Viewpoint: Why PMS contracts remain important to the NHS

The National Association of Primary Care (NAPC) has highlighted challenges facing PMS practices. But Maggie Marum says locally-negotiated deals are a better fit with the Health Act, and warns the days of a national GMS contract are numbered.

PMS practices: local flexibility key to NHS reforms
PMS practices: local flexibility key to NHS reforms

When PMS was first introduced, hopes for its use in delivering tailor made services for local populations were high. This was particularly important then, as it is now, in the face of the very different health needs of people in, say, Surbiton and those in Bradford.

At that time, too, there were new waves of immigrants, and refugees fleeing war-torn homelands, which highlighted the need for a much more flexible mechanism for the delivery of appropriate care. These new populations’ health needs, as they settled in various parts of the country, were very specific and challenging; not in any way met by the then parameters of the GP contract at the time.

Hopes, too, for PMS were high, as a local contractual mechanism, which it was thought would reduce the power and stranglehold of the BMA's GPC in its national negotiations with the government of the day on the GP contract.

21st century primary care

Indeed, in its early days, first-wave PMS practices, often casualties as first-wave GP fundholders, delivered high quality, dedicated services to meet the very specific needs of local practice populations. It was here that we first glimpsed 21st century primary health care.

Countries these days no longer, if they ever did, have homogenous populations. Neighbouring practices can have patients with very different sets of health needs, and, it was through the PMS contractual mechanism that these were able to be addressed and met.

It was another exciting time for primary care, where innovation once again was able to flourish, and the very best of clinicians were once again able to deliver the very best of care, comparable and beyond, to any in the world.

As ever, with innovation, comes imitation, often poor in vision, scope and quality; an expensive option, too, for what later waves of PMS practices delivered, in terms of health improvements, compared with their GMS peers. These contracts were poorly implemented and poorly performance managed. And, it was these that gave PMS a bad name and are responsible for the siege under which it now finds itself.

But take a giant step forward towards the Health Act 2012, which majors heavily on localism, local health and social care economies, and recognises their importance in the ‘modernisation’ agenda.

The new up and coming statutory organisations, clinical commissioning groups, are now indeed charged with population health management and the delivery of tailor made health and social care services to meet the array of needs of local populations around the country.

Local flexible contracts, which meet those needs, can be the only mechanism to invest scarce health and social care resources across the world, where almost all countries find themselves addressing the need for new ways of meeting the complex health needs of an ever ageing population. A national, standard contract can no longer be the way forward to deliver the international class primary care.

GMS 'days are numbered'

It is too blunt an instrument. Its days are numbered. Nationally and globally, health and social care services must embrace partnership and the local agenda – patients’ and clients’ needs overlap. The objective must surely be to keep them out of institutions and at home, safely, for as long as their needs dictate.  Flexibility and localism can be the only way in which this objective can be achieved.

Whatever transpires in national negotiations for the future of a contract or contracts for general practice, NAPC will be lobbying ministers hard and will be vocal in its demands for local flexibility for primary care. We need this to retain this for our populations’ well- being and we need it to retain this  country’s pre-eminent reputation in primary care around the world.

  • Maggie Marum is primary care consultant, NAPC

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