There is a lot of buzz around primary care networks (PCNs). Many GPs and practices eagerly await support in the form of pharmacists, social prescribers and paramedics etc. There is the impression from the BMA that this deal is a game changer and marks a fundamental shift of support for primary care after more than a decade of being starved of the funds. The perception amongst the fellow professionals and the wider public is that primary care has received a bonanza, and so says the headlines.
However, as the dust settles, it is clear that many of these potentially hugely beneficial changes risk being diluted due to lack of clarity and complexities involved.
Extended access from July 2019 poses the first challenge. There is a lot of confusion around how the funding for the extended access DES will work for those practices who do not or cannot participate under the PCNs. There is no clarity around whether they should be asked to pay back the funding that appears to be going into their global sum or should the rest of the practices in the network provide the service on their behalf but for less than existing funding and thus neither being the intended outcome.
As acknowledged in the contract agreement, a chunk of money has been taken off to fund for indemnity and this appears to have reduced the funding earmarked for primary care at the level of local commissioning.
Local and national leaders must recognise this short-sighted approach
The biggest risk, however, is for the deprived areas. We have already seen these areas lose out in the way the CCG funding is shared by NHS England. Carr-Hill formula and weighting mechanisms currently used do not reflect the demands on such areas, nor do they offer any hope for future redistribution.
However, historically, PCTs and CCGs , in some areas, have attempted to direct some funding to these areas to recognise some of the pressures. But now, any future funding for the additional workforce as well as extended access will be distributed based on the size of the PCNs and hence, diluting any local investments which recognise additional demand and load. Many of these areas have already seen significant outflux of funding with PMS redistribution and other such measures.
Hence, as the funding available at the CCG level is redirected to the PCNs, if that is what the new deal is leading to on the ground, the desperately needed additional investment in struggling areas will go down further despite a crisis in the workforce in these areas.
At many places in the country, the commissioners had already provided a varying amount of investment in the form of various projects, some more than the others, now funded under PCNs. An example is the pharmaceutical support to practices to control the prescribing costs and this risk being lost in the new arrangements though the aim of new pharmacists is to provide support for practices to reduce workload, an entirely different objective than controlling prescribing costs. So, additional investment into general practice outside the scope of new contract now appears to be much more discretionary. Essentially, there is a real threat that the new funding turns out not really new but rebranded and redirected streams.
The funding has been wrapped up in rather complex layers which are not only confusing, but potentially open to interpretation at various levels by various organisations, not least the PCNs. Local, as well as national, leaders must recognise this short-sighted approach. Well-resourced primary care is the only way forward for NHS to survive.
Dr Kamal Sidhu is a partner at Blackhall and Peterlee Practice and New Seaham Medical Group; vice-chair at South Durham Health Community Interest Company; and vice-chair at County Durham and Darlington LMC. He writes in a personal capacity