What could be in this year’s GP contract?
Jaimie Kaffash looks at what might and might not be included
We await with bated breath news of what the deal might be for English GPs from April. This year’s GP contract is expected to be one of the most important in recent years, being the ﬁrst since the publication of the GP Forward View, which promised a funding injection of an extra £12bn a year by 2020.
Negotiations have been held up because the Government has been preoccupied with Brexit, and there is the added complexity of a new Prime Minister in Number 10.
Here, Pulse looks at what you could expect to see in the new agreement.
What we can expect
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The most anticipated announcement will be further details on the future of the QOF.
There is a desire from all parties to end the box-ticking and bureaucracy involved with the QOF, and the 2016/17 contract agreement explicitly stated this year’s round of talks would ’explore’ a complete abolition of the QOF in England.
But don’t expect the framework to disappear completely. NHS England chief executive Simon Stevens said last month that the plan was not to go ‘cold turkey’ on the QOF by withdrawing it this year but to look to replace it by 2018.
The discussions are almost certainly revolving around what will replace it.
This won’t be an easy decision and the big question, of course, will be what happens to the money – roughly 15% of practice income. The GPC will want it to go straight into core funding rather than adding any new work for practices, but this cannot be guaranteed.
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NHS England’s GP Forward View last year committed to increasing the funding for general practice by 14% by 2020 - £2.4bn a year. However, there has been no indication whether this will go in to core practice funding.
We do know that the Government has said that GPs should receive a 1% pay rise this year. However, what this actually means in practice is far from clear cut.
GPC and NHS England are negotiating how much practices should receive as a total funding uplift, including expenses.
For example, last year, the 1% pay rise translated to a 3.2% funding uplift overall. With the extra funding coming in through the GP Forward View, it is hoped that there will be a similar uplift – if not more – this year.
The GPC and NHS England are also discussing a reform for the mechanism to calculate expenses – which was a demand in the GPC’s Urgent Prescription for General Practice. GPC deputy chair Dr Richard Vautrey says a new mechanism ‘will give certainty to practices that their rising expenses will be covered’.
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The GP Forward View also committed to funding the increases in indemnity fees incurred by GPs in 2016/17, after NHS England acknowledged that indemnity fees were rising at an alarming rate.
It launched a review on how much would be a fair amount to reimburse practices, which revealed that the reimbursement was likely to be worth around 50p a patient – which practices will be expected to pass on to locums and salaried GPs too.
But the final figure may differ, based on the methodology they use.
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The CQC has hiked its fees by 76% for 2017/18, equating to an extra £2,000 for the average practice.
The Department of Health last year committed £15m for practices to cover the increases in CQC fees as part of the funding uplift. There has been no indication whether they will provide funding to cover the further increase this year – but it would be very surprising if they didn’t.
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Avoiding unplanned admissions DES
The 2016/17 contract also included a commitment to exploring the abolition of the unplanned admissions DES. It has been an unpopular DES since its introduction in 2014 and there has been little evidence to suggest it has been effective in preventing avoidable unplanned admissions, with a CQC report last year concluding that the care plans involved are not seen as an ‘effective document in the wider health and social care system’.
Again, it is not clear what will happen to this money. The GPC will push strongly for it to be reinvested in the global sum.
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A long-term contract
One of the demands of the Urgent Prescription for General Practice is a move away from annual contract negotiations.
This is a relatively easy concession for NHS England to make, and it is a good bet that this year’s contract will take a longer view than 12 months – including the possible abolition of the QOF next year.
What else to keep an eye on
GPC’s Urgent Prescription demands
The GPC called off a potential mass resignation of GPs last year after claiming that NHS England was considering the demands for the future of general practice outlined in its Urgent Prescription.
This included a call for a new mechanism to calculate practices’ expenses and a move to a longer-term contract – and these are likely to feature in the contract announcement.
But many of the other issues – including a cap on the number of appointments GPs should do in a day, 15-minute consultations, cutting down over-the-counter prescriptions and stopping non-NHS work such as confirming eligibility for bus passes and disability parking permits – are more likely to be passed to local commissioners for implementation.
Prime Minister Theresa May reiterated the Conservatives’ seven-day, 8am-8pm GP access policy last month (see page 19), but the GPC says it has been given guarantees that seven-day access will not form part of the GMS contract negotiations.
GPC Dr Chaand Nagpaul said: ‘I have spoken to NHS England and the Department of Health… and there will be no obligation on individual GP practices to be open for seven days, or beyond their current contractual hours.’
The health secretary plans to turn practices into ‘one-stop shops’, managing long-term conditions, such as end-stage renal disease, rheumatology and more complex cardiology, that are usually managed in hospital settings.
However, this will be done locally. The DH has told Pulse: ‘The secretary of state is thinking about local enhanced services, not a national scheme.’
Funding for atypical populations
NHS England is looking at new ways of funding ‘atypical’ practices that are ‘unavoidably small and isolated’, based at universities or have high numbers of patients who do not speak English.
It is unlikely to form part of the national contract for 2017/18, but NHS England has published guidance for CCGs and local area teams outlining how to identify these atypical practices, and how to allocate such funding in future.
Voluntary (MCP) contract
The voluntary contract announced by then-PM David Cameron in October 2015 is set to be rolled out this April in five pilot areas, which are setting up ‘multispecialty community providers’ (MCPs) – organisations run by GPs offering secondary care services.
Commissioners in the five areas said more details on the contracts would emerge this month.
However, we do know GPs can choose to take on the new contract at three different levels, allowing them to hold on to their GMS contracts if they wish, but also giving them the option of giving up their contracts and becoming fully integrated into an MCP.
What’s happening in the rest of the UK?
In 2014, Scotland officially left UK contract negotiations.
A three-year stability deal was agreed while working out a new Scottish GMS contract.
The contract was originally intended to be rolled out in full from this April but the Scottish Government and the GPC recently extended their stability deal until April 2018, telling GPs not to expect ‘big bang’ changes in 2017/18. The changes will instead be phased in over the next two years.
Practices have already stopped working to the QOF and, in October 2016, the First Minister committed to increase annual investment in primary care by £500 million by 2021/22, which will see the proportion of NHS frontline spending dedicated to primary care increase to 11%.
Again, though, it is unclear how much of this will be used to increase core funding.
The GPC and the Welsh Government have agreed to suspend almost the whole of the QOF until April, to free up GPs’ time.
The GPC and the Welsh Government are evaluating the success of the care homes and diabetes enhanced services and the item of service fee for vaccinations and immunisations. Once this is completed, negotiations for the 2017/18 contract will begin.
The Northern Ireland Government recently collapsed, and NI GPC chair Dr Tom Black has said he is seeking a contingency plan from the permanent secretary and the civil servants regarding negotiations for the 2017/18 contract.
He said he has made suggestions to them to reduce workload, such as stopping the QOF and enhanced services.
But this is amid the move by the NI GPC for all GPs in Northern Ireland to hand in their resignations from the NHS unless they receive a support package to alleviate the crisis in general practice.