Primary Medical Services Policy and Guidance Manual: Why is it important to me?

If commissioners or GP contract holders have questions relating to how different parts of their contract are to be implemented, or how the regulations governing the sector are to be interpreted, one of the starting points is to refer to the Policy and Guidance Manual (“PGM”).

The PGM is essential reading for anyone involved in GP commissioning and all contract holders should keep it close to hand especially when working with their commissioning partners.

Since April 2013 NHS England became responsible for direct commissioning of primary medical services and since 1^st July 2022, Integrated Care Boards (“ICB”) have had delegated authority to commission the services. The move to delegated authority commenced under the Clinical Commissioning Groups and it was recognised that there was a need for consistency in how the sector was managed. The PGM was produced and was first published in January 2016. It provided to both commissioners and contract managers a structured framework which reflects the latest legislation and national direction so that all groups can work together with as little variation as possible and thereby creating a transparent and level playing field.

NHS England has recently published an updated version.

While the PGM is only guidance, and has no statutory force, the importance of the PGM is that it helps to ensure that all commissioners, providers and patients are treated equitably and that NHS England and the ICBs meet their statutory and (where applicable) delegated duties in a consistent and compliant way, whilst providing good advice and practical tools to help with highly complex areas of contract management.

What does the PGM cover?

The PGM takes into account such matters as (but not limited to):

1. policies to support a consistent and compliant approach to primary medical services across England
2. identification of mandatory functions (i.e. functions defined in legislation and law) together with guidance and best practice, and
3. education relating to commission and contract management that may arise under the PGM

The PGM is set out into four parts (A to D) which address various matters falling under the following topics:

1. excellent commissioning and partnership working
2. general contract management
3. when things go wrong, and
4. general

Although not a legally enforceable document, it does set out guidelines and procedures for commissioners and providers to follow. For example, you may not have considered what to do on the death of a contractor; the PGM is clear in its approach in dealing with this situation. It considers different scenarios, and provides template documents to assist commissioners when responding to providers.

The PGM therefore remains an important tool within the GP primary care sector and it has been great to see a new version published. This replaces a word document which had become rather tricky to read with the multiple amendments over the years, but now with a new electronic version it is arguably more user friendly. It is also a much shorter version with many of the updated documentation, such as the templates, being moved to their own sections, allowing the document to focus on the guidance and advice.

What are the most recent updates?

In relation to the actual content of the PGM, the most recent updates from July 2024 include guidance on:

1. The Provider Selection Regime (“PSR”), which came into force on 1 January 2024. The PGM sets out how this will be implemented in practice in primary care and what it seeks to achieve, which in brief established new rules for arranging NHS services to give decision markers a more flexible and proportionate decision making process for selecting providers to deliver healthcare services to the general public.

Visit our PSR hub to find learn more.

2. Partnership Disputes, the recent development in common law which the decision in the recent case of Bhat & Anor, R (On the Application Of) v NHS Litigating Authority has brought into question the status of a partnership governed by a partnership agreement or being a partnership at will sole dependent on the Partnership Act 1890. The consequences of this has resulted in a new approach for ICBs to follow when faced with partnership disputes which may result in the dissolution of the partnership.
3. The NHS GMS premises costs directions 2024, has been addressed with new guidance on how ICB’s will consider applications from GP contractors for financial assistance towards the running costs of premises including service charges and in particular the relevant legislation under Part 5 (recurring premises costs), directions 47 and 48 of The National Health Service (General Medical Services-Premises Costs) Directions 2024, which came into force on 10 May 2024.

Learn more about the Premises Costs Directions here.

Contact us

Whilst the PGM is an essential part of the toolkit, it does not replace the contractual arrangements or the core legislative regulations which ultimately govern the general practice sector. Our team of general practice and primary care legal experts are available to help with any issues you may be facing.