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GPs must now vote on the whole future of PCNs at the special LMC conference

Dr David Jenner 

Now that GPs have responded to the primary care network DES specification consultation we have to check what happens next.

We have just heard that the BMA is calling a special general meeting of LMCs to meet as soon as possible after the conclusion of contract negotiations to consider the outcome.

This is great news and democracy in action.

The specifications had met widespread opprobrium from the profession, with 80% of GP partners saying they would want to pull out of the PCN DES if the specifications are not changed.

NHS England is already saying that it will listen and change them, the RCGP wants the specifications redrawn, and there has been speculation that the anticipatory care and personalised care specifications will be dropped from next year’s specification. Though that still leaves a lot of extra work and costs for GPs.

As a GP, I listen to the words but read the body language, and it is clear to most of us that NHS England want PCNs to do a whole load more work, which will not be properly funded and will cost GP practices more - as Berkshire, Bucks and Oxford LMCs so clearly analysed in their excellent analysis paper.

Not to mention the current lack of enough GP and nurses to properly deliver the core contract let alone anything else.

Those LMCs call for a complete standstill of the PCN DES for next year, and they are right, as I doubt there is enough time for the BMA and NHS England to make sense out of the specifications before April - and gain the confidence and mandate of the profession.

We need the LMC special general meeting to give the BMA a clear mandate for a response to the PCN DES policy they currently have no mandate for, and which potentially completely remodels the provision of general practice.

This is democracy in action

PCNs came out of the blue a year ago as part of a contract deal negotiated by the BMA but never agreed by the profession and without GPs being aware of the full implications.

We were told the PCN DES was 'voluntary,'  yet new requirements for all GP practices have crept into GMS and PMS regulations as a duty of cooperation for those who choose not to play the PCN game!

How many of you had clocked this?

Some poor GPs are being threatened by their CCGs with breach of contract over these clauses under guidance issued by NHS England.

So even if you opt out of the crazy workload associated with PCNs you still potentially have to attend meetings and share data to the PCN to provide the DES services to your patients.

Where does this end? Who defines what is reasonable? Who draws up the data-sharing agreement? And if a PCN pharmacist performs a medication review on your patient, who is responsible for any changes they make?

If the PCN changes the medication of someone in a care home are they responsible, or are you under your core contract?

Come on BMA - this is a gargantuan mess, and despite what you say this is not truly voluntary.

Quickly agree a complete standstill on the DES for 2020 with NHS England, renegotiate the whole deal and then at the LMC meeting we can give you a mandate or not for the PCN DES and any specifications within it.

If NHS England won’t agree the standstill, call for that mandate now and don’t compound what is undoubtedly a rotten deal by making minor changes.

We should have had this special general meeting a year ago, but thank you BMA, you have listened and now the profession can decide through the meeting whether we scrap PCNs altogether or agree a deal that works for us and our patients.

These are the personal views of Dr David Jenner, a GP in Cullompton, Devon and not necessarily those of his partners or PCN.

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Readers' comments (9)

  • The BMA will predictably sell GPs down the river following some cosmetic tinkering.

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  • We are unlikely to collectively have the backbone to see this one through. The DES will be passsd in altered form, and then, by increments, NHSE will remodel general practice in the image it wants. Lots of superpractices that can jump to its diktats and through its hoops. They will offer existing GP partners cash to agree to merge (those in their fifties will jump), and no sensible people going forward will join such partnerships. Then they will claim that selling the practices to private providers, and having a whole scale salaried model, will be the only solution. GPs will work in ‘Boots the GP surgery’ style branches, or patients will be sent to central hubs for on the day treatment. The quality of care will be poorer, referral rates higher, continuity will be non-existent, and the whole system more expensive overall.

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  • 'personal views' likely spot on.... the slow agonising death of UK general practice continues...

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  • Scrap PCns altogether
    No level of detail or funding will be able to let practices survive in the PCN model, we need to see the future, can’t walk towards this cliff edge with open eyes
    Cmon , BMA and GPC- ur not so naive that you can’t see this being the death of general practice as it is and for what it is
    Let’s vote to scrap PCns altogether and find core GMS to make to profession sustainable and attractive to the new generation of GPs

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  • Our GP partners will not vote for any deal unless there is 100% funding for the extra staff ( not 70% ) because we now see that the extra staff will only have time for DES work , not GMS work.

    On a wider point , personal General Practice with continuity of care will only survive if there is some form of payment per consultation. Otherwise might as well delegate everything to digital triage , non Partner workers and non medical staff. The really ill people will just go to A/E. It will be good for Part time workers I suppose.

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  • At a meeting over 20years ago the wise negotiator Laurence Buckman suggested we are on a journey to GP services being absorbed into American Style HMOs. Partnership based practice has been resistant to that process. However PCNs are the latest way of breaking the partnership model and enabling the vertical integration with secondary care to achieve this role.With a recruitment crisis undermining General Practice and inadequate funding promises to support Primary Care time is right for their aim to be met. PCNs as formed and funded are doomed to fail if as a profession we dance to the NHSE tune. It is time for the profession to stand together to protect General Practice. As General Practice will be a poorer place being run by Secondary Care which doesn’t understand or respect what we do

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  • IT would seem that NHSE and the professsion are on completely different roads, although the final destination might be the same.. The trust has now evaporated and with it so will PCNs, there is no alternative but to withdraw cooperation now, Sad because the idea of PCNs is good

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  • DO NOT FALL FOR IT - IT'S A TRAP !!

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  • Sold down the river by the BMA pretty much sums up my feelings on the contract.
    I left the BMA this year.
    I agree with David Jenner’s conclusion and suggestions.

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