With much recent discussion regarding the PCN DES and Enhanced Access, due to begin in October 2022, Londonwide LMCs’ advice to practices in the Capital is to consider carefully the requirements placed on practices and evaluate whether, applying full cost recovery, funding is sufficient to cover the expense of providing the services.
Conceived and presented as stabilising general practice, the PCN DES (and related Additional Roles Reimbursement Scheme (ARRS)) have led to reports in London of staff vacancies, increased workload for existing staff, and longer working hours. This approach is neither sustainable nor safe for clinicians (increasing the risk of burnout, stress and early exit from general practice) or patients (who risk being treated by a decision fatigued clinician).
As understood at present, the PCN enhanced access requirements will require the existing workforce to cover increased hours. It is likely that clarification will be sought on the application of new measures. And new work should be clearly assessed to ensure that it does not have a negative financial impact on practice workforce and finances. Considering enhanced access in more detail;
- PCNs will be expected to provide a range of general practice services within enhanced access network standard hours (6.30-8pm weekday evenings and 9am-5pm on Saturdays), including vaccinations. Clarification is needed on the language used in the contract.
- PCNs will be required to provide 60 minutes per week per 1,000 patients, weighted using CCG primary medical care weighted populations.
- Funding will be £7.46 per weighted patient.
From a financial viewpoint, providing these services could create additional income that can be invested in delivering core services. However, there are equally valid concerns that delivering these services could effectively be a disinvestment from core services.
London practices will be considering signing-up/opting-out of the DES before the cut off date of 30 April (Saturday). Advice from Londonwide LMCs is that current levels of practice funding must be considered carefully. The key message is before agreeing to participate in the PCN DES you need to understand what the real cost of delivering the services will be.
For an indicative assessment of how the PCN DES requirements would impact on one London PCN, see this anonymised example.