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Commissioners attempt to impose larger network after blocking GP proposals

London commissioners are trying to impose their preferred size of primary care network on practices after blocking initial proposals.

The South West London Alliance of CCGs said plans suggested by two proposed networks in Teddington and Hampton were ‘not permissable’ because they go against NHS England guidance that requires PCNs to serve at least 30,000 patients.

Instead, commissioners want to see practices create just one larger network, serving 62,000 patients.

But Dr Heather Bryan – who has been appointed to lead one of the networks as clinical director – said a larger network will ‘ultimately be worse for patients’.

Practices in south west London’s Teddington and Hampton initially submitted applications to form two PCNs serving around 30,000 people each, which would involve splitting the patient list of the two-branch Green and Fir Road Surgery in Richmond.

They also presented a second option that would keep the two-branch surgery intact – but would create one PCN serving just under 30,000 patients.

However, South West London Health and Care Partnership, a body including Richmond CCG and other local commissioners, has rejected both options, arguing they do not align with national guidance.

When the five-year GP contract was released in January, it was widely understood that a network would serve between 30,000 and 50,000 people.

Further NHS England guidance released last month revealed PCNs must serve ‘a minimum population of 30,000’. It added that ‘commissioners may “waive” the 30,000-minimum population requirement where a PCN serves a natural community which has a low population density across a large rural and remote area’.

The guidance also states ‘a GP practice that holds a single primary medical services (PMS) contract will only be able to hold one Network Contract DES as a variation to the core contract, regardless of whether or not the single practice has multiple sites spanning large areas and/or CCG boundaries’.

In a letter sent to Richmond CCG’s primary care commissioning committee by South West London Alliance of CCGs, the alliance’s director of commissioning operations, Jonathan Bates, said the proposals put forward by the proposed Teddington and Hampton networks were ‘not permissable,’ based on the guidance.

Mr Bates wrote: ‘The panel did not feel that there was sufficient exceptionality to agree below the 30,000 thresholds as set out by NHSE. We note NHSE nationally may look to soften the absolute 30,000 threshold marginally, to allow a margin of approximately 1% (or 29,700). The prospective Teddington PCN would fall materially short of this at 27,088.’

In response, two of the alliance’s CCGs – Kingston and Richmond – presented two alternative PCN structures, including ‘a large consolidated PCN footprint covering Teddington and Hampton with a 62,000-population’.

Mr Bates said: ‘The panel are of the opinion that the option presented to them of having one larger PCN of 62,000 registered patients would best serve the patients and would potentially achieve the desired outcome of the practices through the creation of two neighbourhood teams.’

But one of the network’s clinical directors, Dr Heather Bryan, has warned against the bigger network.

She said: ‘The prospect of forming a large 62K+ PCN is, of course, precisely the situation we feared we would be forced into and were working hard to avoid. This would make Teddington & Hampton disproportionately large with respect to the other Richmond PCNs, all of which were arranged in collaboration with each other to keep a consistent size and feel for practices and our patient populations.’

She added: ‘Denying the options for smaller Teddington and Hampton networks will ultimately be worse for patients, who will be less likely to benefit from geographically sensible, locally arranged services as they evolve.

‘Asking a single network to subdivide itself into “neighbourhoods” is not impossible to imagine, but not what we were originally tasked with, and presents a frustrating, additional barrier to rational arrangements as a new PCN, entailing considerable further expense and time resource.’

A Richmond CCG spokesperson said: ‘We are in discussions with the applicants for the Teddington and Hampton primary care networks to ensure we meet the requirements of the NHS England guidance. We are working to find a local resolution.

‘In south west London applications for primary care networks are being considered by a joint panel made up of lay members, primary care representatives and the local medical committee.’

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

It has also emerged 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.

Meanwhile, some practices have ‘hurriedly’ designed their networks in light of the looming deadline.