PMS funding diverted to pay for ‘polysystems’
By Ian Quinn
Exclusive: NHS managers are planning to scrap growth funding for PMS practices across London and use the cash to fund a new network of 100 ‘polysystems' – the successors to Lord Darzi's polyclinics.
Plans unearthed by Pulse show trusts plan to make huge savings by denying growth money to practices in the capital, and have earmarked it to finance their latest policy drive rather than pay off deficits.
Polysystems are designed to serve populations of up to 80,000, working around polyclinic hubs many of which may be run by private providers.
The Department of Health's policy implementation arm, NHS Primary Care Commissioning, has lent its backing to a policy developed by controversial PCT NHS Camden to finance polysystems using PMS cash.
An NHS Camden policy document posted on the PCC website as a model for other trusts sets out plans in which ‘the PMS growth money will be taken out and invested in the polysystem'.
At a meeting of PCT and DH representatives, PCC endorsed the Camden model and urged trusts to use ‘contractual levers' to squeeze money out of PMS.
It said: ‘NHS Camden has conducted a PMS review and illustrated how to reinvest into a 40% shift from acute medicine to a primary care polysystem.'
NHS North Central London – a group of five PCTs including NHS Camden – plans to move 87,291 outpatient appointments into polysystems in 2011/12, which it claims will save more than £20m a year.
Elsewhere, PMS practices in NHS Newham have been served with breach-of-contract notices after refusing to sign up to plans to cut funding (see left).
NHS London last week announced potential sites for more than 100 polyclinics across London, with care coordinated around each in a polysystem. But it admitted there was a high risk of local and national opposition jeopardising the plans, which will dramatically reduce the number of singlehanded practices and require those GPs who take part to extend their opening hours.
Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, Middlesex, said: ‘Polysystems are being imposed on GPs as a political imperative rather than being led by clinicians. It's the antithesis of the rhetoric we were given in the Darzi report. Just taking money from PMS practices to fund them is a highly crude approach that can only serve to further alienate GPs.'
The BMA is staging a rally at its headquarters on 25 February to protest against NHS London's plans, and is strongly opposing the polysystem drive.
Dr Kevin O'Kane, chair of the BMA's London regional council, said: ‘Polysystems are being used to bring in multinational companies and increase competition. This will enable them to replace small practices.'From polyclinic to polysystem
Networked polyclinic: A hub-and-spoke model with various GP practices linking to the hub for specialist services. Hub premises could be an existing GP practice, a private provider, a new-build or a new existing building.
Hospital-based polyclinic: To be based at the front of the hospital, with a network of care operating from community locations.
Same-site polyclinic: Services such as GP practices provided from the same building. The GP practices could run independently or merge.
Source: NHS London report
GPs fighting against NHS plans to slash the terms of their PMS pay have been threatened with breach-of-contract notices.
Dr Surendra Dhariwal, a GP in Newham, east London, heads up a group of more than 30 PMS practices who have consulted lawyers in an effort to stop NHS Newham bringing in new targets and cutting the funds per patient.
Dr Dhariwal said: ‘The attitude of the PCT is totally alien. All the PCT staff who negotiated the first PMS contract and understood its benefits have now left.'