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One-third of GP pay will come from points scored in quality framework

The quality and outcomes framework of the new contract will make up one-third of GP income and has been backed by a Government cash injection of £1.3 billion.

Points will be allocated and GPs will be able to score a maximum of 1,000 points, plus a bonus of 50 if they meet the 48-hour access target.

The 1,000 points are divided into clinical markers in the group (550), organisational areas (184), additional services (36), patient experience (100), holistic care (100) and a quality practice payment (30) (see pie chart right).

Coronary heart disease is the biggest clinical marker, with 101 points. Other markers include epilepsy, asthma, COPD, mental health, cancer, hypothyroidism, stroke or TIA, diabetes mellitus, hypertension and left ventricular dysfunction.

Organisational areas include keeping records, medicines management and practice management.

The additional services, which GPs will be able to opt out of and exclude patients who give their informed dissent, include cervical cytology screening, child health surveillance, maternity services and contraceptive services.

GPs will be able to receive 'holistic' points for improving care across a clinical marker and quality practice points for improving services across organisation, patient experience and additional service markers.

GPC negotiator Dr Peter Holden said GPs would already be doing most of the work to meet quality targets. RCGP chair Professor David Haslam said the average GP would be on about 500 points.

Dr Holden said practices would receive money in advance for equipment and staff and monthly aspiration payments would increase as GPs aimed higher.

He said GPs should count data for as many markers as possible, decide where they stand on the points system and discuss with their primary care organisation how high they wish to aim.

GPs who over-achieve will be paid in full.

Dr Holden said auditing the quality framework would generate a normal workload and 'very little paperwork'.

Patients who refused to

attend on three occasions or who had given their informed dissent could be excluded from quality pay calculations, he added.

GP services under the new contract

'Normal' services

Essential ­ mandatory: management of all conditions where recovery is expected; chronic diseases; general management of terminally ill patients

Additional ­ mandatory unless in 'exceptional' circumstances: general preventive services including MMR vaccination and other childhood immunisations

'Enhanced' services ­ generally opt-in

Direct enhanced ­ opt-in but obligatory within PCO: include flu immunisations and improved access

National enhanced ­ opt-in: services requiring specialist skills, facilities and equipment such as anticoagulant monitoring, nursing home work

Local enhanced ­ opt-in: services for specific local needs offered across PCO


One-third of GP pay will be for essential services, one-third for additional and enhanced, and the final third will come from the quality framework

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