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PMS practices left unsupported following 'illogical' variety of approaches to transition deals

Exclusive: PMS practices in some areas will not be supported if they move to GMS contracts as local area teams across the country are applying widely varying approaches to mitigate the effect of the PMS reviews, Pulse has learnt.

Local leaders across England say they are in discussions with their area teams about offering parachute payments for PMS practices who stand to lose money from NHS England’s review of the local contracts, with GPs in the West Midlands already being given assurances they will receive deals similar to those in Essex and East Anglia.

However, other NHS England local area teams - including Gloucestershire - have already ruled out any payments, a decision local leaders say could lead to practices reducing their size.

The GPC has hit out at the ‘illogical’ variety of approaches by NHS England’s area team, accusing the organisation of treating some GPs ‘less favourably’ than others.

This is in response to the PMS reviews instigated by NHS England, which will involve local area teams calculating how much extra funding PMS practices are receiving than their GMS counterparts for providing the same amount of work.

Pulse reported this week that some practices are set to lose out on up to £400,000, while the Essex local area team has already offered a seven-year phase out deal that has been taken up by 63 of the 100 PMS practices in the county,

A similar deal has been struck in East Anglia and now the Birmingham, Solihull and the Black Country area team has told Pulse it will be following suit.

Donna Macarthur, area team head of primary care in Birmingham, Solihull and the Black Country, said: ‘We have very recently been advised that this is now something for local determination. As such, we will be meeting with our stakeholders imminently to discuss how we can support GP practices who may wish to explore the option of reverting to a GMS contract.’

However, GPs in Gloucestershire have been told they would not receive transition funding should they revert, with the LMC fearing for one practice in particular.

Gloucestershire LMC chair Dr Phil Fielding said the area has just four remaining PMS practices after having reached a deal with the PCT two years ago for transitional support to practices reverting to GMS.

He said: ‘We aren’t able to do that now and we are having a talk about the last four practices and what their options are. We are desperately concerned about one practice which helps to support the university and we know their financing is under pressure if they lose PMS or if their PMS contract is altered dramatically. I can’t give figures because it is sensitive information but it is significant enough for them to have to reconsider their partnership size.’

Pulse has also learnt that local leaders in Buckinghamshire, Berkshire and Oxfordshire, Leicester and Rutland, Lincolnshire and West Yorkshire have all been in talks with their local area teams about striking deals.

Dr John Crompton, chair of Harrogate & Rural District Locality of YOR LMC says: ‘I think in West Yorkshire they’ve got a bit of a deal but we haven’t. They are looking to bring down the PMS [premium] and they are proposing, because of the north Yorkshire deficit to do this over a fairly swift timeframe, of a couple of years, which is really concerning us. So there is ongoing debate about that but there is nothing resolved at all locally.’

GPC chair Dr Chaand Nagpaul said: ‘PMS practices must not be disadvantaged because of the scale of funding change. They should be treated no less favourably than GMS. And we are hearing widely different reports. We are hearing reports like Essex, where there has been acceptable deals, in others we are hearing about arrangements where they seemed to be blocked in moving back to GMS. We are also concerned about the national PMS contract, what is going to be in that. We are seeking feedback from LMCs what is going on nationally.’

‘It appears illogical that NHS England as a single organisation that individual areas are taking such divergent approaches. And where local areas are agreeing on a return to GMS on terms that are acceptable in other areas it makes no logical sense to create barriers and I think this is something we will be taking up nationally.

An NHS England spokesperson said: ‘We have put in place a clear framework to enable our area teams to ensure that extra investment in PMS is fairly and transparently linked to quality of care for patients or the particular needs of the local population that they serve.’

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