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LMC issues urgent call to GPs on 'viability' of practices following network proposals

LMCs are reporting that GPs are considering whether to continue with primary care networks, with many raising concerns that the new requirements will affect the viability of practices.

One LMC has sent out an 'urgent' survey to practices yesterday asking whether GPs feel the 'stability' of their practices will be affected, after NHS England last month published its proposed specifications for primary care network (PCN) services - including the requirement for fortnightly care home visits by GPs.

Another said that there should be 'outright rejection' of the DES specifications. 

And an LMC leader has said that practices have been providing feedback that they want to withdraw from the DES.

A Twitter chat yesterday revealed the extent of GPs' concerns at the specifications, with many saying they are currently considering whether to continue the DES.

NHS England has said that it is listening to GPs' concerns ahead of the 15 January deadline for feedback on its proposals.

The new proposals, drafted by NHS England and NHS Improvement, state GPs will have to carry out care home visits 'at least' every fortnight and implement structured medication reviews as part of the five national services PCNs will have to phase in from April.

Londonwide LMCs are asking practices in a survey whether they believe that these specifications will 'increase or decrease the stability of your practice'.

In an email sent to all London practices, seen by Pulse, Londonwide LMCs said: 'It is unusual for NHS England and NHS Improvement to take this approach to GP contracts and we do want to have your backs. To help us support you, we urgently need to know what impact you feel these DES specifications will have on your practice's viability over the coming year, so please complete the survey as frankly as possible.'

A position statement from Derbyshire LMC last night said: 'There should be outright rejection of these specifications until there has been robust negotiation to achieve something that is fit for purpose, deliverable and comes with significant additional investment. Such has been the widespread condemnation of the specifications so far that NHS England must take notice as the future of their long-term plan and primary care networks could be at risk.'

Meanwhile, Dr Kieran Sharrock, medical secretary of Lincolnshire LMCs told Pulse: 'Our committee are discussing formally on Thursday night, but informal feedback is that coalface GPs want to withdraw from the DES and not provide PCN services. Unrealistic expectations and timescales in the cauldron of excess workload and workforce crisis.' 

Last night, a twitter chat on the specifications revealed the scale of feeling from GPs at the specifications.

Dr Hussain Gandhi, a GP in Nottingham, wrote about the care home requirements: ‘I said it before. Whoever added the line about GP only face to face visits on a regular basis needs firing. At odds with [NHS long-term plan] and the aims of #PrimaryCareNetworks ethos. Sceptic would say intentionally added to cause angst and frustration.’

In response, NHS England director of primary care Dr Nikita Kanani wrote: ‘This came from the enhanced health vanguards and certainly not to provoke - we need to balance best care for the population and sustaining general practice.’

GP Survival chair and pensions expert Dr Nick Grundy wrote: 'The numbers are unquestionably large, but: (1) PCNs are required to make up 43p in the pound of the staff costs, i.e. £236.5m in 20/21 rising to £771m in 23/2 ; (2) none of that money can be used for GPs.

'The headline numbers are not helpful. With my partner hat on, I have to look at the specs and decide whether it's worth my spending money on the additional staff. That is only the case if they benefit BOTH my patients AND my practice: as they stand, they might do the former, but at the expense of the latter.’

In response to Dr Grundy, Dr Kanani wrote: 'We can’t lose one for the other - this has to be about sustainability, about equality of offer, and about working more closely with the system. Likely in that order.'

She added: 'Thank you for engaging so openly this evening. I know it will make a difference,' adding that the consultation taking place over Christmas was ‘not convenient at all. [It] meant everyone (profession, myself) were distracted by this instead of festive period. But it was the best we could do and we already have a huge amount of feedback to work from.’

NHS England is asking GPs to respond to its six-question survey on the proposals by 15 January.

In October, NHS England admitted some areas across the country will have a 'real challenge' in recruiting the 20,000 additional primary care network staff it promised to help fund as part of the GP contract negotiated last year. 

In the summer, NHS Clinical Commissioners, representing CCGs, said its members were 'concerned' their existing budgets were not big enough to cover the additional £1.50 per patient required under network arrangements.

Readers' comments (23)

  • I have read through the 5 specifications with a sinking heart. more paper work more MDTs and more data gathering which will only marginally help patients. Meantime we are struggling to provide just the basics. Are they deliberately trying to demoralise us?

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  • You could not make this up - at a time when General Practice is struggling, most practices joined up to this ill-defined unresourced unilaterally centrally alterable contract. We were under massive pressure in our area to do the same, but resisted. The solution is simple - join the small number of practices that haven't joined and say 'No' to this disaster that is PCN's. Kanani et al aren't hearing your protestations...

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  • I haven't read the specifics as I am no longer in practice, but we tried this in the 90s and it added to workload without having any obvious benefits to the patients. Total patient contact went up and the total number of visits did not go down. And this was before the days of endless paperwork and meetings.

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  • Vinci Ho

    Nikita
    You are clearly NOT Dr Madan . But these waves of reaction from GPs are phenomenal and only expose the hypocrisy of this new five year contract . The ideology of these requirements mentioned in this service specifications aiming to release more GP appointments, is fallible and arguably delusional. The state of general practice ,worn down by this progressive crisis of retention and recruitment, is nearly irreversible. Are NHS England , Improvement and Digital prepared to bear this responsibility of totally destabilise primary care and hence , NHS ? Please wake up . Alice .

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  • Our team of 5 Partners have read all the specifications and frankly we are terrified of this.
    We were under the impression that PCNs was about sustainability and allowing us to have more capacity to do what we are currently doing and to ease workload intensity for GPs to protect the long term GP workforce.
    Having been relatively positive about PCNs this document blows that out of the water.
    The demands are immense, both in planning and then ongoing workload.
    We are currently enjoying the benefits to day to day working of PAs, FCPs, e-consults and Pharmacists and they have added capacity to our day to day working and reduced intensity although there has been a huge investment in support and mentoring that negates some of this.
    This document feels as if we have a completely new job to do in addition and is definitely a move to long term demolition of individual practices.
    This needs rejecting more or less outright and there is no excuse for allowing this to finally finish off Primary Care as we know it.
    Every year gets worse and worse and this needs to stop.

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  • Agree total garbage and little to no evidence it would help anything. As I recall reviewing all cancer Dx at PCN level when already should be doing at GP level is another classic hidden in the depths of the document that was quite deliberately sent out pre-Xmas with a short response time.

    Downside is if get this removed the muppets will no doubt find something marginally less polarizing/useful/evidenced to do.

    Note this from someone who visited patient at 07:30 on way to work after helpful nursing home told relatives I refused to visit Friday 17:00 for 6 months history of poor appetite/intake and Wt loss in patient with Vascular Dementia, best part was I spotted her before staff and she recognized I was her GP before commenting nothing wrong, confirmed by examination too.

    10 weeks left and feel sorry for the poor bastards left

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  • I can’t think of any other explanation for this other than a deliberate attack on GPs designed to destroy the partnership model once and for all. Even the most patient phobic, one session a week GP “leader” that’s come up with this has to be aware that it’s completely undeliverable and will destroy the sliver of morale that might be left. Where are the BMA? They need to be calling for a scrapping of these specs altogether, starting again from scratch, and continuing with the current PCN specs for a year until a workable spec has been produced for 2021/22. Mumbling about engaging with the consultation doesn’t cut it, we all know a couple of minor things will be changed and NHSE will claim to have “listened to feedback”. If the pause and rethink doesn’t happen, the BMA need to formally advise all practice to withdraw from PCNs. Time to forget about the future NHSE/DoH jobs and gongs, and start acting like a union.

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  • Not practical to do this on top of all the other work.
    No evidence that I know of to prove that patient outcomes are better.
    People will abandon PCN 's and it will accelerate others retiring.
    Goodbye General Practice.

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  • I have complete faith in the chain of command.

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  • We are quitting PCN. The money on offer is less than 1/10 of that required to deliver all these new services.
    If everyone else shows some steel and refuses to play this Russian roulette game then NHSE cannot proceed.
    Look at the media and number 10, already briefing against greedy parttime GPs

    BMA I have been paying you for 30 years. Now is the time for you to return the favour and actually do something to support me. Reject these proposals in their entirety

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