A PCN storm

The first full week after the Christmas and New Year bank holidays usually comes as a jolt to the system.

And this year – given the strength of feeling NHS England provoked with its outline, draft contract for the second year of primary care networks – this was surely no less true for NHSE’s primary care contract negotiators.

PCNs were launched as entities on 1 July last year and their first “year” of operation ends on 31 March.

They were formed with haste in the spring and summer last year but with the promise that their first nine months would be light on service demands, giving them time to develop relationships between their constituent partnerships, and between PCNs and others.

The relationships will be crucial to delivering the services that were to begin in year two, which was always going to be a little more onerous. The five-year framework for PCNs, published this time last year, said five new network services would come on stream in April 2020.

NHSE had a timetable set out to provide GPs with greater detail of what these five services would entail in good time – they wanted to have them out in the autumn, giving GPs scope to consider them and feedback their views before NHSE negotiated the final contract with the British Medical Association’s GP Committee in time to deliver the services from 1 April.

Unfortunately, the first December election in over 90 years interfered with these best-laid plans. The pre-election rules meant NHSE had to wait until after the ballot to publish its draft contract.

The paper was put out on 23 December and it seems many used the Christmas break to chew over the details, reserving judgement until everyone was back to school after the break. And the GPs who have voiced their views publicly have provided some uncompromising responses.

The service specifications NHSE wants PCNs to deliver are unworkable, GPs have said. They ask too much, too fast of the nascent networks that have yet to cement those relationships much too fast, without any additional resources to support their overburdened practices. If things do not change, many GPs have said they will wash their hands of the PCN project entirely.

NHSE officials have been working hard to reassure GPs they will listen to the feedback and incorporate it into the next version of the contract, which will be changed to reflect the profession’s concerns. The consultation period for the contract has now finished and the NHS and BMA are thrashing out what they hope will be the final version.

There will need to be flexibility on both sides. Networks cannot only be about providing GPs with the means to bolster their practices. But networks will fail if enough of the GPs they rely on refuse to take part in the extra work that’s asked of them.

NHSE is as of this week planning on taking out two of the five services it wanted PCNs to deliver in year two, pencilling them in to be delivered in subsequent years of the agreement, and watering down requirements for GPs visits to care homes.

This may be sufficient to address concerns that the specifications call for too much work too early in PCN development. And it could be enough to demonstrate to GPs that NHSE is listening, and not just preparing to tinker with specs before pushing them through.

But it may not be enough to address concerns from some senior figures in general practice that the specifications as a whole are too prescriptive, inflexible to the varying pace at which PCNs will be able to deliver services, and potentially stifling of local innovation. The Royal College of GPs, in particular, has made things difficult by calling for an across-the-board slowdown.

Time is short for the NHS and BMA, with the ambition to have something finalised by the end of the month, we are told. Not just the success but potentially the very existence of the PCN project relies on their ability to find a new contract that is palatable to your typical GP, while also starting the delivery services that are central to the long-term plan and its intentions to reform the wider health system.