At the end of March, NHS England revealed how PMS practices would be affected by the 2014/15 GP contract, unveiled for GMS practices in November last year.
The key details are that PMS GP practices will receive an increase in their core funding of £4.55 to the weighted list size of the practice patients. If a practice still has a local arrangement where it is paid for its registered list size, the uplift will apply to the registered list.
In addition, PMS practices will be gaining all their QOF points without any deduction for being PMS. The out-of-hours opt-out deduction will be £4.02 per weighted patient.
Other changes include the reduction by two-thirds of the patient participation DES; the reduction in spending on seniority by up to 15% per annum until 2020 when it is lost; and the new unplanned admissions enhanced service.
Impact on PMS practices
So what does all this mean for a PMS practice? There are two key unknowns: first, the uplift, while welcome, being applied to the PMS practice baseline. An instruction has been issued by NHS England to all their area teams to review all PMS contracts by 2016 with the intention to make the funding streams closer to GMS.
Second, while GMS practices have been given their indicative global sum payments for each year up to 2020/21, we only have the PMS uplift for 2014/15. In order to compare the PMS practice to the GMS practice, we must assume that the PMS uplifts will grow by a similar sum.
PMS practices will need to look carefully at whether the increases GMS practices will be receiving over the next seven years should prompt them to revert to GMS. In making this calculation, a PMS practice will need to check any additional enhanced services it will be gaining under GMS that may already be in their baseline, and any costs it might be able to save if the GMS contract is less onerous than their PMS contract.
It will be necessary to crunch the numbers and each practice should contemplate its individual situation. For example, a suburban PMS practice with 8,900 registered patients and 9,000 weighted patients currently and a baseline of £607,494 will, by 2020/21, be earning £6,693 more than it is now, because its weighted list is larger than its registered list. If this practice were to revert to GMS, its income would be £71,679 per annum greater than its current PMS income by 2020/21. Since income will rise immediately by £40,357 in 2014/15, this practice should make the change back to GMS as soon as possible.
By contrast, a suburban PMS practice with 4,500 patients and a baseline of £433,201 will, by 2020/21, be earning £10,094 less than currently, largely as a consequence of falling seniority and a weighted list smaller than its registered list. If this practice were to change back to GMS, its income would be £121,999 per annum less than its current PMS income by 2020/21.
Ultimately, my key message is that there is no generic advice for how a PMS practice should react to the 2014 new contract terms. The numbers will need to be worked out on a practice-by-practice basis.
- Laurence Slavin is a partner with Ramsay Brown and Partners Chartered Accountants who specialise in the finances of GPs.