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GP concerns over network DES will form ‘basis’ of talks with NHSE, says BMA

The BMA has reassured GPs that concerns about new network DES proposals are being heard 'loud and clear' and these will form the 'basis' of its contract negotiations with NHS England.

In a statement issued today, the chair of the BMA's GP Committee said the organisation was reviewing GP feedback and it would ensure the final versions of the network specifications 'are fair and appopriate'.

Detail of the negotiations are confidential at present but BMA officials are reassuring GPs that they are listening to doctors on the ground.

The BMA will negotiate and agree on the proposals with NHS England before networks are expected to fulfil the seven service specifications from April onwards.

Concerns were first raised over NHS England's proposals for primary care networks when it was revealed GPs will have to carry out fortnightly care home visits.

LMCs have gone on to question how far the draft proposals will affect the stability of GP practices with some saying there should be 'outright rejection' of the proposals.

BMA GPC chair Dr Richard Vautrey said today: ‘General practice continues to be under a huge amount of pressure and we hear the concerns raised by the profession in recent weeks about these draft specifications, the workload implications and the need for a qualified workforce to deliver them, loud and clear.

‘While the content of negotiations is confidential, the profession should rest assured that we are listening to doctors on the ground, reviewing their feedback and this will form the basis of talks with NHS England to ensure that the specifications are fair and appropriate before they are agreed.

‘In turn, we would urge as many clinical directors, GPs, practices and LMCs as possible to raise concerns directly with NHSE to ensure their voices are heard.’

NHS England released the draft proposals at the end of December and asked practices for feedback on the specifications by 15 January.

Pulse is asking GP partners to complete our own short survey on the network contract DES proposals - with participants being in with the chance of winning £100 of John Lewis vouchers.

Readers' comments (25)

  • Give us a vote on your effort then,don’t rush it through,no hiding in political noise honest straight forward and listen to your grassroots.With out the grass roots the lawn will die.Listen and act.Before it’s to late ,if it isn’t already.

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  • Tantalus

    If the BMA want this to work then they better get a move on with these negotiations. From all the chatter I am hearing and reading GPs confidence in the PCN DES to deliver an improvement in their working lives is vanishing fast.
    NHSE have completely misjudged the mood of the profession. It’s beginning to look like an opportunity wasted.
    Give us the resources, let us build the teams and then maybe we can deliver on the metrics, but as it stands all they have done is increase our workload.

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  • I've read the DES. It doesn't up -new money for Social Prescribers, but mandated GP weekly/ fortnightly "home rounds" (presumably not being done by social prescribers), more command and control -Clinical Leads (GPs) for this and that- GPs to take the rap when al the "metrics" don't add up.

    And unless I'm very much mistaken Practices (i.e. GPs) will be paying the unfunded 30% of salaries.

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  • where did he say this, I have seen nothing

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  • Call me cynical but basis for negotiation means basically bugger all unless it’s actually dealt with or resolved

    I have no confidence and suspect my colleagues will be shafted with another baseless useless job(s) that will do nothing for retention and work load

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  • I have just listened to a podcast by Patrick Deneen who cheered me up by saying that the "neo-liberal world" wishes to structure, enforce and report the actions of those who work in vocational professions in the mistaken belief that it is necessary and will generate better outcomes. He made it quite clear that this is misguided and patronising and does not help the morale of those same professionals who don't need to be cajoled and who, given the right conditions (ie time and resources), know exactly what to do anyway. Sadly reassuring but very validating when we look at these sort of sudden contract changes.

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  • ..in my practice we used to do a visit to all of out 150 patients at NH/RH homes each week: a full day, 40+ contacts. Worthy work, the sickest patients, but our other GMS backlog spiralled out of control and then we couldn't recruit. All of us have left that practice now. Fund it properly....!

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  • Vinci Ho

    Had a good conversation with my LMC secretary this afternoon . These are my understandings:
    (1) NHS England has certainly surprised many people as they took an unconventional ( clearly contentious ) approach of bypassing GPC before releasing this draft on 23/12/2019 with the deadline of consultation/feedback one week from today (15/1/2020) . A significant number of LMCs in the country do not routinely have a meeting in January ( Liverpool LMC is one of them).
    (2) Allow me to be judgemental, this ‘testing the water’ act was disingenuous but also imperious . Of course , this government is now holding a strong majority in the parliament facing virtually zero , pathetic opposition. So if it is to exercise their autocracy , there is no better time . And I do not think it is just targeting at PCNs.
    (3) The grand plan is always about changing our terms and conditions as well as moving secondary care in a different direction simultaneously. Hence , these new PCN service specifications are , in fact , consistent with what NHSE would want to impose in secondary care . In a way , we (GPs) are to be sacrificed to ensure the sustainability of hospitals . Whatever obtained from vanguard sites is now used as ‘evidence’ to take the rest of us for granted . Thanks to those enthusiastic protagonists in these sites which were obviously funded excessively to ensure some successes .

    Call me critical and cynical but ‘a scholar prefers death to humiliation’ (士可殺不可辱)(Book of Rites 禮記) . Please do not insult our intelligence anymore.

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  • Vinci Ho

    And for those colleagues in BMA , please remember that it is a fine line between negotiation and extortion.
    Kill the chicken before it can lay any egg. The government gets nothing !

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  • For me it is largely irrelevant what the BMA manage to 'negotiate'. NHSE have shown their hand, and practice sustainability and development doesn't feature in it. Even if we manage to secure a 'less bad than it might have been' settlement, the message is that PCNs will ultimately be subverted to further disinvest and disempower General practice. We engage with them, at any level, at our peril.

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  • Rogue1

    Well that reassures me, the BMA are putting up a robust defence. I'll expect these new t+c's to be in our new contract from April then!

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  • BMA tweaking specifications instead of suggesting the whole sorry lot are canned ....
    Time to consider stopping all DES and LES work with most of it pathetically resourced and just about cost neutral, reduce staff overheads and proceed with core contract work only?

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  • Our team of 5 Partners have read all the specifications and frankly we are terrified of this.
    We were under the impression that PCNs was about sustainability and allowing us to have more capacity to do what we are currently doing and to ease workload intensity for GPs to protect the long term GP workforce.
    Having been relatively positive about PCNs this document blows that out of the water.
    The demands are immense, both in planning and then ongoing workload.
    We are currently enjoying the benefits to day to day working of PAs, FCPs, e-consults and Pharmacists and they have added capacity to our day to day working and reduced intensity although there has been a huge investment in support and mentoring that negates some of this.
    This document feels as if we have a completely new job to do in addition and is definitely a move to long term demolition of individual practices.
    This needs rejecting more or less outright and there is no excuse for allowing this to finally finish off Primary Care as we know it.
    Every year gets worse and worse and this needs to stop.

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  • PCNs are a five year plan to end the Partnership Model and replace it with a Hospital-led PCN system.
    NHSE's vision of the future is an obligatory AI front end, an options for Babylon-like video, and a trip to hospital as the only three options for care.
    GPC have negotiated a 'duty to co-operate' with our own demise.
    First thing they will come after - the LCS money.

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  • Jesus this sounds rubbish

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  • I am sorry, but Matt Hancock is living in his own dream-world. And the Prime Minister, who has only been in office a short time, clearly has not had the opportunity to think the matter out for himself. The result? the PM has, sadly, been swallowed up hook, line and sinker by Matt Hancock's "advice". Call it conspiracy thinking, if you will, but I am beginning to think Mr Hancock is deliberately creating mischief by rushing through his IT nonsense and the latest proposal to pressurise GP workload even more. I warn Mr Johnson that if he doesn't ditch Mr Hancock VERY soon, he will lose everything he has worked so hard to secure, the GP workforce will be non-existent, and the NHS will be dead. Believe me, I do not exaggerate. Mr Johnson. Only you can stop this express train ride to destroy the Health Service.

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  • dear bma GP committee - you have not been listening and you don't know how to do your job. this debacle was totally predictable if you had actually read the contract and did the numbers -they never matched the workload required - took me 45 mins to work that one out. clearly the people you employ are not competent and need replacing.
    as a union this is what i want:
    11% pay rise - no strings attached
    pension limits removed immediately
    max 24 pt contacts a day
    full reimbursement for all training costs
    petrol allowance for home visits and car maintenance
    GMC and all insurance fees paid for by the NHS, except private work
    overtime payment for any work in excess of 44 hours per week including meetings required by CCG, etc
    all necessary locum cover costs covered by the NHS.
    any extra non GMS work is costed fully and paid at nationally agreed rates with some variation for local needs in the case of where extra monies are needed to cover for example - transport costs in rural areas
    otherwise we are leaving and there will be no BMA cause there will be no doctors left in the UK.
    as a union you are not there to serve government or patients, you are there to support us. otherwise what is the point of you. you have forgotten your mandate. you have forgotten why you are there. you have forgotten who you represent. do something or you will be replaced.

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  • |Post-truth Practitioner | GP Partner/Principal|08 Jan 2020 8:25pm
    " Fund it properly....!"

    - it never will be. When the value is determined by the state, instead of free market forces.

    |Dr Katharine Mori | GP|09 Jan 2020 12:52pm

    - Why would you want to keep the unsustainable, all-you-can-eat buffet, state-run NHS alive? All the problems are currently coming from the state, yet you want the state to keep running it? Now, I might not necessarily agree with the MEANS by which the NHS is being run down, but it would be a good thing if we moved to a scaled-down NHS, and with the public taking SOME responsibility for their own healthcare, no?


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  • bma is useless--always has been

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  • So far, PCNs have saddled my practice with the extended hours DES which we had previously opted out of, ie 6hrs a week of extended access cover for our 12000 patient practice (and even more than this to backfill the deficit left after the festive bank hols), the clear and present danger of a fortnightly GP visit to all 4 of the care homes on our patch, and the even bigger threat of OOH coming under the PCN after 2021. Our OOH service is struggling to fill shifts as it is, so if I stay in the job, I guess it'll be back to the dark days of doing our own on-calls. No brainer...?!

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  • Positive feedback on the proposals would hopefully mean they go ahead with it, practices withdraw from PCN's and the only place to then invest money would be the practices themselves? Maybe it is time to play politics ourselves?

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  • This is as predicted. I feel slightly reassured that my increasing cynicism was not a sign that I was burning but valid. I am close to withdrawing from the DES as I cannot see that the BMA will negotiated anything but a slight adjusted version. The BMA are weak and are not acting as any sort of union. I am not sure that they have their members and therefore the patients interests at heart any more. Not many professions have such a weak union. We must never strike but we can say no to addition work and simply work to rule if needed.
    We are accountable as business and professionals and any other business would be insane to agree to increase work load, increased liability and reduced practice resources. We need all GP practices to withdraw from the PCN DES on mass.

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  • Charging a modest fee to consult would reduce GP workload and increase funding overnight.

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  • Peter Swinyard

    It is sad that I have moved on, after 35 years as a principal, to being salaried in the practice I founded in 1995. I would no longer relish the challenge of running the practice, coping financially with the much higher overheads which have come (pension contributions) and which are coming (national living wage) and the ever increasing expectation of outputs from an ever diminishing working pool of GPs.
    PCNs had the opportunity to help in all sorts of ways. This PCN DES is not it. It is poisonous. So many parts of it demands "GP Leads". In my book, leads have an owner on one end and a lapdog on the other.
    GPC - we don't need lapdogs, we need Rottweilers. Until some teeth are shown to the administrariat, nothing will change. Nikki Kanani, as National Medical Director for Primary Care (and a real GP) understands but I think that she is being bounced into accepting this gold-plated specification when practices just lack the workforce to manage it, in conjunction with their core job of looking after the sick.

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  • Peter Swinyard

    and not once in the PCN Draft DES document is Continuity of Care even mentioned.

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