GP Contract changes
2014/15
Summary Outline
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QOF changes
Removal of DESs
Modifications to current DESs
Contractual requirements
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Named accountable GP
OOH monitoring
IT changes
Publication of earnings
Friends and Family Test
Choice of practice
Seniority
Transfer of money to Global Sum
Vision for general practice
What is not included
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OOH 24/7 responsibility
8-8 7 days a week opening
Additional extended hours
Full electronic record access (yet)
Additional money
– Evidence submitted to the DDRB for resource
uplift
QOF – Aims of negotiation
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Reverse imposed QOF indicators
Reduce micromanagement and box-ticking
Reduce workload
Transfer money to global sum/PMS baseline
Increase clinical freedom and professionalism to
enable patients to be treated holistically
according to clinical need
AIMS ACHIEVED
QOF headline changes
• 238 points to global sum/PMS baseline
– no 6% OOH rebate but Carr-Hill will apply
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100 QP points to new admission avoidance ES
No 2nd year imposed threshold changes
Almost all imposed indicators removed
BP target 140/90 returned to 150/90 (and
timeframe changed from 9-12 months + points
reduced)
• No new NICE changes accepted (except LD
indicator)
QOF indicators removed
• Hypertension
– GPPAQ survey + intervention
– 140/90 target
– 150/90 target remains but with 20 points, 12 months rather
than 9 months to achieve and reduced 45-80% threshold
• Annual cholesterol checks
– CHD, PAD, Stroke/TIA, mental health
– retained for diabetes
• Diabetes
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erectile dysfunction questions
albumin:creatinine test
retinal screening
dietary review by suitably qualified professional
QOF indicators removed (2)
• AF - % with CHAD score (but treatment remains)
• Thyroid disease – whole domain removed
• Depression
– Bio-psychosocial assessment removed
– Depression review timeframe increased to 2-8 weeks
• Mental health
– HDL/cholesterol and glucose annual checks
– BMI
• LD – record of TSH check
QOF indicators removed (3)
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Epilepsy
Rheumatoid Arthritis
Public Health
QP Domain
Patient experience/length of consultation
• Other QOF agreements
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Cancer reviews returned to 3-6 months
Extended timeframe for flu immunisations
No 2nd year threshold changes
No new NICE indicators
PMS points off-set will be reduced in line with changes
QOF points summary
Retirements
Points
Clinical domain (to GS) - Including 3
points from LD002 to ES
185
Public health domain (to GS)
33
Patient experience (to GS)
33
Quality and Productivity (to ES)
100
SUB Total points released
351
Less points added to amended
HYP002
10
TOTAL
341
Avoiding unplanned admissions
enhanced service
• Risk stratification to identify 2% of adult population at risk
of admission to form a “case management register”
• Care plans for all on register to include
– a named accountable GP
– a care co-ordinator (any person in multidisciplinary team) is
main point of contact/responsible for delivery of the plan
– review post hospital discharge
• Same day telephone consultations for patients on the
register with an urgent need
• Timely telephone access for A+E, ambulance, care homes
• Monthly reviews of the case management register
• Review unplanned admissions and A+E attendance
Extended Hours ES
• Increased flexibility to work with other
practices if the practice/s want to
• Other specifications remain the same
• No increased amount of extended hours
• Funding remains the same
Other Enhanced Services
• Dementia
– additional development of care plan
• Learning disability
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to be offered to 14yr and older
development of a care plan
money from LD QOF
amount per medical increased to £116
• Alcohol
– Patients identified as drinking excessively to have brief
mental health assessment (eg PHQ9)
Imposed Enhanced Services
• Patient Online
– ended
– £24m transferred to global sum
• Remote care monitoring
– ended
– £12m transferred to global sum
• Risk profiling
– ended
– £42m transferred to new admission avoidance enhanced
service
• Dementia
– continues
Named GP for patients 75 & older
• A contractual requirement
• Provide a named GP to all patients 75yr and older
by 30 June 2014
• Encourages continuity of care and closer
oversight of care
• Contract remains with the practice, not the
named GP
• Does not prevent patients seeing any GP or nurse
in the practice
• Does not mean 24 hour responsibility
Out of Hours
• Contractual requirement to monitor the quality
of care provided OOH and report concerns to
NHS England
• Requirement to cooperate with requests for
information & reviews from OOH providers on
same working day (exceptionally following
working day).
• No contractual requirement to work outside
current working hours
• No contractual requirement to open 8-8, 7 days a
week
Patients needing access to a practice
clinician after assessment
• Relates to patients being advised to contact
practice by NHS 111 or A+E
• “The practice will ensure that when the
patient contacts the practice, a practice
clinician will agree appropriate next steps
having regard to the patient’s condition and
circumstances.”
IT
• Contractual requirements
• Include NHS number in all clinical correspondence
• Offer and promote on-line booking and repeat
prescription ordering
• Upload SCR daily (or plans to achieve this by 31.3.15)
• Use GP2GP transfer (or plans to achieve this by
31.3.15)
• Offer and promote electronic access to SCR
• GPC and NHS England to work during 2014/15 on:
– Electronic communication by patients with practice
– Access to detailed care record from other care settings
Publication of earnings
“NHS Employers and the GPC have agreed to form a
working group with NHS England, to develop proposals
on how the publication of GP NHS net earnings relating
to the contract should be implemented for 2015/16.
“The working group will ensure that the calculation and
publication of GP net earnings is on a like for like basis
with other healthcare professionals.
“Publication of this information will be a contractual
requirement (in line with arrangements for others in the
NHS).”
Friends and Family Test
• A contractual requirement from December 2014
• “How likely are you to recommend our practice to
friends and family if they needed similar care or
treatment?”
• One follow-up question chosen by practice
• Monthly feedback to NHS England
• Replaces survey in Patient Participation DES
• PP DES funding reduced to £20m and £40m
added to core funding
Choice of GP practice
• Government committed to roll out of current pilot from
October 2014 despite GPC, RCGP and CCGs concerns
– Pilots showed very small uptake from patients
• Not just commuters – more likely to be patients moving
outside practice boundary wishing to stay with a practice
• No obligation to visit these patients
• Practice involvement voluntary
• May be reduced global sum for these patients
• NHS England responsible for in-hours urgent medical care
for these patients if unable to attend their registered
practice
• Full details still to be developed
Seniority
• All those in receipt of payments on 31.3.14
will continue to receive payments and
progress as currently set out in the SFE
• No new entrants
• Scheme will end in 6 years on 31.3.20
• Commitment to reduce overall amount by
15% each year
• All savings put in to core funding
Seniority (2)
• 2 years before figures available to show
whether 15% saving made from retirements
• If less than 15% NHSE and GPC to agree
process for achieve this
• Seniority funding has been static for 9 years
and real-terms value eroded by inflation
• Transferred funding to global sum not subject
to 6% OOH rebate and could increase with
DDRB awards
Transfer to global sum
• Value of 238 QOF points
– Based on 12/13 achievement and 13/14 price
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Circa £80m from seniority funding by 2020
£40m from patient participation DES
£12m from remote care monitoring DES
£24m from patient online DES
No 6% OOH rebate
No change to correction factor
NHS funding invested in general
practice
Year
% total investment
% excluding dispensed
drugs
2004/5
10%
N/A
2005/6
10.41%
N/A
2006/7
9.83%
N/A
2007/8
9.17%
N/A
2008/9
8.74%
8.04%
2009/10
8.45%
7.81%
2010/11
8.31%
7.68%
2011/12
8.16%
7.56%
2012/13
8.04%
7.47%
Vision for General Practice
• GPs Committee has published vision
document for General Practice:
• Developing General Practice today Providing healthcare solutions for the future
• Sets out the ways in which it can help provide
solutions to some of the most difficult
challenges the NHS faces
• Can be found on BMA website:
bma.org.uk/gpc
Conclusion
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QOF reduced from 900 to 559 points
Most imposed QOF points and DESs removed
No 2nd year imposed QOF threshold changes
Major transfer of money to Global Sum without 6% OOH rebate
New admission avoidance enhanced service
New contractual requirements
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Named accountable GP
OOH monitoring
IT changes
Friends and Family Test
Publication of earnings
Minor modifications to current DESs
Removal of seniority over 6 years
Voluntary engagement in patient choice of practice
No 24/7 OOH or 8-8 7 day commitment