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Attack on PMS is just the start

PMS GPs may be returning to GMS en masse as their contracts are devalued – but that doesn't mean GMS contracts are safe from draconian cost-cutting measures

With NHS managers gripped by the challenge of making £15-20bn of ‘efficiency savings' by 2014, GP contracts were always going to be vulnerable, particularly those seen as the most bloated by ministers.

But the haste with which PCTs – with no shortage of encouragement from the Department of Health – have moved to devalue PMS contracts is alarming. And now it seems the tipping point has been reached, with PMS GPs around the country taking a GMS return ticket en masse.

No doubt some GMS GPs will greet this news with a degree of smugness, believing PMS practices are paying the price for the extra rewards they received in the past.

GPs who switched to PMS contracts took a risk in stepping outside the relative protection of national negotiating rights and they have mostly been rewarded with significantly higher funding than that of their GMS colleagues.

Most who made the switch were motivated by a genuine belief they could develop services to match local needs outside the strictures of the GMS contract. But there were undoubtedly a few who were motivated more by money than altruism.

In spite of that, PCTs would be wise to realise it's not just practice income that will suffer as the funding of PMS practices is squeezed to the point where they jump ship back to GMS – without even the lifebelt of MPIG. It will have an impact on the flexible, innovative services that were the driving force behind PMS in the first place.

And GMS GPs should be wary of schadenfreude. The moves to devalue PMS contracts send a worrying signal about the direction of travel planned by NHS managers, who talk about quality and productivity being comfortable bedfellows but seem happy to allow the latter to take up more of the bed than the former.

Last week's NHS Confederation report setting out priorities for the NHS was titled Rising to the Challenge, but cynics might feel it should have been called How Can We Get What We Want From GPs?

It effectively calls for the Government to rip up GP contracts, of all types, and to bring in draconian powers for trusts to punish underperformers and reward those who work in polysystems.

What's more worrying is that ministers had no hesitation in backing the plans, with the DH openly admitting it has talked to trusts about granting more power to ‘hire and fire GPs'.

In many ways, what is happening to PMS practices could herald a future NHS in which GPs' contracts are worth little more than the paper they are printed on.

PMS GPs have been backed into a corner – with no national negotiating rights – and see no option but to throw in the towel. But this is something that all GPs – PMS and GMS – need to fight at a national, rather than local, level.

Any minister or manager who cares as much about quality as productivity should see the benefit of involving GPs in the quest to find savings based on well thought-out health priorities – rather than the slash-and-burn cuts the Government insists it is determined to avoid.

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