Are PMS GPs offering value for their money?
If UK GPs are the highest paid in Europe, as the Prime Minister keeps telling us, then PMS GPs are at the very pinnacle.
Income figures for last year showed PMS GPs earning between £17,000 and £34,000 more than their GMS counterparts. And the gap is growing. PMS practice profits rose by 34 per cent on average compared with 12 per cent for all practices.
But the question now being asked by a Government seemingly obsessed by GPs' pay is: do they deserve it?
The Our Health, Our Care, Our Say White Paper announc-ed a year-long 'fundamental' review of PMS which will investigate whether GPs on locally negotiated contracts are delivering the extra services targeted at local needs they are meant to.
It will also question whether they are simply pocketing the tens of thousands in growth money offered to them to switch without offering anything more than GMS GPs.
Most GPs agree there are inequalities in the way practices are funded. But, they argue, these were caused by the Government's decision to throw money at PMS. So it is unfair to suddenly target those GPs who took advantage.
Dr Trefor Roscoe, a PMS GP in Sheffield, says he is happy to talk about how PMS can be improved, but believes the review is driven by ministers' perceptions that GPs are overpaid.
He says: 'There's a little antagonism in the profession, but we should remember [PMS] was designed to improve quality.
'If there are ideas the Government wishes to fund for specific populations then of course we will renegotiate the contract for more money for the extra work.'
Dr David Jenner, PMS contract lead for the NHS Alliance and a PMS GP in Cullompton, Devon, agrees the Government was the cause of the inequalities, but is more sympathetic to its desire to end them.
He says: 'PMS works from historic baselines and some of those have received a lot of money and sometimes fairly arbitrary allocations. You can understand the Government's wish to look at that in terms of fair distribution of resources.
'The problem is they want several national initiatives, yet PMS is locally negotiated.'
This local dimension is another cause of the huge variations, GPs believe. How well PMS practices have done, and how much added value they offer, depends on how much support they have been given by the PCT.
Dr Chaand Nagpaul, chair of the GPC service development subcommittee and GP in Harrow, London, says many PCTs have 'not had the capability to focus on PMS' a view backed by leading academics.
Dr Rebecca Rosen, fellow in health policy at the King's Fund and a GP in south London, says the weakness in developing PMS 'has often been in the commissioning, not the provision'.
She says: 'Part of the problem has been the way PCTs have managed their providers. I don't think PMS providers are feckless and lazy.'
And Dr Martin Roland, director of the National Primary Care Research and Development Centre who evaluated the first wave of PMS practices, says that where clear objectives had been stated in contracts, practices achieved the expectations.
The evidence appears strong that rather than cream off the cash, PMS GPs have been at the forefront of innovation and service development.
But with PMS GPs doing the GMS quality and outcomes framework and the two contracts having virtually converged, how can PMS practices react to the scrutiny and continue to demonstrate added value?
Dr Jenner says if PMS practices felt 'squeezed' by the review they could switch back to GMS.
But Dr Johnny Marshall, a first-wave PMS GP in Wendover, Buckinghamshire, and treasurer of the National Association of Primary Care, suggests practices ought to look again at how they can 'trailblaze'.
The best way, he says, is through Specialist PMS which allows practices to set up specific local services, with their own quality and outcomes framework.
'You can provide a wider range of services without the need for a GP, you don't need a registered list and don't need to provide essential services.
'It's about more joined-up services, designed around the patient. It's moving away from the boundary of primary care and looking at how we can break down the boundaries of secondary care.'
This combination of offering targeted local services, taking on more work from secondary care and, most importantly, saving money, is at the heart of everything the Government wants for the NHS. And it is bound to be the focus of the review of PMS.