NEW GMS CONTRACT

Stephen NewellStephen Newell

Linda TurnerLinda Turner

Susan WattsSusan Watts

WHEN?

COMMENCES 1.4.04COMMENCES 1.4.04

WHY DID GP’S VOTE YES?

No “Red Book”No “Red Book” No Items of Service (IOS)No Items of Service (IOS) No over 75 or 3 yearly checksNo over 75 or 3 yearly checks No Staff reimbursementNo Staff reimbursement No Saturday morningsNo Saturday mornings No out of hours (OOHs) – can opt outNo out of hours (OOHs) – can opt out No permission required for new partnersNo permission required for new partners

SOME IMPROVEMENTS

Increased investment in primary careIncreased investment in primary care Incremental payments for qualityIncremental payments for quality Exception reporting for quality paymentsException reporting for quality payments 100% reimbursement of computer costs100% reimbursement of computer costs Opt in to enhanced servicesOpt in to enhanced services End of 24 hour responsibilityEnd of 24 hour responsibility GP pensionsGP pensions GP seniority paymentsGP seniority payments

SOME CONCERNS

FundingFunding TransitionTransition ITIT Lack of clarityLack of clarity

CLINICAL SERVICES

EssentialEssential AdditionalAdditional Directed EnhancedDirected Enhanced National EnhancedNational Enhanced Local EnhancedLocal Enhanced

ESSENTIAL

• Medical management of patients who are Medical management of patients who are (or believe themselves to be) ill, health (or believe themselves to be) ill, health promotion advice and referral as promotion advice and referral as appropriate – reflecting patient choiceappropriate – reflecting patient choice

• General management of terminally ill General management of terminally ill patientspatients

• Management of chronic disease – in Management of chronic disease – in discussion with patientdiscussion with patient

ADDITIONAL

• SERVICESSERVICES Cervical screeningCervical screening Contraceptive servicesContraceptive services Vaccs and ImmsVaccs and Imms CHSCHS Maternity ServicesMaternity Services Minor SurgeryMinor Surgery

OPT OUT

Can opt out of additional services but will Can opt out of additional services but will loose approximately 10% of global sum if loose approximately 10% of global sum if you opt out of all additional services.you opt out of all additional services.

DIRECTED ENHANCED

Access to GMSAccess to GMS Childhood Vaccs & ImmsChildhood Vaccs & Imms Influenza Vaccs (over 65’s and at risk)Influenza Vaccs (over 65’s and at risk) Quality Information Preparation (1Quality Information Preparation (1stst 2 years 2 years

only)only) Services to support staff dealing with Services to support staff dealing with

violent patientsviolent patients Enhanced minor surgeryEnhanced minor surgery

NATIONAL ENHANCED

Patients who are alcohol misusersPatients who are alcohol misusers Anti coagulant monitoringAnti coagulant monitoring IUCD fittingsIUCD fittings Specialised care for patients with depressionSpecialised care for patients with depression Patients suffering from drug misusePatients suffering from drug misuse Provision of immediate care and first Provision of immediate care and first

response careresponse care

Enhanced care of the homelessEnhanced care of the homeless Intra partum careIntra partum care Minor injuries servicesMinor injuries services More specialised services for patients with More specialised services for patients with

MSMS Provision of near-patient testing, etc etc. Provision of near-patient testing, etc etc.

LOCAL ENHANCED

PCT will decide what is neededPCT will decide what is needed Local terms and conditionsLocal terms and conditions Developed in response to local needs, e.g. Developed in response to local needs, e.g.

diabetic servicediabetic service

OUT OF HOURS

COVERS 18.30 – 08.00 EVERY DAYCOVERS 18.30 – 08.00 EVERY DAY WEEKENDSWEEKENDS BANK HOLIDAYSBANK HOLIDAYS

IF YOU OPT OUT YOU LOSE ABOUT IF YOU OPT OUT YOU LOSE ABOUT 6% OF GLOBAL SUM6% OF GLOBAL SUM

4 QUALITY DOMAINS

CLINICALCLINICAL ADDITIONAL SERVICESADDITIONAL SERVICES ORGANISATIONALORGANISATIONAL PATIENT EXPERIENCEPATIENT EXPERIENCE

PLUSPLUS

CONTRACTUAL & STATUTORY CONTRACTUAL & STATUTORY REQUIREMENTSREQUIREMENTS

CLINICAL

AsthmaAsthma CancerCancer CHD (including LVD)CHD (including LVD) COPDCOPD DiabetesDiabetes EpilepsyEpilepsy HypertensionHypertension HypothyroidismHypothyroidism Mental HealthMental Health Stroke or TIAStroke or TIA

Additional Services

Cervical ScreeningCervical Screening Child Health SurveillanceChild Health Surveillance Contraceptive ServicesContraceptive Services Maternity ServicesMaternity Services

EXCEPTIONS

Patients who refuse to attend on 3 occasionsPatients who refuse to attend on 3 occasions New or recently diagnosed patientsNew or recently diagnosed patients If treatment is not clinically appropriateIf treatment is not clinically appropriate Patient has refused (given informed dissent)Patient has refused (given informed dissent) Patient cannot tolerate treatmentPatient cannot tolerate treatment Patient already taking maximum medicationPatient already taking maximum medication Patient has another condition that affects treatmentPatient has another condition that affects treatment

ORGANISATIONAL

Records and informationRecords and information Patient communicationPatient communication Education and trainingEducation and training Practice managementPractice management Medicines management Medicines management

PATIENT EXPERIENCE

Length of consultationLength of consultation Annual patient questionnairesAnnual patient questionnaires

CONTRACTUAL AND STATUTORY REQUIREMENTS

NO POINTS ATTACHEDNO POINTS ATTACHED NO CHOICENO CHOICE MUST DOMUST DO

EXTRA PAYMENTS

Holistic Care paymentsHolistic Care payments Encourages breadth of clinical careEncourages breadth of clinical care

Quality Practice payments Quality Practice payments Encourages achievement across the Encourages achievement across the

whole range of indicators, not just whole range of indicators, not just clinical.clinical.

ACCESS

Extra points Extra points

Maintaining access targetsMaintaining access targets Maintaining qualityMaintaining quality

REPORTING

LARGELY BASED ON TRUST:LARGELY BASED ON TRUST: Data entry during consultation including Data entry during consultation including

telephone calls / consultationstelephone calls / consultations Audit generated by normal workAudit generated by normal work Virtually no claims or paperworkVirtually no claims or paperwork Annual report on computerAnnual report on computer Annual visit from PCT to check report Annual visit from PCT to check report Appeals process if disagree with PCTAppeals process if disagree with PCT

PATIENT FLOWS

Practice AreaPractice Area Patient choicePatient choice RemovalsRemovals AllocationsAllocations

SUMMARY

There are:There are: 76 Clinical indicators76 Clinical indicators 10 standards for Additional Services10 standards for Additional Services 56 Organisational indicators56 Organisational indicators 4 Patient Experience requirements4 Patient Experience requirements 26 Contractual and Statutory requirements 26 Contractual and Statutory requirements