The must-read stories and debate in health policy and leadership.

PCN predicaments

Things have got rather heated in the world of primary care and general practice in the last week or so. The cause? NHS England’s new draft outline service specifications for the second year of primary care networks.

They had been published on 23 December for consultation, with NHSE asking GPs and others in primary and community care to send in their feedback by 15 January — this coming Wednesday. The specifications are the outline of what NHSE wants PCNs to deliver in the coming financial year, the product of nearly a year of work by NHS policy wonks and working groups made up of interested parties.

GPs had the Christmas and New Year period to chew over the proposals before giving their verdict: a resounding “no”.

They contain requirements that are unworkable and unfunded, they said; they will put an intolerable strain on general practice when it is already creaking at the seams; they are too prescriptive when the PCN scheme is meant to be focussed on places and localities. If they are carried through as is, GPs will drop out of the PCN project entirely, the doctors warned.

The final version of these specs is yet to be agreed, with negotiations ongoing between NHSE and the British Medical Association’s general practice committee. And the NHS has been clear it will be flexible, with officials promising the feedback will shape the next draft.

Given the strength of feeling, NHSE cannot simply tinker around the edges of this draft. But it cannot rip it up and start again either, as some have called for.

There’s a tight timetable to contend with. The plan was originally to have the draft out for consultation in the autumn and the final version done in February. The election nixed that schedule but the need to have this finished as soon as possible remains.

GPs need to start delivering the specs in April, and probably neither NHSE or the GPC will want the public row to rumble on. Given the strength of feeling excited by the first draft, they will have to become a lot more deft if they are going to deliver, in short order, a version the GP workforce can find palatable.

Time is of the essence

How quickly should the NHS respond to a call from someone who is threatening to take, or who has already taken, an overdose?

The answer from many members of the public might be that these calls should be treated as emergencies with the fastest response approach possible. But many overdoses take a long time to take effect and, consequently, such callers may be treated as a category three call by ambulance services with a slower response than the 18 minutes expected of a category two.

But, as HSJ’s story on Monday demonstrates, sometimes the pressure on ambulance services will mean that category three calls won’t get a response for several hours — and that may make a difference.

In two cases, women who had taken overdoses were dead by the time an ambulance crew reached them. In Maureen Wharton’s case, it was nearly four hours before the ambulance crew reached her, even though she said she had taken an overdose on her initial call, and had then called back, appearing more drowsy. The coroner in her case has taken the unusual decision to issue a prevention of future death report to North East Ambulance Service Foundation Trust before the full inquest has been heard.

In the second case, it took over six and a half hours to reach Lincolnshire woman Helen Barker, who had called East Midlands Ambulance Service Trust saying she intended to take an overdose. Pressure on the service also seems to have affected the “welfare calls” she should have received in this time.

Similar deaths and concerns raised by ambulance services themselves have led to NHSE emphasising the importance of clinical oversight of responses to calls like these, and the need to consider upgrading calls to ensure a faster response. But incidences such as these also demonstrate how challenging it is for ambulance services, who are dealing with an unprecedented number of call outs, to respond appropriately in every case.