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GPC concerned over practice funding following NHS England's PMS review

The GPC has expressed concerns after seeing draft plans for the redistribution of PMS funding following a major review by NHS England.

NHS England has now concluded the ‘value for money’ review it launched last summer and is expecting to announce the outcome shortly, Pulse has learned.

However, having seen the review themselves, general practice leaders have reacted negatively. The GPC has warned that many of the 40% of practices that hold PMS practices could be heavily affected - much more than the number of GMS practices to be put at risk resulting from the Government’s withdrawal of the MPIG.

The GPC also worries that the money taken away from PMS practices as a result of the review will not be reinvested into core general practice funding but that GPs will have to jump through hoops to win the money back.

GPC deputy chair Dr Richard Vautrey said: ‘We have seen the intent from NHS England and we have made a lot of comments on that. We have raised some concerns and we hope that they will have been taken on board.’

‘NHS England has a golden opportunity to reinvest in core general practice, using some of that PMS resource to invest in core practice income, allowing practices to plan for the future, take on more nurses and provide more appointments. But our big concern is that NHS England will instead take the resource which they believe is additional payment to PMS practices out and ask PMS and GMS practices to do extra work to earn that money back again.’

‘That would decrease practice morale and make the situation in practices worse not better.’

Dr Vautrey also expressed concern for the practices most heavily affected by cuts, arguing that NHS England must put in place protective measures similar to those agreed for the most heavily MPIG-reliant GMS practices.

He said: ‘There will be far more outliers resulting from the PMS review so the principle that NHS England is offering to MPIG outliers really should be applied to PMS outliers as well. There are many more PMS practices that will lose a lot more income and we hope that NHS England responds to our concerns.’

Specialist medical accountant Luke Bennett, from Francis Clark LLP, said reinvesting the money into core funding would be crucial, as would the length of time PMS practices are given to adjust to changes.

He commented: ‘The length of time over which any withdrawal of funds from PMS practices will be spread is critical. GMS practices are having their MPIG withdrawn over a seven-year period which gives a reasonable time span to take remedial action. The fear is that any PMS “excess funding” will be withdrawn over a much shorter period.’

‘More and more practices are finding it harder to recruit new partners, and there are many partners considering early retirement. If monies saved on PMS are not reinvested into core funding, this will exacerbate the recruitment crisis in general practice.’

NHS England said it is expecting to announce the outcome ‘very soon’.

Readers' comments (10)

  • PMS have had their snouts in the trough for years welcome to the coal face of GMS

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  • Umm no, there are some pms practices that may have been highly paid usually big ones with lots of gps per pt ( it's not a quality issue either)
    There are also pms practices that earns less then gms practices on average

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  • I think we need to be upfront with patients regarding funding issues. This should be led by the BMA.

    If funding (after inflation etc) drops by 10%, there should be an immediate announcement by the surgery that the number of appointments will drop by 10% - perhaps with instructions that extras should be diverted to A+E.

    It should also be made clear to patients that extra services provided under the PMS contract will be withdrawn. If the contract is changed without agreement, there should be consideration by the LMCs in each area to ask practices to decline certain enhanced services - specifically those which would result in more patients being sent to secondary care (referring all joint injections, all carpal tunnel injections, etc)

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  • There should be one national contract for all GPs

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  • I don't think we should allow ourselves to be divided too easily. Whatever the contract, there should be a clear relationship between the funding made available and the work expected. Unfortunately GMS funding is so far below what is required to fund a reasonable level of service that practices use QOF to subsidize huge areas of their surgery costs. Most GP's have done that and taken a huge cut in their pay, but that will not last as a generation of GP's come through who have huge debts and no illusions about the social contract. The general public do not realise how efficient( from an economic perspective) primary care is. Governments do realise but feel its an easy target

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  • I'd applaud the previous poster, especially for noting the fact that the public have broken the social contract. This service has been held together by goodwill, which has now been eroded. Anything that is non-GMS (or PMS) should be reviewed and cut if necessary (e.g. syringing for wax, cryotherapy for warts etc).

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  • At a time when practices are under severe financial pressure,these proposed changes to the PMS Practices many of whom,like mine are underfunded would have a profound impact on ability to meet existing levels of demand let alone the additional demands of the 14/15 contract changes

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  • Peter Swinyard

    Just a few points.
    [1]Anon 1145 - if you are underfunded on PMS, please compare where you would be on GMS and apply to change to GMS if it is better for you.
    [2] Overall, PMS practices earn more than GMS practices (AISMA figures). This is not necessarily unjust as PMS contracts often have included services which are not provided by GMS practices
    [3] PMS has a place - where it was originally intended - for practices which by virtue of exceptionality (students, homeless, whatever) would not get adequately rewarded on the Carr-Hill Formula. This remains valid.
    [4] The government review will now take place over the next 2 years of all PMS practices which have not been assessed on comparable measures to those announced by the government today
    [5] If practices are being paid for extra services and not providing them, it is clear that this should stop.
    [6] At last, GMS practice which work above and beyond their GMS contracts can be paid for the extra work from funds redeployed by the review (about £235 million net, I understand, after the review period).
    It has always seemed bizarre that "local" contracts are all held in Leeds and there is logic to changing everyone to GMS but the government has decided on a more moderate course - the bottom line is that the excellent PMS practices which use their extra funding over GMS to provide services above GMS will keep their money. Those which provide nothing extra will lose it.
    This may not be the most popular - but it does have a slight feeling of equity to it all.

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  • Has anyone seen the rationale behind the review?
    i.e. is the intention to base everything on an acknowledged inadequate GMS £/patient formula - and if so, based on a National or local basis? Is it to remove Growth Money (which has not increased for many years - unlike Basic Sum)?
    Or what rationale will be applied? Some forewarning might allow some current PMS practices to survive...

    To various critics of those who went PMS prior to 2004: this was sometimes - often? - in response to recruitment problems: under the old Red Book, practice income depended on numbers of GPs: lose a partner, income dropped drastically immediately - and if there was a vacancy for long enough to affect the accounts, recruitment became impossible!

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  • The reason General Practice is at breaking point is that core funding is straight-jacketed by a formula which means you get paid the same no matter how much activity takes place. Even if the "formula" is accurate enough to account for "need" it certainly doesn't take account of the exponential increase in "demand" (ratcheted up by successive governments promising more for less as a means to win votes). Though people are living longer with ever increasingly complex needs the real growth in workload comes from the expectations around access. Its time the government owned up about what the NHS can afford to provide. If we are to offer such access there needs to be an incentive to expand workforce and premises to cope. This can only be achieved through an activity based (PBR) core contract!

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