PMS uncertainty threatens consortia

PMS practices face cuts and 'years in limbo' after the abolition of PCTs, GP leaders have warned.

Dr Jane Lothian: 'The abolition of PCTs will leave PMS practices in limbo' (Photograph: JH Lancy)
Dr Jane Lothian: 'The abolition of PCTs will leave PMS practices in limbo' (Photograph: JH Lancy)

Forty per cent of GP practices in England are on locally-negotiated PMS deals, but all primary care contracts will be held by the NHS Commissioning Board from 2013 when PCTs are abolished.

GP leaders have warned doubts over PMS contracts could undermine the success of emerging consortia.

A DoH spokeswoman confirmed 'a local presence' of the commissioning board will review individual PMS contracts 'as necessary' from 2013.

But GP leaders have warned it is 'nonsense' to believe locally-negotiated contracts can be managed efficiently if they are held by a national board.

Dr Jane Lothian, secretary of Northumberland LMC, where most practices are PMS, said the move would 'strip all local elements out of PMS contracts'. 'It will end up like a GMS contract, paid slightly over the GMS bare minimum,' she said.

She called for the DoH to 'come clean' about its plans for GP contracts when PCTs are abolished. 'This will simply leave practices in limbo. If they are serious about moving services into the community they need to decide how they do it contractually now,' she said.

GPC member Dr John Canning said the board would not have the resources to manage large numbers of contracts.

'How will local needs be assessed? It becomes an almost crazy situation,' he said.

PMS under threat
  • Forty per cent of GP practices are PMS.
  • NHS Commissioning Board to take control of GP contracts in 2013.
  • GP leaders warn local negotiations will not be possible.
  • Funding likely to move towards GMS levels, say LMCs.

Laurence Slavin, a partner at specialist medical accountants Ramsay Brown and Partners, said PMS deals would have to be struck across whole regions, rather than practice by practice.

The future of all GP contracts has been under scrutiny since the White Paper Liberating the NHS announced plans to unify GMS, PMS and APMS deals.

But DoH national clinical commissioning network lead for England Dr James Kingsland warned this process would take 'at least five years', well beyond the lifetime of PCTs.

The Health Bill proposes GP consortia will have some powers to commission enhanced services and manage QOF performance locally once they are up and running.

But it is unclear how easily GPs will be able to negotiate these services after the DoH ruled they will be subject to tough new competition rules.

GPC negotiator Dr Chaand Nagpaul said local contracting represented 'a gap' in the government's Health Bill reforms and said repeated calls for assurances had been ignored.

'This is a question the government has to answer,' he said.

'The DoH is already overloaded with issues resulting from the reforms like practice boundaries and performance management. We have flagged up this issue repeatedly.'

Dr David Jenner, PMS/GMS contract lead at the NHS Alliance, predicted around 50 regional outposts of the NHS Commissioning Board to help manage local contracts.

But Dr Lothian said regional offices would be too remote to understand individual practice's PMS contracts.

'We'd be negotiating with people in Sunderland. They don't know us, we don't know them,' she said.

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