News analysis: GP practice mergers cause contracts to be ripped up

A GP investigation finds practices quitting PMS and merging together. Abi Rimmer and Stephen Robinson report.

GPs are facing a time of upheaval, with contract terminations rising as practices merge and PMS practices return to GMS, a GP investigation has found.

Data from 110 PCTs collected under a freedom of information (FOI) request found that, in the past three years, practice mergers accounted for more contract terminations than any other single factor.

Practice mergers accounted for 41% of contract terminations in 2009/10, rising to 49% in 2011/12. A total of 34 GP contracts were terminated as a result of mergers in 2011/12 across the 110 PCTs.

Return to GMS contracts
Meanwhile, a second FOI request by GP found that one in 20 PMS practices returned to a GMS contract in the past two years.

In total 70 PMS practices from 82 PCTs and PCT clusters which responded had switched to GMS since April 2010. Encouragingly, of those that returned to PMS, 46 were awarded top-up funding equivalent to an MPIG by their PCT.

NHS Alliance PMS/GMS lead Dr David Jenner said the rationalisation of contracts was a long-term trend that was likely to continue, especially as new GPs were less likely to want to become partners.

'If practice profits continue to fall, there's a potential risk of salaried GPs earning more than partners. There's a generation of GPs coming in who do not particularly want to get into partnership yet.'

While not directly linked to mergers, this adds to the likelihood of fewer, larger practices in future, Dr Jenner said.

The data also revealed that retirements accounted for 32% of contract terminations in 2009/10 but this fell across the three years, accounting for just 14% of closures in 2011/12.

PCT-led terminations
PCT-led terminations increased over the three years. In 2009/10 there were six PCT-led terminations, which accounted for 16% of the contracts ending in that year. By 2010/11 there were 14, accounting for 20% of contracts ending in that year.

PMS contracts suffered from more PCT-led terminations across the three years than GMS contracts, with 16 PMS contracts terminated by the PCT in 2010/11 compared with eight GMS contracts.

In Derbyshire, all 12 PMS practices returned to GMS after a PCT review which standardised the payment per patient.

In Gloucestershire, 25 out of 30 PMS practices returned to GMS following a PCT review which standardised all PMS contracts across the PCT.

Despite the erosion of PMS deals, GP leaders say it is unlikely that GPs will move to a single contract before the next election.

If the government does create a single contract, GPs would be better off all being on GMS, Derbyshire LMC chairman Dr John Grenville believes.

'Practices on PMS would find it much harder to know what changes they expect to see. GMS practices will be able to see a clear move from one contract to another,' he said.

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