The final draft of the five-year STP for North Central London published by Camden Council last week revealed proposals for a new footprint-wide locally-commissioned services (LCS) contract.
The enhanced service offer would cover practices in all five boroughs of the STP footprint, covering a population of 1.45m, funded from existing LCS budgets and redistributed PMS premium funds withdrawn under the government’s equitable funding policy.
Dr Farah Jameel, LMC chairwoman in Camden, where 15 out of 35 practices operate under PMS contracts, said the plans were ‘extremely concerning’.
GP funding
‘There is a concern around financial viability for PMS practices, this proposal needs further scrutiny and clarification,’ said Dr Jameel. ‘We don’t yet know the full scale of what such a proposal may bring, such as destabilisation of general practice. There is a real risk of the knock-on effect of this destabilisation on the rest of general practice in Camden, and then neighbouring areas. The same applies across the other four boroughs in North Central London.’
Under the national PMS review process - part of the government’s equitable funding policy - local commissioners have been told to equalise core GP funding across contracts and redistribute PMS 'premium' funds across general practice within CCG areas.
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.
NHS England commissioning director Rosamund Roughton froze PMS withdrawal in May until CCGs had published reinvestment plans to protect the service from destabilisation.
PMS contract review
In London, the review process has been on hold since the spring after Londonwide LMCs raised a catalogue of concerns.
GP leaders in the capital have been negotiating a deal which could see redistributed PMS money fund a £5 per patient premium service contract including Saturday opening, electronic prescription ordering, online appointment booking and e-consultations.
CCGs were also expected, under the plan, to use some of the premium money to commission additional clinical capacity.
Dr Jameel fears the North Central London STP proposals could see PMS premium funding redistributed across the five boroughs of the STP, rather than staying within each CCG area. ‘Camden has historically been well funded,’ she said.
‘Practices have in the past, been well supported and as a result have been delivering excellent care. In more recent times, general practice funding has fallen exponentially. Ideally the discussion should be around levelling up of practice funding, but I don't think that is going to happen. So now my concern is evening out, and whether this will occur at a local level within Camden, or across North Central London.’
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She added: ‘That is the biggest area of concern for me within the North Central London STP at this time, because it is a large number of practices that could potentially be affected’
The STP document noted that the proposal was ‘partly dependent on NHS England (London) delegating commissioning of the PMS premium to the CCGs, which is currently under discussion’.
GP services across the NCL footprint area are already commissioned by a joint co-commissioning committee of all five CCGs with NHS England.
The contract, the STP document said, would have agreed outcomes shared with the plan’s integrated locality hubs model, Health And Care Closer to Home Networks (CHINs) and its Quality Improvement Support Teams.
Dr Jameel criticised the lack of consultation and engagement with GPs in the STP process. LMC representatives had only been involved in the final weeks of the process ahead of the publication of the plans, she said. ‘The whole premise, a large part of the STP is based on shifting care out of hospital into the community, which means you'll see a large proportion of activity move into general practice, and yet there has been no meaningful engagement at all with its main providers.
