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Landmark contract deal cuts QOF by 40% and boosts global sum - but will force GPs to publish their pay

GP practices will have their QOF work slashed by almost 40% next year as part of a sweeping new contract deal which will increase the value of the global sum, create a new emergency admissions DES and see GPs forced to publish their net pay.

Under the new deal, practices will see 341 out of 900 QOF points removed from the framework - the equivalent of £54,000 for the average practice - with the majority reinvested in core GP funding.

But in return, GPs will have to accept ‘named GP’ responsibility for all patients aged 75 years and older, publish their net income from 2015 and commit to police the care their patients receive from out-of-hours providers.

Seniority payments will be reduced by 15% each year and eventually phased out and practice boundaries will be abolished completely in October 2014, although practices will not have responsibility for home visits for patients out of their catchment area.

Some 238 points (£37,000 for the average practice) will be reinvested in the global sum, and a further 100 points (£16,000 for the average practice) from the axing of the quality and productivity domain in QOF, will be ploughed into into a new ‘inappropriate hospital admissions’ DES. Three points will be invested in the learning disabilities DES.

The new DES will mean GPs will have to case-manage vulnerable patients and allow emergency providers to contact GPs to decide whether patients should be admitted to hospital or A&E.

Practices will have to publish the ‘full net income’ of their GPs from 2015, in line with the Government’s drive on transparency on public sector pay. But the BMA said that any changes would only be made alongside other healthcare professions.

A statement said: ‘We have negotiated the establishment of a working group to ensure that the calculation and publication of earnings are on a like-for-like basis with other healthcare professionals and that the published earnings would be GP NHS net earnings relating to the contract only.’

The main thrust of the changes to the GMS contract for 2014/15 are:

  • Reducing the size of the QOF by 341 points, with 238 QOF points being put into the global sum;
  • A new DES to prevent patients being inappropriately admitted to hospital, with an overall budget of £162m. This will replace the current risk-profiling DES, with extra funding from the removal of 100 QOF points from the quality and productivity domain;
  • Practices will have to publish the full net income of their GPs from 2015;
  • Complete abolition of practice boundaries from October 2014, although NHS England local area teams will take responsibility for the home visits of patients from out-of-area patients,
  • A new contractual obligation for GPs to monitor the quality of out-of-hours services when used by their patients and report any concerns;
  • Reduction of seniority payments by 15% each year, with no new entrants from April next year;
  • ‘Named GPs’ will take on accountability for patients over the age of 75, to be the main point of call for providers outside the practice;
  • Practices will have to display the result of their CQC inspection in the waiting room;
  • The introduction of the Friends and Family test from December 2014 asking patients how likely they are to recommend a GP practice;
  • The introduction of new IT systems including the ability for patients to book appointments online and access their Summary Care Record

GPC chair Dr Chaand Nagpaul said that the new deal would deliver real benefit to patients and help ease the pressures on GPs.  

He said: ‘The BMA believes that through constructive talks we have reached an acceptable deal that will help to relieve workload pressures on GPs and is a first step towards enabling general practice to meet the challenges that it faces in the coming years.’

RCGP chair Professor Clare Gerada said: ‘This is welcome news for patients and for GPs as it will help us to get back to our real job of providing care where it is most needed, rather than more box-ticking.’

Dr Peter Swinyard, chair of the Family Doctor Association, also broadly welcomed the deal, but he warned that the ‘devil is in the detail’.

He said: ‘I think this is a good deal for GPs as it will take off many of the things we have been arguing about for the past year or two. It will reverse some of the complete daftness of the contract imposition from last spring and it will allow GPs to have a little more headroom to look after people and start planning care rather than spending their entire lives ticking boxes or going through their colleagues’ notes to check boxes were ticked.’

Dame Barbara Hakin, chief operating officer and deputy chief executive at NHS England, said: ‘As a GP myself for many years, I know the importance of being able to do what we have been trained for - to use our professional clinical judgment to provide care and treatment that meets all aspects of a patient’s needs.’

‘We know that patients who receive a proactive and coordinated health and social care service are less likely to need to be admitted to hospital. In fact a fifth of hospital admissions could be avoided if this happened every time, and we know that this is particularly important for the most vulnerable patients with complex needs where properly coordinated care makes such a difference.’

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Readers' comments (74)

  • Its a shame that I learnt about MY contract changes from the BBC news this morning rather than from the BMA yesterday.

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  • Sadly there will never be enough money to save the NHS, its up the creek without a paddle. What is needed is more Drs providing private health care in more private hospitals and clinics, and a change in the attachment by the general public to a failing NHS which will always let them down. Please don't believe if we keep plugging away in this vein, that the headlines in 10 years time, with an ageing population and scant resources will be any better. Paying doctors more won't work, deckchair shuffling schemes won't work. With a huge expanse in private health care and acceptance of this by the public, there could be enormous pressures taken off the NHS, resulting in a much better service for all. Sadly not only patients but also doctors are against this expansion. Can't see it happening. But only a paradigm shift will improve matters.

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  • The GMS contract already requires a GP to care for any patient who is physically in their practice area as a temporary resident, either in the surgery or on a home visit. There is no fee payable for this.
    So, register near work and your " home GP " will visit for free when required. Urban GPs will get the funding and not do the home visits, commuter belt GPs will do the visits and not get any funding. Fab!

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  • reduce earning by reducing qof point and in exchange take responsibility of ooh. they call it exchange? money saved will be ploughed in. would we see money in gp's pocket? if gobal some goes up but a practice has high correction factor they will have net pay cut? whar are the benefit of declaring gp's net income?

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  • The death spiral continues apace,this is really going to save the NHS!

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  • Seniority payments were the only thing that stopped me from becoming salaried or locumming previously. Now there will be absolutely no advantage and certainly lots of disadvantages to being a partner. I know what I am going to do

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  • Patient registered with a GP near work gets flu/ URTI/ has operation and requires certificate or management of post op complication. Not well enough to commute to GP so needs surgery appointment near home. Again, I suspect they will be seen by local GP as a temporary resident for free.
    It's not just home visits that need to be funded.

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  • Once again the Boomers rob Generation X. I presume they agreed for us to publish our falling incomes so they can have a laugh at our expense. GMS is dead - time to walk.

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  • What does 24/7 actually mean -- does it really mean anytime of the day weekend night try can call me and say give me a history diagnosis etc etc , what if the patient has registered 1 week ago ? What if they are from Europe with no history so far ? What if they have a whole list of problems ,register and then do not come for 3 months ---should one read every body above 75 commit to memory --I am not sure if a hospital doctor knows all the ward patients especially if it's post take
    What if I am on a honeymoon , kids birthday ,bankruptcy discussion with bank-- it happens even to us --- what if am at a funeral ?
    What exactly does anyone know what this means

    And yes please explain net income ? Just how is that relevant to anything except I suppose one will suddenly see that most of do not get anywhere near what is quoted , and then I suspect one will be penalized for poor management and business acumen and then a bankruptcy , foreclosure discussion etc etc

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  • How the hell do you interpret this as " boomers rob generation x"?
    I am younger than a boomer but feel we are all being shafted. More experienced GPs now have NOTHING to work for. No career progression, no seniority pay, no allowance or credit for hard work, extra qualifications or experience. Once you become a parity partner, that's it. No progression to aim for within a practice except for your own self esteem.
    It is the government who have done this, not baby boomers.

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