Cash from PMS reviews to fund Saturday opening at all London practices

Every practice in London will be offered additional funding to open on Saturday mornings and make use of electronic appointment and prescription services under plans being developed by NHS England.

The deal - which could offer practices around £9 per patient for a range of additional services and targets - is being drawn up by commissioners in the capital as part of the replacement of local PMS contracts following a national review process.

PMS practices have been hearing in the past few weeks provisional figures for losses from the reviews with some facing six-figure reductions in funding. LMC leaders have said they expect cuts to force some GP practices out of business.

The PMS review, part of NHS England’s equitable funding policy, will see core funding equalised across contracts and PMS practices’ so-called ‘premium funding’ redistributed across general practice within CCG areas.

PMS premium funding

NHS England identified £325m of PMS premium funding - payments above GMS core funding - in 2014. A total of £258m was not identified as linked to defined enhanced services or KPIs, with commissioners concluding it 'may be associated with enhanced services or populations with special needs, but is not defined'.

Commissioners were given until March 2016 to carry out case-by-case reviews of all PMS practices to determine whether premium money was paying for additional services or special populations, and to decide on how far and at what pace to redeploy those resources.

In London, premium funding for 621 PMS practices totalled £90m in 2014/15.

A document published by NHS England last month reveals the first details of how commissioners want to fund premium services after funding is withdrawn from PMS practices.

Both PMS and GMS contractors across London will be offered additional funds for Saturday morning opening, the paper reveals.

GP access

The 'premium service' offer proposed in the document is priced at £3.47 per patient for Saturday opening and use of electronic prescription ordering, online appointment booking and e-consultations, but GPonline has learned that this price has now been increased to £5.

CCGs will also be encouraged to use some of their premium funds to commission ‘additional clinical capacity’ under the London proposals. Current proposals for mandatory KPI achievement for all PMS practices include cervical screening, childhood, flu and pneumococcal imms and patient voice at a price of £3.04p.

An additional non-mandatory KPI achievement called ‘access to services’, priced at £0.96 is also proposed in the January document. 

All London-wide PMS KPIs will also be offered to GMS practices on a voluntary basis under the plan.

Following discussions with LMCs over the offer NHS England commissioners are understood to be working with CCGs which will propose local KPIs and premium services funded from redistributed PMS funds.

The premium services and KPIs in London will sit on top of a new national NHS England PMS contract.

GP funding cuts 

LMCs leaders are also in discussion with NHS England on arrangement to support practices hardest hit by the premium funding cuts. ‘There will be transition arrangements,’ said Londonwide LMCs medical director Dr Tony Grewal. ‘We are looking the criteria for those and what the timescales are and the nitty gritty.'

Dr Grewal warned there would be practices made unviable by the cuts, although it was not possible to say at this stage how many.

CCGs on Friday submitted commissioning intentions to NHS England, setting out their how the services they want to implement PMS reviews to meet local needs.

Commissioners are using redistribution of PMS premium and recommissioning of services to roll out the London Strategic Commissioning Framework launched a year ago which set out plans for routine Saturday opening.

GPonline first revealed plans to use PMS premium funding to meet the new commissioning standards, including weekend access, in 2014.

Around a quarter of CCGs were found to have plans for reinvesting hundreds of millions of pounds of PMS premium funding in GP services by December 2015, a GPonline investigation revealed. 

GPC has called on CCGs to use redistributed PMS money to support core work that practices are struggling to deliver, rather than requiring them to provide additional services. 

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