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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)

  • Vinci Ho

    Malevolence? Incompetence?
    Perhaps if Dr Madan was still in charge , the former was more likely? 🤨😈😂
    Otherwise ,
    ‘’Never attribute to malevolence what is merely due to incompetence’’🤓
    Arthur C. Clarke, 3001: The Final Odyssey (Space Odyssey, #4)

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  • Looks like the stuff about providing capacity for general practice was an afterthought. There are also no figures in document indicating how many hours work the DES spec is anticipated to require vs the hours available. Even without having to to DES work the impact of this work force across a network of 50+K patients is not going to be of significance. If this was a business plan Lord Sugar or the investors on Dragons Den would laugh it out of the studio. I’m no goin’ te invest ahm oot. You’re fired NHSE

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  • Had enough of the state yet?

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  • CH,
    Yes, enough of the Tory run "public services are irrelevant"state!

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  • |DrDeath | GP Partner/Principal|15 Jan 2020 4:22pm

    1. if you think it will be any better under the socialists, you're mistaken. They are for even BIGGER state lol

    2. So you want more public services, and more funding... And you would be happy to pay 10%, 20% more tax? For it to be spent irresponsibly? And if you are, what's stopping you from handing more money to the Treasury now? It's always easier to spend someone else's money isn't it...

    3. The SNP run healthcare in Scotland, and despite receiving more funding per head due to the Barnett formula for healthcare, that and other public services are failing too.... I wonder why...

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  • I did indeed vote socialist.
    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??

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  • home visit is £300 an hour plus petrol and its £80 per 15 min appt, tests and scripts are extra, more for an experienced specialist GP - no wonder you have had no pay rise since 2004!!

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  • oh and any detailed report is £600

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  • we receive

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  • internet not working again

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