Investing in General Practice

The New General Medical Services Contract

1. Vision & Summary2. Workload Management3. Quality and Outcomes 4. HR & Infrastructure5. Funding Flows6. Benefits to Patients7. Implementation & Next

Steps8. NatPaCT Workshop

A few things to remember

• NO Red Book – throw it away!

• NO Items of Service

• NO reimbursements

• NOT England only

• THEREFORE ……..

• SOMETHING COMPLETELY NEW, SOMETHING COMPLETELY NEW, DIFFERENT AND EXCITINGDIFFERENT AND EXCITING

VISION

What it isn’t

a new mechanism for paying GPs

What it is

a new platform for a step change in improved health and health services, improved morale and which creates greater and fairer rewards for GPs

SUMMARY• over £8 billion UK investment over three years (av. uplift 11% per year)

• movement to a practice-based contract between PCO and practice

• fairer allocation formula

• quality and outcomes framework

• management of workload

• strategy to expand and develop the primary care sector

• overhaul and modernisation of the infrastructure and management processes

• programme of financial support for transition

WORKLOAD

Categorisation of services- Essential- Additional- Enhanced

Out of Hours

Essential Services

ALL PRACTICES MUST PROVIDE :-

• Management of patients who are ill or believe themselves to be ill, with conditions from which recovery is generally expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever practicable

• General management of patients who are terminally ill

• Management of chronic disease in the manner determined by the practice and in discussion with the patient

Additional services

ALL PRACTICES EXPECTED TO PROVIDE BUT CAN OPT OUT

Cervical screening

Contraceptive services

Childhood vaccinations and immunisations

Child health surveillance

Maternity services – excluding intra partum care

Minor surgery – curettage, cautery and cryocautery of warts and verrucae, and other skin lesions

Opting Out

Either:• temporary (emergencies)• permanent (long-term problems)

PCOs and practices working together

Maximum 9-month process

Alternatives – sub-contracting, other practices, PCO, other providers e.g. walk-in centres

Money removed from practice global sum

Patient access to services protected – Patient Services Guarantee

Enhanced services

PCO COMMISSIONED FROM PRACTICES & OTHERS

Directed (national specifications and benchmark prices)

violent patients, improved access, childhood vaccinations and immunisations, flu vaccinations, enhanced minor surgery, quality information preparation (2 years only)

National (model national specifications and benchmark prices)

e.g. intra-partum care, anti-coagulant monitoring, intra-uterine contraceptive device fitting, drug and alcohol misuse, sexual health services, depression services, homeless care, minor injury

Local (local terms and conditions)

Developed in response to local need e.g. diabetology services

Out of Hours

End of current 24 hour responsibility

PCO responsible for ensuring provision – 6.30pm to 8am, plus weekends and bank holidays

To start from 1 April 2004 – Expected end date 31 Dec 2004

Price for Opting out = av. £6,000 per GP

PCOs have OOH development fund

QUALITY & OUTCOMES FRAMEWORK

”A bold initiative to improve quality of care”

“With one mighty leap, the NHS vaults over anything being attempted in the United States,

the previous leader in quality improvement

initiatives”

Paul Shekelle, professor of medicine, University of California Los AngelesBMJ, Vol 326, 1 March 2003: 457-8

Rewards for Quality

• £1.3bn for the UK quality

• Non-discretionary

• In addition to the global sum

• Payment for what many already do

• All work converts to points

• 1050 maximum points

• % of income will vary

Quality Principles

• evidence-based criteria

• compatible with coverage of important aspects of patient care

• data should never be collected purely for audit purposes

• fully functional clinical software system is needed

• disease should affect a significant number of people

• criteria must be measurable

• demonstration of change in a reasonable period of time

The four domains of quality

• Clinical

• Organisational

• Patient experience

• Additional services

• (plus contractual and statutory criteria)

Clinical Areas

• CHD & LVD

• Hypertension

• Diabetes

• Stroke or TIA

• Hypothyroidism

• Epilepsy

• Asthma

• COPD

• Mental Health

• Cancer

Organisational Areas

• Records and information

• Patient communication

• Education and training

• Practice management

• Medicines management

Patient Experience

• Standardised approved patient questionnaires

– General Practice Assessment Questionnaire (Manchester)

– Improving Practice Questionnaire (Exeter)

• Length of consultation - 10 mins appts

Points = Prizes

Preparatory Payments – 03/04, 04/05, 05/06

- £9000 per average practice

PLUS

2004-51 Point = £75

2005-61 Point = £120

2004/5 QUALITY SCORECARD

Totals

Clinical indicators

CHD including LVD etc 121

Stroke or transient ischaemic attack 31

Cancer 12

Hypothyroidism 8

Diabetes 99

Hypertension 105

Mental health 41

Asthma 72

COPD 45

Epilepsy 16

Clinical maximum 550

Organisational indicators

Records and information 85

Patient communication 8

Education and training 29

Practice management 20

Medicines management 42

Organisational indicators maximum 184

Additional services

Cervical screening 22

Child health surveillance 6

Maternity services 6

Contraceptive services 2

Additional services maximum 36

Patient experience

Patient survey 70

Consultation length 30

Patient experience maximum 100

Holistic care payments1 100

Quality practice payments 30

Total for organisational, additional, patient experience,

holistic care and quality practice

1,000

Access bonus 50

Total 1,050

QUALITY & OUTCOMES

Funding - Preparation (for 3 years)- Aspiration (one third up front)- Achievement (two thirds at end of year)

Exception reporting

High trust monitoring by PCO – annual practice report and visit

HUMAN RESOURCES

GP Career structure

Protected time

Salaried option

Seniority payments

Family-friendly policies

Practice Management competency framework

MODERNISED INFRASTRUCTUREIM&T

100% Funding

PCO Ownership and liability

Choice of systems

Development, implementation, support

Education & training

Implementation

MODERNISED INFRASTRUCTUREPREMISES

Protected Resources

New flexibilities

Improved quality standards

Branch/split-site surgeries

FUNDING FLOWS

• Global Sum (new allocation formula)

• Enhanced Services(unified budget)

• Quality

• Transition

• Premises

• IT

• Pensions

• Seniority

• PCO-administered e.g. HR

CARR-HILL FORMULA

Components:

• age and sex, including patients in nursing and residential homes

• additional needs of the population - morbidity and mortality

• list turnover

• unavoidable costs - staff Market Forces Factor and rurality

• tailored version for Scotland

THE MONEY (England)

Global sum payments£300k 04/05 per av. practice (av. per patient of £53)£305k 05/06 per av. practice (av. per patient of £54)

Investment in enhanced services –

unified budget£315m 03/04£518m 04/05£586m 05/06

Transitional protection£297m 04/05£197m 05/06

PRACTICE

GLOBAL SUM

PCO

UNIFIED BUDGET

ESSENTIAL ADDITIONAL Directed and National ENHANCED

LOCAL ENHANCED

GUARANTEEDFUND(S)

ASSUREDQUALITYMONEY

ALTERNATIVEPROVIDER

TOP-SLICED

ALLOCATION

PREMISES IT

SO WHAT’S IN IT FOR US?

Patients – choice, access, quality

Practices – resources, workload, autonomy, outputs

Primary Care Workforce – teams, HR, training

PCOs – relationships, infrastructure, services

NEXT STEPS - National

NHS Confed and GPC roadshows – Feb/March

GP ballot - 20 March to 11 April

If YES……

Primary & Secondary Legislation

Topic-specific Briefings – April

National conference (London) - May

NatPact roadshows – early summer

Implementation guidance – late summer

HOW TO FIND OUT MORE

• READ THE DOCUMENT – LOTS MORE IN DETAIL

• EMAIL US WITH ANY QUESTIONS – QUICK TURNAROUND

• LOOK AT WEBSITE FOR:

– SUPPORTING DOCUMENTATION (quality evidence, salaried contracts, enhanced services specifications, ready reckoner and lots more)

– SLIDES

– Q&A

– ON-LINE VIRTUAL PRESENTATION

www.nhsconfed.org/gmscontract