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Networks will ‘struggle’ to find 30% of funding for extra clinical roles



Primary care networks in some regions of England will struggle to find the money they are expected to contribute towards hiring additional clinical staff under the new DES agreement, GPs and academics have warned.

Under the new network DES arrangements, NHS England funding will be unlocked to employ 22,000 additional practice staff – including pharmacists, physiotherapists, paramedics, physicians and social prescribing workers – by 2023/24.

NHS England has guaranteed to cover 70% of the costs for pharmacists, physiotherapists, paramedics and physicians and 100% for social prescribers.

But GPs and policy leaders have argued some networks – particularly those in deprived areas, where funding can already be insufficient – may be unable to provide the remaining 30% of costs for some of the roles.

Speaking at a King’s Fund event on PCNs this month, the think tank’s senior policy fellow, Beccy Baird, suggested the Carr-Hill Formula, used to reflect factors that influence patient needs and costs, may be to blame.

She said: ‘I think that for some areas in the country the finances are great but will still be challenging.

‘We know that there are already issues around the Carr-Hill formula, which is how a lot of the contracts work, as it doesn’t necessarily reflect deprivation in the way that it might. There’s a little bit of a worry that the money might not reflect the needs out there.

‘There are networks where actually [finding] 30% of the funding for the new roles will be a challenge, [especially those] that are stressed, have got particular issues going on and are in very deprived areas and already struggling with paying really high locum costs because they can’t attract GPs.’

Echoing her comments, a Londonwide LMCs spokesperson said: ‘Whilst the additional staffing support provided for within the network contract DES is welcome, we know that at a time of massive workload and workforce pressures some practices will struggle to find the necessary funds to cover additional salary costs as they juggle the demands of their existing practice teams and meet patient demand.’

Farzana Hussain, a GP in London who has also been appointed as a PCN clinical director, said the new roles – particularly those taking on advanced clinical tasks  – would require a ‘clear job description and training’ that would be costly.

She said: ‘In my network we want the pharmacist to play a key role in the new network-based quality improvement QOF indicator for high-risk medications. We want them to do medicines reconciliation from hospital letters and undertake long-term condition reviews with prescribing.

‘A clear job description and training for pharmacists is essential. This will need initial investment and extra money, which some practices will struggle with due to high GP locum costs, for example.’

A recent report by the Health Foundation found that networks were ‘rushed’ and implemented at a ‘very difficult time’ when GP practices have limited resources to spare.

Meanwhile, Pulse reported earlier this month that commissioners’ plans to hire PCN deputy clinical directors in the East Midlands – to work alongside clinical directors and support the development of networks – will exacerbate workload.