The internal progress report on the PMS review process from March 2016 shows that nearly 800 practices faced losses of more than £7.57 per weighted patient. This equates to 10% of their total PMS income, and at least a five-figure funding cut for a practice with an average 7,000-patient list.
Just weeks before the original March 2016 deadline for completing the national PMS review - which aimed to strip £235m in PMS 'premium' funding from practices - over 500 practices facing 10% losses or more had been given no indication from CCGs of the amount they could earn back from reinvestment of withdrawn funding, the report reveals.
PMS cuts campaigner and Yorkshire GP Dr Paul Wilding said the document was ‘absolutely incendiary’. There had been, he said, an ‘utter failure of risk and impact assessment at inception’ of the policy and ‘practices have collapsed’.
Dr Wilding, whose Slaithwaite Health Centre in West Yorkshire saw a threatened 44% funding cut stalled following a campaign by patients, said the concerns in the report appear to have been raised ‘belatedly’ in response to the threat of legal action by GP leaders in London. ‘Where was the risk and impact assessment?,' he added.
The progress update on the national PMS review, which began in 2014 and was supposed to be completed by 2016, was sent by NHS England’s national director for commissioning development Rosamond Roughton to chief executive Simon Stevens.
An assurance process identified ‘around 200 practices’ which commissioning bosses believe ‘there is possible concern (or lack of confidence) on the ability of those practices to manage the funding transition safely for their patients’. The assessment, heavily redacted by NHS England before being released seven months after a freedom of information request, was made before the effect of the current year’s contract uplift was accounted for.
Ms Roughton suggested local commissioners could rely on existing powers to vary the pace of PMS cuts and the use of section 96 financial support funding to relieve those hardest hit. Section 96 money was the mechanism eventually authorised by NHS England, following a campaign by GPs and patients, for CCGs to provide support to practices hardest hit by MPIG cuts, the parallel element to the PMS review of the national policy to make GP funding equitable across contracts.
The internal memo reveals NHS England bosses’ concern over the lack of CCG reinvestment plans for recycled PMS premium funding and the effect that would have on practices facing heavy losses.
The absence of CCG reinvestment plans ‘undermines the assurances given on practices’ abilities to manage funding losses safely if they cannot plan on the basis of the net impact of the funding changes’, it said.
GPonline understands that by September 2016 at least 18 reviews had been put on hold due to lack of CCG reinvestment plans. In London LMC leaders sought legal advice over concerns about the effect of PMS cuts on practice stability. The process in the capital has been rebooted following a pause during half of last year.
CCGs in London have now taken responsibility and Londonwide LMCs has been given an assurance role in the process which is now due to complete by October this year. The internal memo reveals that almost half of London’s more than 600 PMS practices face losses over 10% of their income.
The document also warns the NHS England chief executive that PMS practices may terminate their contracts because they are ‘unwilling to accept the revised contract from the PMS review’. At the time of the memo, two CQC outstanding rated practices had so far taken that drastic action.
Ms Roughton’s update flagged up a ‘growing (but unquantified) problem of practices stopping or threatening to stop services which may be regarded as "core" GP services’. Further detail on this issue has been redacted by NHS England.
GPonline reported last year that three out of five GP practices provide non-core services for free, with BMA leaders urging practices to drop this work to ease pressure.
GPC deputy chair Dr Richard Vautrey said: 'With the longstanding and systemic underfunding of general practice, at the same time as there has been a rapid increase in the population and workload, many practices are already on a financial knife-edge and losses of this magnitude could put many at real risk of closure.
'When there is an urgent need for more GPs, the country can ill-afford the risk of losing more local practices with all that that means to the health and wellbeing of local communities.'