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GP practices to be guaranteed £95 per patient by CCG

GP practices across a whole area are set to receive a guaranteed £95 per patient funding from April as their CCG invests £3.4m as part of a move to co-commission general practice.

The ‘Bolton Quality Contract’ will see practices’ core funding brought up to £95 in return for meeting a number of ‘quality standards’, including practices agreeing to a transfer of work into general practice where this is ‘clinically appropriate’ and working proactively to anticipate and prevent emergency admissions, NHS Bolton CCG board papers revealed.

Under the plans, practices will be paid 60% of the extra funding for meeting four mandatory standards which besides the work transfer and emergency care planning also includes a commitment to cooperate with the CCG’s co-commissioning agenda and do blood testing on site in practices.

The remainder of the extra funding is paid in return for providing services such as:

  • Physical health checks for people with learning disabilities;
  • reducing wasteful prescribing;
  • reviewing urgent care cancer presentations or referral DNAs;
  • positive patient ratings in the Patient Survey.

This represents one of the first finalised plans for CCGs to commission primary care and the CCG said it was in response to primary care being stretched. To date, 37% of CCGs have applied to take on full delegated commissioning responsibility for general practice - one step further than NHS Bolton CCG. Meanwhile the deadline to apply to commission GP services jointly with NHS England only expired on Friday last week.

Running as an add-on to the core contract, the Bolton contract will be applicable to GMS, PMS and APMS practices and be separate to their performance payments against QOF and DESs. The Bolton contract will also exclude LESs that can only be done in specialist practices, such as anticoagulation or insulin initiation and management. However the LESs which the CCG deems can be done in any practice will be performance indicators under the local contract, such as for example sexual health clinics, health checks and glucose testing.

The scheme, which has been approved by the CCG board, is set to be run under a joint co-commissioning arrangement with NHS England, Bolton Council and Public Health England. The core element of the contract will continue to be commissioned and performance managed by NHS England.

The CCG is hoping the money will lead to increased GP capacity in core hours, so more patients can be seen within shorter waiting times and reduce pressure on emergency services. The largest budgeted saving however relates to reducing unnecessary prescribing.

Bolton CCG clinical director for primary care and health improvement Dr Stephen Liversedge said the contract was ‘a local response to a national problem’ of stretched general practice capacity.

He said: ‘For patients, this will mean better access, improved health outcomes through getting the very best care earlier, and and all-round better experience of using general practice. We have worked closely with out GP member practices in developing these plans and will continue to do so over the coming months.

‘Bolton practices will see increased investment and greater staffing capacity, which will allow them to deliver the standards of responsiveness and quality set out in the contract.’

Dr Tracey Vell, honourary secretary of neighbouring Manchester LMC, commented: ‘I have heard of it as Manchester CCGs have shown interest in it. As Greater Manchester LMC we have briefly discussed it and concluded that the indicators have to be useful [and] realistic… Apart from that, in principle I would welcome funding coming directly to practices to balance MPIG and PMS losses which may be coming.’

Meanwhile, NHS England is planning for general practice to be expanded to include services such as ‘step-down’ beds, homecare, counselling, dentistry and district nursing, among others as part of its pilots for new models.

The 19 elements of the Bolton Quality Contract:

Mandatory standards:

  • Transfer of Care
  • Phlebotomy
  • Emergency Planning
  • Membership Engagement

Paid-against-performance standards:

  • Access to General Practice
  • Best Care - Diabetes, Heart Failure, COPD, Asthma, High risk reviews
  • Cancer Referral
  • Carers
  • End of Life Care
  • Exception Reporting
  • Health Improvement
  • Health Protection
  • Mental Health
  • Patient Experience
  • Patient Safety
  • Prescribing
  • Referrals meeting evidence
  • Screening
  • Sexual Health

Source: NHS Bolton CCG

Readers' comments (19)

  • No doubt targets will be set so high, and increases every time the CCG are given a chance that a lot of work will be done without payment as the last few unreachable or engaging patients will scupper the whole exercise. Access to general practice just means all times of night and day right? sign up at your peril.

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  • Maybe it's just me but doesn't this remove the whole point of the Carr Hill type formula, ie giving extra to deprived areas? Seems to me you'd be working as hard for much less in those areas

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  • One of the problems with all local schemes (and most National ones) is that the funding has no guarantee that it will continue.
    There seems to be a mistaken view that the expenses are purely to set up a service - and any new service can then be assumed to be unfunded "business as usual".
    How will this be addressed?

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  • How may consultations a year does the CCG want supplied. That's the elephant in the room for most of us. For me it's 6 per patient which after pension payments tax and expenses to run the 'business' of being a GP leaves not a lot. The sooner we are on piece work the better but CCGs/HA/HMG know that we couldn't be afforded.

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  • Its £95 per weighted patient list, Ian (11.42)
    Virtually all the targets are set at a level that roughly 25% of practices already achieve, although there are some that are a stretch for everyone.
    And it only deals with in hours access. (10.54)
    I take Mary's point (11.54) - ongoing funding will depend on how we do.
    There are strict criteria about transfers of care overseen by a health economy committee including the LMC.
    And it is after all, all voluntary.
    Early indications are 50 practices out of 50 are going to sign up

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  • Interesting stuff. We will see a lot of this.

    Will the GP's have to take on extra indemnity for this new work.

    I would hate my premiums to rise because GP's elsewhere are taking on secondary care work.

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  • Today its a favour, tomorrow its your job … all the projects come with a catch!

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  • If the Carr Hill formula only pays you for ¾ of your patients this would come down to £71. There should be a guaranteed amount per patient and the Carr Hill formula should be scrapped.

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  • The Carr-Hill effectively pays me £54 per patient as calculated by HWCA up to year end the 31st of March 2014. £ 95 per patient is going to be WOW! but it probably won't happen in Medway and Kent due to 'historical' reasons ie a chronic lack of transparency.
    As for workload being increased, I think - it can't get worse.
    In my case, More Funds = More GP hours- which should actually make life a bit easier.

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  • One hand gives.
    The other takes away
    Plus ca change.....

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