• Draft service requirements for PCNs in 2020-21 seem likely to be changed
  • Long-awaited specifications have been met with vocal opposition

NHS England looks likely to row back quickly on its proposed requirements on GPs and primary care networks, after a deluge of strong opposition from GPs and others.

Responding to criticism of the specifications which GPs would be asked to deliver as part of their PCN, NHSE director of primary care Nikita Kanani said: “The feedback is crucial and will absolutely be heard and reflected.”

Several other sources close to the development of the GP contract between NHSE and the British Medical Association’s GP committee also indicated to HSJ the draft specifications were very likely to be flexed, and that officials were not set on rigid requirements.

The draft specifications were published on 23 December with a consultation process due to run until 15 January. The network specifications are one component of ongoing contract negotiations between NHSE and the committee. Both parties have said the feedback they receive will be crucial to ongoing contract talks.

NHSE had hoped to release the draft specifications in the autumn last year, with a consultation informing negotiations leading up to the release of a final version at the end of February. But the strictures on what can and cannot be released by public bodies during an election period delayed this plan until the end of the year.

However, the BMA and NHSE are “now in the negotiating stage,” according to Richard Vautrey, chair of the GP committee.

Overloaded networks

HSJ understands NHSE is still hoping to get to a final version by the end of February, despite a call from the Royal College of GPs chair for NHSE to “take more time to properly consult with the profession”.

Martin Marshall, who has been RCGP chair since November, said the nascent networks should not be “overloaded with work before they have time to mature or they will fail”. This echoed criticism from a wide array of GPs, and others in primary care, who believe the draft specifications are unworkable given the resources available to PCNs, and the existing workforce and workload pressures on primary care.

The Berkshire, Oxfordshire and Buckinghamshire local medical committee, a body that represents the interests of individual GPs, told its members not to sign up to the specifications, regardless of the outcome of the contract negotiations, as it has “no confidence that any final version will be in the interests of practices”.

The BMA has encouraged GPs to “make their frustrations explicitly known” in their feedback to the union and to NHSE directly.

Despite the specification document stating requirements had been “phased” in a bid to avoid “overburdening” primary care networks “at an early stage”, many GPs have said delivering their requirements would put a big strain on their practices, when a GP workforce shortage means they are already stretched, and that they would have to pull out of the network scheme.

Further funding

There is additional funding for PCNs in the coming financial year, but it is ringfenced to reimburse the networks for part of the salaries of additional clinical staff. There will also be an “investment and impact fund” to reward PCNs which “go further and faster to deliver national service specifications” and “provide an incentive for PCNs to reduce unwarranted demand on NHS services, including overprescribing and inappropriate [accident and emergency] attendances”.

NHSE’s specification said: “Providing that PCNs move forward swiftly to engage new staff and use their [entitlement to funding for this], there will be significant additional capacity within primary care in 2020-21 to deliver the specifications.” In particular, this involves hiring new clinical pharmacists, who will be instrumental in delivering structured medicines reviews and enhanced care in care homes — the two service specifications that have to be delivered in full in 2020-21.

However, many PCNs have struggled to hire the pharmacists. Several reasons for this have been suggested, including a shortage of suitably trained pharmacists as well as the PCN policy increasing demand for the clinicians, which has inflated salaries being offered to them by some networks consequently pricing out others.