GP practices have until 30 April to opt out of the PCN DES, which has been expanded from the start of the 2022/23 financial year under contract changes imposed by NHS England.
BMA leaders said in early March that practices should 'consider' whether the demands of the expanded DES would allow them to offer safe and effective patient care with their current workforce.
However, in a letter to practices just over a week before the 30 April cut-off, BMA GP committee leaders appeared to go a step further, warning: 'We fear that the newly added demands within the PCN DES are a risk to patient and practice staff safety in terms of potentially unmanageable/unsafe workload and burnout.'
The letter added: 'Opting out would free practices from the requirement to deliver the PCN DES. They could then choose to focus on the delivery of core general practice to their registered patients if that is what they believe to be the safest and best way to organise the services they provide to their local patient community.'
The BMA letter came as LMC leaders reported practices contacting them for 'contractual advice in relation to withdrawal from the PCN DES'.
An indicative ballot last year by the BMA suggested that more than half of GP practices would be prepared to withdraw from the PCN DES - the contractual framework that underpins networks covering around 50,000 patients that the vast majority of practices now participate in, and through which a huge tranche of primary care funding is channeled.
The BMA's GP leaders have faced criticism from senior doctors who feel the indicative ballot should have been followed up with a push towards a full ballot over potential industrial action. However, the latest advice could yet encourage more practices to ditch PCNs.
The GP committee letter said it continued to 'support the principle' of practices working together under the DES, but warned that the 'realities of the unagreed contract changes brought in by NHS England' could leave practices feeling unable to continue to take part.
The letter said that imposed contract changes 'likely increase work for already exhausted practice staff, clinicians and, especially, GP contractors' - and warned that despite 'countless' GPs contacting the BMA to ask for more flexibility, NHS England had ignored 'our entirely reasonable requests'.
The BMA said it had asked for a string of changes from NHS England, including more freedom over staff recruitment through the additional roles reimbursement scheme (ARRS), the ability for PCNs to retain unspent ARRS funding, more flexibility over enhanced access requirements that will force practices to expand services on Saturdays and after 6.30pm, and freedom for practices to opt out of elements of the PCN DES.
Opting out of the DES would mean practices lose access to funding streams including the PCN participation payment, use of ARRS staff, core network funding and funding available through the impact and investment fund.