In a move that raises serious questions over the future of the £1.8bn primary care network (PCN) programme, Berkshire, Buckinghamshire and Oxfordshire (BBO) LMCs has demanded that NHS England cancel or freeze the proposed specifications - calling them 'completely unrealistic'.
The LMC said it 'cannot in any way endorse these specifications, nor do we have any confidence that national negotiations will result in NHS England agreeing to sufficient positive changes'.
Its analysis warns that the specifications are 'impossible to deliver' with the available workforce and that that in a best-case scenario practices will face costs 'at least in excess of £100,000 per annum'. The financial impact of the plans 'pose a threat to the viability and survival of constituent practices', the LMC warns.
The document says that the specifications offer 'no benefit to practices' and are 'so far removed from what is realistically possible that we have no confidence that any final version will be in the interests of practices'.
It calls on NHS England to 'cancel these specifications, freeze the entitlements and requirements of the DES to their 2019/20 status until April 2021 so that appropriate, realistic specifications can be negotiated with the GPC which must then be voted on by the profession'.
Alternatively, the LMC suggests practices could withdraw en masse, potentially continuing to operate together 'albeit outside the DES'.
The LMC analysis concludes: 'We do not recommend practices renew the PCN DES in 2020. We would advise practices consider urgently whether they wish to withdraw from the DES, and if so, also consider whether it is in their interest to remain a member of their PCN and continue to operate as a network under locally commissioned arrangements pending discussions with CCGs.'
The specifications are currently out for consultation, in a process set to close on 15 January. But the response to the draft plans has been devastating - with leading GPs warning they will pull their practices out of PCNs unless there is significant change, and at least one PCN clinical director stepping down in response to the proposals.
BMA GP committee chair Dr Richard Vautrey stressed this week that 'we hear the concerns raised by the profession in recent weeks about these draft specifications, the workload implications and the need for a qualified workforce to deliver them, loud and clear'.
With confidential contract talks between the BMA and NHS England set to follow the consultation, the BMA is not expected to set out its reaction publicly to the draft specifications, but Dr Vautrey added that 'the profession should rest assured that we are listening to doctors on the ground, reviewing their feedback and this will form the basis of talks with NHS England to ensure that the specifications are fair and appropriate before they are agreed'.
NHS England director of primary care Dr Nikita Kanani has also said on Twitter that feedback on the DES specifications 'will absolutely be heard and reflected'.
But the BBO LMCs analysis reflects grave doubts in general practice over the extent to which the service specifications can be overhauled before the start of the coming financial year.
BBO LMCs' analysis of the PCN specifications suggests that workload involved in delivering five draft specifications covering structured medication reviews, support for patients in care homes, anticipatory care, personalised care and early cancer diagnosis would require around 14 sessions per week of clinical time per average practice, and a further 26 hours of admin workload each week.
The estimated minimum funding shortfall per PCN would be in excess of £500,000, the document suggests - with each average practice facing a loss of around £105,000. But the LMC analysis says this estimate assumes that PCNs are able to recruit staff and that they are able to do so at the 'cheapest possible rate', among other factors - and that true costs are likely to be substantially higher.
An NHS spokesperson said last week: 'We published the draft service specifications, aimed at stabilising general practice and reducing health inequalities, to provide the opportunity to feedback views through the survey. GPs are getting significant extra funding through their agreed multi-year contract and this feedback will shape the final agreement with the BMA GP committee.'