GP contract: the headlines in full
All you need to know about the 2020/21 GP contract in England
The 2020/21 contract has now been agreed after a rocky few months of negotiations. We will be updating this constantly, so check in throughout the day.
The main headlines so far:
Partnership £20k boost
To boost the GP partnership model, from April 2020, the 'new to partnership' payment guarantees first-time partners a £20,000 one-off payment, plus £3,000 funding for business training. This will extend to practice managers and other practice staff.
This is part of a £94m to address recruitment and retention issues
Increased funding into the contract which should allow for an above inflation pay uplift, as agreed in the 2019/20 deal.
There will now be given 100% reimbursement for all additional staff recruited via the primary care networks. PCNs will be able to recruit around seven staff for 2020/21, with funding totalling around £344,000.
More roles are now added to the scheme from April 2020, at the request of primary care network (PCN) clinical directors. PCNs can now choose to recruit from the following roles within the scheme, in addition to those previously agreed, to make up the workforce they need:
- Pharmacy technicians
- Care co-ordinators
- Health coaches
- Occupational therapists
- possibly advanced nurse practitioners
Mental health professionals will be added from April 2021 following current pilots – including IAPT therapists.
As announced by the Conservatives ahead of the election, 6,000 extra staff are funded by Government…..expanding the scheme to 26,000.
Reimbursement now increases from the current 70% to 100% for all 26,000 roles.
More trainees & GP training length change
GP trainee numbers increase to 4,000 a year from 2021 – up from current 3,500. From 2022, 24 months of the 36-month training period will be spent in general practice, instead of the current 18 months.
The Targeted Enhanced Recruitment Scheme (TERs), which offers a payment of £20,000 to GP trainees in hard-to-recruit regions, will be expanded: from 276 places now, to 500 in 2021, and 800 in 2022, encouraging trainees to work in under-doctored areas
From 2020/21, all international medical graduates entering general practice training will be offered a fixed five-year NHS contract.
Return to practice scheme
From April 2020, GPs on the Induction and Refresher Scheme with children aged under 11 will be able to claim up to £2,000 towards the cost of childcare for each child whilst on the scheme (or £1,000 for those on the Portfolio Route
‘Patient experience’ measure
An improved appointments dataset will be introduced in 2020, alongside a new, as close to real-time as possible, measure of patient experience.
As agreed in the five-year deal, a new, as close to real time as possible and transparent measure of patient experience will be designed and tested in 2020, for nationwide introduction by no later than 1 April 2021
The new PCN Investment and Impact Fund (see further below) in 2021/22 will support improved access for patients - with money aimed at improving access starting at £30m a year and rising to at least £100m of the £300m fund in 2023/24. A new GP Access Improvement Programme will identify and spread proven methods of improving access including cutting waiting times for routine appointments.
Progress against the new patient reported experience metric will be supported by the new PCN Investment and Impact Fund in 2021/22, when at least £30m of the £150m Fund will be directed at improving access. However, we intend to introduce the measure as early as possible across all practices in England during 2020/21, and to begin incentivising performance against it at the equivalent rate of £30m/annum pro-rata.
Vaccinations and immunisations will become an essential service in 2020. New contractual core standards will be introduced.
Item of service payments will be introduced and standardised across all routine programmes over the next two years. This will begin with measles mumps and rubella (MMR) in 2020/21 and extend to other vaccines from April 2021. New incentive payments will be introduced to maximise population coverage as part of QOF, replacing the current childhood immunisation directed enhanced service (DES).
The asthma, chronic obstructive pulmonary disease (COPD) and heart failure domains have been overhauled, with 97 points recycled into 11 more clinically appropriate indicators.
£10m of additional funding will support a new indicator on non-diabetic hyperglycaemia worth 18 points. This brings the total number of available QOF points to 567. In 2020/21, the quality improvement modules are learning disabilities and supporting early cancer diagnosis.
Maternity medical services become an essential service with a universal six-eight week postnatal check for new mothers, backed by £12m of additional funding.
A nationally consistent offer will be developed and discussed with GPC England and patient groups, reflecting what works best in existing local schemes.
The structured medication review and medicines optimisation, enhanced health in care homes, and supporting early cancer diagnosis service specifications have been revised following consultation and will be introduced in 2020/21.
But those covering anticipatory care and personalised care will be held back and developed further, despite initially being planned for 2020/21.
These and two other service specifications – CVD diagnosis and prevention, and tackling inequalities - will be introduced in 2021/22, following negotiation with GPC England.
The proposed requirement for fortnightly face to face medical input to the care homes is replaced with a requirement for medical input to be ‘appropriate and consistent’ but with the frequency and form of this medical input to be based on local clinical judgement by the PCN.
A new care home premium payment worth £120 per bed per year will be introduced when the service goes live from 30 September 2020.
By 31 July a delivery plan for the new service will be agreed.
Structured medication reviews
The volume of structured medicines reviews undertaken will be ’determined and limited by the clinical pharmacist capacity of the PCN’.
Impact and Investment Fund
This is new money related to NHS long-term plan goals. It will operate in a similar way to QOF.
Eight indicators are included in 2020/21, relating to seasonal flu vaccination, health checks for people with a learning disability, social prescribing referrals, and prescribing.
The fund will be worth £40.5m in 2020/21, increasing to £150m in 2021/22, £225m in 2022/23 and £300m in 2023/24.
Opting in/out of PCNS
NHS England and GPC England will support PCNs to have stable membership through the introduction in 2021/22 of auto-enrolment for existing practices and PCNs, combined with an annual one-month window in which practices will be able to opt-out of the network contract DES, or opt-in if they are not currently participating.
Removal of violent patients
The regulations currently enable a contractor to remove a patient from their list if they become aware the patient has previously been removed from another GP practice list for committing or threatening an act of violence.
The change will clarify that patients should not be removed from the GP practice list if, having been previously removed from a GP practice list and entered into a ’special allocation scheme’ for violent patients, they have subsequently been discharged for reintegration into mainstream primary care.