• Birmingham and Solihull CCG wants to end PMS additional funding, which pays for extra services
  • GPs appealed, arguing PMS reviews were supposed to end in 2016
  • But NHSE/I said it was “confident” commissioners followed proper procedure

NHS England/Improvement has defended a clinical commissioning group over planned cuts to services aimed at health inequalities facing marginalised groups.

Birmingham and Solihull CCG plans to end personal medical services contracts with 15 GP practices in April. Commissioners rejected business cases for continued funding made by 12 of the practices last month, HSJ recently revealed.

Partners at one affected practice, Highgate Medical Centre, have also argued the decision breaches NHSE/I’s PMS guidance in an appeal seen by HSJ.

PMS contracts were introduced from the late 1990s to allow GPs to provide a wider set of services. PMS practices are typically funded at a higher rate than those on the longer-standing general medical services contracts.

National policymakers said PMS contracts should be phased out from 2013-14, with a view that the extra income often fails to provide good value for money above GMS peers. Commissioners were asked to review the contracts no later than 2016.

A spokesman for NHSE/I in the Midlands did not confirm whether national guidance had since been updated. But he said the organisation, which delegates its responsibility for primary care commissioning to the CCG, was “satisfied” the group had followed “appropriate processes” during their reviews.

The spokesman added: “We are confident that they are taking the necessary steps to ensure public money is spent appropriately and effectively across the area.”

Birmingham and Solihull CCG decided to decommission ”legacy” PMS contracts in December 2018, eight months after the organisation was created with the merger of Birmingham CrossCity, Birmingham South Central and Solihull CCGs. The two Birmingham CCGs held PMS contracts that had passed earlier reviews.

A spokeswoman for the merged organisation said commissioners assessed the contracts to align “consistency of services and equity” for all patients. The CCG serves 1.3 million patients and received an allocation of £2.4bn this financial year. Any money saved through PMS cuts will be reinvested across primary care, it has said.

PMS contracts in Birmingham

Among the services likely to be affected by the cuts are:

  • Five enhanced screening services for minority ethnic groups;
  • Five services for patients with chronic conditions and/or complex comorbidities;
  • Two services for patients experiencing homelessness;
  • Three services offering culturally-specific consultations;
  • Two home visit services;
  • A 24/7 phone number for end-of-life patients; and
  • Chaplaincy and counselling services.

The affected practices serve some of the most deprived areas of Birmingham. PMS contracts currently fund at least 30 services, many of which are designed to address the health needs of minority ethnic patients, who are disproportionately affected by chronic conditions like diabetes and who may face linguistic and cultural barriers when accessing healthcare.

Race Equality Foundation chief executive Jabeer Butt previously called the funding cuts “appalling” and said they would “only widen racial and socioeconomic inequalities”.

Meanwhile, the CCG’s equality and impact assessments of the cuts, now published on its website, reveal roughly 850 patients, carers or other members of the public per week may be affected.

The assessments, which suggest alternative funding and pathway options, predict withdrawing PMS funding from 13 services will have some impact on patient safety, experience, effectiveness of care and/or equality. Most predicted impacts were negative, but a handful were positive.

Every funding cut was expected to damage the CCG’s reputation.

Highgate Medical Centre partner Jui Pandit told HSJ: ”We are simply trying to meet the needs of our patients — deprived communities need more from their local surgeries.

“Cutting 20 per cent of our budget in the way that has been proposed neither appears to meet the guidance set out by NHSE nor actually supports the closure of the health gap that is an aspiration for all involved in healthcare.

“Equity of provision in this case appears to be a race to the bottom for all. It shouldn’t mean taking resources away from those who most need it.

“Though this may lead to equitable distribution of resources it will inevitably widen the health gap for a deprived community whose outcomes are known to be already worse than others.”

The CCG assessments state “resilience funding” will be available for affected surgeries. Practices may be eligible for further funding through an “enhanced universal offer,” but this will be subject to targets.

The CCG declined to comment further while the appeals process is ongoing.

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