Paul Evans

Plans to boost GP and community services have ignited a fiery reaction from GPs and led to a fast climb down from NHS England. The controversy leaves key proposals for Primary Care Networks hanging in the balance.

Responding to an announcement before christmas, 70% of GP leaders said in a survey this month that the targets set for the newly formed partnerships of GP practices – known as Primary Care network (PCNs), were “impossible” to achieve.

Opposition has grown rapidly since NHS England released more details of its plans for primary care. PCNs are one of the main pillars of the NHS Long Term Plan and such a strong reaction against the new scheme will be a big blow to NHS leaders as they concede the need for a re-think.

Concerns centre on a lack of money and insufficient staffing levels to support the additional activities which the new partnerships of local GPs are being asked to perform.

The British Medical Association is due to enter further talks on the contract, but growing numbers of their members are already publicly rejecting it.

Dorset’s 18 PCNs have opposed the draft plans while more than 1,000 GPs have signed a petition calling for the “impossible” targets to be scrapped.

Eight out of ten of the 447 GP partners asked by PULSE for their views, said they would not agree to signing the proposed contract.

Primary Care Networks: What’s the idea?

Unrealistic plans

The new contract would require PCNs to do extra work across seven categories including reviews of all patient medication and more visits to care homes.

Many GPs feel that just don’t have the capacity, but they are in a double bind though as only those GPs who sign up to the Primary Care Networks will get access to the government’s £1.8bn pot of extra funding.

In an analysis of the impact of the new plans in their area; Berkshire, Buckinghamshire and Oxfordshire LMC estimated that each of their GP practices would end up with deficits of £100,000 a year.

In theory extra funding from the government should help to fund additional staff, but this only meets 70% of the cost and there is a considerable time burden in organising all the extra work and recruiting the staff to do it.

This LMC’s report concluded that “These specifications carry an extremely high workload that would be impossible to deliver based on available workforce which exists within the health system.”

Doubts amongst backers
Even supporters of the PCN concept are expressing doubts.
The National Association of Primary Care (NAPC) says that draft service specifications are ‘too early and too detailed”, heavily implying top down interference.

The Kings Fund think tank reinforces the view that some fundamental issues must be addressed  before PCNs can move forward.

“The urgent action needed to stabilise general practice, by addressing workload and workforce issues, raises important questions around the timing, implementation and pace of these new service specifications.”

Conflicting objectives
The government has made it clear that a key objective of this change is to achieve cost savings, by steering patients away from hospital towards community based care. In recent weeks GPs at all levels are offering them a reality check.

This week, NHS digital published figures showing that GP practices delivered 3.8 million more appointments than last year, despite GP numbers remaining static.

The strong message being sent to NHS leaders can be paraphrased as ‘don’t ask any more from us, General Practice cannot work any harder’. And their demand to the Government is simple: put in the proper funding and allow us time to increase capacity and staff numbers before asking us to cope with a whole new stream of patients redirected from hospitals.

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director of the NHS Support Federation

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