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CCGs are trying to 'manipulate' formation of networks, warn GP leaders

Exclusive CCGs in some areas of England have been trying to 'manipulate' new primary care networks to ensure they align with their own plans, according to GP leaders.

GPs told Pulse a number of CCGs have been trying to influence how networks are set-up, including telling practices which GP should become their clinical director.

When announcing the new five-year GP contract, NHS England and the BMA said formation of the new primary care networks should be GP-led, with CCGs becoming involved to make adjustments to membership and boundaries where necessary, for example where a practice falls between two networks.

But speaking at an event last week - outlining the new GP contract - BMA GP Commitee executive team member Dr Farah Jameel said GPs are reporting cases where CCGs are telling them who should be their network director and how they should form geographically. 

Dr Jameel said: 'We have heard from around the country that there have been different approaches suggested, which include CCGs telling primary care networks who their clinical directors should be, and CCGs telling primary care networks what their geography and boundaries should be in order to align with local community teams.'

'Our advice and guidance is that it is imperative that the formation and development of primary care networks should be led by GPs and practices,' she added.

Under the new five-year contract, all primary care networks must submit registration information to their CCG by 15 May 2019.

CCGs are then required to confirm registration requirements and approve variation to GMS, PMS and APMS contracts for all networks by 31 May 2019.

GPs in Lancashire and Lincolnshire told Pulse practices in their region have experienced issues with local CCGs.

Lancashire and Cumbria LMCs chief executive Peter Higgins said: 'We have some anecdotal evidence of one CCG that is trying to reinvent the wheel and manipulate practices in a particular way to create one large primary care network fitting their footprint.’

'Generally we are seeing an acknowledgement that primary care networks will develop from the bottom upwards but there are inevitably people out there that want to protect their own interests,' he added.

Meanwhile, GPs in Lincolnshire said the CCG told practices that networks would have to align with existing neighbourhoods teams - a grouping of professionals including GPs - to fit with the local vision.  

 Lincolnshire LMC medical director Dr Kieran Sharrock said: 'Initially our CCG/STP lead stated that primary care networks would need to align with already created community trust neighbourhoods.

'Thankfully when we challenged this, the NHS trust agreed to be flexible to allow for the primary care networks configurations.'

He added: 'The CCG/STP lead has acknowledged this position, although I am still anxious that the primary care networks which are developing will receive pressure to align to the STP vision.'

Under the five-year contract, primary care networks will be based on geography, covering 30,000 to 50,000 patients, and led by a local GP in a clinical director role.

NHS England said every network will allow general practice to 'take a leading role' but pointed out 'marginal adjusment to primary care network membership and boundaries' might be needed in some CCG.

The GP contract said as of October 2018, 88% of practices in England had chosen to join or lead a Primary Care Network, according to CCG data.

But last month, Pulse reported that many existing federations of GP practices will not be counted as networks, because in 'most areas' federations are 'too big to be regarded as one primary care network'.

Key network contract dates

January to April 2019: Primary care networks prepare to meet the Network Contract DES registration requirements

By 29 March 2019: NHS England and GPC England jointly issue the Network Agreement and 2019/20 Network Contract DES

By 15 May 2019: All primary care networks submit registration information to their CCG

By 31 May 2019: CCGs confirm network coverage and approve variation to GMS, PMS and APMS contracts

Early June: NHS England and GPC England jointly work with CCGs and LMCs to resolve any issues

1 July 2019: Network Contract DES goes live across 100% of the country

July 2019 to March 2020: National entitlements under the 2019/20 Network Contract start:

  • year one of the additional workforce reimbursement scheme
  • ongoing support funding for the clinical director
  • ongoing £1.50/head from CCG allocations

April 2020 onwards: National Network Services start under the 2020/21 Network Contract DES

Source: A five-year framework for GP contract reform to implement The NHS Long Term Plan

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Readers' comments (6)

  • My CCG letting us get on with it...and community trusts being told to work their teams around us

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  • Peter Swinyard

    DrDr quite correct. Time for others to fit in with us rather than dictating what we should do. This is intended to be a GP led initiative, whatever you may think of "working at scale"! Look out for Family Doctor Association factsheet series coming to your practice manager's inbox shortly to give you the rules, untainted!

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  • So0 what can LMC or BMA do about it - just cry wolf. Maybe for once they do need to shut up. We don't have problems locally and, historically, our so called 'Leaders' from BMA and LMCs sow discontent if things don't suit their personal plans.

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  • Aren't PCNs just a step on the way to huge Integrated Care Systems -and then CCGs won't be needed..

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  • Let's distance ourselves and consider this again.
    We had the Darzi Centres which were heavily criticized as a waste of resources and feeding only private builders who could lease these out at exorbitant rates.

    Now, we have our CCGs investing in construction of Hub centres and inviting (sic) GP Practices to move in(with the threat of the likes of Virgin taking over if,God forbid, no GPs are willing to do so)

    So, is this Darzi bis? a re-organization of re-reorganization or a ruse to bleed money out of the NHS into pockets of private investors? For some reason, all politicians and even our NHS Leaders feel that the only thing that an drive economy is the building and construction sector - I wonder what the cost of that is for other sectors like the NHS.

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  • We have some very non conforming PCN proposals already... no value whatever as no overlap with any other community services. Almost proves futility of the concept. I wonder if topdown diktat will now follow. There are ways to make this work but it'll be hard work. We'd need trust and grassroots primacy... neither of which we have (nor are likely to get).

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