It seems like only yesterday that I first wrote about primary care networks (PCNs), but it was actually back in June 2019. Controversial from the start, they were formed in a hurry. Many GPs have been dubious about whether they will benefit patients, or just take GPs away from them to network meetings instead.
A draft PCN specification brought out last December was met with universal derision. A group of local medical committees estimated that the average practice would be £100,000 worse off over the course of a year, if the new contract was signed. It was swiftly rejected by the British Medical Association’s England GP committee.
A revised version has now been accepted by the BMA. Reactions from grassroots GPs ranged from ‘it’s as good as we are ever going to get’ to the more robust ‘no matter how many times you cover a turd in glitter, it’s still a turd’. Variants of these are all over GPs’ social media at the moment.
So, how does this new contract affect pharmacists? Given the falling number of GPs, it is vital that we look at how primary care can be delivered using a wider range of professionals. The new iteration of the contract allows for full funding of these roles – better than the 70% initially proposed – which includes provision for pharmacy technicians as well as pharmacists.
The questions of indemnity and responsibility for decision-making remain, as well as whether there are enough pharmacy professionals who want to take on more clinical tasks. It’s important not to diminish the importance of having pharmacists available to safely dispense drugs. I massively value this important safety net and would be worried if the move to get pharmacists to fill holes in primary care clinical provision left the dispensing aspect understaffed.
The £20,000 ‘golden hello’ to new GP partners has been a focus of headlines, and new partners don’t have to be GPs. I know several practices where nurses and practice managers are partners, and there’s no reason why a pharmacist couldn’t do the same under the new GP contract.
While £20,000 sounds superficially very attractive, the small print is that it’s only available for those working full-time, even though full-time GP partnership is a rapid route to burnout. The money is also contingent on a pharmacist staying in the partnership for five years, so it’s more of a golden handcuff amounting to £4,000 per year than a golden hello.
GP partners pay their employer’s and employees’ pension contribution. It’s likely that around two-thirds of the £20,000 will disappear to tax and pension. A cynic would say that the golden hello has been put in there to feed the ‘fat-cat GPs’ stereotype portrayed in the media and make it harder for doctors to negotiate future improvements in terms and conditions.
It’s difficult to cover the whole contract in one short blog, but I must point out something very concerning for the safety of the GPs, pharmacists, nurses, receptionists and other administrative staff who work in practices. Patients who have been violent towards healthcare professionals, which is sadly a common occurrence, can currently be removed from our lists and directed towards special schemes. This is as it should be: We must have a zero-tolerance approach to violence towards healthcare staff.
Up until now, if a violent patient tried to register again at a normal practice, they could be refused. If they were accidentally registered, then they could be removed from the list. But the new contract mandates that GP practices can’t remove violent patients from their register who have been discharged from a special allocation scheme.
Given that some special allocation schemes are expensive, and many intend to return the majority of patients back to routine general practice, it seems likely there will be an ongoing risk of further violence and harm to primary care staff.
It’s unacceptable that practices should be forced to re-register people who have shown themselves to be violent while in primary care. This potentially puts GP partners at risk of legal action from their employees, whom they are now unable to fully protect. That is certainly a risk that no golden hello can make up for.
We’ll have to wait and see how this new contract pans out. If I was a betting woman, I would put a substantial sum of money on PCNs not existing in five years, maybe sooner, and that they will be added to the list of ‘once-in-a-generation’ NHS reorganisations that take money and clinicians away from the front line.
Toni Hazell is a GP based in a practice in London