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PMS reviews thrown into disarray as NHS England halts local negotiations



Exclusive Local negotiations regarding the future of PMS funding have been thrown into disarray after NHS England said it was meeting to ‘agree policy options for area teams to follow’, Pulse has learnt.

Local GP leaders have reported that area teams have been forced to break off talks about the future of PMS funding because NHS England executives are meeting this week (11 September) to work out consistent national guidance to replace the varied approaches currently being taken.

The meeting will especially focus on ‘pace of change’ and how the savings made from withdrawing the ‘premium’ funding are going to be used following concerns over the varying local approaches taken, despite its own previous guidance stating that the implementation of the reviews will be agreed on a local basis,

It comes as LMCs in some areas were able to negotiate ‘transition deals’ for hundreds of practices to switch to GMS on ‘favourable’ terms, with their PMS premium phased out over timescales that varied from a couple of years and up to seven years in different areas, while practices in some areas are having their PMS premiums reduced at a swift rate without being offered a switch to GMS.

But area teams are now ‘advised to await the outcome’ of this meeting, as well as a meeting between NHS England and GPC this week, with new guidance to be expected sometime next week according to a note to LMCs from the Thames Valley area team.

The note said: ‘[We are] writing to let you know that we need to postpone the PMS Contract Review Steering group meeting… The reason for this is that NHS England executives are meeting on 11 September to agree policy options for area teams to follow, particularly in relation to pace of change and recycling of premium funding. In addition, we understand that NHS England is meeting with representatives from the GPC this week.

‘We are advised to await the outcome of both these national meetings and therefore anticipate further NHS England guidance during week beginning 15 September. Please accept our apologies for the late notice but we have only recently been made aware of these national meetings. I will be in touch shortly with an invitation to a revised meeting date.’

An LMC leader in a different part of the country, who wished to remain anonymous, said that NHS England’s meeting later this week has come as they have realised the vast ‘inconsistencies’ in approaches to reviews around the country, and comes as there were still reports of widely different routes taken by area teams.

However, NHS England’s guidance from February this year said that the reviews will be carried out locally.

It said: ‘We have concluded that area teams should make local judgements on the appropriate pace of change for redeploying funding, balancing the need to ensure that funding is used more productively, equitably and transparently and the need to provide a manageable pace of change for the individual practices involved.’

It comes as local leaders have reported confusion over the implentation of the reviews, including:

  • the area team in North Staffordshire had thought no further reviews were necessary in light of having had a major review two years ago, but has now been told by NHS England centrally that it needs to claw back 10% of PMS funding;
  • in Devon, the PMS reviews have been put on hold awaiting co-commissioning, because the area team wants CCGs to run the exercise;
  • in Wakefield, LMC leaders said the local PMS review had unveiled a proposed funding loss for practices equating to ‘38 full-time GPs or 95 practice nurses’ across 34 surgeries, and that they still did not know if the review would be led by the area team or by the CCG as co-commissioner.

Dr Paul Scott, chair of North Staffs LMC, said: ‘In our area we had extensive PMS reviews about 18 months to two years ago. These reviewed budgets against activity and also extra GP headcount and were rigorous. Our area team did not feel it necessary to revisit this again so soon and we have a low percentage of PMS [contracts] as well. [However] only last week they said that NHS England have insisted they revisit this with up to 10% automatic budget slicing, which will cripple many practices who have already had cuts.’

Devon LMC interim medical secretary Dr Mark Sanford-Wood said: ‘Here in the peninsula all PMS reviews have been put on hold pending the move to co-commissioning.’

Meanwhile, Wakefield LMC medical secretary Dr Lyn Hall said: ‘Our area is due to lose £3.8 million from PMS reviews between April 2015 and April 2018. We are not clear whether negotiations are with the CCG, who are asking for co-commissioning, or NHS England. We have five practices who will lose between 17 and 22% of their budget.

‘They are all small and may face closure in the future. These funding cuts equate to losing 38 full-time GPs or 95 practice nurses over 34 practices. The lack of clarity from NHS England is extremely frustrating for practices.’

GPC deputy chair Dr Richard Vautrey said there was ‘real confusion around the country about what is happening’.

He added: ‘Practices in some areas have received notification of their review process, in other areas they have been told it has been put on hold and there seems to be debate going on within NHS England about how PMS will be reviewed, whether it will be at a CCG level, an area team level or whether it will be at a wider level, and I think practices are very confused and anxious about what the future holds.’

It comes as area teams are still awaiting an update to a new standardised PMS temlate contract onto which, as part of the review, they are meant to switch all PMS practices onto, with NHS England’s website still stating that this ‘will follow shortly’.

A spokesperson for NHS England said: ‘NHS England has taken no decision nationally to put all PMS reviews on hold. The PMS review process is kept under continual senior review by NHS England.’