Reverting from a PMS agreement to a GMS contract

  • GP contracts

PMS practices may wish to consider reverting to GMS, following changes in the mid-2010s to level down overall PMS contract funding to be equivalent to GMS.

Background

PMS contract holders should be aware that in February 2014 NHS England (NHSE) sent out national guidance to Area Teams to undertake a review of PMS contracts to be completed by the end of March 2016. The premise of the review was to withdraw the additional premium funding from PMS practices and fund PMS practices at an equivalent rate to GMS practices. The withdrawn PMS premium was then re-invested in contracts for services above and beyond core that were offered by all practices (GMS, PMS and APMS), thereby distributing the withdrawn premium funding more equitably across all practices within a borough.

Londonwide LMCs negotiated a pan-London agreement with NHSE London Region to minimise the risk of destabilising any PMS practice, which resulted in transition payments to eligible practices. For most areas in London this period of transition has already or will soon be coming to an end.

Deciding to revert or remain

The key benefit and main reason why practices switched from GMS to PMS contracts initially was that local negotiation enabled additional investment to fund specific local services that catered to local population needs and growth money. If there are no longer any financial incentives, the question then arises as to whether there are greater advantages of reverting to a GMS contract.

We recommend that practices check their PMS agreement and Primary Care Support England (PCSE) statements to confirm if they are still receiving any transition payments. Any payments received for locally contracted services including the ones utilising what was formerly the PMS premium funding will still be available to all practices regardless of the contract they hold. It is advisable for the practice to contact NHSE to request their Global Sum Equivalent (GSE) budget and once in receipt of this, confirm with their financial advisors/accountants that reverting from a PMS to a GMS contract will not have any detrimental effect on the practice finances.

A full comparison of the GMS and PMS contract regulations has been produced by the BMA and was last updated on 7 September 2020. The main contractual advantages of reverting to a GMS contract are;

  • Easier to make partnership changes in the contract holders; under GMS regulations it is a contractual right to add a partner to the contract or for a partner to leave without the need for commissioner approval, I.e. only by giving notice, whereas under the PMS regulations these need the permission of the commissioner (ICB).
  • Termination of the contract; the GMS regulations, unlike the PMS regulations do not enable the commissioner to unilaterally serve a 6-month notice to end the contract without a cause.
  • Quality standards and staff; the obligations within the PMS regulations to comply with quality standards are much broader, as are the prescriptive requirements regarding staff than in the GMS regulations.

As an individual practice, we recommend that you undertake a simple pros/cons exercise, based on the points above to enable the practice to make an informed decision on whether to revert to a GMS contract.

At the current time, it is our opinion that if there are no financial, contractual or other incentives to continue with the PMS agreement, the practice should exercise its option to revert to a GMS contract.

The process of reverting

Should a practice wish to revert to GMS, the PMS regulations section 6(19) outline the process for this. The practice would need to inform NHSE in writing, including in the following in the notice;

  • State that the contractor wishes to terminate the PMS agreement and the date on which the contractor wishes the agreement to terminate, which must be at least three months after the date of service of the notice.
  • Give the name(s) of the person(s) whom the contractor wishes the relevant body to enter into a general medical services contract with.
  • Confirm that the person(s) so named meet the condition set out in section 28S of the Act (persons eligible to enter into GMS contracts)(a) and regulations 4 and 5 of the General Medical Services Contract Regulations or, where the contractor is not able so to confirm, the reason why it is not able to do so and confirmation that the person(s) immediately prior to entering into the GMS contract will meet those criteria.

The process of reverting from PMS to GMS is detailed in NHSE’s Primary Care Policy and Guidance Manual (PGM), under Section 9 “Managing a PMS contractor’s right to a GMS contract”, p. 275 – 279.

Please note that if a practice does not actively revert to GMS, it will remain on a PMS contract. It is a common misconception that PMS contracts automatically revert to GMS once transition funding arrangements have ended, but this is incorrect. You must submit a three-month written notice to your ICB in order to revert to GMS.

If you have any questions regarding the reversion process, or would like to discuss this option in confidence, please contact the GP Support team at gpsupport@lmc.org.uk.