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GPC Negotiators / LMC Meeting
February 2014
Today’s matters
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GP contract 14/15
PMS
Workload, funding and morale
Prime Minister’s Challenge Fund
Alliances & Federations
CCGs
Premises
CQC registration
Revalidation
Occupational Health Services
Care.data
NHS 111
Contract negotiations for doctors in training
GP contract 2014-15: context of
negotiations
• Backdrop of 2013-14 imposition
• Grassroots perception & morale
• Policy by political pronouncement
• Adverse media publicity re A&E pressures, 8-8,
GP OOH opt out
GP contract 2014/15: to sum up
• A negotiated agreement; give and take on both
sides; restored faith in the negotiating process
• A package with good and bad
• On balance a step in the right direction
• Not a panacea for workload, morale crisis and
no new funding
GP contract 2014/15: objectives
• Reverse adverse impact of 2013-14 imposed
changes
• Reduce bureaucracy, box ticking and chasing of
targets
• Increased resources in core GP budgets,
provide stability, enabling clinical judgment and
flexibility in providing care
GP contract 2014/15:
achievements
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238 QOF points released to core funding
100 QP points released- > new ES
Almost all unacceptable imposition indicators removed
Removal of many indicators creating most bureaucracy
Threshold increases for 2014-15 retracted
New NICE indicators for 2014-15 removed
3 of last year’s imposed DES ended
Most removed DES monies into core funding
No increase contractual/extended hours or OOH
responsibility
Movement to core funding
• Value of 238 QOF points (based on 12/13
achievement)
• £40m from patient participation DES
• £12m from remote care monitoring DES
• £24m from patient online DES
• Circa £80m from seniority funding pot by 2020
• No 6% OOH deduction
• ALL practices receive- CF “floats on top”
• PMS mirrors GMS agreement
What will this mean for GPs &
practices?
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More time to look at patient in front of us
Ability to use clinical judgement
Freeing up nurse/GP appointments
Freeing up admin time
Reduced scope for QOF post payment
verification
• More core funding, not vulnerable to annual
unpicking
Avoiding unplanned admissions
enhanced service (1)
• Funded from 100 QP points and £42m risk
profiling enhanced service = £160m
• No longer a requirement for external peer review
meetings
• If CCGs want external QP-style meetings to
continue they will need to support this with new
money
• No targets for reducing admissions
Avoiding unplanned admissions
enhanced service (2)
• Risk stratification to identify 2% of adult population at risk of
admission to form a “case management register”
• Care plans for all on register to include
– a named accountable GP
– a care co-ordinator
– review post hospital discharge
• Same day telephone consultations for patients on the register
with an urgent need
• Timely telephone access for A+E, ambulance, care homes
• Monthly reviews of the case management register
• Review unplanned admissions and A+E attendance of care
home patients
Imposed Enhanced Services from
2013/14
• Patient Online
– ended
– £24m transferred to global sum
• Remote care monitoring
– ended
– £12m transferred to global sum
• Risk profiling
– ended
– £42m transferred to new admission avoidance enhanced service
• Dementia
– continues
Named GP for 75s & over
• Contractual requirement to provide a named GP to all
patients 75yr and older by 30 June 2014
• Named GPs-lead responsibility to ensure services under
contract delivered to patients aged 75 +
• “Usual GP” already in many practices
• Contract remains with the practice, not named GP
• Patients can still see any practice GP/nurse
• Does not mean 24 hour or vicarious responsibility
• Registration was with individual GP pre-2004
OOH Quality Monitoring
• Contractual requirement to review clinical details of
consultations received from OOH providers same
working day; report concerns to NHS England
• Respond to any information requests OOH providers
same working day (exceptionally next working day).
• Take reasonable steps to work with OOH provider
systems for rapid and effective transmission of OOH
patient data
• No contractual requirement to work outside current
working hours; no extended 8-8, 7/7 working
I.T. Changes
• Contractual requirements
• Include NHS number in all clinical correspondence
• Offer and promote online booking and repeat prescription
ordering
• Upload SCR daily (or plans to achieve this by 31.3.15)
• Use GP2GP transfer (or plans to achieve this by 31.3.15)
• Offer and promote electronic access to SCR
• GPC and NHS England to work during 2014/15 on:
– Electronic communication by patients with practice
– Access to detailed care record from other care settings
Publication of earnings
• Working group being formed with NHS England
and NHS Employers for publication of earnings
from April 2015
• Calculation and publication of earnings to be on a
like for like basis with other healthcare
professionals
• Published earnings will be GP NHS net earnings
relating to the contract
Friends and Family Test
• Contractual requirement from December 2014
• Replaces survey in Patient Participation DES
• “How likely are you to recommend our practice
to friends and family if they needed similar care
or treatment?”
• One follow-up question chosen by practice
• Monthly feedback to NHS England
• PP DES funding reduced to £20m and £40m
added to core funding
Choice of GP practice
• Government committed to roll out of current pilot
from October 2014 despite GPC, RCGP and
CCG concerns
– Pilots showed very small uptake from patients
• Practice involvement voluntary
• No obligation to visit these patients
• NHS England responsible for urgent medical
care for patients if at home address
Seniority
• Government commitment to end age-related pay
progression across public sector
• A redistribution - £80m seniority pot will be
cemented into core funding to GP practices
• No new entrants
• 6 year stability: those in receipt on 31.3.14 will
continue and progress as per SFE until
31.3.2020
• 15% value each year to be transferred to core
funding, based on expected retirement rate
Seniority (2)
• If <15% NHSE and GPC to agree process
• Money in GS will be subject to annual DDRB
rises; seniority funding has been static for 9
years and real-terms value eroded by inflation
• After 2020- GPs will be paid equivalent seniority
throughout working lives compared to only in
latter stages of career
Unfinished Business
• Guidance & regulations currently being drafted and
approved
• Imposed equitable funding changes for 2014 onwards.
MPIG outliers: NHS England letter leaves responsibility
for outliers to ATs - unacceptable to GPC. Big role for
LMCs
• Local QOF/contract initiatives
• PMS
PMS
• Contract changes to mirror negotiated
agreement for 14/15 - further details awaited
• Equitable funding / PMS review arrangements
announced
- “Premium” element of PMS expenditure identified as £325m reduced to £235m as MPIG phased out
- Area Teams have two years to review local PMS contracts from April
2014 - pace of change following reviews left to local judgement
- Area Teams to invest premium funding in GP services according to
criteria set out by NHS England
What the contract will not resolve
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Demand exceeds capacity
Workload and morale crisis
Changing demographics; out of hospital care
Need more GPs
Need more practice staff
Need bigger and more premises
Need greater support services
Need integration to manage austerity
NHS funding invested in general
practice
GPs overworked and demoralised
• DH commissioned 7th worklife survey GPs (Aug 2013)
lowest levels of job satisfaction since 2004 contract
highest levels of stress since start of the survey series
substantial increase in GPs intending retiring next 5 yrs
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• BMA GPC GP contract survey (Sep 2013)
9 out of 10 increased workload past year
9 out of 10 say reducing appts and time for patients
Nearly 9 out of 10 reduced morale
1 in 2 GPs less engaged with CCG due to workload
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GPC Vision for
General Practice
“With more GPs, spending more
time with their patients, working in bigger
and more comprehensive teams built around the
practice, based in better quality premises and
underpinned by a fairer share of NHS resources,
general practice can deliver the healthcare
solutions for the future”
www.bma.org.uk/gpc
Prime Minister’s
Challenge Fund
• Separate to negotiations for 14/15
• £50m fund for pilots to help extend access to
general practice, including 8-8, weekend access,
increased use of technology
• 9-10 pilots planned
• Expressions of interest invited from groups of
practices
– Many practices moving to work in networks / federations to bid
• Only funding for one year
Alliances & Federations
• We’d like to hear about emerging local alliances
and federations
• Contact info.gpc@bma.org.uk to share
examples of activity and your experiences
• This will help us generate a national picture of
activity
• We have published guidance on Collaborative
GP alliances and federations
– bma.org.uk/gppractices
What could CCGs do?
• Use commissioning levers to move resources to
match changing patterns of care out of hospital
• Sort out primary/secondary interface problems
• Commission integrated care
• Limit targets and bureaucracy
• Support practices working together
• Limit excessive performance management
• Support GPs to have manageable workload
Premises
• GMS Premises Costs Directions 2013 are
interim
– Further negotiations required e.g. trade waste
• Joint national guidance on directions once
finalised
– Agreement on a national template GP lease and Principles of
Best Practice guidance very close
– This will be followed by process guidance from NHS Property
Services (NHSPS)
– Agreement on whole package required before publication
CQC Registration
• Practices required to register from April 2013
• Concerns about content and variation in
inspection process since then
• GPC strongly objected to approach to press
release at end of 2013
• CQC currently looking at re-vamping inspection
process, including more GP involvement
• Ratings will form part of process in the future.
GPC objects to simplistic rating system
Revalidation
• Concerns remain about:
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consistency of approach
evidence collection for sessional GPs
approach for informing GPs about revalidation decisions
choice of toolkits
• GPC has set up revalidation implementation group and
is holding regular meetings with NHS England
• Discussions on remediation funding ongoing
Occupational Health Services
• NHS England proposed discontinuing dedicated
OHS for GP practices
• GP practices to fund OHS for non-medical
practice staff from April
• GPs with stress or burnout will have to flag the
issue with their appraiser or Medical Director’s
office
• Unacceptable situation - we have written to DH
to stress need for fully-funded OHS for general
practice
Care.data
• Health & Social Care Act gives powers to Health &
Social Care Information Centre to require Personal
Confidential Data (PCD) from GP practices, without
patient consent
• Right for patients to object to the extraction of their PCD
for care.data was negotiated by the BMA
• Data Protection Act requires practices to make patients
aware of the ways in which information from their record
is used and shared beyond their direct care
Care.data (2)
• Information leaflet being delivered to all households in
England
• Patient information line open until 31/3/14
• Patients have a minimum of four weeks to read the
leaflet and register their objection at their GP practice
before the first extract begin in spring 2014
• Ongoing updates provided in GPC News
NHS 111
• GPC lobbying NHS England to reduce length
and improve quality of post-contact information
• National 111 service specification to be revised
and published in April 2014
– GPC has prepared a paper proposing solutions to improve the
problems experienced during initial implementation
– GPC key proposal – call handling and OOH provision must not
be divorced if services are to be integrated
• All NHS 111 contracts to be re-commissioned
from April 2015
Contract negotiations for doctors in
training
• Negotiations underway for new contract for all
doctors in training
• If agreed, would mean a significant change for
GP trainees who have until now had no formal
national contractual arrangement
• Currently a framework contract for GP trainees maintained and agreed by the GPC and
COGPED
• Negotiations are at an early stage - anticipated
they will be ongoing throughout 2014
Questions and
discussion
Further details about these areas and
more are available at
www.bma.org.uk/gpc
You can e-mail info.gpc@bma.org.uk
with further queries