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Cynics like me are I’m sure tired of hearing a new three lettered acronym every year and how it is going to save general practice! So, why then have we negotiated an enhanced service in this year’s contract which features investment to support working in primary care networks? Well, for a multitude of reasons really, and I hope the following explains our thinking.
First and foremost, the way the PCNs have been incorporated into the core general practice contract will give the ownership of ‘working together’ back to GP practices. Just to be clear, PCNs aren’t completely new. 88% of practices in England already work in some kind of network – like neighbourhoods, localities, federations or super-partnerships. The concept is not new, but the support and safeguards are, and that is what will make PCNs different to the previous TLAs.
Only GP practices can set up PCNs. The framework in which the PCNs operate should go some way to help alleviate workload pressures on practices and allow GPs to concentrate on caring for our patients at a local community level. We believe that this should happen with the support and backing of a robust national contract and that is why it is now a directed enhanced service.
PCNs will consist of a grouping of GP practices within a coherent geographical area, typically covering a population of 30-50,000 patients. Whilst the exact number is not something we should get fixated on, the underlying principle is that they should be small enough to still provide the personal care valued by both patients and practices, for practitioners working within it to have a reasonable chance of knowing the people they are working with, but large enough to have impact and economies of scale through deeper collaboration between practices and others in the local health and social care system. Practices will also have opportunities to collaborate with other local primary and community services as part of PCNs, and build relationships with voluntary, secondary and tertiary services. This gives GPs the opportunity to lead a renewed primary healthcare team.
There is now guaranteed, recurrent, national funding available to PCNs through the enhanced service to expand our workforce and reduce our workload. Commissioners locally are expected to supplement this and it is us, GPs, who will lead the networks to ensure general practice remains at the core of PCNs. Aspects of competition between providers will now be replaced with collaboration.
So, as a GP practice, do you have to be part of a PCN? The short answer is that you do not, in the same way that you do not have to take part in QOF. They are both voluntary. However the opportunities are not only of additional funding to deliver an expanded workforce, but just as importantly the ability to lead and shape community services in your area means this is something we would hope every practice would want to be part of. I would suggest that you consider the information that is available to you and discuss what opportunity this provides your practice and colleagues around you with your LMC. Richard, Mark, Farah and I will be doing GPC contract roadshows, hosted by LMCs in the coming weeks explaining the details of the contract. Please do come and attend these and share your thoughts with us.
The BMA’s initial guidance on PCNs can be accessed here. The BMA will continue to provide you with all the necessary national guidance in the coming weeks – please look out for these and discuss these in your LMCs about the local challenges and opportunities this brings you.
In the coming weeks, we will add more blogs on the following topics:
what about the real shark in the water....................ICP's
The development of PCNs is the single greatest threat to general practice since the last big revamp of our contract. it entrenches the extended hours requirements at the same value which many practices had given up as non financially viable. The much vaunted additional staff funding leaves practices paying 30% and the maximum reimbursed is below the going rate for a qualified pharmacist so the costs to practices are likely to be greater. Later requirements, such as enhanced care home work, will bring the non-GMS services desired by the homes into the GP contract with no ability to opt out. The clinical lead funding is below the going rate for a partner because the average includes salaried GPs. The need to back-fill means that the director will effectively take on the additional responsibility for nothing. No mention is made that the CCGs have been told to reduce admin costs by 20% and that PCNs will take up the slack as 'leads' for local primary care planning. I have attended an STP meeting where it was told by NHSE that this contract will bring GPs under the performance management umbrella of the ICS allowing greater control.
We have been struggling to recruit GPs. We have approx. 16000 patients. We have two pharmacists, 2 paramedics, 2 advanced nurse practitioners in training, an F2 Doctor, a physio and 3 GP retainers already. We have multiple very part-time salaried GPs, some regular locums and several doctors approaching retirement. The remaining GP partners are already very stretched trying to cope with our own clinical work and the supervision needs of our current staff. I am told that the 70% reimbursement is only available for "new staff". How many allied health professionals can one GP reasonably be expected to supervise? Where is the support and training available to GP partners to help us in this supervisory role? How can we physically fit in these extra professionals who take 20-30 minutes to see a patient compared with. a GP who has 10 minutes when our building is already 40% undersized, we have converted all available office space to clinical rooms and moved our paper notes off-site at great expense? Help!
If your staff are taking 30 minutes to see patient, there are major training issues. Why dont GPs learn and adopt the great model that hs worked for over 2 decades in West Yorkshire. GPs and Hospotal Consultants are paid to teach Trainee ANPs. Yes the carrot you always go for £££..and these ANP study to MSc 18 months to 2 years. Are HIGHLY competent qualified staff work I 10 to 15min appts.