Primary Care
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GP Contract Seminar
DUNCAN MILLER
Programme Manager – More Scottish GP
Contract
• NHSScotland
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5.3 million people
£12 billion
14 Health Boards
8 Support Boards
Integrated delivery
Moving towards
social care
integration
“2020 Vision”
 Our vision is that by 2020 everyone is
able to live longer healthier lives at
home, or in a homely setting.
 Integrated health and social care;
 A focus on prevention, anticipation and
supported self management;
 Where hospital necessary, day treatment the
norm and focus on getting people back into
their home as soon as appropriate, with
minimal risk of re-admission.
The Healthcare Quality Strategy for Scotland
 Person-Centred - Mutually beneficial partnerships between
patients, their families, and those delivering healthcare services
which respect individual needs and values, and which demonstrate
compassion, continuity, clear communication, and shared decision
making.
 Effective - The most appropriate treatments, interventions,
support, and services will be provided at the right time to everyone
who will benefit, and wasteful or harmful variation will be eradicated.
 Safe - There will be no avoidable injury or harm to patients from
healthcare they receive, and an appropriate clean and safe
environment will be provided for the delivery of healthcare services
at all times.
ROUTE MAP TO THE 2020 HEALTH AND SOCIAL CARE VISION FOR SCOTLAND
Triple Aim
Quality Ambitions
12 Priority Areas for Improvement
Person Centered Person Centered Care
Safe
Safe Care
Primary Care
Quality of Care
Unscheduled and Emergency Care
Integrated Care
Care for Multiple and Chronic Illnesses
Health of the Population
Effective
Early Years
Health Inequalities
Prevention
Workforce
Value and Sustainability
Innovation
Efficiency and Productivity
The Importance of Primary Care
The foundation of the NHS:
Over 90% of interactions with healthcare
start and finish in primary care.
Key to addressing:
 Inequalities in health and care;
 Access to health (and often social) care.
The Challenges
 Demographic shift to an ageing population
 Ageing brings a more multi-morbid population (two or more
long term conditions)
 Worsening health inequalities
This matters because:
 Living with multiple conditions is the norm rather than the
exception for many people. It is associated with poorer quality
of life, more hospital admissions and higher mortality, and
significantly worsens the impact of deprivation.
But:
 We still tend to design healthcare along single disease
pathways
Multimorbidity is common in Scotland
– The majority of over-65s have 2 or more conditions, and the majority of over-75s
have 3 or more conditions
– More people have 2 or more conditions than only have 1
There are more people in Scotland with
multimorbidity below 65 years than
above
Particularly true in more deprived areas
There are very few generalist hospital services for the under-65s
People living in more deprived areas in
Scotland develop multimorbidity 10 years
before those living in the most affluent
areas
Primary Care
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PC Strategic Assessments and
development plans
 Assessment of current local provision –
strengths, weakness, interventions;
 Vision of what needs to be achieved for
20:20;
 Development Plan - priority areas;
 Workforce – skill mix and new models of
care.
Primary Care
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New integrated models of care
 Improve person-centred care;
 Improved team working around the needs of the
individual;
 Meets the needs of the locality;
 Better addresses multiple morbidity;
 Optimises working relationships across all
sectors.
Primary Care
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Contractual arrangements
 Development of the more Scottish contract –
impact of the independence referendum;
 Opportunity for joint working with Community
Pharmacy – Wilson Report/ Prescription for
Excellence;
 Wider impact of Health and Social Care
Integration – GP clusters;
 Dental and Optometry.
Primary Care
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Better Primary Care data
 National GP Information Services;
 Primary Care data set – variation and
benchmarking;
 Unscheduled care datamart
 OOHs performance indicators.
Primary Care
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GMS Contract Agreement in Scotland 2014/15
• 264 points retired, with funding transferred to GS
• 151 points from clinical QOF, 80 points from
disease registers and 33 points from patient
experience
• For clinical changes – expectation is that GP
practices continue to provide care that is clinically
appropriate
• Return to 15 month review cycle
Primary Care
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GMS Contract Agreement in Scotland 2014/15
• New patients still be to coded at diagnosis and
provide clinically appropriate lifestyle advice
• New Quality and Safety Domain
o Nominated liaison GP for H&S integration
o Review of Access
o Continuous Quality Improvement
o ACPs continue – annual report/ SEA cease
o Patient Safety
Primary Care
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GMS Contract Agreement in Scotland 2014/15
• Publishing GP Earnings – greater transparency
• Support the development of a Scottish GP
Contract over the next 3 years
• Important role of GPs in the development of
Health and Social Care Integration
• Impact of caring for elderly population, and
patients in deprived and rural areas
• Recruitment and retention – Golden Hellos,
Seniority
Primary Care
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Scottish GMS Contract Arrangements 2014 -2017
• No planned major change to QOF – will be kept under
review by SG/ SGPC
• NICE recommendations out – Diabetes Bundling,
Hypertension and AF changes – still under consideration
• Work with SGPC to develop a Scottish GMS Contract
from 2017 onwards to support 2020 vision for Health and
Social care
Primary Care
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Scottish GMS Contract Arrangements 2014 -2017
• Golden Hellos
o Remove automatic entitlement: focus on remote, rural and
deprived areas
o greater flexibility on payment
o Support for appraisal for sessional locum GPs
o Support for GP Returners
• Publication of GP NHS Net Earnings – develop ‘model’
report on GP Practice data held at Practitioner Services
Division
Primary Care
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Scottish GMS Contract Arrangements 2014 -2017
• Seniority Payments
o £18m currently spent across Scotland
o Review of current programme to consider how best to deploy
this resource to support the sustainability of general practice in
Scotland
• Others important areas
o Review of the Scottish Allocation Formula – financial framework
to support the Scottish GMS Contract going forward
o Review of variability of funding to ensure funding supports
general practice across Scotland but addresses inequity
o Review of immunisations
Primary Care
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Scottish GMS Contract Arrangements 2014 -2017
• Others important areas (continued)
o Work with emerging Health and Social Integration Authorities to
ensure general practice plays leadership/ integral role in the
development of locality planning arrangements
o Work with the programme supporting the implementation of
Prescription for Excellence
• Others contractual areas
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GP workload
Infrastructure (GP Premises and IT)
Enhanced Services
Recruitment and Retention
Primary Care
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Questions/discussion