Network DES will cost GPs money and threaten independent contractor status, warn LMCs

A group of LMCs has warned it 'cannot recommend' GPs sign up to revised plans for primary care networks (PCNs), warning the deal could cost practices thousands of pounds a year and threaten their independent contractor status.

Funding risk (Photo: Matthew Horwood/Getty Images)
Funding risk (Photo: Matthew Horwood/Getty Images)

Analysis by Berkshire, Buckinghamshire and Oxfordshire (BBO) LMCs of reworked PCN service specifications - backed by the BMA's GP committee after a major overhaul - found that an average network could lose £17,191 a year for signing up.

There is 'no evidence' the network DES will reduce practice workload, which 'seems to have been designed to shift the workload and liability of other providers onto general practice', the LMCs' analysis warns.

Suggestions that elements of the DES will be 'rolled into the core contract' further down the line raise 'significant concerns that this DES poses a threat to the independent contractor model, the core GMS contract, and the autonomy of individual constituent practices', the LMCs say.

Network DES

The scathing evaluation of the network DES - a major part of the 2020 GP contract and a key plank underpinning the rollout of PCNs - is a major blow for networks ahead of a special LMCs conference next month that could yet echo the BBO LMCs advice and urge GPs nationwide to think twice about signing up to the DES.

The BBO LMCs analysis warns that ‘significant elements of workload’ created by the PCN specifications would leave networks out of pocket, rating networks' chances of seeing net financial benefits as 'highly unlikely'.

Fulfilling the three agreed national specifications from April 2020, covering structured medicines reviews (SMRs), enhanced care in care homes and early cancer diagnosis, along with other responsibilities, would require 61.5 sessions of clinical time per week.

An average PCN will have around 40 sessions a week of usable workforce time from staff hired through the additional roles reimbursement scheme, the LMCs say - suggesting a likely shortfall of 21.5 sessions per week.

Practice costs

Unfunded expenses, such as clinical supervision for incoming staff and recruitment costs, were aso highlighted as further costs to practices within networks.

The BBO LMCs analysis says: ‘Based on [our] analysis, the LMC cannot recommend that practices sign up to the PCN DES. Conversely, we do not necessarily recommend all practices withdraw from the DES as each practice and network will be different.

‘Some practices and PCNs may feel they are in a financially strong enough position that they can absorb the associated risks – we would recommend any such constituents take steps to maximise their ability to withdraw from the DES in future, and that they take a view in 12 months.

‘In any case, we would strongly advise all practices to await the outcome of the imminent special conference of LMCs being held on 11 March before making any commitment to the 2020/21 PCN DES.’

BBO LMCs was a strong critic of controversial draft service specifications published in December - warning the plans threatened to cost practices £105,000 a year.

Requirements for PCNs from April have been significantly scaled back as part of the 2020 GP contract package backed by the BMA's GP committee earlier this month, with funding increased to cover the full cost of hiring staff into additional roles and two out of five service specifications originally set for rollout from April deferred to 2021/20.

Despite optimism around the updated terms, some clinical directors have warned that the revised service specifications are still ‘too much too soon’ for practices.

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