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LMC still ‘cannot recommend’ signing network DES due to 'significant' concerns

EXCLUSIVE A group of LMCs has said it ‘cannot recommend’ that its practices sign up to the network contract DES, despite it having been revised, due to ongoing ‘significant’ concerns about the extra workload it will create for GPs.

Berkshire, Buckinghamshire and Oxfordshire LMCs analysed the newly-negotiated primary care network (PCN) DES and found there was still a risk of financial loss for practices - of £17,191 per average network in a year.

It said this loss in income was due to the level of work required to deliver the contract, including the three new service specifications, in 2020/21 - which it argued would not be offset by the additional clinical staff PCNs are expected to hire, despite extra funding.

The group of LMCs estimated the service specifications - covering care homes, structured medication reviews and early cancer diagnosis - plus other requirements such as those relating to flu vaccination and social prescribing, will require 61.5 sessions per week.

But an average network will only be able to deliver 40 sessions per week using its additional staff – leaving a deficit of 21.5 sessions, warned the LMCs.

The LMCs' analysis adds that a ‘further workload burden’ of 27.5 hours per week will fall upon PCNs because there is also the additional administrative and managerial work that extra clinical staff will be required to carry out.

Overall, the requirements under the network DES could result in a potential net loss of £17,191 for an average PCN delivering the requirements of the DES, according to the LMC’s financial modelling.

The analysis says: ‘The DES was initially heralded as a means of relieving and reducing existing workload pressures in general practice. There is no evidence that this is the case, given that the DES lacks the utilisable workforce to deliver even its own requirements, let alone manage any pre-existing workload.

‘It seems highly unlikely that the practices in an average PCN would see any net financial benefit from the DES and indeed it seems probable that they would make a loss in the process of delivering the work required.’

The analysis adds that ‘significant’ workload is due to be added to the DES in 2021 and beyond and that the contract suggests that some aspects of the DES may be ‘rolled into’ or cause changes to the core contract.

It says: ‘As time passes, and systems become more integrated, it will be more difficult for practices to extricate themselves from the DES if they so wish without significant adverse financial implications.

‘We have significant concerns that this DES poses a threat to the independent contractor model, the core GMS contract and the autonomy of individual constituent practices.’

The group of LMCs said: ‘Based on the above analysis, the LMC cannot recommend practices sign up to the PCN DES.’

It added that it ‘does not necessarily recommend’ that all practices withdraw from the DES, but that those practices and networks that feel they are able to absorb the financial risks should ‘take steps’ to ensure they are able to withdraw in future.

Practices should await the outcome of the special LMCs conference to be held on 11 March to discuss the impending GP contract changes ‘before making any commitment’ to the DES, it added.

Berkshire, Buckinghamshire and Oxfordshire LMCs CEO Dr Matt Mayer told Pulse the estimated financial loss that the DES could bring is a ‘best case scenario’ as it is based only on the workload laid down in this year’s deal.

He said: 'The specs that are coming in next year seem to be at least as onerous as these ones because there are quite a lot of them – reducing inequality, cardiovascular disease, anticipatory care and personalised care - which have just been deferred.’

He added: ‘The main concern my reps and I have is the effect [the DES] has on your core contract the longer you are in it and therefore the difficulty and financial or contractual damage if you delay coming out of it.

‘We’re concerned this might be one of the last times you can get out of it without causing your practice a lot of damage – but we honestly don’t know and that’s why we’re really concerned.’

Readers' comments (21)

  • Nhsfatcat

    Massive thanks to the CEOs and 3 chairs of the BBO for their hard work and detailed analysis; and to Pulse for maintaining traction on this story.
    For all GPs- please speak to you LMC reps attending the special conference 11/03/2020 so they can represent your feelings. You pay your levy, have your say through them.

    (DOI: Dr Simon Ruffle, Board Chair BBO secretariat.)

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  • Absolutely spot on. There is real risk in PCNs developing faster than the necessary assurances can be factored in, leaving them exposed to financial and operational risks, and leaving practices picking up largely unfunded work and with CCGs needing to divert what is essentially core GP money, and an important income stream, to prop up underfunded 'initiatives'.

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  • Surprise surprise........where is NHSE to show us how we are wrong? Please bring out the PCN cheerleaders to answer the points above......

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  • dump it before the OOH gets dumped on you

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  • ‘We have significant concerns that this DES poses a threat to the independent contractor model, the core GMS contract and the autonomy of individual constituent practices.’ Absolutely spot on exactly my thoughts last week ! For the sake of future independence the answer needs to be NO

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  • Bob Hodges

    Whereas if you are a single practice PCN, it is a no-brainer and very much helps to sustain yhr independent contractor model.

    Its a curate's egg alright.

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  • Well Done Berkshire, Buckinghamshire and Oxfordshire LMCs!
    I dont think GPC is used this level of scrutiny. GPC thrives on herd mentality of GPs. Berkshire, Buckinghamshire and Oxfordshire LMCs are a credit to the profession.

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  • To the vast majority of my fellow GP's who seem keen on PCN's: do your diligence and visit the BBOLMC website to read the analysis in full. If that doesn't persuade those that still think the PCN concept is a good one otherwise, I'm not sure anything will, but count me out.

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  • NHSfatcat - "You pay your levy, have your say through them." - I wish! Our LMC tends towards saying what a marvellous deal everything is (including elements of the previous incarnation of this DES). Never mind - just a few years until early retirement. (still waiting for RoboMatt to try and retain me).

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  • Nhsfatcat

    ‘fed up’

    I’m very easy to find on NHS mail as there aren’t many called Ruffle.
    Be interested to know which area you are.
    I was vet much anti LMC/BMA thinking that they do not represent grassroots. I got elected as rep and haven’t looked back. BUT I am grassroots first, front and forever. I will not go native and I will represent constituents. There is no personal gain. I’m thankful that my partners support me in LMC work.

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