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GPs buried under trusts' workload dump

How primary care networks can strengthen GP practices

Dr Krishna Kasaraneni 

19 dr krishna kasaraneni

 

Around 88% of practices in England already work in some kind of network – like neighbourhoods, localities, federations or super-partnerships. So, why then, did we feel that investment to support working in primary care networks would support general practice, when the concept itself is not new?

Firstly, most practice collaboration happens with shoestring budgets and a miniscule level of non-recurrent funding, which means that these structures so far have only functioned due to the goodwill of general practice staff. That is simply not sustainable. To support general practice to work together, we needed a structure that is flexible enough for GP practices of all sizes to work together, but more importantly, it needs to be a sustainable packet of support.

Secondly, the way the PCNs have been incorporated into the core general practice contract will give the ownership of ‘working together’ back to GP practices. Whilst some cynics are unsure about the potential benefit of PCNs, it is important to state that PCNs are being built from the ground up. They are created via the GP contract and therefore will not go out to tender – they will not be offered to any other organisations except NHS GP practices. As a directed enhanced service, we do not need to worry about procurement and commissioning – creating a PCN is a right that has to be offered to NHS GP practices. If they choose not to take up this offer, then it will not be offered to other (private) organisations. Therefore, PCNs will be within the control of the GPs and practices that operate them.

We do not need to worry about procurement and commissioning – creating a PCN is a right that has to be offered to NHS GP practices

Practices will also have opportunities to collaborate with other local primary and community services as part of PCNs, and build relationships with voluntary, secondary and tertiary services. This gives GPs the opportunity to lead a renewed primary healthcare team. It is for the PCN themselves that decide who, when and how this collaboration happens with the interests of patients and their organisational and workforce resilience. The framework in which the PCNs operate should go some way to help alleviate workload pressures on practices, and allow GPs to concentrate on caring for our patients at a local community level. This can only happen with the support and backing of a robust national contract.

At the inaugural clinical directors conference on 5th June, Richard, Mark, Farah and I will be discussing the above with colleagues from all over the country. The conference, which we will host on an annual basis, will support CDs in understanding the challenges of leading the PCNs and supporting general practice at a local level. With support from LMC colleagues, GPDF and NHS England, the BMA will continue to be the voice of PCNs and support GPs and general practice going forward.

Dr Krishna Kasaraneni is GPC negotiator at the BMA and a GP in Sheffield 

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Readers' comments (17)

  • And who, exactly, will be doing the day job while we take on all this additional work, stress and responsibility?

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  • Robust National Contract anything but I am afraid.Epic fail BMA.

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  • David Banner

    Look, we were effectively forced into networks (all the new money is attached to them), how many of us would have joined voluntarily?

    Our negotiators failed yet again to have money put straight into practices, so now we have to squeeze another hoop-jumping meaningless meeting into what used to be called our “lunch break” just to break even.

    These layers upon layers of expensive and useless bureaucracy eat into precious clinical time, and keep GPs away from their patients.

    Please don’t try to dress networks up as a brave new world, we’ve seen too many of these ruinously redundant reboots crash and burn over the last 20 years and we’re thoroughly sick of them. All of them. Just leave us alone....please.

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  • A simple question arises, why do we now need to have these 'support' networks? If practices were adequately funded and staffed then there would be no time/ money/ resources (Or echo chambers) - wasted on running a network.... the effort would be focused instead at direct patient care and efforts focused within the practice.....dear Dr Krishna, is this an acknowledgment / acceptance that the funding is indeed adequate and this fight is already lost so to speak, and now the aim is simply to try and prevent the total collapse of the system with prop up plan B? I would appreciate others thoughts as to why we have found the system going down this route.......

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  • What the system needs is a proper cash injection, or the ability for patients to co-pay,.... its not rocket science.... look how much tax Boots and Amazon dodges... if we could just sort out the tax laws to deal with the new online retailers, and divert part of the funds from this to fund primary care we might have a fighting chance.... but our leaders just keep negotiating with the government which is a complete waste of time... stick to the facts and negotiate with the public directly, educating them in the areas where current government is failing.... the government fears loosing votes more than taking to a bunch of cardigans.... use the walls of every surgery for a political campaign to educate our service users.... advise them that if as voters they dont apply pressure then services will be withdrawn, we should be fighting with the public not against them..... but oh, that might loose our leaders their gongs, and their big pensions in their big management roles, they wouldn't want to rock the boat with Matty, Jeremy (He might be PM next after all) or NHS England.. heavens forbid..... Our leaders need to be a thorn in the side of government at present, not tow the party line..... the more unreasonable you are the more reasonable a settlement you get.... can we please push out the pacifists and get in a leadership in thats ready for a fight? Our profession is on its knees in many areas and we are lead by the Neville Chamberlains of our time.... this constant tinkering at the peripheries of the problem is ultimately not going to help..... just preventing a complete implosion of the service by having a 'support network' is not a successful outcome.... if this comes from the same school of management that brought us colouring pencils then the most useful thing we can do, is shove the pencils up our noses, wear underpants on our head and say 'wibble' in the hope we'll be declared insane and get carted off to a nice rehab centre somewhere and not have to pick up the tab for the financial fallout of yet another failing practice. At this moment in time you would have to be bonkers to consider a career in General practice .....so perhaps the RCGP was being humorous in Black Adder fashion by sending out the colouring pencils in which case I apologise for thinking they were seriously trying to help.

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  • This will not prop us up the network BS will futher destabilise primary care.Experience in the private sector shows that working at scale and reducing the workforce that way only makes savings once.To make this work you have to increase profit or the amalgamtion fails.Increase demand should increase supply by increasing funding going to the supply side.In a semi communist system that doesnt happen so we are doomed to system failure.Co payaments the only way.Shame on you BMA.

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  • Cobblers

    Dr K has gone to the dark side. 6 years ago he gave Pulse a 'Day in the Life" see

    https://is.gd/yY59bN

    but now at the Crown Street Surgery, Swinton he is not listed as staff.

    LMC, BMA and unlikely much clinical, he has most likely dipped out leaving the rest of you suckers to try and make it work.

    I tend to agree with David Banner 12:56, only I go back 40 years of almost constant reboots. None have worked. PCNs are another, doomed to fail.

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  • After 35 years, I have learnt such concepts are rewording of the same nonsense they are attended to replace with the same local GPs who get off on this sort of thing. It will fail as all things have.

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  • Trump has let the cat out of the bag. NHSE busy priming the Trusts and Bundling up the practices into 50k patient lumps to flog off to American HOs (health organisations, not the other ho’s). Problem is, impossible to make profits for the shareholders from poorly funded primary care under current farcical global sum pittance.

    Simon Stevens probably been sitting on the blueprints since he returned from the States.

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  • The ink is not yet dry, but already Dr K and the other leaders are off on a conference. Meetings always a lot easier than coalface.

    A wise hospital clinical director once told me, ‘always better to be the kicker than the kickee.’

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