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GPs buried under trusts' workload dump

GP federations will not count as primary care networks 'in most cases'

Exclusive Practices will have just a couple of months to join new primary care networks if they are to qualify for a significant amount of funding being invested in the organisations by NHS England.

There is much uncertainty about how primary care networks - being brought in under the new GP contract - will be established and information released so far has only indicated they will be based on geography and be between 30,000 to 50,00 patients in size.

NHS England and the BMA previously said that approximately 88% of practices in England are already part of networks, although it is unclear how a network was defined. 

But Pulse has now been told that many existing federations of GP practices will not be counted as networks, because in 'most areas' federations are 'too big to be regarded as one primary care network'.

This gives GP just over two months to organise into primary care networks, a feat which GP leaders said will be 'really challenging'. 

Under the new five-year contract, details on the arrangements for networks and their service specifications will be released by the end of March - and networks will need to be set up by the end of May.

Practices will receive around £1.70 per patient to join a network, with extra funding being provided to the networks themselves.

The networks will also take over the provision of the extended hours DES.

BMA GP committee chair Dr Richard Vautrey told Pulse in most regions of the country, federations would be too large to count as a primary care network.

He said:  'In some areas a federation may cover a number of networks and provide a support for the developing networks but in most areas federations would be too big to be regarded as one primary care network.'

But Dr Vautrey stressed the creation of networks would not lead to reorganisation because federations would still need to exist alongside them.

He added: 'This is about building up relationships not just with other practices, but with other services within an area, and for it to be meaningful it needs to be a scale that people can reasonably get to know one another. 

'Forming networks isn't about reorganising as they will still need to work at wider federation level for the delivery of some services where is makes sense to operate at that scale.'

In an interview with Pulse, NHS England's acting director of primary care Dr Nikita Kanani said the networks will be an 'evolution' because 'enough of the population is part of a group of practices'.

CCGs have told NHS England that around 88% of practices in England are already working in networks, said Dr Kanani.

But she admitted that in reality it was likely to be a smaller proportion than this as networks were being accounted for in 'slightly different ways'.

Despite this, Dr Kanani said the timeframe in which primary care networks will need to be set up, and for practices to join them, would be achievable.

She said: ‘At the last count, CCGs have said that 88% of their practices are in networks.

‘I think that’s probably a little bit lower, because people account for networks in slightly different ways. But I think enough of the population is part of a group of practices.

‘We’ve got to remember this is more of an evolution. This is about practices working together. Naturally most areas will have developed into localities or clusters.’

Speaking about the difference between federations and primary care networks, she added: ‘Typically a patch would have a CCG, a federation and three or four primary care networks – maybe five. And the federation would be there to help support those networks.’

GP and Essex LMC chief executive Dr Brian Balmer said it would be a struggle for practices to join networks in time.

He said: ‘I would be astonished if the entire country can get this together. That timescale I think is ambitious to say the least. Some will do it probably more than we realise because GPs are very good at grabbing new opportunities but to say everybody will do it would be optimistic.’

Dr Uzma Ahmad, a GP and Walsall LMC medical secretary, added: 'We’re are part of a federation, which was not geographically set up. For a network we have to align ourselves to our patch, which is totally different from the federation.

'Specifications have not come out yet. The current information is primary care networks are going to be different from the federation set up. But I don’t know whether there is going to be any flexibility in the ways around that. I think it will be really challenging.'

NHS England has not yet released its template network agreement, which all practices within a network will be required to sign.

The agreement, which will lay out the network's collective rights and obligations and will be the basis for working with other community-based organisations, is due to be released at the end of March.

Patients belonging to practices that choose not to take part in networks will still need to be covered by a network.

Timetable for network contract DES introduction

January to April 2019: Primary care networks prepare to meet the Network Contract DES registration requirements

By 29 Mar 2019: NHS England and GPC England jointly issue the Network Agreement and 2019/20 Network Contract DES

By 15 May 2019: All primary care networks submit registration information to their CCG

By 31 May 2019: CCGs confirm network coverage and approve variation to GMS, PMS and APMS contracts

Early Jun: NHS England and GPC England jointly work with CCGs and LMCs to resolve any issues

1 Jul 2019: Network Contract DES goes live across 100% of the country

Jul 2019-Mar 2020: National entitlements under the 2019/20 Network Contract start:

  • year 1 of the additional workforce reimbursement scheme
  • ongoing support funding for the clinical director
  • ongoing £1.50/head from CCG allocations

Apr 2020 onwards: National Network Services start under the 2020/21 Network Contract DES

Source: A five-year framework for GP contract reform to implement The NHS Long Term Plan

Readers' comments (9)

  • shambolic

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  • one day this will make it into the Mckinsey textbook on how NOT to manage business....

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  • National Hopeless Service

    The BMA are hopeless/reckless/stupid......

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  • This is all being made up on the hoof! 88% of practices are part of a network according to CCG? I am sure CCGs assumed this was part of a federation when asked rather than the new "definition" of PCNs. I know of very few practices working in small groups in my CCG. Having looked at the funding coming through (and the already shifting goal posts on what was agreed financially as well as finding the staff and the 30% to employ allied staff) and what is being expected (changes to QOF, care home services, enhanced medication reviews etc), the contract changes seem like a dud. There are also wider risks in PCNs with the loss of practice autonomy and the need to support PCN members who may be struggling or about to fold. It will make the CCGs job easier when a practice gives up its contract or there is a single hander retirement as the responsibility will be pushed to the network. Overall, this is a contractual herding exercise prior to setting up ACOs as the federation experiment has been a failure in most areas of the UK and will be the death knell for small and medium size practices. Going forward, it will also herald the end of the GP independent contractor status; what control do we or will we really have in a few years time? Very little to none so we are heading towards a controlled salaried workforce with pay restraint. General practice will cease to be a profession and will be no more than a technically skilled job. Pretty sad that the BMA has been complicit in this.

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  • Beyond parody!!

    Just as well that the average doc has so much free time available to plonk around with all this.

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  • Let's re-re-re-re-re-organise... again.That should occupy whatever minutes of free time we still have left. And then we can re-re-re-re-re-re-reorganise a further time in 18 months (just when we've got into the hang of dealing with the current re-re-re-re-re-organisation).
    Don't managers realise that the cost of reorganisation isn't just the time that it takes to move things around, but the time taken to get accustomed to working with it, to plug the gaps, to find the advantages, to remember where the weak points are? It's like changing to a different computer system: it takes 18 months before productivity is back to where it was before the change.

    What an utter, shambolic, totally unnecessary waste of time.

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  • I agree with all the above. Being a compulsory member of a CCG with no influence or control, a federation and also a network is really going to improve the time and energy available for clinical care! Plenty of opportunities for would be managers and doctors who are bored with clinical practice. It may be best for practices not to take the bribe-responsibility for failing practices would not be worth the money, and might well cause more dominoes to fall.

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  • First it was herding people into Federations, now it is goading them into PCNs. All very well, it's about who corners the money.
    As a Practice, one wonders whether and what difference it will make if one's payments were channelled through the Federation or the PCN (who controls this?. We know who sits in our Federations and how much we can rely on them for their effort to improve things and transparency but have no clue about those managing the PCNs?
    And transparency is a major issue in the NHS !
    Is it convenient to those higher up that there is always an organizational mess at the primary care level?

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  • Not difficult, join nothing.
    100% coverage with 50% participation, now that will work won't it....?!
    Its no-ones wish, and there should be en masse rejection until this is clear, sensible and better understood.
    Do not forget everyone here runs an INDEPENDENT business, personally liable for losses, redundancy and buildings. If it's not right don't join up.
    £20k for an average size practice is not worth the hassle.

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