The BMA’s GP committee for England backed a revised package of GP contract measures for 2020/21 on Thursday - just three weeks after rejecting an initial offer from NHS England.
Changes to the network contract DES include a significant rethink of the additional roles reimbursement scheme (ARRS) after networks called for greater flexibility around which staff they could recruit - and a major concession over funding following warnings that practices could face average costs of £100,000 a year to remain in networks.
All ARRS roles will now be fully funded by NHS England (NHSE), with available funding hiked from £257m to £430m in 2020/21, while six new roles have been added to the scheme - extending the range of staff PCNs can employ. These include pharmacy technicians, health and wellbeing coaches and care co-ordinators, occupational therapists, dietitians, podiatrists and community paramedics.
The BMA said these changes would mean ‘PCNs can recruit fully, without worry about the theoretical risk of future employment liability and redundancy costs’.
Concerns about the 'impossible' GP workload implications raised by controversial draft network DES specifications published in December have also been addressed - with plans to introduce five service specifications from April scaled back.
Service specifications for personalised care and anticipatory care have been shelved until 2021, with updated specifications covering three areas set to go ahead - covering structured medicines reviews, enhanced care in care homes and early cancer diagnosis.
GPs will no longer be expected to carry out fortnightly care home visits; a requirement that some GPs said threatened to collapse of the PCN model. Meanwhile, other staff will be able to carry out visits, with a requirement for medical input to be ‘appropriate and consistent’ based on the PCN's judgement.
Care home patients
A new ‘care home premium’ will provide networks with £120 per care home bed per year, following concerns raised by GPs over huge variations in potential workload between areas. This comes into effect when the service goes live from 30 September 2020.
The reworked contract deal makes a further concession around the volume of structured medicine reviews (SMRs) required from PCNs, with a clarification that networks with lower clinical pharmacist capacity will be required to carry out fewer reviews.
Dr Nicholas Grundy, of pressure group GP Survival - whose petition for complete overhaul of the service specifications received more than 1,350 signatures - welcomed the changes. He wrote on Twitter: ‘Brilliant work from Dr Richard Vautrey, Dr Farah Jameel, Dr Krishna Kasaraneni and the BMA GP committee to secure the PCN agreement for 2020/21.
‘Biggest thanks to Dr Nikki Kanani, however, for having the courage to trust the profession to get this right. Onus now very much back on PCNs to deliver.’
Brilliant work from @rvautrey , @DrFJameel , @Dr_Kasaraneni and the @BMA_GP to secure the #primarycarenetworks agreement for 2020/21.— Nicholas Grundy (@nick_grundy) February 6, 2020
Biggest thanks to @NikkiKF, however, for having the courage to trust the profession to get this right.
Onus now very much back on PCNs to deliver.
Supporting primary care
Watford GP and LMC representative Dr Simon Hodes described the updated service specifications as ‘very encouraging’.
He wrote: ‘Just what the doctor ordered. Thanks to all you negotiators out there who must have been working overtime to achieve such sensible, patient centred and supportive measures for primary care and PCNs.'
The updated terms will be scrutinised at a special LMCs conference over the coming weeks, and could yet face further challenges from LMCs.
However, the revised contract confirmed a government pledge to bring in 26,000 additional staff in total through PCNs - 6,000 more than the total announced in the original five-year contract deal.
Total funding for additional staff will rise from £257m to £430m in 2020/21 and, in 2023/24, from £891m to £1,412m, with an average PCN now expected to recruit around seven full-time equivalent (FTE) staff in 2020/21, rising to 20 in 2023/24. The renegotiated contract reveals mental health professionals will be added to the range of staff PCNs can bring in from April 2021 following ongoing pilots.
The revised contract also confirmed that all funding previously invested by CCGs in LES/LIS arrangements which are now delivered through the DES must be reinvested within primary medical care - and PCNs do not carry contractual responsibility for any failure by community service providers to deliver their part of the service.
Better patient care
Following an overwhelmingly negative reaction to the draft service specifications published in December, GPC England chair Dr Richard Vautrey promised final specifications would be ‘fair and appropriate’.
He said: ‘After months of challenging and tough negotiations we’re pleased to have secured this package of changes that have the potential to make a real difference to GPs, the practices they work in and the patients they treat.
'An expanded healthcare team working in GP practices as well as increasingly closely with community colleagues across groups of practices, will mean patients have access to a wider range of staff, allowing GPs to see those who need them most more quickly. These extra roles are now fully funded so will come at no extra cost to practices'.
NHS medical director for primary care and London GP Dr Nikita Kanani, said: ‘This agreement means better care for patients, and will help relieve pressure in general practice. This contract is good news for practicing GPs, and supports our practices in the new PCNs to bring in extra skilled staff.’