Opinion: Chaos theory – is the DES deliverable?

The PCN DES is in full swing. NHS England is sitting pretty as hardly any practices have resigned from the DES. So while they are sipping Champagne in their ivory towers, feeling smug, practices up and down the country have no choice but to clutch the crumbs being thrown at us.

To compound this further, the Government has decided not to award GP partners the 4.5% pay rise that is being given to salaried GPs and the wider healthcare sector. It must be down to the terrific five-year contract that had no clauses or caveats for emergencies like Covid. What top negotiators we are.

Despite this kick to the guts, we soldier on and the flavour of the month is enhanced access. PCNs up and down the country spent hours understanding the nuances of GP supervision, then had to grapple with how they’re going to deliver this, while undertaking huge amounts of patient feedback. No worries, it didn’t take up practice resources; we just missed a few rounds of golf.

To add to that, NHS England has provided us with the support and reassurance we desperately need: it will step in to support PCNs that are struggling to deliver enhanced access. Alas, there is no support for practices struggling to deliver their core contract.

If PCNs cannot deliver enhanced access on their own, they can collaborate, federate or do whatever it takes to forward the political agenda.

My question is this: has NHS England now recognised how undeliverable and pointless this whole DES is as it is now providing advice on how to make it workable? The answer is ‘yes’. Now, if the Fuller Stocktake report is to be taken as policy, NHS England wants to transform PCNs into neighbourhood teams. 

In our PCN, we did provide a functioning plan, but the system can’t decide whether it wants to move towards more digital appointments or more face-to-face appointments. So we bat away the arbitrary figures being thrown at us and proceed in the best way for our patients.

On another note, how many people have heard of the balancing mechanism? There is confusion about whether this is actually operating or not. As far as I understand, it means that if, God forbid, the GP partners make a lot of money for working every God-given hour, vaccinating people in a pandemic and forsaking a family life, NHS England can deduct money from PCNs and contracts. But if GP incomes fall because of inflation, PCN additional roles reimbursement scheme (ARRS) funding could be diverted into core. Has this been agreed? I’m confused. We will not know until year-end accounts.

What happens to PCNs like ours, which have spent almost 100% of the ARRS budget? Is it advisable not to recruit via the scheme as the money might come into core funding? No one knows.

It seems the Government is against any income coming to partnerships.

I think the biggest problem is, whatever is thrown at us, we make it work, and we will make the DES work as well – but at what cost?

So, there is no clarity about whether PCNs are fit for purpose or if this balancing mechanism is operating. There are concerns about the future of the partnership model. I wonder what the desired outcomes are for the policy of chaos?

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