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LMC issues urgent call to GPs on ‘viability’ of practices following network proposals



LMCs are reporting that GPs are considering whether to continue with primary care networks, with many raising concerns that the new requirements will affect the viability of practices.

One LMC has sent out an ‘urgent’ survey to practices yesterday asking whether GPs feel the ‘stability’ of their practices will be affected, after NHS England last month published its proposed specifications for primary care network (PCN) services – including the requirement for fortnightly care home visits by GPs.

Another said that there should be ‘outright rejection’ of the DES specifications. 

And an LMC leader has said that practices have been providing feedback that they want to withdraw from the DES.

A Twitter chat yesterday revealed the extent of GPs’ concerns at the specifications, with many saying they are currently considering whether to continue the DES.

NHS England has said that it is listening to GPs’ concerns ahead of the 15 January deadline for feedback on its proposals.

The new proposals, drafted by NHS England and NHS Improvement, state GPs will have to carry out care home visits ‘at least’ every fortnight and implement structured medication reviews as part of the five national services PCNs will have to phase in from April.

Londonwide LMCs are asking practices in a survey whether they believe that these specifications will ‘increase or decrease the stability of your practice’.

In an email sent to all London practices, seen by Pulse, Londonwide LMCs said: ‘It is unusual for NHS England and NHS Improvement to take this approach to GP contracts and we do want to have your backs. To help us support you, we urgently need to know what impact you feel these DES specifications will have on your practice’s viability over the coming year, so please complete the survey as frankly as possible.’

A position statement from Derbyshire LMC last night said: ‘There should be outright rejection of these specifications until there has been robust negotiation to achieve something that is fit for purpose, deliverable and comes with significant additional investment. Such has been the widespread condemnation of the specifications so far that NHS England must take notice as the future of their long-term plan and primary care networks could be at risk.’

Meanwhile, Dr Kieran Sharrock, medical secretary of Lincolnshire LMCs told Pulse: ‘Our committee are discussing formally on Thursday night, but informal feedback is that coalface GPs want to withdraw from the DES and not provide PCN services. Unrealistic expectations and timescales in the cauldron of excess workload and workforce crisis.’ 

Last night, a twitter chat on the specifications revealed the scale of feeling from GPs at the specifications.

Dr Hussain Gandhi, a GP in Nottingham, wrote about the care home requirements: ‘I said it before. Whoever added the line about GP only face to face visits on a regular basis needs firing. At odds with [NHS long-term plan] and the aims of #PrimaryCareNetworks ethos. Sceptic would say intentionally added to cause angst and frustration.’

In response, NHS England director of primary care Dr Nikita Kanani wrote: ‘This came from the enhanced health vanguards and certainly not to provoke – we need to balance best care for the population and sustaining general practice.’

GP Survival chair and pensions expert Dr Nick Grundy wrote: ‘The numbers are unquestionably large, but: (1) PCNs are required to make up 43p in the pound of the staff costs, i.e. £236.5m in 20/21 rising to £771m in 23/2 ; (2) none of that money can be used for GPs.

‘The headline numbers are not helpful. With my partner hat on, I have to look at the specs and decide whether it’s worth my spending money on the additional staff. That is only the case if they benefit BOTH my patients AND my practice: as they stand, they might do the former, but at the expense of the latter.’

In response to Dr Grundy, Dr Kanani wrote: ‘We can’t lose one for the other – this has to be about sustainability, about equality of offer, and about working more closely with the system. Likely in that order.’

She added: ‘Thank you for engaging so openly this evening. I know it will make a difference,’ adding that the consultation taking place over Christmas was ‘not convenient at all. [It] meant everyone (profession, myself) were distracted by this instead of festive period. But it was the best we could do and we already have a huge amount of feedback to work from.’

NHS England is asking GPs to respond to its six-question survey on the proposals by 15 January.

In October, NHS England admitted some areas across the country will have a ‘real challenge’ in recruiting the 20,000 additional primary care network staff it promised to help fund as part of the GP contract negotiated last year. 

In the summer, NHS Clinical Commissioners, representing CCGs, said its members were ‘concerned’ their existing budgets were not big enough to cover the additional £1.50 per patient required under network arrangements.