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Trusts write termination clauses into PMS contracts

By Gareth Iacobucci

Exclusive: NHS managers are writing potentially unlawful 'variations' into PMS contracts allowing them to be unilaterally terminated or tying GP payments to controversial efficiency measures, Pulse can reveal.

Almost two-thirds of trusts across England are writing in tough new 'variations' that in many cases allow them to unilaterally terminate PMS contracts if GPs don't agree to reductions in funding or tough new requirements for payment.

The practice of writing in variations that allow unilateral termination could be declared illegal next month when a landmark case brought by GPs in London challenges attempts to force through 40% cuts in funding under the threat of closure.

The case was brought after the Department of Health inserted a new clause into PMS contract regulations last year that appeared to give the green light for terminations ‘without grounds'.

Our investigation reveals trusts across England have written variations into practice contracts or are in the process of doing so, with many specifically inserting clauses allowing unilateral termination.

PCTs are also requiring GPs to hit tough new performance targets, with one tying funding to GPs' ‘use of resources' by requiring them to adhere to specific care pathways.

NHS Sandwell has written in a host of new indicators to PMS contracts, including ‘adherence to local clinical pathways for diabetes and orthopaedics' and achieving ‘a minimum number of appointments per 1,000 registered patients'.

NHS Sandwell would not comment on whether its targets amounted to payments for restrictions to referral.

A manager close to the PMS negotiations told Pulse the changes ‘were implemented in a very messy fashion'.

NHS Wolverhampton City has written in new indicators requiring PMS practices to operate Choose and Book and extended opening, carry out in-house surveys with 25 patients per GP, and develop an action plan for practice improvement.

Of 35 PCTs providing information to Pulse, 21 have written variations into PMS contracts in the past year, or are in the process of discussing variations.

At least one-third of PCTs, including three trusts in the North East, and nine across London, have written in variations allowing termination, leaving their actions open to legal challenge.

In some cases, such as NHS Sunderland and NHS North East Essex, this was the only clause inserted, although it leaves PMS practices open to the imposition of further performance management measures in future.

GPC negotiator Dr Chaand Nagpaul, a PMS GP in Stanmore, Middlesex, said: ‘What is important is to ensure reviews are being carried out for the right reason, to ensure there is a fair contract in place, that promotes quality care and allows for innovation. Lamentably, many PCTs are misusing the contract to vary terms for the purposes of cost efficiencies.'

Dr Jane Lothian, a PMS GP in Ashington and chair of Northumberland LMC, fought a battle against her PCT over the imposition of variations to PMS deals back in 2008.

She told Pulse some of the measures being pursued by trusts were ‘ludicrous': ‘My fear is that [reviews] will be used to impose non clinically-sensible clauses. You'd be into very dangerous ground if you started restricting for referrals contractually.

‘Measuring the number of appointments is ludicrous and an extremely crude measure which shouldn't be used.'


Contract threats are no way to do business: read the editorial here.

Dr Jane Lothian