GPs call for partial suspension of network DES amid heavy workload

GPs leading primary care networks (PCNs) have called for the partial suspension of service specifications due to kick in from October - warning that practice teams are fatigued from responding to COVID-19 and already face an expanded flu campaign.

NHS under pressure (Photo: Kathy Tomlinson/Getty Images)
NHS under pressure (Photo: Kathy Tomlinson/Getty Images)

PCNs will begin work on three service specifications set out in the network contract DES from 1 October, including enhanced health in care homes, structured medicine reviews (SMRs) and early cancer diagnosis.

Work on the specifications originally was due to start on 1 April, but was deferred following the start of pandemic. NHS England confirmed last week that PCNs will start work on the three service specifications next month.

PCN leaders, however, argue that they have not had the time nor the headspace during the pandemic to recruit additional staff to carry out this work.

They also warn it is the wrong time to introduce new objectives with everyday work being 'ramped up' in recent weeks, including planning for the expanded 2020/21 flu campaign.

Recruitment

GPonline has previously reported that PCNs face losing out on millions of pounds of recruitment funding because they have struggled to bring in new staff. Clinical director of Newcastle South PCN in North Staffordshire Dr Barry Edwards explained that COVID-19 had further exacerbated recruitment difficulties.

He said: ‘During the last few months our heads have been around COVID-19, we’ve not been focusing on employing people to deliver the service specifications. So, we end up now with this sort of flurry during the last two quarters - trying to use up funding and seeing how we can deliver against the three specifications.

‘There aren’t many PCN pharmacists out there, and what we are finding now is that PCN pharmacists are moving between networks. So it's a mobile workforce and there are not enough of them. Being able to recruit more than one pharmacy technician would help us out.

‘In terms of what’s in the SMRs specification, it's not rocket science to deliver. But it's about the workforce [and] lack of workers which is hindering specification work at the moment. But that may be different in other areas.’

Deferred indicators

Dr Edwards said the enhanced health in care homes specification would be hardest to deliver, but added that work carried out during the pandemic had put his PCN at an advantage.

He suggested that delaying work around SMRs could help networks struggling with workload issues. ‘I think you could argue that the care home is vitally important in COVID times,' he said. 'But you could look at whether the metrics could be altered to make them more achievable. The cancer one, could you really park that? So, of the three, I think that SMRs would probably be the one I would look at to delay.’

Clinical director of Whitewater Loddon PCN near Basingstoke, Hampshire Dr Tim Cooper echoed concerns over recruitment and how it could impact on specification work. He said: ‘A lot of work around enhanced health in care homes is kind of already being done and being managed. With the SMRs, that sort of comes down to whether or not you've been lucky enough to recruit into a pharmacist role.

‘Going out to advert takes time and consideration and planning to do. And, being brutally honest, everyone's minds are elsewhere at the minute, trying to focus on getting through the day job stuff which is just ramped up immeasurably.’

Care home work

Dr Cooper suggested that starting three specifications in October would be challenging for fatigued practice teams. GPonline recently revealed that GPs delivered a huge increase in face-to-face appointments in early September, while work has risen considerably since May.

He said: ‘Personally, I think it would have been better to delay one or two of those indicators - it's just quite hard for people to find more time to do that work at present. Everyone is feeling really fatigued now, so I think we should be prioritising one or two areas, such as COVID-19 and flu, or care homes,  to really hit home - three indicators feels a lot at this time.

He said prioritising the care homes specification initially would have been sensible. 'It's testing the model of what the PCN should be doing, which is collaborating with each other but also collaborating with their community sector.'

Practices have been handed a one-month opt-out window by NHS England as it released a revamped network contract DES including the three service specifications. However, many GPs remain optimistic about PCNs, with half of GP partners believing networks will have a positive impact on patient care in their area over the next year.

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