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BMA: GP practices opting out of DES ‘risk losing influence’ over future services

GP practices that don’t sign up for the network DES ‘risk losing influence’ over the development of GP services in the future, the BMA has warned.

BMA GP Committee chair Dr Richard Vautrey made the comments in a webinar on PCNs ‘for the undecided’, hosted by the NHS Confederation last night ahead of the deadline to sign up for the DES on 31 May.

Some GP leaders have advised practices to think twice before signing up to the DES and two entire PCNs in Buckinghamshire and Milton Keynes have already decided to opt out over workload concerns.

GPs were also told that CCGs will have the power to defer practice funding if PCN targets are not met in a Q&A document published following the webinar.

Meanwhile, NHS England will hold onto unspent PCN funding for additional roles to ‘avoid CCGs using it for other purposes’, according to the document – contrary to current rules, which allow commissioners to reallocate unused money.

Dr Vautrey said told GPs that practices choosing to opt out of the DES will ‘risk losing the influence on how things develop for the future.’

He said: ‘I don’t think there’s any prospect of any practice losing their contract as a result of the decision that they make. 

‘But it is possible that if they don’t take part, they will miss out not just on the new funding and on the help that will be offered from the new workload through additional staff, but crucially [and] perhaps most importantly risk losing the influence on how things develop for the future.

‘As an independent practitioner that is what I would want to retain going forwards.’

However, he added that the GPC ‘will continue to support all practices whatever decision they make’.

Dr Vautrey echoed comments made by other panellists, including GP and NHS Islington CCG chair Dr Josephine Sauvage.

Dr Sauvage warned that practices not in a PCN will find it ‘difficult’ to have a say on the care of their patients.

She said: ‘In terms of how this will affect the commissioning of primary care going forward, we will be looking as commissioners to very much commission services at primary care network level. 

‘Of course, if a practice isn’t involved in that space, then it will be difficult to involve that practice equitably in the voice of general practice for those patients.’

NHS England director for primary care strategy and NHS contracts Ed Waller told GPs that PCNs will give practices ‘a voice’.

And NHS Clinical Commissioners chief executive Julie Wood added that GPs ‘won’t have a voice’ outside PCNs ‘in the world of provision’.

Meanwhile, a Q&A document following the webinar said that ‘underperformance in delivering the DES is equivalent to underperformance in delivering the GMS’ and therefore CCGs could ‘defer funding’.

It said: ‘It is correct that the DES should be considered an “add on” to the GP contract. As such, legally underperformance in delivering the DES is equivalent to underperformance in delivering the GMS. 

‘The ultimate sanction for commissioners is to issue breach notices, however it is considered highly unlikely to ever reach this stage. A more likely measure to be used by commissioners for underperformance would be to defer funding.’

It added that ‘a significant proportion of future funding for primary care will be channelled through PCNs’. 

And funding under the additional roles reimbursement scheme (ARRS) not spent by networks will not remain with CCGs but will be held ‘centrally’, the document said.

It said: ‘On ARRS underspend, commissioners have been urged by NHSEI to encourage PCNs to use up their funding allocation within the financial year. 

‘This is a legal entitlement for PCNs and NHSEI will be retaining ARRS funding centrally to avoid CCGs using it for other purposes.’

Last week, Pulse revealed that PCNs in Kent are ‘in danger of folding’ due to large practices opting out of the network DES over concerns with the controversial care homes element of the contract.

Meanwhile, Berkshire, Buckinghamshire and Oxfordshire LMCs told practices last month that they ‘cannot advise signing up for the network DES’ in light of ‘significant concerns’ over its workload requirements.

And Pulse revealed this month that an 85,000-patient PCN in Buckinghamshire and a 40,000-patient network in Milton Keynes have already opted out of the DES – with other PCNs in the regions ‘planning to follow suit’ in the coming weeks.

Earlier this month, NHS England warned that practices that opt out of the network DES will not be able to negotiate ‘better’ local contracts.


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