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Independents' Day

PMS practices face contract clampdown

By Steve Nowottny

Exclusive: NHS managers are preparing to launch a major clampdown on PMS contracts as part of a nationwide drive to ramp up value for money.

Dozens of PCTs across the country plan to start renegotiating PMS deals, with thousands of GPs facing having to take on new work for no new funding.

The moves follow a directive from the Department of Health on this year's pay deal, making clear ‘a smaller proportion of PMS practices' should receive an uplift than GMS GPs.

Two thirds of PCTs told Pulse they were seeking to obtain better value from PMS GPs, with 41% planning to review or renegotiate contracts in the next few months.

PCTs are employing a variety of tactics to drive up value for money, including adding contractual requirements to PMS practices or asking GPs to justify their funding.

NHS Eastern and Coastal Kent said it was investigating the contracts of 30 PMS practices, initially looking at premises, list size and superannuation, and was in the process of drawing up a revised contract with ‘additional objectives'.

Sheffield PCT said it was reviewing all PMS objectives, while in Newham, the local Professional Executive Committee has just approved a review of PMS contracts.

West Sussex PCT said it had recently held a meeting for PMS practices to discuss how GPs could provide better value for their existing levels of funding.

‘The intention is for the practices to justify their funding through providing extra services in line with the PCT's commissioning plans,' a spokesperson said.

The clawbacks threaten to see a repeat of recent PMS contract rows in areas such as in Northumberland, Suffolk, Waltham Forest, Redbridge and Hounslow, but on an even bigger scale.

Pulse's investigation, based on information from 39 trusts across the country, also found in nearly every case PMS income has been frozen for the past two years.

Just one PCT reported a significant uplift in funding, while most trusts blamed local freezes on a DH edict.

DH guidance obtained by Pulse recommends trusts apply the pay review body's recommendations for GMS practices to PMS GPs, and that the proportion getting a pay rise should be smaller than the 7% of GMS GPs who received a full uplift.

GPC negotiator Dr Peter Holden said: ‘It was always a risk with a local contract that when PCTs were strapped for cash they'd want more bang for their buck.

‘There's concern among the negotiating team about unfair attempts at renegotiation of PMS practices. PMS practices are uniquely open to bullying.'

Dr David Lloyd, a GP partner at a PMS practice in North Harrow, northwest London, said there was little scope for practices to take on additional work.

‘I would dispute that they can get any more value out of this contract. I work hard and there are only so many things I can fit in.'

Dr James Kingsland, president of the National Association of Primary Care and a PMS GP in Wirral, warned against contractual reviews being used as a ‘witchhunt against practices'.

Contract clampdown: how PCTs are squeezing PMS contracts

- 67% of PCTs have plans to obtain better value for money from PMS contracts

- 41% of PCTs launching imminent review of PMS contracts

- 82% of PCTs have awarded PMS practices 0% pay uplift for past two years

Source: Pulse survey of 39 PCTs

Dr David Lloyd, a PMS GP in Harrow

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