NHS England has published a national framework for PMS reviews, replacing previous guidance which left most of the decisions up to local areas teams to agree.
The guidance includes the promise revealed earlier today as part of the GP contract 2015/16, for money reclaimed via PMS reviews to be reinvested within general practice, adding specifically that it should be reinvested within the same CCG area. It says that ‘wherever possible’, the PMS reviews should be ‘agreed jointly with CCGs as part of anticipated co-commissioning arrangements’.
It comes as Pulse reported earlier this month that area teams had been forced to break off talks about the future of PMS funding because NHS England executives were meeting to work out consistent national guidance to replace the varied approaches currently being taken. This was despite its own previous guidance stating that the implementation of the reviews will be agreed on a local basis.
According to the new document published today, ‘any resources freed up from PMS reviews’ should now ‘always be reinvested in general practice services, including, as appropriate, general practice premises developments’. It added that this should be within ‘the current CCG locality’ except in circumstances where ‘all CCGs involved’ had agreed differently.
Amid wide variation across the country, the new framework further sets out that area teams must give practices at least four years minimum as a readjustment period to phase out additional funding they currently receive.
And although many area teams have already reached deals which have seen practices revert from PMS to GMS with interim funding guaranteed, including for example in Essex where over half of practices have made the switch, NHS England has asked other area teams to consider keeping practices on PMS even if the funding was in line with GMS.
The new guidance said: ‘Area teams were previously asked to make local decisions on the pace of change for any redeployment of funding arising from PMS reviews. Without prejudice to agreements that have already been reached with practices, but in the interests of greater consistency for future decisions, area teams should – unless there are compelling reasons otherwise -redeploy any freed-up resources over a minimum four year period (year one being 2014/15).’
It added: ‘Where, as a result of PMS reviews, practices are likely to move towards levels of funding equivalent to GMS funding, area teams should consider the potential benefits of practices nonetheless having the option of remaining on PMS agreements as a way of preserving future flexibility.’
NHS England said the principles will ‘not apply retrospectively where agreements between area teams and practices have already been made’.
Rosamond Roughton, NHS England’s director of NHS Commissioning, said in a letter to area teams: ‘The revised framework is intended to give greater consistency on the timescales for change and the redeployment of funds, with a guarantee that any funds freed up will be reinvested in general practice, within the current CCG locality. This will not apply retrospectively.’
GPC chair Dr Chaand Nagpaul said: ‘We have been successful in securing a commitment from NHS England that all current PMS monies will be reinvested in general practice services, subsequent to PMS practice reviews. This is a significant agreement, given that there has always been the risk and concern of PMS monies being used for non-GP purposes.’
GPC deputy chair Dr Richard Vautrey also welcomed the commitment to retain the PMS funding within general practice but warned that any PMS practices that had already seen funding withdrawn quicker than within four years would need to be ‘revised’.
He added: ‘Clearly CCGs that have a number of PMS practices will be pleased that they can retain the freed-up PMS funding in their own area but those with few PMS practices will be concerned at the way this preserves historic inequity. It will be important going forward that we see CCGs with little or no PMS funding to invest to use their wider allocations to level up investment in general practice.’
An LMC leader, who wished to remain anonymous, told Pulse earlier this month that NHS England’s meeting to plan new national guidance had come as it had realised the vast ‘inconsistencies’ in approaches to reviews around the country, and followed reports of widely different routes taken by area teams.