A CCG is proposing to remove £1.5m from its primary care budget after failing to phase out PMS payments – creating a ‘disaster’ for local practices as surgeries could be forced to shut, local GP leaders have warned.
Mid Mersey LMC said NHS Knowsley CCG’s proposed funding cut would affect all 25 GP practices in the region, but its 16 PMS practices would bear the brunt of the cash removal, including one set to lose £0.5m.
The LMC said the funding raid largely stems from the removal of PMS payments, but also includes deprivation funds and money for some local enhanced services relating to improving prescribing and access to primary care, with an overall annual budget of around £5.7m covering all three funding pots.
Local GP leaders said they acknowledged that in other CCGs PMS practices ‘have suffered the pain’ already of having PMS money taken, following an NHS England review.
But they stressed all 25 GP practices in Knowsley, including GMS, are opposed to the £1.5m cut because of the extra workload that will be created if practices have to shut or reduce services.
CCGs have been gradually removing PMS payments in recent years after an NHS England review found practices in receipt of this money were being paid a ‘premium’ of around £260m more than GMS practices, which was not linked to providing any additional services to patients.
Under the 2013/14 contract, PMS practices with high payments were supposed to have their funding reduced over a four to seven year period. CCGs were expected to have completed reviews of their PMS practice funding by 2016.
NHS Knowsley CCG told Pulse it is ‘in discussion’ with GP practices and the LMC about how to ‘resolve’ the £1.5m overspend above its delegated primary care funding allocation.
It also noted that, compared with other regions, the CCG’s primary care allocation is the highest in England against set targets.
Pulse understands NHS Knowsley CCG only identified it had not been phasing out the funding after its new financial director joined the body in 2019.
Mid Mersey LMC said there was now an ‘urgency’ by local commissioners to balance their books in time for April 2022 when CCGs will be taken over by integrated care systems (ICSs).
The funding is set to be removed over a 20-month period, starting later this year, added the LMC.
The LMC’s medical secretary, Dr Ivan Camphor, said it is ‘a disaster waiting to happen’ and warned the impact will be felt by practices in nearby regions.
He said: ‘This will have a huge impact because Knowsley is one of the most deprived wards in England, to the extent that some practices may have to make redundancies, including GPs, and some practices may well have to consider shutting branch surgeries.’
He added: ‘In a deprived area as Knowsley, having a significant reduction in health services is going to be to the detriment to the health of the community.
‘This is going to have a major impact on recruitment which is again an issue, as well as workload. It can only be bad news.
‘We as an LMC are arguing this is not a good way forward and the money should stay in general practice rather than disinvesting in it.’
Dr Camphor added that local GMS practices in the region do not want to see the payments removed from neighbouring PMS practices – despite the fact the funding would be redistributed to them.
He added: ‘In my conversations with everyone at GMS practices they want to stand steadfast together because they recognise if the PMS practices are affected then it will ultimately have an impact on them – because if practices are shutting or cannot provide the workforce to do it then it will fall to them.’
A spokesperson for NHS Knowsley CCG said: ‘The CCG has been in discussion with Knowsley GP practices and the local medical committee (LMC) about how to resolve an identified primary care funding overspend and to consider potential options for returning to a more sustainable funding position.
‘Knowsley CCG currently spends around £1.5m per annum above its delegated funding allocation and faces further challenges given that its primary care allocation is the highest percentage “distance from target” in England and financial pressures are likely to only increase year on year as costs continue to rise above minimum growth levels.’
They added: ‘The new funding arrangements to be agreed would still see Knowsley with the highest level of primary care funding in the North West, per head of population.’
The spokesperson declined to comment further while discussions with practices and the LMC continue.