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NHS England: PCNs must succeed or face 'being salaried to other NHS providers'

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

A paper for the NHS England board meeting last week said that the implementation of networks have given the independent contractor model a 'major shot in the arm'.

But it added is was the responsibility of PCNs to either 'take responsibility for securing a new generation of partners, or by default (rather than choice) become salaried to other NHS providers'. 

GP leaders said that suggesting the survival of the partnership model is now the responsibility of PCNs is a 'false premise' and warned about the risks of having independent contractors 'swallowed up' by larger providers.

The document states: 'Looking ahead to 2023/24, our ambition is that PCNs will have done five things: (i) stabilised the GP partnership model. Through the network contract, we have given the independent contractor model a major shot in the arm.

'It is now down to PCNs to decide their own long-term future: take responsibility for securing a new generation of partners, or by default (rather than choice) become salaried to other NHS providers.'

Other expectations for PCNs include: 

  • Help solve the capacity gap and improve skill-mix by growing the wider workforce by over 20,000 wholly additional staff;
  • Become a proven platform for further local NHS investment, including in premises;
  • Dissolve the divide between primary and community care;
  • Achieve clear quantified impact for patients and the wider NHS once completing the previous duties.

Londonwide LMCs chief executive Dr Michelle Drage said that the networks should not bear the responsibility for saving the partnership model.

She said: 'The additional investment via the network contract provides useful support, but it is a false premise to suggest that the survival of the partnership model is now the responsibility of PCNs and their member practices.

'There is much more that the Department of Health and Social Care can do to alleviate the bureaucratic burden on partners, reduce financial uncertainty, support struggling practices and encourage proportionate regulation. If independent contractors were to be swallowed up by larger providers, the Government would rapidly realise that it has lost a service which provides unprecedented quality of care for patients and value for money to taxpayers.'

Dr Farzana Hussain, a GP partner in Newham, said: 'I agree with NHS England's view and believe that PCNs will give the partnership model a chance to not only survive but also thrive. However, its important to recognize that taking responsibility for and growing a new generation of partners will require time, new skills of collaborative team  working and much effort. 

'Making partnerships an attractive option for younger colleagues remains a challenge with the current workload issues faced in primary care and the lack of training that GP trainees have in the curriculum to enable them to be partnership ready.'

She added: 'I remain optimistic that this is achievable but requires specific funding for training and education. The requirement to deliver increasing number of services over the next five years and embed new health professional roles in networks may be a distraction to this vital work. There should be an investment in the PCNs to release this time and grow the leaders and teachers who can fulfil this positive ambition.'

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Readers' comments (30)

  • PCNs will not save parnerships.The partnership model has been put to the sword by underfunding from NHSE/HMG and betrayed by the BMA/RCGP,whilst being overregulated by the CQC,GMC,Healthwatch et al.Let the failing secondary care sector take over see how bad things can get.The Partnership model is dead it just flapping around like a caught mackerel while partners wait for a opportunity to retire.PCNs and the new contract will no reanimate what is now a corpse.

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  • 100% agree; Turn out the lights.

    I must live in a different universe to NHS E

    PCN's are neither the cause or the solution to the current pickle/predicament.

    Need to look closer to home!

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  • This is simply passing the buck.
    The failure of the partnership model and approaching collapse of general practice is nothing to do with PCNs, and everything to do with years of neglect and underfunding.
    This is either very cowardly, or just confused thinking at the heart of NHSE.

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  • The 2004 contract did away with the basic practice allowance which paid and incentivised the partnership model . The hamster wheel model of medicine whereby work harder and harder for the same money, add to that over regulation and you have suffocated and strangled GP . The BMA negotiated the 2004 contract and sold it to the profession as a triumph. It wasn’t .

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  • We have broken you and have provided you with our version, the only but fatally flawed view of salvation. Game over, check mate.

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  • The burdensome over regulation and under funding will cause it to fail. The shot in the arm is not curative drugs but more like a poisonous shot to pass the bug for their failures. Nobody thinks the PCN will solve the problem. It is time we go private like the dentists and stop this meddling dictating what you can or cannot prescribe and who they deem worthy to be referred or treated. If the patent is the limiting factor, most complaints and demands will be stopped.

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  • If the partnership model goes NHSE will find that there will be even more locums / agency / chambers GPs setting their own rates, just as already takes place in the nursing profession. NHSE may try to regulate GP locum pay, but lack of supply and market forces will stop this. They have unsuccessfully tried to keep agency nursing pay down, attempting to get nurses to work on ‘bank’, if not salaried. They have been partially successful in keeping most agency nurses inside IR35, but the daily rate of pay has had to rise in order to keep agency nurses interested. The same will apply to the majority of GPs.

    So the result will be zero continuation of care and patients will hate it! Of course in the long run the job of a clinician will become less desirable leading to fewer people training...this will increase the scarcity of clinicians...this creates a cycle where market forces force up pay and workload...repeat...

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  • I really don't think they understand just how much extra work they get for free out of the partnership model. If we all go salaried I think itll be a real shock for them. Bring it on. We'll all go salaried. Same pay scale as hospital consultants and push back all extra unfunded work.

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  • Somewhere in NHSE someone is patting him/herself on the back about being brave enough to inform those ignorant GPs of the ‘burning platform’ driving ‘change’. This afternoon they will spend 2 hours putting this onto a PowerPoint slide.

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  • The majority of us will not be salaried NHSE. We will do exactly as Tony says we will let the market find a level and do a lot less work.There are not enough noctors to fill the holes left,you have sown the seeds of the NHS downfall,you will reap what you have sown.PCNs and the new contract will NOT undo this.

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  • How will Digital First affect all of this?
    This consultation on Digital First practices *is* important.. not that disagreeing (if possible) is likely to make any difference.
    I'm so glad to have retired!

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  • It's all part of the "game plan" to privatise the NHS, and turn it from a "health care provider" to a "source of profit" for the rich "elite".

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  • The responsibility lies with NHSE, HEE and the DoH. We are doing the same job we ever did -looking after patients on our list- but the conditions in which we have to work are increasingly dictated from outside.

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  • What have the BMA and RCGP done to us?

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  • Well, if we worked in GP chambers contracting directly with health commissioners we will be better off financially and have more control - no more staff worries (except a manager to bring in the work)or CQC or financial liabilities. Could work well. But would cost tax payer about 30-40% more but with reduced productivity.

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  • GP chambers I think most of us will be doing that,salaried to a trust or conglomerate will be more of a hell on earth than our current situation.Chambers for GPs,Consultants and other grades are what we are heading towards,more expensive less productive but a better quality of life for us.

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  • I agree completely with Michelle Drage.
    NHSE know exactly what they're saying - the intention has always been to shaft the awkward independent Partnership model, to provide a malleable, downskilled, obedient and poorly paid workforce, working for healthcorps.
    Simon Stevens always was the Letwin privateers' pet poodle, destined to do just this.

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  • Stab in the chuffing arse more like

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