Exclusive Hundreds more PMS practices have been offered a deal to switch to a GMS contract, with other areas set to follow suit, Pulse understands.
The NHS England East Anglia area team has given the 149 practices in its region until the end of July to take up the offer, which will phase out the reduction in their PMS premium payments in an attempt to prevent ‘significant’ destabilisation from the PMS review led by NHS England.
This was after an area team analysis estimated that two-thirds of practices stand to lose more than £100k a year as a result of the ongoing review of the local contracts as they were ‘delivering core services at a higher cost than GMS practices’ while ‘not generally delivering services or quality beyond that which would be expected from a GMS practice’.
Pulse can reveal that a number of areas are also considering offering transition deals, following those offered by the East Anglia team, and those already put it place in Essex, which was taken up by 63 of Essex LMC’s 100 PMS practices
The analysis by the East Anglia LAT that found 67 practices were estimated to lose between £100,000 to £199,000 annually and 42 practices were set to lose more than £200,000 as a result of NHS England’s PMS review, while only two practices were set to gain.
The practices in Cambridgeshire, Norfolk and Suffolk are being offered the choice between a direct move to GMS – an option which the LAT said ‘would make no financial sense’ – remaining on PMS and undergoing a review, or the new ‘transition offer’, which will gradually bring practices in line with the predicted ‘seven-year endpoint’ for GMS practices of £78.33 per patient.
The scheme will see any funding removed from PMS reinvested into primary care to support patient care, and local LMC leaders told Pulse that the scheme offers practices ‘certainty’ that other regions don’t have.
The East Anglia LAT’s proposal says: ‘Many of the PMS practices appear to be delivering core services at a higher cost than GMS practices.’
‘Without prejudice to the outcome of any PMS reviews, the area team considers that most PMS practices are not generally delivering services or quality beyond that which would be expected from a GMS practice.’
It explains that practices wishing to take up the offer can ‘opt to revert to a GMS contract and apply for transitional support’.
The proposal adds: ‘It is proposed that the funding released through the PMS review/transition will form a General Practice Transformation Fund held by the area team. […] This funding will be available to all practices in East Anglia to support developments in line with the agreed primary care strategy.’
Dr Ian Hume, medical secretary for Norfolk and Waveney LMC, and GPC representative for Norfolk and Suffolk, told Pulse that he would prefer more national investment, rather than disinvestment, in general practice but stressed the deal they had developed offered practices security.
Dr Hume told Pulse: ‘This is a deal we’ve been working with to try to give practices further options to maintain stability and certainty going forward.’
He added: ‘The important things are the principles we’ve agreed that the funding remains within clinical care so it’s not going off into other things like QIPP. It’s remaining within primary care to deliver clinical services, which means it benefits all practices.’
‘And also, to give a degree of certainty and show that you will not be going below the seven-year endpoint.’
Pulse has also identified another region, Lancashire, where the area team has agreed to consult with LMCs and CCGs in identifying the additional services delivered by practices.
Lancashire is also looking at a scheme to protect a proportion of PMS funding, equivalent to the MPIG uplift for GMS practices, which will be phased out at the same rate as MPIG.
Peter Higgins, chief executive of Lancashire and Cumbria LMCs, said that negotiations were still underway but that the LMC was looking to avoid destabilising already ‘stressed’ practices.
He told Pulse: ‘We’re looking at what services [PMS practices] are providing, and if they are providing services over core service, or an enhanced level of quality. We will agree, between the area team, ourselves and the CCG if they are to be funded in future.’
‘It’s a triumvirate, a three-way thing, at the end of the day the area team will make that decision but they’ll do it in close consultation with the CCG and ourselves. Because this is something that’s got the potential to destabilise primary care, and reduce services for patients in areas that are particularly stressed.’
Dr David Jenner, the PMS lead for NHS Alliance, said that more regions are looking at making such a deal.
He said: ‘I think the same conversations are going on in many places. Things like the Essex deal are being shared as a potential way forward – I think if you went across the patch, you’d find lots of people talking about it. But not so many people ready to say exactly what the deal is.’
Katie Norton, director of commissioning for NHS England East Anglia, told Pulse: ‘The East Anglia area team has developed a number of options for PMS practices to consider. These have been developed in the context of the NHS England requirement for all Area Teams to undertake a PMS Review. We believe that the options reflect our shared commitment to quality, service stability and fair funding and seeks to respond to the issues and risks that have been highlighted locally.’