All seven practices in Skegness and Coast PCN in Lincolnshire opted out of the network DES, warning they would be unable to deliver on the enhanced health in care homes (EHCH) specification due to the demands of a large elderly population - and constraints around recruitment and resourcing.
LMCs stressed last month ahead of the 31 May deadline for practices to sign up to the network DES that it would create ‘additional work’ for practices, with one LMC warning that the negatives of the deal could outweigh the benefits.
A GPonline poll last month found that most practices had yet to commit to signing up to the DES with just days to go until the deadline - and some GP leaders have been deeply critical of the decision to press ahead with network development during the coronavirus pandemic.
Skegness and Coast PCN had been in discussions with other local network leaders and Lincolnshire CCG to identify what additional support it would need to deliver services to 26 care homes, if they were to sign up to the DES in the future.
Four practices in the network have accused Lincolnshire CCG of breaking the network agreement, claiming it held secret talks with individual practices before the 31 May sign-up deadline to explore the delivery of care home services through a new network.
The clinical director of Skegness and Coast PCN has already resigned, while the four practices have warned the CCG’s behaviour has ‘the potential to undermine the trust’ of all local PCNs and their clinical directors.
In a letter to CCG commissioners Dr Stephen Savory, a GP partner at Spilsbury Surgery - a member of Skegness and Coast PCN - criticised attempts to form a new PCN, Skegness and Mablethorpe PCN, without approaching the clinical director or project manager.
He said: ‘The conversations taking place between commissioners and Skegness and Mablethorpe GP practices were hasty, ill-conceived and have created a problem far greater than that the parties sought to address.
‘Any accusation that this is a problem of all Skegness and Coast GP practices’ making is not tenable. Our four practices see no realistic prospect of a return to trusting network collaboration with Skegness and Mablethorpe practices should proposals for their new PCN founder.’
Care home support
Dr Savory told GPonline that a large elderly population and fears around delivering on the care home specifications had caused practices to opt out of the DES. Around 29% of the population are over 65, compared to an average of 15.6%.
He highlighted concerns about the collapse of the PCN and the creation of a new PCN. He said: ‘There is currently no PCN or PCNs to serve the 80,000 patients in the Skegness & Coast Division of Lincolnshire CCG. There is no infrastructure for a single system working to support delivery of the Lincolnshire long-term plan.
‘It is entirely possible that new PCNs will not be formed in one or both of the Skegness and Mablethorpe or "inland" areas. Both Boston and East Lindsey PCNs have indicated they do not have the capacity to deliver the PCN DES for this population,’ he added.
Dr Savory also highlighted that there was no network in place to facilitate a local primary care response to the COVID-19 pandemic. Meanwhile, he said the creation of Skegness and Mablethorpe PCN could risk ‘the sustainability and quality’ of primary care in the area.
He added: ‘I request that primary care commissioners consider the potential impact on clinical leadership, collective provider effectiveness and patient safety. In the coming weeks I may need to share this concern with the CQC.’
A spokesperson for Lincolnshire CCG said: ‘Following the decision of a number of GP practices in the Skegness and Coast PCN to opt out of the DES for 2020/21, Lincolnshire CCG is responsible for ensuring the total population is covered by the network DES 2020/21, and is continuing discussion with all practices on how this will be achieved in line with contract specifications by 30 June 2020.’
During the pandemic practices have been asked to work in their PCNs to provide care home 'check ins' and develop personalised care plans for all residents.
In April NHS England brought forward plans for practices to support care homes, but has said this work is not part of the Enhanced Care in Care Homes specification under the network DES.