Queen’s Speech

Viscount Bridgeman Excerpts

Thursday 29th June 2017 Lords Chamber

[Viscount Bridgeman (Con)]

My Lords, at this late hour in the debate I briefly bring to your notice a specific issue which has arisen in the GP sector of the NHS in England. The GP settlement of 2006, a far-reaching measure by the party opposite, introduced two categories of general practice: the General Medical Service, GMS, where practices continued broadly with their existing level of funding; and the Personal Medical Service, PMS, whereby practices could opt for extra responsibilities in return for which they received extra remuneration—typically £15 to £30 per patient per annum. I must be careful not to generalise, but the PMS has attracted the more far-reaching entrepreneurial GPs, while those who are happy with the status quo tended to remain with the GMS. However, the PMS unlocked a whole spectrum of entrepreneurial initiatives on the part of many PMS practices. In particular, one PMS practice that I know of used the premium funding to introduce: counselling for sexual health, alcohol misuse and depression; the management of common mental health problems and enduring mental illness; providing facilities for rough sleepers and homeless people; specialist care for the vulnerable elderly; and, last but not least, walk-in surgeries. In this practice, these have led to high levels of patient satisfaction and, with its improved facilities, it and others like it have encouraged patients to avoid the use of overstretched A&E units, in turn reducing costly but avoidable emergency admissions. All in all, it is fair to say that the vast majority of PMS practices have put the extra funding they received to good use.

For the first 10 years or so, this arrangement has worked very well for PMS practices. However, in the 2013-14 GP contract imposition, NHS England decided that the premium paid to PMS practices was to be withdrawn and redistributed via the local CCGs—significantly, to all practices in their areas. Particularly hard hit have been practices in authorities with a small number of PMSs relative to GMSs, and where they receive back only a tiny fraction of the premium surrendered. The arithmetic is simple: in a not atypical split, an authority may have one PMS practice and 19 GMS practices. The PMS practice will therefore receive only 5% of the funds which it has surrendered.

I agree that this redistribution of funds is for the benefit of general practice as a whole, and that the proposals as they stand will have the effect of providing resources for many GMS practices which need them. Where I take issue is that this redistribution is at the expense of the PMS practices, which as a group embrace many practices that have shown initiative over the past 12 years in expanding their services, for which they have received the extra funding I referred to. I know of one central London practice which will lose £400,000 in funding per year that, after a partial clawback from the CCG, will result in a net loss of £200,000. This is an annual, ongoing figure and clearly cannot be sustained. This, by the way, is a total NHS practice with no private patients and therefore no income from rich private clients. There can only be one outcome from this haemorrhage of funding: inevitably, some of the services built up since the inception of the 2006 agreement will have to go.

However this policy is viewed, it means that many GP practices will be subsidised by the star performers in their sector, at a huge cost to the latter. It is simply wrong that these PMS practices, which simply by the way they were constituted have attracted many entrepreneurial and far-sighted GP doctors, should see a significant proportion of their funding withdrawn. Several GPs I have spoken with who took advantage of the PMS funding are quite simply perplexed that, at this time when the NHS is faced with a massive black hole, NHS England should apparently be pursuing a course of what is effectively the disincentivisation of many leading practices within the sector that are dedicated to taking the strain off the hard-pressed and expensive A&E departments. They also show, as a group, much initiative and enterprise in helping to keep GP practice—what has been described as the jewel in the crown within the NHS—as healthcare providers of excellence.

I wholeheartedly agree that our aim must be to ensure that all patients get a minimum standard of treatment. However, I urge the Minister and his colleagues in the Department of Health and NHS England to look elsewhere for funding and not penalise so many high-achieving practices in the GP sector. I understand that the redistribution is to be rolled out over four years, so I hope it is not too late for NHS England to accept my submission that this imposition on the PMS practices is a basically short-sighted process, and to reconsider the department’s policy on it.