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‘Writing on the wall’ for PMS as GPs quit en masse

By Ian Quinn

Exclusive: PMS practices across the country are being forced back into GMS en masse and GP leaders warn this could be the beginning of the end of PMS.

Pulse has learnt that concerted attempts by PCTs to drive down the value of their contracts have made the majority of PMS practices in some areas start to make the transition.

Many said the final straw was last week's announcement, exclusively revealed by Pulse, that the Government had given PCTs the power to terminate contracts without any grounds.

LMC leaders are now saying the writing is on the wall for PMS contracts and that it is only a matter of time before they disappear for good. But PMS GPs warn the local services they have developed will disappear with them.

In Gloucestershire, 26 out of 30 PMS practices have agreed a deal with their PCT to switch back to GMS, accepting an across-the-board funding deal of just £65 per patient.

In Northumberland, seen as a test bed for PMS after previous bitter struggles, the value of contracts has sunk so low that the majority of PMS GPs have asked their LMC to start negotiations about a switch.

In other parts of the country, battles are raging between PMS GPs and PCTs, with some GPs still threatening court action if PCTs use the power to terminate contracts.

PMS GPs who revert to GMS will not qualify for the MPIG, but Dr Will Haynes, a GP in Gloucester whose PMS practice has opted to switch back, said: ‘It's partly damage limitation. Had we stayed in PMS, we would have been less well off than by switching to GMS.

‘Negotiations will be stronger too, rather than potentially being picked off one at a time.'

Dr John Batten's PMS practice in Cheltenham is also switching back. He said: ‘The game's almost up for PMS. We've been strangled, everybody is under pressure. It's the right time to move on.'

Dr Jane Lothian, secretary of Northumberland LMC, said around 20 PMS practices – two-thirds of the total – will enter negotiations about switching back as from April 2011. PMS practices in the area were forced to settle for massive funding cuts after being served termination notices two years ago.

She said GPs in the area would also accept funding of £65 a head, with a significant number having seen it fall below the base level of GMS.

‘I can't see that PMS is going to survive. It's a real pity because we're talking about a contract that was not just about bringing in extra money but also about extra services.'

In London, where more than 20 trusts are holding reviews, talks have broken down in Newham and Greenwich, with GPs preparing to take legal action. Greenwich GPs rejected an offer of £85 per patient as ‘not acceptable'.

In Sheffield, the PCT has told PMS practices they can either revert to GMS or agree to funding cuts of more than £100,000 each. But Dr Trefor Roscoe, a GP in the city, insisted it would be ‘absolute madness' for GPs to switch to GMS without the protection of the MPIG.

‘I'd have to get rid of one of the partners and a practice nurse or take a 25% pay cut,' he said. ‘PMS practices have got to be aware that they can fight these moves.'

But Dr Michelle Drage, joint chief executive of Londonwide LMCs, agreed the writing is on the wall for PMS. ‘I don't know of any PMS practice that has got a half-decent, or even a quarter-decent deal,' she said.

Dr Will Haynes: switch back to GMS is partly damage limitation The end of the line for PMS?

Sept 09: Pulse reveals order for PCTs to carry out wholesale renegotiation of PMS or fail the Government's World Class Commissioning standards if they do not act by April 2010.

Jan 10: GPs threaten court action, as Pulse investigation reveals almost three-quarters of PCTs have begun reviews

Feb 10: Pulse reveals NHS managers plan to scrap PMS growth funding to use the cash to fund polysystems

Mar 10: Pulse reveals PCTs will be able to unilaterally terminate PMS contracts from next month under new powers granted to them by the Government.