Reviews in one CCG area seen by GPonline show more than half of practices fear they will be at risk of closure from the loss of PMS premium funding.
A report by East Lancashire CCG on its reviews of PMS practices, part of the national drive for equitable funding, found that four out of seven practices reported on said they could become unviable without additional reinvestment following the cuts. A fifth said it could be forced to close a branch practice.
GPC executive lead on PMS Dr Brian Balmer said he had warned NHS England they face ‘practice collapse’ or a ‘very public’ loss of services when the funding cuts begin to bite.
East Lancashire CCG said the threat of closures had ‘significant implications in terms of the continued provision of primary care services in some areas’.
PMS premium withdrawal
All seven of the CCG's 11 PMS practices visited between April and June 2015, said they faced either redundancies or workforce reductions because of the withdrawal of PMS premium funding, a policy announced by the government in 2013/14. Six of them anticipated reduced access, and five said they anticipated reduced services, reduced training capacity, and increased demand on other NHS services.
Meanwhile four out of five practices in the neighbouring CCG areas of Greater Preston and Chorley and South Ribble told commissioners they could be forced to reduce services, with three out of five facing staff reductions.
Practices told commissioners that PMS premium funds are currently used for services including prescribing, training, minor surgery, additional staffing, provision for isolated populations, serving homeless patients, additional admin time, and diabetes services.
The East Lancashire reviews report recommended the CCG develop an investment strategy for primary care and that plans for reinvestment be drawn up in time for the withdrawal of premium funds from April 2016. The area team, CCG and LMC have agreed a seven-year pace of change for the redistribution.
The CCG, which has delegated co-commissioning powers, will now decide which services being provided by PMS practices over and above core it wishes to continue to commission.
Practices could 'collapse'
While the situation varies across England, Dr Balmer said, the GPC ‘anticipates a number of practices will be seriously looking at their financial future because of this’.
‘We have well run practices beginning to think about how long we are going to stay in business. Or thinking about how long can we provide this level of service,' Dr Balmer added.
‘I have said this to NHS England. Do you want practice collapse or do you want a removal of services, which will be very public? You start closing branches, closing on afternoons: if the figures don't line up you have to cut expenditure. Some PMS practices are being hit very, very hard. And their populations are used to a level of service which the NHS now says it doesn't want to buy.’
NHS England identified in 2014 £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 the funding 'premium' received by PMS practices will drop to £235m.
Local commissioners have until March 2016 to conclude reviews of local PMS contracts and decide how far to redeploy any premium funding. Reinvestment must take place over a minimum four-year period from 2015/16.
In August GPonline exclusively revealed the extent of premium funding local areas teams expect to redistribute. Information obtained by freedom of information request showed that nationally a fifth of PMS practices had reverted back to GMS since the national review process was imposed in 2013.
NHS England’s Lancashire subregion said it had identified £1.4m of PMS premium funding.
Sheffield CCG confirmed in July plans to use withdrawn PMS premium funding to offset struggling practices' losses, opting to divert nearly £3m to unfunded workload across all practices in the city.