A new pay uplift clause should be included in both the GMS contract and PCN DES, guaranteeing annual funding rises, the NHS Confederation has recommended.
Following a number of stakeholder meetings and consultations, to which DHSC and NHS England were invited, the NHS Confederation has set out a number of ‘tangible’ recommendations for the new GP contract PCN DES amendments currently being negotiated.
It also contains a series of non-contractual recommendations that the NHS Confederation believes will ‘enable general practice and at-scale primary care to best deliver for patients in the short and medium term’.
It also set out a number of recommendations for reforming QOF, including streamlining the framework with IIF and including incentives for group consultations for long-term conditions (see box).
QOF recommendations include:
- The Quality Outcomes Framework (QOF) and the Impact Investment Fund (IIF) should be streamlined to focus on high-impact areas and true outcome-based measures while protecting primary care funding.
- Consolidate the quality improvement (QI) elements of QOF and create a quality-improvement incentive within the PCN DES focused on continuity of care. This approach should encourage PCNs to work collaboratively to improve continuity of care across their practices.
- Delivery of QOF should recognise new ways of working to achieve outcomes, for example group consultations (where appropriate) in patients with long-term conditions.
- Review the QOF markers for vaccinations and immunisations t reflect the challenges associated with different groups of the population. This approach should facilitate a more flexible delivery approach and collaboration with partners while securing existing GP provision.
Arguing that GP practices need more financial security in order to plan care, the report said: ‘As we approach the end of the five-year framework for general practice and PCNs, the uncertainty has been difficult for primary care leaders and their staff, who rely on national contracts for business planning and continuity.
‘We recognise the cultural issues that need to be addressed and we need greater recognition of primary care’s changing, adaptive and innovative abilities within the system.’
And it added: ‘Both the GMS and PCN contracts should rise annually with a new pay uplift clause. This clause should account for Pay Review Body (PRB), Doctors and Dentists Review Body (DDRB) recommendations and wider changes to NHS pay including on-costs.’
The NHS Confederation’s ‘short-term asks’ include:
- Explore proven delivery models that will improve practice resilience and sustainability, enabling a mixed economy that continues to support access to services for patients.
- Explore new legal structures, such as limited liability partnerships, to hold GMS and PMS contracts and limit GP partner liability helping to modernise the partnership offer.
- Both the GMS and PCN contracts should rise annually with a new pay uplift clause. This clause should account for Pay Review Body (PRB), Doctors and Dentists Review Body (DDRB) recommendations and wider changes to NHS pay including on-costs.
- National primary care contracts should be streamlined, retaining a core national focus on areas of high impact. Streamlined national
contracts should provide continuity and assurance to providers with a clear, concise long-term vision.
- To increase local flexibility and encourage innovation, a national ‘Pathfinder’ programme should be developed for those PCNs that can demonstrate a level of maturity and innovation.
Backing the partnership model for the future, the NHS Confederation also recommended to explore new legal structures, such as limited liability partnerships, to hold GMS and PMS contracts and limit GP partner liability ‘helping to modernise the partnership offer’.
It also called for modernised funding formulas, with existing investment levels ‘no longer adequate’ to serve the ‘changing health needs of our populations and the evolving role of general practice’.
The authors added: ‘The current funding formulas fail to adequately account for deprivation, which contributes towards inequitable funding across general practice.
‘If we are to truly harness the role of general practice in tackling health inequalities and improving population health, fairer funding, based on need will be at the core of getting this right.
‘The “stop-start” nature of incremental resource undermines primary care’s ability to plan and deliver, making investment decisions difficult.’
They also pointed out that with increasing demand and workforce, the physical space to consult and see patients is also ‘becoming inadequate’.
‘The lack of space is one side of the coin but the repair bill for primary care estates is another huge challenge,’ the report said.
In August, Pulse revealed exclusively that NHS England is ‘not in a position’ to negotiate to a new five-year GP contract due to a lack of a funding commitment, with the 2024/25 contract set to be a ‘stepping stone’.
The current contract runs out in 2024, and prior to this it had been thought that the 2024/25 would herald a seismic change in general practice in England, similar to the 2004 contract that removed out-of-hours obligations from practices.
The NHS Confederation report said: ‘We believe that while the 2024/25 contract provides a “stepping stone” year it is important to describe the high-level objectives that set out the intentions for the longer-term contract discussions and provide the criteria against which to assess the compatibility of any future proposals.’
And it added that there is ‘an opportunity to adopt a “pathfinder” approach so that those PCNs that can demonstrate a level of maturity and innovation (agreed with their integrated care board) could be afforded additional freedoms and flexibilities during 2024/25 to test out new approaches that support the longer-term objectives.’
‘Ultimately, PCNs should be commissioned to define the needs of their local population, design the services and workforce that meet those needs and deliver those services against a set of agreed outcomes,’ the report said.
And the PCN DES ‘needs to offer stability and commitment to the existing PCN model long term, with specific recognition for the growing leadership role PCNs are expected to play to integrate at all levels,’ it added.
NHS Confed’s longer-term asks (to be considered over the next year) include:
- Creation of a Primary Care Investment Standard, as seen in mental health, that enables a move towards a high-trust model of primary care commissioning and delivery tailored to local needs.
- Review the current primary care estates programme – specifically the HBN-11 Guidance that is no longer fit for purpose in respect of new ways of working.
- DHSC should consider the impact on primary care services of the Levelling up and Regeneration Bill, ensuring levies on future developments adequately account for primary care estate’s needs.
- National review of the funding formulas for primary care to reduce disparity in funding across the country and ensure future models adequately reflect health inequalities.
- Future funding should flow directly into streamlined national contracts and local incentive schemes, allowing systems to commission and design services based on local needs, driving resource into preventative and curative primary and community-based care.
- Review of (primary) urgent care needs and consideration given to the opportunities to streamline and integrate current delivery models that span primary care, NHS 111 (call handling and clinical assessment), GP out of hours and urgent care services.
Source: NHS Confederation
Announced in May as part of its GP recovery plan, the review will also evaluate the additional roles reimbursement scheme (ARRS) to assess its options from 2024/25 onwards.