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Almost a quarter of PMS practices have switched to GMS following £258m cuts

Exclusive  Close to a quarter of PMS practices have switched onto GMS contracts in light of NHS England’s national funding review, Pulse can reveal.

An FOI request to NHS England showed that there were 3,042 PMS practices in England when the review began, but by December last year 711 (23%) of these had reverted to GMS.

It also shows that the review of PMS budgets identified £258m to be cut – close to NHS England’s original estimate – having found they were not linked to providing specific services above GMS contracts. Only £67m of the extra funding received by PMS practices will be untouched, as it is linked to specific services.

A further request to CCGs found that almost half are using the funding to set up their own local ’quality contracts’ that will see practices receive enhanced funding for meeting key performance indicators.

NHS England announced a review of funding received by PMS practices that were not linked to specific services in 2013, in a bid to save £260m, which it said was set to be ‘redeployed’ across all GP practices in each area.

It was the biggest change to the contracts, which were first introduced in 1998.

During the course of the review, many areas offered PMS practice the opportunity to switch to a GMS contract but retain a diminishing portion of their PMS premium over a phasing out period.

Pulse’s investigation has revealed that almost a quarter of practices have switched to GMS contracts, but this number could be higher, because NHS England’s FOI response goes up to December 2015, while the reviews ended in April this year. 

Dr Nick Simpson, a GP principal near Lougborough, moved from PMS to GMS funding at the start of April and stands to lose around £40,000 as a result. 

But, he said: ’I think the switch from PMS to GMS is a good thing for the stability of general practices as you are protected by a national contract and can’t be sacked unless you do something really bad.

‘You go back to delivering what you might call core practice of general practice such as [treating] diabetes, managing hypertension and dealing with patients who walk in and say they are unwell,’ he said.

More specialist services, such as dietitians and possibly vasectomies, that may have been funded with a ‘premium’ included in PMS contacts, will probably have to be cut when a practice reverts to GMS funding, he said.

Out of 116 CCGs sharing their plans with Pulse under FOI, 46 are setting out ‘quality standards’ or ‘key performance indicators’ for practices to meet in order to receive an ‘equitable’ share of the redistributed funds.

This includes the new London ‘offer’, which will include mandatory KPIs covering cervical screening, vaccinations and immunisations and two indicators to be chosen by CCGs based on local priorities identified in the Patient Survey.

It also includes the ‘Manchester standards’, a set of targets developed for primary care by CCGs and local authorities involved in the devolution of healthcare in Greater Manchester (for example, improved cancer survival and better mental health services), which CCGs plan to incentivise using PMS money.

Other areas setting out quality contracts include the Reading area, Wakefield, Cumbria, Rotherham and parts of Kent – with all practices, including those on GMS contracts, getting a shot at receiving the premium funding.

As previously reported, NHS Greater Huddersfield CCG is distributing £170,000 across three practices disadvantaged by the Carr-Hill allocations formula.

NHS England’s national PMS review guidance was that ‘resources freed up’ should ‘always be reinvested in general practice services (including, as appropriate, general practice premises developments)’, and that ‘PMS resources should not be redeployed outside the current CCG locality’.

Out of the 116 CCGs responding:

  • 41 have not decided what they are doing with the funding;
  • 26 have commissioned new LCSs, including for elderly care and long-term conditions management;
  • 9 are doing their own schemes, including practice pharmacists, nurse prescribing, staff training, extended access;
  • 7 are spending it on ‘transforming’ general practice or making it ‘sustainable’;
  • 5 CCGs completed the review but found no PMS premium that was not linked to services;
  • 3 CCGs have just redistributed it across all practices.

Click here for the data in full