April will mark one of the few opportunities practices have each year to opt out of the PCN DES. Is this a move GP practices should be considering, or do the benefits of staying outweigh the additional requirements on practices?

The lack of a negotiated contract for this year means the existing 5 year deal for general practice agreed by the GPC in 2019 rolls through into next year.  The response by the GPC has been a thinly veiled encouragement for practices to consider opting out of the PCN DES, “Should practices decide that they cannot accommodate the below changes, that their patients would be better supported outside of the PCN DES, that the practice would operate more effectively and safely outside of the PCN DES or any other reason, they are able to opt-out” (GP Contract Changes, BMA).

This theme is continued in the BMA’s recently published “Safe Working in General Practice”, which states, “There is an increasing view that the requirements of the DES outweighed the benefit brought by the investment into practices and ARRS staff… Practices will need to consider if the PCN DES enables them to offer safe and effective patient care within the context of their wider practice, and their present workforce”.

This all feels somewhat disingenuous, and more of an attempt by the BMA to score political points over NHS England than genuinely putting the interests of practices first.

The reality of the 2019 deal and the introduction of the PCN DES is that it put an additional £3 billion funding into general practice, £2 billion via the PCN DES.  The majority of that funding has not yet come through.  We are only half way through the recruitment of the ARRS roles, the IIF funding has been limited due to covid and grows significantly over the next two years, and enhanced access brings £6 per head under the control of PCNs that previously in most places came nowhere near practices.

From a staffing perspective there are no new GPs, and whatever the promises (5,000 GPs, 6,000 GPs etc) there are unlikely to be any anytime soon.  The only way for practices to manage the ever increasing workload is to use different roles.  Notwithstanding the challenges of training, supporting and integrating these roles, they are the only realistic route for practices to find a way of managing the workload.  100% reimbursement (even if that doesn’t mean free) for these roles is not a bad deal.

PCNs are also the only route by which general practice can influence the newly developing integrated care systems.  The future NHS is not interested in any provider that wants to stand alone and not work in partnership with others.  If general practice wants to continue to be able to have a voice post-CCGs then it needs to work on how its PCNs can influence local arrangements.

The alternative is, as the BMA points out, to opt-put of the PCN DES.  This means practices will lose out on the PCN funding, the ARRS staff and worse, “NHS England is likely to transfer the funding, requirements and staff – likely via TUPE (Transfer of Undertakings) – to Trusts or alternative providers to maintain as much of the PCN DES as possible without general practice.” (GP Contract Changes, BMA).  Given the current Secretary of State’s penchant for nationalising general practice I am not sure the government would be that uncomfortable shifting PCN resources to acute trusts and making practices even more vulnerable going forward.

The only real rationale for opting out of the PCN DES is a protest vote because of the lack of any negotiated outcome to this year’s contract, which is what the BMA seems to be pushing for.  But any rational analysis of the situation shows that it is in practices best interests to stay in the DES and to continue to be able to access its (growing) resources.  That said it doesn’t mean things shouldn’t change.  As I have argued previously, in many places PCNs are too distant from practices, and not run with enough attention being paid to the sustainability of practices in mind.  Now is the time not for practices to opt-out of the PCN DES, but rather to ensure that the PCN DES, a part of the national GP contract, is playing its part in ensuring the future sustainability of the service.