GPs face £450m overhaul in PMS and MPIG reforms

Practices could be forced to cut services as almost £450m is redistributed or stripped from the profession under PMS and MPIG reforms starting from April, GP leaders have warned.

Dr Kingsland: It is difficult to encourage the primary care sector to deliver NHS reform when they are destabilising its funding
Dr Kingsland: It is difficult to encourage the primary care sector to deliver NHS reform when they are destabilising its funding

GPs face a huge shake-up of funding as MPIG correction factor payments worth £118m and PMS funding worth £325m are redistributed.

An NHS England review of the locally negotiated PMS contracts held by about 3,000 practices in England concluded that £325m of their funding was ‘premium’ income they would not receive through GMS global sum payments.

About two thirds of this funding could now be ‘redeployed’.

NHS England has also revealed that 40% of GMS practices will lose out as MPIG payments are withdrawn and redistributed through global sum payments over the next seven years.

The worst-hit 98 practices – one in 50 of all GMS practices – face average losses in excess of £150,000 each.

GPC deputy chairman Dr Richard Vautrey told GP the PMS review had been a ‘golden opportunity’ for NHS England to invest in core practice funding.

‘Instead it is taking a massive amount of funding away, that will cause huge concern to PMS practices,’ Dr Vautrey said.

Part of the £325m ‘premium’ funding will move between practices to equalise their basic income with the level to which GMS practices will move as MPIG correction factor payments are redistributed.

But the estimated £235m that will remain – worth £80,000 per PMS practice – could be ‘redeployed’. 

NHS England’s area teams have two years from April 2014 to decide ‘how far to redeploy any premium funding and on the pace at which redeployment takes place’. Practices across all contracts should have ‘an equal opportunity to earn premium funding’ for enhanced quality or 
services, it said.

Dr Vautrey criticised the decision to remove funding from practices ‘with the expectation that they can only earn some of it back if they do even more work’.

‘At a time when practices are being crushed by massive workload, and GP recruitment and retention is reaching a crisis point, this is the last thing they wanted to hear,’ he said.

Dr Vautrey said redistributing the funding through core pay across both PMS and GMS contracts could have helped to ease losses to practices hit hard by MPIG removal.

Now, he said, ‘all practices will face difficult decisions about the sustainability of the services they offer.’

GP leaders have also questioned the accuracy of the ‘premium’ figure.

Londonwide LMCs medical director Dr Tony Grewal told GP: ‘The figures are very suspect. Unpicking value for money from PMS contracts is incredibly difficult.’

NHS England has confirmed that ‘at a national level all premium funding will continue to be invested 
in general practice services’.

However, GPC chairman Dr Chaand Nagpaul said he remained concerned that area teams may not adhere to NHS England’s intention.

NHS England has made clear that area teams should ‘provide a manageable pace of change’ for practices hit by PMS reforms. 

But GPs warned that many practices could be severely destabilised, with some calling for a transition 
period in line with the seven-year MPIG redistribution.

PMS architect and National Association of Primary Care vice-president Dr James Kingsland said he was disappointed with NHS England’s handling of PMS contracts.

He said the local GP contracts had been created to drive innovation, and reducing the debate to ‘Is PMS v GMS funding fair?’ was too simplistic.

He added: ‘They should be stabilising the primary care sector, beefing it up – but it is difficult to 
encourage that sector to deliver NHS reform when they are destabilising its funding.’

Ben Dyson, director of commissioning policy and primary care at NHS England, said: ‘NHS England is committed to supporting innovation and quality improvement in primary care and reducing health inequalities. We want to continue to use PMS arrangements to achieve these objectives. At the same time, we need to ensure there is an equitable approach to funding.’

Expert view The specialist medical accountant

Laurence Slavin is a partner at specialist medical accountants Ramsay Brown
A comparison between GMS and PMS shows that PMS practices currently receive a premium of £13.52 per patient. By the time MPIG has gone, the discrepancy will have reduced to £9.80.

The average practice has about 2,700 patients per partner, so in crude terms, the average PMS partner will lose £26,460. However, some resources will be put into other services that GPs can apply for.

The real concern will be the implementation for practices that have had higher than average funding in the past, for reasons that were acceptable at the time. If the criteria have changed, the loss could be dramatic and would necessitate a review of the way the practice used its resources.

The key point to bear in mind is that a practice can only use the resources it is allocated, and can only use them once, and this has to leave the partners with a reasonable profit.

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