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Independents' Day

Practice funding could be linked to A&E attendances and cancer survival rates

Exclusive Hundreds of PMS practices in London are set to be tied to a standardised contract that will pay them based on a set of ‘outcomes standards’, which could include cancer survival rates and A&E attendances, local leaders have told Pulse.

Under plans drafted by the NHS England London area team, PMS practices will have their ‘premiums’ - the money that PMS practices are paid above the core contract - clawed back and used to pay only practices performing well against standards including cancer survival rates, long-term conditions management, A&E attendance rates and ease of access.

The area team said that GMS-contracted practices could also be incentivised under the plans, which come as part of NHS England’s national bid to ‘redistribute’ £260m worth of PMS ‘premium’ funding,

But Londonwide LMCs medical director Dr Tony Grewal warned that clawing back money from practices may see patient care suffer if GPs were defunded as a result of failing to affect health outcomes that were often outside of their control.

He told Pulse that the area team was drawing up plans for PMS practices, and looking at incorporating the standards from its ‘My Health London’ website, which is used by the area team in performance management and also to allow patients to compare London GP practices.

It also typically measures GPs against expected ‘outcomes standards’ based on their demographic, such as a certain number of cases of identified depression, expected breast cancer or bowel cancer survival rates, among other areas.

Dr Grewal said: ‘The outcome standards that you see on the My Health London website are being beefed up and made fit for whatever purpose is leading on this. Our understanding is that any extra payments made to PMS practices will be based on their achievement against the newly developed outcome standards.’

He said that practices will need to invest in premises, training, staff and other resources before they achieve the outcomes, yet the outcomes might still be out of their control.

Dr Grewal added: ‘Practices will be hedging on that they will be able to achieve these outcomes. A lot of them are based on patient survival and outcomes for long-term conditions and while that is laudable as a theory, in practice there are so many other factors that are going to affect the outcome, such as demographics of the area, access to referral services, patient behaviour - 101 things over which GPs have little or no control.’

Asked whether the LMC would oppose the plans, Dr Grewal said he expected them to be imposed.

He said: ‘It will affect patient services as well because if they are taking away the additional payments which are currently based around service delivery, and changing those completely, then practices will not have the resources to continue delivering the extra services that PMS was designed to produce, and that means those services will go because practices won’t have the resources to continue to deliver them.’

An NHS England London spokesperson said: ‘By standardising the PMS contracts across London, we can ensure that all patients registered with a PMS practice receive the same high-quality core services with the opportunity to tailor services for localised needs. This means that patients will be able to secure services or outcomes that go beyond the essential services delivered by GMS contracts. Enhancements to GMS contracts are being considered.’

‘NHS England (London) is currently reviewing PMS contracts to help reduce health inequalities. By linking the contracts to local need and service improvements, the review is directed at improving health outcomes and providing practices the ability to develop services appropriate to their patients.’

The spokesperson added that the review was yet to be completed.

This follows moves by area teams to offer deals to practices that will be adversely affected by the PMS reviews, including those in Essex and East Anglia.

Readers' comments (13)

  • Bit like a lottery really,do we have any control of these outcomes, little if any.I would be a little miffed if this was imposed on my practice.

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  • The off-list letter printing presses are churning as we speak.

    If I was a partner in a London PMS practice I would be resigning before my colleagues did.

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  • These people obviously thinks patients should be treated as economical nuisance rather then an individual human being.

    Unless they've found a cure to cancer, people die of cancer. Even if you detect it early, people can still die. People will still attend AED eve if I was personally available 24/7 - some just like hospital doctors more (because juniors are more likely to over test and over treat), some just find GPs balancing demand and access too inconvenient, and many are just plain genuine "accidents and emergencies".

    Having said that, I assume this is just another ploy to phase out PMS practices.

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  • Harry Longman

    Of course we all want these outcomes... but a system of carrots and sticks is not the way to achieve them. It will just create arguments about unfairness, factors outside the practice control - and is likely to raise inequalities as lower funded practices will lose good staff. Instead, understand what works and help everyone do it.

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  • Stop the inappropriate demand - charge patients for lifestyle illnesses, inappropriate use of the NHS etc

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  • What else is going to be reduced at GP practice level we are working with a short sighted government who should visit practices around the country to see exactly how busy GP practices are!! The problem of patients presenting at A&E is long standing and until every A&E triages and educates patients to return to primary care within working hours of GP practices with primary care problems the problem will continue and hospital will continue to profit from a broken nail presentation! GP need more funding simple as that to spend time at what they are excellent at doing caring for patients with the correct treatment. Freq flyer patients should all have care plans with A&E as to what should happen if they present, not just to let them through the door for another £100 A&E attendance its wrong and a waste of money! As for the cancer referrals all of the practices I have worked closely with are excellent at detection and refer within 2 week rule processes. It bemuses and annoys management and GPs within GP practice when the blanket approach is taken and presented on TV with no statistics or areas of country analysed in more detail. Sorry to go on but we should close walk-ins open GP practices or areas 7 days and fund primary care so we can staff patient demand and walkins simply feed this becuase if a patient attends a walk-in in year 1 back in 2008-09 walkins received around £90 reduces over the five year period to around £30 now this year however some of these patients are then sent to A&E so double cost when given time and correct training (when required) primary care can deal with most of this as NP's are often working without GP support or advice before deciding to admit or send the patient to hospital. I will stop now as my frustration is increasing due to the on-going criticism GPs receive when we are all very much demoralised by government changes which is completely unhealthy for the stablisation of NHS.

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  • So if somebody works in deprived areas and has high A&E attendance with mortality also ( could be cancer) he will have to do magic to improve or otherwise Jeremy will come running around with a stick cutting his pay. Sadly this kind of disservice to deprived areas is highly despicable and so are the quick fix solutions to grab headlines.Luckily on the other side it is sign of a desperate Government trying to get some votes in last year of service sorry disservice.

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  • Our surgery offers afternoon and morning triage.

    At 1220 a patient called with a COPD exacerbation, at 1340 I called him - no answer. At 1500 got call from A+E as he'd turned up there with his mild exacerbation of COPD that he'd had for 5 days. Fortunately A+E doctor refused to give him antibx and steroids and called me- he was given an appointment for 1600.

    I'm not sure what I could have added to prevent that patient from attending A+E initially. I've given him standby antibx and steroids for next time and a lecture.

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  • Just wait for the first Daily Mail story - My GP refused to let me go to A&E with my sick baby who then died.

    My GP told me it was a cold and I was wasting precious NHS resources, but it was only done as they are paid to stop us seeing a proper doctor.

    The politicians want us to have to bite the demand and expectation POISON PILL they have created.

    They will then sit back and watch GPs hang themselves trying to hit the CCG (GP) performance management targets.

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