The newly-negotiated network contract DES will increase the admin and managerial workload of primary care networks by 27.5 hours each week – a burden that will fall primarily on practice managers, LMCs have warned.
Under the contract, PCNs would be expected to administer clinical services such as covering care homes, structured medication reviews and early cancer diagnosis, taking up 61.5 sessions each week. However, the contract does not take account of the extra admin and managerial workload these services will require.
This increased volume would not be offset by the additional clinical staff that PCNs are expected to bring in with their additional funding, the LMCs said. The average network will only be able to deliver 40 sessions per week using additional clinical staff – leaving a deficit of 21.5 sessions.
‘This would add a further workload burden of 27.5 hours per week on PCNs, which would be borne by practices, specifically practice managers,’ the LMCs said.
They also reiterated that there is ‘no capacity’ under the Additional Roles Reimbursement Scheme (ARRS) for admin or managerial time.
Berkshire, Buckinghamshire and Oxfordshire LMCs analysed the DES and found that there was still a risk of financial loss for practices – of £17,191 per average network in a year. It said this loss in income was due to the level of work required to deliver the contract.
The analysis says: ‘The DES was initially heralded as a means of relieving and reducing existing workload pressures in general practice. There is no evidence that this is the case, given that the DES lacks the utilisable workforce to deliver even its own requirements, let alone manage any pre-existing workload.
‘It seems highly unlikely that the practices in an average PCN would see any net financial benefit from the DES and indeed it seems probable that they would make a loss in the process of delivering the work required.’
The analysis adds that ‘significant’ workload is due to be added to the DES in 2021 and beyond and that the contract suggests that some aspects of the DES may be ‘rolled into’ or cause changes to the core contract.
It says: ‘As time passes, and systems become more integrated, it will be more difficult for practices to extricate themselves from the DES if they so wish without significant adverse financial implications.
‘We have significant concerns that this DES poses a threat to the independent contractor model, the core GMS contract and the autonomy of individual constituent practices.’
‘Cannot recommend’ signing up
The group of LMCs said: ‘Based on the above analysis, the LMC cannot recommend practices sign up to the PCN DES.’
It added that it ‘does not necessarily recommend’ that all practices withdraw from the DES, but that those practices and networks that feel they are able to absorb the financial risks should ‘take steps’ to ensure they are able to withdraw in future.
Practices should await the outcome of the special LMCs conference to be held on 11 March to discuss the impending GP contract changes ‘before making any commitment’ to the DES, it added.
Berkshire, Buckinghamshire and Oxfordshire LMCs CEO Dr Matt Mayer told, Management in Practice’s sister publication, Pulse, the estimated financial loss that the DES could bring is a ‘best case scenario’ as it is based only on the workload laid down in this year’s deal.
He said: ‘The specs that are coming in next year seem to be at least as onerous as these ones because there are quite a lot of them – reducing inequality, cardiovascular disease, anticipatory care and personalised care – which have just been deferred.’
He added: ‘The main concern my reps and I have is the effect [the DES] has on your core contract the longer you are in it and therefore the difficulty and financial or contractual damage if you delay coming out of it.
‘We’re concerned this might be one of the last times you can get out of it without causing your practice a lot of damage – but we honestly don’t know and that’s why we’re really concerned.’