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Practices should ‘consider’ opting out of PCN DES, says BMA ‘safe working’ guidance

by Costanza Potter
14 March 2022

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New BMA guidance on ‘safe working’ has encouraged practices to ‘consider’ opting out of the PCN DES.

It also suggested that practices may choose to close their list to new patients.

The GP ‘safe working’ guidance updated last week (11 March) reiterated that new PCN requirements for 2022/23 were published ‘without agreement’ from the BMA’s GP Committee for England.

It added that practices ‘will need to consider if the PCN DES enables them to offer safe and effective patient care’ as requirements have become more onerous.

The BMA guidance said: ‘NHS England has published its proposals for PCN requirements for 2022/23 without agreement from GPCE, asking PCNs to deliver greater requirements than previously.

‘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.’

It added that practices may opt-out from the DES between 1 April and 30 April 2022, but that those who remain are ‘contractually obliged to provide the requirements as set out’.

It said: ‘It would be the case that on leaving the DES, the payments associated with it would cease to practices, ARRS staff would no longer be able to provide services to patients on the list of the relevant practice, and the PCN itself may be at risk.

NHS England last week announced the imposed GP contract changes for 2022/23, which said that PCNs in England would need to offer routine services between 9am and 5pm on Saturdays from October.

The guidance added that action ‘must be taken by practices and GPs in order to preserve safe care for patients and to protect the health and wellbeing of the existing general practice workforce’.

It said this comes as the GP contract updates ‘do not provide sufficient opportunity’ to address the ‘unprecedented’ workload and workforce challenges facing GPs ‘via contractual means’.

The BMA set out various ‘system changes’ practices can take to alleviate the ‘crisis’, including closing their list to new patients and using ‘alternative sources’ and services – such as walk-in clinics, extended access appointments, pharmacies and PCN additional roles staff – to their ‘maximal requirement’.

It also advised practices to reject requests to do extra work passed to general practices from ‘outside agencies’, such as ‘un-resourced, noncontractual work coming from secondary care e.g. undertaking tests, or referrals on behalf of secondary care providers’.

‘Practices have no contractual obligation to undertake this work and should pass requests back to the provider from where it came,’ it said.

It added that it ‘may be the case that some patients regrettably have to wait longer to access GP care for their non-urgent problems or are directed to another more appropriate provider’ as a result of decisions practices make about how to prioritise ‘finite’ resources.

It comes as a report last week warned that PCNs have ‘inadequate funding’ and support to implement the additional roles scheme, with many networks lacking ‘a clear, shared overall purpose’.

And last month, an LMC claimed that the ‘window of opportunity’ for the BMA to organise a mass opt-out from the PCN DES had closed – after more than half of GPs said in November that they were prepared to do so in protest against the Government’s controversial access plan.

England LMCs have demanded that the BMA does not negotiate any new work or funding for GPs via the PCN DES beyond 2023.

Other actions advised by the BMA ‘safe working’ guidance

The BMA advised GPs should also consider:

  • ‘Prioritising’ areas of non-core work that ‘provide safest and most effective patient care’ and deprioritising those that either ‘do not provide direct patient care (e.g. data submission) or are underfunded to provide that care efficiently for the practice’
  • Using ‘remote consulting with triage’ to ‘provide patient appointments more flexibly, direct patients to the most appropriate provider of care’ and prioritise care ‘for those most in need’
  • Changing their appointments to 15-minute slots and ensuring GP sessions do not exceed four hours and 10 minutes (with no more than three hours spent in consultation with patients) and that ‘adequate rest breaks’ are taken
  • Recording all patient contacts in their appointment books to account for extra workload, such as discussions with community teams regarding specific patients, calling a patient about a result and home visits
  • Re-triaging any patients booked in for appointments by NHS 111 directly
  • Engaging patient participation groups (PPGs) to ‘discuss openly the challenges being faced’ and lobby CCGs directly 

However, the BMA stressed that the guidance is ‘not exhaustive’ but provides ‘an example’ for practices. 


This story was initially published on our sister title Pulse.