How the new contract effects
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
7,000 x (800 - 174) x £75 = £18,596
PMS practices will also be entitled to receive
the quality preparation payment.
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.