Planned GP contract changes
2013-2014 and beyond
Place and date of road show
Name of negotiator
Presentation outline
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Where are we?
How did we get here?
Outline of the changes
Why we should all be concerned – workload, quality and funding
Changes to locum superannuation
Redistribution of funding
What can you do?
What are we doing?
Also coming our way…
Questions and discussion
Where are we?
 Government is consulting on changes it intends to
impose to GP contracts
 Changes are far reaching and potentially damaging
 GPC will respond robustly and you should too
 Very different arrangements across the UK
How did we get here?
Proposed contract changes
 Phase out correction factor payments over 7
years
 Review PMS funding to reduce variability in
practice funding
 Implement all changes to QOF recommended
by NICE, including those rejected for good
reasons by GPC
 Reduce the time period for achieving most
indicators from 15 to 12 months
Proposed contract changes (2)
 Increase upper thresholds for QOF indicators to match
upper quartile achievement
 Remove the whole organisational domain. Will then be a
900 point QOF
 Reform the QOF Contractor Population Index (CPI)
 New immunisations
 rotavirus added to childhood immunisations
 shingles for patients aged 70
 Introduce significant new work through DESs
Why we should all be concerned:
workload
 More box ticking
- unworkable and underpriced new work in QOF
 Shifting the goal posts
- chasing points at QOF margins
- reducing time available to meet targets
- Requirements for additional training
 Impact on access
 Impact on secondary care
Why we should all be concerned: quality
QOF
Clinical problems with clinical QOF changes:
 Unworkable new indicators, unavailable services
 Changed blood pressure targets + higher thresholds 
polypharmacy
 Repetitive or inappropriate questioning
 Rise in exception reporting
 Less time for holistic patient care
Why we should all be concerned: Quality
DESs
 Online patient access DES
– Risk of e-consultations and inappropriate on-line access to
records.
– Could widen health inequalities
 Case finding for dementia DES
– Evidence for dementia screening lacking and could cause harm
– Will come at cost of other patient care
– Real problem is lack of services
 Risk profiling
– Volume planned makes this unworkable
 Remote care monitoring
– What is this really? Unclear
Why we should all be concerned: funding
Average practice 2014-2015, threshold QOF loss +
organisational point loss =
+
=
£11,300
£19,800
£31,100
= Biggest pay cut yet for some GPs
Funding redistribution
 Major redistribution of funding from 2014
 Impossible to predict new global sum figure
 Some practices to be seriously destabilised, others will gain
– High funded PMS practices – almost certainly under current plans
– Practices with large correction factors – probably depending on
global sum increases
– Not clear what will happen for legitimate outliers
 Not clear whether PMS money will be re-invested in GMS.
Changes to locum superannuation
 Responsibility for locum superannuation payments to
move to practices
 Transfer of funds into contract to cover this
 Practices use locums differently, likely to have
disproportionate impact on small practices
 Likely to be bad for locums
What can you do?
 Protect your patients
– don’t chase targets that put your patients at risk or treats them
inappropriately
– Speak to the commissioner - say NO to unresourced workload
shift from secondary care
 Prioritise your practice
 Think 2013 – times have changed since ‘04
What can you do? (2)
 Start to plan for the changes
– look at the bottom line of your accounts not the top line and
consider the cost of your services and work, especially high funded
practices
 Do not allow government to divide and rule – GMS/PMS,
locums/practices
 Engage all members of your practice, involve all GPs
 Be fair to your locums – pay promptly
 Keep up to date on the BMA website
bma.org.uk/gpcontract
What can you do? (3)
ACT NOW to stop this happening again
 Complete the BMA survey
 Contact the Department of Health by 26
February
 Write to your MP if your services will be affected
 Tell your CCG
What are we doing?
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Meeting the Department of Health and NHSE
Talking to MPs
Talking to patient groups
Working with the media
Gathering your views – survey and road shows
Responding to the consultation – trying to ameliorate the
imposition
 Developing guidance for GPs
 Preparing for the future
Also coming our way…
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Commissioning and CCGs
CQC registration
Revalidation
Pension changes
Commercialisation and fragmentation of the
NHS
 Retention crisis?
Questions and discussion
Remember:
– Use the BMA website to understand the proposals in
detail and calculate your potential losses
– Respond to BMA survey bma.org.uk/gpcontract
– Write to Secretary of State and your MP. If these
changes will hurt your practice, tell them