Intended for healthcare professionals


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
  1. Gareth Iacobucci
  1. The BMJ

A proposed new contract for general practices to participate in primary care networks contains unrealistic demands and will pile new layers of bureaucracy on overstretched practices, GPs have warned.

NHS England and NHS Improvement published draft service specifications for the primary care networks directed enhanced service (DES) in a consultation released on 23 December.1 Practices that sign up from April 2020 will be required to provide five national services over a phased period of a year.

The draft document stipulates that from September 2020 GPs will have to visit patients in care homes at least once a fortnight as part of an enhanced care service in residential homes. And from April 2020 primary care networks will be expected to initiate structured medication reviews for the patients most likely to benefit, including all those in care homes.

It also states that general practices must produce plans for providing anticipatory care and personalised care services by no later than June 2020, have a clinical lead in place to provide a service to support early cancer diagnosis from April 2020, and introduce a “safety netting approach for monitoring patients referred for suspected cancer” in 2020-21.

Nearly all general practices (99%) signed up to the new network DES last year as a way to get additional funding for collaborating in networks.2 In the first year the only major stipulation was for practices to join a network.

But since details of the draft contract emerged GPs have warned that it would be almost impossible for some practices to deliver, because of the short deadline.

Helen Salisbury, a GP in Oxford and BMJ columnist, criticised the “micromanagement” and the “hopelessly unrealistic” demands being made. “There is a ridiculously brisk timetable. The staff haven’t been recruited and would need training. If you look at the number of things they want networks to do, it’s a huge amount of extra work,” she said.

Mike Smith, a GP in St Albans, Hertfordshire, took to Twitter to urge GP colleagues to respond to the draft document and for the BMA to intervene. “If this contract goes through it is a large nail in the coffin of the future of general practice,” he warned.3

Smith told The BMJ, “Although I support the principle of helping vulnerable groups, the ask is too much, given the pressure of general practice, particularly the care homes part of the specification. We are giving serious thought to pulling out of PCNs [primary care networks] altogether, which, although it will be financially punitive, may be the better option in the long term.”

Joe McManners, a GP in Oxford and clinical director of a primary care network, said that excessive performance management could “kill PCNs at birth.” He told The BMJ, “I am an enthusiast, but I have a genuine worry that going too hard too fast on the contractual side kills all that enthusiasm and stops PCNs from fulfilling their potential.”

The consultation runs until 15 January. The final version will be published as part of the GP contract for 2020-21, after negotiations between NHS England and the BMA’s General Practitioners Committee.

Krishna Kasaraneni, a member of the committee’s executive team, tweeted about the concerns raised: “We are receiving a lot of feedback on this . . . it is important for colleagues to respond to the consultation so that we can act on it.”4

In its document NHS England says that it will “continue to develop and refine the proposals . . . in response to feedback from patients, clinicians and organisations.”