Exclusive PCNs will need to provide GP appointments covering the ‘full’ periods of 9-5 on Saturdays and 6.30pm-8pm on weekdays, NHS England has confirmed to the BMA.
Under this year’s updates to the network DES, GPs in England’s PCNs will be ‘required to provide Enhanced Access between the hours of 6.30pm and 8pm Mondays to Fridays and between 9am and 5pm on Saturdays’ from 1 October 2022.
But a BMA spokesperson has confirmed its understanding that practices will be expected to offer the service to cover the ‘full’ additional hours.
The spokesperson said: ‘NHS England and Improvement have confirmed their expectation that all PCNs will be required to provide appointments for the full Network Standard Hours, covering the hours 6.30pm-8pm on Mondays to Fridays, and 9am-5pm on Saturdays.’
They stressed that this is not the BMA’s position and that the BMA has been seeking amendments to the imposed GP contract, including a relaxation around Saturday opening times under the network DES.
An NHS England spokesperson told Pulse on background that they do not believe any formal clarification has been provided to the BMA but that they do not believe this to be an issue of contention.
They stressed that the DES contract was clear, that this position was confirmed when it was published and that NHS England’s position has not changed.
The DES also set out that the service does not have to be provided by a single practice, but can be shared out among PCN member practices.
It said: ‘A PCN must ensure that all practices in the PCN’s membership actively engage in planning of the provision of the extended hours access requirements and acknowledges that nothing in this Network Contract DES Specification requires an individual clinician or practice within the PCN to deliver a particular share of the appointments.
‘The exact number of extended hours access appointments delivered from each member practice premises will be for the PCN to determine subject to complying with the minimum additional minutes.’
Appointments must be provided ‘in continuous periods of at least 30 minutes’, it added.
Meanwhile, the DES also said that if any PCN member practice is already providing appointments during the enhanced access time period, additional appointments must still be provided regardless.
It said: ‘If another core network practice in the PCN provided core services at its premises until 8pm, then:
- ‘any additional clinical appointments provided after 6:30pm but before 8pm must not be provided at the later closing practice’s premises (as these would not be additional hours appointments) but could be provided at the other practice’s premises; and
- ‘a proportion of the additional clinical appointments must be provided after 8pm’
The BMA reiterated to Pulse that its GP Committee for England did not agree to the changes in the GP contract this year, meaning the DES specification updates have also been ‘effectively been imposed on the profession’.
GPC deputy chair Dr Kieran Sharrock said: ‘GPC England supports the principle of independent practices collaborating together, and with other providers, in their localities, but the DES is too restrictive and places too many burdens on practices.
‘We are aware that some practices are gravely concerned about the inflexibility of the programme, given ongoing staffing shortages, and the bureaucratic requirements associated with it.’
He reiterated that practices can opt-out of the DES ‘if they do not believe they can guarantee capacity within the staffing compliment they have’.
Dr Sharrock added: ‘The BMA remains open to discussion with NHS England and NHS Improvement about ways to improve the flexibility of the PCN DES, and ensure the programme works for every practice and its patients and realises our shared ambition of at-scale working for the benefit of all.’
It comes as the BMA said this week that NHS England has rejected its requests for certain relaxations of the DES, including around Saturday opening times and GP availability for the new extended hours service.
It has repeatedly encouraged practices to consider their ongoing participation in PCNs.
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.
What are the network DES enhanced access requirements?
The DES set out the requirements for PCNs to provide enhanced service access from 6:30pm to 8pm on weekdays and 9am to 5pm on Saturdays.
Under the requirements, networks will have to provide 60 minutes’ worth of appointments per 1,000 population within the network, delivered within the hours stipulated.
The appointments will be available ‘for any general practice services and services pursuant to the Network Contract DES that are provided to patients’, the DES says. It also says that they should be bookable a minimum of two weeks in advance, and that same-day appointments should be made available.
The service will go live in October, when it will be funded £7.46 per patient pro rata. Until then, networks will receive 72p per patient for the preparatory arrangements.
PCNs must submit plans to commissioners by 31 July, which will set out the mix of services to be provided, how networks will offer appropriate levels of face-to-face appointments and what locations are to be used.
This article was updated at 12.30 on 27 April 2022 to clarify the BMA’s position.