The 2014 GP contract deal: what we know so far
The BMA and NHS England have announced the key changes agreed as part of the 2014 GP contract deal - although the full agreement has yet to be released. Here is what we know so far…
QOF to be cut by almost 40%
The most immediate change for practices will be the removal of 341 points from the QOF. Some 238 points - worth around £37,000 for the average practice - will be moved into the global sum. Indicators which will be removed include the GPPAQ surveys and those relating to cholesterol monitoring, hypertension and erectile dysfunction in diabetic patients. For a full list of the changes planned for QOF, click here.
Many of the changes to QOF thresholds introduced last year will be reversed, although the planned hike in all thresholds to match the upper quartile of achievement amongst practices is only delayed by a year.
The remaining 100 points to be removed from the QOF - worth around £16,000 for the average practice - will come from the quality and productivity domain and will be used to fund a new emergency admissions DES.
Three points will be used to improve the learning disabilities DES.
Emergency admission DES
A new DES has been created - worth around £162m in total - for one year that will also incorporate the existing risk-profiling DES. It will be an enhanced service aimed at avoiding unnecessary hospital or A&E admissions among patients with complex health needs. It will involve the following:
- providing timely telephone access, via ex-directory or bypass number, to relevant providers to support decisions relating to hospital transfers or admissions, in order to reduce avoidable hospital admissions or A&E attendances
- case-managing vulnerable patients (both those with physical and mental health conditions) proactively through developing, sharing and regularly reviewing personalised care plans, including identifying a named accountable GP and care coordinator
- improving access to telephone or, where required, consultation appointments for patients identified in this service
- reviewing and improving the discharge process, sharing relevant information and whole system commissioning action points to help inform commissioning decisions.
- undertaking internal reviews of unplanned admissions/readmissions.
Every patient aged 75 and over will be assigned a ‘named GP’, a move which has been heavily trailled by Jeremy Hunt and interpreted by the national newspapers as a return to 24-hour responsibility.
The details of how this will work are still unclear; however, the GPC claims this will not extend to out-of-hours responsibility. Dr Richard Vautrey, GPC deputy chair, says: ‘It is ensuring there is one GP the patient can turn to, and who will be someone they can identify more closely with.
‘If someone else from outside the practice wanted to speak about the patient, it may be the named GP who they will contact. It may be that when the patient is having particular difficulties in their care or the relationship they are having with various providers, it may be the named GP who pulls that together.’
GPs will be given contractual responsiblity for out-of-hours care - another heavily trailed development. But it may not be as scary as it seemed at first. GP practices who have opted out of providing out-of-hours services will have to simply ‘monitor the quality of those services and report any concerns they may have’ and there is no mention of providing those services.
Seniority payments scrapped
Seniority payments are to be reduced by 15% a year and eventually abolished on 31 March 2020 - a move which is likely to be controversial. There will be no new entrants to the scheme from 1 April 2014 and the funding freed up will be ‘reinvested in core funding’.
GPC chair Dr Chaand Nagpaul hailed this as an important concession given ‘the Government has expressed a determination to phase out age related pay progression across the public sector’, but has expressed concern about the retention of older doctors.
Abolition of practice boundaries
In a move to full competition between GPs, the controversial pilot schemes to encourage choice for patients, allowing them to register with practices away from their home, will be extended across England from October 2014. NHS England will have responsibility for arranging all home visits for out-of-area patients.
It is not certain whether practices will be paid the full amount for patients who live outside of their areas - this is still a matter of discussion between GPC and NHS England.
Publication of GP pay
All practices will have to publish GP NHS net earnings in 2015.
Existing enhanced services
The patient online and remote care monitoring DESs will be scrapped and the associated funding reinvested into core funding and the new emergency admissions DES. The patient participation scheme will continue for another year with the requirement to carry out a local survey removed due to the introduction of the Friends and Family Test.
The Extended Hours Access DES is extended for another year with a number of flexibilities included to allow practices to work together to provide the most appropriate service for their patients.
The Dementia, Alcohol and Learning Disabilities DESs will be extended for a further year with some changes made.
When the CQC’s new inspection arrangements are introduced, practices will be required to display the inspection outcome in their waiting room(s) and on the practice website. According to some national newspapers, this will be an Ofsted-style ‘outstanding’, ‘good’ or ‘failing’ rating, although this has yet to be confirmed.
Friends and Family Test
This will be rolled out as expected to all GP surgeries by December 2014. It will see patients asked ‘would you recommend this service to a friend or family member’ - and as elsewhere in the NHS, results will be published online in what NHS England describes as ‘part of a drive to improve quality and transparency’.
NHS England has continued with its commitment to improve online access for patinets, with patients to be given the facility to book and amend appointments and order all repeat prescriptions online.
GPs will also have to update patients’ Summary Care Record ‘daily’ and give patients access to it - under a move that looks like a shift in the Government’s existing commitment for patients to be able to access their full record online by 2015.
GPs will also have to use patients’ NHS Number in all clinical correspondence and transfer patient records using the GP2GP system.
The agreement announced today does not include a possible funding uplift to the GP contract, which will be subject to the usual DDRB process in due course.
Today’s deal covers only GMS practices in England - the first time that has happened. Separate negotations are ongoing in Scotland, Wales and Northern Ireland. It is not clear what deal PMS practices will receive.