You will be aware that all PMS practices across the country are facing a very uncertain future following the instruction from NHS England that all Area teams must carry out PMS reviews to be completed within the next two years.You will also know from your own bitter experience following the aborted attempted local reviews that the PCT Cluster attempted to carry out in Birmingham previously that the process willbe work-intensive, stressful and bureaucratic and result in substantial levels of funding being removed from your practice.All the indications are that PMS practices will suffer a significant loss of income following the PMS review process, which will seek to remove “premium funding” from your current contract price to bring it in line with GMS “global sum” funding.Across Birmingham the total amount of funding which is to be removed from PMS practices amounts to about £7 million.
Yourpractice has two options:
The option of a return to GMS would under normal circumstances seem even less satisfactory as MPIG (correction factor) does not apply to PMS practices returning to GMS.A shift from PMS baselines to GMS global sum would therefore result in an immediate and substantial loss of income for most PMS practices.However you may have become aware of a local proposal negotiated between Essex Area Team and its LMCs which secured a significant concession with regards to a return to GMS.The conditions that would apply in Essex if a PMS practice choose to revert to a GMS contract within a determined deadline are:
Once in GMS, the transitional payments would directly mirror the arrangements applying to MPIG correction factor payments.This means transitional funding would reduce by 1/7th each year, over a seven year period. The annual reduction intransitionalpayments wouldbeusedtocreateaGeneral Practice Transformation Fund. The General Practice Transformation Fund would be held by the Area Team and wouldbe available to all practicesto support developmentsinlinewith thePrimary Care Strategy.The LMC wouldhave a key role in ensuring that this funding is used effectively to benefit practices.
These concessions would only be available for a limited period of time within this financial year.Practices choosing to exercise their right of return to GMS after this date would have no access to transitional funding and therefore risk their practice funding falling to the level of GMS global sum in the very near future.
A right of return to GMS under the terms detailed in the agreement would continue to be entirely voluntary for all practices, in line with existing regulations. The decision about how to proceed would rest with individual practices.
Following ameeting today with the Birmingham Solihull and Black Country Area Team, I can confirm that, should it be acceptable to NHS England nationally, they would support a similar proposal being in place locally.
The LMC’s view is that all practices should give serious consideration to such an agreement if available locally.Whilst any significant loss of income for your practice is to be abhorred, it is inevitably going to happen.A phased funding reduction over seven years would certainly better allow practices to plan services appropriately and reduce the risk of disruption to the care of patients and indeed to the very the viability of some practices.I would also again remind all PMS practices that PMS contracts may be terminated , on six months’ notice, without reason by NHS England.This allows NHS England to introduce unilateral variation to contracts with, in effect, a gun to practices’ heads, giving them little option but to accept unfavourable variations, or to revert to GMS in circumstances which, of course, would not allow them to benefit from any of the transitional funding detailed in this proposal.I would further remind practices that NHS England intends to introduce a national template for PMS contracts, which would almost certainly place obligations on practices over and above those of GMS contracts.
It would be extremely helpful to the LMC in its discussions on your behalf with the Area Team, if you could give an indication as to how likely your practice might be to accept such a proposal should it be available locally.Note, your practice is not being asked to make a decision at this stage, we are merely trying to get a picture of how acceptable such a proposal might be and it would be extremely helpful if every practice could respond.
Please could you select which of the following options best describes your practice’s position in respect of accepting transitional funding phasing out over a seven year period, in return for reverting to GMS within an agreed deadline within the next financial year.Remember that the only alternative would be to undergo a PMS review, to be ineligible for transitional funding, and to lose the equivalent amount of funding over a far shorter timescale.
I should be most grateful if you could consider this matter within your practice and respond to the LMC as soon as possible with your view.Please do not hesitate to contact the LMC if you require further advice.
Dr. Robert Morley
Birmingham Local Medical Committee
36 Harborne Road, Edgbaston, Birmingham B15 3AF
Tel. 0121-454 5008, Fax. 0121-455 0758
Office email: firstname.lastname@example.org
Birmingham Local Medical Committee
Supporting the Business of General Practice
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