CONTEXT FOR NEGOTIATIONS IN SCOTLAND
Last year, contract imposition in England, agreed contract
changes in Scotland, planned to last 2 years to provide
stability, but option to re-open if anything which happened
elsewhere in UK was thought to be worthwhile.
In negotiations in autumn 2013 agreement reached in
England to move a number of points to core, also new IT
requirements, choice of practice, and a DES looking at
Unplanned admissions . Also publication of earnings, and
timeframe for end of Seniority payments
Some of these things could be attractive….
Scottish Government didn’t commission
NHS Employers this year.
SCOTTISH AGREEMENT FOR 2014 / 2015
Contract changes overview
“
The BMA's Scottish GP Committee has agreed changes to the GMS (GP) contract for 2014-2015
with the Scottish Government.
We have gone a long way to achieving the aims of our negotiations, building on last year's agreement.
We believe the agreement will:
•
Substantially reduce unnecessary targets and bureaucracy, reducing interference in consultations
and allowing us to focus more on the needs of the patient
•
Focus primary care resources on the most vulnerable patients in the community
•
Provide greater stability of funding for GP practices
•
Address some GP practice workload concerns
•
Continue to promote a return to the concept of GP professionalism and leadership.
”
.
“Negotiations conducted over very short period” – even shorter this year!
CONTRACTUAL UPLIFT
• SGPC/GPC clear that DDRB should report.
• Not part of negotiations or agreement
• DDRB recommendations are being honoured, whatever
we may think of them…
• “The Scottish Government intends to apply uplift to the value of the contract
reflecting an element for expenses and a pay uplift but this will also take account of
the Scottish Government’s public pay policy. The Scottish Government remains
committed to the Doctors’ and Dentists’ Review Body (DDRB) process and will await
the DDRB’s recommendation before deciding on the level of the uplift”
GOING FORWARD….
Future negotiations
In addition, SGPC and the Scottish Government will explore the development of a
Scottish Contract as part of a longer term agreement (for three years) to create a
stable funding environment for general practice.
 This will include discussions on how a GP contract in Scotland can be structured,
taking account of:
•
Moving toward the 2020 vision for health and social care
•
Strengthening primary health care teams in and around GP practices
•
Addressing issues relating to caring for the elderly population and those within
deprived and rural areas
•
Scottish Government proposals around seniority and recruitment and retention
incentives.
….. Things that both sides will want to discuss.
SO, WHAT’S CHANGING THIS YEAR?
We have agreed that 264 points will be retired from the QOF and moved to a core
standard payment within the Global Sum. This includes retirement of disease
registers (80 points), patient experience (33 points) and 151 points from clinical QOF
areas.
This means 659 QOF points will remain for 2014-2015.
•
The transfer will occur in line with the process applied in 2013-2014, based on an
average GP practice QOF point achievement for the past three years.
•
As part of the retirement of disease registers, the 2014-2015 QOF guidance will
include a general statement advising GP practices to continue to appropriately
code diagnoses and provide clinically appropriate lifestyle advice.
A BRIEF WORD ON CORE STANDARD PAYMENT
•
•
•
Different from last year (post payment verification)
Freezes current achievement
• Doesn’t recognise changes in size or demographics of practice population
Doesn’t affect OOH 6% opt-out etc
SO, WHAT ARE THESE RETIRED POINTS?
AF register
Dementia register
CHADS2 scoring (but not what you do with it!)
Biopsychosocial assessments
CHD register
Mental health register
CHD cholesterol target
Cancer register
HF register
CKD register
Hypertension register
Epilepsy register
PAD register
Epilepsy reviews
PAD cholesterol target
Epilepsy contraception advice
Stroke register
LD register
Stroke cholesterol measurement
TSH in Down’s syndrome
Stroke Cholesterol target
Osteoporosis and Dexa register
Diabetic register
Rheumatoid register
Diabetic cholesterol target
Rheumatoid fracture and CVD risk
Diabetic ACR recorded
Palliative care register
Diabetic retinal screening
Obesity register
Diabetic dietary review
Smoking status aged >15
Diabetic ED annual questioning & advice
Smear test results
Hypothyroid register
Antenetal care
TFT measurement
Child development
Asthma register
Contraception register
COPD regsiter
LARC advice (except EC)
COPD recording of FEV1 in last 12m
10 minute appointments
ANYTHING ELSE GOING?
Review timeframes
•The Scottish Government has agreed to
return to a 15-month cycle of review (or
27 months for items under two-year
review) for the QOF indicators changed in
2013-2014.
•This is to reduce unnecessary
bureaucracy and enable the peak time of
this activity to move out of the third
quarter of the year, allowing GP practices
to deal more effectively with acute winter
pressures.
QUALITY AND SAFETY DOMAIN…
A NEW QOF QUALITY AND SAFETY DOMAIN WILL BE INTRODUCED
TO REPLACE THE QUALITY AND PRODUCTIVITY DOMAIN.
IN
OUT
•An indicator requiring GP practices to identify a
•Five previous QOF QP indicators: reviews
liaison GP for health and social care integration
on outpatient referrals/emergency
(5 QOF points)
admissions; external peer review; and
•An indicator requiring GP practices to
care pathways (QP001 to QP005)
undertake a review of access (25 QOF points)
•An indicator for setting out a programme for
continuous quality development (25 QOF
points). The current patient safety indicators
(11 QOF points) will transfer to this domain.
•The current arrangements for Anticipatory Care•BUT… GPs will no longer be required to
Plans will continue (45 QOF points)
produce a report or Significant Event
Review.
ACCESS, INTEGRATION AND PRACTICE QUALITY
• “We have agreed a series of changes with the aim of
improving patient access to general practice,
maximising workflow, continuing quality improvement
and working with wider health services.”
• So, what does this mean?
PATIENT ACCESS
Patient access
•
Practices will undertake an annual assessment of current demand, assessing
met and unmet need. This will follow a template and process agreed by the
Scottish Government and SGPC.
•
Following the annual assessment, practices will produce a ‘Patient Access
Action Report’, which will be submitted to NHS Boards. Practices will be
encouraged to involve patients in the process, and share the report with them
in an appropriate, understandable way. This report will be discussed every
three years at the new quality visits (see 2 slides down).
INTEGRATION
Liaison with Health and Social Care Partnerships
•
Practices will nominate a liaison GP to link with a specified person from their
local Health and Social Care Partnership. These GPs will input into the
HSCP's decisions as appropriate.
•
Any additional workload will be funded separately on a local basis between
the GP practice and the Health and Social Care Partnership.
QUALITY
Quality
•
Practices will produce an annual report, based on an agreed template, to
support continuous quality improvement. National clinical and non-clinical
data will be available to help NHS Boards and GP practices identify areas to
focus on, and to help inform the annual report.
•
Practices will receive a Quality Programme peer review visit once every three
years. This will be informed by the annual report. The aim of these visits is for
allow constructive discussions, identify areas of priority, share best practice
and provide peer support.
PUBLICATION OF GP EARNINGS
Publication of GP earnings
•
An agreement has been reached to increase transparency by publishing GP
NHS earnings from 2015-2016.
•
The Scottish General Practitioners Committee and Scottish Government will
work together to determine how the publication of net earning relating to the
contract should be implemented.
•
The final arrangement will ensure the calculation and publication of 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.
•
The information will be on a national website and there will be consideration
of the right to privacy of individuals.
ANY QUESTIONS?