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GPs go forth

Pulse 2019 review: Networks - collective working for bright future?

The implementation of networks dominated English primary care in 2019, finds Allie Anderson

Back in January 2019, the new GP contract – heralded as the most significant in 15 years – promised a great deal for practices.

Provisions included a guaranteed increase in the global sum for 2019-20, NHS funding of all staff indemnity, the promise of 22,000 new practice staff to support GPs and the removal of unnecessary QOF indicators.

But perhaps the most headline-grabbing was the announcement of new, geographically based primary care networks (PCNs). Under the new DES, practices would get £1.70 per patient just to join a network, equating to an average of £14,000.

Although practices would not be forced to join a network, NHS England and the BMA said they expected all practices to do so. And, even if practices chose not to join, every patient in England would be covered by a PCN – each covering 30,000 to 50,000 patients.

To tempt them, several pots of gold were on the table.

As well as this ‘practice participation’ incentive, the contract would see NHS England pay 70% of the ongoing costs of employing support staff like pharmacists, paramedics and physiotherapists – and the total cost of taking on a social prescriber.

Appointing a leader would get the PCN 59p per patient, while a further £1.50 per-patient ringfenced sum would be provided by CCGs.

However, not everyone was convinced the PCNs would be the general practice panacea they purported to be.

Some say collaborative working like this doesn’t improve patient care, nor help to fix problems in general practice, like long hours, inadequate staffing, high demand and heavy workloads.

Others feared the tight timeframe for setting up PCNs might effectively mean practices being coerced into a network, all of which must have registered with their CCG by mid-May.

Indeed, problems were afoot by June, when Pulse discovered that CCGs were refusing to sign off PCNs that had excluded unpopular ‘pariah’ practices.

And it seems that some areas of the country are unlikely to be able to recruit the additional practice staff, with networks in deprived areas in particular struggling to come up with their 30% share to pay for them.

NHS England said extra money would go to PCNs that hire social prescribers through an organisation, totalling a flat sum of £2,400 per staff member.

If GP leaders at November’s LMCs conference are anything to go by, there’s a long way to go before this sways GP opinion. Some 63% said they had ‘no faith that networks will result in a reduction in GP workload’, and a vast majority said PCNs do nothing to boost the ‘dwindling GP workforce’.

But some remain positive, touting PCNs as a system change with as much potential to change lives as modern hospitals and heart transplants.

Only time will tell, comrades.

Readers' comments (4)

  • "some remain positive, touting PCNs as a system change with as much potential to change lives as modern hospitals and heart transplants."
    Well, we have yet to see any "modern hospitals" - and the number of lives changed by heart transplants remains minute compared to the loss of lives associated with the pressures inflicted on the NHS since 2010 by - face it - the Conservative government - starting with the Health & Social Care Act 2012.
    It is unfortunate that NHS England (and all Secretaries of State for Health & Social Care) appear from their actions to believe that the answer to all the problems created is yet another redisorganisation involving unaccountable organisations without any guidelines/requirements for structure - and draconian penalties for the front line if there is any criticism or failure of enthusiastic support.
    Boris Johnson claims to be heading a new government: I had thought political parties had continuity when they changed Leaders? - so no doubt there will be more new plans along any minute now..

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  • Vinci Ho

    I took more pleasure last week from the news that our manager(LFC) had signed a extended contract to 2024-5 than our PM taking the helm of government in the same period of time .
    The reality is whether you are a die hard , traditional fan of either of the two big political parties( especially you are a Remain) , you have to be humbled by this extraordinary result of general election . The so called ‘Red Wall’ of Labour collapsed as far as their traditional supporters in the Midlands and North East are concerned . Only Liverpool and Merseyside have been left behind becoming the ‘’Winterfell in the realm of Westeros’’(Sorry , can’t help it , Game of Thrones again !).
    Well , one day of politics was too long , wasn’t it? These are the facts :
    (1) Like many , I was totally wrong to assume that people cared more about domestic issues especially NHS than Brexit . What is clear was , the uncertainties and frustrations generated in the last three years because of Brexit were the only real focus of attention in this election . If the referendum result in 2016 was a major trauma in life for many Remainers , they had realised that they needed to ‘move on with lives’ to avoid any more post traumatic stress disorder (PTSD) . That evidently explained why many traditional Labour supporters ended up casting their votes ( with shaking hands)to Mr Johnson and his party instead . I think one must respect this wish of these voters to reconcile with reality. And I personally even consider this as a new ‘quality’ of voters .
    (2) This victory bestowed to the PM , however , does not come with no price tag . Yes , it was monumental as far as a majority of 80 seats since Margaret Thatcher’s reign in the 80s(cannot wait until the next season of The Crown to see Gillian Anderson dressing up as the Iron Lady). But I think it is also extraordinary that many politicians in all parties(other than Mr Johnson’s most faithful sycophants) are well prepared to watch him closely under microscope and most outlandish of all , they could not wait to see him making the first serious mistake .
    (3) The similarities between Mr Trump and our PM are egregious and historic . Both had probably failed badly for the score of trustworthiness. They both succeeded by aid of some impenetrable, mystical but undoubtedly intelligent gurus (Mr Bannon and Cummings). And most importantly, both would survive any attempt to overthrow their current position as their own parties are far more superior in terms of number of seats in the decisive chamber( the Senate and House of Commons). Despite subjective feelings , I think Mr Trump will survive the impeachment as well as getting re-elected next year .


    So often , western democracy is about soldiering on with the mandate approved by the majority in a ballot to settle disputes. But what about the feelings of the minority? It becomes more contentious if the so called minority is , in fact , fairly substantial. The winner certainly cannot ‘take it all’ as the minority will always want to voice their disagreements. Is a consolation prize necessary for some sort of settlement?
    I wonder if NHS is to serve this purpose in the next five years ?
    The PM spared no time to involve the Queen delivering this ‘settlement’ to appease those willing to loan him the winning votes. The Queen’s speech declared that the plan to enshrine multi-billion boost of NHS funding in law . This was amongst multiple announcements to pass a long series of legislation, obviously including the Brexit Withdrawal Bill , in this coming year .
    The PM and his cabinet was a paper tiger before the general election , it has now become a beast with 80 teeth . There is very little doubt these legislations will be passed smoothly with a comfortable majority. That was then and this is now (from zero to hero in politics).
    So , what are we(GP) up against in reality ?

    (a) It is only fair to say that we have all been burnt out in variable degrees for the last decade . Our labour force is now constituted of half part-time and half so called full-time colleagues. The hitherto trend is that more will become sessional and part-time . How ruthless our PM and health secretary will tackle this ? I would rather keep my answers to myself at this stage .
    (b) Then the workload continues to rise due to the simple fact that secondary care really cannot deal with the number of patients walking through the door everyday .They will cut down even more referrals and dump them onto us . Of course , we cannot cope either . The government had negotiated with our representatives to develop this five year GP contract with the ideology of Primary Care Network (PCN) which has rapidly become a ‘household’ name amongst medical professionals and policy-makers. I would argue that the ‘dumping ground’ has only been made bigger instead of truly integrating care with secondary care . After all , a robust integration will only mean that we(GPs) will weaken either our sovereignty or the democracy.
    (b) I can only hope our representatives ( unfortunately including myself as a bloody senior partner , LMC member and hapless PCN Clinical Director) can grow up a bit more , away from political naivety and insensitivity. Next five years will be a fierce war against a PM and his health secretary characterised by notoriety , skulduggery but also tremendous power . The truth is that the PM does not need to believe in the ethos and telos of NHS as long as it can protect the votes loaned from those who would have remained in the opposition camps .
    (3) If you are a fan of the currently running TV series , His Dark Materials , we are now up against a ‘Magisterium’ . One thing for sure , however , is this war we are facing is no longer about blindly adhering to our moral alethiometer . There is no Lyra in real life . Instead , governed by terms and conditions, our weapon used in negotiations is ironically this retention and recruitment crisis following the line of a scorched-earth policy .
    While I always oppose BMA and RCGP officially declaring their position of remaining in EU , the potential animosity created by this government will be simply fuelled by this corresponding post-truth politics . I suppose that one will have to choose a side in a fierce war and there is no room for any middle ground rationality .....................

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  • Vinci Ho

    ‘’This is the way"
    The Mandalorian

    ‘’Valar morghulis -‘’all men must die,
    ‘’Valar dohaeris "-all men must serve.
    Game of Thrones

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  • Will apparently there's no new money for the new PCN deliverables that include:

    Structured medicines review and optimisation (from 2020/21)

    Enhanced health in care homes (from 2020/21)

    Anticipatory care (from 2020/21)

    Personalised care (from 2020/21)

    Supporting early cancer diagnosis (from 2020/21)

    Good luck with that guys!

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