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First CCG left with no PMS practices

Exclusive One CCG has completely abolished the PMS contractual model after 20 practices reverted to GMS in April.

All 20 practices in the NHS Dudley CCG area will now see their PMS ‘premium’ payments phased out in a seven-year transition in what is believed to be the first area to have removed all PMS contracts.

Meanwhile, NHS Coventry and Rugby CCG has also come close to abolishing the model, after 29 of the 30 PMS contracted practices reverted to GMS contracts from 1 April and will have their additional funding phased out over five years.

GP leaders said it was ‘worrying’ if PMS was being abolished unless there was another alternative contractual model to drive local innovation, or to serve atypical populations.

It comes as NHS England is looking to make £260 million savings from ‘premium’ PMS funding it says was not linked to patients receiving extra services.

When the review was launched in 2013, NHS England claimed that PMS practices were receiving on average £14 extra per patient compared with GMS counterparts.

The most recent national statistics - from 2013/14 - saw 43% of GP providers still on PMS contracts, receiving 47% of total funding to all GP practices.

However, practices in many areas have been offered the chance to have their funding removed gradually to mitigate the potential losses, including in Essex where ‘over half’ of PMS practices signed up to switch and in Cambridgeshire where 85% took up a similar offer.

In NHS Dudley CCG all practices have chosen to take up the deal which was offered after the CCG’s local review concluded 13.8% of funding to PMS practices was not linked to providing extra services.

But GP leaders reiterated warnings that the loss of the locally negotiated contractual model may lead to poorer support for particular patient groups.

NAPC chair Dr Nav Chana said: ‘The whole purpose of the PMS contract was to enable local flexible contracts for practices to design services around local populations.

‘The concern NAPC has is if the principles behind that are removed and there isn’t a mechanism by which practices can innovate and transform local services.’

GPC chair Dr Richard Vautrey said it was sensible for practices to switch to GMS is they were not serving atypical populations, however he added: ‘There will always be practices serving atypical populations and these are ideally suited for PMS contracts.

‘NHS England should continue to offer these arrangements, increasingly working with CCGs through co-commissioning, so that practices that would not be viable under a national capitation formula arrangement can continue to meet the needs of their patients.’

Dr Jas Rathore, clinical lead at NHS Dudley CCG, said no extra services will be lost, just funded via enhanced services instead.

He said: ‘After careful consideration by member practices in consultation with the CCG, Dudley PMS practices chose to convert to a GMS contract from April 2015’.

Martina Ellery, head of primary care for NHS England in Coventry said: ‘The funding released by the tapering of the PMS “premium” is… ring-fenced for the CCG area it originates from and will be reinvested into primary care.’

HSCIC statistics revealed overall PMS spend reduced by 1.4% across England between 2012/13 and 2013/14, from £3.329bn to £3.284bn.

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Readers' comments (18)

  • I think you will find that the phasing out of PMS contracts was done in a very underhand way, certainly in Leicestershire - we were effectively held to ransom over it, and we are now having to contemplate cutting our GP staff to cope.

    It is short sighted, and I for one am sick and tired of being treated like this by the 'powers' that be.

    In response, we are looking into doing what other GMS practices in our areas do - shut for a half day training every week, and make someone redundant. I am not going to continue to work like this and have none of the benefits our GMS colleagues had

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  • To be fair PMS have had a substantial premium compared to GMS.

    the reality is we're fighting for little scraps when both GMS and PMS were underfunded.

    PMS did have sev advantages - it could ignore the model contract for its salaried GP's and now will have to revert to a more expensive contract for its salaried GPs.

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  • We have an atypical population in that more than 60% are BME patients in one of the most deprived areas nationally.
    We were advised into accepting a GMS contract by the LMC as apparently a PMS review would really only be a token gesture and funding would be removed anyway in a shorter timeframe.
    As we lose 1/7th each year inevitably service at some point will suffer, we are in the dark about recouping any of the PMS premium through enhanced services.
    Eventually the lack of funding will definately result in the surgery not being able to provide adequate number of GP appointments as employing any kind of GP whether partner, salaried or locum will not be affordable if the business it to make a realistic profit.

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  • Best would be to get in touch with your federation (start one if you don`t have one!) and look at options for private GP services. Don`t wait for the ship to sink before leaving it . Get the lifeboats ready in time so when it sinks you don`t have to go down with it.
    The leaders who should have prevented this have mostly got their luxury yachts nearby and will sail in it. Some are already actually in the yachts while pretending to be suffering like us.
    If anyone thinks General Practice will last in its present form in the next few years they have no one else to blame than their naivety.
    Remember with any government the most unpopular things will be done early after the election and popular vote catching changes just before the election year.

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  • @1033, it is the divide between partners and salaried GPs which is causing many of these problems and yet you seem to be ain favour of a model that allows partners to exploit salaried GPs even more than they do already. Shame on you. We can either stand united (too late for that) or fall divided.

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  • Yes in sandwell, we also had little choice and participiate in a what sounded like a "game show"
    either 1. face a "closed box" pms review, lots of paperwork to fill and if found not worthy: have funding cut pretty much straight away or
    2. go onto gms and face funding cuts over 7 years

    most practices went for option 2.

    widely under reported in gp and national press at the time. surgeries having varying funding cuts and laying staff off(medical and non medical) as a result creating further pressures.

    most gms top dogs, no sympathy for pms practices hence no united front. Area one of the most deprived i have come across and one wonders who will actually work in these areas after these cuts.

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  • No offence but when our federation got together and compared access, AED attendance, referral rates, Qof achievement, drug overspend etc there were no noticable difference between GMS and PMS practices.

    So what is the justification for PMS practices gettin 15-25% more funding then GMS? Without answering this, I'm not sure how PMS can justify it's existance.

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  • @1:00pm
    So it follows without the pms growth money these practices will now be at risk of underperforming adversely in comparison to previously...

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  • PMS practices have for years done exactly the same job as GMS practices, but for a lot more money. There is no justification for the discrepancy in funding, and a levelling of the playing field is long overdue

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  • 2:02

    No it doesn't follow - but they might just have to work a bit harder

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