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As the contract roadshows continue, discussions about PCNs and how the new workforce expansion will support GPs and practices are creating much debate. Naturally, there is a wide range of opinions on this from ‘Haven’t we heard this all before’ to ‘Why are GPs and nurses excluded from the workforce reimbursement’ and also interspersed by others who already work with an expanded workforce team that are concerned that they won’t be able to capitalise on the new opportunities that this offers them.
So, the first point – why are GPs and Nurses excluded from the workforce reimbursement? Well, to answer that, first and foremost we need to be clear about what the PCN DES is intended to do. Our vision of the PCN is that it helps expand the workforce team beyond the current numbers. It is no secret that is the biggest issue in general practice - unless we have more bodies on the ground to help us with the ever-increasing workload, we will not be able to turn the tide. Added to that, the last thing we want to do is remove GPs and nurses from practices who are the nucleus of general practice to work at a PCN level. That would be analogous to removing the building block of the foundations to cover the roof – it won’t stay up!
There is no general practice without GPs, nurses and the legions of staff that help us run our practices every day. The PCN DES is not about substituting them, but is about taking some work off them to make the system more sustainable.
That brings us to the promises that we’ve heard before - the extra 5000 GPs and other commitments. For the first time in a while, you will see in the contract document that there is an acknowledgement that this target is not that easy to achieve. An honest conversation is the first step in addressing the problem and that is what we have in this deal. Whilst any target would be ambitious, and the progress would be slow, the fact that we are now working together to make sure that GP practices get the extra support, shows that this is a joint ambition and commitment that underpins this year’s contract deal and one that we will work together to achieve.
What are we aiming for? We are aiming for every single practice to have a Clinical Pharmacist working for them in the next 5 years as part of the PCN. We want Physiotherapy Practitioners in every single practice to be the first line of contact for patients for musculoskeletal problems. We want Physician Associates in practices to support the work GPs are currently doing and take some of the burden off the current workforce. We want Paramedics to be shared between practices who can assist them with appropriate clinical work in practices and with the home visiting services that they are trained to do. We want Social Prescribers to assist GP practices with patients who are having to deal with challenges that extend beyond ‘health’.
Will we hit the targets for the workforce expansion in the next 5 years? That is mostly up to us. Whilst the policy and political environment is not entirely in our control, the determination and vision to help ourselves is firmly in our control. Therefore, we will need to try our best to make this work for us. And remember, we are in control of this. The Clinical Director role for PCNs is costed on a GP performing the role. The PCN agreement realigns the narrative of putting clinicians in leadership roles and that is an opportunity to make it work for our practices, our staff and our patients.
As I’ve said previously, if you haven’t looked through the below documents, please familiarise yourself with what the new contract offers you.
Richard, Mark, Farah and I will be continuing to do a large number of 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.
In the next few weeks, we will add more blogs on the following topics:
So, if I may leave you with Churchill’s quote that was referenced at a GPC meeting recently – “If you are going through hell, keep going”. That is something every single one of us can relate to in terms of the out of control workload in recent years. The workforce expansion is our opportunity to address this.
Krishna Kasaraneni is a GPC executive member
The new contract documentation states that the money for the roles is predicated on delivery of the 7 new pathways. It also states that there is no additional money planned for the PCNs or practices other than what has been stated in the contract documentation. As the PCNs will have to cover the unfunded 30% aren't we just expecting GPs to pick up a tab for new work. In essence the new staff are doing new work and subsidies by existing GP partners? This in no way helps existing General Practice.
You said that "The Clinical Director role for PCNs is costed on a GP performing the role". That is not quite the same as saying that the clinical direct needs to be a GP. If every clinical director was a GP you would be taking several hundred FTE GPs away from patients.
So who can be a clinical director? Nurses? Pharmacists? Practice Managers?
Oh dear. such naivety. do you drink flat whites?
Sadly the Churchill quote could be so much more appropriate .....
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I am so sorry that people I normally respect have fallen for this nonsense. At every level it offers to deliver reduced income, more work and increased shackling. In forcing us into extended hours it takes us a half-step back to the days of compulsory out-of-hours. It is pretty well recognised that ancillary clinical staff bring us more work and responsibility, not less. Whatever were you thinking?
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this whole pcn thing is a complete waste of time and money
if we need pharmacists, paramedics etc, couldnt the CCGS just employ them directly????? instead of creating thousands of new companies/"networks" across the country to employ them?
What if you are already part of a nice medium/small sized surgery with relatively happy patients/staff that runs efficiently and well and now you are forced into "network" discussions and closer liaisons with random practices on the basis of their geographical location, thus potentially creating more bureaucracy/admin workload/opportunity for interpersonal conflicts and disagreements [to think otherwise would display naivety of epic proportions]? Such practices are being forced into PCNS as if they dont join they will be gradually starved of cash----extended hrs DES will go and all LESs will in future only go to network members. More top down illogical re-organisation from the NHS senior team and the BMA sadly should have shown more support for small independent surgeries instead of setting everything up for mass mergers in a few yrs time
Can the GPC provide reassurances that those practices who dont join will not lose EXISTING FUNDING?? [ie extended hrs DES and LES]
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