Exclusive: Patients consulted in less than half of PMS reviews that could cut services

Commissioners have consulted patients in less than half of completed PMS reviews that are expected to change GP services, GPonline has learned.

Figures from NHS England’s last stocktake of PMS review progress in December 2015 revealed that local teams could confirm a patient engagement process had taken place for just 48% of those reviews which had been assessed to deliver changes to services.

Details of the reviews have emerged just a month after a West Yorkshire GP warned that PMS reviews could be unlawful if commissioners fail to properly involve patients when services are affected. Dr Paul Wilding’s Slaithwaite Health Centre is facing a possible funding cut of 44% following a contract review.

A patient at the practice is seeking a judicial review of the process over claims from the local patients' group that it failed to involve the public.

PMS contract reviews

Senior lawyers have also warned that PMS reviews may be open to challenge. A briefing written in February 2015 by Andrew Lockhart-Mirams, senior partner at Lockharts Solicitors said that if PMS reviews propose a reduction or cessation of services ‘there should almost certainly be formal consultation’.

‘If the implementation of the proposal would have an impact on the manner in which the services are delivered or the range of services available, there has to be consultation,' said Mr Lockhart-Mirams.

In 2014 a High Court judge found NHS England had breached its legal duties to involve patients in primary care commissioning decisions to withdraw practices’ MPIG funding.

But an NHS England spokeswoman told GPonline that decisions to reduce practice funding did not necessarily equate to a change in commissioning arrangements. 

The December stocktake found that PMS reviews had been completed for two thirds of the 3,038 PMS contracts in England, with 61% assessed to deliver changes to patient services.

Patient involvement

While just 3% of local teams said there had been no patient engagement, the status of the remaining 49% was unclear because local teams responded ‘not applicable’ to the question. NHS England said that this could be because they had misunderstood the question.

A July 2015 national update obtained by GPonline revealed a similar rate of engagement. With 32% of reviews completed, patient engagement had taken place in just 43% of cases where it was assessed as needed. At that time 19% of completed reviews had not been assessed for patient impact.

Documents obtained from NHS England through the freedom of information act also revealed that the GPC raised concerns over a lack of public consultation.

GPC leaders have called on commissioners to ensure they consult with patients over changes to services. GPC deputy chairman Dr Richard Vautrey told GPonline in December it was ‘behoven’ on commissioners ‘to ensure they are open with the public and consult with them in a meaningful way as part of the PMS reviews’.

GP commissioners

Dr Vautrey said it was difficult to judge whether commissioners were meeting their obligations as reviews were being carried out on a local basis. LMCs, he added, should raise concerns they may have over the lack of patient involvement. 

An NHS spokeswoman said: ‘Any involvement exercise must be appropriate and timely and in line with NHS England guidance on public involvement.

‘When undertaking a PMS funding review, local teams must first aim to gather data concerning the basis of existing PMS funding and its component parts, and to compare that to funding which would have been payable under GMS contracts. Such data capture would not ordinarily require patient involvement. A reduction, or proposed reduction in funding, that could have an impact on patients and their health services does not necessarily equate to changes in commissioning arrangements.’

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