An LMC analysis has found that the updated PCN DES offers an overall net funding increase of £2 per patient, but that this does not recognise the ‘significant’ increased workload.
Berkshire, Buckinghamshire & Oxfordshire (BBO) LMCs said that ‘any noticeable real terms investment is grossly lacking’ amid a ‘significant quantum of increased workload’ for PCNs.
BBO LMC’s analysis of the 2022/23 PCN DES service specifications, sent to practices last week and seen by Management in Practice’s sister title Pulse, set out a breakdown of the funding available to networks this year compared to 2021/22.
It found that direct network payments have seen an overall £2.007 per patient per year net increase – up from £5.412 last year to £7.419 in 2022/23.
But it pointed out:
- The PCN leadership and management payment has been reduced by 0.8p with ‘no explanation’;
- The PCN support payment has been discontinued;
- Clinical director payments have remained static rather than increasing in line with inflation as in previous years, despite a potential ‘significant’ workload increase;
- Core PCN funding has also not been increased in line with inflation, although it never has been before.
The analysis concluded: ‘This iteration of the PCN DES appears to offer new funding on the one hand (e.g. Enhanced Access), whilst removing funding on the other (e.g. lack of inflationary uplifts, discontinued funding streams, increases in complexity of IIF target thresholds).
‘When coupled with spiralling inflation and costs of living, together with increased National Insurance, any noticeable real terms investment is grossly lacking. In concert with such small real-terms investment, a significant quantum of increased workload is expected with no attempt to acknowledge or deal with existing insurmountable workload.’
For example, the LMC pointed to cancer service specification requirements for PCNs to ‘develop and implement a plan to increase the proactive and opportunistic assessment of patients’ for a potential prostate cancer diagnosis in cohorts with referral rates below pre-pandemic levels.
‘This would equate to a significant increase in workload and the LMC would expect an additional quantum of resource to be provided to facilitate this’, it said.
Meanwhile, the £2 uplift does not take into account payments for the additional roles reimbursement scheme (ARRS) or Investment and Impact Fund (IIF).
As with clinical director payments, no inflationary uplifts have been applied to any ARRS roles ‘unlike in previous years’.
The LMC said that this is ‘particularly unreasonable’ given the ‘current cost of living crisis’.
And while the total number of IIF points has increased by 764 from 389 to 1153 – representing an increase of £152,800 – the value of each point has also remained static at £200.
The LMC pointed to one indicator that has been reintroduced with reduced funding and ‘significantly increased’ requirements, but said the new workload accompanying this year’s IIF is ‘largely unknown as formulae and calculations of the IIF are particularly opaque’.
It added: ‘Calculating the general requirements for meeting “composite” IIF indicators is very difficult if not impossible due to the Byzantine equations used in their calculation, and also considering they are subject to demographic weighting via a formula which has not been published.’
The LMC advised PCNs to ‘seek individual clarification on these requirements’.
What did the LMC analysis say about the enhanced access scheme?
The document urged PCNs to consider subcontracting the enhanced access scheme, which requires PCNs to provide appointments between 6:30pm to 8pm on weekdays and 9am to 5pm on Saturdays, saying this ‘will be crucial in delivery for many’.
Also on the new scheme, it said:
- Practices can decide what specific services to offer during these shifts,
- GPs do not need to be ‘physically present onsite at all times’ during the service but can provide ‘remote’ cover,
- Practices that operate a total triage system don’t have to comply with the requirement to ‘make same-day online booking for available routine appointments where no triage is required’,
- Practices should make their initial plans ‘as flexibly as possible’.
The LMC warned that a ‘significant increase in risk has now shifted to practices within their PCNs, as services previously provided elsewhere now become their responsibility’.
It added: ‘It will require particular resilience, ingenuity and enterprise for any PCN to be able to use these specifications to meaningfully improve the terms and conditions of staff, or improve services to patients.
‘As smaller, less resilient constituents in more deprived areas will find it even more difficult to make these specifications work, population health inequalities will almost certainly significantly widen.’
It advised PCNs to take ‘a flexible and pragmatic approach’ to the service specifications.
The long-awaited network DES, published last week, set out that PCNs have six months to deliver a targeted social prescribing programme and that PCNs will be able to deploy twice as many adult mental health practitioners.
GP leaders and accountants have said the DES funding ‘falls short’ of what is needed and represents a real-terms ‘pay cut’, warning of difficulties recruiting to ARRS roles, as well as the impact that inflation and the cost-of-living crisis will have on practices.
Last month, BMA guidance on ‘safe working’ encouraged GPs to ‘consider’ opting out of the PCN DES between 1 April and 30 April 2022.