I am aware that there are some practices that have not signed up to the Essex deal because they have a lot of funding to lose, probably around £300,000.
They need to keep some of that money because otherwise they will have to cut services, which then may increase referrals into secondary care. They are preparing a case for when they do get reviewed to be able to explain why it may be beneficial, looking at NHS care as a whole, for them to keep that funding.
The PMS premium is very much like the MPIG and varies from very small amounts to very large amounts, and it depends on how the Carr-Hill [population weighting funding] formula will affect them. So there are some areas, like Mid-Essex, where it is probably not very favourable, while Southend is perhaps not bad. But I still have some practices with £50,000-plus to lose.
In Suffolk, the deal for returning to GMS while phasing out PMS gives them just four years, so the loss will be felt immediately. The mood in Suffolk is not that it will be accepted because 80% of patients are being looked after by PMS practices, and it is probably better to stick together rather than for practices to splinter off.
In Essex we did a lot of work talking to our practices about the funding prospects proposed by the area team allowing them to make up their mind what to do but in Suffolk they haven’t given out any figures, they have just presented them with a paragraph of what the deal is. Practices are due to sign up at the end of July with a view to returning to GMS at the end of October, but it is more difficult than that and lots of other things to consider. We have said to our practices that it is impossible for you to make that decision without having any figures.
Most of my Ipswich practices could lose between £150,000 and £250,000 and we have, of course, no data on how much of that they could earn back in new enhanced services. As the area team doesn’t seem to have any idea of that either, it is difficult for them to make a decision.
A lot of the PMS practices in Ipswich went PMS because they had recruitment issues in the early 2000s and this is now putting them back in the same position that they were in 15 years ago. I think fewer people will want to become GP partners, take that financial responsibility. This in turn will push up the demand for locums and then the wage of a locum goes up, further increasing the cost of GP services. This is based on economies.
It is a very difficult time. A lot of PMS practices use the extra money to take on salaried GPs, nurse practitioners, to be able to offer more or better services to their patients, or to open longer. They will have to consider perhaps closing a half day, perhaps not spending so much time with patients.
A lot of my GPs try to do as much as possible in primary care and not have to refer, but if they don’t have time, or the capacity or the funds to do it then it will get referred on which will then push the costs into secondary care which will be more expensive than what they will save.
On the one hand you’re asking GPs to take the pressure off A&E, to reduce unplanned admissions but you are taking away funds which would help support them to do that. At the same time, driving down the desire of anyone wanting to be a GP, just adding to the recruitment issue and the issue overall.
Although the principle of core funding for core work on the same basis is great, it doesn’t work in practice because you have certain pockets in certain areas where patients are much more demanding.
Lizzy Lloyd is a medical accountant and a partner at Lloyd Hubbard