CCGs wrote to practices last week to inform them of the problem. Practices in the Greater Huddersfield CCG area were told to keep the funding NHS England had failed to remove ‘in reserve’ so that it could be claimed back.
PMS practices in the region were due to have their funding reduced by 12.5% from October 2015 as part of the national PMS review. The review, part of the government and NHS England’s equitable funding policy, will see core funding equalised across GMS and PMS contracts, and PMS practices’ so-called ‘premium funding’ redistributed across general practice within CCG areas.
In West Yorkshire, however, commissioners failed to remove the 12.5% from practices’ payments.
An email from Greater Huddersfield CCG to practices said: ‘Unfortunately we were made aware at the end of last week that none of the practices in Greater Huddersfield have had their payments adjusted, so you have continued to receive the same level funding throughout the year. This now means that all practices should, at this time, assume that NHS England will be seeking to collect this amount of money back. So we advise to keep it in reserve until you hear otherwise.’
The CCG had already begun distributing a share of the premium funding to practices through an incentive scheme despite the money having not been removed from practice payments yet.
Huddersfield University Health Centre partner Dr Nicky Mounsey told GPonline the delay had created further uncertainty.
The 12,500-patient practice is facing cuts of around £330,000 over three years from 2015/16, amounting to a 33% reduction in its £1m budget, which the practice says is a serious cause for concern.
The CCG has now informed the practice it must hold over £40,000 in reserve for NHS England to reclaim.
GP funding cuts
Dr Mounsey said: ‘We feel certain that the CCG were sending this email with the best interest of practices in mind. Practices are now left in the position of wondering what is happening. Do [NHS England] intend to remove these monies retrospectively?’
NHS England’s head of co-commissioning in West Yorkshire Kathryn Hilliam said that the ‘agreed pace of change’ for practices could now be extended following the delay.
Dr Mounsey has also raised concerns over the effect of applying the Carr-Hill formula to PMS practices with atypical populations, such as hers. The shift from paying global sum equivalents for raw patient list to a weighted list will have a significant effect on practices’ funding. High numbers of young people on a practice list will, said Dr Mounsey, be ‘disadvantaged’ by the changes.
Up to 40% of consultations at the Huddersfield University practice are for mental health issues, Dr Mounsey said. Consultation rates for this group can exceed the national average, but based on weighted capitation university practices like hers with a high proportion of younger patients can receive just 70% of the funding they would receive through raw capitation.
Ms Hilliam said: ‘PMS practices in the West Yorkshire area were due to see a reduction in the extra PMS funding they receive to address the distance from PMS funding to align with core GMS practice funding.
‘The financial framework agreed and communicated implied that this would be implemented over a three-year pace of change, allowing a period of time for each practice to adjust.
‘There has been a delay in implementing this for 2015/16 and as such deductions have not occurred as scheduled. Practices will therefore not have seen any adjustment on their monthly financial statements. NHS England and the CCG are now working together to look at a number of options for 2016/17 onwards, which may include an extension of the agreed pace of change.’