new contract effects PMS practices
It has always been intended that PMS practices would be
given the same opportunities as GMS practices. Therefore
under the new GMS contract, PMS practices will benefit from
the new investment in primary care.
PMS is to be a permanent option from the 1st April 2004.
The financial arrangements already agreed within existing
PMS practices will not need to be unpicked under the new
Quality & Outcomes framework
PMS practices can participate in the quality and outcomes
framework (QOF). PMS practices can use the national QOF
or can develop local quality frameworks.
It is assumed that some quality payments are already included
in the PMS baseline and therefore a deduction of points
will be made. The points deducted in 2004/05 will be 174
points and in 2005/06, 109 points.
The QOF will be paid in the same way as for GMS practices,
an aspiration payment equal to third of the quality points
the practice is aspiring to and the achievement payment
for the balance of the points the practice achieved.
If a PMS practice with a list of 7,000 patients is aspiring
to 800 quality points then the aspiration payment will be:-
7,000 x (800 - 174) x £75 = £18,596
PMS practices will also be entitled to receive the quality
PCTs will also be able to commission the six Directed Enhanced
Services to PMS practices.
The Quality information preparation (QuIP), Access and
flu immunisation for the under 65s at risk will apply for
PMS practices. However as PMS baselines are not going to
be unpicked it is assumed that funding for age 2 and 5 target
payments are already included in the baseline. The enhance
service for minor surgery will need to be discussed with
PCTs as an element will already be included in the PMS baseline.
Seniority pay for GPs will increase and PMS practices will
also benefit. However for PMS practices there are two ways
to calculate the increase in seniority. The first is the
uplift the whole contract by 3.225%, which is the uplift
to cover the equivalent increase in GMS fees of 2.85% and
the increase in seniority. The second is to uplift the contract
by 2.85% and then add the exact amounts for seniority that
would be calculated under the GMS contract.
We understand from some of our clients that they have not
been given a choice of which method is to be used however
per the "Sustaining Innovation Through New PMS arrangements"
if the first method is to be used then this needs to be
agreed with the practice. Which method is preferable will
depend on the practice. A practice with young doctors who
would not receive a lot of seniority under the new arrangements
are likely to prefer that their contract is uplifted by
3.225% whereas a practice with more senior partners are
likely to want to have their seniority calculated in the
same way as GMS GP's.
Out of Hours
PMS practices will also have the opportunity to opt out
of providing out of hours cover. The cost for a GMS practice
is 6% of the global sum, however as PMS practices will not
be issued with a global sum the cost will be £6,000
per average GP.
The cost to opt out of out of hours may be more expensive
for PMS practices. The reason for this is that 80% of GMS
practices require the MPIG correction factor and the cost
to opt out for GMS practices is a percentage of the global
sum only and not the global sum plus MPIG correction factor.
GMS practice with registered list of 9,255 patients has
been allocated a global sum of £438,600 and a MPIG
correction factor of £89,959. The cost to opt out
would be 6% of £438,600, which is £26,316.
If a PMS practice had a registered list of 9,255 the cost
to opt out would be 9,255/1838 (average list per GP) x £6,000,
which is £30,212.
PMS practices will also benefit from their computer maintenance
and minor upgrades being reimbursed at 100%, and this should
be reflect in PMS contracts.
Uplifting PMS allocations in future years
Uplifts to PMS baselines in the future will be proportionately
equivalent to the uplift for GMS practices.
Return to GMS
The right for PMS practices to return to GMS still continues.
PCTs will be required to offer the practice a GMS contract.
However PMS practices have no entitlement to an MPIG. PMS
practices will need to make a strong case to their PCT for
having a MPIG and whether a practice receives this will
be at the PCT discretion.
Where the PMS practice has received growth funding as part
of its PMS contract it could continue to receive this when
it returns to GMS either included in the GMS allocation
or as a locally enhanced service. However the PCT will review
the reasons for the practice receiving the funds and it
will be at their discretion whether the growth funding will
continue once the practice moves to GMS.