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How to make your case at a PMS review

It is essential to highlight the difference your services make to patients and outcomes, supported by strong evidence, writes Dr Anita Sharma.

Our practice is in the midst of a PMS review and we were recently visited by representatives from NHS England to discuss our funding.

A national review of PMS contracts by NHS England in 2014 found that PMS practices receive £325m in funding over and above GMS core pay.

On average, PMS practices receive a premium of £13.52 for patients registered with PMS practices. The premium will reduce to around £235 million over the seven years to 2021/22, as the MPIG is phased out. This will reduce the average premium per registered PMS patient to £9.80.

NHS England says that of the £325m, around £67m is linked to defined enhanced services or key performance indicators (KPIs). The remaining £258m may be associated with enhanced services or populations with specific needs, but NHS England does not know this is the case. NHS England also said that there is no obvious relationship between current PMS expenditure and deprivation.

Making your case

Practices are likely to see funding reduced, but your meeting with NHS England provides an opportunity for them to make their case as to why they need the funding they receive.

The best way to do this is to highlight the improvements to patient care the practice delivers, backed by evidence. Where possible, explain what the impact would be if a particular service was stopped.

Highlight the additional services your practice is providing to patients over and above core contracted services – and make sure NHS England knows if these are linked to enhanced services, populations with specific needs or KPIs.

Explain the ‘high level themes’ that your practice is working on and how you are supporting the population to maintain their own health and wellbeing.

These could include:

  • Consistently high quality care,
  • Innovation/any new model of care which your practice provides,
  • Information system and technology,
  • Workforce development

Innovative services

Some possible examples of what you might want to highlight are detailed below.

If you are providing in-house ECG for early diagnosis of atrial fibrillation you must have increased your prevalence and reduced strokes in patients with non-valvular AF. Provide evidence for this. You must be doing ECG for patients presenting with palpitations. Without this service these patients would have attended local A&E department and increased their workload.

Mention if you provide in-house 24-hour blood pressure monitoring and explain by doing this you are reducing cardiovascular morbidity and improving outcomes. If your local hospital provides this test, mention the waiting time, which in some areas could be between 4-6 weeks.

Most PMS practices have invested in spirometers. If your practice has, I am sure you must be using this for screening at-risk patients for early detection of COPD. Early detection means early management, you should provide evidence of this.

Workforce development

If you have invested in workforce development, elaborate on this during your review. It could be a full time/part time HCA employed with in-depth knowledge and skills to do phlebotomy or smoking cessation. Or an advanced nurse practitioner, community matron or a GP with some extra skills.

Focus on the services they provide and how they benefit your patients. For example, in my practice I have a GP who is a former consultant gynaecologist and can deal with complex gynaecological problems. If you have a pharmacist who has made a difference in your medicine management and reduced adverse reactions, mention that too but be prepared to provide evidence.

Care closer to home

Highlight if you have invested in care closer to home. Some examples could be contraceptive services, sexual health and minor surgery. Focus on areas that are not part of DESs or what were local enhanced services in your area.

If you are involved in any local or national audits or projects add that to your list. Explain how it would benefit not just your patients but others too. Highlight that you are a forward thinking practice.

If you are helping neighbouring practice/practices because of your skills and increased knowledge in a particular clinical area, elaborate on this.

Elaborate on any improved primary care service you are providing by understanding the needs of local population, for example drug misuse, weight management, smoking cessation, managing venous and lymphatic problems.

If your A&E attendance rate is low, explain why. If the only reason is your robust call and recall system, then you deserve plaudits for this.

If you have received any awards for any service delivery, do not forget to mention these.

If you practice has developed any new service or made improvements in existing services locally or regionally mention that. You need to provide evidence for this and how you measured the improvement.

Highlight any investment your practice has made which enables multidisciplinary teams to work together more effectively, improves access and creates training opportunities in primary care.

New models of care

If you are testing new or innovative models of delivering primary care, explain what you are doing, how you are measuring it’s impact and the importance of funding for this. This might include, text messaging service, virtual clinics, any reduction in your DNA rate, improved prescribing of unlicensed drugs, reduction in admission due to medicine error, or any role you have played to develop a community service.

In my opinion PMS has helped broadened the work force beyond GPs, enabling practices to make better use of roles such as healthcare assistants, non-medical prescribers and practice nurses with clinical expertise in particular areas, in-house pharmacist and GPSIs. The negative outcome of the review process will result in a backward step for practices aiming to develop new ways of working and improving the service patients receive.

  • Dr Sharma is a GP in Oldham

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