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Practices 'who do not get along' being forced into CCGs' preferred networks

Exclusive CCGs are trying to force practices to form primary care networks without consideration for working relationships or GP opinions, according to a consultant for GP networks.

Consultant Scott McKenzie, who advises GPs on mergers, forming federations and now networks, told Pulse he has been inundated with questions from practices who are being pressured to form networks in a specific way by CCGs.

He said CCGs are turning up to initial discussions with LMCs with a list of exactly how the networks will form, and telling practices they must form large networks of 60,000, despite the groups of practices not getting along.

When announcing the new five-year GP contract, NHS England and the BMA said formation of the new primary care networks - which will roughly cover between 30,000 and 50,000 patients - should be GP-led, with only CCGs becoming involved to make adjustments to membership and boundaries where necessary, for example where a practice falls between two networks.

But Mr McKenzie said he has numerous examples where CCGs are overstepping that line.

He said: ‘I have had a lot of questions from practices - GPs who are either interested in forming a network and then either being told “oh you can’t form a network that way” or “the geography does not make sense”.

‘One example that sticks out is, I have one network of 33,000 patients over five practices that wants to form a network. But the CCG has said “you can’t, because we have 27,000 patients in a practice near you, and they don’t meet the minimum number of 30,000, so you are all going to have to merge into one network.

‘That has caused real consternation because the working links are not there, the history of collaboration is not there. To be honest they do not get along, so it almost feels like the CCG are creating something that is destined to fail.’

This is despite NHS England’s acting director of primary care Dr Nikkita Kanani telling GPs last week that said networks could be a ‘bit smaller or a big bigger’, depending on relationships, which should prevail over geography.

Mr McKenzie said practices are also concerned about power dynamics within networks, especially when practices without a history of working together are forced to join.

‘The five that have got together – the 33,000 – they have a really long history of working together. One of the things they are worried about is, if they are forced to join with the one practice of 27,000, that they could completely dominated them,’ he explained.

‘This is a repeated pattern I’m seeing. I had a huge area in the home counties, where I spoke with GP federations and local LMCs about networks. They told me they had been at a meeting that afternoon, where the CCG told them “we have sorted out the networks for you, this is how it is going to work”.

‘They were completely thrown by this, because it was completely contrary to all the messages they have been given about these networks being formed by GPs, from the ground up. I have seen this to varying degrees scattered up and down the country,’ Mr McKenzie said.

Other issues being raised include the offering of extended hours DES, which some practices currently offer but others do not.

He told Pulse: ‘I have had a few interesting conversations around that, where you have a network of seven and five of the practices offer extended hours, and two do not. And the two that do not, have the mind set of “I don’t, I haven’t, I’m not going to”. So it then becomes the other five practices' problem to cover the other two practices' patients.’

New contract documents released last week have provided slightly more detail on networks, including that they would normally not cross CCG boundaries and that they will include pharmacies and dentists.

According to the documents, any changes to the membership of the networks, for example practices leaving or joining, must also be approved by the CCG.

Commenting on this, Mr McKenzie said: ‘I can foresee issues with this.

‘I can imagine that the way that CCGs and before them primary care trusts have acted, is that once it is set, it is set for life. There has never tended to be any flexibility.’

Pulse reported last month that CCGs in some areas of England had been trying to 'manipulate' the formation of networks to align with their plans, according to GP leaders. 

It was also reported that pariah practices would still have to be part of primary care networks, as their patients 'deserve care', according to RCGP chair Helen Stokes-Lampard. 

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Readers' comments (10)

  • its happening everywhere. Who thought it was a good idea to force GP surgeries into big blocks? The history of General Practice in the UK shows that medium sized surgeries are the best unit for both patient and doctor satisfaction. This whole PCN idea is taking up huge amounts of valuable doctors time and with the current political uncertainty is it all going to be changed again in a year or so?:
    Its more 'deck chairs on the titanic'.

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  • NONE OF THIS MATTERS.....

    BEING A GP PARTNER IS CRAP-AND NO DOCTOR IN THEIR RIGHT MIND WOULD WANT TO BE A PARTNER-IT IS LIKE VOLUNTEERING TO GO "OVER THE TOP" IN THE FIRST WORLD WAR AND CHARGE THE MACHINE GUNS...EXCEPT AT LEAST THE END WAS QUICK THEN.
    MIGHT TRY STICKING SOME PENCILS UP MY NOSE LIKE BLACKADDER IN THE HOPE OF BEING SECTIONED.

    NHS ENGLAND LOVES LOCUMS-THAT IS WHY THEY ARE BEEFING UP LOCUM WAGES EVEN MORE WITH FREE INDEMNITY AND NO RESPONSIBILITY. WELL-GOOD LUCK WITH THAT LOVE AFFAIR....

    THE NHS AND CCGs CAN STICK THEIR PLANS WHERE THE SUN DON'T SHINE AND FIND SOME OTHER DELUDED MUG TO DO THEIR DIRTY WORK...

    GO ON BRIEF YOUR SILLY FRIENDS AT THE DAILY NUTTER...NOBODY CARES AND MORE....

    \/ SALUTE.

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  • Vinci Ho

    Human nature : it is hard to get four/five partners within a single practice to agree easily on an issue , what makes you think it is easy for so many GPs to agree on more complex issues in a massive network .
    Furthermore , do not forget the Trilemma Theory : For integration, sovereignty and democracy , you can only have two but never all three of them.
    The political reality was that politicians did not believe in funding individual practices ideology from day 1 . They always think that is too expensive. To put in new money/investment, they wanted to be ascertained that there would be substantial structural changes .

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  • More top down reorganisation by people who haven`t got a clue.
    It will eventually become even clearer that the so-called economies of scale will be dwarfed by the inefficiencies of scale.
    How can one assess the benefits of continuation of care and the personal doctor-patient relationship?

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  • Teresa May learnt from this to get along with Jeremy Coban.

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  • It's all a load of utter bollocks

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  • Research has shown that the happiest workers have autonomy, skills that few others have, and a high demand for their services. So they can pick where and when they will work, with who (only if they want this as many prefer to work without others), and receive a high hourly rate of pay e.g. a self-employed plumber.

    In the distant past GPs commonly worked by themselves, just with the help of their spouses and their job enjoyment was extremely high, sadly very very different to today.

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  • It is all going to go wrong and we will see another reorganisation in a year, forcing people who do not like each other for various reasons is not going to work.

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  • It's ore coming down to the needs of Practices being different. Bigger Practices employ Pharmacist's - it improves QoF- we are told. Smaller achieve 100% QoF without pharmacists. So, with 30% of funding to come from the pocket of Practices, are smaller Practices going to opt to have a Pharmacist? I don't think so.
    The stitch up is in forcing PCNs to employ staff which CCGs promise will improve productivity - the bottom line is that Practices have to pay 30% of this additional staff expense from their budgets and there is nowhere to recover this money from !! This is an additional expense and we don't know when and whether this will bring results or profits.
    In a year, all the staff newly employed will have employment rights and at that stage, the govt may change it's mind and stop funding even the 70% they are contributing this year. Do we trust that this will not happen? Choose and Book was a fine example.
    Tread carefully, the coals can get really hot!

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  • This is a good time to hang up one's stethoscope.

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