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Practice funding could be linked to A&E attendances and cancer survival rates

Exclusive Hundreds of PMS practices in London are set to be tied to a standardised contract that will pay them based on a set of ‘outcomes standards’, which could include cancer survival rates and A&E attendances, local leaders have told Pulse.

Under plans drafted by the NHS England London area team, PMS practices will have their ‘premiums’ – the money that PMS practices are paid above the core contract – clawed back and used to pay only practices performing well against standards including cancer survival rates, long-term conditions management, A&E attendance rates and ease of access.

The area team said that GMS-contracted practices could also be incentivised under the plans, which come as part of NHS England’s national bid to ‘redistribute’ £260m worth of PMS ‘premium’ funding,

But Londonwide LMCs medical director Dr Tony Grewal warned that clawing back money from practices may see patient care suffer if GPs were defunded as a result of failing to affect health outcomes that were often outside of their control.

He told Pulse that the area team was drawing up plans for PMS practices, and looking at incorporating the standards from its ‘My Health London’ website, which is used by the area team in performance management and also to allow patients to compare London GP practices.

It also typically measures GPs against expected ‘outcomes standards’ based on their demographic, such as a certain number of cases of identified depression, expected breast cancer or bowel cancer survival rates, among other areas.

Dr Grewal said: ‘The outcome standards that you see on the My Health London website are being beefed up and made fit for whatever purpose is leading on this. Our understanding is that any extra payments made to PMS practices will be based on their achievement against the newly developed outcome standards.’

He said that practices will need to invest in premises, training, staff and other resources before they achieve the outcomes, yet the outcomes might still be out of their control.

Dr Grewal added: ‘Practices will be hedging on that they will be able to achieve these outcomes. A lot of them are based on patient survival and outcomes for long-term conditions and while that is laudable as a theory, in practice there are so many other factors that are going to affect the outcome, such as demographics of the area, access to referral services, patient behaviour – 101 things over which GPs have little or no control.’

Asked whether the LMC would oppose the plans, Dr Grewal said he expected them to be imposed.

He said: ‘It will affect patient services as well because if they are taking away the additional payments which are currently based around service delivery, and changing those completely, then practices will not have the resources to continue delivering the extra services that PMS was designed to produce, and that means those services will go because practices won’t have the resources to continue to deliver them.’

An NHS England London spokesperson said: ‘By standardising the PMS contracts across London, we can ensure that all patients registered with a PMS practice receive the same high-quality core services with the opportunity to tailor services for localised needs. This means that patients will be able to secure services or outcomes that go beyond the essential services delivered by GMS contracts. Enhancements to GMS contracts are being considered.’

‘NHS England (London) is currently reviewing PMS contracts to help reduce health inequalities. By linking the contracts to local need and service improvements, the review is directed at improving health outcomes and providing practices the ability to develop services appropriate to their patients.’

The spokesperson added that the review was yet to be completed.

This follows moves by area teams to offer deals to practices that will be adversely affected by the PMS reviews, including those in Essex and East Anglia.