Personal Medical Services (PMS) Contract Review Update 1. Introduction NHS England commenced the Personal Medical Services (PMS) Review process across the North West London (NWL) Collaboration of CCGs in October 2015. Discussions with Londonwide LMC, and with CCG Chairs and Primary Care leads, resulted in a number of decision-points listed below. These were subsequently re-affirmed at the inaugural meeting of the NWL PMS Contract Review Steering Group in February 2017. A set of NWL principles to guide the execution of the Review (attached for review at Appendix 1) A unified NWL framework for transition funding, based on a 2, 3 or 4 year timetable dependent on forecast loss of income by practices (attached at Appendix 2) Establishment of a NWL Steering Group to act as a single point of communication between CCGs, Londonwide LMC and NHSE (attached Terms of Reference at Appendix 3) Drafting and Submission of Commissioning Intentions by each CCG in February 2016 Ongoing discussion was subsequently suspended in February/March2016, at the request of the Londonwide LMC, to enable a pause for negotiation with NHS England. The PMS Review process was restarted in November 2016, when NHS England asked London CCGs to undertake the Review on their behalf, with Londonwide LMC and NHSE jointly responsible for assuring their Commissioning Intentions. Commissioning Intentions were submitted by all CCGs to NHS England for joint assurance at the end of April 2017. These Commissioning Intentions set out the proposed commissioning offers to be made available to all practices (over and above the services practices deliver under the GMS, PMS and APMS contracts). At the time of writing, no CCG in NWL has received assurance via this process on the specific commissioning intentions. However, a succession of meetings with NHS England, the local LMC, and Londonwide LMC has discussed the Commissioning Intentions in detail for each CCG, and in many cases made adjustments and clarifications to the Commissioning Intentions where appropriate. 2. Hammersmith and Fulham (H&F) position For Hammersmith and Fulham (H&F) CCG, there have been no formal requirements via the LMC to amend or re-clarify the two commissioning intentions for Year 1 - Patient Voice and Pre-school booster immunisation. However it should be noted that these commissioning intentions, have been included within the CCG s Network Plan for 17/18 implemented in July 1
2017 and commissioned to all practices, on the basis that the funding released from the PMS review in year would be used to support Network Plan delivery of these commissioning intentions. The funding associated with the commissioning intentions; Patient Voice and Preschool booster immunisation equates to a total of 45,838. We have been discussing the financial implications of the new PMS arrangements with the one PMS practice in H&F and there continues to be a constructive dialogue between the CCG and the practice in question. That notwithstanding, and as part of the NWL PMS Review process, there is the requirement for the LMC and NHSE to formally assure the CCG s commissioning intentions in order to proceed with formalising the offer and to facilitate the release of PMS Premium monies to support Network Plan funding. 3. Options for the Primary Care Committee s consideration Given the time that has already elapsed in 2017/18, it is appropriate for the Primary Care Committee to discuss the options that can best deliver the agreed principles underpinning the Review. At its last meeting on 21 September, the NWL PMS Steering Group asked for a stock-take of each CCG s progress with assurance, and for advice from the CCG s Primary Care Committee on the next steps they wish to take. In summary, the options available to H&F are set out below; although other options may emerge in discussion at the Committee. 1) Await the outcome of the joint Londonwide LMC/NHSE assurance process 2) While the assurance process continues, the CCG to prepare a detailed offer for the one PMS practice, setting out the transition trajectory to inform the practice of the financial implications 3) While the assurance process continues, remind the PMS practice formally of their option to revert to a GMS contract and invite the practice to discuss with the CCG the detailed financial proposals for their practice within the PMS Contract Review A risk assessment and commentary on these options are set out in the table below. 4. Risk Assessment for Options Option Summary of Risk Potential Mitigation Notes 1) Await outcome of joint assurance process The assurance process with NHSE and Londonwide LMC is not concluded soon, meaning that the timeline for contracts variation to be issued to the H & F PMS practice is uncertain. 2 Continued discussion with the practice, local LMC and CCG leads. With no guaranteed end-point in sight for conclusion of assurance process, delays will occur to individual negotiation the PMS practice, and release of money to support Network Plan
2) Prepare detailed offers for the PMS practice setting out the transition trajectory to inform the practice of the financial implications 3) Remind the practice of their right to revert to a GMS contract, and invite them to discuss with the CCG the detailed financial proposals for their practice The original deadline for 1 October has passed. Potential for conflicting messages between Londonwide LMC and local LMC in advising the PMS practice on how to respond to contract offers. Potential for disruption to release of PMS premium for Network Plan funding The Practice is likely to understand the terms of their PMS contract, and it is unlikely that the offer to revert to GMS will be sufficiently attractive. Money cannot be released to support Network Plan arrangements for 17/18 until formal offers have been negotiated with the PMS practices. Briefing meetings held between the practice, local LMC and Londonwide LMC, with clear communication of financial sums available for release once variations to PMS contracts are agreed. Briefing meetings held between practices, local LMC and Londonwide LMC, with clear communication of financial sums available for release once variations to PMS contracts are agreed. delivery for 17/18 thereby creating potential CCG cost pressure. The CCG has had continued dialogue with the practice which included the local LMC, in relation to the PMS financial breakdown and understanding the transition trajectory.. Release of 17/18 funding - including the PMS premium can only be made once agreement has been reached with the PMS Practice on their transition trajectory. This does mean that 17/18 money may be lost for redistribution unless progress can be made in reaching agreement with PMS practices on the terms of their contract variation. 5. Overall Timetable and Next Steps The next NWL PMS Steering Group is to be held on 9 November, with a number of assurance meetings with NHS England and Londonwide LMC to be held (fortnightly) before that date. It is proposed that a summary of this Committee s discussion, and details of their preferred option (if any) should be taken to the Steering Group as an update on the current position across NWL CCGs. 6. Action Required This Committee is asked to: discuss the above options regarding the PMS Contract Review; agree on the next steps it wishes the CCG to finalise the PMS Contract Review 3
authorise officers to inform the NWL PMS Review Steering Group of their preferred course of action. 4
Appendix 1 Underpinning NWL Principles for PMS Contract Review No. Topic Description 1 NWL VISION NWL CCGs have agreed a common vision for primary care in NWL incorporating the London Strategic Commissioning Framework. 2 PACE NWL alignment NWL will align on the transitional arrangements to ensure a common transition approach and trajectory 3 REINVESTMENT IN GENERAL PRACTICE 4 REINVESTMENT IN GENERAL PRACTICE - RECOMMISSIONING (EX-PMS) SERVICES Any money released as an outcome of the review will be reinvested into general practice services within the respective CCG. CCGs will review any extra services currently provided by PMS practices and may decide to re-commission some or all of these to reflect the needs of local populations and/or as a route to achieving 100% population coverage 5 LOCAL PRICING When setting local prices, a minimum consistent offer will be promoted across GMS and PMS practices. The same price should be set across NWL for the same service. 6 GMS EQUALISATION All services offered to PMS practices as part of the premium contract should also be offered to GMS practices 7 TRANSITION SUPPORT Where practices suffer a loss of income as a result of the review, transitional support will be made available, so that the loss is phased in over an agreed period of time. 8 VALUE FOR MONEY Each CCG will have a rationale for current and future investments into general practice which considers value for money. 9 QUALITY AND EQUITY NWL and individual CCG will assess the impact of decommissioning and recommissioning services in adherence to their statutory duties. 10 TRANSPARENCY CCGs will promote transparent engagement with their local practices noting that NHSE will lead on the practice negotiations. 5
Appendix 2 PMS Transition Pathway for Practices 2 Year Transition % Year 1 Year 2 90% 55% 5% to 9.9% income loss 3 Year Transition % Year 1 Year 2 Year 3 90% 70% 40% 10% to 14.9% income loss 4 Year Transition % Year 1 Year 2 Year 3 Year 4 90% 70% 40% 20% Over 15% income loss NB: The one PMS Practice in Hammersmith and Fulham CCG is on a 4-year transition pathway. 6
Appendix 3 Terms of Reference of NWL PMS Contract Review Steering Group Date approved: Discussed and amended at inaugural meeting on Thursday 2 February 2017 Chair: Lay Member from CCG Governing Body (to alternate) Core membership: The Steering Group shall have the following core membership: CCG GB Lay Member representatives (1 CWHHE representative, 1 BHH representative), to act as alternating Chair of Steering Group CCG Commissioners (1 CWHHE representative, 1 BHH representative) GP provider membership (equal representation from PMS and GMS practices, and across CWHHE and BHH) Londonwide LMC (representation to be agreed) CCG Finance (NWL, CWHHE and BHH, with advisory support as necessary) NHSE (London) representation NWL Strategy & Transformation team representatives Members of the Group will represent their own organisation, but will act wherever possible across NW London, to oversee the process of the PMS Review and ensure consistency of approach and outcomes, for the benefit of improving services to patients and assuring sustainability of local general practice Frequency: Purpose: TBC. Likely to be fortnightly in the first instance. A work-programme will be drawn up to enable completion of the Review by October 2017. The Group will: Oversee and co-ordinate the process of the PMS Review across NW London Ensure that CCGs observe the NW London Principles and use common financial models for the PMS Review In particular, agree the NWL transition timetable for withdrawal and reinvestment of the PMS premium Work with CCG Primary Care (Co)-Commissioning Committees (PCCCs) to ensure consistency of approach for services to patients across NW London, against the agreed timetable and NWL Principles. In particular, to offer the same service at the same price across NWL Support the PCCCs by resolving questions of principle that affect more than one PCCC Ensure that local LMCs and Londonwide LMC, CCG Governing Bodies and NHSE London are key and equal partners in the delivery of the 7
Review Duties: decisionmaking The Steering Group will have no formal decision making powers unless the NWL Collaboration Board (or similar pan-nwl authorising body) request the Steering Group to make formal recommendations. The CCG s PCCC, and Governing Body, will be responsible for agreeing Commissioning Intentions for re-investment of the PMS Premium, and (with the local LMC) for agreeing practice-based approaches to the transition. Duties: advisory Duties: monitoring Secretariat NWL principles of subsidiarity will apply. The Steering Group will: Ensure that NWL, and local CCGs, have access to the necessary analytical and financial support required to complete the Review locally and pan-nwl Make regular reports to the NWL Collaboration Board (and other Groups as necessary), and to NHSE, on the progress with the Review The Group will: Ask for regular reports from the PCCCs on progress with the Review, and demonstrable delivery against the consistent principles set out for NWL To be provided by NWL Strategy and Transformation team Accountability: The Steering Group is responsible to the NWL Collaboration Board, and accountable to CCG Governing Bodies, for its support and oversight work to the PCCCs. 8