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Job prescription

Perhaps it’s the change in season, the easing of lockdown or the vaccine programme but I’m starting to feel more positive about the PCN project, albeit with caution. 

Since becoming chair of South Staffordshire LMC in April, I’ve realised just how ill-understood general practice is in the wider system, especially by our colleagues in secondary and community care. There is a real opportunity to fuel recognition that we are not only the best but the cheapest and most efficient part of the NHS. 

The proactive systems want to work with us. They want our resources and help to move work into primary care, of course at considerably lower levels of funding than secondary care. 

So there have been a few positive moves, but not without caveats.

First, the system has some recognition of the pressures – the DES specifications have been delayed for this year. However, I’m wary of when and how they will be introduced, considering we have a booster Covid vaccine to deliver on top of normal QOF and flu vaccines this year, and we’ve not even finished the first round of Covid vaccines for our population. 

Second, there has been an increase in additional roles reimbursement scheme (ARRS) funding for PCNs. But the CD payments, PCN support payment and network participation payment have seen little or no uplift, which is effectively a pay cut in real terms. Again, this completely ignores the workload the additional funding, recruitment, management and system expectations bring. And no, I’m not talking about the CD uplift purely for vaccination purposes for three months. What about after that?

Although there is some recognition of workload, I still feel we have been sold short as CDs. As a CD, I’m not sure where my role starts and ends – and I’m sure my colleagues feel the same. By taking on the CD role, have GPs opened themselves up to unlimited system meetings and demand?

We need a job description. We need our leaders at the BMA General Practitioners Committee to define what the CD role is – not the broad-brushed notion of ‘supporting system development’. And CDs need to start working within their remit, rather than jumping at every opportunity of unfunded work. 

We had a great talk the other day from a public health consultant on population health management. We GPs can provide a wealth of knowledge here, but when I asked about resourcing CD and GP time, it seemed like all hell broke loose. Similarly, we were asked to develop a nationally funded scheme by meeting weekly for an hour. On raising the question about time and resourcing, suddenly those meetings were not needed any more. 

I feel positive that we can support the system to deliver services, but we need to be more corporate in our approach to resourcing, and this is where we have let ourselves down. Let’s have an open conversation about proper resourcing of GP, CD and practice time for non-contractual work. I hope the system can recognise that we are open to adequately resourced work to help the patients and system, and if they appreciate this and agree to work along these principles we can move forward with a spring in our step.

Dr Manu Agrawal is clinical director for Cannock North PCN, Staffordshire, senior partner managing three practices in three PCNs and chair of South Staffordshire LMC

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DrSoup Dragon 29 July, 2021 11:52 am

The NHS ruthlessly and enduringly, exploits goodwill.

A corporate approach with defined boundaries rebutts exploitation.

A man who says No is listened to, a man who always says yes is a doormat, and treated as such.