NHS England has launched a consultation that ‘could herald the most substantial changes to the GP contract since 2004’, according to board papers.
These will include changes to the partnership model, a wideranging overhaul of QOF as well as changes to practice funding calculations aimed at enabling ‘full adoption’ of ‘digital’ primary care models, NHS England said.
As part of plans, it is taking GP contract negotiations in-house from NHS Employers for the 2019/20 round, with a special committee appointed to negotiate the extensive changes with the BMA.
Funding changes could include so-called ‘digital first’ providers – who take on out-of-area patients – receiving a smaller amount of money for their patients compared to practices which offer a fuller service.
NHS England said this comes as ‘over the next decade’ it ‘will be supporting faster full adoption of digital primary care’, and therefore ‘the way in which we contract and pay for care needs to keep up with digital delivery’.
To mitigate ‘unjustifiable redistribution’ of GP funding, NHS England is proposing three adjustments to the global sum:
- A reduction to the payment to practices for out-of-area patients. Currently, practices receive the same payment for both in-area and out-of-area patients, even though GPs do not have to deliver home visits or out-of-hours care to out-of-area patients.
- The London weighting – which currently gives practices based in the capital £2.18 extra per patient, to only apply to patients who are London residents.
- The rurality index, which currently gives additional payment to practices with a higher average distance between patients’ homes and the practice location, to instead be based on ‘average distance between the practice and its out-of-area patients, rather than to all patients’.
In addition, NHS England may ditch the so-called ‘list turnover index’, which gives practices 46% more funding for newly registered patients in their first year of registration with a practice. It said that the funding could be better spent on ‘other priority areas’.
It said this comes amid ‘concerns’ that ‘the rapid expansion of digital-first practices is leading to patient selection effects not being adequately captured in the GP funding formula’.
Board papers said: ‘The vast majority of practices would not be impacted significantly, and in fact would gain marginally from the redistribution of funds through the formula towards in-area patients. This is fairer, and as such, removes the potential for providers to seek to maximise income by advertising to patients from particular locations.’
Ian Dodge, NHS England’s national director of strategy and innovation, said: ‘Over the next decade we will be supporting faster full adoption of digital primary care and the way in which we contract and pay for care needs to keep up with digital delivery and those payment mechanisms need to be fair and need to be seen to be fair.
‘We conclude from the evidence currently available that there are three specific ways that payments need to change to avoid an unjustifiable redistribution of practice income due to digital first models. And these all relate to the geographical relationship between the practice and it’s patients.’
BMA GP Committee chair Dr Richard Vautrey said: ‘The BMA recognises the many advantages that technology and innovation can provide for general practice and would like to see all practices supported by NHS England and their CCGs to improve what they are able to offer to their patients, but funding models need to adequately account for the changing health landscape.
‘We are therefore glad that NHS England has finally listened to our concerns and started work to address this. As we respond to the consultation we will need to consider the various proposals carefully to avoid adversely impacting other practices who are delivering the full range of services to their patients.’
The new NHS England negotiation team comprises: Ian Dodge (chair), Ed Waller (NHSE director of primary care contracts), Dr Abid Irfan (GP, and chair West Berkshire CCGs), Kathy Winfield (chief officer, West Berkshire CCGs and integrated care systems lead), Dr Amanda Doyle (GP, chief clinical officer Blackpool CCG and Lancashire ICS lead), and Dr Nikki Kanani (GP in Bexley and deputy primary care medical director, NHS England).
A quarter of QOF indicators could be cut under new proposals drawn up following a review of the framework. The indicators that are to scrapped will be discussed following an ‘engagement exercise’ with GPs and other stakeholders, launching today.
Meanwhile, the GP partnership review will look at how to reduce premises liabilities and how GP partners can work more like sessionals.
GPs can respond to the consultation online until the end of August.