Leader: Is this the beginning of the end for PMS?

Many GPs working under PMS contracts will have been contemplating their futures this week, following the latest financial guidance from the DoH.

The officials at Richmond House have never been shy about putting their best and biggest feet forward, whether to deliver a swift kick or inadvertently to follow through and lodge them firmly in their mouths. So it was no great surprise to read instructions to cash-strapped PCTs suggesting that they freeze the pay and query the contracts of PMS practices, with the brutally simplistic aim of 'constraining the costs of such agreements'.

It seems that the scheme might have finally outlived its political usefulness.

For while the first wave in the late 1990s had a genuine pioneering spirit, the second and third waves became more of a herding exercise as the government drove primary care managers to encourage and coerce as many practices into the scheme as possible.

The logic behind such a strategy seemed to be a ministerial desire to split the profession, with the government refusing to recognise the GPC as representative of this growing band of GPs. That situation remains unchanged and the government used it to great effect during the latter stages of the new GMS contract negotiations. PMS GPs were included in the ballot on whether to accept the deal, knowing that, at the government's insistence, they too would benefit from the out-of-hours opt-out and quality payments.

Now it is the mass of PMS practices who entered during the middle waves that are likely to be the focus of PCTs' cost-saving activities. Indeed, some areas are even said to be trying to claim back the growth monies originally paid out to these practices. Have these managers suddenly raised their standards of accountability, or is it simply a case of new and more pressing political and financial priorities?

But do PMS GPs have a guaranteed ticket back to a GMS contract? Given the pressure to bring more private provision into primary care, coupled with the NHS financial crisis, it might be more difficult than previously thought. If the requirement is to provide value for money, it is not beyond the pale to suggest that GPs might find themselves in a bidding contest to provide GMS services to their 'own' patient population. At this point, the lack of national representation for these GPs might become a real problem, notwithstanding the fact that the chairman of the GPC is himself a partner in a PMS practice.

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