Medical accountant sounds death knell for PMS contract

PMS contracts are unlikely to survive the NHS reforms, while GMS contracts may include time-limits and key performance indicator targets, a medical accountant has predicted.

Talking at the National Association of Primary Care (NAPC) annual conference in Birmingham on Tuesday, Bob Senior, director of medical services at accountancy firm RSM Tenon, said once PCTs are abolished the only local alternative for managing PMS contracts would be clinical commissioning groups (CCGs).

He said this would create ‘one heck of a conflict of interest’ and that he thinks it unlikely that PMS contracts could continue in the future.

He said: ‘The fact that you haven’t got an easy replacement for the PCT to manage PMS contracts there has to be a big question mark about what will happen.

‘I can’t see that we could move the whole profession to APMS contracts as the whole profession would be up in arms. Maybe we could move PMS back into GMS.’

Mr Senior also said the days of an ‘open ended’ GMS contract is at risk as the NHS drives through its agenda to improve performance.

He said in the future GPs could lose their contracts if they fail to meet key performance indicators (KPIs) that would be written into the contract.

He said: ‘I could easily see [the government] saying, we haven’t got time to put a full new contract in place, maybe we will do this as an initial stage. That might moderate some of the government’s concerns.

‘If it wants to be able to control practices more there is no reason why it shouldn’t modify a KPI-type process within the GMS contract.’

He admitted the changes to the GMS contract would have to go through a negotiation process, but he said it would take a ‘pretty brave negotiator’ to refuse the inclusion of KPIs in the GMS contract.

‘It’s inappropriate that if a practice is doing very badly that you can’t do something about it,’ he said. ‘I don’t see how you can really argue against that.’

Mr Senior also predicted that enhanced services are unlikely to form 10% of practice income in the future as cost-pressures force CCG to do things differently.

He said: ‘We could see CCGs saying some enhanced services need to be done on a locality basis, so we could see funding move out to locality. If you are smart, you might deliver one while a neighbouring practice delivers another.

‘There is also the risk of any qualified provider. Are we going to see people coming in saying we can do this better and cheaper? Practices need to be thinking about what they would do if there is a drop in income [from enhanced services].’

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