Are you moving your practice from a PMS to GMS contract? Beware!
Increasingly over the last few years, general practices have been moving from their Primary Medical Services (PMS) contracts onto the standard General Medical Services (GMS) contract. Whilst this transition should be seamless, there have been cases where the funding has not been correctly paid, meaning that practices have suddenly found they owe significant amounts of money or have been underpaid. Below are the main areas that need to be carefully checked.
GMS baseline payment
A PMS practice was paid based on a historic budget, adjusted over the years for changes in list size, inflation and changes to enhanced services etc. Out of hours opt-out was also deducted as a separate amount on PMS statements.
Under GMS, a practice has a monthly payment which is calculated by reference to the number of weighted patients rather than actual patients and the pounds per patient value (which is currently £87.92 for 2018/19). You can obtain the quarterly Global sum calculations from Open Exeter. To access these calculations, select GP Statements, highlight the quarter beginning date and year.
The Global Sum statement shows you what weighting factors have been applied to your practice. The Global Sum annual payment is then divided by 12 to give you the monthly payment.
The Global Sum includes funding for essential and additional services. Practices may opt-out of additional services and out of hours. For each service the practice opts out of, the global sum payment is reduced by a set percentage.
Most practices opt-out of out of hours. For 2018/19 the opt-out percentage for out of hours is 4.87%.
However, we have found that Primary Care Support England (PCSE) have failed to apply the out of hours opt-out meaning that some practices would overpay thousands a year! It is therefore vital that practices check this deduction is being made as it will not show separately on the GMS statement.
There is also provision for payments to be made via the Global Sum or separately for temporary residents. Again, you should check that your practice is receiving this funding.
Some PMS baselines included funding for minor surgery, childhood immunisations etc. Under GMS, all enhanced services will be paid separately. Childhood immunisation target payments will be paid quarterly in arrears. This may result in delayed cashflow for the practice if the childhood immunisations were paid monthly through the PMS contract.
PA and Dispensing
Historically PMS baselines have included the element of the PPA reimbursement relating to dispensing fees, with just the cost of the drugs being paid separately. Under GMS, the PPA will pay the full amount of the dispensing fees and cost of drugs. You should check the PPA statements to ensure that you are being paid in full.
Now that the June quarterly Exeter statements are available it is a good time to undertake a checking process.