How the 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 GMS contract.

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
------- -------------
5,891 3

PMS practices will also be entitled to receive the quality preparation payment.

Enhanced Services

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

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.

Example

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.

IM&T

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.