NHS England to block local deals for GPs who opt out of PCN DES

GP practices in England that opt out of the network contract DES will be unable to negotiate better deals for services and funding at a local level, NHS England has warned.

NHS warning (Photo: SOPA Images/Getty Images)
NHS warning (Photo: SOPA Images/Getty Images)

NHS England director of primary care strategy Ed Waller last week urged practices to sign up to the DES - and insisted they will not be able to negotiate better terms locally.

In a primary care webinar on 7 May, Mr Waller said: ‘We’re really clear that the contract management around the DES is going to be supportive and collaborative. So, we will expect CCGs to focus on the DES itself and the delivery of that rather than the core contract and to look to support practices.'

But he added: ‘One thing that is important to clarify is that practices who opt out of the DES won't be able to secure the same services and funding entitlements on better terms via a local agreement. This is a nationally negotiated DES, and to make sure we are fair to everybody it's a nationally negotiated set of terms and conditions.’

Network DES

Practices have been given until 31 May to enter the network DES, which was recently updated to defer start dates for service specifications within it until October.

Some LMCs have called for the deadline to be extended and urged practices to think carefully about taking part, calling the decision to press ahead with this part of the contract during the COVID-19 pandemic 'astonishing' - and warning it could leave practices facing significant extra work without adequate funding to support it.

GPs have been told there are no plans to make ‘substantive changes’ to the network DES in 2021/22 beyond existing plans to bring in specifications on personalised care and anticipatory care - but that practices will be able to pull out of the DES at that stage if they wish.

Mr Waller said: 'There is not, contrary to some thinking, a plan to make substantive change to the DES terms in the future... if the DES terms and conditions changed, practices would have the opportunity to think about their involvement in it as ever because it's a voluntary instrument.'

Practice workload

BMA GP committee chair Dr Richard Vautrey has previously urged NHS executives to be ‘flexible in response to what the reality is on the ground’ for GPs over the coming months in relation to DES workload. He reiterated that practices could pull out in future if they signed up to the DES for this year.

He predicted most practices would sign up to the network DES, but told GPonline that practices would have to look at the details of the contract before making an individual decision. He said: 'The [pandemic] has thrown a completely different light onto the way that practices working together will benefit from each others’ support - the support from wider colleagues from within that locality, whether that is community nursing teams or others.

‘That collaborative working has been to the benefit of everyone over these last really difficult weeks. Practices have an opportunity to sign up by the end of the month, but they also have an opportunity to opt in or out next April. This isn't a once and for all decision.'

NHS Confederation PCN Network director Ruth Rankine said the DES represented the best chance of significant investment in general practice and primary care for future years, arguing it was 'too good an opportunity to miss'.

‘Adapting to the COVID-19 crisis has shown the significant progress PCNs have made to redesign the way primary care can work when given the resources and the autonomy. We need to recognise the advancements that have been made and how these can inform the future potential of PCNs over and above the current specifications so we get the right balance between national consistency and locally driven, bottom-up responsive services,' she said.

PCN DES service specifications for early cancer diagnosis and structured medicines reviews are expected to take effect from October this year, with an enhanced care in care homes specification due to start at the same time - although with practices expected to plan additional support for care homes from next week under plans 'brought forward' by NHS England.

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