Where a PMS practice has used its extra funding to provide more services, improve patient satisfaction and provide more cost-effective care by keeping within its drug budget, using hospital resources well and relentlessly pursuing quality care for its patients, it deserves its extra resources.
(PCTs gain right to unilaterally axe PMS deals)
The problem is that all these criteria are also being satisfied by some GMS practices with much less funding. And, even worse, in some PMS practices none of these is being satisfied.
PCTs are good at measuring inputs and outcomes and although we may argue about the validity of some of their calculations, there is no escaping the fact that some practices get the same outcomes with very different funding.
PMS was introduced to fund general practice in ‘difficult' situations where the GMS funding was too inflexible to meet the needs of populations. One would have expected this to mean a small proportion of practices would be suitable – and not the very high proportion in some PCTs.
With the NHS having to be as efficient as possible, and striving to understand the variation, it is no surprise that PCTs are wondering if they are getting value from GP contracts. At least these practices enjoyed generous funding for several years before trusts started to ask these very difficult questions – ones that should have been asked at the start of PMS. If this had happened there would be none of this pain now, as every PMS practice would have been producing high-quality outcomes from the start of their contract and would not be having to justify themselves.
The sadness is that there are PMS practices that invested their extra funds in great quality care and they are at the same risk as those that used their funding to increase partner drawings without a great change in services.
From Dr Patrick Craig-McFeely
Salisbury, Wiltshire
