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Networks were ‘rushed’ and introduced at ‘difficult time’, says think-tank

Primary care networks (PCNs) have been introduced at a ‘very difficult time’ for general practice, and as a result may not succeed, a think-tank has said. 

A new report by the Health Foundation found that the PCNs, which came into being this week, were created at a time when GP practices have limited resources to spare.

The report also warned that the rapid establishment of PCNs might ‘undermine the best intentions’ of the policy, while the networks could reduce the amount of time GPs spend with their patients. 

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.

All networks were required to submit registration information to their CCG by 15 May 2019, with PCNs covering 100% of the population by 1 July

The report said that tight deadlines have prompted practices to rush to form PCNs, not allowing them to consider what is the best to meet the needs of their populations.

The report states: ‘The most immediate challenge is the extremely tight timetable for setting up the networks. Practices across the country have had to understand the policy, form themselves in to networks, appoint clinical directors and agree ways of working sufficient to sign their network agreements, all in very little time.

‘In their design of the network policy, NHS England and the BMA have attempted to strike a balance between top-down guidance and allowing room for practices to determine what organisational forms are best suited to them.

‘While the freedom to determine what works best locally makes sense, these decisions will have been challenging to make in the limited time available, not least because they have important implications for individual practices. Mandating that networks form at such speed risks pushing them to make decisions based on what is most possible, or easy to do, rather than allowing time to consider how to best structure themselves to meet the needs of their populations.’

The report continued: ‘The speed of implementation means that NHS England has not yet made any comprehensive organisational development support available to networks, and there is no leadership development offer for clinical directors (who may have been selected from a relatively small pool of available and willing GPs within a network). These resources are in development, but are large omissions that need to be rectified quickly.’

Pulse reported earlier this year that under the network DES contract practices will receive 45p less than they currently get per patient. The funding for the DES will remain the same, but it will cover 100% of patients, as opposed to the 75.7% currently covered by the extended hours DES.

The Health Foundation expressed concerns that funding might not reach all practices equally as the networks will be in charge of the distribution of funds across their member practices. 

According to the report, possible funding-related risks include:

  • The removal of other sources of income for practices. To cover the cost of providing core PCN funding (which must come from CCG core allocation) CCGs may remove other payments available to practices (for example, some locally incentivised schemes).
  • If income available to individual practices from enhanced services is reduced in order for CCGs to afford to pay networks, it is possible that funding to individual practices may fall.
  • Payment for the clinical director role is being made on a whole-of-England average – but GP salaries vary by locality. PCNs in areas with high salary costs may find themselves out of pocket in reimbursing clinical director time
  • NHS England has promised to meet 70% of the costs of employing most additional staff, but networks will be expected to meet the remaining 30%. This may be more feasible for some networks than others. Financial liability for the new roles, for example in the case of redundancy, will also sit with the practices in the network.

NHS England said this week the networks will have to succeed in convincing a new generation of GPs to go into partnerships or face becoming ‘salaried to other NHS providers’.

But the RCGP warned that there is no ‘one-size-fits-all’ solution to address the issues general practice currently faces, pointing out that some practices will need more resources than others to grow further.