GPs warned vote against Primary Care Network contract could mean non-GP providers get the contract and funding

GPs in England have until midnight on January 19th to vote on whether they think the Primary Care Network Directed Enhanced Service contract should continue and inform the British Medical Association’s future negotiations with NHS England.

But it seems that the quango NHS England is ready to use strong arm tactics against a No vote. In a video to GPs, the British Medical Association GP Committee Chair Richard Vautry says the consequences of a “No” vote could include NHS England giving the DES contract and funding to non-GP NHS providers. This is a rather big stick to wave at GPs.

Aren’t the British Medical Association basically the GPs’ trade union and meant to back them up in negotiations with the bosses?

Update 22 Jan 2021 On 21 Jan the British Medical Association reported:

Voting has now closed, and the results are as follows:

‘Prior to any further negotiations, extension or changes for 2021/22, do you give GPC England a mandate for the PCN directed enhanced service?’

Yes: 80%
No: 20%

Total valid votes: 4,534

GPC England will now proceed with negotiations on the PCN DES for 2021/22.

On the same day, the British Medical Association and NHS England agreed that only minor changes should be made to the Primary Care Network Directed Enhanced Service contract for 2021/22. This is because of

“the huge pressure on practices and need to prioritise work related to the pandemic response – including the delivery of the vaccination programme.”

Local Medical Committees Conference resolved to seek democratic mandate for the contract

This vote is being held because the November 2020 conference of local medical committees in England passed a resolution that:

“Conference notes that the BMA GPC (GP committee) England has never secured a robust democratic mandate for the PCN DES and so again asks the GPC England to secure a firm mandate from the entire profession by means of ballot before negotiating any extension or changes to the PCN DES for the year 2021 / 2022.”

The British Medical Association GP Committee are therefore holding a vote of the GP profession on whether GPC England should continue negotiations on the Primary Care Network Directed Enhanced Service contract. It says,

“Due to the potential impact upon the third year of the current five-year GP contract agreement, the vote is being held in early January ahead of any further contractual negotiations on the PCN DES before April.”

Primary Care Networks: no solution to GPs’ chronic underfunding and understaffing

After years of GP underfunding and understaffing, the Primary Care Network Directed Enhanced Service was introduced in 2019 as part of the five year contract framework agreed by the British Medical Association GP Committee England and NHS England.

Calderdale and Kirklees 999 Call for the NHS urged local GPs not to allow themselves to be rushed into the Primary Care Network contract.

As key building blocks of the contentious Integrated Care Systems that are to fragment the NHS in England into 42 regional units by April 2021, 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. Instead, Primary Care Networks are designed to restrict patients’ access to professional health care – under the rubric of “managing demand” and “empowering” patients and their family and friends to “self care”.

And isn’t a big lesson from this pandemic that NHS hospital beds, staff and Intensive Care Units have already been cut far too much for safety? We really shouldn’t be looking to make more hospital services cuts. There is something deeply wrong with the whole cost-cutting redisorganisation of the NHS that has called Primary Care Networks into existence.

While the Primary Care Network Directed Enhanced Service contract does not formally require GPs to restrict patients’ access to NHS elective care, the extra money it brings into GP practices is tied to specifications that require reductions in the use of the NHS (as well as the employment of less-skilled auxiliary health care staff). The contract contains an irresponsible and potentially detrimental incentive for GPs to make fewer referrals, with GPs unlikely to ignore this incentive since their contract and funding depend on it.

Basically as far as Calderdale and Kirklees 999 Call for the NHS can see, GPs have been starved of funding and workforce and then told if they sign up to a ‘managed care’ contract that requires them to restrict patients’ access to planned hospital care, they will get additional funding and more (lower-grade) staff to do a lot of the routine patient care, manage medicines (ie reduce prescribing costs) etc. They basically had their arms twisted big time to shift to this contract.

These are the “additional roles” planned for the five Calderdale Primary Care Networks.

Calderdale Clinical Commissioning Group reports that West Yorkshire and Harrogate Integrated Care System has received £1,885,500 for Primary Care Network Development in 2020/21, to be divided between the 52 Primary Care Networks – working out at £36,260 for each Primary Care Network. Not exactly sure what Primary Care Network Development covers.

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