Last year’s primary care White Paper said that the DoH would ‘undertake a fundamental review of the financial arrangements for the 40 per cent of practices on local PMS contracts’. This was followed by guidance stating that the specific aim was to ‘constrain costs of PMS contracts’ in line with GMS (GP, 24 March 2006).
Now, a top 10 list of cost-cutting measures for PCTs says they should ‘consider giving notice to PMS contracts, where practices are not seen to be offering value for money’ according to Nottinghamshire LMC.
Chris Locke, Nottinghamshire LMC chief executive, said that he had not yet seen evidence of PCTs revoking contracts, but the tone of a letter sent by East Midlands SHA chief executive Dr Barbara Hakin to local PCTs had caused alarm. If contracts were revoked many GPs would see it as a ‘statement of war’.
‘PCTs are reliant on GPs to make a success of practice-based commissioning (PBC), which is key to bringing the NHS into financial balance. This is the wrong time to start annoying people,’ he said.
‘The knee-jerk reaction of some of our members was to use PBC as a bargaining tool when they read the letter.’
PMS contracts were not the only area of concern in the top 10 financial management tips.
‘PCTs are no longer to take anything at face value. The letter tells them to target practices where the suspicion is that quality framework figures are too good to be true,’ he said.
He said that the letter told PCTs to use a ‘range of intelligence’ to decide what level of scrutiny was required, including quality framework scores and exception reporting.
It also encourages financial directors to see whether money can be cut on prescribing and enhanced services.
Dr Hakin, who also chairs the NHS Employers’ negotiating team, said the letter summed up established good practice.
She said PMS contracts were an issue for PCTs and that in her own experience PMS practices could provide a range of services at value for money, but it was simply best practice to make sure they were doing this.
‘There were a range of things in the letter for PCTs to consider around value for money,’ she said. ‘GPs have come in for a lot of criticism about salaries and value for money in the press recently, some of it undeserved. The best way to counter that criticism is with openness in everything they do.’
Areas for PCTs to review costs
- Enhanced service payments.
- High rates of exception reporting.
- Discretionary maternity or sick payments.
- All PMS contracts.
- Premises payments.
- Over-claiming quality points.