'Inflexible' network DES could block funding and drive up health inequalities

Primary care networks (PCNs) could miss out on a huge proportion of their funding because of a lack of flexibility in the network contract DES, GP leaders have warned.

PCN funding (Photo: Altinosmanaj/Getty Images)

Senior GPs say the problem threatens to increase health inequalities by unintentionally punishing well-developed PCNs at the same time as undermining those that struggle to recruit.

Almost half of the £1.8bn available to support PCNs by 2023/24 will be delivered through the additional roles reimbursement scheme, which supports practices to recruit specific staff.

In 2019/20 PCNs can claim 100% reimbursement for employing a social prescriber and 70% funding for a clinical pharmacist.

Staff shortages

But GPs say some PCNs have struggled to recruit to these specific roles due to national staff shortages and increased competition as networks across England seek to fill similar posts. Meanwhile, because funding is only available for additional roles - not existing ones - practices that hired shared staff before the formation of PCNs may also be unable to benefit.

PCN leaders have called on NHS England to increase flexibility within the network DES to allow clinical directors to use funds in alternative ways to ensure they don’t miss out on funding and allow more advanced PCNs to continue their development.

In a letter sent to commissioners earlier this month, NHS England deputy director of primary care strategy Robert Kettell suggested that PCNs that failed to use this money to employ additional staff would see their funding removed and offered to others within their CCG making ‘swift progress’ with their recruitment.

At the time, BMA GP committee chair Dr Richard Vautrey said it was important that funding made available for PCN workforce expansion remained in general practice and was not lost to other NHS budgets.


Speaking to GPonline, a senior LMC official from north-east England said there was ‘next to zero chance’ that PCNs would be able to meet recruitment targets set by NHSE.

‘When you come to a really rural area like the north east, the chance of being able to recruit the required professionals reduces even further because we haven’t got a vast number of people in shooting distance compared to more populated areas… there just aren’t enough of these professionals.’

The LMC official, who asked not to be named, said it would be unfair if PCNs that struggled to recruit had their funding taken away, warning it would mean ‘the rich get richer and the poor get poorer’.

Clinical director of Newham Central One PCN and East London GP Dr Farzana Hussain agreed it was a concern that PCNs struggling to recruit could lose out on funding.


‘I’m a bit concerned because we don’t find it easy to recruit in Newham for anything. It’s a very deprived area with abnormally high house prices, so it’s not a great place to attract doctors or pharmacists… people generally move out of Newham.

‘By diverting the funding to other networks, surely all we are doing is expanding that health inequality gap, something which PCNs are here to try and solve. I think we do need to be quite careful of that and be quite proactive and push back.’

Meanwhile, the LMC representative added that many PCNs in north-east England were already ‘skill-mixed up to the hilt’. This meant clinical directors in those areas did not need to employ some of the staff incentivised through the network DES - and that these ‘mature’ PCNs risked seeing their development stunted if they were unable to take advantage of funding on offer.

‘Over the last 10 years, practices have employed pharmacists, they’ve employed physios and, in some cases, they’ve employed a social prescriber, and they’re saying that they don’t need any more of these people. At the minute, there is no option to use funding in any other way.

‘It’s fine for a practice that has stuck to an old-fashioned model of GPs and a few nurses. But when you have a PCN with vastly skill-mixed teams, they’re going to be losing out on money. We just need the flexibility to employ to other roles or to employ managers…it feels like it’s being given with one hand and taken away with another’.

Dr Hussain accepted that the NHS England could only make ‘one set of rules and policies’, but called for flexibility. ‘The innovators are in a difficult place because they can’t claim funding if they already have these staff in post, which seems a little bit unfair - I think they are losing out.’

She warned that in areas where funding was not used, NHS England should explore why and consider flexibility.

NHS England was approached for comment.

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