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GPs go forth

NHSE dilutes PCN care home plans and agrees £120/bed as it delays two services

NHS England has agreed to delay the introduction of two of the controversial primary care network (PCN) service specifications, but will push ahead with three pared back versions in 2020, covering care homes, medication reviews and early cancer diagnosis.

Under new contract arrangements for networks confirmed yesterday, GP practices will not have to deliver services covering personalised care and anticipatory care for another year, until 2021/22 - though PCNs are still required to set up a social prescribing service.

Care home services will still go ahead in 2020, but GPs will not be required to visit care homes every fortnight as was originally proposed.

Instead it will be for PCNs to decide how often 'medical input' is required - suggesting other clinical staff may take on the visits instead - as long as this is ‘appropriate and consistent’.

A new care home premium payment for networks, worth £120 per care home bed, will also be introduced from September, when the service is launched for patients. It follows concerns that networks with more care homes might have been left without proportionate funding.

By 31 July, each PCN will have to have agreed the care homes it is responsible for with its CCG, drawn up a draft delivery plan, and ensure a lead GP or GPs have been appointed for each care home.

Meanwhile, under the structured medication review (SMR) service being introduced from April, NHS England has stressed the number of SMRs that networks will have to deliver will be 'determined and limited by PCN clinical pharmacist capacity'.

It follows wide-ranging concerns about the additional workload for GPs created by the proposals. In the original draft service proposals, NHS England said it expected an SMR to take 'considerably longer than an average GP appointment'. 

The network service aimed at supporting early cancer diagnosis will also continue to be delivered this year, from April.

The original contract required GPs to deliver five of the seven PCN service specifications in 2020/21, but two planned for this year - the personalised care and anticipatory care services - will be delayed until 2021/22, following negotiations.

The network services covering CVD diagnosis and prevention, and tackling inequalities, will also be introduced in 2021/22, as was originally planned. 

Details of the original proposals, released by NHS England on 23 December, first attracted criticism when it was revealed GPs would have to carry out visits to care home patients 'at least' every fortnight from this September, among other activities. 

GPs expressed outrage over the increase in workload and lack of additional funding, with some resigning as network clinical directors over the proposals.

But today's new contract said: 'The structured medication review and medicines optimisation, enhanced health in care homes, and supporting early cancer diagnosis service specifications have now been significantly improved in the light of consultation responses.

'Agreed by GPC England and NHS England [...], they will be introduced in 2020/21.'

GP leaders welcomed the delay to some of the service specifications, but suggested NHS England should have gone further.

Doncaster LMC chief executive Dr Dean Eggitt  said: ‘It’s very welcome that they’re delaying any of the major changes. I would even suggest that those changes don’t come next year because the scale of the changes they’re talking about now are ginormous for the entire health and care system.

‘You can’t make such large-scale changes within one-year period of time, these need to be five to 10-year programmes.’

Dr Eggitt said it still wasn't clear whether the fee of £120 per care home to carry out visits would be enough, adding: 'This is where we need the details before we can agree to what it is.’

Other contract commitments confirmed yesterday include: 

  • £94m to address recruitment and retention issues, including a ’partnership premium’, which is a one-off payment of £20,000 available to new partners with additional training support - including nurses and practice managers;
  • 100% reimbursement for all additional staff recruited via the PCNs, which now include pharmacy technicians, care co-ordinators, health coaches, dietitians, podiatrists and occupational therapists, and mental health professionals from 2021.
  • £173m for PCNs to employ a wider range of professionals to help manage workload and provide appointments, including pharmacy technicians.
  • Funding to support practices to deliver a six-eight week postnatal health check for new mothers.

All the contract headlines can be found here

Readers' comments (6)

  • It costs a £100 call out fee to get a plumber to attend once. Great to see that the Government really appreciates GPs.

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  • looking forward to not being here after 2022. Good time to go before the really big s##t hits the fan.

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  • As above. Throwing small change to us doesn’t value us. We are being left behind other professions ( and our Consultant colleagues) when we look at true hourly rates. For those that that find this acceptable, good luck! Seriously!!! - £120/ bed of very complex and time consuming complex care PER YEAR!!! When we see how much even a single outpatient appointment is valued at! ....or an ambulance call out or A&E visit etc etc. If we accept this we get what we deserve. Glad I’m out of my partnership and nearly out the door of General Practice.

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  • "personalised care and anticipatory care services - will be delayed until 2021/22, following negotiations."
    Delayed. BMA's job's not done. We don't want it at all.
    Endless amount of letters, results having to do it at home etc, we really do not need more work. They do not understand what is maxed out.

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  • ‘If we accept this we get what we deserve.’

    That sums it so well that it comes to far more than the negotiators ever said. (paraphrased from LC)

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  • I think it's still a bad deal!
    The care home bit still requires lots of extra GP time we have not got, and the £120 per pt and even adding in the DES fee does not add up to enough.
    BMA have backed away from a vote on this which we do need as they have no formal mandate from the profession for PCNs so how do we call for one ?
    And what does this paragraph mean?

    "9.5 To ensure that the whole of England benefits from the investment and service improvements that PCNs offer, CCGs must ensure 100% population coverage of PCNs. Existing practices have guaranteed preferential rights. But where they choose to opt-out, arrangements for alternative provision of core GMS with network services will automatically apply. "
    Does this mean it's now compulsory? I am waiting for an answer from BMA!

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