The BMA has urged GPs, practices and local medical committees to give their views about the draft specifications for PCNs (primary care networks) – with negotiations on the next stages of the process continuing.
Doctors leaders are in talks with NHS England about the details in the specifications, released shortly before Christmas, and will echo concerns already raised by clinicians and managers about workload implications and the need for a qualified workforce to deliver change.
BMA GPs committee chair Richard Vautrey (pictured below) called for more staff involved in PCNs to give their views – with the feedback being used to ‘form the basis of talks’.
Dr Vautrey said: ‘General practice continues to be under a huge amount of pressure and we hear the concerns raised by the profession in recent weeks about these draft specifications, the workload implications and the need for a qualified workforce to deliver them, loud and clear.
‘While the content of negotiations is confidential, the profession should rest assured that we are listening to doctors on the ground, reviewing their feedback and this will form the basis of talks with NHS England to ensure that the specifications are fair and appropriate before they are agreed.
‘In turn, we would urge as many clinical directors, GPs, practices and LMCs as possible to raise concerns directly with NHSE to ensure their voices are heard.’
Free up GPs
The draft guidance, released on December 23, outlines five national services PCNs will be required to deliver from April 2020 onward, when they will be ‘phased in’.
- Structured medication reviews
- Enhanced health in care homes
- Anticipatory care
- Personalised care
- Services to support early cancer diagnosis.
Sian Stanley, PCN clinical director in Hertfordshire, said the original idea behind PCNs – freeing up GPs from rocketing workload with the appointment of other staff and new models of care – was still a ‘positive’ concept, but said NHS England’s draft specifications were ‘too rigid’ and said doctors should be trusted to make the right decisions locally.
She said: ‘The BMA viewed [PCNs] similarly to myself – a way to get funding into the profession. It was a positive step for collaboration and enabling that but I can’t help feel there is an agenda and NHS England seem to have seen it as an opportunity to direct the day-to-day activities of a general practice and have overloaded it.
‘Good funding needs to flow into general practice and GPs be allowed and trusted to save the service. Ultimately, we are the only ones that can. We need to be trusted and respected and allowed to do what we do best which is to use the funding to improve patient care.’
Dr Stanley said the new ways of working had already had positive outcomes in her local area – and those positives needed to be protected.
She said: ‘We had a social prescriber employed by the county council for the elderly pop already so ours has been employed for the adolescent population. We noticed we had a lot of adolescent mental health problems – we are struggling to get people into services, people couldn’t understand services and patients and families were very frustrated. He has gone out to local schools and he works with people aged from 11 to 25 to help them negotiate services and try to improve their mental health. We are also taking on another social prescriber to help the elderly use IT around their health – utilising various systems we are piloting. We think that technology can solve a lot of problems and improve access.’
Call for change
Dr Stanley said two new pharmacists had done ‘amazing work’ in terms of audits and patient safety and had helped with workload. The PCN had also begun to use population health management tools to look at frequent attenders, identifying that the most needy patients were those with drug and alcohol problems, rather than the frail elderly. In response Dr Stanley created a role for a drug and alcohol specialist to lead a clinic in practices once a week.
North Halifax PCN clinical director Geetha Chandrasekaran said her area had been working well, collaboratively, for some years and that the PCN process had helped to continue that process. In North Halifax musculoskeletal and phlebotomy services offered in practices and late collection of samples had an effect.
But Dr Chandrasekaran said ‘some things need to come out and change’ – and asked NHS England to provide more clarity on targets for social prescribing and other areas, IT and personalised health budgets. The Pennine GP Alliance director also urged consideration of the demands over lead clinicians, with GP resource dwindling.
Dr Stanley and Dr Chandrasekaran will speak at the BMA’s ‘Primary Care Networks… What’s Next?’ conference on 8 February. Sign up or to find out more about the event
Last year, the BMA surveyed PCN clinical directors about the process so far. The results showed that 72 per cent of clinical directors who indicated they were confident about providing clinical and strategic leadership for their network were part of PCNs where some practices had already been working at scale.
The survey also found that clinical directors who were confident about their ability to provide clinical and strategic leadership for their network were most likely to be based in medium-sized PCNs. It also found that those in medium-sized PCNs were also most likely to be confident in their ability to influence, lead and support the development of ‘excellent relationships across the network’.
A majority of clinical directors in small-sized PCNs, 63 per cent, said their workload was not manageable.
The full survey results will be released in a BMA report later this month.
Find out more about PCNs
Find out more about the NHS England survey
Submit your feedback on PCNs to NHS England
Read more from Peter Blackburn and follow on Twitter.