Local commissioners in parts of England are developing plans to reinvest £325m of PMS funding identified as 'premium' funding, over and above the basic funding practices on GMS contracts receive.
Commissioners plan to use the money to pay for services including improved access schemes. In some areas the funding, being withdrawn from PMS practices under NHS England’s national equitable funding policy, could be used to fund MPIG payments for practices that choose to revert to GMS contracts in the face of funding reviews.
Commissioners will use part of the PMS premium cash to fund an uplift to core pay for PMS practices to keep them in line with their GMS counterparts as MPIG funding is redistributed.
GP leaders called on commissioners not to create significant additional workload for practices to access the reinvested funding, and to shift more money into general practice from secondary care to help redress historic underfunding and inequalities.
Analysis by GPonline of freedom of information responses and board papers from 120 CCGs revealed that 30 had begun developing proposals for how redistributed premium funding will be used.
NHS England has asked all CCGs to help decide how the money will be reinvested in local GP services.
In 2014, NHS England identified £325m of 'premium' funding that PMS practices receive above GMS equivalent, including £258m which 'may be associated with enhanced services or populations with special needs, but is not defined'.
After the redistribution of MPIG top-ups among GMS practices, the funding premium received by PMS practices will drop to £235m.
PMS contract reviews
Local commissioners have until March 2016 to conclude reviews of local PMS contracts and decide how far to redeploy any premium funding. Reinvestment back into general practice must take place over a minimum four-year period from 2015/16.
CCGs with delegated co-commissioning authority are carrying out PMS reviews according to the NHS England framework. But NHS England has said that all CCGs, regardless of their co-commissioning status, need to be involved in deciding how funds are reinvested in their area.
Despite that requirement, 30 CCGs told GPonline they do not hold any information about plans for reinvestment. While some CCGs will have no role because they have no PMS practices, or no premium funds have been identified for reinvestment, others seemed unaware of NHS England’s requirements. Several suggested planning reinvestment was the sole responsibility of NHS England.
A further 60 CCGs said they had yet to begin or were in the process of developing proposals, with many due by the end of 2015, or by March 2016.
Many of the CCGs that have begun developing proposals plan to use the funds for local enhanced, non-core, or ‘core-plus’ service specifications or quality standards contracts with practices.
Unfunded GP services
Commissioners aim to use the reinvestment, often alongside new funding, or reallocated enhanced service funding, to resolve inequality of funding and service provision with a locally agreed single price per patient contract for all practices which addresses local needs with specific standards or KPIs.
GPC deputy chairman Dr Richard Vautrey said it was ‘early days’ in the process and many CCGs were only just beginning to understand how much PMS premium they will have to reinvest.
Dr Vautrey said that practices would not want to have to do significant extra work to earn the reinvested funds. ‘I think [practices] recognise it will be used to ensure equity of opportunity across the CCG area, so that all practices can benefit from that funding in an equal way,' he said. ‘But we would hope to see CCGs really trying to ensure it is supporting core activities that practices are struggling to deliver at the moment with the inadequate funding they have, rather than expecting them to do lots of extra stuff on top.’
He added: ‘If CCGs are wise they will work with practices in a supportive way, funding work in many cases funded through PMS historically, but in ways that allows GMS practices to be levelled up to a common standard so that there is equity of opportunity for all practices, and dealing with some of those unfunded areas of work that practices have had to contend with over the last few years.’
The GPC has previously warned that NHS England's decision to allocate PMS premium cash for reinvestment within CCG areas, rather than redistribute it nationally, would replicate existing funding inequalities between areas.
Dr Vautrey called on commissioners to shift more funding from secondary into primary care to address historic inequities and underfunding in general practice.