BMA advises GP practices to consider leaving PCNs after NHSE rejects DES changes

The BMA has encouraged practices to consider their participation in the Network DES after NHS England rejected proposed amendments to the contract.

In an email sent to GPs last night, the BMA said it had ‘approached NHS England to seek further clarification and propose practical solutions’ to ‘alleviate’ GP concerns and ‘any potentially negative impact’ from the ‘unagreed’ changes to the DES imposed by NHS England.

The BMA’s proposals had included:

• a ‘relaxation’ of the new extended hours requirements, including regarding GP availability and Saturday opening times;

• allowing PCNs to opt out of parts of the DES they feel they cannot deliver ‘safely’; and

• increased flexibility around ARRS recruitment and funding.

However, the BMA said: ‘Despite countless members of the profession telling us flexibility is what they desperately need in order to manage patient care in the safest way possible, NHS England have told us they are unable to accept any of our entirely reasonable requests.’

It added that while the BMA’s GP Committee in England ‘continues to support the principle of the DES’, some practices may decide that the ‘imposed additional requirements’ increase workload ‘beyond safe working limits’.

It said: ‘We fear that the newly added demands within the PCN DES are a risk to patient and practice staff safety in terms of potentially unmanageable/unsafe workload and burnout. 

‘With this in mind, practices will need to carefully consider the DES changes for 2022/23 and how this may impact them going forward. In particular, the incoming Enhanced Access requirements from October 2022 and the expanded service offer.’

It added: ‘Opting out would free practices from the requirement to deliver the PCN DES. 

‘They could then choose to focus on the delivery of core general practice to their registered patients if that is what they believe to be the safest and best way to organise the services they provide to their local patient community.’

However, opting out ‘would of course mean not receiving the funding that comes with participation in the DES’ as well as losing access to some additional roles staff and any resulting employment liabilities, the BMA added.

Practices could also ‘face competition’ for recruitment of ‘wider primary care team roles from the remaining PCN’ and opting out ‘could pose very serious problems to systems given current transitional arrangements’ between CCGs and new ICSs, it said.

Alternatively, practices can reduce the DES workload without opting out by subcontracting some services such as extended hours, the BMA advised.

Practices have until 30 April to opt out of the DES without breaching their contract as part of the current annual opt-out window, but may have additional 30-day windows to do so if any in-year changes are made to the enhanced service specification.

A Pulse survey last week revealed that as many as a quarter (25%) of GP partners are still unsure as to whether they will sign up to the 2022/23 Network DES.

The long-awaited specification for the new Network DES was published in full earlier this month (1 April), clarifying the new funding available for participating practices, and offering further details on additional services they will be expected to deliver.

Notably, under the updated contract, GPs in England’s PCNs will be required to open between 9am and 5pm on Saturdays.

However, the BMA GP Committee has since advised that a GP does not have to be ‘physically’ present so long as they are ‘available’. NHS England has not clarified whether they agree with this interpretation.

Recent analysis by one LMC found that the updated PCN DES offers an overall net funding increase of £2 per patient, but said that this does not recognise the ‘significant’ increased workload to practices.

Previous BMA guidance on ‘safe working’ last month also encouraged GPs to ‘consider’ opting out of the PCN DES between 1 April and 30 April 2022.