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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.

 

Named GPs

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.’

 

Out-of-hours responsibility

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.

 

CQC inspections

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’.

 

Online access

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.

 

Pay uplift

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.

 

Devolved nations

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.

Readers' comments (16)

  • These look like radical changes but in reality this will do nothing to address the real crisis facing general practice. The fundamental issue is that we are being swamped by ever increasing demand (both access and clinical complexity). Global sum doesn't incentivise increased activity or growth. PBR does! It's obvious that, for the NHS to be sustainable, even more activity needs to take place in Primary care. At present the most expensive part of the system gets paid for every bit of work it does whilst the most efficient is straight jacketed by an underfunded block contract! Give GP's the tools to save the NHS and watch us rise to meet the challenge!

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  • Out of hours care must be included as an essential element of any new contract.

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  • Well done and congratulations to Chaand Nagpaul on negotiating such a sensible deal. Considering that we are in times of austerity with a dearth of resources, it would have been tempting for Jeremy Hunt and the treasury to have pressurised for a significant clawback . The GPC team have done well to highlight the folly of pushing GPs beyond breaking point and have negotiated what appears to be a sensible list of changes . Well done on getting rid of ridiculous aspects of the QoF. The changes described are a basic revision that most of us as GPs would have recommended anyway. The DESs should hopefully be the correct vehicle to allow JH to pursue some of the more complicated areas.

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  • "Robbing Peter to pay Paul" comes to mind! It is obvious we are saddled with an increase to our gait keeping role, but that no extra monies for the Primary care part of the NHS , are available. Should we congratulate ourselves on being hood-winked? I think not! Being paid the same or in our case, less year on year, for more work and more complex work demoralises people......even GP's! The people responsible for the financial Armageddon we plumbed the depths of are still paid vast sums of money, outside the curiosity of public auditors, yet we are to e publically examined for what we earn. Maybe it would be fairer if they publish what we have earned over our careers and divided it by the number of hours that we have actually been on duty! It is possible some of us have actually been earning above minimum wage levels!

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  • There is no mention regarding how the global sum is to be calculated? To still work off 2004 model would be unfair and a huge mistake. ?addressing inequities of payments?

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  • Well done GPC and Chand Nagpaul, this is a brilliantly negotiated contract with common sense at the core. The named GP is something that most good practices do anyway, I have my regulars who will call me to talk about care homes, whether they should have their hip op done etc which I actually enjoy. Well done again

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  • very much England centric, let us see what the devolved administrations have to say.

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  • Out of hours monitoring of services has already been happening as far back as 2010 with monthly reports sent to PCT so nothing new
    Named GP for all patients already exists for small practices(1 or 2 GP's) so nothing new

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  • this could work very well, as long as community services such as district nursing, and social services are funded/managed well enough to support this. If they aren't the burden on GPs will increase and patients will still not get the most appropriate care. If they are, it'll be really good to get back the cross-communication and cooperation which seems to have decreased over the years

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  • Thank God I don't work in England! I can see nothing positive for GP's in this - only negative point after negative point. No agreement on pay uplift ("subject to the usual DDRB process" and we all know that means another pay cut) and loss of seniority. Add to that the NHS pension robbery that is taking place, loss of control of your practice boundary and taking over 24 hour responsibility for no additional pay (remember they took that money off us in 2004). So when you are sick to death of trying to justify your self published earnings to opinionated patients who despise you anyway, try and reflect what a great job the negotiators have done.

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