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Pulse 2019 review: Networks – collective working for bright future?



Back in January 2019, the new GP contract – heralded as the most significant in 15 years – promised a great deal for practices.

Provisions included a guaranteed increase in the global sum for 2019-20, NHS funding of all staff indemnity, the promise of 22,000 new practice staff to support GPs and the removal of unnecessary QOF indicators.

But perhaps the most headline-grabbing was the announcement of new, geographically based primary care networks (PCNs). Under the new DES, practices would get £1.70 per patient just to join a network, equating to an average of £14,000.

Although practices would not be forced to join a network, NHS England and the BMA said they expected all practices to do so. And, even if practices chose not to join, every patient in England would be covered by a PCN – each covering 30,000 to 50,000 patients.

To tempt them, several pots of gold were on the table.

As well as this ‘practice participation’ incentive, the contract would see NHS England pay 70% of the ongoing costs of employing support staff like pharmacists, paramedics and physiotherapists – and the total cost of taking on a social prescriber.

Appointing a leader would get the PCN 59p per patient, while a further £1.50 per-patient ringfenced sum would be provided by CCGs.

However, not everyone was convinced the PCNs would be the general practice panacea they purported to be.

Some say collaborative working like this doesn’t improve patient care, nor help to fix problems in general practice, like long hours, inadequate staffing, high demand and heavy workloads.

Others feared the tight timeframe for setting up PCNs might effectively mean practices being coerced into a network, all of which must have registered with their CCG by mid-May.

Indeed, problems were afoot by June, when Pulse discovered that CCGs were refusing to sign off PCNs that had excluded unpopular ‘pariah’ practices.

And it seems that some areas of the country are unlikely to be able to recruit the additional practice staff, with networks in deprived areas in particular struggling to come up with their 30% share to pay for them.

NHS England said extra money would go to PCNs that hire social prescribers through an organisation, totalling a flat sum of £2,400 per staff member.

If GP leaders at November’s LMCs conference are anything to go by, there’s a long way to go before this sways GP opinion. Some 63% said they had ‘no faith that networks will result in a reduction in GP workload’, and a vast majority said PCNs do nothing to boost the ‘dwindling GP workforce’.

But some remain positive, touting PCNs as a system change with as much potential to change lives as modern hospitals and heart transplants.

Only time will tell, comrades.