GP premises need major investment to let PCNs recruit, warns BMA

Primary care networks (PCNs) are struggling to make use of hundreds of millions of pounds in recruitment cash because practices have no room to accommodate new staff, the BMA has warned.

GP premises warning (Photo: Glyn Kirk/AFP/Getty Images)
GP premises warning (Photo: Glyn Kirk/AFP/Getty Images)

A total of £430m is available to PCNs in 2020/21 - around £344,000 per network - to recruit staff from a list of 10 roles through the additional roles reimbursement scheme (ARRS). The average PCN is expected to employ around 21 extra staff by 2023/24.

If used fully, the funding would allow general practice as a whole to recruit an additional 27,000 staff such as first contact physios, paramedics and social prescribers in a bid to ease pressure on GPs.

However, the BMA has warned that without significant investment in GP premises, many practices 'simply don't have space' to accommodate new staff.

Primary care workforce

PCN clinical directors have told GPonline that they cannot make use of recruitment funding because practice premises are already ‘stuffed to the gills’ - or they won’t be able to recruit the staff they would like because of limited practice capacity.

GPs leading PCNs have called on the government to provide separate funding for networks to improve existing premises, or to rent additional space for PCN activities.

Clinical director of Kingston PCN in London Dr Richard Van Mellaerts told GPonline that many GP teams were already operating out of substandard settings. He said: ‘We would love to continue to expand our clinical pharmacy workforce… and there is the money within the ARRS, but we are going to be prevented from recruiting by virtue of the lack of space.

‘Somebody like a health coach or a social prescriber may be able to work outside of a generic office space, particularly if they're operating over the phone or by video, but somebody like a physiotherapist - a more clinical role - will need to have something far more like a traditional GP consulting environment.

Estates funding

‘We're a PCN that's got three practices, so five buildings between us, and we're stuffed to the gills - and that's with people hot-desking and working from home as well,' he added. 

Dr Van Mellaerts said health leaders needed to provide separate funding, or grants, to ensure networks could deliver ‘really ambitious' extra services. He said: ‘Extending existing practices could be difficult, so ultimately we would need to consider PCN-specific premises with rent reimbursement or notional rent in the same way as for general practice.'

Co-clinical director of Wokingham North PCN in Berkshire Dr Rupa Joshi told GPonline that a lack of space meant that her network was forced to amend its recruitment plans. She said: ‘We did have in mind that we wanted to recruit a physician associate, but we haven't gone down that road and that's because of the space…we're recruiting another GP because we know that they won't require the same level of supervision.'

She explained that to hire a physician associate more space was required to carry out supervision and training. She called for networks to be allocated extra funding towards managing estates, and said her PCN would use this to expand their current site or move to a different one completely.

Growing patient demand

BMA GP committee chair Dr Richard Vautrey said: ‘The government has committed to expanding general practice by 27,000 staff by 2024, to meet the growing demand from patients. Achieving this goal is not just about recruiting those new members of the team, which has started in earnest, but having the space for them to provide those services to their patients. At present practices simply don’t have that space.

‘If the government is to live up to its commitment, then it must invest significantly in general practice premises and expand practices to house the 27,000 new members of the workforce. Without this, practices cannot fully recruit, and patients will ultimately be let down by another government commitment that is unfulfilled.’

NHS Confederation PCN Network director Ruth Rankine said estates problems would become clearer when services started to ramp up again after the pandemic. She said: ‘In some ways it’s easier at the moment because there’s a lot of remote working... but when things get back to normal, where is the estate that actually houses that workforce?'

She added that clinical directors and networks would need assistance with estates planning in the same way that they need help with workforce planning to use ARRS funding effectively.

Lloyd George records

NHS England guidance on accommodating additional staff hired under the network contract DES states that PCNs should consider ‘digital first’ solutions to deliver services. It also advises networks to digitise Lloyd George records, promote flexible working and look into estate sharing arrangements with partners in the community.

However, GPs have argued that a digital first approach is not always plausible, with new starters often needing to be close to colleagues at first for supervision and training.

A DHSC spokesperson said: We recognise physical premises and the space available are important considerations for GP practices. We have invested £800m in the last four years in improving the primary care estate and technology available to GPs, on top of ‘business as usual’ infrastructure funding like minor improvement grants.

'The government will continue to invest in primary care and further NHS funding will be confirmed at the next spending review.'

A BMA survey in 2019 found that more than half of GP premises were not fit for purpose.

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