PMS cuts will increase pressure on hospitals, warns Conservative peer

The removal of PMS premium funding from GP practices across England risks undermining the ability of primary care services to keep patients out of hospital, a Conservative peer has warned.

Parliament (Photo: iStock/majaiva)
Parliament (Photo: iStock/majaiva)

Hereditary peer Viscount Bridgeman told the House of Lords last week that the decision in 1998 to offer PMS practices a 'premium per patient for undertaking additional duties' was a 'farsighted development'.

'It attracted a number of very forward-looking GPs,' the Conservative peer said. 'The arrangements worked well for 10 years. Patients benefited and a significant contribution was made by many PMSs to reducing the workload of hospital A&E departments.'

PMS funding helped practices develop extra services that saved the NHS money - and its removal had been 'adverse for patients, for the viability of the practices and an additional workload for the hospitals' A&E departments', he warned.

GP funding

NHS England aims to ensure that by 2020/21 all GP practices receive the same basic weighted capitation payment. This is being achieved by stripping £235m in premium funding from PMS contracts, which will be redistributed across all practices - alongside the redistribution of minimum practice income guarantee (MPIG) funding for GMS practices.

Viscount Bridgeman cited examples of practices with levels of emergency admissions and A&E attendances well below the national average that had been enabled by PMS funding, and said the practice where he was registered had been able to offer walk-in surgeries on five mornings and four afternoons a week because of PMS investment.

These services had saved the NHS significant sums, he suggested, because the fees paid to PMS practices were dwarfed by the cost of hospital attendances.

The Conservative peer warned: 'Among the PMS practices, there is predicted an average fall in income in year four of 35%. How will those practices address this shortfall? Inevitably, it will involve a reduction of support staff, practice nurses, nurse practitioners, healthcare assistants and administrative staff.'

Premium funding

GPonline reported earlier this year that practices deliver services worth millions of pounds for free - and Viscount Bridgeman suggested the withdrawal of PMS money could exacerbate this. 'Perhaps some doctors will be unable to bring themselves to curtail some services, walk-in surgeries being an example. The shortfall will have to be made good out of partners’ profits.'

Northumberland LMC chair Dr Jane Lothian told GPonline that across her area - one of the first to see PMS funding reduced through a local review process that predated the national initiative - primary care capacity had been reduced by the withdrawal of PMS cash.

'We had £500,000 across a large number of practices, and when the money was lost, extra services and some jobs were lost - it reduced primary care capacity in the area. We lost about 10% of our budget overall at the time,' Dr Lothian said.

'Ultimately, PMS funding was extra money into core general practice - if it goes, something will go with it.'

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