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At the heart of general practice since 1960

GMS practices to get PMS cash

By Gareth Iacobucci

Exclusive: GPs are to be pitted against each other in an NHS funding shake-up that will see a systematic redistribution of money from PMS to GMS practices.

PCTs have been ordered to carry out wholesale renegotiation of PMS contracts, with trusts warned that they will fail the Government's World Class Commissioning standards if they do not act by April 2010.

But to make the plans more palatable to GPs, trusts have been advised to offer GMS practices potentially lucrative new PMS deals in return for accepting tougher targets and taking on more work.

Senior NHS managers are deliberately setting out to create a new set of GP ‘winners and losers', in what appears a classic example of divide and rule.

Pulse has obtained the plans in a policy document developed by NHS Primary Care Contracting and a consortium of NHS managers, urging PCTs to make value-for-money savings by negotiating better PMS terms.

The document also turns its fire on PMS GP principals, whom it claims are deliberately boosting their earnings rather than taking on new partners or salaried GPs. It says if PCTs allow the practice to continue they will be seen by the public to be ‘supporting high GP personal earnings'.

But, aware of how unpopular the plans will be with the 42% of GP practices that are PMS, the document advises trusts to ‘offer new PMS contracts to GMS practices at a higher price linked to improved service outcomes' – thereby ‘creating winners as well as losers to help the politics of the situation'.

PCTs are told to target practices where there are a low number of GPs per 1,000 patients and launch an investigation into partners' NHS superannuable earnings figures.

The 72-page report is packed with measures it says PCTs should use to drive down primary care spending, including cutting money from the PMS baseline, getting PMS practices to offer additional services for the same money and not awarding DDRB uplifts to PMS practices.

‘PMS practices may see this as a threat, but it could offer practices and PCTs the opportunity to sort out long-standing contractual issues. GMS practices may feel the PCT is not being consistent or equitable if it chooses not to review PMS.'

The NHS document stresses that in 2009/10, World Class Commissioning has an ‘explicit focus' on driving better value from primary care. But NHS

Primary Care Contracting – the Department of Health's policy implementation body – expects a backlash from LMCs and has told PCTs the cutbacks have ‘risks to reputation in the eyes of professionals and patients' and ‘risks of legal disputes'.

An LMC leader, and member of the committee that leaked the document to Pulse, predicted there would be ‘blood on the carpet' because of the plans.

And Dr Jane Lothian, secretary of Northumberland LMC, who was involved in a long-running battle over PMS clawbacks last year, said ‘confrontation is inevitable' if PCTs take a hawkish attitude to the guidance.

GPC negotiator Dr Chaand Nagpaul said it backed moves to create greater equity of funding, but not by taking PMS money: ‘We want a levelling up for GMS, not a levelling down.'

A DH spokesperson said: ‘We support PCTs in ensuring value for money in all contracts, including PMS.'

Believes confrontation is inevitable if PCTs take hawkish attitude Dr Jane Lothian How NHS plans to redistribute GP funding

• Cash to be taken out of PMS baseline, phased or in one go
• GMS practices to be offered new PMS-style contracts but with tougher targets in line with World Class Commissioning priorities
• PMS practices to get no DDRB uplift
• PMS practices to offer greater access for same funding
• GP principals with low investment in practices to be singled out

Personal Medical Services reviews: a commissioning toolkit, NHSPCC

PMS reviews: a commissioning toolkit

PMS reviews: a commissioning toolkit

Read the plans for yourself

To read the full PMS Reviews: a commissioning toolkit document please click here.

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