The draft PCN service specifications were finally released just in time to put a dampener on Christmas for anyone eager enough to read them that quickly.  If you have avoided that particular pleasure so far, you can find them here.

It is worth stating right at the outset that the specifications have been published as draft, and that NHS England is seeking input/feedback from GPs (and “interested parties”), in the form of a survey (which you can access here).  The deadline for comments is the 15^th January.  The final version of the specifications won’t be available until “early 2020”, when the contract for next year has been negotiated with the GPC, at which point we can look forward to “further detail for each requirement, followed by guidance”.

There were rumours circulating before these specifications were published that there would be no additional funding attached to support their delivery, and unfortunately these fears have been realised.  The guidance tries to make as much as it can of the existing funding that has come into general practice through PCNs (the practice funding for engagement, the £1.50 per head, and the funding for the new roles). It also suggests £75M will be available via the Investment and Impact Fund, meaning an “average” PCN could secure c£60,000 in 2020/21 via this route.

The problem is this funding has not felt significant to practices this year, and that is without any additional (unfunded) work being included.  More new roles are available to each PCN next year (with associated funding), but each one comes with its own 30% cost, and it is hard to see practices being motivated to put their hands in their pockets to carry out work on top of the work they already cannot cope with.

In an apparent attempt not to “overburden” the nascent PCNs, only two of the five specifications (medication reviews and enhanced health in care homes) are to be implemented in full next year.  The remaining three will be phased in over the next four years.  It seems there is at least some insight behind the guidance of just how these proposals are likely to land with most GPs.

Perhaps this is all an NHS England negotiating tactic.  Perhaps there is a plan to incite general uproar amongst the GP community, which will be quelled by the inclusion of additional resources at a later date.  The request for feedback and inclusion of a survey on the draft specifications does suggest that at least some parts of NHS England understand the implications of asking these specifications to be delivered unfunded.  However, it is entirely likely that senior parts of NHS England think that this is a reasonable ask of general practice, and so I doubt there is a grand plan or that the final outcome is fixed at this point.

It would be a shame if PCNs, who have come an extremely long way in a very short amount of time, are stopped in their tracks by such short-sightedness.  PCNs represent a major change to the fabric of general practice, and it is one that requires much more nurturing to succeed.  Where we are right now is that they are not at the point of irreversibility, and asking too much in too short a space of time without providing the necessary resources is likely to send many areas right back to the beginning.

But these are not the final versions.  As yet nothing is fixed in stone, and there is a whole round of contract negotiations to go through yet.  My advice to GPs is to send comments in nationally and to your local LMC.  Use the survey, although if doesn’t allow you to say what you want to say send your comments directly to england.networkscontract@nhs.net, and include what is needed to make delivery achievable.  Let’s not give up just yet, and let’s see if something positive can be salvaged out of what is admittedly a less that promising start.

Happy new year to you all!!