GPs worry that additional staff hired by primary care networks (PCNs) will have no time to take on core general practice workload despite practices paying tens of thousands of pounds towards their salaries
This is an edited version of an article first published by GPonline.
Draft specifications published by NHS England before Christmas outline requirements for five services set to be added to the network contract DES from April 2020 – covering structured medication reviews, support for patients in care homes, anticipatory care, personalised care and early cancer diagnosis.
But doctors running PCNs have warned that the volume of work required to deliver these services from ‘additional roles’ staff hired by the networks could mean they have little impact on reducing existing GP workload – something they believed new recruits would help to address.
With practices contributing up to 30% of the wages of some additional staff taken on by PCNs, GPs have warned that those who do not see the draft specifications as good value for money could pull out to save time, effort and money.
Their warning comes after clinical directors warned last week that a failure to properly resource PCNs and overburden staff could lead to the collapse of networks.
Clinical director of Newham PCN Dr Farzana Hussain said she struggled to see how additional staff hired by her PCN would help to reduce reduce pressure on general practice with ‘all the added asks’.
“We thought that the clinical pharmacist we hired was here to help us with our general practice work, we thought that we were going to be able to do repeat prescriptions together as a network by working with the pharmacist. But where has all that gone?
“That’s what we thought the additional roles were for, and that’s why we were happy to put in 30%. Otherwise, why would we have paid 30% for something that is also the responsibility of the care home and the community trust, not just primary care.”
She added that the draft specifications had to be changed to prevent GPs from walking away from PCNs, which went live in July last year.
Primary care networks
“We are still at such an early stage PCNs are only six months old,” Dr Hussain said. “There’s a lot of enthusiasm, but with something like this we don’t want to push it so far that people think: “I can’t be bothered, I’m not going to do this…” and then we don’t make any meaningful change at all.”
Nottingham GP and clinical director of Nottingham City East PCN Dr Hussain Gandhi said doctors had to see the benefits of hiring additional staff to continue to believe in PCNs. He added that the draft specifications gave additional roles staff too much work.
“PCNs were designed to stabilise primary care and there was the reality that more would be asked and the draft specifications show additional roles are designed to deliver that ask. Aligning their work to the new specifications is sensible, but balance is key. The draft specification workload means that the new roles are unlikely to be enough [to stabilise general practice] and help deliver local healthcare aims.
“If networks are to contribute to additional staff salaries they have to have a benefit for both the local area and the national agenda. If it is only a benefit for the national agenda, then it will be a waste for practices to invest those funds in their local network.”
Stabilising general practice
Under the additional roles recruitment scheme, PCNs have been supported to recruit ‘an army’ of 20,000 new staff to support primary care. Although social prescribing link workers will be fully funded by the government, networks have been asked to stump up 30% of the cost of salaries for physiotherapists, clinical pharmacists, physician associates and paramedics set to be hired by PCNs.
Additional staff have been identified by NHS England as the main vehicle for both stabilising general practice and delivering the five national service specifications, with an average networks expected to engage 5.5 additional staff members by April 2020.
BMA GP committee chair Dr Richard Vautrey last week emphasised the importance of PCNs hiring additional staff to achieve DES service specifications and feel the benefit of government funding going into general practice.
An NHS spokesperson said: “We published the draft service specifications, aimed at stabilising general practice and reducing health inequalities, to provide the opportunity to feedback views through the survey. GPs are getting significant extra funding through their agreed multi-year contract and this feedback will shape the final agreement with the BMA GP committee.”