GP leaders have assured practices they will not be forced to join emerging primary care networks (PCNs) after London doctors voiced concerns over pressure to join - and fears of being frozen out.

GPs at a Londonwide LMCs conference spoke out over concerns about PCNs - which all practices are being incentivised to join as part of the five-year GP contract unveiled earlier this year.

One Lambeth GP said she was worried that ‘a lot of us are going to be pushed slightly into networks geographically, not necessarily out of choice,’ and that this would create a ‘complex’ governance structure.

‘We are going to have to performance manage within our network,’ she said, arguing: ‘If you are put into a network - and we will be put in, eventually… a lot of us will be facing that dilemma [whereby] one or two of our colleague practices are needing a lot more support.’

GPs under pressure

Other GPs felt some practices were ‘on the back foot’ when it came to forming or joining a PCN. One GP from Harrow - where the local CCG covers 250,000 patients - said: ‘Some surgeries have been linked together and were talking about merging into a group covering about 100,000 patients. My surgery sits outside of that 100,000, so we’re feeling a bit threatened that we’re not part of a network already.

‘Our fear is that all business will go to this large organisation… How can we survive long term if all the services are going to another network?'

GPC executive team member Dr Krishna Kasaraneni told the conference that practices would not be forced to join PCNs against their will.

He said practices ‘can’t be forced into joining a primary care network’ and urged GPs to view the new contract as an opportunity for collaborative working - assuring them that they will be ‘better off’ if they sign up to networks built ‘on your terms’.

Network model

GP practices across England are expected to join a primary care network by July 2019. Each primary care network (PCN) will bring together a group of neighbouring GP practices to cover a population of 30,000 to 50,000 patients.

Dr Kasaraneni said: ‘First of all, not all practices need to get into a network. Let’s be absolutely clear. You can’t be forced into joining a PCN. So if you as a practice choose not to that’s fine. But overall the general direction of travel is that it is a DES, it is optional, but there’s going to be a lot of funding coming through to support it.

‘Governance-wise there will be guidance nationally that helps you make those decisions… But it’s got to be what works for you locally. This can't be another top-down reorganisation where everyone from the top tells you how it’s done. It’s got to be local.’

Londonwide LMCs chief executive Dr Michelle Drage said she didn't believe 'rigid governance' would be vital to run networks. 'I think you have to have an attitude within the network supported by the CCG that isn’t anti-collaboration. And I think form should follow function with networks.

‘If we find that practices are being performance managed either unrealistically or unfairly then we will be taking a view at on how that is done. We will support the practices that need support and we will try and measure the system that is driving that performance management to make it fair.’

Dr Kasaraneni said practices’ local LMC would be able to offer help in ‘uncomfortable’ situations.

‘This is an opportunity for you to have those discussions with your colleagues, look at the current collaborative structures that you have, think [whether it is] the right one and how [you could] realign to make it work for you as practices and the patients that you serve. Part of that will mean facing difficult conversations.'

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