• NHSE planning on significant changes to its PCN specifications in bid to save policy
  • Current intentions are to drop two of five services from the 2020-21 specifications altogether
  • Care homes visiting requirements also due to be changed, HSJ told
  • GPs and PCN leaders have threatened to pull out of PCN enterprise if contract is not changed
  • NHSE says talks on “phasing… well under way”

NHS England is planning to drop altogether two of the five services it wanted primary care networks to deliver in 2020-21, in response to outcry from GPs, HSJ has learned.

GPs and others have levelled trenchant criticism at NHS England’s draft specifications for the second year of PCN operations, which were put out for consultation on 23 December. NHSE officials have publicly and privately said this feedback will lead to changes in the next iteration of the PCN specifications.

NHSE’s current plan is to drop altogether the “anticipatory care” and “personalised care” services from the 2020-21 contract specs, according to several sources with first-hand knowledge of NHSE discussions. They are likely to be pencilled in to be introduced in future years of the current five-year contract deal, HSJ was told.

It is also planning to weaken the requirement that PCNs visit care homes on their patch each week, and that every two weeks the visits should be led by a GP or geriatrician, which is part of the “enhanced care in care homes” service spec, sources said. This has been a particularly contentious component.

It is not known whether NHSE is also planning further significant changes, which go beyond these, and talks are ongoing.

Two of the proposed enhanced services in the PCN specs — enhanced care in care homes and one concerning structured medication reviews — were due to be implemented in full in 2020-21, according to the original draft contract. 

Anticipatory care and personalised care, along with a service on “supporting early cancer diagnosis”, were due to see some work start in 2020-21, but full implementation will be staged over the next four years (see details of anticipatory care and personalised care services in the box below). Their delay is likely to cause some problems delivering linked commitments from last year’s NHS long-term plan.

Senior figures in primary care at NHSE have actively addressed concerns about the specs on social media, striking a mollifying tone in the face of robust contributions from GPs.

Nikki Kanani, NHSE’s director of primary care, has repeatedly told GPs the centre will make sure their feedback is incorporated into the redrafting process. And the director of primary care and transformation, Matt Neligan, has said the centre had received “lots of feedback that tells us we need to make changes. We are committed to doing just that.”

GPs and others involved in PCNs have said the specifications are overly prescriptive and unworkable as they stand, criticising them for increasing the workload on GPs without providing them commensurate resources. Many in the profession are threatening to walk away from the PCN project altogether if the draft requirements are not changed.

Rules around what public bodies can do in the run-up to general elections stymied NHSE’s original plan to publish the draft specifications in the autumn last year, which would have given longer to respond to the consultation.

The consultation ends on 15 January when NHSE and the British Medical Association’s general practice committee are due to start negotiating the contents of the final version.

The centre is planning to publish a new version of the proposals at the end of January.

An NHSE spokesman said: “Patients are keen to see further improvements in their highly valued local GP services, and taxpayers are backing these with extra funding in line with the contract GPs agreed in January 2019.

“Discussions on the phasing of these improvements are well under way with a view to agreeing the final contract for 2020-21.”

Updated 14 January 8pm to include NHSE’s comment and detail on the anticipatory care and personalised care specs.

What are the “anticipatory care” and “personalised care” services?

Anticipatory care enables doctors to provide proactive, preventive care to patients with high needs or at risk of significant problems by analysing a population and dividing patients into different levels of risk using tools like frailty indeces.

The draft specifications would have seen this service start in 2020-21, when PCNs would have had to appoint a clinical lead for the service, start building a list of priority patients, and develop a multidisciplinary team to start coordinating care delivery to this cohort. Further delivery requirements were to be staged over the following three years.

Personalised care is a prominent priority of the long-term plan. It involves patients being given more choice and control over how their care is planned and delivered.

PCNs would also have had four years to bring in this service. They would have had to introduce personalised care plans for people eligible for anticipatory care, in care homes, and in the last year of their life. The PCNs would also have to deliver a specified number of social prescribing referrals through their social prescribing link worker, a new staff member funded through the first year’s PCN contract.