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GPs to form 'clusters' to improve care in Wales, under new contract deal

GP practices will have to work in new ‘clusters’ to improve the co-ordination of care in Wales, under a new contract deal from April that will see QOF shrunk by a third and a final solution on withdrawing MPIG.

The GPC has agreed a new contract deal with the Welsh Government that will see clusters of practices - due to be formed under a new QOF domain worth 160 points - improve integration, collaborative working and tackle health inequalities.

GPs will also be expected to sign up to three new care pathways for cancer diagnosis, end-of-life care and the frail elderly that are designed to have a ‘high impact’ on reducing emergency and unplanned hospital admissions.

Some 300 points will be removed from QOF and moved into core funding and MPIG will be phased out over seven years from 2015.

The announcement from the Welsh Government says: ‘Practices will be required to participate in three national care pathways covering the early detection of cancer, end of life care and the frail elderly.

‘These national care pathways, which will have a high impact on reducing, where appropriate and in the best interest of the patient, accident and emergency admissions and unscheduled care admissions.

‘A national approach will enable both GP clusters and local health boards to benchmark within and across localities as well as across Wales. It is anticipated that this work will also foster the development of wider skills within general practice.’

The GPC said it had also achieved increased stability for GPs with an agreement between the parties to build on this contract deal over a three-year period.

GPC Wales chair Dr Charlotte Jones said: ‘We believe this will make a significant difference to GPs in Wales - removing unnecessary bureaucracy, reducing tick box medicine and enabling individual patient management.’

‘The networks are a prime focus of the contract changes and we believe that they are the way forward for general practice as GPs are ideally placed to use their innovative skills and knowledge of what patients need to design services for patients. It also fits with the Welsh Government’s strategic direction. This year’s framework will enable a consistent approach across Wales which will be built on over a three-year period.’

Commenting on the agreement to remove MPIG, which the Welsh GPC had strongly opposed, she said: ‘The MPIG proposal will no doubt cause anxiety for patients but we will be sending additional details to all GPs on the MPIG changes within 24 hours - the MPIG proposal will commence 2015 - each practice will get an individual letter so we would urge practices to wait for that.’

Welsh health Minister Mark Drakeford said the changes would remove the ‘treadmill of bureaucracy’ facing GPs.

He said: ‘We are both freeing up valuable time and putting more trust in the professional judgement of doctors, allowing them to treat their patients as individuals rather than to satisfy a set of criteria.’

‘We are also, by changing the funding formula for practices, addressing the inequalities in health which exist between the most and least affluent areas of Wales.It makes perfect sense for GP practices to work with each other to provide a wider range of care within geographical areas, which we will see happen more as a result of changes to the contract.’

Key points of the Welsh GP deal include:

  • A reduction of almost a third in the number of points in the QOF which GPs currently need to achieve in order to receive funding, from 969 points to 669 points
  • Beginning in 2015/16, the redistribution over a seven-year period of MPIG funding on a formula weighed needs basis. In order to protect those practices most at financial risk, income losses will be capped at 15% of global sum.
  • A small number of QOF lower payment thresholds will be increased to incentivise those practices who currently do not achieve QOF lower payment thresholds to improve QOF achievement
  • Practices required to agree a GP Practice Cluster Network Plan to improve care co-ordination, integration of health and social care and collaborative working with local communities and networks to reduce inequalities in health
  • Addressing A&E admissions and unscheduled care admissions through a requirement for practices to participate in three national care pathways covering the early detection of cancer, end of life care and the frail elderly.

In full: 2014/15 Welsh GP contract deal

Readers' comments (5)

  • Federations will only work between parties who want to, contractually obliging them is plain stupid.

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  • Nut clusters? Mmmm.

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  • Any news on seniority payments in the Welsh GP contract deal?

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  • The "clusters" have been in existence since QOF QP was introduced but outside of looking at the referral data, A&E data and developing / using cluster agreed pathways there has been marked variation in other work / engagement with cluster working across Wales. This variation is not the fault of anyone but if General Practice in Wales is to progress then we need to be maximising their potential over the next few years with year one being a foundation from which to build on. GPs are innovative, have excellent business acumen and natural leaders - they know what services their patients need and through working together can bring about improved services in their cluster area (and also ensure that where there are obstacles / gaps that feedback to the HB and WG will enable these to be addressed - this is all written into the framework). GPCWales knows that all too often the innovations suggested by GPs are either piloted with non recurring funding or nothing happens leading to loss of engagement and enthusiasm. This is an opportunity to address this, and if we are truly serious about making a difference and potentially holding budgets and managing community staff (note wording - not holding their contracts) then we need to start the process by gearing up and supporting the clusters.
    There is no suggestions of forcing practices to federate / merge - as the first poster says - you can't just force this, it has to be wanted. However, working closer together may naturally lead to this happening for some practices or there may be opportunities for practices to share staff / streamline working practice.
    Seniority is staying in its current format in Wales.
    I hope to see GPs at the roadshows (dates to be announced shortly) so that we can give more detail on the contract detail and cover any other issues you may have.
    Regards, Charlotte

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  • The Mpig withdrawal will have severe consequences for patient populations relying on branch surgeries. Of that there can be no doubt whatsoever. To mitigate this or in some cases even to survive this catastrophic onslaught, multisite practices all over Wales (rural and urban) will be forced either to close branches and/or run run considerably fewer parallel opening surgery sessions in those branches that remain in order to survive.
    Welsh government is in effect driving out general practice from more remote communities by forcing this through, despite the brave face put on it all by our well intentioned but ignored negotiators efforts to explain these consequences to mark drakefords minions.

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