Intended for healthcare professionals

Rapid response to:


New primary care network contract won’t work, GPs warn

BMJ 2020; 368 doi: (Published 07 January 2020) Cite this as: BMJ 2020;368:m39

Rapid Response:

Re: New primary care network contract won’t work, GPs warn

Dear Editor,

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

13 January 2020
Kathryn E Brown
GP and Clinical Director SEOxHA PCN
SEOxHA PCN including partners of the Leys Health Centre; Dr Eleri Shellens, Dr Louise Gardner, Dr Bridget Greer and Dr Lucy Minden and Salaried GP Dr Mel Phillips; partners of Donnington Health Centre; Dr Sharon Dixon, Dr Stephen Willis, Dr Petra Bohme-Kahn, Dr Anne Prendergast, and Dr Gillian Howe; partners of Hollow Way Medical Centre Dr Martin Fleminger, Dr Louise Bradbury, Dr Robert Bennett, Dr David Chapman, Dr Alison Maycock and Dr Helen Roskell and partners of Temple Cowley Medical Centre; Dr Andrew Wilson, Dr Ruth Wilson and Dr Hilary Nowell and practice managers Clare Messenger and Daniel Freeman