Exclusive A CCG is proposing to increase average funding for GMS practices by £200,000 under a local contract, which will see GPs providing extra services in clusters, Pulse can reveal.
NHS Warrington CCG is currently consulting the public on its draft strategy, proposing to pay GP practices baseline funding of £90 per patient – almost £17 more per patient than the current national global sum payment of £73.56 – which has become possible due to its co-commissioning status.
However, it has admitted that PMS practices will lose out under the new model, as it is using the PMS ‘premiums’ to fund the new contract model.
Under the proposals, practices would work in clusters covering more than 30,000 patients, as stipulated in the new contract announced by Prime Minister David Cameron last week.
The Warrington plans will also see multidisciplinary teams offering integrated care, 8am to 8pm access on weekdays at one location within the cluster, a dedicated team for care home patients, extra children’s nursing services and some community, preventive and mental health services.
The plan also mentions social prescribing, including activity classes.
However, the CCG has ruled out Sunday opening, after its ‘Challenge Fund’ pilot reported low uptake of Sunday appointments.
Some of the extra money will come from redistributing PMS funding and some as a result of national redistribution of MPIG, as the CCG has hardly any MPIG practices but historically high PMS funding.
The plan would also see the CCG topping up funding by at least £1.8m.
The CCG said: ‘Increasing funding to a level of £90 per weighted patient would significantly increase investment in GMS practices. Data on weighted patient numbers for GMS practices is awaited from NHS England, therefore this analysis cannot determine the spread of impact on individual practices.
‘However, given that the investment required is £1.1m across six practices, the average increase in income is just under £200k per practice.’
It has admitted that that five PMS practices wil lose out under the new model, four of which would lose less than £50,000.
One significant outlier would see a drop in excess of £200,000 but the CCG said it was working with that practice – which has been found to receive a premium of close to £40 per patient – on how to reduce costs and added it was not at risk of closure.
The draft strategy says: ‘The analysis shows that there is a strong case for moving at speed to a local weighted patient currency per weighted patient as the commissioning approach for the Warrington brand.’
Under the plans, the practices would remain on the national GP contract with the ‘Warrington Brand’ extra commitments contracted on top via the Standard NHS Contract. The Carr-Hill formula would continue to be applied both on the base contract pay and on the Warrington element.
NHS Warrington CCG clinical chief officer Dr Andy Davies said of the £90 per patient: ‘That is just an estimate of where it might land.
‘Historically practices have had fairly decent global sum returns for PMS but they haven’t had any extended or enhanced services so what we want to try and do is redress that balance and look at what we can do better in primary care, such as for example in mental health and medicines optimisation.
‘We would also probably wrap up some of the over-75s work that has been going on into that extended contract, such as for example complex case management, which could mean a higher price per patient.’
He added: ‘Hopefully we can use this to create a more cohesive system of primary care and give practices benefits too. Hopefully their workload can be more managable by utilising resources where there is demand.’
Dr Davies said there would be extended hours working, but the CCG would not want to provide appointments when there was no demand, such as on Sundays.
He said: ‘What I would be worried about, if you look at the evidence from the PM’s Challenge Fund sites, most have stopped offering Sundays because there was such a lack of demand. Why would you want a routine hypertension check on a Sunday with a GP? Saturday morning into the early afternoon there seems to be demand, but beyond that it tapers off quite quickly.’
The 90-day patient consultation is due to conclude in November, with the ‘brand’ set to launch from April 2016.