Extra help for hardest hit practices as Sheffield PMS overhaul goes ahead

Commissioners in Sheffield have rejected calls to use withdrawn PMS premium funding to offset struggling practices' losses, opting to divert nearly £3m to unfunded workload across all practices in the city.

Funding: PMS overhaul in Sheffield (Photo: JH Lancy)
Funding: PMS overhaul in Sheffield (Photo: JH Lancy)

Sheffield CCG agreed at an extraordinary governing body meeting to implement a plan to use £2.8m of premium funding identified in a PMS review to support all practices providing unfunded non-core work.

Unfunded work is a huge contributor to soaring general practice workload, with a GPonline investigation earlier this year revealing that GP practices in England deliver services worth tens of millions of pounds a year for free.

LMC leaders appeared to support the plan in a statement issued to GPonline. One GP at a PMS practice facing closure because of premium funding losses said she was ‘cautiously optimistic’ about the deal following the meeting.

Unfunded GP work

The CCG agreed to use PMS money, cut as part of NHS England's nationally-mandated equitable funding policy, to create a locally commissioned service (LCS) to pay practices for delivering any of a list of key services. Practices will be offered around £5 per weighted patient over three years.

The CCG will also to set up a special cases fund for the practices hardest-hit by funding changes along the lines of the support package initiated by NHS England London for MPIG outliers. Practices will have to show extenuating workload or demographic factors.  

Of Sheffield’s 87 practices, 62 are set to lose funding from changes including PMS reviews or MPIG cuts under the equitable funding plans. Some 40 practices will lose more than £5 per patient and 11 will lose more than £20. Twenty-seven practices are set to gain between 10p and £4.97 per patient from the changes.

Dr Trish Evans from Page Hall Medical Centre, which had warned it faced closure because of £260,000 a year PMS losses told the Sheffield Telegraph: ‘I think the future will depend on what happens with this fund, and what information is brought back to the CCG in September. But I think we did make our patients voices heard and we can be cautiously optimistic that we can carry on providing good quality of care for our patients.’

MPIG funding cuts

The CCG meeting considered proposals including making PMS premium cash available to all practices to support core service delivery, using the funds to address health inequalities, or using the cash directly to offset losses from MPIG and PMS cuts.

The CCG acknowledged that the agreed plan would not help address health inequalities other than via Carr Hill formula assumptions. But it said proposals to support only practices affected by the cuts contravened NHS England guidance that the money should be redistributed fairly among practices.

Sheffield LMC has been working with the CCG on the plans for PMS redistribution, secretary Dr David Savage said in a statement to GPonline.

The PMS process, said Dr Savage, must be equitable, with funding released to be GMS and PMS practices, as the CCG has agreed.

‘Those practices who believe they are providing services above core general practice and can demonstrate exceptional circumstances should be able to apply for extra funding. Examples may include care of the homeless, care of specific ethnic communities and specific services to vulnerable populations. These considerations for special circumstances should take into account both GMS practices losing their Minimum Practice Income Guarantee (MPIG) and PMS practices losing their PMS premium.’

Core GP services

‘The remaining monies should be available to all practices that provide services above core, such as dressings, sutures, phlebotomy and supervision or prescribing of secondary care medication.'

Dr Savage added: ‘Sheffield has similar numbers of GMS and PMS practices, many providing services to under-privileged and vulnerable populations. This split means there will be difficult decisions to be made and the LMC Executive continues to strive to represent all constituents equitably and fairly.’

NHS England has identified £325m of 'premium' funding that PMS practices receive above GMS equivalent, including £258m which 'may be associated with enhanced services or populations with special needs, but is not defined'.

NHS England subregion teams with co-commissioning CCGs have until March 2016 to conclude reviews of local PMS contracts and decide 'how far to redeploy any premium funding and on the pace at which redeployment takes place'. PMS money must then be recycled over a four-year period from 2015/16.

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