The Primary medical care policy and guidance manual (PGM) was first published as ‘the Policy book’ in January 2016 to support local commissioners to effectively commission and contract manage primary medical care providers, recognising this was a new area of commissioning for clinical commissioning croups (CCGs) under delegation.

A commitment was made to review and refresh the PGM periodically to ensure it remained fit for purpose and reflected the latest legislation and national direction. The PGM was refreshed in November 2017, April 2019, February 2021 and May 2022. 

Amendments have been incorporated following legislative changes related to the delegation of primary care medical services. Predominantly, this involved updating the term ‘CCG’ to either ‘integrated care board (ICB)’ or commissioner and signposting commissioners to the new provider selection regime (PSR) and the need to consult the PSR statutory guidance when procuring services.

The updates to the PGM encompass a reduction in content from approximately 450 pages to under 300 pages. This streamlining was achieved by eliminating redundancies, cross-referencing relevant legislation and guidance, and relocating certain information to annexes. Importantly, these modifications do not alter the material requirements presented in the manual.  

The refreshed PGM has received approvals from the legal team and finance and the PSR in accordance with the publishing approvals request.

Some templates and annexes have been updated to align with policies. The main changes within this refresh are summarised below:

Executive summary 

• Confirmation of the delegation of primary medical services to integrated care boards (ICBs) under the new delegation agreement incorporating which now includes all dental (primary, secondary, and community), general optometry and pharmaceutical services. 
• Additional information on the new Health Care Services (Provider Selection Regime) Regulations 2023 and statutory guidance. 

Part A: excellent commissioning and partnership working 

• The legislation, abbreviations and acronyms chapter has been updated with links to relevant – chapter 2 (2.1).
• ICB delegated commissioning arrangements – chapter 3 (3.2).  
• No other significant changes. 

Part B: general contract management

• Managing patient list – removing children and young people from practice list – chapter 3 (3.2.14). 
• GP patient registration standard operating principles for primary medical services – chapter 4 (4.9).
• Managing [non-violent] inappropriate and unacceptable patient behaviours, including protecting discrimination, harassment or victimisation – chapter 6 (6.5.4 and 6.5.5).
• Managing violent patients – special allocation scheme (SAS) patients notification – chapter 7.
• Contract variations – partnership split/members disputes – GMS and PMS – chapter 8 (8.5.43).
• Discretionary payments (made under section 96 of the NHS Act) – process for financial assistance for individual provider – chapter 11 (11.5).
• Premises running costs and service charges has been updated to reflect NHS (GMS – premises costs) directions 2024, part 5, directions 47 and 48 – chapter 12 (1.1.3; 2.1.2 and 2.2.4). The process flowchart has also been updated.

Part D – general

• Protocol in respect of locum cover or GP performer payments for parental and sickness leave – chapter 2 (2.3.2; 2.6.1 and 2.14.3).

Publication reference: PRN00613