This site is intended for health professionals only

The mystery of paragraph 3.12

We need to talk about the elephant in the room. That being mysterious para 3.12 of the Network Contract Direct Enhanced Service Draft Outline Service Specifications, with which you are all now painfully familiar. Except with mysterious para 3.12, which, for some weird reason adding to the overall mystery, doesn’t seem to have registered.

It might be that we are self-consciously ignoring it, like most elephants-in-rooms. Or maybe, despite being an elephant, it has genuinely been overlooked, because the Draft Specification room is so overwhelming.

Whatever. Mysterious para 3.12 is in the ‘Enhanced Health in Care Homes section’, and this is what it says:

‘In future years we will consider whether and how to bring out of hours provision under the authority of PCNs, to ensure more effective and coordinated out of hours support for care homes.’

They’re going to need a bigger shovel

So, pick yourself up off the floor, get back in your chair and try to stay calm. But yes, mysterious para 3.12 does appear to suggest that PCNs might have to take back OOH care in residential homes, and there’s enough wriggle room ambiguity in the phrasing to suggest that this responsibility might extend to all OOH care. And that would put you and I just one doctor/noctor-off-sick away from having to do it ourselves.

I’m old enough to remember doing my own OOH work, and how the 2004 contract enabled us to opt out, transforming GP life overnight. An undisturbed one. Since then, OOH workload has increased horrifically, through the relentless rise in public expectation and via various Government demand-stoking initiatives. Taking it back would be unthinkable.

Except I’m thinking about it now, because of mysterious para 3.12. Which leads us to why mysterious para 3.12 is so mysterious. It’s because, while the whole para is about wanting GPs to take responsibility, nobody seems to want to take responsibility for para 3.12. Pulse has tried to establish what it means, exactly, and why it is there, but with absolutely no success. No one seems to be able to fathom how para 3.12 came to be, nor what its implications are, or, if they are, they’re not prepared to say.

It’s as if they are all holding their noses and averting their eyes as they step over or around a noxious steaming pile that has been dumped in the middle of their lovely specifications. Probably they blame the elephant.

The GPC can’t ignore it, though, as they try to clear up the specification mess. And I think they’re going to need a bigger shovel.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield