GP VTS Training Session
24th April 2012
General Practice Income
Joanne Wales-Smith
Aims
 Understand
sources of GP income
 Understand
structures that govern NHS
income
 Practical
look at maximising income in
general practice
Objectives
Participants will be able to
 Identify sources of GP practice income
 Describe operating / contractual
framework for NHS income
 Apply a service specification to a Practice
situation
Why important?
 GP
Partner – personal income
 Efficiency
of NHS income
 Effectiveness
patients
of resources for benefit of
PRACTICE INCOME
PRACTICE INCOME
N
H
S
I
N
C
O
M
E
Contract Global Sum
Reports & Certificates
Minimum Practice Income
Guarantee (MPIG)
QOF (Aspiration & Reward)
£
Private Rental Income
Teaching Income
Seniority
Private Services
Enhanced Services
Notional Rent & Service Charge
Training Income
N
O
N
N
H
S
………….
I
N
C
O
M
E
Contents
 Structure
of NHS (& changes)
 GMS Contract
 PMS
 QOF
 Premises Income
 Training Income
 Enhanced Services
*
Structure of NHS
Structure of NHS
DoH
10 SHAs
152 Primary
Care Trusts
Primary Care
Services
Community Health
Services
Acute hospital
trusts
Mental health
trusts
Ambulance
trusts
Commercial
providers &
Voluntary
organisations
NHS Foundation
Trusts
GMS – the last version
 Red
Book
 Item
of service approach
 Per
Doctor funding
 National
framework only
 Contract
between individual GP & DoH
PMS?
PMS
 Brought
in as an alternative to the Red
Book & old inflexible system
 Focused on special areas or needs
 Additional funding for additional work /
responsibilities
 Contract between Practice & PCT
 Separate contractual & monitoring
arrangements
GMS – the new contract
 Set
contractual framework nationally &
ability to commission outside the
framework for local needs
NHS budget – weighted
population basis
 Re-distribute
Carr-Hill formula
Factors involved:

patient age and gender (used to reflect frequency of
home and surgery visits)
 additional needs: Standardised Mortality Ratio and
Standardised Long-Standing Illness for patients under
the age of 65 years
 number of newly registered patients (generate 40% of
work in 1st year)
 rurality
 costs of living in some area (ie South East - higher staff
costs)
 patient age/gender for nursing/residential consultations.
GMS – the new contract
 Set
contractual framework nationally &
ability to commission outside the
framework for local needs
 Re-distribute NHS budget – weighted
population basis
 Quality drive
 Out of Hours / GP recruitment
 Failed hospital contract
Contract Structure
Enhanced
Services
GMS Main Contract
– global sum
Enhanced
Services
Essential Services
Additional
Services*
Enhanced
Services
QOF
Enhanced
Services
Enhanced
Services
*Vacc & Imms
3%
Key Aspects of nGMS Contract
Contract between the Practice & the PCT
The global sum allocation
 covers the payments PCTs will make to GMS practices as a contribution towards the
contractors’ costs in delivering essential and additional services.
The Minimum Practice Income Guarantee (MPIG)
 covers the payments PCTs will make to GMS practices to protect income levels in
relation to some previous fees and allowances and is delivered through the correction
factor. (no Practice worse off)
“Global Sum Allocation Formula”
QOF
Enhanced Services
 local flavour & flexibility
nGMS – income statement
*
*
QOF
QOF Quiz – how much do you know about
the QOF?
The Quality and Outcomes
Framework (QOF)

is the annual reward and incentive programme detailing GP practice
achievement results.

is a voluntary process for all surgeries in England and was
introduced as part of the GP contract in 2004.

awards surgeries achievement points for:





managing some of the most common chronic diseases e.g. asthma,
diabetes
how well the practice is organised
how patients view their experience at the surgery
the amount of extra services offered such as child health and maternity
services
http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Primaryc
are/Primarycarecontracting/QOF/index.htm
*
Example of a Clinical Indicator
CHD Indicator 6
Example of an Organisational
Indicator
*
GP Registrar Involvement
Changes to the QOF 2012/13






the retirement of seven indicators (CHD13, AF4, QP1, QP2, QP3,
QP4, QP5) releasing 45 points to fund new and replacement
indicators
the replacement of seven indicators with eight NICE recommended
replacement indicators, focusing on six clinical areas namely
Diabetes, Mental Health, Asthma, Depression, Atrial Fibrillation and
Smoking
the introduction of nine new NICE recommended clinical indicators,
including two new clinical areas (Atrial Fibrillation, Smoking, PAD
and Osteoporosis)
the introduction of three new organisational indicators for improving
Quality and Productivity which focus on accident and emergency
attendances
amendments to indicator wording for CHD9, CHD10, CHD14,
STROKE12, DM26, DM27, DM28 and DEM3
inclusion of telephone reviews for Epilepsy 6.
Premises Income
 Cost
rent
 Notional
rent
Cost Rent

The Cost Rent Scheme is no longer used. It previously
existed for new extended or refurbished surgeries.

The Cost Rent Scheme, as its name implies, is more
closely associated to the costs involved, as opposed to
the associated rental levels. Its purpose was to
reimburse the cost of finance from providing new or
considerably modified buildings.
Notional Rent

Re-imburse Doctors who own their surgery.

The Notional Rent remuneration based on the Current
Market Rental (CMR) value for the property i.e. what it
would let for on the open market.

District Valuer assesses for PCT. GPs can involve
professional advisors.

A primary factor affecting value is location.
Training Income

GP Registrars




Training grant for Practice Educational grant for Trainers - £750
Salary & costs re-imbursed
Medical Students


Different payment structure for different years
Groups of 4 students over 4 years – differing
payments
Enhanced Services
Directed
National
Local
• Enhanced services are services not provided through essential or
additional services,
• or essential and additional services delivered to a higher specified
standard.
• Key tool to help PCTs reduce demand on secondary care.
Their main purposes are to expand the range of local services to
meet local need, improve convenience and choice, and ensure value
for money. They were designed to provide a major opportunity to
expand and develop primary care, and give practices greater
flexibility and the ability to control their workload.
Directed Enhanced Services
PCT has to commission these services for its population:





Access (have to offer to GPs)
IM&T (have to offer to GPs)
Violent Patients
Choose & Book
Childhood Imms
National Enhanced Services
PCTs don’t have to commission

Services commissioned to meet local need to national
specifications and benchmark pricing. Other examples of
NES are enhanced care of the homeless, more
specialised services for multiple sclerosis and
specialised care of patients with depression

E.g. IUCD, Minor Injuries, NPT, Amber Drugs
*
Local Enhanced Services
Up to the PCT what they commission, how much & how

locally developed services designed to meet local health
needs e.g. Wound Care
North Yorkshire Enhanced
Service Directory
Examples of service specifications
- Extended access
- Minor surgery
Any questions?
Objectives
Participants will be able to
 Identify sources of GP practice income
 Describe operating / contractual
framework for NHS income
 Apply a service specification to a Practice
situation