NHS England has written to its regional and area team directors about its proposals for PMS contract reviews. Local area teams have inherited somewhat of a mixed bag as, in some areas PMS reviews are being seen as a way of delivering QIPP savings during the current financial year, and in other areas PMS reviews are already nearing completion. In addition more than a third of PMS practices have already had their contracts changed since 2011 following the last review of PMS funding.
NHS England's objective is to maintain the pace and momentum of improving value for money from the NHS's investment in PMS contracts while at the same time ensuring that now all PMS contracts are commissioned centrally by a single NHS organisation PMS practices are being treated fairly and consistently across England.
There is an obvious and inherent conflict in this approach. The original rationale for PMS contracts was to promote innovation and local service improvement and NHS England local area teams will not want to sacrifice that flexibility where local services are benefitting. However with NHS England as the sole national commissioner of these services it will be increasingly difficult to justify any inconsistencies of treatment between PMS contractors particularly as regards 'core funding'.
Local area teams have a good deal of work to do over the coming months as they are being asked to:
- review all PMS contracts according to a consistent set of principles and parameters but taking into account local circumstances and priorities;
- consider how far PMS expenditure that exceeds the equivalent GMS expenditure is paying for: 'core' primary care services (and should be treated in the same way as MPIG expenditure); innovation and quality improvement; and 'enhanced' primary care services;
- local area team should not initiate their own independent reviews of PMS funding in the current financial year unless:
- the LMC supports a local review of PMS funding; or
- the former PCT clusters had consulted on changes to PMS arrangements and the local area teams have now to consider the outcome of those consultations and implement the resulting changes
- with local practices and LMCs review the precise nature of the enhanced service elements or higher quality requirements that are being delivered under PMS contracts to ensure PMS funding is being used as effectively and efficiently as possible in a manner that reflects local health and wellbeing priorities and complements CCG commissioning plans;
- identify where savings could be made in 2014/15 and beyond.
Link to NHS England's letter of 5 June to the area teams : http://cms.pulsetoday.co.uk/Uploads/2013/06/10/e/a/v/PMS-review-letter.pdf