The BMA’s England GP committee has voted not to accept a contract agreement with NHS England and condemned the recently-published draft service specifications outlining what is expected of Primary Care Networks over the next four years.
Members of the committee, who met in London on Thursday 16 January, were presented with a package of changes but voted against accepting them. The GPC’s executive team will now return to negotiations with NHS England. Details of the package remain confidential.
A separate motion* condemned the draft service specifications, put forward by NHS England and NHS Improvement in December, and called for a Special Conference of English LMCs to allow GP reps from across the country to debate and consider the outcome of contract negotiations.
Since the specifications were released for consultation at the end of December, the feedback from GPs was overwhelmingly negative, with practices concerned at the levels of workload involved, especially for those networks that were struggling to recruit additional staff.
BMA GP committee 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 were inappropriate, unreasonable, and completely unachievable.
“At a time when demand and workload for practices are unprecedented, GPs working on the front line felt these draft specifications piled on more pressure and risked destabilising general practice entirely.
“This overload would also put in jeopardy all of the good work and progress PCNs have already made for the good of both staff and patients.
“Even in the short time GPs were given to respond to the consultation, NHS E/I 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 demanded that policymakers engage properly with GPs working on the frontline.
“This is not the end of the process, and we will now go back, with a clear mandate from our colleagues, to negotiate a deal that truly benefits and safeguards general practice, family doctors and their patients.”
*You can read the full text of the motion at https://www.bma.org.uk/news/media-centre/press-releases/2020/january/bma-gp-committee-england-votes-down-contract-package-and-calls-special-conference.
We will keep you informed of further developments with this issue.
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.
NHS England is seeking feedback on the five national service specifications, of the GP contract framework, which will be delivered by primary care networks (PCNs) - in collaboration with community services and other providers - from April 2020.
The GP contract framework set out seven national service specifications that will be added to the Network Contract DES: five starting from April 2020, and a further two from April 2021. The five services are:
• Structured Medication Reviews and Optimisation
• Enhanced Health in Care Homes (jointly with community services providers)
• Anticipatory Care (jointly with community services providers)
• Personalised Care; and
• Supporting Early Cancer Diagnosis.
The LMC's position on the specifications is set our in our advice update which can be downloaded here.
There are a number of opportunities to share your thoughts on the outline draft of the service specifications. Please note there is a tight timescale to submit responses.
• The document is available online here, with a number of questions to be answered to help shape the final service specifications. This will be live until 1pm on 15 January 2020.
• A series of facilitated interactive webinars will be taking place as follows:
• Wednesday 8 January 2020 – 12 noon-1.30pm
• Thursday 9 January 2020 - 10am-11.30am
• Tuesday 14 January 2020 – 3pm-4.30pm (focusing on the community services elements of the Enhanced Health in Care Homes and Anticipatory Care service specifications, aimed at directors and chief executives of community health providers).
Nikki Kanani will be hosting a Twitter chat on 7 January 2019 specifically about the service specifications. Follow #primarycarenetworks from 8pm and join in the conversation and share your views.
Should you have any questions, please contact email@example.com.
The Joint Committee on Vaccination and Immunisation (JCVI) published its advice on the use of influenza vaccines for the 2020/21 influenza season in September 2019. The guidance covers:
- adults who are 65 and over
- at-risk adults (including pregnant women) and children for whom there are contraindications for use of LAIV
The guidance can be downloaded here.
In December 2019 the JCVI published follow-up advice on the 2020/21 vaccination programme and reimbursement guidance for 2020/21. This latest guidance can be downloaded here.
The December issue of the LMC newsletter is out now and available to download. In this final edition of 2019 you will find all the latest news, events and opportunities including:
- New LMC events in 2020 including a premises seminar with Capsticks solicitors
- News regarding GP direct access to diagnostic services - managing patient care and investigations
- Registration of individuals leaving the secure residential estate - guidance for practices.
Humberside LMCs today publishes its manifesto for general practice.
Workforce and wellbeing
• We need to retain the excellent workforce we have and recruit new GPs by widening the bursary funding to attract doctors to parts of our region where there have been consistent shortages of trainees. The LMC welcome work force investment benefitting every practice to support the training of current reception and clerical staff to play a greater role in navigation of patients and handling clinical paperwork to free up GP time.
• In our August survey GPs told us that high workload, fear of complaints and low staffing levels are leading to low morale & burnout across the profession. The LMC would believe we need continuous funding for resilience support for GPs and the wider medical and support workforce in primary care.
• The LMC believe that primary and secondary healthcare providers in our region could work better together. We know there is a willingness from practitioners across our system to communicate, integrate and evolve to provide a better patient care experience. The LMC want to work with commissioners and providers to improve this integration and invite all stakeholders to embrace this opportunity.
• The pensions taxation crisis means that doctors are being forced to turn down vital extra shifts caring for patients in our under-pressure GP surgeries because they would be literally paying to go to work. Doctors are trapped in a dilemma between wanting to care for patients and not wanting to end up financially worse off. The LMC support the work of the BMA to lobby Government to deliver pension taxation reform and for pensions administration to change to offer a responsive, timely and accurate service to GPs.
• An historical underinvestment in premises and increasing demand for accommodation for new PCN roles is placing an unsustainable demand on our primary care estate. The charges levied on premises are frequently difficult to understand and non-negotiable. The LMC would like long term realistic capital funding to meet the needs of patient care and a premises charging administration which is responsive, transparent and fair.
IT and Infrastructure
• The LMC is concerned about the impact of digital health providers on our local system. Continuity of care lies at the centre of traditional general practice, with local surgeries providing person-centred care from the heart of communities. We would highlight the risk that digital only practices poses to this and want to see a well-integrated and mixed provision which serves the need of all of our patient population.
• Effective primary care should be built on a stable and integrated IT platform. The LMC supports a case for fast and reliable infrastructure integrated across the whole healthcare system with controlled access to patient records by all practitioners.
The November issue of the LMC newsletter is now available. Included in the latest news, updates and events:
- Invitation to complete our 2019 LMC survey
- A number of medication supply alerts practices need to be aware of
- Changes to the the community pharmacy contract and patients with diabetes