NHS England launched a consultation just before Christmas on draft service specifications for five areas of clinical work that Networks are due to start delivering from April 2020.
The specifications have provoked a backlash from GPs concerned the proposals involve an unmanageable increase in workload and are inadequately resourced, with Primary Care Network (PCN) leaders and LMCs warning practices not to sign up to the Network contract DES in its current form.
A Pulse survey found that four out of five GP partners would choose not to sign up to the Network DES if the services go ahead as planned, and one LMC has warned that the proposals risk destabilising practices, estimating that individual practices could lose over £100,000 a year if the plans go ahead.
The consultation has now closed and the BMA and NHS England are set to negotiate the final contents of the specifications.
NHS England officials have hinted that they are prepared to roll back on certain specification requirements in a bid to bring practices on board.
In particular there are reports that measures in the ‘Enhanced health in care homes’ specification could be watered down, including a requirement for two-weekly visits led by a GP or geriatrician.
However, RCGP Chair Professor Martin Marshall has written to NHS England chief Simon Stevens calling for a delay and urging NHS England to begin the whole process of developing the specifications again from scratch.
And the BMA GP Committee (GPC) for England has now voted to reject NHS England’s contract deal. The GPC will now hold a special conference of LMCs to debate the future of Networks.
GPC England chair Dr Richard Vautrey said: ‘The message from GPs in recent weeks has been a clear one: proposals put forward by NHS England and NHS Improvement before Christmas have clearly been judged by the profession as unreasonable, and completely unachievable.’
Dr Vautrey added that frontline GPs clearly felt the proposed specifications would ‘pile more pressure’ on already overloaded teams and would ‘undermine primary care networks that are only just getting off the ground’.
He said: ‘Even in the short time GPs were given to respond to the consultation, NHS England and NHS Improvement were overwhelmed with feedback, which was unanimous in its condemnation.
‘Now GPC England – which is elected to represent GPs across England – has made its own position clear and we will now go back to NHSE/I to seek a way forward.’
Below is a summary of what is in the draft consultation document.
The new five-year GP contract introduced in 2019 stipulated that the new Networks DES would introduce seven ‘national service specifications’ beginning in April 2020.
Five of these are due to start in April, as follows:
The draft proposals state that the top two specifications – structured medication reviews and optimisation, and enhanced health in care homes – will be implemented in full from April.
The other three specifications are to be phased in over the next four years, with details subject to GP contractual negotiations each year.
PCNs will appoint a clinical lead for each specification who will be responsible for its delivery.
NHS England says it is confident the specifications ‘are supported by a strong clinical evidence base’ and ‘will enable PCNs to draw upon the partnerships with other providers that are at the heart of the network philosophy’.
There is no dedicated funding for delivering the specifications, but funding for the Additional Roles Reimbursement Scheme, which reimburses Networks for costs of employing allied health professionals, is meant to support their delivery while still alleviating wider workforce pressures.
NHS England says the additional roles funding (worth a total of £257m in 2020/21 rising to £891m in 2023/24) will support the deployment of over 6,000 additional staff by 2020/21, rising to over 20,000 by 2023/24.
For a typical PCN of 50,000 patients, that could equate to around five additional staff in 2020/21 and around 16 additional staff by 2023/24.
Furthermore, it says that from April, an average PCN might engage:
3 WTE clinical pharmacists
1.5 WTE social prescribing link workers
0.5 WTE physiotherapists and
0.5 WTE physician associates.
This, the document states, ‘would provide more than sufficient capacity to deliver the requirements across all five services with significant capacity remaining for these additional roles to provide wider support to GP workforce pressures by handling appointments or queries that would otherwise have been the responsibility of the GP’.
Networks are also expected to use the funding allocation for Network participation, worth around £14,000 per practice per year, and the Network administration payment worth £1.50 per patient and 0.25 WTE salary funding for the Clinical Director, towards delivering the specification. Taken together this provides ‘over £109,000 for a PCN covering 50,000 people’.
Meanwhile fast-track PCNs are promised extra funding through a new Investment and Impact Fund (worth a total of £75m in 2020/21, rising to £300m in 2023/24) for making ‘strong progress in delivering the service specifications’. An average PCN could secure funding of around £60,000 a year in 2020/21 through this fund.
To read a summary of each service specification follow the links below.
Structured medication review and medicine optimisation
Enhanced health in care homes service
Supporting early cancer diagnosis service
You can download the full draft service specification document here.
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