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Primary Care Networks – Employment Issues

June 5, 2019

As GP practices join Primary Care Networks (“PCNs”), they will need to be mindful of the employment issues that this will inevitably involve. In order to avoid, or at least minimise, future difficulties within the PCN it is advisable to make decisions regarding network staff and their management and ensure that, as far as possible, these are dealt with in the Schedules to the Network Agreement.

The directed enhanced service (“DES”) will cover funding for additional staff who would effectively be network employees rather than employees of an individual practice.  However, as the PCN may not in itself be a legal entity, the network employees will need a formal employer which is.  This inevitably results in choices needing to be made in terms of an employment structure.  Some issues which should be considered when taking on network employees and deciding how they should be employed are:

  • How do you intend to employ network employees? The BMA has proposed several structure options and each option has a different intended employer.  However, it is important to be mindful that just because you intend Practice X, the lead practice, to be the employer of the PCN pharmacist, Employee A, if this is not reflected in practise then, if it was ever questioned by an Employment Tribunal, you could find that the actual employer is not who you intended it to be.  When considering who the employer is, a Tribunal will consider issues such as who pays the employee and who has day-to-day control of them.
  • How do you intend to manage network employees on a day-to-day basis? For instance, if Employee A is technically a joint employee of 5 GP practices, i.e. in a flat practice structure, you would need to consider who would be responsible for managing her and how this would work on a day to day basis.  This would include issues such as who would deal with performance or conduct issues and who would manage sickness absence.
  • If Employee A is employed by the lead practice, but works across all the practices how will this be managed? If the intention is that Employee A will be seconded, the PCN will need to ensure that the appropriate secondment agreement is in place to address issues such as cost and the division of time.
  • How would you deal with cross-practice issues? For instance, if Employee A, is being managed by a practice manager at one practice but has an issue with an employee of another practice within the PCN and raises a grievance, who would be responsible for dealing with this issue.  How would the practices work together to resolve this?
  • If Employee A resigned and brought a constructive dismissal claim as a result of the behaviour of her colleague in one of the practices, would all of the practices bear the cost of that litigation equally even if some practices had no involvement in the situation that resulted in the claim? This is particularly significant if you choose a flat practice structure as all the practices would be liable as joint employers of the network employees, even if your practice had no involvement in, or control of, the issue.
  • What terms and conditions and policies and procedures will apply to network employees? The practices will very likely be employing their own staff on their own terms and conditions, which will not necessarily match the terms and conditions of the other practices in the PCN.  How will you select which terms and conditions should apply to the network employees and how could this impact on the practice employees.  For instance, if employees in Practice X have 28 days’ annual leave, but Employee A has 33 days to match Practice Y as the lead practice, how will this impact on the morale of employees of Practice X who may work alongside Employee A.

These are just a few examples of employment issues that need to be considered when choosing the network structure and working practices for your PCN.  However, the most important thing is that you and the other intended members of the PCN discuss and agree both how you intend to deal with employment issues on a practical day-to-day level and how you intend to address legal issues before formally establishing the PCN.  The more issues that have been pre-empted and addressed in the Schedules to the Network Agreement, then the smoother your PCN should run in practise.

For further information please contact Richard Humphreys.
T: 0191 256 9500


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