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Analysis: UK countries go their own way on the GP contract

GPs in different parts of the country are set to have subtlety different contract terms from April, here are the changes that have been agreed so far

ENGLAND

Status: After UK talks broke down, the Department of Health said it would seek to impose the deal on English GPs. A formal consultation is ongoing with the BMA.

Uplift: The Department of Health initially offered a 1.5% funding increase, but this may change as ministers said they would take the Review Body on Doctors’ and Dentists’ Remuneration’s recommendations into account. They also said it would be targeted towards those with less current funding per patient.

QOF:  The entire organisational domain will be removed, apart from the quality and productivity indicators and some public health points) and QOF upper thresholds will be increased to the achievement of the top 25% of practices for 20 indicators. All new QOF work recommended by NICE will be implemented, including removing 14 indicators and introducing new ones for cancer, diabetes, asthma, depression and hypertension. Most QOF indicators will move from a 15-month to a 12-month window, a public health domain will be introduced, and the way QOF points are calculated will be revised to take into account rising list sizes.

DESs: Funding ‘released’ from retiring QOF indicators will be used to create four new DESs: dementia case-finding; case-management of patients at risk of hospital admission; online access to GP services and telehealth for certain patients with long-term conditions.

Other: MPIG will be phased out over seven years from 2014/15, alongside an adjustment of the Carr-Hill formula to take account of deprivation. GPs paid for two new vaccination programmes for rotavirus and shingles, and the responsibility for locum superannuation payments will be placed on individual practices by moving funding into the GMS contract.

Workload rating: *****

SCOTLAND

Status: Deal has been agreed with Scottish GPC

Uplift:  Decision pending a recommendation from the DDRB.

QOF:  The organisational domain is removed, but 77 points’ worth of funding will be moved back into the global sum. Majority of NICE’s recommendations will be implemented, but some ‘unworkable’ indicators will not be included and others have wider exception reporting requirements. A new ‘patient safety’ indicator will be introduced and public health and medicines management domains will be introduced. There will be limited QOF threshold increases, with none set above 90%.

DESs: No new DESs.

Other: Decision on the removal of MPIG has been deferred.

Workload rating: ***

WALES

Status: Deal has been agreed with Welsh GPC.

Uplift: 1.5%, unless the DDRB recommendation is higher.

QOF: Fifty-nine organisational QOF points are retained, the remainder of the domain scrapped with the points to be reused elsewhere in QOF. All QOF indicators recommended by NICE will be implemented, as in England, but with some concessions and some not included at all. Upper thresholds will rise according to median achievement over two years. Changes to hypertension indicator (HYP3) introduced, the target goes from 150/90 to 140/90, but the thresholds for this indicator will not be changed. The A&E quality and productivity indicators will be removed and re-invested in the global sum.

DESs: No new DESs.

Other: MPIG will be retained, but discussions over more equitable funding will take place. GPs paid for two new vaccination programmes for rotavirus and shingles, and the responsibility for locum superannuation payments will be placed on individual practices by moving funding into the GMS contract.

Workload rating: ****

NORTHERN IRELAND

Status: At the time of writing, negotiations were still taking place in Northern Ireland

Click here for Pulse’s news story on changes to the Welsh contract

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