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NHS England begins major ‘value for money’ review of all PMS contracts



Exclusive Health managers have launched a major national review of all PMS practice funding to ensure that the contracts are providing ‘value for money’, Pulse has learned.

In a letter sent out last week (5 June), NHS England said local area teams will be required to gather information from practices so the national body can centrally review how far PMS funding is being used to fund innovation and local service improvement – the ‘original rationale’ for PMS contracts – and not for ‘core’ services.

The GPC warned against the national process becoming a means to remove money from general practice to plug deficits elsewhere in the Government’s budget.

The review, first flagged by Pulse at the end of last year, will take place during 2013/14 with changes to be implemented for 2014/15, said NHS England.

Pulse revealed in February that over a third of PMS practices have already had their contracts changed by managers within the past two years in the biggest reappraisal of PMS funding since the alternative contract was introduced.

The NHS England letter, obtained by Pulse, said: ‘The wider review will commence with systematic work to gather and understand fully at individual contract level by area team the basis of existing PMS funding and its component parts. We will write shortly to set out the proposed process for gathering this information by the end of August and the support that will be available to assist you in this to ensure a nationally consistent approach.

‘This review will need to consider how far PMS expenditure (in so far as it exceeds the equivalent expenditure on GMS services) is effectively paying for “core” primary care services and should be treated in the same way as MPIG expenditure; how far it is paying for innovation and quality improvement in primary care; and how far it is paying for “enhanced” primary care services. The review will need to establish both how we ensure equitable “core” funding between GMS and PMS practices and how we ensure the best possible value from investment in services that go beyond the “core”.’

‘We want to ensure that we bear in mind the original rationale for PMS contracts… to promote innovation and local service improvement.’

It also set out clear guidance to LATs not to launch their own local reviews of PMS contracts to reach cost-saving targets.

The letter said: ‘We have been conscious that some area teams have been looking to PMS reviews as a way of delivering QIPP savings during 2013/14 – and that some area teams have inherited PMS reviews that are almost complete.’

‘To ensure a nationally consistent way of reviewing the way forward for PMS contracts, we have concluded that, subject to the two caveats below, area teams should not initiate their own independent reviews of PMS funding during 2013/14. The only exceptions to this will be where there is Local Medical Committee support for a local review of PMS funding, or where PCT clusters had gone out to consultation on changes to PMS arrangements and it now falls to you to consider the outcome of those consultations and put into effect the resulting changes.’

Commenting on the letter, an NHS England spokesperson said: ‘NHS England wrote to area teams on Thursday 5 June to advise on progressing a national approach to reviewing PMS contracts during 13/14 and beyond. The letter asked area teams to confirm a lead representative by 14 June to input to the review.’

Click here to read the letter

GPC deputy chair Dr Richard Vautrey expressed concern that this review would take money away from PMS practices.

He said: ‘We believe it is important that there is a national approach to this but would be concerned if there was any attempt to remove funding from general practice funding as part of this process and it certainly should not be used to plug deficits elsewhere in the NHS budget. General practice funding is already woefully low and needs adding to, not further funds taken away.’

‘It is important that this work is done fairly and consistently across the country but it will be complex and LMCs should be involved in the process.’

NAPC vice president Dr Peter Smith added: ‘The NAPC has always supported the need for PMS to deliver value for money. It is correct to remove PMS from the slings and arrows of local fortune but only if the non-core elements are treated with respect where value for money has been demonstrated locally. A large number of PMS practices have already been through sometimes disruptive and destabilising local reviews to deliver this added value. It would be inequitable to put these practices through further draconian changes. At the very least, Barbara Hakin’s statement regarding contract changes, which established the principle that convergence requires a seven year evolution should apply to noncore elements if significant changes are proposed.’