GP leaders have raised ‘grave concerns’ with a new national PCN pilot which puts ‘excessive’ conditions on practices.
The BMA GP Committee England and a group of LMCs have highlighted several issues with NHS England’s plan, including its potential to worsen health inequalities and the requirements to share income data.
In June, Pulse reported on NHS England’s new pilot scheme which will give between 15 and 20 PCNs a 10% funding uplift for more GP clinical staff to ‘accelerate’ delivery of the long-term workforce plan.
In a letter to NHS England chief executive Amanda Pritchard, seen by Pulse, a collective of LMC leaders said this pilot could ‘create a third tier to our current two-tier system’ since the PCN selection criteria is based on the ‘stability of practices’.
They also referenced the Fuller stocktake, a landmark review on integrating primary care with other NHS services which the pilot scheme will build on.
The LMCs argued that ‘the way in which the Fuller stocktake is being interpreted and implemented is further undermining’ the key ‘characteristics’ of general practice.
Meanwhile, the GPCE has ‘sought advice’ on the funding agreement being offered to practices in test site areas, and has identified ‘several concerns with the drafting’.
According to the GPCE guidance, in order to access funding for the pilot scheme, practices must be a member of the PCN and therefore signed on to the Network DES until 2027.
This means practices would be ‘unable to opt out of the DES’ even if it changes ‘significantly’ year on year and becomes ‘excessively onerous’.
The guidance said: ‘Whilst practices could opt out of the Network DES and allow the Grant Agreement to terminate due to this breach, this would have potentially large consequences for the practice(s) as additional staff funded via the scheme would, unless funded by other income streams, be subject to potential redundancy.
‘Consequently, practices could effectively find themselves effectively unable to opt-out of the PCN DES, regardless of any future changes to it.’
The GPCE also urged ‘extreme caution’ when entering the agreement for the participation payment, which seeks to reimburse practices for the time they spend partaking in the scheme.
Participation stipulates that practices ‘prepare detailed breakdowns of GMS/PMS/APMS and PCN DES incomes and expenditures for provision to the Commissioners’.
GP leaders warned that this would ‘effectively create an open book situation’ with practices ‘required to share their income data’ with both ICBs and other practices.
‘We believe that this requirement is excessive and should only be entered into with extreme caution,’ the guidance said.
The GPCE pointed out that one of the options for collective action, which began at the start of August, is for ‘practices to delay signing up to any local or national pilot schemes until the dispute is resolved’.
According to this recent guidance, they ‘strongly encourage all practices to undertake this’ action.
The letter to Ms Pritchard, which was led by Londonwide LMCs on behalf of six others, said the pilot ‘has generated a considerable number of grave concerns’ and sought clarification from NHS England.
It sought ‘assurances that the interventions and other aspects of the pilot will not undermine the characteristics of high quality, effective general practice and the role of the GP as a family doctor’.
On inequalities, the LMCs argued that the selection criteria for participating PCNs ‘are mostly proxy markers of stability’ which is ‘directly related to funding’.
The letter said: ‘Due to the funding mechanisms employed by NHSE, practices serving populations with high needs receive less national funding and data shows that deprived areas are much more likely to have higher patient: GP ratios and struggle to recruit.’
LMCs who signed the letter
- Londonwide LMCs
- Somerset LMC
- Suffolk LMCs
- Lincolnshire LMC
- Gloucestershire LMC
- Humberside LMCs
Today, NHS England responded to the LMCs in a letter – seen by Pulse – which sought to ‘allay’ their concerns.
The letter argued that there are no ‘pre-determined set of interventions’ for the pilot programme, that ‘participation is voluntary’, and that there is ‘no change’ to the GMS, PCN DES nor the ‘function of general practice’.
National primary care director Dr Amanda Doyle and primary care medical director Dr Claire Fuller said that evidence gathered from the test sites will ‘inform local ICB policies’ as well as ‘national’ policies – but that any new policies ‘will be subject to the usual rules around patient and public consultation’.
On information governance concerns raised by the LMCs, the letter said: ‘Our lawyers have reviewed, refined, and addressed the key concerns in the final version of the agreement that PCNs have been asked to sign.
‘It is important that data sharing is done in a way that safeguards the integrity of general practice
data and we will continue to work with the PCN Test Sites to achieve this.’
The letter did not address potential health inequalities, but it sought to reassure LMCs that they ‘all have the shared aim of improving the sustainability of general practice for the benefit’ of the patients they serve.
NHSE’s pilot scheme is designed to ‘test’ whether implementing the long-term workforce plan, along with other digital tools such as process automation, can plug gaps in general practice capacity.
The test sites, based in seven different ICBs across England, will gather extensive data over the next three years to understand whether these interventions make a difference compared with the current ‘baseline’.
This will help to ‘further deliver’ on the Fuller stocktake, according to NHS England.
Earlier this year, Londonwide LMCs raised ‘immense concern’ with an ICB’s plans to effectively mandate the use of same-day access hubs, which also built on ideas in the Fuller stocktake.
The plans laid out by NHS England for this new pilot scheme do not explicitly reference same-day or urgent care.
Pulse's survey on collective action
Fancy yourself as the next Pulse blogger? Enter our writing competition now!
The greed and mercenary attitude of PCN CDs (some exceptions) colluding with NHS England remote managers in the destruction of Primary Care as previously stated will continue to devastate the lives of NHS Primary Care staff, patients and the future of General Practices.
Overcoming the monetary bribes (in my view) accepted by the few small number of PCN GPs across the country who are complicit with NHSE in causing years of misery to newly qualified GPs, locums and other GP practices as well as patients will require the profession to unite against the ongoing unbalanced and unrepresentative view of multiple self-serving PCN CDs (some exceptions) in position often by default as their colleagues refuse these destructive PCN CD roles .
The BMA collective action requires.
• Refusal to co-operate with the greed of GP PCN CDs
• This will lead to refusal to co-operate with PCNs by default and prevent future PCN imposed straight-jackets.
• Staff who cannot be employed, are left for NHSE to either continue to fund via the practice or to make redundant (this is a decision for NHSE and caused by NHSE)
• In the same way as is currently mandated in BMA collective action to reduce the number of appointments per day to further reduce appointments relative the remaining GP practice staff (more effective than current action) in accordance with whether appointments with ARRs are no longer available (NHSE choice to stop funding ARRs or not within the GP practice ).
I am certain the BMA and the entire of Primary care has realised the controlling, manipulative nature of the continually failing NHSE many of whom have never been anywhere near a patient.
Unless a completely detached, underperforming ,failing irrational quango such as NHSE is addressed , they will continue to devastate the NHS and increase the numbers of deaths and morbidity in my opinion that are directly attributable to this faceless group called NHSE.
I am certain the BMA and the entire of Primary care has realised the controlling, manipulative nature of the continually failing NHSE many of whom have never been anywhere near a patient.
Apologies for the plagiarism. The NHSE machine appears undaunted, but it is abundantly clear that more of this up with we should not put. Pump-priming for dashboards, PAs, ‘process automation’ and undefined digital IT, (hub resurrection?) are not solutions to the cause of general practice’s problems. When the medical profession led general practice it was cheap and effective. NHSE has repeatedly shown itself to be captured in the revolving door and more importantly, incapable of leading the profession.
Multiple reorganisations (DHA/FHSA, PCT, CCG and now ICB and PCN) have sequentially sidelined the influence of LMCs. Their place has been taken by PCN and ICB CDs who (mostly) seem concerned with advancing their own careers than representing their GP “constituents”. This latest pilot scheme seems designed to further distance grass roots GPs from having any say in what happens in their area.
Likely to be those PCNs that are already doing well financially. To those that have…
Whatever happened to using resources to tackle deprivation and challenge the ongoing Inverse Care Law?