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Independents' Day

GP leaders to vote on wholesale rejection of the network DES

England LMC leaders will vote on whether the profession 'should reject the PCN DES' as they meet for a conference next week.

The motion, to be presented by Berkshire LMC, suggests the network DES is 'a Trojan horse to transfer work from secondary care to primary care'.

It urges the GPC to survey the profession on whether they intend to sign the DES and goes so far as to say it 'poses an existential threat to the independent contractor model'.

Last month,  Berkshire, Buckinghamshire and Oxfordshire LMCs told practices they ‘cannot recommend’ that they sign up to the network DES, despite it having been revised, due to ongoing ‘significant’ concerns about the extra workload it will create for GPs.

The LMCs conference will also vote on whether the deadline for signing up to the DES should be deferred to October. 

The BMA GP Committee will host the special conference of LMCs to discuss the impending GP contract changes on 11 March.

The conference will be held at the Mermaid Conference Centre in London and will allow regional representatives to discuss the 2020/21 deal which has been negotiated between the BMA and the Government.

The motion to hold a special conference was passed at a GPC meeting in January, before the GPC reached an agreement on the contract.

Other motions set for a vote include bids to make publication of high earnings anonymous; calls for incentives to offer 15-minute consultations; and calls to increase the £120 per bed care home premium.

Motion in full

AGENDA COMMITTEE TO BE PROPOSED BY BERKSHIRE: That conference believes the PCN DES is a Trojan horse to transfer work from secondary care to primary care and that:

(i) this strategy poses an existential threat to the independent contractor model

(ii) there should be immediate cessation of LES and DES transfers from practice responsibility to that of PCNs

(iii) GPC England is mandated to urgently survey the profession to get feedback on whether they intend to sign the new PCN DES

(iv) GPC England must urgently negotiate investment directly into the core contract as the only way to resolve the crisis in general practice is by trusting GP partners with realistic investment

(v) the profession should reject the PCN DES as currently written.

Source: BMA

Readers' comments (17)

  • Well said Berkshire LMC at least someone is standing up for us and telling the truth about what is going on. please for the sake of us all vote to reject the DES

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  • Reject it its a mess.Agreeing to it will mean an end to primary care and eventually the NHS.

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  • Vinci Ho

    The motion, to be presented by Berkshire LMC, suggests the network DES is 'a Trojan horse to transfer work from secondary care to primary care‘

    I am glad the label ‘Trojan horse’ was used in the motion as I asked the question of whether PCN ideology is a TH from day one .
    Well done guys

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  • well now ''this is a test' as Graham Taylor once said before England crashed out of the Euros

    The majority of LMCs have so far been quiet, at least publicly

    I have spoken to some opinion leaders whose opinion I value and have had interesting responses

    After strongly rejecting the first DES service spec draft and threatening to walk away they now have responded to the redraft more optimistically with comments like

    'some lingering reservations about the DES, especially around guaranteed long term funding for the new staff we take on, but on the whole happy enough with the it to sign up to it.

    Others have said they 'view PCNs as a vehicle that can support General Practice, and in particular support the independent contractor partnership model'

    Could be a very close call ... then again I might be wrong and folk may see the risk of lines blurring between DES and core contract and wake up and smell the coffee

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  • Vinci Ho

    When you look at the irony that the government is trying to cajole , coax and convince our honourable retired colleagues to come back to the frontline in the midst of this Covid-19 situation (I will write a long comment later ) , as they are treating currently working colleagues like sh*t ( no matter way to put it ) , it only reinforces once again how much more the system needs GPs, particularly partners , than GPs need the system and its leaders .

    It is no longer about one’s moral alethiometer as being a doctor , the system has failed us more than we ever failed it ........

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  • As an older partner that will be retired by the time these changes take full effect I have been open minded about the PCN situation. We have added First Contact Physios, PAs and Pharmacists to our clinical team and they have definitely led to a genuine reduction in workload with all staff having less intense days.
    These benefits have occurred because we have been very careful to make sure that they only do work that was previously being done by a GP. They are part of our independent happy practice team.
    We also feel we have scope to improve care of NH patients and housebounds using these additional roles.
    This DES is a disaster and lumbers us with so much additional 'activity' with very little evidence of what it is trying to be achieved. The staff who are currently making life better for us will be taken away from this work to do all the extra additional rubbish eg SMRs and we will see only additional workload that will come from the questions that this brings.
    The long term funding is going to entangle practices and mean being independent becomes impossible to persist with.
    It is the end of our practice structures as we know it and has to be put to a vote which needs to include younger non partner GPs as most of the people making these decisions (including myself) will never have to work the majority of our careers in this structure, as many of our younger GPs will have to do.
    We need to not sell our younger colleagues down the river for short term gains without asking them and all of us if we want this.

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  • GPC must be hoping that coronavirus shuts down the conference.....

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  • dump it or destroy general practice forever. its a bad contract and grossly underfunded with penalty clauses that will lead to OOH being dumped back on GP practices. If you agree to it you are crazy. unless you want more practices to fold and want all GPs to become locums or leave the UK. as a doctor i would not recommend any new GP to sign up for this. This contract is NOT GOOD ENOUGH. stop accepting crap contracts and demand better. your patients deserve better than this.

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  • It is a Trojan horse for OOH, free care home visits. The "extra staff" that we do not want will only delay things and I have already got unnecessary tasks from the pharmacist we used to employ before he went to another PCN.

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  • I welcome funding for additional roles but currently some of groups identified are not necessarily what general practice needs and certainly will not reduce work load. At a time when being a partner means 60+ hours per week with salaried drs unkeen to take on more work or responsibility and wanting portfolio working I see publishing Gp earnings as absolutely crazy .. it will cause issues in practices and will further destabilise general practice.
    Why should we have to justify if some of us earn over 150k per year.. name and shame ..why? 60 Hours per week at £100 locum rate per hour ..add it up .. they seem to forget the additonal business aspects of running general practice with financial stresses etc.
    Sadly I agree this network DES is not going to be beneficial to the profession going forward and will lump more work and more employment contracts on us.

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  • GPC should have held this vote before signing off the contract for this year!
    However in the face of an epidemic I think we need NHSE to withdraw ALL the reporting requirements for QOF and PCN DES for next year whilst maintaining previous agreed funding so we can concentrate on meeting this healthcare emergency.
    Then we can draw breath after (hopefully) we have seen off the epidemic and only agree for 2021 on measures agreed by a vote of the profession!

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  • It's 2020.Let's face it. We're all bored, tired and dehumanised. No one is coming to help, so help yourself deeply.

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  • Vinci Ho

    It is important that we all ‘wake up’ to this : the INTENTIONS of NHS England, by the evidence of the terms and conditions set in the draft of service specification for PCN(even after it has been watered down to be included in the actual GP contract ) , does NOT categorically represent a rescue package to save general practitioners from this dire GP workload crisis .
    A simple majority rejection is NOT enough , ladies and gentlemen. For those colleagues attending the conference on the day to vote , please think carefully and play your part . Of course , whichever way you vote is well respected.

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  • Indeed we should support the rejection of this claptrap. We may think we won some ground with the revision to the DES, but don't forget the footnote about dumping OOH onto the PCNs after 2021, which as far as I know, is still there...
    Battle may be over but war is still on.

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  • Tantalus

    Are we rejecting it with the expectation that a better deal can be done, or are we rejecting it and carrying on with the status quo?
    Carrying on as we are without additional investment does not seem that appealing.

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  • More money to core contract and incentives to attract new partners will help. Go back to the drawing board. When you look at current decision making process, younger GPs are completely cut off from what is happening. Decisions are made mostly by senior GPs or principals nearing retirement. Some have taken retirement already or work very part time but remain in decision making bodies . The network DES destroys the General Practice as we have known it and the only opportunity younger GPs will have is to join as salaried staff in PCNs. You can already see this happening where new GPs are hired to work in hubs and to do extended hours shifts . Most of these projects are designed or negotiated by senior principals. Some money may come in initially for senior GPs to take and retire ( and they have had enough too ). This leaves the younger GPs to pick up the pieces. Hats off to BBO LMCs for standing up to bullish GPC. I am really confused why the rest of the LMCs in England are quiet and in doing so they are complicit in the destruction of General Practice. GPC no longer represents the grassroots GPs. Such fundamental reorganisation of General Practice should be put to a vote to all GPs . The conference will be an opportunity to express your views . Pulse ran a piece earlier stating that the conference on 11th of March can only express ‘dissatisfaction’ but GPC does not have to listen. It will be difficult not to listen to any overwhelming criticism by profession. Please vote with your conscience on 11th of March. The irony is a day earlier on 10th of March , Londonwide LMCs are running a conference in support of PCNs. With such ‘representatives’ , no wonder why we are in this situation.
    Once again , Thank you BBO LMCs for having the guts to stand up for the profession.We owe you.

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  • Vinci Ho

    As a weary and PCN-sceptical PCN clinical director(schizophrenic, isn’t it ?) , I am only interested in this LMC conference on 11/3/2020 if every single of us attending to vote has discerned facts of this matter BEFORE applying one’s own principles and emotions .
    Whether this DES is the last straw on the camel’s back as far as the fate of NHS general practice, I leave it to you all .
    At 55 , I am the ‘biased beneficiary’ of GMS contract and always wish my younger colleagues could move up the ladder without much complication but this current state of general practice is no where near to satisfy the prerequisite.
    I suppose , at the end , we are where we are. But it is yet to convince a stubborn bugger like me to change my belief .........

    ‘’We are not now that strength which in old days
    Moved earth and heaven, that which we are, we are;
    One equal temper of heroic hearts,
    Made weak by time and fate, but strong in will
    To strive, to seek, to find, and not to yield.’’

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