GPs not convinced PCNs will ease pressure on general practice

Most GP partners do not believe the formation of primary care networks (PCNs) will ease the crisis facing general practice, a GPonline survey shows.

GPs concerned over PCN impact on workload (Photo: Westend61/Getty Images)
GPs concerned over PCN impact on workload (Photo: Westend61/Getty Images)

GP practices across England are expected to join PCNs by July this year. The networks will cover populations of around 30,000 to 50,000 patients each - with £1.8bn in funding earmarked to support them over the duration of the five-year contract agreement that takes effect from April.

Network funding will allow groups of practices to employ 'an army of 20,000 more staff' - including physios, paramedics, pharmacists, physician associates and staff to support social prescribing, according to NHS England.

But 66% of GP partners responding to a GPonline poll said PCNs and the new staff that would come with them would not ease the crisis facing general practice. Just 10% of 146 GP partners who responded said the networks would help - with the rest unsure.

Primary care networks

A total of 18% of partners said the formation of PCNs and additional staff would help ease GP workload, although 60% said it would not. Respondents warned that additional staff would be difficult to recruit, and that supervising them would inevitably create additional workload for GPs.

One GP said: 'Not sure where we are going to get all these experienced non-GP staff from, particularly with the funding available. In addition these extra staff will need supervision, which will need to be done by GPs - increasing further workload.'

Another warned: 'Where are the 20,000 new ancillary team members going to materialise from? No one would argue that physios/pharmacists etc would not be of great benefit to the primary care team but we simply don't have this number of people waiting to step in and those who are will need significant time and support to transition into primary care roles.

'Huge input will also need to be put into educating patients to accept alternative pathways of care - all roads do not have to lead to the GP.'

Workload shift

Another GP responding to the survey warned patients may not accept plans for work traditionally carried out by GPs to shift to other healthcare staff. The GP wrote: 'It's a transformation plan. There has been a 14-year disinvestment in general practice to manufacture a crisis which is now being addressed by the replacement of GPs by other therapists.

'Do patients know or want this? Were they asked? It's devious, deliberate and a disaster.'

GPs also voiced concerns about being pushed into networks against their will. The GPC has said that practices can choose whether to join the groups, but in practice those that choose not may be significantly disadvantaged because they will have no access to funding linked to them, or potentially to enhanced services - which will be managed at a network level in future.

Despite GPs' concern that their workload could be pushed up by supervision of support staff, the profession's dwindling workforce has increasingly pushed skill mix to the fore as a potential solution.

GP workforce

A report last week by three influential think-tanks warned that the NHS faces a shortfall of 11,500 GPs in a decade from now if current trends continue. The report highlighted the need for physiotherapists, pharmacists and other staff to be employed 'much more widely and routinely in and alongside general practice' to ease pressure on the GP workforce.

GP leaders have sought to allay fears over the formation of PCNs. GPC executive team member Dr Krishna Kasaraneni said this month: ‘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.’

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