Scale of premium funding stripped from PMS practices revealed

Information collected by GPonline from NHS England subregion teams shows the scale of premium funding that CCGs are stripping from PMS practices.

Dr James Kingsland: Wide funding differential should not have existed
Dr James Kingsland: Wide funding differential should not have existed

The data show that more than 600 PMS practices in England have agreed to return to GMS since the government imposed a plan to strip hundreds of millions of pounds of funding.

In London £92.9m has been identified to be cut from 659 practices, an average of £140,000 each. In the West Midlands £23.5m has been identified, and £15m in both the South West and West Yorkshire.

PMS to GMS transition deals offered by local NHS England commissioners allow practices to switch contract with a tapered reduction in identified PMS premium funding over four to seven years. 

The West Midlands area has, so far, the largest number of transitioning practices, with 193 agreeing to move back to GMS with transitional support tapered over seven or five years.

PMS practices offered transition deals

The east region has 155 PMS practices switching to GMS. Those in East Anglia were offered a reduced premium in quarterly payments to the MPIG reinvestment endpoint or to maintain PMS value, if lower, until the GMS global sum catches up. In Essex, where the first offer to return to GMS en masse was made, PMS practices were offered a phase-out of the PMS premium on MPIG reduction timescales. 

Elsewhere, 122 PMS practices have accepted an offer to return in Cumbria and the North East. 

Recent GPC guidance has encouraged PMS practices to consider returning to GMS, arguing the national contract provides more stability and security.

The recycling of MPIG correction factor into GMS global sums over seven years, said the GPC, are likely to make GMS more attractive. The GPC argues practices transitioning should receive correction-factor type transitional funding, although this has only happened in some areas.

NHS England targets £325m of funding

NHS England identified in 2014 £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’s 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. Reinvestment must take place over a minimum four-year period from 2015/16.

All areas confirmed to GPonline that decisions on how premium funding will be redistributed within primary care will be taken by or with CCGs. 

Four out of 19 NHS England areas said they had completed the review process, with 12 aiming to finish by the March 2016 deadline and two due this winter. Just one area, Shropshire and Staffordshire, has yet to begin the process. 

Last month Sheffield CCG agreed plans to use withdrawn PMS premium funding to offset struggling practices' losses, opting to divert nearly £3m to unfunded workload across all practices in the city.

'NHS managers failed to understand PMS'

National Association of Primary Care (NAPC) president and former DH clinical lead on implementing PMS Dr James Kingsland said PMS was developed to be cost neutral, so the wide funding differential should never have existed.

The current situation, he said, arose from NHS managers who failed to understand the principles and potential for PMS and saw it as a ‘mechanism to get rid of collective pay bargaining’ and so introduced growth funding to attract more practices some of which, he said, have trouble explaining what services they provide differently from their GMS neighbours. 

He added: 'The real loss for the NHS is the organisational memory of what we were trying to do, and now we are just having a bun fight over contract value as opposed to what it was meant to be for: services and delivering to local populations and changing out of hospital services.’

Read more: Number of PMS practices in England falls by 20%

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