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PCNs opting out of Network DES due to workload concerns



Exclusive Two PCNs – one covering 85,000 patients – have opted out of the Network DES for 2020/21 due to concerns around the workload involved in the services specifications, a group of LMCs has told Pulse.

The 85,000-patient PCN in Buckinghamshire and a 40,000-patient network in Milton Keynes have opted out after their LMCs –  Berkshire, Buckinghamshire and Oxfordshire LMCs – had said they ‘could not recommend practices remain signed up to the DES’.

The LMCs told Pulse that other PCNs in the region are ‘planning to follow suit’ in the coming weeks, ahead of the 31 May deadline for opting out of the DES.

Pulse has been contacted by a CCG chair in the north of England, who said they were ‘at a loss why anyone would take that level of risk by signing up to the DES at this point’.

But NHS England said that these concerns are ‘not an accurate reflection of the contract’, and the networks will be receiving £575,000 worth of additional funding on average this year.

At the same time, Kent LMC has also expressed concern around the tight deadline PCNs were given to opt out of the DES for next year in a letter to its members today.

This follows the Special LMCs Conference in early March, where a motion that said the ’profession should reject the PCN DES as currently written’ was carried by a majority of 83 to 53.

Pulse understands that the PCNs opted out last Friday.

Dr Matt Mayer, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, told Pulse: ‘We have been informed of at least two PCNs who have given formal notice that they are opting out of the PCN DES en masse, one of which covers 85,000 patients.

‘We have also been told of other PCNs planning to follow suit over the coming weeks, as well as some individual practices who are planning to individually opt out of the DES.

‘What we are hearing consistently from many constituents is that they remain concerned about the work and requirements which will be added to the DES in the future, and also concern over how it will affect their core contracts, particularly regarding plans for further system integration.’

The LMCs have released an update to their previous analysis of the DES, which had said there was a risk of financial loss for practices of £17,191 per average network in a year.

The new document – an updated summary of their previous analysis – says: ‘In February, we advised practices that following our analysis of the PCN DES, we had significant concerns that as well as having extremely onerous workload requirements, the DES poses a threat to the independent contractor model, the core GMS contract and the autonomy of practices, and therefore we could not recommend practices remain signed up to the DES. Our position and advice have not changed.’

It added: ‘Given recent events it is now even more necessary that there be an extended sign up window and moratorium on new service specifications and requirements so that practices can focus on core services, and the pandemic response.

‘We therefore find it alarming and astonishing that NHS England continues to implement the enhanced services of the DES as planned, during the greatest pandemic of the last 100 years.’

Separately, a CCG chair in the north of England – who asked not to be named – told Pulse: ‘While practices working together on a local level is potentially beneficial, I do not see any benefit to the top down, nationally mandated specs NHSE have forced on PCNs.

‘A special conference of LMCs voted to reject the DES, the motion that it “posed an existential threat to the independent contractor model” passed, the question of the implications of practices’ GMS/PMS contracts being irrevocably changed has still not been adequately answered by NHSE, and the future direction of travel has been clearly foreshadowed by the initial draft spec in December. I’m at a loss why anyone would take that level of risk by signing up to the DES at this point.’

But Dr Nikki Kanani, national medical director for primary care and a London, said: ’Networks provide a real opportunity for practices to work together, in the current independent contractor model, with additional funding of around £575,000 on average this year to support the sustainability of general practice and better patient care.

’The concerns set out are not an accurate reflection of the contract and we would strongly encourage practices to judge for themselves, discuss with their neighbouring colleagues, their LMCs and CCGs, and take advantage of the additional support that being part of a PCN can bring.”

A letter from Kent LMC, sent out today, also expressed concern around NHS Kent and Medway CCG giving practices until 7 May to opt out of the Network DES.

It said: ‘The LMC believes that practices should have a genuine choice over whether to sign up to the DES or not and we acknowledge that there may be a number who decide not to. This is likely to be a difficult decision and we have expressed concern to the CCG about their requirement that practices inform them of their intentions early to mid May.

‘The contractual requirement is that practices inform the CCG of their intentions by 31 May. This will allow precious time to consider all the consequences of whichever choice you make.’

A statement from NHS Buckinghamshire CCG said it has ’received notification from one of the 12 PCNs in Buckinghamshire that they do not intend to sign up to the PCN DES 2020/21.

’NHS Buckinghamshire CCG is working with all PCNs in the CCG on the sign up process which will continue until the sign up deadline of 31 May.’