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The waiting game

Practices opting out of DES won’t get ‘better’ contract locally, warns NHSE

Practices that opt out of the network DES will not be able to negotiate ‘better’ local contracts, NHS England has warned.

It comes as GP leaders have advised practices to think twice before signing up to the DES on the basis that it would create unmanageable workload for GPs and their teams.

Two primary care networks (PCNs) have already decided to opt out of the agreement ahead of the 31 May deadline, due to concerns around the workload involved in the service specifications.

However, NHS England’s director for primary care strategy and contracts encouraged GPs to sign up and warned that they wouldn’t find better terms for the same funding through locally-negotiated contracts.

Speaking in a webinar, Ed Waller said: ‘One thing that is important to clarify is that practices who opt out of the DES won’t be able to secure the same services and funding entitlements on better terms via a local agreement. 

‘This is a nationally negotiated DES and to make sure we are fair to everybody, it’s a nationally negotiated set of terms and conditions.’

His deputy Rob Kettell added that practices would have another opportunity to opt out of the DES if ‘substantive’ changes were made.

He said: ‘There are no plans to change the DES. If the DES were to have a substantive variation, then practices would have the opportunity at that point to opt in and out of the varied DES.’

Mr Waller added that the BMA were not consulted on the bringing forward of elements of the DES’s care homes service because there was ‘no need to’.

He said: ‘The DES hasn’t changed and therefore we haven’t consulted the BMA on a change to the DES. There was no need to.’

Meanwhile, he encouraged practices to sign up, saying CCGs would be ‘supportive’ of PCNs delivering ‘as much of the DES as they can’ - rather than ‘resorting immediately to contractual action’.

He said: ‘We’re really clear that the contract management around the DES is going to be supportive and collaborative. 

‘So, we will expect CCGs to focus on the DES itself and the delivery of that rather than the core contract and to look to support practices who are working together in a network to deliver as much of the DES as they can, in the right way, rather than resorting immediately to contractual action.’

NHS England caused controversy when it announced that GPs should start conducting ‘virtual’ weekly care home rounds this month - a ’key component’ of the network DES’s Enhanced Care in Care Homes service.

It later clarified that the ward rounds remain separate to the DES until it begins formally in October, but were being brought forward backed by the Covid support fund.

However, NHS England warned that practices may face regulation if they fail to set up the service - including nominating a clinical lead - by the 15 May deadline.

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

Readers' comments (10)

  • It would be great if we had a union who could represent us on things like this. It's a mystery in whose interests the BMA are operating in recent times.

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  • Actually, they might. In our area we have a care home enhanced service which pays better money for less work than the PCN one.

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  • I nominate NHS E for employer of the year. Clearly not grasped the concept regarding differences between a carrot and a stick.

    Do they not listen to those at coal face and various think tanks that have pointed out changing direction does take time and also hinges on the fact we don’t get a second wave?

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  • In fairness to NHS England, the "treat em mean keep em keen" approach to GPs has always worked in the past. Why would they offer anything better when, regardless of how bad it is, the signup is usually around 100%.

    I think I'd get a blank look if I asked GP colleagues what the last thing they said "no" to was....

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  • we are not under any obligation to do locally funded services either and if we want to stick to just GMS work and qof we can. I suggest we do exactly that and see how far NHSE gets with its 5 year plan.

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  • The main problem is We GP do not stand united. If every GP practice refuse to sign the DES then what is NHSE going to do? punish all the practices ?? . Send notice to all practices that they have breached the contract and they will be awarding it to some one else?
    NHSE knows very well that We are not united so its very easy to show stick to few practices till they fall in line. Fault clearly lies with us ......

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  • classic divide and rule.............

    DO NOT SIGN UP TO IT !!

    don't say you weren't warned !

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  • Just say NO --- surely we can demonstrate a backbone for once ?

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  • Unfortunately most of our colleagues have a vague notion that "it's better to be in than out" under the misapprehension that they can influence centrally dictated policy from within. Most have not even read the spec or crunched the numbers let alone considered the additional workload. Why do they pay no heed to the independent voices of our LMC's? Your PCN leaders and CCG's have vested interests and are NHSE mouthpieces with not an original thought amongst them. Most of NHSE Leadership who came up with PCN DES have never been involved in the business of partnership and maximising available partnership income. We have become a compliant unthinking morass of subservient employees and it is deeply frustrating. Wake up out of you torpor and say no to this DES - it really is possible to come up with something better.

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  • They wont get any of the under resourced and unstaffed DES obligations. That's better!

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