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pms reviews

october 2009

ever had the feeling that you are being shoe-horned into a position, similar to grains of sand passing through the eye of an hour-glass?  so the pms review process seems to be pushing pms gps into a predetermined restricted amount of resources with a one-sided contract.


the process generally works by the pct looking at the pattern of spending on their pms practices (baseline and growth) and then trying to set a benchmark around the average. at the beginning of the process, different pcts had different figures, from around £75 up to £97 but, for most of the reviews currently taking place, the benchmark is around £75.


what can you do to protect yourself?


first of all, challenge the process.  if you are a quality practice, having your resources constrained on the basis of an average practice makes no sense.  ask the pct to look at your outcomes, how the resources are used, rather than just the inflow of resources.  the problem is that it is unlikely the pct will be interested in what you have to say.  recent pms reviews i have attended have not been a negotiation, but rather to hear what the pct are going to do.


secondly, challenge the basis of the figures.  the pct will be looking at the baseline and growth, but the baseline will be made up of a number of items.  in order to have some parity and equality between practices, you need to ensure that the pct are comparing like with like.  some pms budgets will include age two and five immunisations, minor surgery, drug reimbursements, all of which need to be unpicked before a valid benchmarking can take place.  it is clearly beneficial to have all pms practices working together to achieve this in a pct, with a lead voice from the gps ensuring parity.


thirdly, look creatively at what is being suggested.  pcts justify this process partly on retaining equality with gms.  pms gps suffer a 105 point deduction from their qof payments and most pct are refusing to give this back to the pms practice following the review on the basis that it is against national regulations.  however, bexley pct have found a way to return these resources to the gps by paying an additional qof payment of £3 per patient.


fourthly, consider your options.  if the pct are putting onerous obligations on your practice to continue as a pms practice, look at reverting to the national gms contract.  the increase in the global sum to £63.21 has reduced the potential loss for those practices moving back to gms.  you are also entitled to ask the pct for a correction factor (mpig) which is payable at their discretion.  that means the most likely answer is no, but there is no harm in asking.


finally, protect yourself.  the contracts that practices are being asked to sign are heavily biased in favour of the pct.  either instruct your own legal advisers to review the contract, or see if the lmc can help.  ensure your right or return to gms is put into the contract to avoid the situation where your contract can be terminated and you have nowhere to go.


laurence slavin