New primary care network contract won’t work, GPs warnBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m39 (Published 07 January 2020) Cite this as: BMJ 2020;368:m39
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
We agree with the concerns cited in your news article “GPs attack draft primary care network deal”. While the aspirations may be well-intentioned, we believe that their requirements far outstrip our primary care capacity, both at a practice and PCN level. The contract provides support for other staff members to join the primary care team (if you can recruit them, we have not been able to), however all of the contract specifications explicitly require GP time and work.
For us, this begs the question; what will the opportunity cost of this contract be (if implemented as it currently stands)? Although this contract nominally sets out to ease workforce pressures on primary care, achieving the stipulations of this draft PCN contract for us would necessitate taking GPs away from the clinical front line, increasing pressure on GPs workload and increasing waiting times for patients to see GPs.
However, our greatest concern about these draft specifications is their potential impact in significantly worsening existing health inequalities. As GPs working in a PCN with high levels of deprivation and multi-morbidity (within an affluent county), we are very distressed at the lack of apparent consideration of equity in these draft specifications. We identify no mechanism in this contract to ensure that care and resources are utilised equitably.
PCNs in socio-economically deprived areas with higher levels of multimorbidity, poor health at a younger age, and poor health literacy will have a higher workload resulting from the DES- more patients needing SMRs, higher numbers of patients needing anticipatory care and more patients needing care plans. We are concerned that this higher workload will further exacerbate our current difficulties with recruitment and retention.
If PCN payment and resource provision continues to be allocated on a per head of PCN population basis, without a robust, mandated, and transparent mechanism to ensure that reimbursement matches work done; then we are concerned that this specification risks grossly worsening health inequalities. This gross homogenisation of PCNs, resource allocation and care, is apparent throughout the document and we believe risks further de-stabilising primary care.
We implore NHSE to listen to GPs feedback, and think again about this contract. It is our grave concern that without urgent revision and consideration now, they risk exacerbating an already critical level of health inequalities.
Competing interests: No competing interests
Working through the specifications of the proposed Direct Enhanced Service (DES) for Primary Care Networks (PCN) it is clear that the workload will be completely unmanageable. The resources, even if available, do not cover what is being asked of General Practitioners.
Berkshire, Buckingham & Oxfordshire LMC’s have analysed the proposals and estimate it will cost over £100,000 to a practice of 10,000 patients to provide the service.
In my area, where there are more numerous care homes than the average, the cost and workload will be far greater.
Accepting this DES will exacerbate the crisis in general practice and the only alternative is to resign from your PCN.
Where has the BMA and RCGP been in protecting our interests? There appears to have been no scrutiny or understanding of the workload involved despite the DES reaching an advanced stage.
I fear for the future of general practice under our present leadership.
Competing interests: No competing interests