• Central funding for networks was meant to be a ‘floor’ for systems to build on
  • Dr Nigel Watson says more resources are essential if PCNs are to start delivering network services
  • Says recommendations from a government review of general practice “haven’t been fully embraced and implemented”

Local leaders have not provided enough support or investment to primary care networks, according to a senior GP who led a government review.

Nigel Watson, who chaired a government review into the partnership model of general practice, says local NHS systems need to offer more support to the emerging networks, on top of increased funding from NHS England.

While NHSE has promised to put £1.8bn into primary care networks by 2023-24, the five-year framework agreed with the British Medical Association in January 2019 described this as a “floor level” that clinical commissioning groups and integrated care systems “are likely to supplement further”.

Dr Watson told HSJ that some systems had provided organisational support and management training to their networks’ clinical leaders, but added: “If we want to expand services that are delivered there needs to be more resource in terms of people to do it.”

Dr Watson’s partnership review was published a year ago. It was set up to assess the challenges facing the partnership model of general practice and recommend ways to “revitalise and transform the model”.

A key recommendation said PCNs should be established and operated “in a way that makes constituent practices more sustainable and enables partners to address workload and safe working capacity”.

Stabilising the GP partnership model by 2023-24 is a central ambition for PCNs, according to NHS England. It aims to do this in part by funding 20,000 additional clinical staff to work across the PCNs to help increase the capacity of primary care.

In the first year, NHSE said it would reimburse PCNs for 70 per cent of the salary of clinical pharmacists and 100 per cent of the salary of social prescriber link workers. More clinical roles would be added to this reimbursement scheme in subsequent years, including first contact physiotherapists and physician associates.

However, few PCNs had hired the social prescribers and pharmacists until the latter stages of 2019 “and some still haven’t recruited pharmacists,” Dr Watson said. Most areas would say their additional staff have not yet started taking work off GPs, he added.

In late December, NHSE published a set of draft service requirements for PCNs to deliver in 2020-21, the second year of PCN operation. The draft was met with near-universal opposition from GPs who said the service specifications were unworkable without additional resources. There were concerns the network service requirements would take up all the additional clinical staff’s time, as well as a lot of GP time, exacerbating the strain already on practices.

Dr Watson, who is also chief executive of Wessex Local Medical Committee, identified three issues with the specifications: “One is the level of prescription and detail you’re required to deliver. Second is the lack of additional resources in terms of people to help you deliver it and at the same time take workload off of you, and third is the timescale that you’re expected to deliver it in.”

NHSE for its part said that the additional staff would be able to both deliver the specifications and support GPs in their practices. It is currently negotiating a new version of the contract with the BMA’s general practice committee after the committee rejected its first iteration.

There has been some progress on the seven recommendations detailed in his review, including resolving some of the risks attendant on taking on a GP partnership, including introducing a state-backed indemnity scheme for GPs, Dr Watson said.

But the review’s recommendations “haven’t been fully embraced and implemented,” partly because the final report was published while the government was heavily involved in its ongoing attempts to extricate the UK from the European Union.

“I think the need to make general practice a better place to work… is as important now as it was before,” he said. “We need to fix general practice. The rest of the NHS is not going to be able to deliver care to an increasing number of people with more illnesses and long-term conditions if we don’t get general practice stable.”