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Primary care network serving 80,000 patients collapses due to DES concerns

Exclusive A primary care network (PCN) serving 80,000 patients has collapsed due to concerns about the care homes requirements of the network DES.

All seven practices that made up the Skegness and Coast PCN in Lincolnshire have withdrawn from this year’s DES because ‘recruitment and resourcing constraints’ mean they are ‘unable to envisage’ the delivery of the services, they said.

It comes as Pulse revealed that PCNs in Kent are ‘in danger of folding’ over similar concerns while two PCNs in Buckinghamshire and Milton Keynes had previously opted out of the DES due to the workload involved.

In a letter to commissioners seen by Pulse, GP partner Dr Stephen Savory said his practice and three others in the PCN cover 26 care homes and asked Lincolnshire CCG to advise how they can deliver the specifications to all residents ‘with the inadequate resources available’.

He said: ‘The seven GP practices in Skegness and Coast PCN individually stated that they would withdraw from collective provision of the 2020-21 PCN DES, unable to envisage delivery of the Enhanced Health in Care Homes specification to our demographic, with the recruitment and resourcing constraints we face.’

Two neighbouring PCNs have said they ‘do not have the capacity’ to deliver the PCN DES for the population of 80,000, which is currently not covered by a PCN, he added.

And Dr Savory and his colleagues are concerned that there is no network in the area to ‘facilitate primary care’s response to, and recovery from, Covid-19’, he said.

Meanwhile, the letter added that a proposed new PCN involving three coastal practices previously within the original PCN could undermine the ‘sustainability and quality of primary care’ in the area due to the movement of staff.

It said: ‘Our practices fear that additional support for the putative Skegness and Mablethorpe PCN will consist of the preferential deployment of existing human resources to the coast (eg specialist practitioners) at the expense of the inland population.’

Dr Savory warned of an impact on ‘patient safety’ and that the resignation of the PCN’s clinical direction means that patients now ‘lack clinical advocacy’.

In the run-up to the deadline on 31 May, the BMA warned that practices not signing up for the network DES ‘risk losing influence’ over the development of GP services in the future.

But Pulse revealed that PCNs in Kent were under threat due to large practices opting out of the DES because of the enhanced health in care homes specifications.

In April, Berkshire, Buckinghamshire and Oxfordshire LMCs told practices that they ‘cannot advise signing up for the network DES’ in light of ‘significant concerns’ over its workload requirements.

And Pulse revealed last month that an 85,000-patient PCN in Buckinghamshire and a 40,000-patient network in Milton Keynes had already opted out of the DES - with other PCNs in the regions ‘planning to follow suit’ in the coming weeks.

Readers' comments (25)

  • these pcn's don't 'serve' patients; they are a fudge by NHSE for the chronic underfunding of and lack of support for General Practice, which does its best to serve patients. If the DES cannot be met by employing extra staff to deliver, then it can't be done. what a surprise. not

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  • Not a huge surprise -they are asking PCNs to co-ordinate and provide care for nursing home patients without any more doctors or nurses to do the job.

    All very well funding social prescribers and pharmacists, but they won't carry risk, and they don't have the skillset.

    If PCNs had fully funded workforce of a 2 or 3 dotors and nurses to do the ward rounds and manage care- it might be feasible. Otherwise we're just draining resources from Primary to Intermediate care.

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  • Nhsfatcat

    The whole idea was to get funding to primary care without delivering a pay rise. Any top down change is designed to deliver more for less.
    Berks, Bucks and Ox were Laocoön to the GPCs Sinon and NHSE Epius. Good for all those that reject the DES so they can get on with workload they already have.

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  • well done to all of you for not falling for the "free beer tomorrow" stunt !

    this was always just another stick to poke us with.

    now that some practices are looking more closely at this stitch up, with any luck more and more will turn down this unresourced, unquantified, extra work that benefits nobody except the (well paid) pen pushers at the top.

    if everybody gets on with the work they have - seeing patients - life would be much easier for us and for the patients.

    with luck, some of the well paid pen pushers will lose their jobs - saving a shed load of money which can be diverted to those doing real, useful, work.

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  • It shows the money is there. But NHS England cant see its our independent ownership that delivers such efficiency - We take ownership because we own it!
    But they just don't get it. Its because most of them have never run their own business and only worked in large institutions and follow policy and regulate.
    They distrust GPs because they cant control us.
    Anyway, they wont change and they control access to power and hold the purse strings.
    So either we go private or put up with more and more of this.
    Its just the way it is. We've written to our mp several times, I think he wants us to go private [ I think secretly the govt does too]
    Well done those who rejected the DES. We're Carr-Hill'd to death so have to take the money.

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  • Perhaps the need for PCNs has evaporated with the mass take up of teleconsultations. Remember how PCNs were sold to us as the only way to cope with recruitment issues? Now we have the opposite situation where there is no demand for locum cover and locums are moving to take up substantial/permanent posts.
    The natural size that works for primary care is the medium sized partnership embedded in its community. Groups of 50k or more lose the 'ownership' and become less enjoyable to work in. PCNs RIP.

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  • What is interesting is that even though our LMC advised against signing we were the only practice not to sign up in our CCG and thank goodness we didn't as even more pain in the future I am sure

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  • It is interesting that there has been no official communication about sign-up nationally yet - maybe Pulse could co-ordinate FOI requests from all CCGs? I suspect & hope that the examples in this article are the tip of the iceberg - in our CCG area, sign up is only 50% & some of those practices signed up with huge reservations. This will all play out again next year when even more onerous specifications are released. PCNs were not set up to help solve primary care’s problems; they are an inadequately-funded vehicle to divert work from secondary care in the hope of reducing unplanned admissions to hospital. And it is clear that they want to foist the responsibly for out of hours care back to GP eventually.

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  • Wait until the terms of the DES begin to bite.

    A frequently overlooked part is that the DES practices have to take over care home patients from the DES practices:

    7.3.1: By 31 July 2020, a PCN is required to:
    c) support people entering, or already resident in the PCN’s Aligned Care Home, to register with a practice in the aligned PCN if this is not already the case

    and

    4.1.4 (Enhanced Care Homes Spec)

    In supporting patients to re-register with a practice in the aligned PCN, care homes, PCNs and CCGs should describe the benefits offered under the enhanced service, and consider the use of advocacy services to support this transition.

    Interesting time....

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  • That should read

    A frequently overlooked part is that the DES practices have to take over care home patients from the NON DES practices

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