LMC leaders have said an agreement with NHS England will give them more say in approving the new PMS review process.
The nationally directed review, launched in 2014 as part of the government’s equitable funding policy, aims to redistribute PMS 'premium' funding to ensure it pays for enhanced, non-core services.
England-wide, GP leaders feared PMS reviews could strip £235m from general practice, while in London alone the process targeted premium funding for worth £90m in 2014/15 across 621 PMS practices.
Outside of London, PMS reviews have already stripped premium funding from GP practices, but in the capital the process has stalled. An agreement reached at the end of last year saw London's PMS review process - originally due to complete by April 2016 - restarted. The process, now being conducted locally by CCGs, is expected to be complete by October 2017.
NHS commissioners have agreed to give LMC officials an assurance role in the process to ensure PMS premium funding reinvestment plans sustain general practice and that practices are not destabilised by the national review requirement.
Previous proposals by NHS England London for a pan-London PMS contract offer have been scrapped. Londonwide LMCs took legal advice in spring 2016 over fears the review process would destabilise practices.
Londonwide LMCs raised a list of 17 concerns over NHS England London's plans. The capital's GP leaders called for a proposed £5 per patient PMS premium redistribution to fund extended access to be reviewed after the GP Forward View said roll-out of extended access should be determined locally. NHS commissioners had already agreed, according to GP leaders, that there would be no contractual requirement to provide extended hours.
Londonwide feared that with access fund-type programmes expanding across London, substantial sums of redistributed PMS funding could be lost to general practice.
NHS England said in 2014 that PMS premium funds must be reinvested in GP services within the CCG of the practice from which they are removed.
Atypical GP practices
Other issues raised by Londonwide LMC last year include confirmation of the treatment of atypical practices; how and when GMS practices will get access to services offered under the new contract; eligibility details for transition support payments; and how patients are engaged in the process.
The process in London was put on hold in May while NHS bosses and LMC leaders tried to hammer out an agreement to restart the reviews.
That agreement has seen the proposed London contract - expected to include mandatory KPIs, such as screening and immunisations; a premium specification, including Saturday access; and optional CCG commissioned local KPIs - torn up.
London CCGs are now consulting LMCs and practices to agree local review processes that will be considered alongside CCGs’ requirements to fund and support general practice in the GP Forward View. Local CCG PMS arrangements will be subject to a Londonwide LMCs assurance process to ensure general practice is sustained and not destabilised.
Londonwide chief executive Dr Michelle Drage said: ‘Our role, agreed with NHS England London, is to assure that the process has been fair and sticks to the principles we have agreed, even though it's happening out in all those CCGs; so to hold the ring. And we won't assure if the reviews destabilise and don't sustain general practice.’
Sustaining general practice
Once the arrangements have been assured by Londonwide, said Dr Drage, it will be ‘safe’ for practices to begin negotiations for their reviews.
LMCs want reinvested PMS premium funding to be used to support ‘non-core non-funded’ workload, said Dr Drage. ‘Unresourced, unfunded non-core things that practices have no real alternative without affecting the patient relationship: reports, that sort of stuff. The same list that has always been around.’
‘The second thing we want to see is that core services in general are properly supported’, she added. ‘The rules say you can't put money into core, but you can certainly put money into things that support core.’
Dr Drage said that plans by one London STP to redistribute PMS premium across the footprint rather than within CCGs may not now happen. Local LMC leaders had warned that some practices could lose out after the North Central London STP made the ‘extremely concerning’ proposal.
Dr Drage said Londonwide was monitoring the situation but understood the plan could not go ahead without full agreement from all parties. ‘I'm not aware that all parties are agreeing to it in North Central. And we are not seeing it elsewhere, because most of the CCGs want to hold on to what they've got.’