Londonwide LMCs con-firmed PCTs across the capital were reviewing PMS deals to 'squeeze down' pay per patient towards the GMS average.

GP reported last month that reviews were taking place throughout England to push PMS practices into GMS deals.

Laurence Slavin, a partner at specialist medical accountants Ramsay Brown and Partners, said reviews in Bexley, Haringey, Surrey and Greenwich aimed to standardise payments per patient for PMS practices.

Bexley Care Trust has adopted flat-rate payments of £75 per patient. NHS Surrey confirmed a move to £70. PMS pay prior to the reviews ranged from £50 to £150 per patient, Mr Slavin said.

It was 'not unusual' to find 10,000-patient PMS practices earning £100 per patient, and a £25 per patient cut would cost £250,000, he pointed out. He said the changes would 'destabilise practices' and force some to lay off partners or nurses.

But he said most practices would accept the deals because the pay was better than the £63 per patient GMS average.

Anthony McKeever, chief executive of Bexley Care Trust, said: 'Our GPs and the LMC realised current arrangements were unfair and unsustainable.'

Alastair Greenan, commercial lead for NHS Surrey, confirmed plans to cut pay per patient at the highest paid PMS practices and level up lower paid prac-tices to bring 'greater equity'.

NHS Greenwich said its review had just begun, and NHS Haringey confirmed plans to standardise PMS payments.