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GMS Contract changes

At the end of January, the GPC and NHS England announced details of a 5 year contract which has been described as the “most significant” change to contracts in the last 15 years.

Investment and evolution: A five-year framework for GP contract reform to implement the NHS Long Term Plan, will see practice funding increasing by almost £1bn in 5 years time.

The global sum will rise from £88.96 in 2018/19 to £89.88 in 2019/20, so an increase of 92p per weighted patient.

This global sum rise includes an additional 2% uplift for GP and staff pay/expenses.  In addition, the value of some vaccinations will increase, to bring them all up to £10.06.

A further £20m has been included in the contract increases to cover the increased costs practices face due to subject access requests which are now provided free under GDPR and will be included in the global sum for the next three years.

QOF

The value of each QOF point will rise from £179.26 in 2018/19 to £187.74 for 2019/20.

For 2019/20, 175 points will be removed.  74 points are to be used to create a new Quality Improvement domain, split into two modules of prescribing safety and end-of-care.  A further 101 will be recycled into 15 “more clinically appropriate indicators,” mainly on diabetes, blood pressure control and cervical screening.  

The current system of exception reporting is to be replaced by a more precise approach of the “Personalised Care Adjustment.”  In addition, over the next three years, domains such as heart failure, asthma and mental health will be reviewed.

Networks

There is also a further £1.8bn which will provide support for the formation of primary care networks.  Practices which sign up to the network contract direct enhanced service by 1 July 2019 will receive £1.761 per weighted patient and this will be paid in monthly instalments from July onwards.   Networks will be able to employ a social prescribing worker and a clinical pharmacist and in subsequent years will receive funding for physiotherapists, physician associates and paramedics.  All other network funding will be paid to a “nominated provider”. Further guidance is expected to be released at the end of March and it will be particularly interesting to see what form the networks will take and also whether the treatment for VAT has been considered.

Technology 

From April 2019, all patients should have access to their digital records and should be able to order repeat prescriptions.  

Practices will need to make one appointment per 3000 patients available each day to allow NHS 111 to book appointments for patients who have been triaged. From July 2019, practices will be expected to make 25% of appointments bookable online and from April 2020 should provide online consultations.

Indemnity 

The long awaited state backed indemnity scheme “Clinical Negligence Scheme for General Practice” will begin in April 2019.  The scheme will be run by NHS Resolution.

The scheme will cover all NHS GP service and OOH providers and will cover all GPs, salaried GPs, locums, prison GPs, nurses, health professionals and practice staff.  This will also cover public health work, under arrangements with local authorities, NHS England, a CCG or NHS Trust.  GPs will therefore be covered by the organisation they work in, rather than individually, however, practices will continue to need cover for non-NHS work, such as for the GMC, report writing or private vaccinations.

The scheme will only cover clinical negligence claims, so GPs will still need cover for legal representation in GMC fitness-to-practice hearings, performers list and criminal investigations.

There is also still some uncertainty regarding whether the new scheme will take on responsibility for historic claims and hopefully this is something that will be clarified before the new scheme comes into force.

There will be a “one-off permanent adjustment” to practices global sum payments to pay for the package.

The Welsh government is working on its own scheme, which will be comparable to what is available in England and will be run by NHS Shared Services Partnership - Legal and Risk Services (that currently arranges cover for hospital and OOH GPs working in Wales). 

Whilst in Scotland, costs are traditionally lower, the Scottish Government has indicated it will not allow its GPs to be disadvantaged.

Other changes

The cost of locum cover for GPs taking shared parental leave will be reimburse by NHS England in the same way as maternity leave.

GPs with NHS Earnings over £150,000 for 2019/20 will be required to make this public.

Practices will be required to support six national NHS marketing campaigns each year, by displaying campaign material in their premises.  These campaigns will be agreed between NHS England and the GPC.

Further guidance will follow on the changes to be made to the PMS and APMS contracts for 2019/20.