Wrong to throw PCNs ‘out with the bathwater’, BMA warned

The BMA is wrong to call for PCNs to be scrapped, the NHS Confederation has warned after its GP committee called for all PCN DES monies to pooled into one simplified funding stream.

The Confederation said that dredging up more ‘distracting structural reform’ to the NHS to scrap PCNs would be like throwing ‘the baby out with the bath water’.

In a ‘call to action’ document setting out points for contract negotiations issued last week (23 June), the BMA GPC called for a unified contract folding in all QOF, IIF and PCN DES funding.

This included calling for all micro-targets – namely QOF and IIF – to be scrapped with the PCN DES which it said was a proven ‘failed project’, better replaced with a quality improvement-based contract.

But the Confederation said that scrapping PCNs after four years of work would ignore their ‘real impact for local communities’ in recruiting 26,000 additional roles and delivering the Covid-19 vaccination programme.

Professor Aruna Garcea, chair of the NHS Confederation’s primary care network, said: ‘To label them as a “failed project” is disrespectful to the huge commitment that PCNs clinical directors and their staff have put in over the last four years.

‘There are huge GP vacancies, high demand from patients, and the NHS has already been through a very recent upheaval in the pandemic and in the formation of integrated care systems which enable primary care to finally have a voice in broader population health management.’

She added: ‘Rather than throw the baby out with the bath water by introducing further distracting structural reform to the NHS, we need to look at what additional support and flexibilities can be provided to PCNs so they can deliver on the ambitions set out in the NHS Long-Term Plan and Fuller stocktake.’

The 2024/25 contract negotiations will be the first since the end of the five-year deal, with GPC England previously urging doctors to join the BMA ahead of a potential ballot over industrial action if 2024/25 contract negotiations turn sour.

In its new points for negotiation, the BMA said that practices should be encouraged to work collaboratively but exclusively on services that must be provided at-scale, with all practice level activity contracted and resourced at that level.

This would include redeploying ARRS staff to ‘support the provision of core general practice care as their primary function’.

The GPC also said that GP practices should be the preferred provider for all clinical services commissioned in general practice ‘that would ordinarily be provided by general practice’.

And on workforce, it stated that general practice needed a fully resourced seven-year plan to bring GP numbers up to 40,000 at least by the start of the next decade.

Prime Minister Rishi Sunak on Sunday told the BBC his Government’s long-term NHS workforce plan will be published later this week.

Other principles set out in the GPC’s call to action include:

• The transfer of unresourced workload from other providers to become a ‘never’ event, with systemic measures in place to review, fund and resolve breaches
• Recognition and support for the independent contractor model as the best and ideal mechanism for the provision of practice-level contracting
• Fully funded long-term premises plan to be prioritised as well as fully-funded and future-proofed modern IT solutions
• Safer working recommendations to be adopted by all practices with capping of contacts universally applied
• Recognition, measurement and management of all work undertaken by GPs in general practice.