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Networks to receive 45p per patient less through DES for providing extended hours

Exclusive The new network DES will pay £1.45 per patient for fulfilling the requirements of the extended hours DES – 45p less than practices currently get per patient, Pulse has learnt.

As part of the new contract, the extended hours DES will be scrapped and networks will be required to offer the same service as the current extended hours DES.

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 BMA and NHS England point out that £30m has been added to the global sum  – which was increased by 92p per patient – to make up for this extra work needed to receive the total funding, and to help cover the requirement for NHS 111 to directly book appointments.

Speaking at events around the country on the new five-year GP contract, BMA GP Committee representatives revealed the payment per patient given to networks will be £1.45 per patient, as opposed to the £1.90 currently received by practices.

They added that it might lead to ‘difficult conversations’ between practices who offer extended hours and those that don’t.

Pulse revealed last month that from July, the extended hours access DES will be transferred from practices to the new primary care networks, under the new GP contract.

This means there is no guarantee GP practices will continue to receive funding for the provision of the extended hours access DES, although NHS England and the BMA said they expect the networks to pass it on to the practices that provide the service.

Under the new contract, an average network with a population of 50,000 will be required to provide 25 hours extended access per week, which will be shared between morning, evening and weekends.

Networks will also be required to cover 100% of patients – including those of practices that are not part of a network – to receive the funding.

BMA GP Committee chair Dr Richard Vautrey told Pulse the new DES is not a reduction in funding as the difference is covered by the £30m added to the global sum, which also recognises the implementation of 111 direct booking.

He said: ‘It is fundamentally untrue to say that funding has been reduced. In fact, it has increased. Practices will receive an additional £30m for the extra patients to be covered.

‘When the transfer takes place to the networks, there’s £30m that’s been added to the global sum as a result of changes relating to the extending access DES and the NHS 111 appointments that practices will be providing. That’s the difference.’

He added: ‘The DES currently funds the equivalence of 76% of the population so the expectation is the DES, going forward, will cover 100% of the population. To enable us to do that, £30m has been added to the amount. So the £87m that is currently spent on the DES is transferred to the primary care networks to deliver the extended access and the £30m has been added to cover the extra 25% patients that need to be covered.’

Speaking at the Londonwide LMCs’ annual conference on Wednesday, GPC executive team member Dr Krishna Kasaraneni told delegates practices that will be part of a network without providing extended hours might be asked by the practices delivering the service to financially chip in to help them cover all the patients in their area.

‘The difficult conversation will be, I am not going to pretend it will be easy, where if in your networks two practices provide it and two practices don’t then what do you do? You have to get 100% coverage so that’s the conversation you need to have,’ he said.

‘[It’s has to be] as local as possible so if the other two practices can provide it, using the expanded workforce, great. If not, it may be that you have to come to an agreement saying “okay, I’ll provide for your patients but that payment comes through to you”.’

Dr Kasaraneni also said the 45p difference should not be seen as a reduction in funding.

He said: ‘The payment will look like a difference because at the moment you get £1.90 per head for extended hours. A quarter of that has moved into the global sum so now the payment looks like it’s £1.45 but you have to look at the global sum and then it adds up.

‘So the payment will remain the same. What we would expect the primary care networks to do is pass on that £1.45 [per patient] to you directly to continue to do what you’re doing now so this is not dismantling where practices are doing extended hours already at all. Where the practices are doing it, it just flows straight through.’

As reported by Pulse yesterday, some CCGs have been trying to ‘manipulate’ new primary care networks to ensure they align with their own plans.

Meanwhile, the BMA said last month that networks might not be able to recruit additional staff if inflation rises significantly as that pot of funding would be used to cover practices’ increased core costs.