Second patient group considering legal action over GP practice cuts

A second patient group is considering legal action against NHS England over practice funding cuts that threaten GP services.

Contract: patients challenge lack of consultation over PMS reforms
Contract: patients challenge lack of consultation over PMS reforms

Patients at a group of practices in West Norfolk are taking legal advice on possible action against commissioners after they learned about a possible annual funding cut of around £250,000 a year following a PMS contract review.

GPs at the Vida Healthcare group of practices have had one appeal against the decision to withdraw the PMS premium funding rejected by NHS England, but have lodged a second appeal with health secretary Jeremy Hunt.

Medical director Dr Gareth Allen told GPonline the practice believes its contract review - part of NHS England and the government's equitable funding policy to equalise core funding across contracts - was unfair because it considered the five PMS practices as a whole and did not properly take account of deprivation for which some of the individual practices had previously been funded.

GP funding

The practice would find it 'difficult to manage a cut like that', said Dr Allen. 'We will have to reduce face-to-face contact with patients.'

The practices are looking at which services could be stopped and considering reducing costs through natural wastage of GPs and nurses.

Patient participation group member Dan O'Connor said they had approached lawyers to seek advice on possible legal action. The group is investigating joining up with a patient from Slaithwaite Health Centre in West Yorkshire who is seeking a judicial review into an alleged failure by NHS England to comply with a legal requirement to involve patients in decisions which affect services.

Yesterday GPonline revealed that patient involvement processes had been confirmed by NHS England in less than half of completed reviews that were assessed to deliver changes in patient services.

Senior lawyers have warned that PMS reviews may be open to challenge. A briefing written in February 2015 by Andrew Lockhart-Mirams, senior partner at Lockharts Solicitors said that if PMS reviews propose a reduction or cessation of services ‘there should almost certainly be formal consultation’.

Patient consultation

In 2014 a High Court judge found NHS England had breached its legal duties to involve patients in primary care commissioning decisions to withdraw practices’ MPIG funding.

But NHS England has said that decisions to reduce practice funding did not necessarily equate to a change in commissioning arrangements.

Mr O'Connor told GPonline: 'We are taking advice on whether [legal action] is feasible. It is something we are looking at very carefully. We are concerned about what impact the cuts would have on a GP service which is hugely stretched.'

Mr O'Connor asked why, if ministers accept the need for more funding for GP services should have more funding, PMS practices were facing cuts.

In those circumstances, he said, it was 'crazy' to cut funding to the largest practice in Norfolk. 'It doesn't make sense.'

Dr Allen said he informed patients about the threat of funding cuts because, as far as he was aware, no one else had told them.

GP services cut

'I think that's why [patients] are upset. That they'd heard nothing about it and were likely to be facing some kind of cuts to their services,' he said. 'Their point is there has been a lack of public consultation on the use of public funds and a reduction in services.'

Locality director for NHS England East Ruth Derrett said: 'We have carried out a review of all PMS practices as part of a national programme.

'The outcome for some practices in Norfolk was a reduction in funding over a four year period. This funding would then be reinvested into GP services in the area by the local clinical commissioning group, which is best placed to identify appropriate need.

'I can confirm that Vida Healthcare has formally appealed against the results of the review and that the appeal will now be reviewed by the secretary of state for health, Jeremy Hunt.'

An NHS England national spokeswoman has said about patient involvement in PMS reviews: 'Any involvement exercise must be appropriate and timely and in line with NHS England guidance on public involvement.

‘When undertaking a PMS funding review, local teams must first aim to gather data concerning the basis of existing PMS funding and its component parts, and to compare that to funding which would have been payable under GMS contracts. Such data capture would not ordinarily require patient involvement. A reduction, or proposed reduction in funding, that could have an impact on patients and their health services does not necessarily equate to changes in commissioning arrangements.’

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