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GPs buried under trusts' workload dump

CCGs 'concerned' core funding not enough to fund £1.50 for PCNs

Exclusive CCGs fear they will not have sufficient resources to provide the £1.50 per head for primary care networks (PCNs), the CCG representative body has warned. 

NHS Clinical Commissioners (NHSCC) told Pulse that some of its members 'are concerned’ their existing allocations do not go 'far enough' to deliver the £1.50 per patient as mandated in the new five-year GP contract. 

GP leaders have said this requirement will add additional drain on CCGs that are already grappling with driving up standards while NHS funding 'suffers an unprecedented squeeze'.

Under the new network contract DES, all PCNs will receive an annual uplift of £1.50 from CCGs’ core funding as an entitlement to cover their general administration costs, such as the remaining 30% of funding needed to fund the additional practice-based roles. 

The commissioner body said it is a 'difficult time' for CCGs that already have to 'reduce running costs' at a time when they are faced with 'increased financial pressure'.

The Health Foundation previously warned that some practices might struggle more than others to cover the costs of the new clinical roles within PCNs. 

Speaking to Pulse, NHSCC co-chair Dr Graham Jackson said he has heard some CCGs expressing concerns about their capacity to ringfence £1.50 per head for the networks in light of 'spiralling demands, competing priorities and increasing financial pressures'.

He said: 'The £1.50 per patient uplift for PCNs will be drawn from CCG central funds and is a continuation of the primary care transformation funding originally announced in the GPFV, most of which will flow through the network contract via CCGs.

'We have heard from our members that some CCGs are concerned that the new funding [to CCGs] doesn’t go far enough. Ensuring patients get the best possible care and outcomes against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest challenges CCGs face.'

An NHSCC spokesperson added: 'CCGs are under increased financial pressure with having to reduce running costs so it is a difficult time for them.'

As set out in the GP Forward View (GPFV), published in 2016, CCGs were allocated a £171m one-off investment - around £3 per patient over two years (2017/18 and 2018/19) - for practice transformational support.

According to the BMA's PCN handbook, the £1.50 funding for networks is an extension of this investment, which was used 'in various ways across the country'. 

Dr Jackson said: 'Funding for PCNs is largely a continuation of previous transformation funding as set out in the GPFV, and a number of CCGs may well be able to meet this requirement without difficulty. However, financial pressures on CCGs should not be underestimated, nor should the high expectations for PCNs.

'Commissioners are facing the considerable challenge of delivering system financial balance whilst reconfiguring local structures and delivering new clinical priorities as set out in the long-term plan. This comes alongside a 20% reduction in running costs, which means that clinical commissioners will have to do more for less, and continue to make difficult decisions to ensure the best value for the patients and local populations they serve.'

Responding to his comments, Tower Hamlets LMC chair Dr Jackie Applebee said: 'If the Government were really worried about the future of general practice they would not have insisted that the £1.50 per patient uplift for PCNs came out of existing CCG budgets.

'CCGs are, like the rest of the NHS, struggling to drive up standards while NHS funding suffers an unprecedented squeeze, just like all other public services, under austerity.'

London GP Dr Nick Mann said: 'An uplift of £1.50 per patient for networks represents 1% uplift on the global sum per patient. The activity required to set up, staff and manage networks and DES requirements, for example extended access, will far exceed 1% in my opinion.

'Funding for the clinical directors and ancillary staff, except social prescribers, will be a significant extra drain on CCGs - money which needs to be spent on holding services together until the political will exists to fund the NHS sustainably.

NHS England said earlier this month that the networks will have to succeed in convincing a new generation of GPs to go into partnerships or face becoming 'salaried to other NHS providers'.

Readers' comments (11)

  • No Surprise,no funding for the new contract well doen BMA/RCGP collaborators another fine mess you got us into(as Ollie would say).Laurel and Hardy theme music in my head reading this!!!

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  • Well CCGs can always hand back delegated commissioning....

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  • CCG paid money to 5 practices in one PCN. One Practice did not get the money and CCG is unable to trace where it went !!! Finally, they've asked the GP to personally chase SBS about money 'given' with advice that 'there may be a parallel account to which your other surgery money may also be going'
    Wow ! this belongs to that 'Believe it or not'

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  • .....furthermore - if the £1.50 is not uplifted next year and in subsequent years to fund staff costs in years 2,3,4 and 5 - PCN's will fail nationwide.

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  • Getting harder for CCGs to siphon primary care funding to the acutes, federations tearful that money being given to practices...i feel so sorry for them all........

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  • Vinci Ho

    1) It is increasingly apparent that this ideology of PCNs has become a slippery slope fallacy . In fact , if I deviously reverted to a populistic conspiracy theory ,this is a ‘trap’ set up to destroy GP partnership ( my previous question of PCN being a Trojan Horse?) once and for all .
    (2) While the slogan ‘CCGs are GPs and GPs are CCGs’ is still ringing in our ears , the continuing austerity imposed on CCGs from NHSE and above is never going to be consistent with this new ideology anyway . It is easy to say that CCGs must find the money to ensure the ‘success ‘ of PCNs , but the year and year on financial restrain from NHSE is simply stifling. Worst of all , the end game is CCGs having no choice but drastically reducing spending elsewhere in various services . The consequences of these services being slashed could easily divert pressure back to GPs and increase our workload paradoxically.
    (3) The argument ,of forcing the already diminished number of GPs to spend more time in the bureaucracy of PCNs leading to compromised patient care ( hence , continuity of care ), is a valid and realistic one . Continuity of care becomes a price to be sacrificed.
    What is the final destination ?
    Discard the formula of funding GP practices individually (D)
    ‘Unite’ GP practices into humongous practice(s) (U)
    Digitalise all GP services (including GP consultation in Babylonian style). (D)
    End GP partnership model ( E)

    Boris , dude , you and your new government has a serious decision to make for the health service!

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  • told you it was a bad deal - suggest every GP practice pulls out now and demand a 11% uplift in GMS - thats the amount been shown is required to improve GP services. otherwise PCNs are a waste of time. It will lumber all GP practices, who sign up with it, the 24/7 rota again when CCGs collapse. You have been warned - its on its way back to you.

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  • The complication and bureaucracy is so much now that nobody knows what they are doing. Hence the mess.

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  • being mandated to take back responsibility for the ludicrous 12 hrly 7 day access is a poisoned chalice. We are fools to be bribed to take it on. We need leaders prepared to stand up to this nonsense. Where are they?

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  • so what's new? All "New" initiatives are thin end of wedges. Why get sucked in? (again)

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