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LMC still ‘cannot recommend’ signing network DES due to ‘significant’ concerns



EXCLUSIVE A group of LMCs has said it ‘cannot recommend’ that its practices sign up to the network contract DES, despite it having been revised, due to ongoing ‘significant’ concerns about the extra workload it will create for GPs.

Berkshire, Buckinghamshire and Oxfordshire LMCs analysed the newly-negotiated primary care network (PCN) DES and found there was still a risk of financial loss for practices – of £17,191 per average network in a year.

It said this loss in income was due to the level of work required to deliver the contract, including the three new service specifications, in 2020/21 – which it argued would not be offset by the additional clinical staff PCNs are expected to hire, despite extra funding.

The group of LMCs estimated the service specifications – covering care homes, structured medication reviews and early cancer diagnosis – plus other requirements such as those relating to flu vaccination and social prescribing, will require 61.5 sessions per week.

But an average network will only be able to deliver 40 sessions per week using its additional staff – leaving a deficit of 21.5 sessions, warned the LMCs.

The LMCs’ analysis adds that a ‘further workload burden’ of 27.5 hours per week will fall upon PCNs because there is also the additional administrative and managerial work that extra clinical staff will be required to carry out.

Overall, the requirements under the network DES could result in a potential net loss of £17,191 for an average PCN delivering the requirements of the DES, according to the LMC’s financial modelling.

The analysis says: ‘The DES was initially heralded as a means of relieving and reducing existing workload pressures in general practice. There is no evidence that this is the case, given that the DES lacks the utilisable workforce to deliver even its own requirements, let alone manage any pre-existing workload.

‘It seems highly unlikely that the practices in an average PCN would see any net financial benefit from the DES and indeed it seems probable that they would make a loss in the process of delivering the work required.’

The analysis adds that ‘significant’ workload is due to be added to the DES in 2021 and beyond and that the contract suggests that some aspects of the DES may be ‘rolled into’ or cause changes to the core contract.

It says: ‘As time passes, and systems become more integrated, it will be more difficult for practices to extricate themselves from the DES if they so wish without significant adverse financial implications.

‘We have significant concerns that this DES poses a threat to the independent contractor model, the core GMS contract and the autonomy of individual constituent practices.’

The group of LMCs said: ‘Based on the above analysis, the LMC cannot recommend practices sign up to the PCN DES.’

It added that it ‘does not necessarily recommend’ that all practices withdraw from the DES, but that those practices and networks that feel they are able to absorb the financial risks should ‘take steps’ to ensure they are able to withdraw in future.

Practices should await the outcome of the special LMCs conference to be held on 11 March to discuss the impending GP contract changes ‘before making any commitment’ to the DES, it added.

Berkshire, Buckinghamshire and Oxfordshire LMCs CEO Dr Matt Mayer told Pulse the estimated financial loss that the DES could bring is a ‘best case scenario’ as it is based only on the workload laid down in this year’s deal.

He said: ‘The specs that are coming in next year seem to be at least as onerous as these ones because there are quite a lot of them – reducing inequality, cardiovascular disease, anticipatory care and personalised care – which have just been deferred.’

He added: ‘The main concern my reps and I have is the effect [the DES] has on your core contract the longer you are in it and therefore the difficulty and financial or contractual damage if you delay coming out of it.

‘We’re concerned this might be one of the last times you can get out of it without causing your practice a lot of damage – but we honestly don’t know and that’s why we’re really concerned.’