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PCNs ‘in danger of folding’ over concerns about care home services

Exclusive Primary care networks (PCNs) in Kent are ‘in danger of folding’ due to large practices opting out of the network DES, Pulse has learned.

‘Significant’ practices have decided not to sign up to the DES due to concerns about the care homes element of the contract, local GP leaders told Pulse.

It comes as GP leaders have advised practices to think twice before signing up to the DES and two entire PCNs in Buckinghamshire and Milton Keynes have already decided to opt out over workload concerns.

Kent LMC medical secretary Dr John Allingham told Pulse that two practices ‘in the order of 10,000 patients’ have decided to opt out of the DES after initially signing up last year, while another will continue to opt out.

Now the redistribution of PCN workload among the remaining practices could threaten the networks with collapse, he added.

Dr Allingham said: ‘We’ve got some PCNs that are in danger of folding because practices are not signing up, principally because of the care homes DES.

‘Some significant practices that are not signing up to the DES are going to become orphan practices whose patients will have to be provided with network services by other PCNs.’

He added that the LMC has had ‘quite a few difficult discussions’ with practices who are worried about signing up, particularly due to the care homes service.

Workload problems in Kent have been well-documented, with another practice forced to close in the crisis town of Folkestone in February after it was unable to cope with the extra demand from the ‘forced allocation’ of patients. 

Meanwhile, the requirements around care homes are also ‘threatening the stability of PCNs’ because they are ‘not evenly distributed’ between practices within some networks, Dr Allingham added.

He said: ‘There’s one [network] in particular where there’s a very large care home that falls in the area of two practices and the other practices in the PCN have got hardly any or no care homes.

‘We’ve got 600 care homes in Kent so we are a big problem.’

Earlier this month, NHS England warned that practices that opt out of the network DES will not be able to negotiate ‘better’ local contracts.

However, Kent has various ongoing care homes service contracts and some are ‘more generous’ than the DES, Dr Allingham told Pulse.

He said: ‘In actual fact, there are some deals that are a lot better than the £120 per bed [in the DES].

‘One of our CCGs has a scheme where they tiered their care homes according to the acuity of their patients and the higher acuity patients are paid around £190 per bed.’

While the DES’s fee per bed is ‘not very good money’, particularly for care homes that deal with end of life care and have a high turnover, he said.

Dr Allingham said: ‘One bed might have twenty patients in it during a year. Well £6 per patient – each patient who’s end of life and requires an awful lot of work – that isn’t very good money.

He added: ‘The only way they won’t get a better contract locally is if they require CCGs to serve notice on all existing care home contracts. 

‘But if they serve notice on all existing care home contracts and then the practice decides not to accept the new DES, they’ve got network services they’ve going to have to commission from other providers.’

NHS England caused controversy when it announced that GPs should start conducting ‘virtual’ weekly care home rounds this month – but separate to the DES until it begins formally in October.

However, NHS England warned that practices may face regulation if they fail to set up the service – including nominating a clinical lead – by the 15 May deadline.

Last month, Berkshire, Buckinghamshire and Oxfordshire LMCs told practices that they ‘cannot advise signing up for the network DES’ in light of ‘significant concerns’ over its workload requirements.

And Pulse revealed this month that an 85,000-patient PCN in Buckinghamshire and a 40,000-patient network in Milton Keynes have already opted out of the DES – with other PCNs in the regions ‘planning to follow suit’ in the coming weeks.