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Independents' Day

Network proposals prompt GPs to resign as clinical directors

GPs are resigning from their roles as clinical directors of primary care networks due to the 'unachievable' proposals NHS England has put forward for services they will have to deliver.

They say the inability to recruit additional clinical staff for networks, and the lack of extra funding to carry out the increased work stemming from the network DES proposals, are behind their decision.

It comes after NHS England released a draft document on 23 December outlining five PCN service specifications, which revealed GPs in networks will have to carry out fortnightly care home visits, among other activities, in 2020/21.

GP Dr Nick Rayner, chair of Suffolk Primary Care super partnership, announced this week he is resigning from his clinical director role due to the amount of work that will result from the specifications. 

In a tweet posted on 8 January, he said: 'I today took the difficult decision to resign as clinical director of my PCN. 

'I have grave concerns about the overly didactic content of these PCN DES specifications and suggest all GPs in every practice read them and feedback to NHS England about their views before next Wednesday or it will be too late to influence them.

'That is assuming this is a consultation and not a "show of a consultation".'

Dr Rayner said both the amount of work being asked of GPs and the speed at which the plans are expected to be introduced was 'unachievable'.

He added: 'I took on the clinical director role as I wanted to help shape the local direction of travel through collaboration like I have through the likeminded practices within Suffolk Primary Care. 

'However the level of work needed in these specifications, with the speed of introduction suggested, makes me believe this is unachievable, and my energies would be better spent on my established super-practice made up of the willing with three years of trust-building and teamwork.'

In response to his decision, NHS England director of primary care Dr Nikita Kanani said her team was 'absolutely listening to feedback and will reflect this in the spec[ifications].'

Meanwhile, Dr David Jenner, a GP in Devon, told Pulse he decided to resign from his role as clinical director for Culm Valley PCN after becoming 'frustrated with the expectations being made of PCNs'.

He said he was becoming concerned about the inability to recruit partly-funded staff for networks and following the release of NHS England's proposals for service specifications, he resigned on 31 December, after having 'related' concerns.

He said: 'My decision to resign as clinical director did precede this guidance - but was related to the inability to recruit the staff and the awareness of the intended expectations of workload [from the service specifications].

He added: 'What I realised very quickly when we went out to advertise for staff we couldn’t get a pharmacist and I became aware that people were expecting us to do masses more than we could ever do.'

In his formal response to NHS England's consultation on the proposals, Dr Jenner said: 'The real problem with PCNs is you don't get the staff funding unless you get the staff, but the service specifications mean PCNs will be obliged to complete the work even if the staff are not available.'

Pulse is aware of a number of GPs who intend to resign as partners if the proposals for the service specifications go ahead as they stand now. 

Dr Jenner, who is one of them, believes most practices will not renew their contract DES with the current requirements. 

Speaking in a personal capacity, he said: 'If they didn’t change these at all, and my partners decided to stay signed up to the DES, then I would resign as a partner. I think if they stayed as they were it’s highly likely that the vast majority of practices would resign the DES.'

Pulse reported this week that Berkshire, Buckinghamshire and Oxfordshire LMC has urged GPs not to renew their PCN contract DES this year after concluding the requirements threaten the financial viability of practices.

The LMC estimated practices will face a deficit exceeding £100,000 per year, despite having access to the 22,000 extra practice staff partly funded by NHS England

The BMA will negotiate and agree on the proposals with NHS England before networks are expected to fulfil the seven service specifications from April onwards.

Readers' comments (18)

  • Took Early Retirement

    Can someone show some decent evidence that two weekly visits to the otherwise well elderly stops them getting suddenly ill?

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  • No..but it sounds like a nice little vote earner. Whether it works or not in practice is besides the point

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  • Time for undated letters of resignation?

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  • Dr Kanani signed off on these proposals in the first place. Bit late to ‘absolutely listen‘. The parallel universe she inhabits with the relentless spinning that PCN’s are going to save General Practice is so far removed from reality as to be delusional. Might wish to consider your position, because your opinions and proposals are utterly unrepresentative of those of my grassroots colleagues battling relentless demand and chronic underfunding compounded by pointless regulatory bureaucracy.

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  • BMA non of the usual slightly less shitty fudge will do this year you need to start doing your job as a UNION or else the NHS and the profession is toast.

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  • The claim that NHS England is listening to feedback is risible, However if you wish to vent your spleen this is the portal
    Plenty of time to give a considered response: the deadline is the 15th

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  • As NHSE made clear in the PCN DES specifications, this is designed to be the bottom of a very steep slope.

    This is the global health model of "managed care", which started for GPs as light-touch QI with QOF in 2004, followed by DES, LES, POLCV, MOLCV, EBI, etc.

    Stratification and QI tools and metrics are extremely inaccurate, generating much unnecessary work for which there is little or no proper evidence at all. But it is intended to make these the basis for funding, or not funding, future general practice.

    If this is supposed to be the acceptable face of the bottom of the slope, then no-one will be able to climb it. NHSE set out their stall by declaring that, if GPs can't make PCNs work, then we will become forcibly salaried to 'other providers'.

    What to do now? I don't believe that GPC can renegotiate a truly viable contract, or one which can protect general practice for the future.

    Would I rather lose a leg, or renegotiate to lose just a hand?
    We need to follow the lead of BBO LMC and advise members not to sign up to PCNs in 2020. Clinical Directors should resign forthwith, en masse. We risk signing our own death warrants here.

    Since 2012, qualified FTE GP workforce has decreased by 26% in real terms (GPs per 100k population). That's *10,218* FTE GPs lost from a 40,000 workforce. PCNs will make this worse, not better.

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  • Our PCN CD has resigned today.
    PCNs are finished. Even if they improve the terms it's clear that the intention is to screw GPs further. There is no good will left. I won't sign the DES again. Any losses to the practice will be met with a reduction of service with all non contractual work declined. Come on LMCs work together on this one and you could make a stand that protects our profession and our patients.

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  • x4 CDs resigned in our area in last few for the hills all of you...

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  • Politicians telling us that prevention is better than cure while they watched in slow motion the current crises unfold.

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