Personal Services Contracts Research Articles

Equity and the funding of Primary Care Networks.

There is a 19-year difference in healthy life expectancy between deprived and more affluent populations in England.1 These health inequities have multiple direct impacts, such as increased disease burden and reduced economic activity.2 Their reduction is an important goal of the NHS Long Term Plan (LTP).3 High-quality and accessible primary care is recognised internationally as an important component of an equitable health system,4 yet there are 15% fewer GPs per capita in deprived areas of England.5 The proportion of the NHS budget spent on primary care has decreased in recent years.6 The LTP promised increased funding to address this.2 Currently, general practice funding in England goes directly to individual practices, according to formulae that include some adjustments to account for workload variation. Rather than directing additional resources into primary care via these existing funding streams, the LTP proposed the creation of new Primary Care Networks (PCNs). These are voluntary groups of practices contracted to work together to deliver additional services for additional funding (technically called a Directed Enhanced Service). The PCN contract offers £1.8 billion extra funding as part of the £2.4 billion increase in overall primary care funding; this is a 14% real-terms increase compared with the £9.6 billion budget in 2014/2015.7 To understand whether this will address or exacerbate existing health inequities and address the so-called ‘inverse care law’,8 it is important to explore how these resources will be allocated and what conditions will be applied to how they can be used. The majority of funding for primary care is distributed through General or Personal Medical Services contracts, with additional payments paid for some specific extra activities.9 The core of practice income is derived from the ‘global sum’, a weighted capitation payment. The average payment of £93.46 per …

Physician Personal Services Contract Enforceability: The Influence of the Thirteenth Amendment.

We explore the influence of the Thirteenth Amendment to the US Constitution on the enforceability of personal services contracts for physicians. This influence extends from the ambiguous definition to the legal interpretation of personal services contracts. The courts have struggled with determining contracts to be a personal service and whether to grant injunctions for continued performance. The award or denial of damages due to a breach of contract is vested in these enforceability complications. Because of the Thirteenth Amendment's influence, courts and contracting parties will continue to struggle with physician personal services contract enforceability; although other points of view may exist. Possible solutions are offered for health care contract managers dealing with challenges attributable to physician personal services contracts.

Impact of primary care funding on secondary care utilisation and patient outcomes: a retrospective cross-sectional study of English general practice.

In international studies, greater investment in primary health care is associated with improved population health outcomes. To determine whether investment in general practice is associated with secondary care utilisation, patient satisfaction, and clinical outcomes. Retrospective cross-sectional study of general practices in England, 2014-2015. Practice-level data were stratified into three groups according to GP contract type: national General Medical Services (GMS) contracts, with or without the capitation supplement (mean practice income guarantee), or local Personal Medical Services (PMS) contracts. Regression models were used to explore associations between practice funding (capitation payments and capitation supplements) and secondary care usage, patient satisfaction (general practice patient survey scores), and clinical outcomes (Quality and Outcomes Framework [QOF] scores). The authors conducted financial modelling to predict secondary care cost savings associated with notional changes in primary care funding. Mean capitation payments per patient were £69.82 in GMS practices in receipt of capitation supplements (n = 2784), £78.79 in GMS practices without capitation supplements (n = 1672), and £84.43 in PMS practices (n = 3022). The mean capitation supplement was £5.72 per patient. Financial modelling demonstrated little or no relationship between capitation payments and secondary care costs. In contrast, notional investment in capitation supplements was associated with modelled savings in secondary care costs. The relationship between funding and patient satisfaction was inconsistent. QOF performance was not associated with funding in any practice type. Capitation payments appear to be broadly aligned to patient need in terms of secondary care usage. Supplements to the current capitation formula are associated with reduced secondary care costs.

Considerations in Drafting Medicaid-Compliant Personal Services Contracts

More than half of all patients entering U.S. nursing homes will rely Medicaid to pay for their care. Before enter- ing a nursing facility, many patients at some point will pay a relative to care for them at home. Some nursing home resi- dents are paying (or would like to pay) a relative to provide them with additional services or supplemental care. But when a Med- icaid applicant or recipient has made or is making payments to a relative, those payments can trigger a period of Medicaid ineligibil- ity. A carefully drafted care contract (or personal services contract [PSC] ) executed before initiation of services can prevent Medicaid ineligibility.This article introduces PSCs and discusses common consid- erations for drafting Medicaid-compliant agreements, comparing and contrasting the provisions from the Medicaid manuals of four states, and noting some related appellate decisions from various state courts. Last, a sample PSC (see Appendix) for use in Min- nesota is attached, with the caveat that each state applies its own statutes and interpretation manuals to these contracts, and there- fore drafters should consult applicable laws.INTRODUCTIONMedicaid is a federal program1 that uses a state and federal partner- ship to provide comprehensive medical insurance for persons with low incomes and very limited assets. The rules for eligibility and type of assistance available vary somewhat from state to state2; but a universal rule in Medicaid is that applicant is not permitted to make uncompensated for less than fair market value, and then obtain assistance.3 In other words, one may not give away assets to become eligible for Medicaid.THE CASE OF BARB AND HER FATHER TEDWhen Barbs 83-year-old father, Ted, fell and broke his hip, Barb knew her life was about to change dramatically. Barb was only child, and her mother had died a year earlier. Her parents were of modest means, living Social Security in a small rented apartment and clutching tightly to a small nest egg they had built. Their dream had been to pass some inheritance onto their grand- children through Barb.Ted hated the idea of life in a nursing home and shuddered at the thought of a complete stranger providing care in his home. So Barb and Ted developed a plan-in exchange for most of her folks' little nest egg, Barb would quit her job and devote herself to Ted's care.When Ted was discharged from rehab to go home, the social worker warned Barb that Ted might end up requiring nursing home care and that, given Ted's modest means, he would likely end up on Medicaid. The social worker told Barb that to keep Ted eligible for Medicaid, she should enter into a contract for his care. Without a contract, money paid from Ted to Barb would have all the appearance of an uncompensated transfer or gift.Barb wrote up a simple nontransferable PSC with Ted. It stated that in return for a $65,000 up-front lump sum payment, Barb would agree to provide to Ted home care for the rest of Ted's life. Then she signed it, using her power of attorney to execute Ted's signature as his attorney-in-fact.After 9 months of caring for Ted, it was apparent to Barb that she simply could not continue-her dad was declining rapidly, and he needed more care than she could devote. Furthermore, Barb had not realized how expensive her family's health insurance was and how her out-of-pocket costs would add up when taking care of Ted. Having quit her job, most of the money she received from Ted was gone. Barb needed to go back to work.On the advice of Ted's doctors and to the relief of her own fam- ily, Barb arranged for Ted to move to the local nursing home. She continued to visit him every day, taking him out occasionally, and managing his finances. But Ted's care costs far exceeded his income, and soon the balance of his modest savings was gone. Barb had no choice but to apply for Medicaid behalf ofTed. …

Primary care in England: coping with financial austerity

General practices in England are currently facing possibly their most challenging financial circumstances since the NHS was founded in 1948.1 GPs and their primary care teams have traditionally been patients’ point of first contact with the NHS. Primary care teams are responsible for providing access to health services for all residents of England and dealing with most of the acute medical problems patients present with, as well as providing long-term care for people with chronic diseases. They also provide a wide range of systematic and opportunistic preventive and health promotion activities, such as smoking cessation services, NHS Health Checks, and screening for alcohol misuse. A strong primary care sector has allowed the NHS to make efficient use of resources, through the gatekeeping role that GPs have in controlling access to specialist services, and through the wide range of medical, social, and psychological problems that GPs and their teams manage through a mix of person-based and population-centred care. In the past decade, GPs have benefited from increased health spending on the NHS, leading to improved access and shorter waiting times for specialist services; and access to a wider range of services within primary care that are closer to patients’ homes. General practices also benefited from the implementation of a new contract and the introduction of the Quality and Outcomes Framework (QOF) in 2004 that led to an increase in the resources that the NHS allocated to primary care, and a greater focus on health targets. Additional flexibility in the provision of primary care services came from the introduction of personal medical services (PMS) contracts and local enhanced …

PMS contracts being cut or abolished, warns NAPC

Patients are being “seriously failed” by the continuing erosion of personal medical services (PMS) contracts in general practice, the National Association of Primary Care (NAPC) has warned. The association said that practices are increasingly reporting that PMS budgets are being slashed or that primary care trusts are forcing them to revert to the general medical services (GMS) contract. This trend flies in the face of the localism agenda that the government promotes and will make it hard for services to respond to local need, says …

Work patterns in UK general practice: turning the clock back?

The 1966 contract for UK GPs can be judged to have brought about a remarkable renaissance in primary care. For those unfamiliar with the history, it is worth recalling what it was like before then. Most practices were single-handed, and there was no incentive to invest in staff or premises. GPs were memorably faced with the choice of maximising their income by looking after large lists of patients, or having smaller lists, employing staff, and investing in their premises and surviving on lower incomes. Significantly, the 1966 contract marked the end of the ‘assistant with a view’. These were doctors unable to get a practice of their own, and employed by existing doctors ‘with a view’ to taking over the practice in due course. Such doctors ended up trapped, waiting for a partnership that came late or not at all, and working for another doctor at a lower rate of pay. The 1966 contract introduced a fee structure with a number of different elements, specifically rewarding doctors working in partnerships, providing generous arrangements for investing in premises, and reimbursement for employing staff. Over time, much of this complex structure has been eroded, first with the 1990 contract, followed by personal medical services (PMS) contracts. The 2004 changes found in the new general medical services (GMS) …

Reviewing Your Contract: A Basic Primer

This article is reprinted from the February 2005 issue of the Journal (2005;105:198-200). Reviewing your contract: A basic primerJournal of the American Dietetic AssociationVol. 105Issue 2PreviewContracts abound in the business aspects of professional life. Professionals find themselves confronted with a wide range of contracts, including leases, supplier contracts, purchasing contracts, provider contracts, employment contracts, and personal service contracts. Without some legal training, a professional may feel overwhelmed by the technical language and legalistic concepts that she or he finds in the typical contract. Full-Text PDF

El debate jurídico en torno al contrato de prestación de servicios

<p>A la aparente reducción de las plantas de personal de las entidades estatales corresponde un aumento en la celebración de contratos de prestación de servicios, mecanismo que permite evadir los sistemas de selección exigidos para la contratación estatal lo mismo que para el ingreso y permanencia en el sector oficial. Dada la discrecionalidad en su celebración, el contrato de prestación de servicios también es el vehículo empleado para oficializar y legitimar el incumplimiento de los mandatos constitucionales y legales que imponen la carrera administrativa para el ingreso y permanencia en la función pública. Además con la desfiguración del concepto legal del contrato de prestación de servicios se logra eludir el reconocimiento y pago de prestaciones sociales, lo cual se traduce en desmejoramiento de las condiciones económicas de los contratistas. En síntesis el prestación de servicios de manera velada desconoce el ordenamiento jurídico superior, no obstante la posición de censura adoptada en un comienzo por las altas instancias judiciales. Ello, en razón a que la legislación colombiana a partir de la Constitución Política define el carácter del servidor público con los derechos y obligaciones que le son propios; de igual manera, establece en el Estatuto de la Contratación Estatal - Ley 80 de l.993- los principios rectores que deben orientar todos los procesos de contratación a cargo de las entidades oficiales.</p><p>En consecuencia, ambas instituciones: la del servidor público y la del contrato estatal, pertenecen al campo de la función administrativa; están reguladas por normas de Derecho Público y más exactamente por el Derecho Administrativo. A partir de tales presupuestos es labor de la investigación, ubicar tanto la contratación estatal como la función pública bajo las directrices que impone la Carta Política en un Estado social de derecho, con todas las consecuencias que tal consagración conlleva. La investigación debe abrirse al interrogante sobre la conformidad de estos contratos de prestación de servicios para vincular personas a la nómina de las entidades oficiales, con la preceptiva constitucional que instituye el Estado Social de Derecho. El estudio deberá extenderse a los procesos de reestructuración como dispositivo que desplaza los empleados públicos por los contratistas de servicios personales y el papel de las cooperativas en esta modalidad contractual </p>

Costs and consequences of Personal Medical Services (PMS): a case study approach to the national evaluation of PMS in the UK

Personal Medical Services (PMS) contracts, introduced in 1997, provide a new financial model for providing general practice. The aim of this study was to measure the costs and consequences of the PMS first wave contracts for sites that aimed to increase the accessibility and the quality of care for vulnerable population groups; to describe the problems encountered in this measurement. A purposive sample of first wave PMS sites targeting vulnerable population groups were selected. A two-stage data collection procedure was used, to obtain micro-level data on the quantity and costs of capital and recurrent funds, and top-down data on costs and apportioning of monies received from central source to broad expenditure categories. The costs data focused on the largest cost components, such as staff and prescribing as well as alternative stakeholders’ contributions. The consequences data measured the accessibility and the quality of care for vulnerable population groups. Five case studies were considered. Sites that were formerly independent general medical practitioner (GP) contractors consolidated their staff with few changes in their staff-skill mix. In all sites the prescribing costs per patient were below the national average in 2000/01. Access was either consolidated or improved over the period and improved quality of care was in evidence through appropriate prescribing patterns. Though the evaluation found that the PMS sites were addressing their main objectives the data collection revealed difficulties in tracking the flows of PMS resources under the current budgetary system. We highlight the limitations of the PMS data monitoring procedures and discuss how these limitations can be overcome so that future National Health Services (NHS) reforms can be appropriately evaluated in the future.

Reviewing your contract: A basic primer

Contracts abound in the business aspects of professional life. Professionals find themselves confronted with a wide range of contracts, including leases, supplier contracts, purchasing contracts, provider contracts, employment contracts, and personal service contracts. Without some legal training, a professional may feel overwhelmed by the technical language and legalistic concepts that she or he finds in the typical contract.

Do Personal Medical Services contracts improve quality of care? A multi-method evaluation

To assess whether the new contractual arrangements of first-wave Personal Medical Services (PMS) practices in England improved their quality of care, compared with changes in care provided in a control sample of General Medical Services (GMS) practices. Controlled 'before' (at or near 1 April 1998) and 'after' (at or near 31 March 2001) quantitative observational study in a sample of 23 PMS and 23 GMS practices. Quantitative data focused on access, chronic disease management, mental health care, primary care of older people, costs and patient evaluation using the General Practice Assessment Survey. Case studies were also undertaken in all PMS pilots, involving interviews with general practitioners, nurses, practice managers and Health Authority and Primary Care Group/Trust managers, documentation review, and analysis of site-specific data. There were improvements in quality of care in PMS sites in all areas of care evaluated, but improvements in care over and above those found in GMS sites (the 'PMS effect') were only statistically significant for angina care (P = 0.05) and elderly care (P = 0.04). Teamwork, shared culture, clear objectives and leadership were important catalysts for quality improvement in PMS sites. Improvements in PMS practices came at additional financial cost. There were concurrent improvements in GMS practices. No PMS site succeeded in meeting its aims without successfully introducing effective leadership and management, and changing relationships within the practice (e.g. equalising power between nurses and doctors). Small but steady improvements were observed in English primary care. PMS contracts facilitated quality improvements in specific areas over and above these broad improvements (the 'PMS effect') during the study period. New contractual arrangements for health care can be used to improve quality of care. However, the mechanisms that resulted in quality gains, while facilitated by the new contractual arrangements, were not specific or unique to the PMS experiment. Factors such as effective management, clear objectives and flexible professional relationships within practices are likely to be important in determining whether new contractual arrangements result in improved outcomes. The context within which care and services are provided is as important for quality innovations as specific contractual arrangements.

Do Personal Medical Services contracts improve quality of care? A multi-method evaluation

Do Personal Medical Services contracts improve quality of care? A multi-method evaluation

Principal-agent relationships in general practice: the first wave of English Personal Medical Services pilot contracts.

To investigate how far English National Health Service (NHS) Personal Medical Services (PMS) contracts embody a principal-agent relationship between health authorities (HAs) and primary health care providers, especially, but not exclusively, general practices involved in the first wave (1998) of PMS pilot projects; and to consider the implications for relational and classical theories of contract. Content analysis of 71 first-wave PMS contracts. Most PMS contracts reflect current English NHS policy priorities, but few institute mechanisms to ensure that providers realise these objectives. Although PMS contracts have some classical characteristics, relational characteristics are more evident. Some characteristics match neither the classical nor the relational model. First-wave PMS contracts do not appear to embody a strong principal-agent relationship between HAs and primary health care providers. This finding offers little support for the relevance of classical theories of contract, but also implies that relational theories of contract need to be revised for quasi-market settings. Future PMS contracts will need to focus more on evidence-based processes of primary care, health outputs and patient satisfaction and less upon service inputs. PMS contracts will also need to be longer-term contracts in order to promote the 'institutional embedding' of independent general practice in the wider management systems of the NHS.

Commentary on Patronage

In his article on Illinois after Rutan, David Hamilton (1993) describes the steps that the state has taken to comply with the Supreme Court's prohibition of patronage hiring. Although the patronage system established under Governor James Thompson has been dismantled, there is good reason to believe, as Hamilton hints, that the sun has yet to set on patronage in Illinois. The current governor's commitment to eliminating patronage seems at best questionable. Like his predecessors, Governor Edgar has carried on the hoary traditions of Illinois' job-centered politics by keeping control of the personnel function in political hands. Once again a political operative rather than a personnel professional has been put in charge of the state's Department of Central Management Services (DCMS). In carrying out the Rutan settlement, the Edgar administration has also identified an extraordinary number of positions as exempt, thus preserving them as patronage posts. So far, at least 3,200 positions out of a total of 65,000 under the governor's control have been put in the exempt category. According to the Volcker Commission (1989), this is approximately the same number of appointments made by the President, who heads a work force almost 50 times larger. Although protests forced DCMS to abandon its attempt to put though a plan turning another 1,000 positions into term appointments (Finke, 1993), the 3,200 existing exempt positions are probably sufficient for the administration to exercise considerable control. Because many of the 3,200 political appointees will be in supervisory positions, they will be able to influence the hiring, promotion, and evaluation of rank-and-file employees. The Edgar administration is also fighting to preserve as much patronage as it can by filling hundreds of part-time and seasonal jobs on a political basis. The Illinois Department of Transportation (IDOT) has admitted that it gets political referrals for summer jobs, but claims it is within the law because Rutan does not apply to part-time or temporary jobs. This is a dubious interpretation of the Court's ruling and Mary Lee Leahy, the attorney who won the Rutan case, has already filed a class action lawsuit on behalf of all those who have been denied jobs because of their political affiliation. She charges that officials have regularly turned to Party leaders throughout the state for advice on hiring temporary highway maintainers, who handle snow removal and other maintenance on state roads and that the party officials made recommendations based on people's voting records, political contributions and other partisan factors. While the state is fighting the charges, its case has been undercut by a Republican county chairman who acknowledged to a reporter that IDOT lets us know whenever a position comes up in Saline County (McDermott, 1993). The suit against is just one of several that have been filed against the state for violating Rutan. In addition, the Edgar administration has been under fire as a result of muckraking reports in the Chicago Tribune, the Springfield State Journal Register, and the St. Louis Post-Dispatch documenting its extensive use of pinstripe patronage, including consulting and personal service contracts. Criticism of the administration for changing the state's purchasing rules has been widespread. The state is now allowed to award no-bid contracts for any purchase under $25,000. Previously, bids were required for all contracts of $5,000 or more. …

Contract Remedies and Inalienable Rights

I. IntroductionTwo kinds of remedies have traditionally been employed for breach of contract: legal relief and equitable relief. Legal relief normally takes the form of money damages. Equitable relief normally consists either of specific performance or an injunction – that is, the party in breach may be ordered to perform an act or to refrain from performing an act. In this article I will use a “consent theory of contract” to assess the choice between money damages and specific performance. According to such a theory, contractual obligation is dependent on more fundamental entitlements of the parties and arises as a result of the parties' consent to transfer alienable rights.My thesis will be that the normal rule favoring money damages should be replaced with one that presumptively favors specific performance unless the parties have consented to money damages instead. The principal obstacle to such an approach is the reluctance of courts to specifically enforce contracts for personal services. The philosophical distinction between alienable and inalienable rights bolsters this historical reticence, since a right to personal services may be seen as inalienable.I will then explain why, if the subject matter of a contract for personal services is properly confined to an alienable right to money damages for failure to perform, specific enforcement of such contracts is no longer problematic. Finally, I shall consider whether the subject matter of contracts for corporate services is properly confined to money damages like contracts for personal services, or whether performance of corporate services can be made the subject of a valid rights transfer and judicially compelled in the same manner as contracts for external resources.

Damages: "Value of the Contract," a Novel Standard for Assessing Damages Resulting from Fraudulently Induced Personal Service Contracts

Damages: "Value of the Contract," a Novel Standard for Assessing Damages Resulting from Fraudulently Induced Personal Service Contracts

Negotiation of Personal Service Contracts

Negotiation of Personal Service Contracts

Enforcement of Personal Service Contracts in the Entertainment Industry

Enforcement of Personal Service Contracts in the Entertainment Industry

Negotiation of Personal Service Contracts

THIS PAPER will discuss only contracts for the employment of talent, viz., -actors, writers, directors and producers, since all other employment is covered by collective bargaining contracts. Before considering any individual contract however, it is essential to read the particular guild contract relating thereto.' When the contract is for an actor to appear in one picture for a salary of less than $25,000, the Screen Actors Guild enforces the use of a printed form of contract which it has approved and which cannot be modified except for the benefit of the actor. This contract is very favorable to the actor, so this is no hardship to one negotiating an employment agreement in behalf of an actor. It is to be noted that the $25,000 relates to cash compensation paid during production and if the actor is to receive cash plus a deferment or cash plus a percentage of receipts or net profits, in computing whether the compensation is $25,000, only the cash may be considered. For example, if an actor is to receive $20,000 in cash, $30,000 as deferred compensation to be paid after the cash negative cost of the picture is recovered, and 10% of the net profits, under the interpretation of the Screen Actors Guild, this is still a contract for less than $25,000. In using the Screen Actors Guild minimum contract form about the only important matter to negotiate will be the screen and advertising credit to be afforded the actor.