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One in three PMS practices hit by contract change since 2011

Exclusive Over a third of PMS practices have had their contracts changed by managers within the past two years, in the biggest reappraisal of PMS funding since the alternative contract was introduced, a Pulse investigation reveals.

Some 55% of PMS practices have been subject to a contract review since April 2011, while 37% seeing their terms varied as a result. In total, 4% of contracts have been terminated, resulting in practice closure, merger or – in most cases – reversion to a GMS contract.

The investigation findings are based on data obtained under the Freedom of Information Act from a sample of PCTs, covering 1,278 PMS contracts which were in existence on 1 April 2011.

In some areas practices have lost tens of thousands of pounds in funding, sending GP drawings plummeting and putting staff at risk of redundancy. Many GPs attributed the changes to managers seeking efficiency savings, although a small number of practices did gain from the reviews.

Dr Di Aitken, a GP in Lambeth in South London, said her local PCT had unilaterally reduced her PMS practice’s annual funding by £179,000 since 2011, with the partners taking a 40% pay cut as a result.

‘We [the partners] are now being paid less than our salaried GP, and I know that is not unusual because I am part of a peer support group and it is the same across the board,’ she said.

A spokesperson for NHS Lambeth said the contract review had been an ‘opportunity to refocus and better incentivise the provision of primary care contracts to be more closely aligned towards our priority health goals’.

Dr Tom Frewin, a single-handed GP in Bristol, said a PCT-wide review of PMS contracts had resulted in his practice losing about £67,000 a year.

He said: ‘There were no negotiations. They said they would negotiate and there were a lot of meetings, but what a complete waste of time that was. It is an entire hypocrisy.’

A spokesperson for NHS Bristol insisted it had followed an ‘extremely robust’ process in renegotiating PMS contracts.

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Overall, 30 of the 1,278 total practices switched to a GMS over the two-year period. Many were in Derby, where the PCT has retained just two PMS contracts after reviewing all 16 PMS contracts it held two years ago, with 14 contracts moving to GMS.

An NHS Derby City spokesperson said the move was ‘an opportunity for the PCT to standardise and simplify primary care contracts’ and that practices now had ‘the additional security that a GMS contract gave them.’

Meanwhile, trusts reporting that GPs had received additional funding included NHS Suffolk, where two tenders for procurement of new services contracts went to two existing PMS practices - although a spokesperson explained that the PCT had carried out an ‘equitable funding’ review of all PMS and GMS contracts in the area prior to 2011.

Pulse’s investigation comes as the NHS Commissioning Board prepares to review all PMS contracts from 2014 as part of the Government’s ‘equitable funding’ drive. Last week, the Board promised that the review of contracts would follow a single, more rigorous process than the PCT reviews but the GPC has express concern over the process.

Pulse Live: 30 April - 1 May, Birmingham

Richard Apps, partner at RSM Tenon accountants, will be presenting a session on ‘Maximising your income and keeping an eye on your cashflow’ at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.