Every GP practice in Sheffield could be offered £5 per patient towards the cost of providing non-core services.
Earlier this year GPonline revealed that practices across England provide services worth tens of millions of pounds for free.
Sheffield CCG will offer a special support package to PMS practices facing the heaviest losses as funding is redistributed to bring all practices to £78.53 per weighted patient in line with the GMS target for 2020/21. But commissioners admit some practices face significant cuts and GPs have warned of closures.
The CCG plans to use £2.9m of 'premium' funding cut from PMS practices to pay practices to continue providing non-core services that have previously been unfunded.
Unfunded GP services
Commissioners want to use the PMS money, cut as part of NHS England's nationally-mandated equitable funding policy, to create a locally commissioned service (LCS) that would pay practices for delivering any of a list of key services.
Services that would attract funding under the LCS include dressings, phlebotomy, supervision or prescribing of secondary care medication, pre-op preparation, supervision of dementia patients, telephone advice, and spirometry. Practices will be offered around £5 per weighted patient over three years.
Of Sheffield’s 87 practices, 62 are set to lose funding from changes including PMS reviews or MPIG cuts under the equitable funding plans. Some 40 practices will lose more than £5 per patient and 11 will lose more than £20. Twenty-seven practices are set to gain between 10p and £4.97 per patient from the changes.
The CCG wants to set up a £200,000 fund for the hardest-hit PMS practices along the lines of the support package initiated by NHS England London for MPIG outlier practices.
PMS premium funding
NHS England has identified £325m of 'premium' funding that PMS practices receive above GMS equivalent, including £258m which 'may be associated with enhanced services or populations with special needs, but is not defined'.
NHS England subregion teams with co-commissioning CCGs have until March 2016 to conclude reviews of local PMS contracts and decide 'how far to redeploy any premium funding and on the pace at which redeployment takes place'. PMS money must then be recycled over a four-year period from 2015/16.
In a report published earlier this month Sheffield CCG acknowledged its policy to redistribute PMS funding, worked out in consultation with the LMC, ‘will not be sufficiently satisfactory to many’ practices.
The report said: ‘Despite the CCG’s best efforts to reinvest the £5 per weighted head and our looking to appropriately supplement the offer in time, there will still be a significant number of practices in the city which will lose significant sums over the next few years and as yet it is not clear as to how this will impact on practice viability and potential practice closures.’
GPs at the Page Hall Medical Centre PMS practice have said it could be forced to close by the cuts. Dr Kate Bellingham told the Sheffield Star the practice will lose £260,000 per year - more than a fifth of its budget.
GPs facing closure
‘We are facing massive financial challenges at the moment and don’t know how we are going to remain viable’, she said. ‘If we lose the full 21% I can’t see how we can continue to operate.
‘We have fought for our funding for the past 25 years and now they are taking it off us and spending it across the whole city, with no opportunity to justify why we needed more money in the first place.’
Sheffield CCG chairman Dr Tim Moorhead said: 'We have been listening to our practices and will be considering options on how we redistribute the money, which will create some flexibility to respond locally to practices.'
'In redistributing the money we need to be mindful that all practices in Sheffield, and nationally, are facing the same pressures that the whole health and social care system faces. The impact of this puts pressure on the delivery of the full range of services widely provided to patients by practices within the city
He added: 'There is little or no link between the type of contract a practice has and the level of needs of their patients. The national process of equalising practice income aims to address this disparity. However, the CCG is proposing to invest a further £4 million in general practices over the next four years and provide an opportunity for individual practices to be considered for additional funding where their needs can be demonstrated to be over and above that found in the rest of the city. We need to use the funding available in a way that best supports the delivery of services to patients across Sheffield and that meets the aims of the CCG – improving the quality of care, reducing health inequalities, ensuring healthcare is affordable and sustainable at least at current levels.'
The CCG board will decide on the proposals later this week.
NHS England did not respond to requests for comment.