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GP pay deal and changes to practice boundaries revealed

GP pay will be frozen, practice boundaries will be relaxed and practice income will be linked for the first time to patients' A&E attendance, under the terms of the new GP contract agreed for 2012/13.

The new GMS contract will not scrap practice boundaries entirely but will allow many patients, where clinically appropriate, to stay in their current GP practice even if they move home.

The surprise early announcement of the contract follows negotiation between the GPC and NHS Employers, on behalf of the health departments of England, Scotland, Northern Ireland and Wales.

There will be no increase to GP pay overall ‘in line with other NHS doctors', although the GMS contract will be uplifted by 0.5% to help meet the costs of increased practice expenses.

A number of changes to the QOF will see the controversial quality and productivity indicators on prescribing replaced with a number of new indicators, initially lasting one year, which will incentivise GPs to reduce avoidable A&E attendance.

Meanwhile, all GPs will be able to agree an 'outer boundary' with their PCT where they will retain, where clinically appropriate, existing patients who have moved to the outer boundary area.

In addition, a one-year pilot will test two alternative models to completely replace the existing practice boundaries structure, with trials in two or three cities yet to be named. This will allow non-registered out of area patients to visit practices, and out of area patients also to register with a number of voluntary practices.

Other key developments include:

- Two new disease areas – osteoporosis and peripheral arterial disease – have been added to the QOF

- The QOF's quality and productivity indicators on emergency admissions and referrals have been extended by one year

- A number of upper and lower thresholds in the QOF will be increased

- Extended hours funding has been rolled over at the same funding levels until March 2013

- Two clinical DES funding alcohol and learning disabilities services have been extended a further year

Stephen Golledge, lead negotiator for NHS Employers said: ‘These changes to the GMS contract put a strong emphasis on improved patient care, greater choice for patients and value for money for the NHS. This agreement will help in addressing the financial challenges faced by the wider NHS but not at the expense of services for patients. The choice of GP practice pilots will also allow us to explore the best way for patients to access the services provided by GPs.'

GPC deputy chair and Leeds GP Dr Richard Vautrey said:‘Most GPs were against the complete abolition of practice boundaries because of the potential negative impact on continuity of care, so we're pleased that we have been able to agree this alternative which will help commuters as well as patients who move out of a practice's boundary but want to stay registered. It will be important to learn from the results of the pilots.'

‘The NHS is operating in a difficult financial climate and while GPs, like other doctors, won't get a pay rise, we've worked hard to ensure practices get some compensation for rising expenses and that the changes made are consistent with good clinical practice.'


Key changes to the GMS Contract for 2012-13 are:

Uplift to the GMS contract
· there will be no increase to General Medical Practitioners' pay in 2012/13
· there will be an uplift of 0.5 per cent to the GMS contract to help meet the costs of increased practice expenses, including pay increases for employed staff with a full time equivalent salary of less than £21,000.

Quality and Outcomes Framework
· A number of changes to QOF following the recommendations made by NICE including the introduction of two new disease areas; osteoporosis and peripheral arterial disease.
· The QP prescribing indicators will end on 31 March 2012 and will be replaced by a number of indicators which aim to reduce avoidable accident and emergency attendances. These indicators will initially be in place for one year.
· It has also been agreed to extend (for one year) the emergency admissions and referrals indicators.
· It has been agreed to increase a number of upper and lower thresholds.

Extended Hours Access Directed Enhanced Services
· the Extended Hours Access Directed Enhanced Service (DES) has been extended by one year (to 31st March 2013). The requirements and funding remain the same.

Clinical Directed Enhanced Services
· two clinical DESs in England (alcohol and learning disabilities) will be extended for a further year (to 31 March 2013).
· the osteoporosis DES will end on 31 March 2012 in England, Scotland and Northern Ireland (they do not have the DES in Wales). New indicators relating to osteoporosis have been included in QOF from April 2012.