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At the heart of general practice since 1960

Scottish GP contract: what is proposed?

Read a summary of the 69-page new Scottish GP contract

Funding

  • From April, 2018 a three-year transition period will start with a new funding formula underpinned by additional investment of £23 million and a guarantee no GP will earn under £80,430.
  • No practice will lose funding under new arrangements.
  • The GPC estimates two-thirds of practices will receive a funding boost.
  • The current minimum practice income guarantee and ex-QOF funding will be consolidated as new global sum.
  • A minimum earnings expectation for GP partner whole time equivalent will be introduced from 2019.
  • In 2020, a second round of negotiations will see the GPC proposing pay comparable to consultants and direct reimbursement of practice expenses – subject to second poll of profession.
  • In small remote GP practices, extra resources will continue to be made available to ensure long-term sustainability and such practices will continue to provide a broader range of services.

Role of the GP

  • The GP as expert medical generalist will focus on undifferentiated presentations, complex care and quality and leadership.
  • GPs will be supported by an extended multi-disciplinary team responsible for some of the activities currently being performed by the GP, including prescriptions, acute and minor illness, and chronic disease management.
  • Among other things the GP will be responsible for care planning for patients with complex needs.

Workload

  • From April 2018, one session per month extra protected time for clinical leadership extending to regular protected time for every GP.
  • Responsibility for vaccines to move to NHS boards, maternity and contraception services also to continue to be provided by community teams but with no loss of funding
  • A community treatment and care services team will manage minor injuries and dressings, phlebotomy, ear syringing, suture removal as well as chronic disease monitoring and related data collection.

Staff

  • New staff will be employed by NHS Boards and attached to practices and clusters.
  • By 2020, every GP practice will receive pharmacy and prescribing support under a new pharmacotherapy service with pharmacists dealing with acute prescribing repeat prescribing, medicines reconciliation and safety review as well as dealing with hospital queries and medication reviews in some circumstances.
  • Health boards will provide physiotherapists, community mental health workers, and link workers to work in general practice under plans to be developed locally.

Premises

  • NHS Boards will gradually take on the responsibility from GP contractors for negotiating and entering into premises leases with private landlords.
  • All GP contractors who own their premises will be eligible for an interest-free loan by 2023, including those in negative equity, for an amount of up to 20% of the Existing-Use Value of the premises.
  • The loans will be repayable if the premises are sold or are no longer used for the provision of GMS services.
  • A yearly cycle of loans will be in place until by 2043 where GPs no longer own their premises.

Extra services

  • Essential services will remain unchanged – care based on the registered practice list, generalist care of the whole person and sufficient consultation time for patients according to their clinical needs
  • Additional services are to be removed from contract, eg, minor surgery. GPs can choose to provide such services under core contract but enhanced service for minor surgery will continue
  • A new out of hours enhanced service – which will move from opt out to an opt in for practice choosing to provide out of hours. A 6% deduction from the global sum will be applied nationally instead of the current out of hours deduction.

Source: Scottish Government

 

 

 

 

 

 

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Readers' comments (5)

  • GPs will be responsible for a "multidisciplinary team", but the team will be employed by someone else. Good luck with that Guys.

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  • So, probably a reduction in workload for general practices, but not for the general practitioners, whose workload/stress is likely to increase.
    An increase in hassle from the ‘community treatment and care service teams’. The least uncertainty about anything (though relatively unlikely for dressings, phlebotomy or suture removal) and the GP responsible will be phoned or the patient asked to make an appointment - urgently of course.
    External management of CDM blood results are a concern. Will deteriorating but still notionally normal results be noticed? Will there be central protocols for managing trivial but irrelevant abnormalities, or will GPs be alerted to chlorides of 97mmol/l? Who is responsible for errors?
    Community mental health workers (presumably not qualified CPNs) and link workers will no doubt show what a thorough job they are doing by referring their every query to the GP.
    Worst of all is pharmacy ‘support’ which from personal experience created vastly more work than it relieved.
    I remember that in the early stages of all this a year or two ago, it was stated that GPs would not be responsible for anything done by others, but that was rapidly changed.
    Cynical? Me?

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  • Cobblers

    I sort of follow that guff about money. However we seem to be cementing inequity with MPIG & ex QOF into the Global Sum.

    So some practices will get X pounds per patient and others may get X + 50 pounds per patient.

    What I would like to see is this being transparent in current time. It is public money. We need to know what each practice is getting and why. What they do with it after that I need not know but two neighbouring practices doing much the same thing should receive the same, per patient, money.

    Why not? If anyone has taken a look at the historic funding of practices of any area you will see some get almost double others and that excludes dispensing.

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  • Will the wearing of kilts be mandatory?

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  • No account of turnover or increasing expenses. I assume eventually those that are left will be on £80,000 at which point (if not before) we all become salaried.

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