Underfunding will severely limit services GPs offer under PCN enhanced access

Services available in general practice under the PCN enhanced access scheme will be severely limited by a shortage of funding to pay for staff, an LMC chair has warned.

Funding concern (Photo: John Lamb/Getty Images)

Updates to the GP contact published earlier this month ask networks to provide bookable appointments between 6.30pm-8pm on weekday evenings, and 9am-5pm on Saturdays - with these times to be known as 'network standard hours'.

NHS England says that these appointments must use ‘the full multidisciplinary team’ and offer a range of general practice services, including routine services such as screening, vaccinations and health checks, in line with patient preference and need.

However, an LMC chair - who asked not to be named - has told GPonline that the funding allocated to PCNs will prevent networks from recruiting the appropriate mix of staff they would like to run the service and could limit what it can offer.

Enhanced access

The GP explained that networks will have to rely more heavily on additional roles reimbursement staff to run the service because they would be more affordable for networks compared to GPs and nurse practitioners. But they said that the latter were better suited to carry out the work.

Other services that previously relied on surplus funding provided by CCGs for extended access could also be ‘destabilised’ because of the cost of the requirements in the PCN DES, according to the LMC chair.

Warnings that inadequate funding could limit the success of the enhanced access service follows widespread criticism of NHS England's decision to impose changes to the GP contract for 2022/23, with the BMA advising practices to consider opting out of PCNs.

From October, PCNs will receive £7.46 per patient pro rata for providing enhanced access services. This pools the £6 per head extended hours funding from CCGs and £1.44 per patient from PCN extended access - and a small addition.

ARRS staff

Although the LMC chair said that the service could be achieved on budget, they warned that available funding was not enough to employ a staff mix involving significant numbers of higher-level, higher-cost staff such as GPs and advanced nurses.

The LMC chair said practices could only make the service work 'as long as you keep your GP hours to the minimum possible and you potentially do it with the cheapest staff you can find'.

They added: ‘This doesn't sit very well with us and [the CCG who] are really not convinced about this. At the moment, the extended access works locally because it's a very transactional service. It does not do long-term condition management, it does not attempt to do day-to-day general practice.

‘But the DES says [this service has] got to be for long-term conditions [and that] it's got to be essentially an extension of normal, in-hours general practice.’

Long-term conditions

They said: ‘The workforce that is [supposed] to do the enhanced access work doesn’t necessarily have long-term knowledge or commitment to the patients...there's no relationship there…The last thing that a practice wants is someone who's got no knowledge of a patient changing half their repeat medications.’

The GP also said that merging the extended access budgets could disrupt how other services in the locality are run due to their dependence on surplus funds from the £6 per head previously provided by CCGs.

They said: ‘The extended access service [funded through CCGs] was never money that was given to GPs [in this area], but…to GP federations to deliver this service. Not all of it got used to deliver the extended access service because not all of it was needed to deliver the mandate.

‘This surplus is not necessarily going to be there, which means actually it's potentially [having] destabilising effects upon the wider local healthcare system, if this money or service is not there to fund stuff that it has by common consent funded over the last few years.’

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