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GPs go forth

PCNs opting out of Network DES due to workload concerns

Exclusive Two PCNs – one covering 85,000 patients – have opted out of the Network DES for 2020/21 due to concerns around the workload involved in the services specifications, a group of LMCs has told Pulse.

The 85,000-patient PCN in Buckinghamshire and a 40,000-patient network in Milton Keynes have opted out after their LMCs -  Berkshire, Buckinghamshire and Oxfordshire LMCs - had said they ‘could not recommend practices remain signed up to the DES’.

The LMCs told Pulse that other PCNs in the region are ‘planning to follow suit’ in the coming weeks, ahead of the 31 May deadline for opting out of the DES.

Pulse has been contacted by a CCG chair in the north of England, who said they were ‘at a loss why anyone would take that level of risk by signing up to the DES at this point’.

But NHS England said that these concerns are ‘not an accurate reflection of the contract’, and the networks will be receiving £575,000 worth of additional funding on average this year.

At the same time, Kent LMC has also expressed concern around the tight deadline PCNs were given to opt out of the DES for next year in a letter to its members today.

This follows the Special LMCs Conference in early March, where a motion that said the ’profession should reject the PCN DES as currently written’ was carried by a majority of 83 to 53.

Pulse understands that the PCNs opted out last Friday.

Dr Matt Mayer, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, told Pulse: ‘We have been informed of at least two PCNs who have given formal notice that they are opting out of the PCN DES en masse, one of which covers 85,000 patients.

‘We have also been told of other PCNs planning to follow suit over the coming weeks, as well as some individual practices who are planning to individually opt out of the DES.

‘What we are hearing consistently from many constituents is that they remain concerned about the work and requirements which will be added to the DES in the future, and also concern over how it will affect their core contracts, particularly regarding plans for further system integration.’

The LMCs have released an update to their previous analysis of the DES, which had said there was a risk of financial loss for practices of £17,191 per average network in a year.

The new document – an updated summary of their previous analysis – says: ‘In February, we advised practices that following our analysis of the PCN DES, we had significant concerns that as well as having extremely onerous workload requirements, the DES poses a threat to the independent contractor model, the core GMS contract and the autonomy of practices, and therefore we could not recommend practices remain signed up to the DES. Our position and advice have not changed.’

It added: ‘Given recent events it is now even more necessary that there be an extended sign up window and moratorium on new service specifications and requirements so that practices can focus on core services, and the pandemic response.

‘We therefore find it alarming and astonishing that NHS England continues to implement the enhanced services of the DES as planned, during the greatest pandemic of the last 100 years.’

Separately, a CCG chair in the north of England – who asked not to be named – told Pulse: ‘While practices working together on a local level is potentially beneficial, I do not see any benefit to the top down, nationally mandated specs NHSE have forced on PCNs.

‘A special conference of LMCs voted to reject the DES, the motion that it “posed an existential threat to the independent contractor model” passed, the question of the implications of practices’ GMS/PMS contracts being irrevocably changed has still not been adequately answered by NHSE, and the future direction of travel has been clearly foreshadowed by the initial draft spec in December. I’m at a loss why anyone would take that level of risk by signing up to the DES at this point.’

But Dr Nikki Kanani, national medical director for primary care and a London, said: ’Networks provide a real opportunity for practices to work together, in the current independent contractor model, with additional funding of around £575,000 on average this year to support the sustainability of general practice and better patient care.

’The concerns set out are not an accurate reflection of the contract and we would strongly encourage practices to judge for themselves, discuss with their neighbouring colleagues, their LMCs and CCGs, and take advantage of the additional support that being part of a PCN can bring.”

A letter from Kent LMC, sent out today, also expressed concern around NHS Kent and Medway CCG giving practices until 7 May to opt out of the Network DES.

It said: ‘The LMC believes that practices should have a genuine choice over whether to sign up to the DES or not and we acknowledge that there may be a number who decide not to. This is likely to be a difficult decision and we have expressed concern to the CCG about their requirement that practices inform them of their intentions early to mid May.

‘The contractual requirement is that practices inform the CCG of their intentions by 31 May. This will allow precious time to consider all the consequences of whichever choice you make.’

A statement from NHS Buckinghamshire CCG said it has ’received notification from one of the 12 PCNs in Buckinghamshire that they do not intend to sign up to the PCN DES 2020/21.

’NHS Buckinghamshire CCG is working with all PCNs in the CCG on the sign up process which will continue until the sign up deadline of 31 May.’

Readers' comments (27)

  • I have received nothing but platitudes when questioning how our local LMC's analysis could somehow favour full-on cheer-leading for PCNs, in direct opposition to the Special Conference outcome, and nothing at all when asking why an analysis like BBOLMC's had not been attempted. Might be because they couldn't be arsed to even attend the Special Conference, and appear to have discouraged their reps from attending, but presumably wholly unconnected to their Glorious Leader's work for NHSE and associated gong....

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  • Nhsfatcat

    DOI: Chair of BBO and proposer of motion 23. Comment here are my own. At conference we also asked for a survey of the profession. This was voted for. The GPC said that it wasn't the time to do this survey due to COVID-19. The very next day we all received a survey on what we thought of 'the Doctor' insert in the BMJ. The email survey did not need to go ahead. What is more important DES or a magazine? No clear leadership has split the profession again. We need core funding to provide GMS which is going to fall apart if we need to keep signing up to bolt-on services that hardly improve patient services for scant reward and a shed-load of work that some unicorns are going to be employed to do.

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  • Skegness & Coast PCN (approx 80k patients) is withdrawing from the DES. Can't recruit the staff and the urban coastal practices haven't got the resources for the Care Home component.

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  • Nikki must be worrying that she's loosing control.... its either a good deal or its not.... if its not a good deal she's responsible..... if it is such a good deal then she still too blame for not being able to communicate it to some of the most intelligent individuals in the country and show how the maths stacks up, or perhaps she is incapable of doing this, is being a good communicator not an important part of her brief????..... welcome to the Job Nikki, you are responsible for the outcomes either way.

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  • The time for reckoning is here, many are showing good sense .
    It’s all about the workforce and workload no use in reimbursement of staff who are not there and are the wrong ones for the job !
    Not sure about my PCN but for me the only way is out!

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  • Vinci Ho

    One has to admire the audacity of LMCs - Berkshire, Buckinghamshire and Oxfordshire LMCs(and the two PCNs) sticking up their spine . The whole story of introducing the DES from first moment shortly before last Christmas is a disaster . NHS England has nobody to blame other than itself .
    To practices in PCNs , it goes back to , a large extent , the trustworthiness of NHS England and hence , government motives .
    These two LMCs could easily now have created a crack on the floodgate and I wonder how many PCNs will follow .

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  • It’s quite apparently nonsense. The PCN model is fatally flawed and will bring about the destruction of the independent contractor model, welcoming an era of salaried doctors presiding over a range of professionals (some of whom will create more work than they save). NHSE trying to sneak it in while we are all preoccupied. Do they want to destroy general practice? Looks very much like it.

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  • take the money this year, there are no consequences for failing to deliver. next year likely to be different

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  • Additional funding of £575,000 that is spent on roles we didn't know we needed, imposed DES we really have no time for. The only winners in this PCN Chairs who can get away without seeing patients for a few days a week and get paid to regurgitate the NHSE drivel espoused by Dr Kanani and her acolytes and additional role employees. Nothing in it for GP's, only more unresourced work, boxes to tick, central diktats to follow. Stand up for yourselves all you independent contractors out there and at least examine the business case for PCN's before committing yourself to further administrative perdition.

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  • Scrap PCNs

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