To all PMS GPs
15 October 2003
PMS GPs AND THE
FUTURE
I
last wrote to you on 5th June this year. Many of you will know that
I spoke about the future of PMS at the NAPC Conference on 24 September. I used
that opportunity to confirm that PMS will be a permanent, flexible local
contract based on quality and patient needs.
I also reiterated the promises set out in my last letter. I am writing
to you today to set out in more detail how those promises will be delivered in
the next phase of PMS.
This
initial guidance will be of interest to those of you who are currently in
pilots and for those of you who may be entering a wave 5B pilot shortly. Other
issues referred to in my speech, such as specialist PMS, will be covered by
future guidance.
Full
technical guidance will be published alongside the GMS guidance in November.
JOHN HUTTON
INITIAL ADVICE FOR PMS GPs FOLLOWING
MINISTER OF STATE’s SPEECH TO THE NATIONAL ASSOCIATION OF PRIMARY CARE ON 24
SEPTEMBER 2003
INTRODUCTION
This
advice follows the speech John Hutton – the Minister of State for Health in
England - gave to the NAPC on 24 September. It covers:
Uplift,
seniority and quality preparation payments in 2003/04
Permanence,
including global investment
Quality
in PMS
Out
of hours in PMS
Growth
funding
Return
to GMS.
Further technical guidance will follow
later this year, alongside guidance on GMS.
QUERIES
Any queries should be directed to the
PMS helpline [0845 9000 008] or your SHA PMS lead. A list of PMS leads is
included at the end of this document.
2003/04
- UPLIFT, SENIORITY AND QUALITY PREPARATION PAYMENTS
By 20 October PCTs will receive an
increase of 3.225% in their PMS allocations to reflect the DDRB award for
2003/04. This increase includes the
uplift for seniority and is the same as for GMS GPs. PCTs will be asked to ensure that increases
in seniority are agreed locally in line with the new GMS contract agreement.
PMS schemes should therefore expect a commensurate increase for 2003/04.
PMS providers will be expected to
engage in developing quality-based schemes in 2003/04. Therefore, PCTs will
receive allocations for quality preparation payments based on £9,000 per average practice, also around 20
October. This payment will be based on
the patient list sizes of local PMS practices and will be passed to PMS
practices to engage in quality-based schemes in 2004/05.
PMS & PERMANENCE
PMS
will stay as a separate permanent local option. Local PMS will complement the
new national GMS arrangements. From 1
April 2004, and subject to legislative change, PMS schemes will no longer
technically be pilots and will be put on a “mainstream” statutory basis.
To
all intents and purposes, PMS has been “permanent” for some time. Legal changes
are required to make PMS a mainstream contractual alternative. So far, under
piloting, there has been a heavily bureaucratic process to follow, requiring a
legal oversight by the Secretary of State. Subject to the legislative changes,
this process will be streamlined.
Wave
5B is the last “wave” of ‘piloting’. After 1 April 2004, those wishing to enter PMS will not be
subject to a national deadline. They will need to deal directly with their PCT
or SHA as appropriate, which may decide to introduce its own ‘wave’ process for
ease of application.
INVESTMENT IN
PRIMARY CARE
PMS
and new GMS practices will receive comparable access to the overall increase in
investment in primary care, 33% UK-wide by 2005/06, from £6.1bn to £8bn per
annum, guaranteed through the new Gross Investment Guarantee mechanism.
GPs
in PMS will be eligible for the same changes to pensions as GMS GPs. The change
to the dynamisation factor and the new flexibility between officer and
practitioner pensions will benefit all GPs.
PMS
GPs will access the same changes in HR improvements, IM&T and premises
flexibilities as GMS GPs will receive.
QUALITY IN PMS
PMS
has always been a quality-based contract. To lever quality further, PMS
providers will have access to funds for increasing quality. These funds will be available for
implementing quality schemes. As in GMS, these will be a source of extra
capacity. Practices may wish to use these monies to fund workforce increases to
achieve agreed quality outcomes.
PMS
practices will be able to use the new GMS framework as the basis for quality
payments. However, PCTs and practices will have the ability to develop local
variations of the GMS quality framework, which may better reflect local
circumstances or build on quality arrangements already in place. They will be required to demonstrate to the
PCT or SHA that local variations will deliver broadly comparable levels of
evidence-based quality improvements for their patients. Beyond that requirement, the arrangements
will be a matter purely for local determination.
We
will be developing additional guidance and support for developing quality
mechanisms in PMS.
A NOTE ON QUALITY FUNDING
The
additional investment for quality in PMS will be comparable to the new money
going into GMS for quality.
Practices
will need to note, however, that the GMS contract has been completely
redesigned. Quality funding in the new GMS
contract includes an element of monies carried forward from “Red Book” quality schemes as well as new
investment. It is the comparable new investment that will be available to PMS.
That is because in accordance with the advice issued in June, we will not be unpicking existing financial baselines in
PMS.
We
will, in due course, set out how many of the 1050 points in GMS are new money
and how many relate to existing funding.
In this way we will provide a transparent basis for making the same
amount of new money available in PMS for quality as will be available for GMS.
OUT OF HOURS
PMS
practices will also be able to opt out of their out-of-hours responsibility, to
the same timescale, using a similar process and at the same price as GMS
GPs. The opt-out price will be
calculated on the basis of £6,000 per average GP and then adjusted for list
size. Subject to legislation, the
current timescale means that, where GMS or PMS providers wish to opt out, the
PCT must take the responsibility from 31 December 2004 at the latest. Of
course, where PMS practices and their PCTs are ready to agree on handling out
–of hours locally in a way that transfers responsibility to PCTs, they may do
so after 1 April 2004.
PMS PILOTS &
GROWTH MONEY
The
Government’s commitment to “no unpicking” means that you will be able to retain
the baseline funding you receive now, together with any growth monies you have
been awarded during the piloting process, as part of your PMS contract price
after 1 April 2004. This includes those considering signing PMS contracts
shortly. The growth money that has already been agreed will be for you to use
flexibly as part of your local agreement. It will no longer be restricted to
its current use for GPs and nurse practitioners.
The deadline for all bids for growth
for current PMS pilots and those entering wave 5b has now passed.
There
will no longer be a centrally held fund for increasing “growth” specifically
for PMS after 1 April. Additional investment in future will be delivered mainly
through the quality and outcomes framework, including the PMS flexibilities
referred to above, and the unified budget.
The national GMSNCL stream, out of which PMS growth is now funded, will
disappear with the introduction of new GMS and permanent PMS arrangements.
PMS PILOTS MOVING
TO GMS
Those
of you currently in PMS pilots will wish to weigh up the benefits for your
patients of each of the contractual alternatives. For those of you who
currently have a PMS contract, and those of you considering entering one for
wave 5B, there is no need for permanence to affect that contract in any
way. It can simply continue if that is
what you wish. There is no need for your contract to be unpicked as a result of
the new GMS contract.
However,
you will wish to consider your options. The rest of this document provides
guidance on the arrangements around return to GMS and transfer to PMS.
THE RIGHT OF RETURN
Permanence in PMS does not imply a once and forever choice. PMS practices will be able to move to GMS on a practice basis, or vice versa, should they so wish after 1 April 2004 and given sufficient notice.
One
of the features of PMS under piloting arrangements has been that individual GPs
entering a PMS scheme from GMS have been given a preferential “right of return”
to the medical list. Under Section 13 of the Primary Care Act 1997, the
Secretary of State has a duty to determine whether each scheme’s practitioners
are to be given the right of return.
From
1 April 2004, there will be a single
PCT list for both PMS and GMS performers. Those on the list (including current
PMS schemes) will have the right to provide through PMS or GMS. Therefore the
current concept of ‘return’ will no longer apply.
We are notifying you of this should you
wish to exercise your right of return under the current arrangements, that is,
by 1 April 2004.
What
has been known as the “Right of Return” will, in effect mean the right to move,
either way, between a nationally negotiated contract and a locally negotiated
one. We want practices to be empowered and rewarded so that they are able to deliver
a wide range of high quality services and build on the skills and expertise of
primary care professionals. Modernised
contractual arrangements – whether nationally determined through new GMS, or
locally determined through PMS - are needed to achieve this.
RETURN TO GMS AND FINANCIAL PROTECTION
There
is a Minimum Practice Income Guarantee in GMS. When PMS practices return to
GMS, financial arrangements for such transfers will be fair for PMS GPs in
relation to GMS GPs. Therefore, from 1 April 2004, there will be an arrangement
protecting aspects of PMS practices’ income if a decision is made to move to
GMS. This arrangement will affect pilots from waves 1 to 5 remaining in PMS
after 1 April 2004, if they decide to move to GMS. It will be based on the
calculations and principles underpinning the MPIG for GMS practices.
Under
GMS, the practice’s MPIG is calculated by comparing the earnings for the global
sum equivalent (GSE) items. If this is higher than their actual global sum
allocation they will be protected to the level of their existing global sum
equivalent income. However, under PMS,
practices do not receive GSE payments, but instead receive payments for the
contract price agreed locally with PCTs. In some cases this arrangement is now
five years old, with adjustments being made for growth, uplift, list changes
and so on in the interim. Therefore it is virtually impossible to calculate a
completely accurate GSE for PMS pilots returning to GMS.
However,
a PMS pilot practice could make a strong and robust case for having an MPIG for
1 April in discussion with the PCT. The practice would be expected to provide
the data which could be assessed by the PCT using:
● the local data on payments for Global
Sum Equivalent items that they may have available for the pilot; this might
include some or all of growth monies relating to contract variations forming
part of the practice’s Global Sum Equivalent
● a national average calculation (if the
supporting data are not robust enough to do the calculation) based on PMS
earnings and GSEs.
In both cases
there will be additional detailed guidance and advice on how the MPIG might
work.
RETURN TO GMS AND
GROWTH
PMS growth will not automatically form part of the Global Sum Equivalent calculations for practices moving to nGMS. However, growth monies will be retained by PCTs to be spent on primary care services for local patients in PMS and GMS. It will therefore be a matter for local agreement between PCTs and practices to determine where these retained growth monies are best spent to meet patient needs. Where a practice provides evidence that some growth should form part of the GSE, this will be allowed.
Under piloting there has been no opportunity to retain growth on return to GMS. Instead practices return to the medical list and earn fees and allowances under the Red Book.
TRANSITIONAL
ARRANGEMENTS DURING IMPLEMENTATION
Many
of you will be concerned about the tightness of the implementation period, and
in particular, the requirement for parties to a PMS contract to give six
months’ notice either way. Ministers do not expect this to be strictly adhered
to in the current circumstances of change. Both parties may alter the six month
period by mutual agreement.
For
those about to enter wave 5B from 1 October, there is a window of opportunity.
What we need to know from SHAs is the number of definite new pilots with signed
contracts by 22 October so that the necessary allocations can be made.
Annex A
Personal Medical Services (PMS)
Strategic Health Authorities (SHA) - Policy Leads
Avon Gloucester & Wiltshire Jane Rennie 0117 9841887
Bedfordshire & Hertfordshire Elaine Askew 01727 792846
Birmingham & Black Country Rachel Loftus 0121 6952422
Cheshire & Merseyside Gary Lucking 01925 406044
Chrissie Connellan 01925 406038
Viv Smith 01925 406016
County Durham & Tees Debbie Edwards 01642 666745
Coventry Warwickshire
Hertfordshire & Worcester Maureen Gilfillan 07970 827205
Cumbria & Lancashire Liz Holt 01772 647046
Dorset & Somerset Mark Callingham 01935 384050
Essex Jeff Franics 01376 302314
Greater Manchester Mandy Wearne 0161 2372670
Alan Berry 0161 7870097
Hampshire & Isle of Wight Carole LeMarechal 02380 725459
Kent & Medway Marianne Griffiths 01622 713070
Leicestershire Northampton
& Rutland Louise Payne 0116 2957616
Norfolk, Suffolk &
Cambridgeshire Annette Jolly 01223 597662
North & East Yorkshire &
Northern Lincolnshire Dr Gavin McBurnie 01904 435194
Annex A
Personal Medical Services (PMS)
Strategic Health Authorities (SHA) - Policy Leads
North Central London Jenny Morris 0207 7562544
Robin Bonner 0207 7562535
North East London Rigo Pizarro 0207 6556762
North West London Geraint Davies 0207 7562644
Northumberland Tyne & Wear Joyce Lovell 0191 2563145
Dr Ian Spencer 0191 2563198
South East London Mo Girach 0207 7167693
Dr Sadru Khera 0207 7167092
South West London Neil Roberts 0208 5456013
South West Peninsula Ann Bond 01392 207510
South Yorkshire Helen Kay 0114 2820403
Staffordshire & Shropshire Margaret Surrage 01785 221179
Surrey & Sussex Anna Taylor 01293 778899
Thames Valley Margaret Crawford 01865 337024
Andy McAllister 01865 337040
Trent Jill Matthews 0115 9684495
West Yorkshire Marie Chappell 0113 2952075
Alex Bower 0113 3059694
Annex B
Personal Medical Services (PMS)
Strategic Health Authorities (SHA) - Finance Leads
Avon Gloucester & Wiltshire Neil Brent 01249 858690
Bedfordshire & Hertfordshire Julie Dean 01727 792819
Birmingham & Black Country Rachel Cooper 0121 6952429
Cheshire & Merseyside Ken Burns 01925 406062
Ian Mottram 01925 406167
Tony Williams 01925 406164
County Durham & Tees Ian Cameron 01642 666727
Coventry Warwickshire
Hertfordshire & Worcester Vicky Smith 01527 587553
Cumbria & Lancashire Rehana Ahmed 01772 647194
Dorset & Somerset Paul Goodwin 01935 384027
Karen Newman 01935 384051
Essex Mark Chessum 01245 397652
Greater Manchester Phil Goldrick 0161 2372764
Diane Dolan 0161 2372479
Hampshire & Isle of Wight Jane Cole 02380 725458
Kent & Medway Martin Sawtell 01622 710161
Leicestershire Northampton
& Rutland Sharon Spencer 0116 2957527
Sue Lawrenson 0116 2957525
Norfolk, Suffolk &
Cambridgeshire Chris Gardner 01223 597581
North & East Yorkshire &
Northern Lincolnshire Trudy Wilk 01904 435119
Mike Joyce 01904 435218
Annex B
Personal Medical Services (PMS)
Strategic Health Authorities (SHA) - Finance Leads
North Central London Scott Hunn 0207 7562524
North East London Tinos Lemonides 0207 6556676
North West London Andy Westwell 0207 7562604
Northumberland Tyne & Wear Jim Halliday 0191 2563147
South East London Michael Turner 0207 7167081
South West London Richard Bailey 0208 5456037
South West Peninsula Davina Ross 01392 687187
South Yorkshire Bob Barnes 0114 2820349
Staffordshire & Shropshire Kathryn Alsop 01785 252233
Surrey & Sussex Derek Harwood 01293 778836
Thames Valley Glen Mackie 01865 337065
Trent Dave Stevens 0115 9684418
West Yorkshire Matthew Turner 0113 3059825