GPs pile pressure on NHS England over 'impossible' PCN plans

NHS England is facing mounting pressure to scrap draft service specifications for primary care networks (PCNs) after more than a thousand doctors backed a petition calling the plans 'impossible' and clinical directors warned they could 'choke off' GP involvement.

NHS (Photo: Mike Kemp/Getty Images)
NHS (Photo: Mike Kemp/Getty Images)

Clinical directors across Dorset's 18 PCNs have unanimously rejected the draft plans - and a petition launched by campaign group GP Survival over the weekend took just 24 hours to amass 600 signatures from GPs who agreed the proposals were 'impossible'. More than 1,000 doctors have now added their names to the petition.

These latest interventions come after Berkshire, Buckinghamshire and Oxfordshire LMC published a devastating analysis last week that estimated GP practices could lose more than £100,000 each in a 'best-case scenario' if they remained in PCNs and the draft specifications went ahead.

GPonline has also reported on at least one clinical director standing down over the draft plans, and a string of senior GPs who have been strong backers of networks threatening to pull out - in developments that have left the future of PCNs in disarray.

GP workload

With just two days until a formal NHS England consultation on the draft requirements is due to close on 15 January, PCN leaders across Dorset have revealed they ‘unanimously reject’ the plans. Writing to NHS bosses, the 18 senior GPs said additional work and bureaucracy proposed in the specifications would ‘do nothing to alleviate the crisis or reduce workload in primary care’.

The group of clinical directors added that the specifications threatened to ‘choke off’ initial enthusiasm for PCNs and reflected how NHS England remains 'out of touch with the conditions on the ground in primary care’.

The RCGP last week called for a longer consultation with the profession over plans for PCNs, amid warnings from many GPs that the draft specifications are so far removed from what would be acceptable that they did not believe they can be put right by April 2020.

NHS England director of primary care and system transformation Matt Neligan, however, said on Twitter on Monday that 'lots of feedback tells us we need to make changes' - adding: 'We are committed to doing just that.'

Network DES rejected

A position statement released over the weekend by campaign group GP Survival condemned the draft specifications, and a further group of clinical directors in Guildford and Waverley, Surrey, recommended practices on their patch reject the DES unless it's ‘completely rewritten’.

Clinical director of Dorset's Sherborne Area Network Dr Rob Childs, said: ‘The initial enthusiasm and hopes for recovery of primary care though new investment has taken a serious hit with the publication of the draft specifications. They demonstrate that NHSE remains out of touch with the working conditions in primary care.

‘The clinical directors of the 18 PCNs in Dorset unanimously reject these proposals and specifications. New proposals that demonstrate a better understanding of the situation in primary care and that produces schemes that actually reduce primary care workload are needed. Without significant change to these specifications, the future of the primary care networks in Dorset and beyond, become very uncertain.’

PCNs in Dorset identified a multitude of problems with the specifications, labelling structured medicine reviews as a ‘massive undertaking’ for practices in their area with a high number of elderly and frail patients. Leaders also flagged fortnightly GP visits to care homes as an unrealistic demand that would have to be looked at during the consultation process.

Care home plans

‘The specification for a GP to attend a ward round at least every two weeks creates significant extra work, even allowing for just a few minutes per patient. It is unclear how primary care could release GP time for this, when it is already struggling with dangerous workloads,' Dr Childs added.

The GP Survival petition says the draft requirements are an ‘inconsistent, grab-bag of ideas’ which ask for ‘an impossible amount of additional unfunded work’. It received just under 600 signatures within its first 24 hours and aims to secure over 1,000 responses before the consultation closes on Wednesday.

Meanwhile, Milford (Surrey) GP Dr Dave Triska revealed on Twitter that clinical directors in Guildford and Waverley would be recommending that practices abandoned the PCN DES in 2020 if the specifications weren’t changed favourably.

Dr Triska has previously said in a PCN Twitter discussion that he would like to see the specifications changed so there was ‘scope for local identification of community needs’.

Berkshire, Buckinghamshire and Oxfordshire LMC took similar action last week as it advised practices in their area not to sign up to the network DES in 2020.

Concerns being heard

The BMA urged GPs to make their frustrations about the specifications ‘explicitly known’ by feeding into the NHS consultation, while reassuring the GP community that they had heard their concerns ‘loud and clear’.

An NHS spokesperson said last week: 'We published the draft service specifications, aimed at stabilising general practice and reducing health inequalities, to provide the opportunity to feedback views through the survey. GPs are getting significant extra funding through their agreed multi-year contract and this feedback will shape the final agreement with the BMA GP committee.'

The draft specifications are currently out for consultation, which closes on 15 January. Click here for full details on how to respond.

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