- 15 GP surgeries will lose funding for additional services in April
- Cuts will impact black, Asian and minority ethnic patients, as well as those facing deprivation
- Equality charity called the cuts “appalling,” but CCG says they will reduce variation
- Warnings raised the cuts, which represent 20-30 per cent of some GP budgets, may “destabilise” practices
A GP surgery will lose funding for services designed to address health inequalities facing black, Asian and minority ethnic patients, while others serving deprived areas also face cuts, under a system-wide review commissioners.
Birmingham and Solihull Clinical Commissioning Group intends to cut funding for 15 practices which have “personal medical services” contracts, after rejecting their business cases for continued funding last month. The CCG announced it wanted to end the “historic” contracts last year.
The practices in question serve deprived parts of the city, including Balsall Heath, Sparkhill and Alum Rock. The additional funding linked to being a PMS practice — as opposed to “general medical services” — ranges between 20 and 30 per cent of these surgeries’ budgets.
PMS contracts were introduced from the late 1990s, and practices with these are typically funded at a higher rate than those on the longer-standing GMS contracts, initially with the aim of introducing a wider set of services. However, in recent years, national policymakers have decided they should be phased out, with a view that their extra income often doesn’t provide good value for money above GMS peers.
In Birmingham and Solihull, commissioners plan to offer alternative services to those the practices’ currently provide, but critics argue these are inadequate and will reduce the level of care available to the most vulnerable patients.
Highgate Medical Center, whose 4,200-patient cohort is 98 per cent BAME, offers several PMS-funded services to address the health inequalities facing these groups.
The practice has improved its breast screening uptake by phoning patients and talking about the tests in their own language, for example. Commissioners told GPs this was a duplication of services because all eligible women are automatically invited for screening, and other interpretation services are available.
Other services, such as extended hours to see patients with comorbidities and complex health needs, will now be commissioned according to the nationally-funded GP core contract.
Highgate Medical Center partner Jui Pandit told HSJ the practice was due to lose around 20 per cent of its funding from April, some of which may be compensated if the practice hits performance requirements to receive an “enhanced universal offer” from the CCG.
She said: “Our chronic disease prevalence is double that of the national and CCG average and I don’t know how we can offer that level of care with this level of cuts.”
She questioned whether the specific needs of her patients had been considered. The CCG has since uploaded quality and equality impact assessments online.
Dr Pandit added: “If the aim is to reduce secondary care burden or admissions, then reduced primary care funding for the group of patients that need it the most is undoubtedly going to have the opposite effect.”
Race Equality Foundation chief executive officer Jabeer Butt called the changes “extremely concerning”.
He said: “In addition to one of the surgeries under threat serving an area which is overwhelmingly black and minority ethnic and an area of deprivation, many of the specific services threatened address inequalities that disproportionality affect black and minority ethnic communities.
“Diabetes and black and minority ethnic communities were highlighted as an area of action for the NHS long-term plan, and both breast cancer screening, and end of life care are issues we have been working on with Public Health England, the [Care Quality Commission], and NHS England and NHS Improvement.
“To see local commissioners disregard known needs and issues is appalling and will only widen racial and socioeconomic inequalities.”
PMS practice reviews
- Many commissioners across England have been reviewing and often curbing or cutting spending on PMS contracts since around 2013-14, in a bid to reduce variation in funding between practices.
- The resources saved are meant to be reinvested in local primary care under arrangements with NHS England, according to the British Medical Association.
Birmingham local medical committee executive director Robert Morley said the cuts may threaten the viability of some practices.
He told HSJ: “The scale of some of these cuts is so great that inevitably, bearing in mind the other huge challenges that practices are facing, there may be a significant risk to the viability of some practices.”
Equity of resources should be achieved by levelling up funding, rather than by “bringing in wholesale cuts to resources which will massively destabilise a number of practices struggling to provide the best possible quality of care under the most challenging of circumstances”, he said.
A Birmingham and Solihull CCG spokeswoman said: “We are committed to providing our patients with a consistent and fair service, no matter where they live, or which GP practice they are registered with.
“Fifteen of our 169 GP practices have had historic PMS contracts, with funding for a range of additional services for their patients only. This causes an inequity, because these services are not available across Birmingham and Solihull.
“In some cases, practices are being paid more than once; this is not a good use of NHS money.”
The spokeswoman added the decisions were made according to national guidance.
Affected practices have until 18 February to appeal, but must provide new evidence or appeal on procedural grounds.
Updated at 10.39am 13/02/20 with a link to Birmingham and Solihull CCG’s quality and impact assessments, which were published online two days after this article was written.
Information obtained by HSJ
January and February 2020