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At the heart of general practice since 1960

Department of Health publishes details of proposed GP contract changes and paves way for imposition

 

The Department of Health has launched a 12-week consultation on its proposed changes to the GP contract ahead of a possible imposition – and has revealed it plans to distribute any funding uplift next year unevenly between practices.

The DH, which had previously offer a 1.5% uplift in GP funding, said that any uplift would now be decided following recommendations from the Doctors’ and Dentists’ Pay Review Body in February.

It said any overall would be ‘distributed in a way that gives some increase to all GP practices but is targeted towards those with less current funding per patient’.

(CLICK HERE FOR FULL COVERAGE OF THE GP CONTRACT CONSULTATION)

The DH also announced the investment of up to £10m annually in two new GP-led vaccination programmes for rotavirus and shingles.

As expected, the DH is pushing ahead with changes to the QOF, raising thresholds, removing £164m in funding from the organisational domain and introducing new indicators recommended by NICE.

It is also a series of new services covering the assessment of patients with dementia, improving care management for frail older people and online patient access.

The DH admitted this would create more work for GPs to achieve the same amount of funding.

It said: ‘This means GPs will be delivering more to retain the money they were getting under the old organisational indicators. The NHS Commissioning Board will develop more detailed specifications for these new schemes.’

Plans to phase out the MPIG over seven years are also included in today’s consultation.

The GPC and other stakeholders have been given 12 weeks to respond to the consultation, after which the changes could be imposed.

Responding to the announcement, GPC chair Dr Laurence Buckman said: ‘Practices are already under huge workload pressures and we have real fears that these proposed changes will result in an even greater load at the same time as forcing through a reduction in core funding. The Government’s proposals may sound attractive on the face of it and some of their suggestions are good, however they have not fully considered the overall impact on practices of all these changes being implemented together.’

‘The BMA will closely analyse the details of these complex proposals. We are open to real dialogue with the government about the impact of these changes as part of its planned consultation.  We hope that ministers intend to engage in a meaningful discussion and that they will listen and act on concerns that are raised, particularly where their proposals are unworkable or will lead to unintended consequences.  We would be extremely disappointed if this consultative process was a rubber stamping exercise for their existing plans.’

 

The changes in brief

The main changes proposed in the consultation letter include:

- The Minimum Practice Income Guarantee will be phased out over seven years as part of the contract.

- Any overall increase in the value of GP contract payments, which will be decided following recommendations from the Doctors and Dentists Pay Review Body in February, will be distributed in a way that gives some increase to all GP practices but is targeted towards those with less current funding per patient.

- All recommendations by the National Institute for Health and Clinical Excellence (NICE) for new and improved indicators to the Quality and outcomes Framework will be implemented in full.

- QOF reward thresholds will be increased so that more patients benefit from the best evidence-based care that can help to save lives.

- Organisational QOF payments will be discontinued releasing £164m which will be used to help fund improvements in patient care through the implementation of all the NICE recommended changes and the commissioning of extra services from GP practices.

- It will stop some GP practices receiving thousands of pounds more than others that care for a similar number of patients with similar patient needs.

- The extra services to be commissioned from GP practices will cover: 1) improving the assessment of people with dementia 2) improving care management for frail older people and other high risk patients at risk of unplanned hospital admissions 3) using technology to help monitor the health of people with long term conditions and improving online access to services.

- This means GPs will be delivering more to retain the money they were getting under the old organisational indicators. The NHS Commissioning Board will develop more detailed specifications for these new schemes.

- The Department of Health is proposing investment of up to £10 million annually (depending on take up) to GP practices for two new vaccination programmes for rotavirus and shingles.

 

Click here to read the full proposed Statement of Entitlement from the DH as outlined 6 December

Readers' comments (16)

  • David Bush

    For 'a 12 week consultation exercise' read 'we will impose this in 12 weeks time'.

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  • The DOH plans to introduce massive QOF changes at the very time that CCGs are due to go live.

    Faced with potentially massive and costly QOF changes all GPs can legitimately state that they are temporarily too busy with practice matters to participate in significant CCG activity. CCG Board Members, of which I am one, simply write to their Board stating that their partners have temporarily withdrawn their support for them being out of the Practice and that therefore they will have to have a leave of absence.

    Any GP who stepped up to replace their colleagues would have a tough job justifying their action.

    The duration of the temporary absence will of course be determined by the willingness of the DOH to stop dicking around.

    CCG Board Members will of course temporarily lose their CCG funding but given tax and superann deductions this is frankly not an issue.

    Simples?

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  • This is what the hard end of QIPP looks like, no doubt a nasty shock to anyone that thought primary care was immune.

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  • If enough of you start to go semi-private, you will have more time for patients, less stress and maintain income - it worked for the dentists!

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  • GP's you must refrain from assisting /forming the CCG's and get back to the shop floor. Be doctors not the DOH puppets of disater

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  • You would have to have been hibernating for the last few years to think primary care is immune - most of us felt it is completely the opposite!

    I'm currently trying to persuade my partners to decide between taking a big pay cut or consider reducing the level of service provided. I'm loathed to do the latter but what choice do we have? I'm not prepared to work 50+ hours whilst spending more than 10% of my income on professional fees and have another 10-30% reduction income next year!

    Having said that, I might invest in shares in towels now - a lot of us will need it to throw it in.

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  • silver surfer

    It would appear that Laurence is saying that GPC is going to go back to the negotiating table again.What exactly is he negotiating?This is an implementation document not a negotiating document.Who wants to talk with a gun to their head?Where is our Leadership.............

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  • To Anonymous - 07 December 2012 11:19am

    We've been dealing with QIPP for several years and never thought primary care was immune. We've been making "efficiency savings" for so long there are none left to make - so we either accept a pay cut or start really cutting back on necessary patient services. The vast majority of GPs will do the former however much we dislike it.

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  • Nhsfatcat

    The government/Department of Health has absolutely no idea on what is happening with patients and their doctors in primary care. A lot of us may be complaining about pensions and finance but this has to be seen for what it actually is. GPs are sick to death of additional workload that adds nothing to patient care and the running of a decent service. It is not just the administrators it is also the complicity of general practitioners and their nursing and consultant colleagues excepting yet another referral form, patients pathway, cut pressure to overbook etc... As the energy, will and rewards (yes we do deserve to be paid) filter away, so does our professionalism and a willingness to remain in the job-making pension changes irrelevant and with us being complicate in the end of a decent NHS for all!

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  • As regards GP's going private, this may not be as good an option as it was for Dentists. Many patients already bypass the GP where possible due to access issues e.g. A&E or nurse led minor injury/illness due to access issues. As patients we are already used to seeing a Nurse rather than a GP for many consultations and thus it would not be such a leap for GPs to be removed all together.
    QOF has long been a tick box money spinner, with more intelligent data flowing round the system in the future, it will be much harder for claims to be made without demonstrable improvements to patient care. Gaming will always occur, but we have seen few benefits for consumers (in our case patients) in other areas of privatisation. Costs more, get less.

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