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Constituent Response to Draft PCN DES Specifications

Publication date: January 2020

Based on feedback received from our constituents, Humberside LMC has submitted a response to the draft service specifications for the PCN DES which were published in December 2019: 

'Constituents are generally supportive of any initiatives aimed at improving patient care by reducing inequity of access and quality of care and can see clear benefits to working together practice to practice but also locally across disciplines. The current draft PCN specifications however are unacceptable to our practices, and if not modified we will be advising practices not so sign up for the 2020/2021 PCN DES.

Our practices believe that PCNs were designed to address the legacy of underfunding in primary care, not to force practices to take on additional services. There are serious concerns about lack of funding and the capacity to do the extra work and it appears that much is dependent on additional staff freeing up capacity to take up the extra services and working with other providers. Recruitment into additional roles has been limited by the available skills resource in our locality and the financial capacity of their organisations to subsidise the new role funding. As a result, the majority of PCNs in our localities have been unable to draw down their full additional roles reimbursement funding. The additional roles have an ongoing cost to practices, in both monetary terms and in terms of time for training. Despite the 100% funding for social prescribers, there is also an impact where CCGs provide a maximum figure which is below the salary range locally. 

Our GPs feel that it is critical that PCNs are not set up to fail by taking on too many tasks too quickly. Many PCNs are still being supported to deal with issues such as resource, funding, data-sharing and organisational development. The risk in driving through new service specifications is that disillusionment following over-inflated expectations, as well as time-limited funding and support, leaves general practice in a worse position. It is also impacting on GPs nearing retirement seeing this as a catalyst that precipitates them leaving practice, so further increasing the resource problem.

The LMC are concerned that by negotiating these DES specifications as a component of the overall GMS contract negotiations, it presents a risk that other components of the main negotiations will be significantly detrimentally influenced. More specifically our constituents have called for:

  • Time to develop more capacity to address the workforce legacy before committing to additional specifications.
  • Specifications which have new supporting funding and can be delivered with the resources available in the PCN’s locality.
  • A phased implementation of specifications which is achievable and commensurate with the development of supporting resources, and PCN maturity
  • Meaningful and detailed consultation on any future specification proposals with a wider representative GP group and the negotiated specifications subject to a vote by the profession; the questions in the current consultation are unhelpful as a feedback mechanism
  • PCNs to remain focused on the wider workforce and their original ethos to move work away from GPs; GPs should not be asked to do any additional work without dedicated funding being included for this
  • Future PCN DES changes to include a cost: benefit analysis for each specification, to ensure they are financially viable for practices to take up

In summary, the draft specifications were described by our LMC committee as “The single most depressing document for a decade…didactic, central command and control that does nothing to alleviate workforce pressure…it feels like NHSE just don’t care.”'

The response was submitted as part of the consultation on the proposals which closed on 15 January 2020.