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Scottish GP contract: what is proposed?



Funding

  • From April, 2018 a three-year transition period will start with a new funding formula underpinned by additional investment of £23 million and a guarantee no GP will earn under £80,430.
  • No practice will lose funding under new arrangements.
  • The GPC estimates two-thirds of practices will receive a funding boost.
  • The current minimum practice income guarantee and ex-QOF funding will be consolidated as new global sum.
  • A minimum earnings expectation for GP partner whole time equivalent will be introduced from 2019.
  • In 2020, a second round of negotiations will see the GPC proposing pay comparable to consultants and direct reimbursement of practice expenses – subject to second poll of profession.
  • In small remote GP practices, extra resources will continue to be made available to ensure long-term sustainability and such practices will continue to provide a broader range of services.

Role of the GP

  • The GP as expert medical generalist will focus on undifferentiated presentations, complex care and quality and leadership.
  • GPs will be supported by an extended multi-disciplinary team responsible for some of the activities currently being performed by the GP, including prescriptions, acute and minor illness, and chronic disease management.
  • Among other things the GP will be responsible for care planning for patients with complex needs.

Workload

  • From April 2018, one session per month extra protected time for clinical leadership extending to regular protected time for every GP.
  • Responsibility for vaccines to move to NHS boards, maternity and contraception services also to continue to be provided by community teams but with no loss of funding
  • A community treatment and care services team will manage minor injuries and dressings, phlebotomy, ear syringing, suture removal as well as chronic disease monitoring and related data collection.

Staff

  • New staff will be employed by NHS Boards and attached to practices and clusters.
  • By 2020, every GP practice will receive pharmacy and prescribing support under a new pharmacotherapy service with pharmacists dealing with acute prescribing repeat prescribing, medicines reconciliation and safety review as well as dealing with hospital queries and medication reviews in some circumstances.
  • Health boards will provide physiotherapists, community mental health workers, and link workers to work in general practice under plans to be developed locally.

Premises

  • NHS Boards will gradually take on the responsibility from GP contractors for negotiating and entering into premises leases with private landlords.
  • All GP contractors who own their premises will be eligible for an interest-free loan by 2023, including those in negative equity, for an amount of up to 20% of the Existing-Use Value of the premises.
  • The loans will be repayable if the premises are sold or are no longer used for the provision of GMS services.
  • A yearly cycle of loans will be in place until by 2043 where GPs no longer own their premises.

Extra services

  • Essential services will remain unchanged – care based on the registered practice list, generalist care of the whole person and sufficient consultation time for patients according to their clinical needs
  • Additional services are to be removed from contract, eg, minor surgery. GPs can choose to provide such services under core contract but enhanced service for minor surgery will continue
  • A new out of hours enhanced service – which will move from opt out to an opt in for practice choosing to provide out of hours. A 6% deduction from the global sum will be applied nationally instead of the current out of hours deduction.

Source: Scottish Government