Recent updates confirmed that start dates for service specifications under the PCN DES for structured medication reviews (SMRs) and early cancer diagnosis have been pushed back to 1 October.
PCN workforce planning targets have also been deferred, while introduction of the Impact and Investment Fund (IIF), which aims to deliver extra money to speed up changes to services delivered by PCNs, has been postponed for at least six months.
However the changes fall far short of demands set out by the GPC in a letter to NHS Improvement on 1 April. The letter had asked for the suspension of all three service specifications until April 2021 and a relaxation of the roles networks could recruit to through the Additional Roles Reimbursement Roles Scheme (ARRS), as a result of the pandemic.
However, NHS England only agreed to the six-month deferral on the SMR and cancer service specifications and decided to press ahead with the ARRS in its current form. The enhanced health in care homes service will also start from 1 October as was originally planned.
Practice deadline extension
LMCs have warned that changes to the DES do not go far enough to protect general practice through the pandemic and could create ‘onerous workload requirements’.
Bedfordshire, Buckinghamshire and Oxford (BBO) LMCs have said that the network DES does not have ‘sufficient benefit to practices to warrant LMC approval’ and have argued that practices should be given more time to sign up to the 2020/21 contract amid the pandemic.
Meanwhile, in a letter seen by GPonline Cambridgeshire LMC has told practices it ‘would advocate caution’ in signing up to the DES at present, explaining that it was waiting on ‘outstanding assurances’ around staff recruitment and specification postponements.
Warnings around participation in next year's network DES come after GP leaders argued that PCN and core contract work may need to be postponed as practices cope with a huge backlog of tasks after the peak of the COVID-19 outbreak.
In March, LMCs voted for the profession to reject the network DES in its current form and backed a motion that called for the deadline for practices to sign up network contract DES for 2020/21 to be deferred until 1 October 2020.
At present, practices are expected to sign up to the DES by 31 May, but BBO LMCs have said that the coronavirus pandemic has strengthened the argument for a deadline extension.
Core service focus
In an update briefing to practices published on Monday, BBO LMCs said: ‘Given recent events it is now even more necessary that there be an extended sign up window and moratorium on new service specifications and requirements so that practices can focus on core services, and the pandemic response.
‘We therefore find it alarming and astonishing that NHS England continues to implement the enhanced services of the DES as planned, during the greatest pandemic of the last 100 years.’
The information that was sent to practices in the area suggested that BBO LMCs were disappointed that the SMR specifications had been delayed, rather than removed entirely, and similarly worried that the specifications covering enhanced care in care homes and early cancer diagnosis remained in place.
‘Our prior analysis of the PCN DES has been detailed and extensive, this has not changed, and we reject it in its current form. We...cannot advise our constituent practices that they sign up to it.
‘The potential consequences of the DES are not clear. The effect it will have on your practice and contract remain unclear and may be irreversible. We are concerned this may be the last point you can opt out without causing irreversible adverse consequences to your practice,’ BBO LMCs concluded.
Assurances for GPs
Cambridgeshire LMC has also expressed caution about practices' participation in the 2020/21 network DES. Although it said NHSE had ‘pretty much’ come good on its promise to support practices during the pandemic, it continued to await further assurances.
‘We know that NHSE wrote to you earlier this week. They have clarified with us that they are not imposing a local deadline strictly, but are adhering to the national 31 May deadline… We would advocate caution in signing up to the DES for the time being, primarily on account of some unanswered queries put to NHSE, and some outstanding assurances we are yet to receive.’
Clinical directors told GPonline in March that restrictions on how PCNs can spend funding to recruit new staff must be lifted to help practices fill roles needed to fight COVID-19.