The award-winning Vida Healthcare group of six practices faces losses of £250,000 a year under PMS cuts that have been dubbed 'appalling' by local Conservative MP Sir Henry Bellingham.
Two appeals against the funding cuts have now been rejected, the second of which was lodged directly with health secretary Jeremy Hunt.
But the patient group at the practices has again demanded a reprieve after a senior NHS England official set out advice for CCGs earlier this year on how to manage PMS cuts that appears to conflict with the handling of Vida's case.
The letter from NHS England director of commissioning Dr Rosamund Roughton ordered CCGs not to press ahead with cutting PMS funding until they had set out publicly how the money would be reinvested. It also made clear that cuts should be 'managed in a way that does not risk destabilising general practice'.
But patient participation group chairman Dan O'Connor said that West Norfolk CCG 'very clearly' hadn't set out in advance how the funding would be reinvested.
In his letter to Simon Stevens, Mr O'Connor wrote: 'West Norfolk CCG failed to comply with the NHS director of commissioning's instructions, no proposals were published, nor were patients consulted - and the cuts to Vida's funding are already taking place. This is completely unacceptable.
'As representatives of Vida's 30,000-plus patients, we are therefore asking that Vida's funding be restored immediately until these detailed proposals are published and discussed, and this matter has been fully investigated. We are also asking for a detailed explanation as to why West Norfolk CCG failed to comply with Rosamund Roughton's instructions.'
Mr O'Connor told GPonline that cutting funding to GP practices was 'crazy', particularly given the acknowledgement in the GP Forward View that practices needed more funding because the profession was in crisis.
'You cannot cut funding to any surgery at the moment - they are underfunded and have been for years,' said Mr O'Connor. 'The funding going to general practice is down from more than 10% a few years ago to 8% now, and demand is rising. As patients we are simply not prepared to give up. We will go on campaigning - these cuts are unjustifiable and they will probably impact on patient mortality.'
Joanna Yellon, locality director for NHS England (East) said: 'NHS England carried out the PMS review in 2014/15 in line with the national process to ensure GP funding was equitable across all GP practices. This review was completed for all practices in East Anglia by September 2015. The outcome of the review saw funding reductions across a number of practices in the area, including Vida Healthcare who currently hold a large PMS contract across a number of sites in West Norfolk.
'Vida Healthcare appealed the outcome of the process to the Family Health Services Assessment Unit (FHSAU). The outcome of the appeal upheld the process undertaken by NHS England. In line with the national timeline funding reduction began in October 2015 and will be phased over four years with the money being reinvested by all CCGs, including West Norfolk.
'West Norfolk CCG will be submitting their plans for the redistribution of the monies by the end of summer 2016. Ros Roughton’s letter was issued on 16 May 2016, after the review in Norfolk had been completed. This was issued as guidance to the CCGs on their plans for the redistribution of the withdrawn monies, to ensure that the monies are distributed evenly and fairly across all West Norfolk GP practices.'