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Practices ‘who do not get along’ being forced into CCGs’ preferred networks


Exclusive CCGs are trying to force practices to form primary care networks without consideration for working relationships or GP opinions, according to a consultant for GP networks.

Consultant Scott McKenzie, who advises GPs on mergers, forming federations and now networks, told Pulse he has been inundated with questions from practices who are being pressured to form networks in a specific way by CCGs.

He said CCGs are turning up to initial discussions with LMCs with a list of exactly how the networks will form, and telling practices they must form large networks of 60,000, despite the groups of practices not getting along.

When announcing the new five-year GP contract, NHS England and the BMA said formation of the new primary care networks – which will roughly cover between 30,000 and 50,000 patients – should be GP-led, with only CCGs becoming involved to make adjustments to membership and boundaries where necessary, for example where a practice falls between two networks.

But Mr McKenzie said he has numerous examples where CCGs are overstepping that line.

He said: ‘I have had a lot of questions from practices – GPs who are either interested in forming a network and then either being told “oh you can’t form a network that way” or “the geography does not make sense”.

‘One example that sticks out is, I have one network of 33,000 patients over five practices that wants to form a network. But the CCG has said “you can’t, because we have 27,000 patients in a practice near you, and they don’t meet the minimum number of 30,000, so you are all going to have to merge into one network.

‘That has caused real consternation because the working links are not there, the history of collaboration is not there. To be honest they do not get along, so it almost feels like the CCG are creating something that is destined to fail.’

This is despite NHS England’s acting director of primary care Dr Nikkita Kanani telling GPs last week that said networks could be a ‘bit smaller or a big bigger’, depending on relationships, which should prevail over geography.

Mr McKenzie said practices are also concerned about power dynamics within networks, especially when practices without a history of working together are forced to join.

‘The five that have got together – the 33,000 – they have a really long history of working together. One of the things they are worried about is, if they are forced to join with the one practice of 27,000, that they could completely dominated them,’ he explained.

‘This is a repeated pattern I’m seeing. I had a huge area in the home counties, where I spoke with GP federations and local LMCs about networks. They told me they had been at a meeting that afternoon, where the CCG told them “we have sorted out the networks for you, this is how it is going to work”.

‘They were completely thrown by this, because it was completely contrary to all the messages they have been given about these networks being formed by GPs, from the ground up. I have seen this to varying degrees scattered up and down the country,’ Mr McKenzie said.

Other issues being raised include the offering of extended hours DES, which some practices currently offer but others do not.

He told Pulse: ‘I have had a few interesting conversations around that, where you have a network of seven and five of the practices offer extended hours, and two do not. And the two that do not, have the mind set of “I don’t, I haven’t, I’m not going to”. So it then becomes the other five practices’ problem to cover the other two practices’ patients.’

New contract documents released last week have provided slightly more detail on networks, including that they would normally not cross CCG boundaries and that they will include pharmacies and dentists.

According to the documents, any changes to the membership of the networks, for example practices leaving or joining, must also be approved by the CCG.

Commenting on this, Mr McKenzie said: ‘I can foresee issues with this.

‘I can imagine that the way that CCGs and before them primary care trusts have acted, is that once it is set, it is set for life. There has never tended to be any flexibility.’

Pulse reported last month 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. 

It was also reported that pariah practices would still have to be part of primary care networks, as their patients ‘deserve care’, according to RCGP chair Helen Stokes-Lampard.