One in three practices could boycott network contract DES from April, poll suggests

A third of GP practices could decide not to sign up to the network contract directed enhanced service (DES) this April, a GPonline poll suggests.

(Photo: Universal Images Group/Getty Images)
(Photo: Universal Images Group/Getty Images)

The survey of 111 GP partners in England found that less than two-thirds (62%) definitely planned to sign up to the DES from April.

Almost a third of GP partners (31%) were unsure about whether their practice would take part in the DES this year, while a further 7% said their practice would definitely not sign up.

The poll comes ahead of a special conference of LMCs in London on Wednesday, where GP leaders are set to debate whether the profession should reject the network contract DES in its current form.

The motion tabled for debate also warns that primary care networks (PCNs) are a 'Trojan Horse' set up to dump hospital work on practices and pose an 'existential threat' to the future of the GP independent contractor model.

The network contract DES formalises arrangements for practices' participation in PCNs, a key plank of NHS England's aim to integrate care as part of the NHS long-term plan. If a significant number of practices decide not to sign up to the DES the future of PCNs could be thrown into doubt.

A substantial amount of the extra investment earmarked for general practice over the next four years of the five-year GP contract will be funnelled into PCNs, including £430m in 2020/21 to recruit additional staff to work in primary care – a figure that will rise to £1.4bn a year by 2023/24.

Additional staff

However, GP partners responding to the poll were sceptical about whether the plans to recruit additional staff via PCNs would help them during the coming year.

Only 45% of the partnersthought that their practice would benefit from new staff recruited by PCNs in 2020/21. Some 35% felt their practice would not benefit from the extra staff, while 20% were unsure about the impact on their practice.

GP partners responding to GPonline's poll expressed concern about the work involved with the network contract DES.

One GP said: '[The] contract relating to networks is appalling – can't believe that some GPs are considering it still. We all need to not sign up to send a clear message to government. It fails to address severe issues of underfunding and continues to force practices to have to meet thousands of targets for small pots of money. If I didn't have to deal with this I could see twice as many patients in a week and perhaps my working day may reduce from the current 12 hours without any breaks.'

Another said: 'Its a risky deal, which surrenders a lot of ground in return from modest financial rewards and little or no impact on core GP workload.'

'I don't think there are enough of these additional staff - and definitely not enough [who are] sufficiently well qualified to be useful and have an impact on workload,' another GP said. 'I worry about the additional workload supervising new co-workers.'

Network contract DES

However, some GPs were positive about the plans. 'It's far better than the draft network DES proposals. Overall very positive news,' one GP said.

'Better than we hoped and generally a step in the right direction but focus needs to remain on supporting practices,' added another GP.

Analysis by Berkshire, Buckinghamshire and Oxfordshire (BBO) LMCs of the reworked PCN service specifications that networks will have to deliver in 2020/21 found that an average PCN could lose £17,191 a year. The LMC has said it cannot recommend GPs in its areas sign up to the DES.

The BMA's GP committee (GPC) voted in January to hold this week's special conference after it rejected an initial contract offer. Following major concessions from the government over controversial draft service specifications, which had received almost universal criticism from GPs, the GPC backed a package of changes for 2020/21 - with 71% of committee members voting in favour.

The BMA has said the contract deal, including the three service specifications that will form part of the network contract DES in 2020/21, is agreed and is no longer up for renegotiation. However, the special conference will be able to make its views known on the new GP contract.

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