'Unfunded' care home role could trigger PCN collapse, GPs warn

Primary care networks (PCNs) could face 'breakdown' if draft plans including a requirement for fortnightly GP visits to all patients in care homes go ahead, experts have warned.

Care home visits (Photo: Dean Mitchell/Getty Images)
Care home visits (Photo: Dean Mitchell/Getty Images)

Draft specifications published by NHS England and Improvement before Christmas suggest PCNs will be required to ensure that practices deliver weekly visits to registered patients who live in care homes by 30 September 2020 - and that on 'at least a fortnightly basis this must be a GP'.

GPs warned that with no additional funding to support the requirements, general practice simply does not have the funding and capacity to deliver them. Doctors have hit out at the fact that the plans cannot be carried out by additional staff PCNs are being supported to recruit.

GPs involved in PCNs said heaping extra responsibility on developing networks could lead to their ‘breakdown’ as they struggle to deal with a growing task list.

PCN specifications

One clinical director said ‘significant adjustment’ to the draft specifications - which are out for consultation until 15 January - was needed before they could be accepted by PCNs. A former clinical director warned that the specifications in their current form would 'crash PCNs'.

Speaking on his video blog, Nottingham GP and clinical director of Nottingham City East PCN Dr Hussain Gandhi said it was 'frustrating' that allied healthcare staff could not carry out care home visits and questioned why extra funds had not been allocated to PCNs to fund additional GP work.

'Asking for this level of extra work particularly by new networks who are still building relationships risks a breakdown in the network working,' he said.

'The extended health in care home specification in particular is a concern as it specifies GPs only as the role to lead the team - for which there is no funding offered at all, and at a level that goes against the existing evidence.'

Skill mix

Dr Gandhi added: ‘This completely obliterates any of the positive skill-mix work that is being done by the network DES… not only do we have to fund a GP or a community geriatrician [to do the work], but there has to be an multi-disciplinary team structured around them. The fact that the work has to be led by the unfunded GP role is clearly frustrating.

‘Whoever has written this clearly hasn’t understood the NHS long-term plan in terms of increasing the use of digital tools to try and improve care. Care homes are an ideal situation where you can use tele-medicine to offer more effective care and support to care home residents and their carers.'

Essex GP Dr Rachael Marchant said on Twitter that fortnightly care home rounds by GPs were 'one of the many challenging and unfunded tasks' set out in the draft specifications.

BMA GP committee chair Dr Richard Vautrey, said: ‘PCNs have the potential to transform general practice and community care, but we must remember that they are new structures and must not overload or set unrealistic expectations.

‘Every care home having a dedicated PCN could be a benefit for patients as they develop links with a single team of healthcare professionals. Many CCGs are already funding practices for their enhanced activity in care homes, and this should continue as without that the important work practices are doing will not be possible.

‘It’s important, however, that PCNs and LMCs provide honest feedback to both the BMA and NHS England about their views on the specifications, and whether they believe they are reasonable and deliverable – especially given the current difficulty in recruiting PCN staff and workload pressures facing the health service.’

An NHS spokesperson said: '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.'

In November, LMCs voted to give clinical directors more protection to avoid excessive workloads, arguing that PCN leaders needed more support to pushback on unfair demands being made of them by CCGs.

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