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CCGs ‘refusing to sign off’ networks where unpopular practices have been left out

EXCLUSIVE CCGs have held up approving networks where unpopular practices have been left out of primary care networks, Pulse has learned. 

Pulse found that some CCGs have refused to sign off networks where practices who submitted applications did not welcome an unwanted practice – described previously by the RCGP chair as ‘pariah’ practices.

As part of the new five-year GP contract, practices will be provided with extra funding to join networks, which will see groups of practices serve between 30,000 and 50,000 patients.

While practices are not mandated to join a network, all patients must be covered – meaning patients of practices that do not join must be covered by a local network.

A GP leader, who wished to remain anonymous, told Pulse they have seen CCGs refusing to sign off networks in several areas across the country, with their own practice also being forced to have an unwanted practice in their already settled network. 

They said: ‘In my area, all the practices but one managed to buddy up into PCNs. The reason is that historically, no one has trusted this practice and the GP is not particularly likeable. Quite predictably, nobody wants them to join. It’s a trust issue, not so much that we all get on and we don’t want someone to destabilise after 30-40 years of working together, and practices have established a reputation with each other.

‘What the CCG are threatening us with is until we take in the practice none of the PCNs in the area is going to be signed off. So they’re putting pressure on our PCN by telling the other PCNs “we won’t sign off your PCN until this other PCN takes this practice”.

Consultant Scott McKenzie, who advises GPs on mergers, forming federations and networks, told Pulse he has received questions from practices who are being forced by their CCG to include practices they do not get along with in their agreed networks.

He said: There’s one practice that wants to be part of a network and that hasn’t been invited by any of the existing networks to become part of. The CCG has basically let everybody know that until such things [are resolved] they won’t be signing off any of the networks.

‘The CCG has required to have a 100% coverage so the likely outcome is that they will select a network that has the most sensible geography, or maybe a smaller network, that the practice could be allocated to.

‘The practices have got a history of working together and this practice, potentially, hasn’t particularly engaged or been part of these working relationships.’

According to official documents, CCGs and LMCs have until the end of June to work together and resolve any outstanding issues to guaranty full population coverage in their area.

An NHS England spokesperson said: ‘We have seen a huge amount of co-operation between CCGs, LMCs and general practices, with many people stepping up to make sure PCNs happen, and we are on track to achieve full national coverage by 1 July.

‘It is important that all those involved are confident that any local arrangements work for the practices and, most importantly, can deliver improved services for patients.’

Other areas have also been faced with difficulties in having their networks approved. GP Survival chair Dr Nicholas Grundy said his STP refused to sign off his network over difficulties in splitting a practice over two networks.

He said: ‘At the moment, Richmond hasn’t been signed off because there’s this question mark over two of the networks.

‘There’s a single set of partners with one GMS contract under two sites in different places in which there are two networks. What the CCG has said is because it’s bureaucratically difficult to split that single GMS contract into two they therefore don’t want to do that.’

The news comes after RCGP chair Helen Stokes-Lampard previously said that pariah practices would still have to be part of primary care networks, as their patients ‘deserve care’.

Pulse previously reported that CCGs in some areas of England had been trying to ‘manipulate’ the formation of networks to align with their plans, according to GP leaders. 

It also emerged that some practices have ‘hurriedly’ designed their networks in light of the looming deadline