And assessment of the state of NHS finances has discovered that around 800 surgeries in the country face average losses in excess of £50,000 annually under the national PMS contract review.
And nearly 200 are at risk of being unable to manage these losses safely in order to deliver adequate services to patients.
PMS cuts are intended to reduce the funding of general practice by £235 million.
The review on the national PMS process began back in 2014, and was supposed to have been completed last year.
Yet delays have ensured that procedures are ongoing.
An internal memo from NHS England’s National Director for Commissioning Development, Rosamond Roughton, to chief executive Simon Stevens discusses the consequences of this delay and the future direction for the PMS process.
Roughton suggested that local commissioners could rely on existing powers to vary the pace of PMS cuts.
It is also believed that section 96 financial support could be used in order to assist those that have been particularly hard hit by the PMS process.
“The absence of CCG reinvestment plans undermines the assurances given on practices’ abilities to manage funding losses safely if they cannot plan on the basis of the net impact of the funding changes,” Roughton commented.
Back in May, Roughton had written to clinical commissioning groups requesting for outstanding PMS reviews to be put on hold.
There were consultations at that time with concerned citizens at London, with the impact on practice stability of the overall procedure being discussed.
Indeed, the internal memo directed at Stevens acknowledges that almost half of the 600 PMS practices in London face losses of 10% of their income, or more.
The document also warns Stevens that PMS practices may terminate their contracts due to being “unwilling to accept the revised contract from the PMS review”.
Such are the difficulties of the current climate, two practices that have been rated outstanding by the Care Quality Commission have already taken this drastic action.
Roughton also noted a “growing (but unquantified) problem of practices stopping or threatening to stop services which may be regarded as “core” GP services”.
Commenting on the issue, GPC deputy chair Dr Richard Vautrey suggested that the picture in general practice is rather grim.
“With the longstanding and systemic underfunding of general practice, at the same time as there has been a rapid increase in the population and workload, many practices are already on a financial knife-edge and losses of this magnitude could put many at real risk of closure. When there is an urgent need for more GPs, the country can ill-afford the risk of losing more local practices with all that that means to the health and wellbeing of local communities.”