The practice needs to be sure why it wants to change from PMS to GMS, and the partners must look carefully at the alternatives on offer. It is important to maintain some control over the situation, rather than sit and wait for NHS England or the area team to unilaterally propose changes.
Speak to the area team about its plans for PMS reviews, and if other alternatives may be available for the practice. It is possible the practice may have an unusual population that would benefit from an ‘add-on’ APMS arrangement on top of a new GMS contract.
Contact the LMC and enquire whether it is negotiating any form of deal on behalf of all PMS practices. This can take two forms: a transitional option for all who wish to take it, or an agreement that the LMC will agree guidelines within which all PMS reviews will be undertaken.
The LMC may also use the strength of collective bargaining to put pressure on the area team. PMS contracts are individual to each practice, but there is nothing to prevent practices from working together and thereby protecting one another.
The practice should be checking the amount of the premium funding with its accountant, and speaking to the local MP and the CCG about any possible risk to patient sevices. The patient participation group is also very likely to be supportive. Such actions ensure that the area team is aware of the possible consequences of a clumsy PMS review.
Another increasingly common option is for practices to explore ways of being involved in providing services over a wider area, or as part of a larger organisation. These organisations are starting to talk to CCGs about providing primary care in innovative ways, and they should be talking to practices about improving income streams and reducing the movement of unfunded work from secondary care.
The one thing the practice must not do is pretend this will all go away, and assume that if it provides good-quality care and attracts patients then all will be well. I fear those days are gone forever from general practice, and everyone now has to be involved in planning for the future of their business.
Dr Brian Balmer is GPC negotiator and chief executive of North and South Essex LMCs
My advice is wait to go to the negotiating table and continue receiving income in accordance with your current PMS contract.
PMS funding for practices is higher than those holding a GMS contract and therefore it is better to wait and undertake the discussions on a group basis with other practices on your locality rather than seek out a transition deal.
The recent announcement from shadow health secretary Andy Burnham that Labour will halt the funding cuts being imposed in primary care (see page 16) adds more uncertainty to what might ultimately happen with GMS and PMS contracts. But there are many potential variables to the future and unless you have the benefit of a crystal ball and know the result of the next general election, sitting tight now would seem to be the sensible option.
However, there could be some upside to a switch to GMS, as certain elements of income that are included within the PMS baseline may well be worth more to the practice when paid in accordance with the Statement of Financial Entitlements applicable to a GMS contract. These could include property reimbursements, seniority (although this is being phased out over the next seven years), childhood immunisations, minor surgery, and so on. This may help soften the blow for a reduced global sum.
Even if you don’t seek out a deal to switch to GMS, it is likely that the PMS funding will ultimately be reduced, so practices should be reviewing their operations and finances now. The partners should consider having a strategy day away from the surgery to discuss opportunities as well as all the threats, and plan for the future of the practice.
Keith Taylor is head of medical services at BW Medical Accountants
Pt.1: Preparing for PMS review
Pt.2: Making savings