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New CCG powers to assign practices to PCNs will ‘erode practice autonomy’

GPC meeting

CCGs will be able to ‘assign’ a practice to a primary care network (PCN) if no other PCN wants to take them from April, under new contract arrangements that GPs have said will ‘erode practice autonomy’.

In the updated GP contract for 2020/21, it states practices in England will only be assigned to a PCN in the ‘unlikely circumstances’ that the CCG and LMC have been unable to reach an agreement with a PCN through mediation.

However, a group of LMCs has warned the move will reduce practices’ independence, warning that ‘giving unilateral control over this to the commissioner is not in practices’ interests’.

Meanwhile, the new GP contract also states that from 2021 onwards practices signed up to a PCN will be automatically enrolled for another year, with only a month to decide whether to opt out.

In addition, GP practices that are not signed up to the network contract DES will also only have a month to decide whether to join a PCN, as part of changes being introduced in 2021/22.

Under the new auto-enrolment arrangements, opting out or signing up outside of the one-month window would only be allowed in ‘exceptional circumstances, at the discretion of the commissioner’.

The contract said the arrangement would avoid the scenario in which PCNs become unviable because a member practice serves notice on the DES contract part way through the year.

Practices that want to opt out for this coming financial year will be able to do so by giving the required one month’s notice up until 31 May – the date by which practices wanting to sign up must also apply.

The contract said: ‘Every practice has the right to sign up to the network contract DES and join a PCN. It is voluntary.

‘In unusual circumstances, we have seen practices wanting to sign up to the network contract DES but unable to find a PCN to join.’

It added: ‘We will introduce from April 2020 the ability for CCGs, in the unlikely circumstances that agreement cannot be secured through the mediation process, to assign such a practice to a PCN.’

Berkshire, Buckinghamshire and Oxfordshire LMCs analysed the part of the new GP contract governing PCNs and said: ‘From 2020 onward, the CCG will have the ability to forcibly impose a practice onto a PCN which does not necessarily want it.

‘This erodes practice autonomy as last year the process was negotiated with LMC involvement and escalation via NHS England and [the BMA’s] GP Committee if necessary. Giving unilateral control over this to the commissioner is not in practices’ interests.’

The LMCs said they could not recommend practices sign the network contract DES owing to the additional workload and estimated £17,000 financial loss it could lead to for GP practices.