On 16 July 2015 NHS Sheffield Clinical Commissioning Group (CCG) held an extraordinary Governing Body meeting in public at the Quaker Meeting House to discuss the options for redistributing Personal Medical Services (PMS) Premium funds across Sheffield’s GP practices.

Decision from 16 July Governing Body

After hearing all views and comments Option 2 was supported which includes a process whereby practices can make a ‘special cases’ submission.

Option 2 – Use the money to fund continuation of non-core services – most of the resource release would be made available to practices (reserving an allocation for supporting special cases) using a locally commissioned service mechanism to secure the provision of service traditionally provided in primary care but outside of the core contract.

The paper, which included four options, can be read on the CCG website here: http://www.sheffieldccg.nhs.uk/Downloads/CCG%20Board%20Papers/FINAL%20PAPER%20Equalisation%20of%20core%20general%20practice%20finances.pdf.

During the meeting a number of public questions were read out and responded to where appropriate. All questions will be also responded to in writing within the next two weeks. As well as hearing from the public, patients and carers, and local councillors, Governing Body also sought feedback from GP practices via the four locality groups, the Local Medical Committee and NHS England.

We were informed that practices provide a number of ‘non-core’ services, which they have been providing over the years, and which patients have come to expect. However, as funding for core services from NHS England levels out, there is a concern these may have to cease, with practices consequently referring patients to secondary care as the alternative provider in many cases. In light of this, we agreed to work with the Local Medical Committee and NHS England to develop a contract offer to practices to commission the ‘non-core’ services that we need to protect.

In redistributing the money we need to be mindful that all practices in Sheffield, and nationally, are facing the same pressures that the whole health and social care system faces – an aging population, with more incidence of long term conditions (including dementia), underlying health inequalities, increasing patient expectation and the need to improve care for people with mental illness and learning disabilities.  The impact of this puts pressure on the delivery of the full range of services widely provided to patients by practices within the city, particularly those services provided beyond their core contract with NHS England. 

Most importantly we need to use the funding in a way that best supports the delivery of services to patients across Sheffield and that meets the aims of the CCG – improving the quality of care, reducing health inequalities, ensuring healthcare is affordable and sustainable at least at current levels.

Working with practices

The proposed redistribution and additional local funding will result in 60% of practices not having a financial loss. However, we understand that for those losing income this may be difficult. For practices having to change how they work to manage that loss, we will work with them to help them do that. We will also do everything we can to work with practices to protect key services for patients.

We are proposing to invest a further £4 million in general practices over the next four years and have agreed to establish a ‘special cases’ process whereby practices can identify if they are providing services over and above those of other practices. We will assess this and, where we can, will provide funding to support practices.  It is envisaged that this will amount to an investment of over £600,000 over the next 3 to 4 years.

What next?

We will now be working with the Local Medical Committee and NHS England to develop a contract offer to practices to commission the ‘non-core’ services that we need to protect. We will be writing to practices shortly to set out the process and criteria for ‘special cases’.

Background information

There are two main types of GP practices in Sheffield, General Medical Services (GMS) surgeries, which must provide certain essential services and can choose to provide more, and Personal Medical Services (PMS) surgeries, which have flexibility to negotiate the services it provides.

NHS England is implementing a policy of equalising core contractual funding for GP practices, whether funded through GMS or PMS contracts to achieve a more equal and fairer funding system.

Inequity in funding has developed over time due to previous policies offering some practices the opportunity to bid for additional funding, usually associated with the provision of additional services. 

The national policy to remove differences in core funding is being implemented by 2018 for PMS practices and 2020/2021 for GMS practices. NHS England have used the first 18 months to review individual practices through 1-1 meetings and the funding changes will commence from 1 October 2015 so that by the end of 2020/21 the core funding per patient for all practices will be the same. 

Although the CCG does not hold the contracts with GPs, NHS England locally have involved the CCG in the process. NHS England has calculated that by the end of the process £2.8m currently in contracts with PMS practices in the city will be available for redistribution. Sheffield CCG is responsible for determining this redistribution within certain rules. All 87 GMS and PMS practices across the city must have equal opportunity to access this money. The money must be spent entirely on General Practice but cannot be used to reverse the national decisions that have been made or spent on core services.

Further Information

If you would like to feedback any comments you can contact the CCG on Sheccg.sheffieldccg@nhs.net.