GP Contract changes 2014/15. Summary Outline QOF changes Removal of DESs Modifications to current DESs Contractual requirements – Named accountable GP.

GP Contract changes2014/15

Summary Outline• QOF changes• Removal of DESs• Modifications to current DESs• Contractual requirements

– Named accountable GP– OOH monitoring– IT changes– Publication of earnings– Friends and Family Test

• Choice of practice• Seniority• Transfer of money to Global Sum• Vision for general practice

What is not included

• OOH 24/7 responsibility• 8-8 7 days a week opening• Additional extended hours• Full electronic record access (yet)• Additional money– Evidence submitted to the DDRB for resource

uplift

QOF – Aims of negotiation

• Reverse imposed QOF indicators• Reduce micromanagement and box-ticking• Reduce workload• Transfer money to global sum/PMS baseline• Increase clinical freedom and professionalism to

enable patients to be treated holistically according to clinical need

AIMS ACHIEVED

QOF headline changes

• 238 points to global sum/PMS baseline– no 6% OOH rebate but Carr-Hill will apply

• 100 QP points to new admission avoidance ES• No 2nd year imposed threshold changes• Almost all imposed indicators removed• BP target 140/90 returned to 150/90 (and

timeframe changed from 9-12 months + points reduced)

• No new NICE changes accepted (except LD indicator)

QOF indicators removed• Hypertension

– GPPAQ survey + intervention– 140/90 target– 150/90 target remains but with 20 points, 12 months rather than 9

months to achieve and reduced 45-80% threshold• Annual cholesterol checks

– CHD, PAD, Stroke/TIA, mental health – retained for diabetes

• Diabetes– erectile dysfunction questions– albumin:creatinine test– retinal screening– dietary review by suitably qualified professional

QOF indicators removed (2)

• AF - % with CHAD score (but treatment remains)• Thyroid disease – whole domain removed• Depression– Bio-psychosocial assessment removed– Depression review timeframe increased to 2-8 weeks

• Mental health– HDL/cholesterol and glucose annual checks– BMI

• LD – record of TSH check

QOF indicators removed (3)

• Epilepsy• Rheumatoid Arthritis• Public Health• QP Domain• Patient experience/length of consultation

• Other QOF agreements– Cancer reviews returned to 3-6 months– Extended timeframe for flu immunisations– No 2nd year threshold changes– No new NICE indicators– PMS points off-set will be reduced in line with changes

QOF points summaryRetirements Points 

Clinical domain (to GS) - Including 3 points from LD002 to ES 185

Public health domain (to GS) 33

Patient experience (to GS) 33

Quality and Productivity (to ES) 100

SUB Total points released 351

Less points added to amended HYP002 10

TOTAL 341

Avoiding unplanned admissions enhanced service

• 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 (any person in multidisciplinary team) is main point

of contact/responsible for delivery of the plan– 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

Extended Hours ES

• Increased flexibility to work with other practices if the practice/s want to

• Other specifications remain the same• No increased amount of extended hours• Funding remains the same

Other Enhanced Services• Dementia– additional development of care plan

• Learning disability– to be offered to 14yr and older– development of a care plan– money from LD QOF– amount per medical increased to £116•Alcohol– Patients identified as drinking excessively to have brief

mental health assessment (eg PHQ9)

Imposed Enhanced Services

• 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 patients 75 & older

• A contractual requirement• Provide a named GP to all patients 75yr and older by

30 June 2014• Encourages continuity of care and closer oversight of

care• Contract remains with the practice, not the named GP• Does not prevent patients seeing any GP or nurse in

the practice• Does not mean 24 hour responsibility

Out of Hours

• Contractual requirement to monitor the quality of care provided OOH and report concerns to NHS England

• Requirement to cooperate with requests for information & reviews from OOH providers on same working day (exceptionally following working day).

• No contractual requirement to work outside current working hours

• No contractual requirement to open 8-8, 7 days a week

Patients needing access to a practice clinician after assessment

• Relates to patients being advised to contact practice by NHS 111 or A+E

• “The practice will ensure that when the patient contacts the practice, a practice clinician will agree appropriate next steps having regard to the patient’s condition and circumstances.”

IT

• Contractual requirements• Include NHS number in all clinical correspondence• Offer and promote on-line 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

“NHS Employers and the GPC have agreed to form a working group with NHS England, to develop proposals on how the publication of GP NHS net earnings relating to the contract should be implemented for 2015/16.

“The working group will ensure that the calculation and publication of GP net 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).”

Friends and Family Test

• A contractual requirement from December 2014• “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• Replaces survey in Patient Participation DES• 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 CCGs concerns– Pilots showed very small uptake from patients

• Not just commuters – more likely to be patients moving outside practice boundary wishing to stay with a practice

• No obligation to visit these patients• Practice involvement voluntary• May be reduced global sum for these patients• NHS England responsible for in-hours urgent medical care for

these patients if unable to attend their registered practice• Full details still to be developed

Seniority

• All those in receipt of payments on 31.3.14 will continue to receive payments and progress as currently set out in the SFE

• No new entrants• Scheme will end in 6 years on 31.3.20• Commitment to reduce overall amount by

15% each year• All savings put in to core funding

Seniority (2)

• 2 years before figures available to show whether 15% saving made from retirements

• If less than 15% NHSE and GPC to agree process for achieve this

• Seniority funding has been static for 9 years and real-terms value eroded by inflation

• Transferred funding to global sum not subject to 6% OOH rebate and could increase with DDRB awards

Transfer to global sum

• Value of 238 QOF points– Based on 12/13 achievement and 13/14 price

• Circa £80m from seniority funding by 2020 • £40m from patient participation DES • £12m from remote care monitoring DES • £24m from patient online DES • No 6% OOH rebate• No change to correction factor

NHS funding invested in general practice

Year % total investment % excluding dispensed drugs

2004/5 10% N/A

2005/6 10.41% N/A

2006/7 9.83% N/A

2007/8 9.17% N/A

2008/9 8.74% 8.04%

2009/10 8.45% 7.81%

2010/11 8.31% 7.68%

2011/12 8.16% 7.56%

2012/13 8.04% 7.47%

Vision for General Practice

• GPs Committee has published vision document for General Practice:

• Developing General Practice today - Providing healthcare solutions for the future

• Sets out the ways in which it can help provide solutions to some of the most difficult challenges the NHS faces

• Can be found on BMA website: bma.org.uk/gpc

Conclusion• QOF reduced from 900 to 559 points• Most imposed QOF points and DESs removed• No 2nd year imposed QOF threshold changes• Major transfer of money to Global Sum without 6% OOH rebate• New admission avoidance enhanced service• New contractual requirements

– Named accountable GP– OOH monitoring– IT changes– Friends and Family Test– Publication of earnings

• Minor modifications to current DESs• Removal of seniority over 6 years• Voluntary engagement in patient choice of practice• No 24/7 OOH or 8-8 7 day commitment