Pared back network DES still 'too much too soon' for PCNs, GPs warn

Primary care networks (PCNs) still face excessive workload under reworked GP contract plans for 2020, clinical directors leading the groups have warned.

Primary care network concerns (Photo: Scott Barbour/Getty Images)
Primary care network concerns (Photo: Scott Barbour/Getty Images)

The warning from PCN clinical directors comes as the BMA prepares to set a date for a special conference of LMCs that will consider contract changes approved earlier this month by the BMA's GP committee - and suggests LMCs may challenge parts of the deal.

Last week NHS England published a revised package of GP contract measures for 2020/21 - including pared back plans for PCNs. The deal - backed by the BMA's GP committee - deferred two out of three service specifications that had been included in controversial draft plans and increased flexibility around the staff PCNs can hire through the additional roles reimbursement scheme (ARRS) - which aims to bring in 26,000 healthcare workers to support primary care by 2023/24.

But PCN leaders have warned that the updated terms of the network DES continue to demand 'too much, too soon' of networks and worry about being able to deliver on requirements for this year.

PCN workload

They say that the updated specifications, although reduced, will continue to take up ‘significant amounts of GP time’ because doctors will have to train incoming staff before they can take on work set out in PCN specifications, and pick up the work in the meantime.

Clinical directors also told GPonline that a new payment worth £120 per care home bed as part of the 'enhanced health in care homes' specification for PCNs would not cover the full cost of additional workload for practices - meaning they could lose out financially.

GPs attending the BMA's PCN conference on 8 February also reported continued problems with the ARRS scheme for this year, with clinical directors expressing their frustration at being unable to access surplus recruitment funds from CCGs.

The updated contract increased flexibility around the roles that PCNs can recruit to from April 2020, adding pharmacy technicians, health and wellbeing coaches, care co-ordinators, occupational therapists, dietitians, podiatrists and community paramedics.

Speaking to GPonline, clinical director of Newham Central 1 PCN Dr Farzana Hussain said the ability to recruit to a wider range of roles was 'music to everybody's ears', but warned that a requirement for structured medicine reviews (SMRs) would still create workload issues.

Medicine reviews

She explained that the pharmacist recruited in her area was yet to start their primary care pharmacy training programme, meaning it would be another 18 months before they could take on work set out in PCN specifications alone - meaning GPs would have to step in in the interim.

'If these specifications had come out in December, I would have still thought it was quite ambitious to deliver,' Dr Hussain told GPonline. 'I would want to do it, but I would say it is still too much too soon - there's still a hell of a lot of extra workload here.

‘Just having someone magically appear doesn't mean they can provide the services that we are asking for, so these are huge pieces of work and that's going to be a challenge to embed them in the network to be absolutely sure they are happy to be working in a different way.

‘A trained pharmacist is very different to a pharmacist that is needing to do this training and the bands of pay have not allowed us to get a more senior pharmacist. So I think it's going to be hard for me as a clinical director how I'm going to deliver that for 2020/21. On the ground, I'm still struggling with that.’

Funding

At the BMA PCN conference clinical directors voiced concerns about recruitment to additional roles this year. GP leaders from both London and Leicestershire shared difficulties of obtaining 'slippage money' to kick on with recruitment plans.

‘I would really welcome some instruction from NHS England to our CCG and the local primary care team to stop putting barriers in place to release the funds. We were told that the slippage would be available if we made a business case but that’s not materialised and it’s really frustrating that we can’t spend money that has been allocated to us,' said Dr Emma Rowley-Conwy, clinical director of Streatham PCN.

Meanwhile, Shropshire LMC chair Dr Simon Hodson told an expert panel of GPs that networks in rural areas needed more support to recruit to additional roles, especially physiotherapists. ‘I wonder if there is any facility for supporting particularly rural areas in recruiting these staff that may well be washing around in the cities but aren’t out in the country,’ he said.

GPonline reported last year that 'unrealistic' wage bands were preventing PCNs from recruiting additional roles staff - with some practices forced to put in additional funding to make salaries competitive.

Clinical director of the Grand Union PCN in Watford Dr Kevin Barrett welcomed reductions in the scope of the network DES, but warned some concerns remained. He said: 'Delaying the implementation of anticipatory care and personalised care for a year will allow time for additional staff to be recruited to help carry out these roles, which is welcome.

‘The simplification of the the remaining three specifications does relieve some of the pressure, particularly in areas where care home alignment has not started. The payment per bed does help address the variation in distribution in care homes among PCNs, but it still doesn't fully cover the additional workload involved.'

Richmond GP and chair of campaign group GP Survival Dr Nicholas Grundy - who led a petition demanding a complete overhaul of the draft specifications released last December - told GPonline he was 'positive about the immediate future for PCNs'.

'Although it isn't perfect, the two biggest plus points as I see them are that the revised specifications do away with the burden of the 50-plus metrics in the draft spec, and that in doing so they give PCNs the chance to be genuinely locally led,’ he said.

‘Although the three most onerous specs do remain, they have been significantly slimmed down, and the compulsory elements largely removed, which I think is a better deal. The challenge now is using the additional staff roles to deliver improved health to our communities, while stabilising general practice at the same time. No small ask, but it’s looking more achievable than it did in December.'

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