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At the heart of general practice since 1960

Opting for personal medical services

ou have weighed up the pros and cons of PMS and decided it is the way forward in the light of uncertainty surrounding the contract.

Now you need to get the

procedure right.

The original policy aims of PMS

have remained to a large extent unchanged:

 · To test new arrangements for the provision of primary care services

 · Services tailored to meet local need

 · A quality-focused contract

 · An opportunity to improve recruitment and retention of GPs

 · To reduce bureaucracy in NHS contracting

 · To improve deployment of GMS resource usage through 'growth' allocation.

Contractual mechanism and rationale

Setting meaningful standards and objectives plays an important part in setting the PMS contract, with individual sites working towards improvement in health care. The standards applied must have relevance and must be deemed to be achievable and agreed locally.

There is ample evidence from the literature that standards indiscriminately applied lead to distortions in the overall function of an organisation, which is unlikely to be to the benefit of the total delivery of care. This is particularly the case in primary care, where a wide variety of patient problems have to be dealt with. This is a feature of much of the current type of PMS contracting.

The common goal of improvement is provided at national level by the mechanics of NSFs, NICE guidelines, appraisal mechanisms and collaborative learning. There is value in diversity of method and process towards these common goals. This will differ in different sites, recognising local demographics, need and skill mix ­ and is the essence of PMS.

Consistency of contracting

From the third wave of PMS pilots, a core contractual framework has been adopted which includes NSFs and other Government initiatives for primary care. The first two waves are not bound by these arrangements. While the 'core contract' guidance issued by the Department of Health outlines the principles of PMS through a standardised framework, the detailed performance and measurement is left to local design.

But lack of local expertise, despite the introduction of a department-initiated National PMS Development Team, has lead to many inconsistencies and irregularities.

PMS and the NHS Plan

The NHS Plan made several statements concerning PMS. Possibly the most damaging was the target for the number of GPs to be in pilots by April 2002. It was not achieved.

There is no clinical benefit to set a target for the number of PMS GPs. This shows both a lack of understanding about the scope of PMS and the limitations of the 1997 Act.

This target has set perverse incentives to commissioners and has deflected clinicians away from the real clinical benefits of PMS contracting. This has created a two-tier system and is storing up problems if and when PMS becomes a permanent arrangement.

PMS and the future

In my view PMS legislation is a fine opportunity. There are new flexible contracting arrangements for the delivery of primary care services and the ability to refocus efforts in clinically appropriate areas.

In future, PCTs should view the PMS option as one of a range of tools for commissioning services where a national contract may restrict the delivery of services to a local population with specific needs. The reason to move to PMS contracts should be for clinical reasons, and not financial gain. GPs thinking of opting for PMS must be aware of this.

The reason to move to PMS should be clinical and not for financial gain~

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