the Norfolk 5 year GP contract (supporting the primary care network delivery)

1. Five-year GP contract
framework
A summary
sadie.parker@nhs.net
4 February 2019

2. The agreement covers…
• Workload issues resulting from workforce shortfall
• A permanent solution to indemnity costs and coverage
• Improvements to the quality and outcomes framework
• Automatic entitlement to a new PCN contract
• Joining up urgent care services
• Practices and patients to benefit from digital technologies
• New services to achieve Long Term Plan commitments
• Five-year funding clarity and certainty for practices
• Testing of future contract changes prior to introduction

3. Addressing the workforce shortfall – 1/3
• GP recruitment targets extended to 2023/24
• International recruitment
• Retained doctors
• GP retention programmes
• Practice resilience programme
• Specialist mental health service for GPs
• Time for Care national development programme
• Guaranteed placements in general practice for undergraduate nurses
• Voluntary 2-year fellowship for newly qualified nurses and GPs
entering general practice

4. Addressing the workforce shortfall – 2/3
• Establish primary care training hubs from 2020/21
• Improved pension offer for GPs
• Reimbursement for certain roles through Network Contract DES –
additional role reimbursement scheme starting from July 2019
• Five reimbursable roles under the scheme eventually:
• Clinical pharmacists
• Social prescribing link workers
• Physicians associates
• First contact physiotherapists
• First contact community paramedics
• By 2023/24 expect typical PCN of 50k population to employ 6 WTE clinical
pharmacists

5. Addressing the workforce shortfall – 3/3
• Scope of scheme extends gradually:
• 2019 – clinical pharmacists and social prescribing link workers
• 2020 – physicians associates and first contact physiotherapists
• 2021 – first contact community paramedics (to avoid net transfer from the
ambulance service)
• Reimbursement is at 70% for all except social prescribing link workers
which is 100%, within maximum reimbursable amounts and only for
new staff. 100% social prescribing link worker contribution represents
full NHS contribution to social prescribing
• Each PCN to decide who employs (can’t be CCG)
• Payment will be on capitation from 2020, but will be one pharmacists
and one SP link worker in 2019/20. Further guidance by March

6. Solving indemnity costs
• Clinical negligence scheme for general practice to start from 1 April,
operated by NHS Resolution
• Costs met centrally
• Coverage extends to all GPs and primary medical services staff, plus
wider PCN and out of hours cover
• One off adjustment to global sum, but still grows by 1.4% this year
• Further details in February

7. Improving QOF 1/2
• Further guidance in March
• 28 indicators worth 175 points will be retired
• 101 points recycled into new clinical indicators in 5 areas:
• Reducing iatrogenic harm and improving outcomes in diabetes care
• Aligning blood pressure control targets with NICE guidance
• Supporting age appropriate cervical screening offer
• Offering pulmonary rehab for patients with COPD
• Improving focus on weight management as part of physical health care for
patients with schizophrenia, bipolar affective disorder and other psychoses
• New personalised care adjustment to replace exception reporting

8. Improving QOF 2/2
• 74 points recycled into quality improvement indicators:
• Prescribing safety, links to:
• Clinical pharmacists in general practice
• Pharmacist-led IT intervention for medical errors (PINCER)
• Polypharmacy for complex patients, including care homes
• Quality payment scheme for community pharmacy
• End of life care
• Early identification and support for those in last year of life
• Well planned, coordinated and responsive care
• Support for family and carers
• Both will have detailed guidance and have a requirement for at least 2
peer review meetings within the PCN

9. Network contract DES 1/3
• Goes live on 1 July, all GMS and APMS eligible, CCGs have to work
closely with LMC to achieve 100% coverage
• 3 parts to the DES:
• National service specifications
• Network financial entitlements
• Supplementary network services (ie locally commissioned services)
• Each PCN required to register with the CCG no later than 15 May, to
include a named, accountable clinical director and the provider which
will hold the funding
• CCGs must confirm registration requirements met by 31 May for all
PCNs to ensure no gaps

10. Network contract DES 2/3
• If practice refuses, population still included in the PCN, expected to
be rare. APMS contracts must be included
• All practices must agree their PCN network agreement, also gives
formal basis for working with community-based organisations
• Ability to have super PCN with virtual neighbourhoods within
• PCN is foundation of ICS and ICS must ensure PCNs can work in an
integrated way
• PCN as a whole is responsible for delivery of network contract DES
even though its only practices who sign up
• Clinical Directors play critical role in shaping and supporting the ICS,
funded at 0.25WTE per 50k population size

11. Network contract DES 3/3
• PCN external support
• Clinical director funding and template JD
• PCN funding of £1.50 per head, funded by CCGs
• CCGs to continue to provide support in kind for PCNs
• NHSE development programme for PCNs coming during 2019
• Supporting and developing future generations of PCN clinical directors
through the NHS Chief People Officer
• National network dashboard introduced from April 2020, to include
population health and prevention, urgent care and anticipatory care,
prescribing and hospital use

12. National service specifications 1/3
• Triple aim of the service specifications
• Improving health and saving lives
• Improving quality of care for people with multiple morbidities
• Helping to make the NHS more sustainable
• Structured medications review and optimisation
• Directly enabled by clinical pharmacists
• Directly tackle over-medication of patients and support meds optimisation
• Focus on asthma and COPD patients, STOMP, frail elderly, care homes
residents, patients with complex needs
• Enhanced health in care homes
• Consistent team of multi-disciplinary health professionals led by named GPs
and NPs, organised by PCN. 100% coverage required

13. National service specifications 2/3
• Anticipatory care
• Delivered by fully integrated primary and community team
• Community providers asked to configure their community teams to PCNs
from July 2019
• Primary care contribution to new community-led urgent response and
reablement service will be included
• Personalised care
• Designed to avoid over-medicalising care
• Model includes shared decision making, enabling choice, personalised care
and supporting planning, social prescribing and community based support,
supported self-management and personal health budgets and integrated
personal budgets

14. National service specifications 3/3
• Supporting early cancer diagnosis (starts 2020/21)
• Key role for practices in improving uptake of screening
• PCNs to ensure GPs are using latest evidence based guidance
• QOF QI module by 2020/21
• Cardiovascular disease prevention and diagnosis
• Service specification to be introduced in 2021/22
• Inequalities
• Service specification to be introduced in 2021/22
• ICS will be required to set out how they will reduce inequalities by 2023/24
with PCNs playing their part

15. Digital first 1/2
• GP IT futures replaces GPSoC from December
• NHSE to ensure predictive analytical tools are available to PCNs
• Three years funding for Subject Access Requests until all records fully
digitised
• CCGs responsible for offering DPO function to practices
• Right to online and video consultation by April 2021
• Online access to full medical record by April 2020 (new registrants
from April 2019)
• Electronic repeat prescriptions and dispensing as default by April
2019

16. Digital first 2/2
• All practices make 25% appointments available for online booking by
July 2019
• Practice leaflet replaced by online only requirement by April 2020
• Patients online access to correspondence by April 2020
• Faxes removed by April 2020
• MHRA CAS responsibilities for practices to provide email and monitor
account by October 2019
• Rurality index payment will only apply to those living within the
boundary rather than all registered patients

17. Joining up the urgent care system
• Extended hours access DES and improved access to form single access
offer as part of network contract DES by April 2021
• NHS review of physical and digital services with a view of reducing
duplication and better integration between settings such as 111, UTCs
and general practice. For full implementation in 2021/22
• Extended hours access DES to transfer to network contract DES from
July 2019 with a 100% population coverage requirement
• Each practice must make available 1 appointment per day per 3000
patients for 111 direct booking from 1 April – core contract req’t
• Development of general practice dataset in place from 2021

18. Investment and impact fund
• To start in 2020 with funding increasing each year
• Intention is to help PCNs plan and achieve better performance against
metrics in the dashboard (guidance to be developed)
• Fund will cover five elements with principle of shared savings:
• Avoidable A&E attendances
• Avoidable emergency admissions
• Timely hospital discharge
• Outpatient redesign
• Prescribing costs (standard national prescribing incentive scheme)
• Access to the fund is a PCN entitlement from 2020/21

19. Guaranteeing investment
• Funding for the core contract fixed for five years
• DDRB will not make recommendations on GP partner net income for five
years
• GPC England recommend 2% increase for practice staff in 2019/20
• GPs with total NHS earnings of above £150k per annum will be listed by
name and earnings in a new national publication starting with 2019/20
income
• Premises review will be published in March 2019 with commitment to
implementation
• “Most local contracts for enhanced services will normally be added to the
network contract DES”. CCGs to discuss with LMCs