Moving Your Practice From a PMS to GMS Contract

Posted On July 20, 2018 By mhauk

GMS

Increasingly, over the last few years practices have been moving from their PMS contracts onto the standard GMS contract. Whilst this transition should be seamless, we have experienced many 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. We have outlined below the main areas that need to be carefully checked.

GMS Baseline Payment

A PMS practice was paid based on an 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. See example below.

Calculation of Monthly Global Sum Payment

Global Sum Annual Payment (15,500 * £87.92) 1,362,760
Temporary Residents Adjustment 0.00 Add
Superannuation Premium 0.00 Add
Appraisal Premium 0.00 Add
Adjusted Global Sum Annual Payment 1,362,760 Equals
Initial Global Sum Annual Payment 113,563.33
Additional Service Opt Outs 0.00 Minus
GLOBAL SUM MONTHLY PAYMENT 113,563.33

Opt Outs

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%. In the above example, the Monthly Global Sum payment would be amended as follows:

Calculation of Monthly Global Sum Payment

Global Sum Annual Payment (15,500 * £87.92) 1,362,760
Temporary Residents Adjustment 0.00 Add
Superannuation Premium 0.00 Add
Appraisal Premium 0.00 Add
Adjusted Global Sum Annual Payment 1,362,760 Equals
Initial Global Sum Annual Payment 113,563.33
Additional Service Opt Outs 5,530.53 Minus
NEW GLOBAL SUM MONTHLY PAYMENT 108,032.80

However, we have found that PCSE have failed to apply the out of hours opt out, meaning that in this example, the practice would have been overpaid more than £66,000 a year! It is vital that practices check this deduction is being made as it will not show separately on the GMS statement.

Temporary Residents

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.

Enhanced Services

Some PMS baselines included funding for minor surgery and 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.

How we can Help

As part of our annual accounts preparation service, we will look out for these types of errors and advise the practice of any discrepancies that we notice, however our work might not identify all the issues.

It is a good time, now that the June quarterly Exeter statements are available, to undertake a checking process and if you would like additional bespoke assistance with this, please let us know.

If you would like to be put in contact with a member of our Healthcare teamplease contact Hannah Farmborough or call on 0207 429 4147.

This article originally appeared on the blog of our member firm, MHA Moore & Smalley.