FINANCE: A primary care trust has won agreement from its GPs to move to a more standard contract and income, including a pay cut for some practices, despite the threat of legal action from some.

Most of NHS Derbyshire County’s 94 practices – both general medical services (GMS) and personal medical services (PMS) – have agreed to provide a newly agreed “core” set of services.

There has been wide variation in what is provided and how much practices are paid for it, as in many other areas, under differing contracts.

Practices will now move towards a new standard per-patient fee for the core services and for a set additional amount for a “basket” of further services, which has also been newly agreed.

For some practices which are currently paid relatively more than others this means a move to a lower income over several years.

Writing on, GP and PCT clinical adviser Paul Cook says the PCT successfully negotiated with a “hard core” of practices which opposed the changes, including three GMS practices agreeing a lesser level of income reduction.

A further four GMS practices refused to agree any change. The PCT says these four will be a “lower priority for premises developments and certain discretionary funding” from the PCT, and will not be commissioned to provide “certain other services… such as CVD screening and minor injuries”.

The PCT has little power to force changes to GMS contracts but Dr Cook says there was “the potential to terminate PMS contracts although we were always clear that this was a last resort”.

He says it would have been possible and “importantly the PCT Cluster board was prepared to support this option if it had been required”, but “in practical terms this would have been problematic” because of workload.

Dr Cook’s piece says: “There were a hard-core of practices who were vehemently opposed to any shift and took considerable time and effort from our team to arrive at a settlement.”