An LMC leader told GPonline that legal action could be possible if commissioners press ahead with contract changes that could destabilise practices and threaten services.
Londonwide LMCs has written to commissioning bosses in the capital asking for implementation of new contractual arrangements to be delayed.
The changes were supposed to have been signed off on 31 March but have been held up.
LMC leaders have now taken legal advice over their concerns about the contract changes and asked NHS England London to delay the process further while a list of 17 outstanding issues are addressed.
GP leaders wanted to ensure ‘no practice is destabilised and that money taken out of practices as a result of a review goes back into general practice’, LLMC medical director Dr Tony Grewal told GPonline.
A document sent by Londonwide LMCs to NHS England London on 27 April raised 17 outstanding issues and concerns with the PMS review process. Dr Grewal said the concerns had been raised in anticipation of possible problems on which GPs needed clarification before agreeing to a new PMS contract.
‘This is about us saying to NHS England - these are areas where you may end up failing to reinvest in general practice,' he said. 'You made an undertaking that you will invest in general practice. We now have the GP Forward View that acknowledges that general practice needs investment and we want to make sure this doesn't get lost.’
Accountants have previously warned that some London practices face closure because of potential six-figure losses under the PMS review process.
GP practice closures
NHS England London said the timeframe for implementation was under review and commissioners were keen to work closely with Londonwide LMCs to address concerns.
Among the issues raised, Londonwide LMCs leaders said proposals for a weekend opening service in the new PMS contract for London should be urgently reviewed in light of plans set out in last month’s GP Forward View. NHS England’s national five-year roadmap for the service said the roll-out of extended access services developed by GP Access Fund pilots would be determined locally and integrated with GP out-of-hours and urgent care services. GPC said it had influenced NHS England to agree that no practice will be contractually required to open extended hours.
As previously reported by GPonline, commissioners have proposed that redistributed PMS money will fund a £5 per patient premium service including Saturday opening, electronic prescription ordering, online appointment booking and e-consultations.
Londonwide LMCs is concerned that because local extended access schemes such as those set up by the GP Access Fund will be providing Saturday opening, the substantial sums of redistributed premium funds taken from PMS practices earmarked for this service may be lost to general practice.
NHS England said in 2014 that PMS premium funds must be reinvested in GP services within the CCG of the practice from which they are removed.
The London PMS contract is expected to consist of three elements: mandatory KPIs, such as screening and immunisations; premium specification, including Saturday access; and optional CCG commissioned local KPIs.
PMS contract targets
Londonwide LMCs has asked NHS England to agree that where underachievement on local PMS KPIs and locally commissioned services results in underspend of the allocated reinvestment, that funding will remain with the CCG for investment in GP services.
Other issues raised by the Londonwide LMCs document include confirmation of the treatment of atypical practices, how and when GMS practices will get access to the services to be offered under the new PMS contract, and eligibility details for transition support payments.
Londonwide LMCs has also raised concerns over patient engagement where services are affected by PMS reviews. It has asked NHS England what mechanisms are in place to ensure patient engagement happens.
NHS England is legally required to involve patients in commissioning decisions which affect services. NHS England has said that decisions to reduce practice funding did not necessarily equate to a change in commissioning arrangements.
Londonwide LMCs has been advised that ‘any initiative which has an impact on patient services needs to be consulted upon with the patients affected’, said Dr Grewal. ‘We are asking NHS England [to] show us what engagement there has been or will be with patients, and what the response or concerns might be.’
Dr Grewal said he hoped NHS commissioners would work with Londonwide LMCs on the areas of concern. But, he added: ‘If they stop talking and listening and working with and decide to impose something which is going to impact on practice stability or patient services then we will have to either challenge it or support a challenge from affected practices and affected groups of patients. But that is something we'd rather not do.’
Any potential future challenge could take the form of an NHS contracts dispute or ‘recourse to law’, Dr Grewal said. ‘It depends on how great the threat is of what they want to impose. We have no idea when and what any final offer is going to be.’
The Londonwide LMCs document said that for the PMS process to move forward there must be clarity on all 17 points of concern, full and explicit PMS offers made to practices in 8-10 weeks, and agreement on the implementation timeline.
A NHS England London spokeswoman said: ‘We are currently reviewing PMS contracts to ensure that all patients, regardless of circumstances, benefit from fair and equitable GP services and it is important to stress that funding will remain invested in general practice.
‘The implementation timeframe for the PMS review process is still under review and we are keen to work closely with the Londonwide LMCs to address any concerns.’