Planned GP contract changes
2013-2014 and beyond (Wales)
Cardiff
Tuesday 29th January
Dr. David Bailey
Chairman, GPC Wales
Presentation outline
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Where are we?
How did we get here?
Outline of the changes
Issues to consider – 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?
 GPC Wales has decided to agree the
latest offer on Welsh GP contracts
 Changes are significant and potentially
disadvantageous (But significantly less so
than England)
 Includes 1.5% resource uplift
 Insistence on eroding correction factor
dropped
 GPCW has negotiated robustly to get what
we think is the best deal possible
 Very different arrangements across the UK
How did we get here?
• June 2012 UK negotiations commence
with NHSE
• October 17th position reached which
negotiators felt was reasonable
• Rejected by governments (Scotland
indicated still willing to negotiate)
• October 2012 initial letter from WG
• December 2012 - revised offer following
discussions rejected – due to MPIG
concerns
• January 2013 new revised offer agreed
Proposed contract
changes
 Initial insistence on phasing out
correction factor dropped
 Open discussions next year on
reducing funding variability
 Implement most changes to QOF
recommended by NICE, taking
account of GPC concerns on some
 Reducing the time period for
achieving most indicators from 15 to
12 months will not be introduced in
Wales
Proposed contract
changes (2)
 Increase upper thresholds for some QOF
indicators to match median achievement
 Remove some of the organisational
domain = 969 point QOF
 Introduce new risk profiling QP domain
 Reform the QOF Contractor Population
Index (CPI)
 New immunisations
 rotavirus added to childhood immunisations
 shingles for patients aged 70
 Re-invest A&E QP points in GSE
Why we should all be
concerned: workload
 More box ticking
- under-priced new work in QOF
 Shifting the goal posts
- chasing points at QOF margins
- However new training requirements and
reduced timeframes NOT introduced in
Wales
 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
Risk profiling QP domain
• Identify 5% of highest risk patients
• Select 10% of those (0.5% of practice list) for
multidisciplinary discussion and care plans
• 47.5 points
• 4 meetings
• 1 page plan – medications, OOH summaries,
carer contacts, allergies, preferred place of
care
• May well actually improve care
Why we should all be
concerned: funding
Average practice 2014-2015, threshold
QOF loss + organisational point loss
=
£2,000 (estimate) on thresholds
+ £6200 for recycled organisational points
= £8200
Ameliorated by funding increase and can be
earned back for new work but still represents
new workload (and prices the new QOF
indicators lower than would have happened in
negotiation)
Funding redistribution in
Wales
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450 practices are within £15 per weighted patient of each
other
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Other 25 anything from £15-55 above average
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Some practices would be seriously destabilised, others
would gain
– Global sum only practices would all gain
– Practices with small (less than 10%) correction factors
would probably also gain a little
– Higher correction factors would lose – the vast majority
either small, rural, multi-site or odd demographics
(university practices)
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These are exactly the practices where the Carr-Hill
factors were altered by Westminster in 2003
Funding redistribution in
Wales (2)
• Commitment to model to practice level
• Acknowledgement that some outliers may
need off-formula solution
• Recognition of the limitations of modified
Carr-Hill
• Commitment to consider rurality,
smallness and multi-site practice
• Commitment to negotiate not impose
Changes to locum
superannuation
 Responsibility for locum superannuation payments
to move to practices
 Transfer of funds into Global Sum Equivalent to
cover this (as this is all expenses)
 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 treat them inappropriately
– protect patient care by saying NO to unresourced workload shift from secondary care
 Prioritise your practice
– may need to reconsider involvement in optional
work outside the practice particularly if full
backfill costs not met
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.
 Tell your AM or MP if patient services are adversely
affected
 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 are we doing?
 Meeting the WG ministers and Civil
servants regularly
 Talking to AMs
 Talking to patient groups
 Working with the media
 Gathering your views at road shows
 Developing guidance for GPs
 Preparing for the future
Also coming our way…
 Health Inspectorate Wales scrutiny
(but not charges)
 Revalidation
 Pension changes
 Secondary care dumping to meet
efficiency targets
 Recruitment and retention crisis?
Questions and
discussion
Remember:
– Use the BMA website to understand the
proposals in detail
– Stay in touch with your LMC via their
website and newsletters
– Write to Health Minister and your AM. If
these changes will hurt your practice,
tell them. If MPIG funding proposals
would damage patient care in your
practice – tell them.