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Independents' Day

A draft of the deluded or deceitful


Even though they’ve only been a Thing for a few weeks, I’m guessing you’re already heartily sick of the network contract Direct Enhanced Service draft specifications and suppose that all necessary bile has been eloquently spewed in appropriate directions.

Well, not quite. Because, early on in the draft spec (1.12, if you’re counting), there’s a short section that bears reading and re-reading and re-re-reading. Not only is it both chilling and hilarious, it pretty much sums up the thrust of the document and saves you having to read further. I reproduce it here, verbatim:

“Providing that PCNs move forward swiftly to engage new staff and use their additional roles reimbursement entitlement, there will be significant additional capacity within primary care in 2020/21 to deliver the specifications. Recruitment decisions by PCNs will depend on their priorities but an average PCN could – indicatively – engage around 3 WTE clinical pharmacists, 1.5 WTE social prescribing link workers, 0.5 WTE physiotherapists and 0.5 WTE physician associates from April 2020. This would provide more than sufficient capacity to deliver the requirements across all five services with significant capacity remaining for these additional roles to provide wider support to GP workforce pressures by handling appointments or queries that would otherwise have been the responsibly of the GP.”

If words fail you, you remain sentient on Planet Primary Care

To summarise: 3 pharmacists and 2.5 associophysiosociotherapists spread across 50,000-odd patients will give us the person-power to deliver all five service specs AND provide enough residual capacity to free up GP time. The bolded out bits, by the way, are theirs, not mine and add insult to injury by implying that they are really certain about what they are saying.

If words fail you, this proves only that you remain alive and sentient on Planet Primary Care.

There are only two rational explanations for section 1.12. Either they genuinely mean it, or they don’t, and they’re just enjoying taking the piss. In other words, this is a draft of the deluded or the deceitful.

This is almost distracting enough to make us forget that the scary spec bits were in the original PCN ‘Investment and evolution’ document of January 2019 which we were corralled into signing. Almost, but not quite. If we should quit now, why were we encouraged to sign up in the first place?

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield

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Readers' comments (17)

  • "Happy to pay a tax increase in exchange for my first pay rise since 2004!
    I suppose you preferred option is to close the NHS and charge everyone £65/appointment, £120/visit?? "

    What makes you so sure you would get a pay rise? And you would pay a 10% tax increase for a 1% pay rise?? The devil is in the detail isn't it...
    No I wouldn't close the NHS entirely, but it should certainly be scaled down. Maybe state emergency treatment provision only, social and elderly care for some, access/co-payments for primary care and subsidies for prescriptions for some... Certainly not the all you can eat buffet, which I presume, you want to maintain in its entirety?

    In the bigger scheme of things, you believe we should continue taxing the lower middle class, or the upper working class e.g. trades/bus drivers, so that the rich can have any treatment on the NHS for free when they can afford it? Or free prescriptions, or the rich kids to have free university education , or even religious circumcisions to be carried out still up in Scotland? Why not let the majority of the public take up their own responsibility for their own decisions?

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  • We need to demonstrate some self-respect and tell them to f**k off. Anything less is too ambiguous! We are in short supply, we are cost effective, actually really cheap, and the voters love us... why is the DoH so dumb to treat us like this?
    This govt is in the best position to absorb nasty shocks right now as it has this trumpeted majority. Take action now, and this will give them time to fix it, allowing time to absorb lots of sh*t from us, and will still give them room to polish some turds in 2024-5.

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  • “Happy to pay a tax increase in exchange for my first pay rise since 2004!”

    Jesus. People really have very low expectations of themselves.

    “In exchange” basically confirms that people willingly will make a pact with the devil for something... ANYTHING in return! Enjoy those returns and please do let us know when they arrive!

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  • have i read this correctly ? willing to pay more tax in order to get a pay rise ? has it not dawned that the cost of running the whole shebang will be hived off what extra tax you pay long before anything extra comes out the other end ? you'd be better off putting it in a savings account - even at 0.5% !!!

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  • One million appointments a day not enough for the DoH?
    ..methinks it is time for them to rethink the model entirely. You just CAN'T HAVE ANY MORE, and that's it. The UK public purse can't afford it, you haven't planned for it and you don't respect what you are already getting. Stop bragging about your NHS at the hustings and to your sniggering international mates, and accept that it should be in the history books and not the newspaper.

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  • A junior lawyer charges £280 not including VAT. yet some very senior doctors has no insight into this, depending and giving their professional freedom and control to the state, their income limited by others, happy to respond to the state asking them to jump and they say how high with contract changes every year and the labour government complaints that GPs have overachieved on health when QoF 1st came in.
    Take back control of our lives, pay and freedom to practice. That is what it means to be a Professional. Even plumbers get to choose their brand of tools but we are not allowed to prescribe what we feel is best. That cannot be right. I though medical school is one of the hardest to get in and only the brightest get in?

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  • "Post truth Practitioner-Stop bragging about your NHS at the hustings and to your sniggering international mates, and accept that it should be in the history books and not the newspaper."

    Totally love the comment!!

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