NHS England commissioning director Rosamund Roughton warned in a letter to commissioners across the country that funding changes should be 'managed in a way that does not risk destabilising general practice'.
In the letter, Ms Roughton warned that local commissioners must ensure CCGs have 'published proposals for reinvesting the funding potentially released from PMS reviews', and that 'no funding is released from PMS practices facing reductions until reinvestment proposals have been confirmed'.
The letter has been welcomed by GP leaders, coming just two weeks after GPonline reported that Londonwide LMCs had taken legal advice in a bid to delay the implementation of PMS contract changes it believed could destabilise practices.
But GPs also questioned why the clarification had not come earlier, with practices in parts of England facing six-figure cuts that threaten their viability.
PMS contract reviews
Londonwide LMCs chief executive Dr Michelle Drage told GPonline that her team were still weighing up the full impact of the letter, but that it was a significant step that acknowledged many of the concerns London GP leaders had raised.
'The letter clarifies some of the issues we raised with NHS England - they have identified, acknowledged and made clear a couple of the things we are concerned about. We haven’t yet had a chance to work out if all the things we have asked for will be dealt with.'
But Dr Drage warned that the landscape had changed significantly for PMS practices since a national review was announced in 2014 that set out to strip £235m in 'premium' funding and redistribute it.
'We still have serious concerns about the PMS review at this time,' she said. 'We are in state of emergency, and the vote [for a potential ballot on industrial action] at the LMCs conference - that changes the layout of the pitch as far as we are concerned.
GP state of emergency
'Three years ago things that might have seemed reasonable, now don’t - practices are having to run on empty, with temporary staff, many practices are planning for closure. You can’t possibly look at what they are planning to do and say this can be applied now.'
In-hours GP services were 'collapsing', Dr Drage warned, and the LMC had shifted its efforts from helping practices to develop resilience six months ago to helping them manage an emergency.
Nonetheless, she said the letter from Ms Roughton was an acknowledgement of the concerns LMCs in London and elsewhere have raised about the impact of PMS closures.
Yorkshire GP Dr Paul Wilding, a Slaithwaite Health Centre partner, questioned why the guidance from Ms Roughton had not come earlier. GPonline has reported that his practice faces cuts worth more than £250,000 that would 'decimate' the service it offers, although pressure from patients recently stalled the removal of funding.
'Why wasn't this letter written when the PMS reviews started?' he asked. The fact it had appeared now looked like an 'admission' that the process to date had been flawed, he added.
Dr Wilding also suggested that setting out reinvestment plans before imposing PMS cuts was not enough. He said that PMS funding had been treated as a 'luxury' that could just be stripped from practices, but that the impact of cuts on patients at practices affected by drastic reductions in funding had not been adequately assessed.
The letter from Ms Roughton also makes clear that additional funding should be 'reinvested in general practice' and that it should 'remain within the CCG area (unless CCGs agree otherwise)'. This point directly addresses Londonwide LMCs concern that funding could be lost to general practice through PMS cuts.
Ms Roughton's letter sets a four-year minimum timeframe for PMS funding changes 'to allow practices to adjust'.