This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

To engage or not to engage…?

Dr Nikki Kanani

Please note - we are pre-moderating comments on this. We should have made this explicit when this was first published and I apologise for not doing so, especially as it was over the weekend. We are more than happy to publish criticism of the policies, but there have been personal attacks in the past, which we cannot tolerate. Your comments will be published ASAP. Jaimie (editor)


Over the past month we have seen frustration and concern over the draft primary care network (PCN) service specifications that were being engaged on.

When we first published ‘Investment and Evolution’ last year, we committed to both sustaining general practice and improving the quality of care. We knew this was going to be a tough ask.

Yet we also know that general practice has been struggling. Too many people are leaving the profession and too many doctors report burnout or compassion fatigue. And we have to acknowledge that satisfaction by our patients with access to their GP practices has also been eroding.

The move to supporting practices - large or small - through working within PCNs is the beginning of addressing this. Bringing in more staff. Recruiting more GPs. Creating more of the right type of capacity, so patients are seen by the right person.

PCNs are also intended to be a way of offering better health and care. Locally joined up services, offering evidenced based improvements for patients, designed through seven service specifications, delivering the improvements set out in the long term plan.

The first five of these were published for engagement in late December. Having been unable to publish during the election we wanted to get your views, reflect on them and agree the overall deal with the GPC so that we can make the necessary payment system changes in time for 1st April.

The draft specifications will indeed change before they are finalised

We needed to get the specifications right for the profession and for the public. The first draft was never going to be the last word and we needed your help to get them right.

There was a lot in the draft specification document. It is clear that some felt it was overly prescriptive, or that too much was being asked of GPs. Some may even have felt that this was not what they expected from PCNs.

Many thought that the aspirations of the individual specifications were sound but were cautious of the implied performance management.

Here, we’ve summarised the feedback we received - from over 4,000 respondents (mainly GPs, PCNs and LMCs), and through webinars and twitter chats.

We wanted feedback and we got plenty. We’ve worked through every response. You’ve given us a clear message, so the draft specifications will indeed change before they are finalised.

The themes in the feedback document are informing our discussions with the BMA’s GP Committee. We hope you will find them realistic, workable and fundamentally supportive of general practice, the partnership model and primary care networks - as well as good for our patients.

I want to thank all those who gave up precious time to take part. This is the first time we have engaged in this way and we hope that once you see the outcome of this process you can see we are genuinely trying to get this right.

Dr Nikki Kanani is medical director of primary care for NHS England and NHS Improvement

Rate this article  (1.33 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (34)

  • |Editor's comments
    "You are making a comment on his or her motives without knowing what they are."

    - I am grateful for a response, and the opportunity to debate censorship/discourse. My response is -
    What if they state their motives? Would it be justified then? E.g. Tony Blair opening up mass immigration to 'rub the Right's face in diversity'? Calling someone a traitor is simply offering an opinion, so is that now restricted?
    How about inferred motives? That's the issue of censorship. It is subjective. You might think its unjustifiably 'personal', whilst the next editor might not. The readership/public should be the only arbiter of whether something has gone too far or not, and respond accordingly with debate/ridicule.
    The level of censorship with this one article is higher than it is with others, whose feelings are we sparing? Nikita's?

    Unsuitable or offensive? Report this comment

  • Does Christopher Ho have a point? If someone in a position of responsibility is having 'filtered' feedback does that skew their self opinion? If someone needs to have filtered feedback are they capable of doing the role? Look at Scott Morrison after the bush fires.... he got a lot of feedback....unfiltered and direct in person.... I believe that if you are to lead and to be effective you have to be able to handle such situations oneself, and not 'need' to have a filter for ones protection. If leaders feel this is a personal attack then they are ailing to grasp that the people expressing these views are being by and large genuine and frustrated with the situation, and that by choosing to take the role she has that she needs to acknowledge the depth of feeling out there. Like many of our so called leaders in our profession, they seem to lack the ability to deal with the cut and thrust of their position. A simple strategy is to simply respond to the critique being made directly with an explanation of how you intend to deal with the problem in straight language, no management speak, and ignore the 'personal' aspects..... remember we choose to be offended at some level..... when leaders act in this way they come across as not having had experience in dealing with the sharp end of life...... perhaps have had a very protected upbringing and haven't had to deal with angry and upset people on a regular basis. Do you think the police get 'filtered' feedback from their 'customer service users?' they dont.... so what makes our leaders so special that they need to be protected in a way that is nowhere near the level of abuse suffered by some of our public service colleagues in the nursing profession, police, paramedics and fire brigade? Thy cope with much worse and a lot of physical assaults and are expected to get on with it....

    Unsuitable or offensive? Report this comment

  • Hi Curious,

    I guess the difference is that the police don't actively allow this abuse. I'm sure if they were able to filter it, they would.

    I believe that criticism around policies and action is completely acceptable. But when we start to see accusations of 'corruption', 'traitor' etc, I can't see that this is contributing to the debate.

    I am honestly happy to host an opinion piece on this if anyone is interested in writing one. Please contact me at

    Many thanks,


  • Calling someone's motives into question is 'not contributing to the debate'? Or 'illegal'?

    Are the police not people too, i.e subjective?

    Should I have to ask 'nicely' what someone's motives are?

    An op-ed on free speech? Sure, anyone who knows their history can rattle on about the last few centuries of the 1st Amendment, or that we did not need 'hate speech' laws against holocaust deniers for the last 70+ yrs, and guess what, we got on by well enough.

    Unsuitable or offensive? Report this comment

  • Hi Jamie!
    Im in Australia because you could see that UK General practice was broken. if comments are getting personal its because our profession is broken and demoralised. How is it that someone at the 'top' could not have predicted the response to these PCN proposals? The fact they were even proposed shows the lack of insight at NHSE. The management are not inspiring the grass roots.... their words and actions are just extinguishing whatever little hope was left..... the UK NHS is too broken for more of the same , tinkering at the edges wont fix it.... hence PCNs wont fix it..... its blindingly obvious.... so why can't our leaders just see it or have they become too lost in their NHS management courses to be able to see things for what they really are????

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say