We’re asking Calderdale and Kirklees GPs not to sign the new Primary Care Network contract – please add your name

GPs are being rushed into signing a new, additional GP contract that ties them into a Primary Care Network. This new Primary Care Network contract aims to restrict patients’ use of the NHS.

A Primary Care Network is a big agglomeration of GP practices, mental health, community health, acute, social care, voluntary sector and outpatients’ services, each serving 30k-70K patients. Primary Care Networks are supposed to provide out-of-hospital services that make up for hospital cuts and downgrades/closures – but there’s no real evidence that they are an effective alternative. There are nine Primary Care Networks in Kirklees and 5 in Calderdale. They have been snuck in with NO public consultation.

Before 15th May, please tell your GP not to sign the contract! You can use this template letter/email , if you like [downloadable here]. (Calderdale GP contact details are here.
N Kirklees GP contact details are here.
Greater Huddersfield GP contact details are here .) Or – before midnight on Wednesday May 8th -you can sign the ck999 letter (below) that we are sending to each of the GP practices in Calderdale, Greater Huddersfield and North Kirklees. Just add your name in the comments box at the bottom of this page

The Morning Star supports our campaign. For more info about the reasons for this campaign, please scroll down past the end of the letter, to the section “Bit of background’. There’s also a downloadable individual letter here that you can amend as you see fit and give to your GP.

Open letter to GPs: Please don’t sign up to the Primary Care Network contract

7 May 2019

Dear GPs,

We are writing to ask you not to sign up to the new GP Primary Care Network contract.

Realistically, we know there’s little chance of that, because vital new money is attached to the contract – after years of damaging underfunding of GP practices.

But the GP Primary Care Network contract requires the extra money to be spent in ways that will wreck your trusted relationship with us – your patients.

And your GP practice will have little or no control over how the money is spent, since the Primary Care Network contract holder will decide on this.

14 Primary Care Networks are already being set up in Calderdale and Kirklees, in order to cut costs by delivering NHS and social care services through the so-called “Care Closer To Home” scheme.

The GP Primary Care Network Contract will nail down these changes.

Our main concerns are:

• A key aim of the Primary Care Network contract is to “manage demand” for NHS treatments. The extra money it brings must be used for Directed Enhanced Services that are designed to restrict patients’ use of the NHS.
• This risks patients’ health and safety.

We appreciate you are short of time. But if you can read on, you’ll find an explanation of our concerns.

Strings attached to the extra money

The extra money provided by the Primary Care Network contract is tied to the employment of new grades of less qualified staff, and to service specifications designed to restrict the use of the NHS by those who have the greatest need for its care: the frail elderly and those with long term physical and mental illnesses.

You will have little or no control over how the money will be allocated among member GP practices, since the contract holder will decide on this. You will also be answerable to the cost-cutting Integrated Care System, in which Primary Care Networks are considered to be a key component.

Under the control of the Integrated Care System (which has the power to enforce spending cuts across the system), you will be required to reduce referrals to hospital treatment and to follow set clinical decision protocols and care pathways. These may or may not be what you and your patients would choose on their basis of their values and circumstances. So person-centred, evidence-based care goes out the window.

Your patient consultations will be mostly limited to patients with complex needs. This will make your days unremittingly demanding; it also means you will no longer be able to build therapeutic, trusting and knowledgeable relationships with whole families over the course of their lives.

The stealth implementation of Primary Care Networks and their care models has already damaged people’s health and trust in their GPs.

The introduction of the cuts- driven “Care Closer to Home” scheme and the related development of Primary Care Networks have never been publicly consulted on. They have just been brought in bit by bit. It’s already clear that this is putting patients’ health and safety at risk.

Patients face long waits for hospital services, because GPs are apparently now unable to book hospital services for patients – including most 2 week cancer referrals. Instead the bookings go to ‘defer to provider’ – so CHFT is in charge of booking, not the patient or GP. Patients then face a wait to be contacted by CHFT and offered an appointment in 6-12 months. This leads to lots of self-funding private treatment – and massive delays in treatment for those who can’t afford that option.

Patients are suffering from lack of access to urgent care from their GPs. For example, someone with a medical emergency caused by cauda equina syndrome had to fight on the phone with an unsympathetic receptionist to get their GP to visit. When the GP arrived, they only prescribed pain killers and didn’t send the patient to hospital. When the patient asked for a scan, the GP said this would involve an 8 week wait. The patient had to resort to attending A&E, which sent her directly to Leeds for an emergency operation

We fear this is not an individual failing but a systemic problem. Changes to management of suspected spinal cord compression have been introduced by West Yorkshire and Harrogate Sustainability and Transformation Partnership – now an Integrated Care System.

These changes make for delays in GPs sending patients with suspected spinal cord compression to hospital for an urgent scan – even though delays to treatment of spinal cord compression can lead to permanent loss of neurological function and immobility.

Cost-cutting is at the root of these problems. Decisions about patients’ treatments are now based on financial considerations, not clinical need.

Last year, West Yorkshire and Harrogate Joint Clinical Commissioning Committee decided to cut elective Musculo-skeletal treatments treatments by 10%. This was on the basis of recent ‘Right Care Commissioning For Value’ packs that identify significant spending cuts to be made from restricting patients’ admission to hospital for such treatments.

Increasingly, GP practices no longer provide same-day appointments. Instead patients must now attend a morning walk-in clinic where they can wait hours to be seen. Then they may find themselves in a consultation with a Community Pharmacist, who seems to struggle to follow some kind of diagnostic questions checklist and to be well out of their depth in terms of reaching a diagnosis and identifying appropriate treatment.

Some of us no longer even know who our GP is, it’s so long since we’ve been able to see them.

Please reject the Primary Care Network contract

We deeply regret that GPs have been put in such an invidious and distressing position by the government, its quangos, local NHS commissioners and your own trade union, the BMA. We are doing everything we can to oppose their actions, and to make sure that adequate funding is restored to a fully accountable, publicly funded, run and provided NHS.

We hope that GPs can find the collective strength to do the same and reject this GP Primary Care Network contract. It will only make an already bad situation worse.

Yours,

Jenny Shepherd,
Chair, Calderdale and Kirklees 999 Call for the NHS

Rosemary Hedges, CK999

Chrissie Parker, ck999

Bit of background

For years now, Calderdale and Kirklees 999 Call for the NHS and other groups have been campaigning to stop and reverse the hospital cuts and centralisation plans for Calderdale and Kirklees.

These plans also involve moving many services out of the hospitals into the “community” – aka Care Closer to Home.

GPs will no longer be able to send many of their patients to hospital – and lots of things that used to be done in hospital will have to be carried out in GP practices, grouped into large scale Primary Care Networks along with mental health, community health, acute, social care, voluntary sector and outpatients’ services.

The Primary Care Networks are key building blocks of the new Integrated Care Systems – formerly called Accountable Care Systems, but renamed by the government last year in order to hide their origins in the USA’s Medicare/Medicaid System. This provides limited publicly-funded healthcare for people who are too poor or ill to pay for private health insurance.

There is no real evidence that this way of providing health and social care improves the public’s health or cuts costs – although both claims are made for it. In fact there is a lot of evidence to the contrary.

The overall intention is to cut costs and restrict patients’ use of the NHS -despite official spin that the aims are to “wrap care around the patient” and “improve population health outcomes.”

In Calderdale and Kirklees 14 large scale integrated primary care networks are being set up, each to serve around 50K patients.

Some information about this was included in the January 2019 progress report on Future Arrangements for Hospital and Community Services in Calderdale and Huddersfield, that Calderdale and Greater Huddersfield NHS Commissioners and the Hospitals Trust has sent to the Secretary of State for Health and Social Care.

This report was scrutinised by Calderdale and Kirklees Joint Health Scrutiny Committee on 15 Feb 2019. At the meeting, ck999 asked the NHS Commissioners several questions about the Primary Care Networks. We didn’t get any answers.

Now the new GP Primary Care Network contract will cement these Primary Care Networks.

• You can read more about the Primary Care Network contract here .
• You can read more about the creation of Primary Care Networks in Calderdale here and in Kirklees here.