The new GMS contract replaces the old GP contract and aims to improve quality of care, reward quality, and invest in general practice. It includes a quality and outcomes framework with up to 1050 points that practices can earn based on achieving standards in clinical care, patient experience, and practice organization. It also outlines essential, additional, and enhanced services that practices must or can provide, as well as provisions for out-of-hours care and a new global sum payment model based on practice population needs. The contract is intended to better support population health while giving practices flexibility and financial stability.

1. The New GMS
Contract

2. The New Contract
• The Old Contract
• Background
• Provision of services
• Quality
• Investment

3. The Old Contract
• Between GP and PCO
– Capitation fees
– Item of service payments
– Rural practice allowance
– Basic practice allowance
– Postgraduate education allowance
– Seniority payment

4. The Old Contract
• No account of practice population demographics
• No reward for quality
• GPs responsible for out of hours cover
• Reduction in practice income if GP left

5. The Old Contract
• Between GP and PCO
– Capitation fees
– Item of service payments
– Rural practice allowance
– Basic practice allowance
– Postgraduate education allowance
– Seniority payment

6. Background
• Negotiations for new contract began late 2001
• New contract documentation February 2003
• Vote
• Result 20/06/03:
– 70% turnout
– 79.4% yes vote

7. Provision of services
• Essential services - all practices
• Additional services - most practices although can
opt out under certain circumstances
• Enhanced services - responsibility of PCO, may be
commissioned from practices
• Out of hours - responsibility of PCO

8. Provision of services
• Essential services
– Management of patients who are ill or believe themselves
to be ill with conditions from which recovery is generally
expected
– Management of patients who are terminally ill
– Management of chronic disease

9. Provision of services
• Additional services
– Cervical screening
– Contraceptive services
– Vaccinations and Immunisations
– Child Health surveillance
– Maternity services
– Certain minor surgery procedures e.g. cryocautery of
warts

10. Provision of services
• Additional services
– Opting out
• temporary ( <1 year)
• permanent
• lack of available skills
• practice struggling e.g. short staffed
• conscientious grounds
• UK wide tariff adjusted by Carr - Hill formula will apply for
opting out

11. Provision of services
• Enhanced services
– Nationally directed
• treatment of violent patients
• improved access
• childhood vaccinations and immunisations (provided to higher
specified standard)
• flu immunisation
• extended minor surgery
• quality information preparation

12. Provision of services
• Enhanced services
– With national minimum standards
• intra partum care
• anticoagulant monitoring
• IUD fitting
• more specialised services for substance misuse, sexual health, depression,
multiple sclerosis, terminally ill, the homeless, those with learning disability
• immediate care, first response care and minor injuries

13. Provision of services
• Enhanced services
– in response to local need
• ? Services for immigrants

14. Provision of services
• Out of hours
– Defined as:
• 1830-0800 on weekdays
• The whole of weekends, bank holidays and public holidays
– Practices retain the option provide out of hours services
– Routine surgeries possible in evening or at weekend but
only get extra funding if agreed as enhanced service with
PCO

15. Provision of services
• Out of hours
– PCOs can use alternatives e.g.
• NHS Direct/24
• Walk in centres
• GP co-ops
• community nursing teams
• commercial deputising services
– In remote areas may be no alternative to practice
provision

16. Provision of services
• Out of hours
– Opting out
• a fixed UK wide tariff will apply - adjusted by Carr- Hill
formula
• Will cost on average £6000 per GP per year

17. Quality and outcomes framework
• Practices awarded points for achieving certain standards
• Total of 1050 points available
• 1 point = £75 on average this year, £120 next year
• Four “domains”
– Clinical
– Organisational
– Additional services
– Patient experience

18. Clinical Domain
• Coronary heart disease • Diabetes
including left ventricular • Mental Health
dysfunction • Chronic Obstructive
• Stroke and transient Pulmonary Disease
ischaemic attacks • Asthma
• Hypertension • Epilepsy
• Hypothyroidism • Cancer

19. Clinical Domain
• Example
– The percentage of patients with coronary heart disease, in
whom the last blood pressure reading (measured in the
last 15 months) is 150/90 or less. 70% 19 points
– A proportion of the points score will be awarded in a
direct linear relationship for achievement between the
minimum (25%) and the maximum (in this case 70%)

20. Organisational Domain
• Records and information
• Communication with patients
• Education and training
• Medicines management
• Clinical and practice management

21. Organisational Domain
• Example
– The practice has arrangements for patients to speak to
GPs and nurses on the telephone during the working day.
1 point

22. Additional services domain
• Cervical screening
• Child health surveillance
• Maternity services
• Contraceptive services
• Example
– The practice has a system to ensure abnormal smears are
followed up. 3 points

23. Patient experience domain
• Patient survey
• Consultation length
• Example
– The practice will have undertaken an approved patient
survey each year. 40 points

24. Investment
• Global sum and MPIG
• Quality payments
• Payments for enhanced services
• Others - premises, seniority, PCO payments (e.g. for
mat leave), dispensing
• Pensions

25. Global Sum
• Payment for essential and additional services
• Staff costs
• Locum reimbursement
• Average UK practice to receive £300,000
• Based on practice population weighted using Carr-
Hill formula

26. Carr-Hill formula
• Six key determinants of practice workload and
circumstances:
– Gender and age for frequency and length of surgery and home
visit contacts
– Gender and age for nursing and residential home consultations
– Morbidity and mortality
– Newly registered patients
– Unavoidable costs of rurality
– Unavoidable higher costs of living

27. MPIG
• Minimum practice income guarantee
– Ready reckoner used to calculate global sum equivalent
– Many practices found their global sum would be lower
than what they were receiving under the old contract
– If global sum equivalent + payment for 100 quality points
is less than income under old contract then MPIG comes
into force and a correction factor makes up the short fall

28. Quality payments
• Preparation
– E.g. IT payments
• Aspiration
– Practice estimates how many points it hopes to achieve in
the next year and is paid upfront for a third of these
• Preparation
– Paid at the end of the year for the points achieved minus
the aspiration payment

29. Pensions
• Under old contract not all work was pensionable
• Under new contract locum work and work for out of
hours co-operatives will be pensionable

30. Current issues
• Dispute over payments for flu vaccinations for at
risk under 65s
• Some difficulty in obtaining quality preparation
payments
• Problems with enhanced services payments
-PCTs not making minimum floor payments as they claim the money
has already been allocated this year

31. UNIFIED BUDGET ASSURED
GLOBAL SUM QUALITY
MONEY
ESSENTIAL PROTECTED PCO-MANAGED DIRECTED AND
LOCAL
& NATIONAL
TIME FUNDS ENHANCED
ENHANCED
ADDITIONAL
PREMISES
PCO GUARANTEED
FUND(S)
IT
ALTERNATIVE
PRACTICE PROVIDER