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General Guidance PMS Third Wave
This is the second in the series of guidance briefings from your Local Medical Committee. It is aimed at helping those GPs whose application for the third wave of PMS pilots has been approved by the Secretary of State, and who will now be embarked on the detailed work of agreeing a budget and a contract either with their Health Authority, or with their PCT where one will exist by April 2001.Third wavers will already be aware that the money for the preparatory professional advice, which you require, is very limited given that it needs to cover the legal costs, accountancy fees, staff time and training and locum costs. There is no arrangement for ongoing management support. Your LMC is keen to see that you have all the advice you need in making this significant transition in your working arrangements and has made advantageous arrangements to assist you.SECTION 1 This section is designed for GPs who are moving into PMS as a practice based pilot and who will remain as independent practitioners. A section on salaried doctors entering Trust or Practice led pilots follows. OUR PMS CONTRACT FOR 2001-2002 AND LEGAL ADVICE our contract with your HA or PCT will need to include:
HOW YOUR LMC WILL HELP YOU:
SETTING THE BUDGET You will of course need detailed advice from your practice accountants; hopefully they will deal with sufficient general practices to understand the implications for you of moving to PMS. Superannuation shares are, for example, particularly complex and need detailed advice. We are setting out the principles of the budget setting process so that you fully understand the advice which your accountant will give you. You will need to negotiate the uplift in your budget annually, so it is essential that all doctors in the practice understand and are confident in the essential baseline calculations.
It will need to include the following, but the list is not exhaustive: Agreed baseline (based on historic GMS payments to 31.3.2000) X (It is crucial that the practice was claiming 100% of entitlements under GMS. You should check every payment from the HA under GMS to ensure that they were 100% accurate according to practice data) Adjust for known changes X (Changes in list size, taking on a new Registrar, etc) Dispensing fees and on cost allowance X (Personally administered items) Actual cost X (Maternity and sickness locum reimbursements)
Staff, premises and IT X (Cost or notional rent, water rates etc) Out of Hours development money X Prescribing budget X (Most pilots exclude the high risk prescribing budget) Statutory LMC Levy and Voluntary Defence Fund levy X The ‘Plus’ element X (For intermediate and secondary care delivered by you) ‘Growth money’ X (For new salaried partners and nurse practitioners)
REMEMBER that although you can apply for change in your budget; this requires the agreement of the HA/PCT and may not be successful.
These may include:
Clearly, the baseline only applies to GMS income; it does not include private fees, earnings from hospital appointments, Bed Fund money, etc. When you renegotiate your budget for 2002, you might try to aim for the gross remuneration increase, which has been achieved for your GMS colleagues in the Review Body Award, but there is no guarantee of this. Finally, it is not yet clear whether HAs and PCTs will attempt to include financial penalties if all the quality criteria in the Core Contract are not met.
There are two main ways of increasing net income:
mainly nurses.
Unfortunately some of the research on PMS indicates that GPs salaried to practice based pilots do not always achieve an appropriate income. This is unlikely to lead to stable and harmonious working arrangements. If in the future we move to PCTs directly employing GPs then low salaries set a poor precedent. Remember that the practice will need to pay additional employer’s superannuation and National Insurance liabilities and also the Medical Defence Organisation subscription.
You must make sure that your cost rent or current market rent are included in your baseline, and that provision for triennial increases in your current market rent is protected. You will also need to take account of borrowing costs, heating, lighting, insurance, maintenance, etc. If you need to fund an extension of your premises you will may be able to do this by uplift in your budget to cover the borrowing costs. However, there are no rights in PMS to extensions or rebuilding as in Red Book arrangements. The HA/PCT continues to pay the ‘employers’ contribution for PMS GPs. You will need to negotiate a ‘superannuation budget’ and the HA/PCT will then need to know how to split this between the partners. You will need to decide how to allocate shares given that there will no longer be separately identified PGEA payments, night visit fees etc. Remember only some aspects of PMS Plus are superannuable. Your accountant needs to produce an estimate now of each partner’s total superannuable income.
There are significant improvements in cash flow in the first year of PMS. This is because you will receive your PMS income in monthly instalments, the first being one month after going live. You will in addition receive in arrears any GMS service and target payments outstanding (i.e. GMS for Items of Service) for the first two quarters of your PMS.
Subsequently you will continue to receive monthly PMS payments RETURN TO GMS You can change your mind about piloting up to the start date if your negotiations do not go well. However, given the amount of work required over these next months, this would be a most frustrating option. Before you go live, you must have secured each partner’s return ticket in your contract. There are financial consequences in returning to GMS if, for example, you have employed a salaried GP or new nurse practitioner. Don’t forget that the GPC is developing proposals for modernising the GMS contractual arrangements.
YOUR AGENDA FROM APPROVAL TO GOING LIVE
The following are essential:
SECTION 2
SALARIED GPs You may be entering PMS as part of a Community Trust led PMS pilot, or joining a practice/s which will be a contract holder in a practice led pilot. In either case you will be an employee of the contract holder and therefore you will have the full range of employment rights available to you. These include sickness and maternity arrangements. You will need to agree a proper contract with a detailed job description and be content that it describes exactly what you wish to undertake e.g. out of hours work. You are strongly advised to take legal advice on the details. You are entitled to choose to be represented by, and elected to, your Local Medical Committee and should ask that the administrative levy, which pays for LMC activities on behalf of GPs, is included in your contract, as well as membership of a Medical Defence Organisation.Your LMC will represent your views and concerns and offer you advice and guidance on a wide range of clinical and ethical problems. If you find yourself on the receiving end of a complaint, the LMC Secretary will assist you in responding.Your NHS superannuation will be calculated on a different basis (officer basis) than for self employed GPs. The details will depend on whether you are moving from self-employed to employed status or have always been an employed doctor. You will need expert advice from your accountant on this.
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