Practices are facing PMS overhaul

Five out of six PCTs across England plan to carry out a review of PMS contracts in this financial year or the next, a GP investigation reveals.

Dr Jane Lothian: 'PMS practices in the north east are waiting with bated breath for the decision about the DDRB pay uplift' (Photograph: Wilde Fry)
Dr Jane Lothian: 'PMS practices in the north east are waiting with bated breath for the decision about the DDRB pay uplift' (Photograph: Wilde Fry)

Data from 59 PCTs, obtained under the Freedom of Information Act, show that just 10 do not plan to review PMS deals.

But while most PCTs plan to alter the locally negotiated contracts, what they intend to change varies across England.

The terms on offer in some areas have meant PMS is no longer the most attractive option. Data from PCTs suggest that - with many reviews still at an early stage or yet to begin - around 1 per cent of PMS practices have already headed back to the relative safety of the nationally negotiated GMS deal.

PCTs and PMS funding
Valerie Martin-Long, a partner at accountancy firm PKF, says that in London and south-east England the first stage for PCTs has been to standardise PMS practices' funding per patient, as revealed by GP earlier this year (GP, 12 March).

Most practices are still better off with PMS despite the cuts, she says. 'Obviously, this depends on the PCT and what its average PMS baseline offering is.

'But so far in London and the south east of England, although the rate has been reduced, it is still higher than the GMS rate.'

The second stage has seen PCTs link a greater share of pay to 'key performance indicators' and identify other services for practices to take on.

This is also apparent elsewhere in the country. Jean Heald, medical services manager at PKF's Leeds office, explains that NHS Leeds has said that for every £5 a practice earns over the average payment per patient, they must comply with one new objective.

'NHS Leeds decides which practice will be required to participate in each of the objectives. Practices do not have a choice themselves,' she says.

A spokeswoman for the PCT says its objectives include weight management, access, safeguarding children, child health, sexual health and carers.

But Ms Heald warns that if practices fail to deliver any of these services to the PCT's satisfaction, it could claw back £5 per patient for each one.

'It has said that money clawed back will be released back in the form of local enhanced services, which GMS practices can bid for, Ms Heald says. 'My concern is that if practices do not achieve the required level in the first year then they will lose money on a permanent basis.'

The PCT is 'still working on proposals in relation to any freed-up resources in the event that practices do not comply with all the indicators', its spokeswoman says.

In the north east of England, Northumberland LMC secretary Dr Jane Lothian says the area could soon lose its label as a hotbed of PMS practices.

'PMS practices in the area are waiting with bated breath for the decision from the DoH about the Doctors' and Dentists' Review Body pay uplift,' she says. Once the DoH makes clear its position on how the 0.8 per cent rise - awarded by the last government - will be implemented, PCTs will begin to decide how much to award PMS practices, she explains.

Impact of pay award
The settlement PMS practices have now 'equates roughly to the global sum baseline with no correction factor', Dr Lothian says. If the pay award is not favourable, a swathe of PMS practices might return to GMS, she predicts.

Meanwhile, Tony Stringer, a partner at PKF's Bristol office, says a review by NHS Gloucestershire led some practices to switch back to GMS.

A spokeswoman for the PCT said practices were given two options: return to GMS, or remain as a PMS practice but on a 'consolidated' deal.

The latter option involved standardisation of all PMS contracts across the PCT.

'NHS Gloucestershire discussed with each practice what they were using their growth money on, and each was given an opportunity to present a case for these services to be re-commissioned,' the spokeswoman says.

Mr Stringer says the financial impact of this for practices wanting to stay PMS varied, but 'no one gained from the exercise'.

Most practices he dealt with moved to GMS. 'The PCT effectively put in place a correction factor adjustment to mirror an MPIG payment,' he says. 'In some cases this mitigated the losses when all aspects of their income are considered.'

The PCT confirms that 25 out of 30 PMS practices moved back to GMS.

While some changes are well underway, in areas such as the Midlands they are just cranking into gear. Sarah Moss, a partner at PKF's Birmingham office, says that so far PCTs have not begun to review PMS deals.

But with so many already trailblazing options for PMS reviews, it is surely only a matter of time.

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