The two-year GP contract for 2015/2017, agreed by the BMA General Practitioners Committee and Welsh government, will provide GPs with greater security.
The changes to QOF include the removal of QOF indicators (102 points) to be transferred to global sum. Senior NHS Wales clinicians and GPC Wales agreed the overall number of QOF points will be reduced from 669 points to 567 points for 2015/16. The funding of 102 points to be released, approximately £15,800 per average practice, will be transferred to core funding through global sum at full points value.
The retirement of these indicators will allow GPs to spend more time caring for the most vulnerable patients with complex care needs, in particular, the frail elderly. The indicators to be removed are considered to be embedded in general practice.
Two new indicators will be introduced into the atrial fibrillation subdomain to replace indicators being retired. This subdomain has also been updated in line with NICE guidance. Separate chronic condition indicators for influenza immunisation have been removed and added to two new influenza immunisation indicators within the public health domain.
A number of indicators have also had their points value adjusted to more accurately reflect their relative workload or to recognise an increased focus, for example, dementia indicator DEM002.
As part of agreed commitments, practices will complete a review of service fee in relation to vaccinations and immunisations and will offer more GP appointments and repeat prescriptions.
The cluster programme will continue with the implementation of year two. As part of the three-year cluster network development programme GP practices will strengthen multi-disciplinary team working and develop more effective collaborative working with community services.
By developing links across the cluster practices, GPC Wales feels this may help practices with respect to sustainability and sharing of staff or working at scale where appropriate.
Clusters have been recognised as the model to transfer resources from secondary to primary care with monies coming in at cluster level as opposed to individual practice level.
The GMS contract for 2016/17 also continues to place a focus on the development of GP cluster networks, which aim to improve patient care in the community.
Speaking exclusively to ICAEW about the impact on practices, Dr Charlotte Jones, Chair of GPC Wales, explained:
“The contract changes for the next two years will bring stability to practices in terms of knowing what their income from the GMS contract itself is going to be. 102 more points are being transferred from QOF (quality outcomes framework) into global sum at full point value to each practice. This money is subject to Carr Hill but not subject to an OOH deduction as we made a one off adjustment for that last year.
Practices will also benefit from workload reduction (appointment usage and administration time) with these changes. The Review Body on Doctors' and Dentists' Remuneration (DDRB) uplift to the contract, and where this will be applied within the contract, has yet to be fully agreed. We do not believe the formula used will cover the expenses that practices face and have made representations to that effect."
The Minimum Practice Income Guarantee (MPIG) redistribution programme commenced on 1 April and practices have been advised of their net losses or gains under this.
“There is an in perpetuity practice support cap payment to those practices whose correction factor was >15% of their global sum,” says Jones. “This will be painful for those losing this money over a seven year period but had been highlighted as a significant risk to practices for a few years following the Welsh Audit Office report.”
For practices experiencing significant challenges, a sustainability programme has been put in place as part of the GPC secured deal. The programme will support practices at risk of closure or those considering reducing services and access.
“If a practice is eligible for support under this programme, the resources provided may be management, workforce or financial,” says Jones. “Support will be provided on a short, medium or long-term basis as appropriate.”
The sustainability programme will be run at health board level. An evidence-based assessment approach to assess any practice support was agreed with the Welsh government as part of the contract.
Julie Penfold is a freelance journalist specialising in all aspects of healthcare.
Healthcare Group, June 2015