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The waiting game

PCNs ‘in danger of folding’ over concerns about care home services

Exclusive Primary care networks (PCNs) in Kent are ‘in danger of folding’ due to large practices opting out of the network DES, Pulse has learned.

‘Significant’ practices have decided not to sign up to the DES due to concerns about the care homes element of the contract, local GP leaders told Pulse.

It comes as GP leaders have advised practices to think twice before signing up to the DES and two entire PCNs in Buckinghamshire and Milton Keynes have already decided to opt out over workload concerns.

Kent LMC medical secretary Dr John Allingham told Pulse that two practices ‘in the order of 10,000 patients’ have decided to opt out of the DES after initially signing up last year, while another will continue to opt out.

Now the redistribution of PCN workload among the remaining practices could threaten the networks with collapse, he added.

Dr Allingham said: ‘We’ve got some PCNs that are in danger of folding because practices are not signing up, principally because of the care homes DES.

‘Some significant practices that are not signing up to the DES are going to become orphan practices whose patients will have to be provided with network services by other PCNs.’

He added that the LMC has had ‘quite a few difficult discussions’ with practices who are worried about signing up, particularly due to the care homes service.

Workload problems in Kent have been well-documented, with another practice forced to close in the crisis town of Folkestone in February after it was unable to cope with the extra demand from the ‘forced allocation’ of patients. 

Meanwhile, the requirements around care homes are also ‘threatening the stability of PCNs’ because they are ‘not evenly distributed’ between practices within some networks, Dr Allingham added.

He said: 'There’s one [network] in particular where there’s a very large care home that falls in the area of two practices and the other practices in the PCN have got hardly any or no care homes.

‘We’ve got 600 care homes in Kent so we are a big problem.’

Earlier this month, NHS England warned that practices that opt out of the network DES will not be able to negotiate ‘better’ local contracts.

However, Kent has various ongoing care homes service contracts and some are ‘more generous’ than the DES, Dr Allingham told Pulse.

He said: ‘In actual fact, there are some deals that are a lot better than the £120 per bed [in the DES].

‘One of our CCGs has a scheme where they tiered their care homes according to the acuity of their patients and the higher acuity patients are paid around £190 per bed.’

While the DES’s fee per bed is ‘not very good money’, particularly for care homes that deal with end of life care and have a high turnover, he said.

Dr Allingham said: ‘One bed might have twenty patients in it during a year. Well £6 per patient - each patient who’s end of life and requires an awful lot of work - that isn’t very good money.

He added: ‘The only way they won’t get a better contract locally is if they require CCGs to serve notice on all existing care home contracts. 

‘But if they serve notice on all existing care home contracts and then the practice decides not to accept the new DES, they’ve got network services they’ve going to have to commission from other providers.’

NHS England caused controversy when it announced that GPs should start conducting ‘virtual’ weekly care home rounds this month - but separate to the DES until it begins formally in October.

However, NHS England warned that practices may face regulation if they fail to set up the service - including nominating a clinical lead - by the 15 May deadline.

Last month, Berkshire, Buckinghamshire and Oxfordshire LMCs told practices that they ‘cannot advise signing up for the network DES’ in light of ‘significant concerns’ over its workload requirements.

And Pulse revealed this month that an 85,000-patient PCN in Buckinghamshire and a 40,000-patient network in Milton Keynes have already opted out of the DES - with other PCNs in the regions ‘planning to follow suit’ in the coming weeks.

Readers' comments (12)

  • Vinci Ho

    As expected
    I have zero sympathy to the system led by NHSE.
    Once , an issue of trust and credibility more than what is supposed to be politically and ethically ‘right’ .

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  • Tough luck - if you sign up to this it's your own fault!

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  • "A PCN has the potential to improve quality and gain efficiency. They must support general practice in terms of workload and expanding the workforce it will then help with recruitment and retention, making general practices more resilient and a better place to work."

    So wrote Nigel Watson 18 months or so ago. Not looking much like this atm & as many of us feared PCNs are not a vehicle to support practices but a way of dumping even more work.

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  • The recent statement by the bma is dubious, about the amount of practices that are signing up. I am not sure about the figures as stating 74 nationally stated not signing up. 15 in the 2 neighbouring Ccg’s alone here.i do wonder if it has been put out to try and persuade practices instead of being factually correct.

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  • You are absolutely right, the wording is misleading and they are trying to persuade GPs to sign up. But again , it has been always their position. They have no regard for what emergency LMC conference mandated them to do. What makes BMA to be obsessed with PCNs? Does anyone know.BBOLMCs are the only LMC who have stood up for GPs

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  • Practices using their brain! GET OUT OF IT BY 31.05.20...or get absolutely nailed by NHSE over the next 4 years. READ HEMPSONS SOLICITORS + PODCAST, LMCs critical analysis too. The des binds to your core contract, breach the des and they can remedial action your core! And they'll add MASSIVE workloads in coming years!!!! Life's worth more, don't die.

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  • In our area most practices are joining on the premise that is ‘better to be in than out’ and to ‘shape services’. Ignoring the fact that the DES are suffocatingly prescriptive; ignoring the fact that the proposed funding is woeful; ignoring the fact that workloads are untenable prior to this addition; ignoring independent BBOLMC projections. Hard to fathom. In it’s current form, the PCN project cannot possibly succeed and I look forward to it’s slow and inevitable putrification.

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  • Escape while you can....... but not from PCN'S.... from the UK :-)

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  • Have today sent the email declining the very kind and generous offer from the CCG of the Network DES.

    It is still possible to be a non core network member, engaging and contributing without being signed up to the DES. If contributions and say are important, practices should consider applying to be a non core member. Any interested body is entitled to request to become a non core member.

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  • PCNs were born out of the failure in GP recruitment. Unless governments address this basic issue any attempt at a "Fix" will, in time fail.
    Address GP recruitment/retention definitively and the need for such schemes will disappear overnight. GP Principals have generally always known what their patients need and weekly, virtual care home "Ward-rounds" isn't one of them. Well done those of you who have actively NOT signed up.

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