PMS Contract review process June 2015

CCG introduction (NHSE speakers, housekeeping) NHSE - review process NHSE - calculation methodology CCG - reinvestment intentions Q and A Agenda

February 2014 national process for review of all PMS contracts announced as £325m or an average £13.52 premium per patient By 2021 NHSE will pay for contracted essential services on similar basis regardless of contract type Responsibility for commissioning ‘supplementary services’ moves to CCG’s and all eligible practices must have the opportunity to provide. All money is staying invested in GP provided primary care – aim is for a fairer payment system Background

Across South West circa £21 million premium of which will reduce to £15 million after MPIG investment DCIOS £6 million - practice premium varies between - £2.75 per head and +£25.80 across BNSSSG - £9 million - practice premium varies between -£8.20 per head and +£52.50 across BNSSSG PMS Premium across the South West

Letter PMS Review: principles, process and timeline Finance template showing potential impact on practice Templates for practices to set out details of any ‘supplementary services’ provided to earn the premium First priority is to understand how much of the ‘premium’ is linked to ‘supplementary services’ practices – Templates to be returned by 10 July 2015 NHSE will share templates with CCG so they can consider continued commissioning of ‘supplementary services’ and impact on the primary care investment plan priorities Would further meetings with ‘surgery slots’ for practices be useful? – End July/August? What information NHSE has sent practices and needs returned

CCG will consider future commissioning of ‘supplementary services’ by 31 August 2015 and advise NHSE Impact assessment including considering whether there is a consultation requirement NHSE will keep practices informed and where necessary give 6 months notice on any contract changes by end of September 2015 CCG’s to advise all practices of commissioning intentions/re-investment proposals by 30 November 2015 Practices to confirm intention to take up LES or other investment opportunities by 31 December 2015 Premium reductions over 5 years starting April 2016 How the process will work for a practice

We realise that the review process creates uncertainty and are concerned about risk of de-stabilising practices NHSE will continue to work closely with CCG’s, LMC’s and individual practices Business ‘Health Check’ tool and other support Final premium will be reduced by 5 equal annual reductions in gross payment to practice Bear in mind that annual inflation uplifts (say £ £1.50 per annum per patient) mean many practices will not lose cash – but recognise its still a real terms income loss Opportunity for all practices to earn money from providing services prioritised in CCG investment plans Minimising the impact on a practice

PMS Premium Proforma: L8**** practice name £ GMS global sum rate at 1/4/2015£ practice-funding/gp-contract england/gp-contract-payments Less OOHS £4.08 (5.39%)-£4.08Adjustments from 1st October for seniority will be applied equally to PMS & GMS practices. GMS rate net of OOHS£71.69B Current PMS Contract Rate (net of OOHS)£79.00AAt practice 2015/16 value Per weighted patient excess over GMS global sum rate equivalent£7.31= A - B Weighted List Size at 01/04/201516,500CAs per Open Exeter system using Carr-Hill formula. Formula outlined in Statement of Financial Entitlements (SFE) Appendix B Excess Over GMS Global Sum Equivalent (PMS Premium):£120,615= C x (A - B) Temporary Residents Fixed Amount£10,164DFrom inherited records, please see letter for further information. Items that are included in PMS Contract that are paid outside GMS contract Childhood Imms - target payments£26,015Calculated from 13/14 Open Exeter information as per SFE Section 11 PA Dispensing Fees£13,245Calculated on 13/14 information, as per SFE Section 23.4 Minor Surgery£0Contract amount NHSE Items to be paid as item of service from 01/04/2016 Total£39,260EPlease check that no other NHSE payments are included in the baseline Please check that no services equivalent for LESs are included in baseline and not funded by CCG Net Total PMS Premium£71,191=(C x (A - B)) - D - ETo be crystallised on 1st April To paid across monthly and reduced once per year. Annual change from 1/4/16-£14,238 Change per year 20% straight line reduction of Net Total PMS Premium Estimated Figure added to PMS payment to match MPIG reinvestment £0.55 per weighted patient per annum£9,075 Increase per yearBased on figures from 2014/15 and 2015/16 Net change in contract per year-£5,163 Change in payment per year Positive values represent an increase, negative values a decrease in the contract value

L8**** practice name GMS global sum rate at 1/4/2015 Less OOHS £4.08 (5.39%) GMS rate net of OOHS Current PMS Contract Rate (net of OOHS) Per weighted patient excess over GMS global sum rate equivalent Weighted List Size at 01/04/2015 Excess Over GMS Global Sum Equivalent (PMS Premium): 16,500 £ £ £4.08 £71.69 £79.00 £7.31 £120,615 Finance Calculations – Stage 1

Finance Calculations – Stage 2 Temporary Residents Fixed Amount Items that are included in PMS Contract that are paid outside GMS contract Childhood Imms - target payments PA Dispensing Fees Minor Surgery NHSE Items to be paid as item of service from 01/04/2016 £10,164 £26,015 £13,245 £0 Total£39,260

Finance Calculations – Stage 3 Excess Over GMS Global Sum Equivalent (PMS Premium):£120,615 Total PMS Premium£71,191 NHSE Items to be paid as item of service from 01/04/2016-£39,260 Temporary Residents-£10,164 MPIG Equivalent Investment - £2.75 per weighted population£45,375 Net Total PMS Premium£25,816

Finance Calculations – Stage 4 Annual change from 1/4/16-£71,191/5-£14,238 20% straight line reduction of Net Total PMS Premium Estimated Figure added to PMS payment to match MPIG reinvestment £0.55 per weighted patient per annum£45,375/5£9,075 Net change in contract per year-£5,163