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CAMHS won't see you now

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)

  • Dear Dr Nagpaul
    I believe the BMA has made it worse. We are a very high QOF achievers and most of this work is nurse led. This is taking 40% of this work away from nurses and dumping it on the GP. We see more added work --more work on appointments/home visits on just picking up the phone by elderly pt's relatives, the social worker, the district nurse, OOH services etc etc " dump it on the GP". On the over 75 we find most issues are minor medical problems but the health impact are social- from poor heating, poor nutrition, social isolation rather that a specific core medical problems. We now are the carer- legally responsible on the over 75's.If anything goes wrong on this class of pt, "say an unavoidable death" we are legally responsible and in court or the GMC complaint . In this group, the medical care and social care cannot be clearly differentiated and is a grey line. The buck( the legal liability and full responsibility ) stops at the GP!!!! Does anyone out there thing law is better career?

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  • 10.00 It's true! The GPC have repeatedly failed in pension negotiations although we are still shoveling cash at anyone over 60. They now agree that younger GPs will loose out on seniority payments. This represents a net transfer of resources to those who still have the option of retirement. This breaks the traditional compact of passing wealth down generations. In fairness, I agree we're all being shafted but those under 40 are bearing the brunt of it. If you aspire to home ownership and a decent retirement then the only solution is to leave GMS before the Boomers run off with your future.

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  • 10:31 law is better always was always will be ..sure hard work conquers all but I know from experience it will all be the GP fault ....all others will step away and say GP should have known , families are absolved of all responsibility , unless I am mistaken here we are all potentially everybody's Mom Dad and Guardian ....unless there is a profit a sent to one office for all the social care , one for all secondary care but even after all that it's a huge lawsuit coming a huge law suit coming
    Lawyers love it they will all have jobs , increase GMC staff jobs , probably lots of destruction of doctors families , divorces , suicides -- all hidden or worse still blamed that the dr could not handle stress and hence could not be doctors etcbetc ---but we have to wait and see
    I believe this is a win win for patients and that is what will always be the guiding rule , doctors we are born to serve the patent be it rain snow or hell , as a vocation we must not complain never utter a word abut our health as doing so will make us look unfit and need I really elaborate
    Soon we will run or told to run the community as. Hospital ward without adequate staff, adequate investigations , adequate monitoring , adequate anything ,daily ward rounds to all the Homes ie houses and care homes pre surgery post surgery ..and if anything ever is not just right we will get hauled up the the GMC, and we all know what happens there
    The above is an opinion and maybe things will be totally different so we wait and see

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  • Boomers rob generation X? I am a 'boomer' and marvel at these comments. Being female and having the temerity to have a family (when the profession was still male dominated) early on I spent several years in low paid (but long hours) salaried partnership which had a hugely detrimental effect on my eventual pension, which was reduced even further by me retiring a couple of years early. For some 20 or so years my pension contributions did not provide 'widower's' benefits even though I paid exactly the same as my male colleagues. A challenge to Europe made the change but it was not backdated so my other half will only get a small proportion of what I paid for if I go first. But that said, I still get a comfortable sum - GP pensions are generally excellent so there is a lot of wriggle room.

    There was no working time directive for my hospital years and the vast majority of my GP working life involved 24 hour responsibility for patients - including being contacted by other ooh providers for information even when I wasn't on duty. It wasn't a big deal, it was just what we did.

    The new contract sounds good in part, especially reduction in QOF - I hope that eventually disappears completely as, for me, that was the thing which had the most detrimental effect on enjoyment of the job .

    Big shame about seniority pay but, dare I say it, more money need not be the only thing worth hanging on for - GP offers a great range of opportunities to enhance work satisfaction once you've got to the point when the core work fails to challenge as much... and you may even get extra pay for some of it. I thoroughly enjoyed the extra (unpaid) stuff I did in the latter years and it was only when I was unable to keep that going that I decided to retire.

    A curate's egg indeed. Headline in the Telegraph (dreadful rag - I only look online to see the Matt cartoon) reads ' New GP contract heralds return of 'proper doctors' ' Were we ever anything else?

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  • 11.10 I agree the Boomers have worked hard for what they have but as a cohort, they have an infinitely better deal from a financial perspective. Unfortunately women's role in the workforce has never been appropriately recognized or remunerated but at least you had the option to retire early. This will be impossible for Gen X and the deal is becoming so poor that few younger GPs can afford take on unpaid work. I doubt we'll see all that QOF money that has just been extracted either!

    I don't remember the rotas changing much when EWD came in, the hospitals just started pretending we were doing less hours!

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  • Does declaring net income mean all GPs (and practices) will be forced to move to a single year end?
    The HSCIC figures for GP income from NHS sources come out 2-3 years after the end of the financial year at present - and I would have thought personal income was personal information under the DPA?

    I'm very interested in obligations over SCR: it looks as though firstly signing up practices for SCR will become contractual obligation and secondly SCR will have to be redesigned to allow individual patient access. What happens to RBAC security measures?

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  • Doc's please read through the contract changes slowly. There is a lot of good in this, its not all good but when ever was it. I appreciate the GP bashing has gone on a little longer that Health Visitor bashing and the Daily Mail diatribe has taken its toll. But!! there really is some good stuff in these changes, for patients GP's and their teams.

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  • I've jsut done a count - we have 741 patients who are above 75 years (and counting). That's almost 10% of our practice list.

    We have 4 full timers. That means each of us will have to somehow personally know 185 patients each - that's even before having to know some who are under 75! Even if I saw them once a month at the surgery, it will take me more then a week to see all of them. If some of them are house bound, it'll be more like 2 weeks of full time work to see them all.

    So does this mean anyone under 75 should be told their GP appointment is effectively halved?

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  • We should have seen the GP contract and voted on it.
    Some policies show politicians out of touch with medicine.

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  • 12.34pm
    I agree this is a bad deal and see nothing good but helps a politician- JH- to say GPs "will" reduce hospital work and admissions. Just dump it to the GP - have a hospital bed at home!.

    This will take time away from the 92% of our patients who equally need doctors on same basis. We now have even a more-- very stressed, overworked, GP who will now have a full legal responsibility- more juice for the lawyers.

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