Is PMS a better alternative than GMS?
PMS was originally developed an as an acceptable community-based face of fundholding. PMS was also considered to offer a way of developing primary medical care to break the Red Book monopoly.
It offered at first sight greater variety to practices by commissioning a level of service from them determined by the local needs identified initially by their health authority and subsequently by the PCOs.
Both PCOs and practices often relished the local adaptability that came with PMS and the application of quality standards. In some areas this has been widely accepted and both sides are happy with the outcome.
The ability to react to locally identified medical problems in a way that allows the PCO to solve them is very much welcomed by the management. The way GPs can be encouraged and funded to provide solutions to problems occurring in their surgeries every day is also much appreciated by both. Where this coincides it is a win-win situation.
Money flows to the PMS practices via growth payments, regardless of GP numbers just as with the new contract. But PMS is already in action and a lot of the administrative difficulties with the contract type have been ironed out.
A problem is that the Government has been generous in the amount of money going to the PMS practices, since there is no doubt it feels it is the way forward to gain more control of general practice. Whether it feels it is getting value for money is another question and there is the distinct possibility that funding will be reduced. Despite the Government saying it will maintain the two contracts I can see an increasing coming together of the two since they work on the same premise.
If the Government does not feel it is getting what it wants in PMS for all the investment, is it going to attempt to reduce the funding available by virtue of the fact it is in the Part I funding stream and as such more locally restrictable?
Certainly, lack of growth money now seems to be putting practices off PMS.
Is in fact the Government's prime intention to make general practice an employee status for doctors? Even if this is the case there is some question as to whether the new contract is in actual fact very different.
The new contract is a national contract but has exactly the same commissioning approach as PMS. It is not as locally responsive but is not independent of local control and possibly could finish up more bureaucratic.
There is still uncertainty about how the new contract will work in practice and how far the Government will actually renege on matters we thought were agreed with the NHS Confederation. Despite being nationally negotiated, in practice a
lot of the decisions will be made locally by the
PCOs determining local priorities (the exception being a few nationally directed enhanced services).
It appears the distinction between PMS and the new contract may be artificial as the two contracts are so similar in intention:
· Both practice based
· Both output (quality) driven
· Both offer increased flexibility of delivery
· Both offer GP career development.
Forward-thinking practices that can adapt to a changing environment are going to be able to cope as well with PMS as with the new contract. National negotiation may be a disadvantage and hold back practices in areas where good co-operation with PCOs is already in existence.
If you are currently in GMS should you now consider going to PMS?
In favour is the fact that PMS is established and will be financially beneficial to you more quickly. Against this is the fact that the new contract is not established yet but may be less controlled locally.
What if you are a GMS practice with an option to
go for PMS in wave 5b?
There is no reason not to go for it. There is a very good chance you could return to the new contract if it turns out to be better. However, if too many practices opt for the PMS route then it will become the majority type and we will be in a whole new ball game!
If you are in PMS now should you opt to go
for the new contract?
There is absolutely no good reason to change at present since, financially, it could be very expensive, and there is too much uncertainty associated with it.
In the final analysis it will come down to how far your PCT is viewed as able to work well with you in a way you can accept, and how far your views on the development of general practice provision actually coincide with theirs.
The poor morale in general practice is not entirely to be laid at the door of low income, but is much more concerned with professional satisfaction and the ability to meet the identifiable needs of patients. The system that better enables you to achieve this is the one for you.