BMA tells practices to consider quitting PCNs after imposed contract

GP practices should consider pulling out of the PCN DES after NHS England imposed changes to the 2022/23 contract that will increase workload, the BMA has warned.

BMA House (Photo: Malcolm Case-Green)

In an update to its ‘Safe Working’ guidance published on 10 March, the BMA emphasised that changes to PCN requirements for 2022/23 were published by NHS England 'without agreement' from its GP commitee and that the changes 'asked PCNs to deliver greater requirements than previously'.

The BMA advice warns that practices now 'need to consider if the PCN DES enables them to offer safe and effective patient care within the context of their wider practice, and their present workforce' - and reminds practices they can opt out between 1 April and 30 April by notifying their CCG.

NHS England's decision to impose contract changes for the coming financial year, including a requirement for GPs to deliver full services from 9am to 5pm on Saturdays through PCNs and three new indicators added to the Investment and Impact Fund (IIF), has been condemned as 'bitterly disappointing' by the BMA.

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BMA GP committee chair Dr Farah Jameel warned that the unilaterally imposed changes ignored appeals from the profession for increased support amid soaring workload exacerbated by the COVID-19 backlog.

The updated BMA guidance comes just weeks after GPs urged the union to ballot the profession on industrial action after NHS England's decision to impose contract terms. An indicative ballot by the BMA in November 2021 showed that more than half of practices were prepared to pull out of PCNs at the next opt-out period - while 39% were willing to disengage before then.

The updated guidance says: ‘NHS England rolled out the PCN DES in 2019/20 and has invested further in the DES since that time. While 95% of practices in England are part of a PCN, the perceived success of PCNs for practices and patients has varied hugely across the country.

‘There is an increasing view that the requirements of the DES outweighed the benefit brought by the investment into practices and ARRS staff. NHS England has published its proposals for PCN requirements for 2022/23 without agreement from GPC England, asking PCNs to deliver greater requirements than previously.

Safe patient care

'Practices will need to consider if the PCN DES enables them to offer safe and effective patient care within the context of their wider practice, and their present workforce. There is a process by which practices may express that they no longer choose to continue within the DES between 1 April and 30 April 2022 to their CCG.’

The guidance warns that practices opting out of the PCN DES would stop receiving payments associated with this element of the GP contract package, in addition to losing staff hired through the additional roles reimbursement scheme (ARRS) - and suggests that practice withdrawals could force the collapse of PCNs.

At the end of February, Dr Jameel labelled IIF targets 'misaligned' and 'overly bureaucratic' - warning they could undermine GPs' ability to deliver quality patient care unless they were amended.

Following its decision to impose the 2022/23 contract package, NHS England described the changes as 'minimal updates...designed to give general practice stability'. The BMA hit out at NHS England over a 'misleading' claim that the BMA's GP committee had been consulted over the changes.

The call for practices to consider their position in PCNs comes after the BMA’s UK GP committee and Wales GPC chair Dr Phil White warned this week that the profession is facing ‘unsustainable pressure’, while grassroots GPs accused the government of ‘trying to destroy' general practice by adding to practice workload.

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