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Gp contract
- 1. Five-year GP contract framework Asummary 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 workforceshortfall – 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 workforceshortfall – 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 workforceshortfall – 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 DES1/3 • 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 DES2/3 • 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 DES3/3 • 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 specifications1/3 • 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 specifications2/3 • 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 specifications3/3 • 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 theurgent 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 impactfund • 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 • Fundingfor 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