Most GPs say PCNs have added to GP workload and bring little benefit to practices

Over three-quarters of GPs in England believe that being part of a PCN has added to practice workload and less than half believe practices in their area have benefited overall from being part of a network, a poll suggests.

NHS logo on side of building
(Photo: Mike Kemp/Getty Images)

A GPonline survey of 233 GPs in England found that just 45% believed that being part of a network had benefited practices where they worked overall. Almost a third (31%) said membership of a PCN had not benefited practices and the remaining 24% said they were unsure about the benefits.

GPs highlighted particular concerns that PCNs were adding to practice workload. A total of 42% said they 'strongly agreed' that the PCN DES would create additional work for practices, with a further 35% saying they 'somewhat agreed' that it would lead to more work. Only 2% of GPs said that they did not think being part of a network would create further work for practices.

GPs were also sceptical about whether practices will see any financial benefit from being part of a network, with just 29% saying that they thought this would be the case.

Meanwhile, only a third of doctors (32%) believed networks would help improve services for patients.  The same proportion said that they thought PCNs would not improve services, with the remaining 36% saying they did not know if patient services would improve.

Enhanced access concerns

A number of GPs responding to the poll raised concern about the work PCNs are expected to deliver this year, in particular enhanced access.

In one of the biggest changes to the network contract enhanced service this year, from October PCNs will be expected to deliver a minimum of 60 minutes of appointments per 1,000 adjusted patients per week in 'network standard hours' - from 6.30pm to 8pm and 9am to 5pm on Saturdays. GPs have already raised concerns that the funding provided for this is insufficient.

Responding to the GPonline poll, a GP partner said: 'While overall it is a benefit to work in a PCN, what is being required to access the funding is becoming impossible such as providing extended access. With staff recruitment and retention issues, it will be impossible to deliver the level of extended access expected. GPs will end up keeping up the service with their own money and time.'

Another added: 'The extra hours until 8pm and Saturdays will be difficult to cover. Doctors, nurses and admin staff do not want to work these hours – it will require paying extra and there are no additional funds. We cannot lose hours on Monday to Fridays to give people time in lieu either. It is really worrying.'

Additional roles

While welcoming many of the new roles being recruited into general practice under the additional roles reimbursement scheme, many GPs responding to the poll highlighted that training and supervision were also adding to GP workload and were a huge drain on GPs' time.

Some doctors also raised concerns about how much work will be involved in the Investment and Impact Fund (IIF), which gets underway in full for the first time this year.

One GP said: 'Training requirements and the supervision needs of ARRS staff are over complicated and laborious. GPs are now in charge of employing and supporting staff who are providing work out of the GMS core contract, so this is adding to workload - not taking away from it.'

Another GP said: 'All our ARRS staff have greatly helped with GP workload. However, the roles require a vast amount of supervision in the first two years. The IIF is creating extra work which will not be managed by ARRS staff, it's additional  work for GPs.'

Another GP added: 'I do agree there has been recruitment of ancillary staff, but it's taken 2-3 years before they can offer help enough to take some workload. Capacity in primary care does not feel increased.'

Impact on practices

GPs also raised concerns about how PCNs would impact on the future of the partnership model. One partner said: 'PCNs are the nail in GP coffin lid. Practices feel they are bound to the PCN enhanced service so they can't financially escape. But if they looked at the work the PCN is doing, how much is actually relieving practices of work they did three years ago and how much is doing new PCN work? [Any extra funding should] be in the core contact and allow practices to employ whichever staff they need.'

Last week the BMA's England GP committee warned that PCNs pose an 'existential threat' to the independent contractor model of general practice.

Criticism of PCNs by the GP committee comes after NHS England imposed changes to the GP contract for 2022/23. An indicative ballot of GP practices by the BMA last year found that more than half of practices would be prepared to opt out of PCNs - and the BMA has faced criticism for not pressing ahead with industrial action.

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