Flawed DES could scupper NHS long-term plan, warns network pioneer

The five-year programme of reform set out in the NHS long-term plan could fail because 'top-down' draft DES specifications have put off 'large tracts' of GPs heavily involved in primary care networks (PCNs), according to a leading GP.

Dr Nav Chana
Dr Nav Chana

Former National Association of Primary Care (NAPC) chair Dr Nav Chana - who helped develop and roll out more than 200 'primary care home' sites across England that helped inspire the PCN model - told GPonline that draft network DES specifications are too prescriptive.

NHS England insisted last July that it would be ‘as flexible as we can’ with PCNs and look to avoid a top-down management approach - emphasising that they did not want to ‘stifle innovation’.

But Dr Chana said the draft specifications create ‘lots of expectations in a quick timescale’, which risked undermining work already carried out by both primary care homes and PCNs. He said 'unrealistic' expectations had been heaped onto additional staff PCNs are expected to recruit.

South-west London GP Dr Chana said some of the GPs who were most highly engaged with PCNs were saying they didn't have the time, energy or resources to deliver the plans in their current form - pointing to an NAPC poll that found 84% of respondents felt they could not achieve the requirements.

Unless the draft specifications are changed by NHS to give practices more freedom, Dr Chana warned that many grassroots GPs and primary care professionals could quit efforts to work in collaborative networks - one of the main aims of the NHS long-term plan.

Local GP engagement

Dr Chana said: ‘While I understand the need for an accountability around the funding that is going into PCNs, there's a balance between over-specifying what you expect networks to be doing versus allowing colleagues to transform services locally, based around need and demand.

‘The reason that the primary care home model was so successful was because we encouraged people to innovate and design, and we didn’t burden them with a lot of bureaucracy… we set out a broad direction of travel but did not specify to the nth degree what they needed to do or achieve.

‘It almost feels like the balance has gone the wrong way and there's too much top-down over specifications and not enough local engagement and encouragement allowing people enough time to build relationships and focus on the things that matter to them and their patients.

‘If the draft doesn't change, then I think it will disengage a lot of people, a lot of grassroots GPs and primary care professionals, from creating collaborative networks.’

Dr Chana said work outlined in the specifications would naturally be achieved by networks without the need for guidance. He said that giving practices detailed instructions at a time when the sector was under pressure may not be the best way to get GPs onboard.

Undermining PCH work

‘We found in the PCH programme that people will naturally be doing stuff around frailty, around medicines management and social prescribing schemes. But it's not that we specified that, it's because they realised when you look at need and then start developing models of care that some of these things just fall into step.

‘There's been a strong feeling of these specifications undermining some of the work that primary care homes and PCNs have already been doing because of the expectation now that they have to deliver all of this stuff in addition to what they have been doing already.'

Last week, the NAPC published its response to the draft service specifications in which it described the requirements as ‘too early and too detailed’ following a survey of over 240 members. Dr Chana argued that the specifications in their current form risked some of the aspirations of the NHS NHS long-term plan, explaining that the strategy was predicated on PCNs having a signifcant role.

‘If the specifications are unchanged, I think that will be a significant risk to enabling PCNs to do the stuff we all want PCNs to do. Most informed and transformative members said they don’t feel they have the time, energy or resources to deliver the specifications...imagine how that then applies to those who haven't been engaged, that’s probably going to be more of a challenge.

‘Looking at the ambitions of the NHS long term plan, it almost feels that we could do that differently. We could achieve those by engaging much more around collaborative networks, allowing people to understand the value of that without almost telling everyone what they've got to do with limited resources.’

Senior GPs in leadership roles within PCNs have quit or threatened to pull out, some LMCs have urged doctors not to sign the contract unless changes are made - and last week the BMA's GP committee voted to hold an emergency conference once contract talks between its executive committee and NHS bosses are complete.

Earlier this week NHS bosses promised to consider what ‘what can realistically be delivered’ by PCNs after ‘large numbers of GPs’ submitted feedback on draft network DES specifications.

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