Will the PCN DES help us provide more Primary Care?

Primary Care is what we do – it is our core function and doing other things will not let us off the hook if we fail to provide Primary Care to our patients.Primary Care is that care which can be provided by a Doctor (along with their support team) to their own patients. This stops you imagining that just because some GP somewhere can do specialist cardiology or specialist gynaecology that all GPs everywhere should be expected to meet the same standard. Providing special interest care without having your own list of patients is actually just Secondary Care in a Primary Care setting.Providing more Primary Care is looking after more patients or looking after them better. We are not selling consultations so it is patient outcomes that count (patient satisfaction, proven treatment targets, best practice, death and sickness rates).The promise to make 50 million more appointments increases capacity only if you pay extra to practices so they can recruit more doctors and nurses to see people. Otherwise you are just asking us to work harder and longer for the same funding.Requiring GPs to do extra work that is not necessary (ward rounds, additional medication reviews, switching from dry powder to MDI inhalers, reducing prescribing of medications) may help the NHS as a whole but it actually reduces Primary Care Capacity as it takes GPs away from what they need to be doing.A year ago I stood up at an LMC Open Meeting and asked what resources we were being offered to persuade us to form up into PCNs. The answer if I remember correctly was that the PCNs would get funding of a similar size to what we got for QOF so about £10-15 per patient. This kind of money would be enough to recruit an extra GP for a 5000 patient practice which would certainly improve our capacity to provide Primary Care.However, looking at the proposed changes it seems there is a lot of extra work – much of which will need to be done by GPs and precious little money which is not tied up in other staff. £4,000 per year for 5 year golden handcuffs for a new full time partner is great but it isn’t going to solve long term sustainable growth. The provision of lots of new non-clinical roles we didn’t ask for and have to spend time working out what to do with is not really going to help either.So, prior to the LMC open meeting, it would be really helpful to have the LMC’s analysis of how the proposed DES actually increases our capacity to provide Primary Care.

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