In many respects, the 2015/16 GP contract is business as usual for GPs in England. However, there are amendments GPs should be aware of, some of which may require action in advance.
GPs must assign a ‘named GP’ to all patients (not just the over 75s). They should also improve patients’ access to their records by making all coded information available, and increase the number of appointments available online.
The Patient Participation and Alcohol Reduction directed enhanced services have been discontinued and elements incorporated into the contract, with income that used to be available to GPs who undertook the work being rolled into the global sum.
The Avoiding Unplanned Admissions DES reporting template has been simplified but it has been proposed that GPs add a patient survey. At the time of writing, however, no specifications for this had been published.
The contract also has a requirement for GPs to publish information about their income.
Pulse has compiled information on 10 key tasks for GPs and their teams to undertake by April in preparation for the new contract.
1 Assign a ‘named GP’ to all patients
The contract requires practices to allocate a named GP to all patients by 31 March 2016 and tell patients who this is at the ‘next appropriate interaction’.
Match patients to the GP with whom they have recently had most contact by running reports on patient records tagged with ‘Not already notified of named accountable GP’. You can add search terms such as ‘patients seen only by Dr X in past year’, ‘had a surgery, visit, telephone consultation with Dr X in past year’ or ‘not had a surgery, visit, telephone consultation with Dr A, Dr B in past year’.
For patients who have been seen by multiple doctors, it’s possible to use advanced features in Microsoft Excel to identify which doctor has seen them most frequently. Further information on this is available online.1
Assigning a named GP is helpful for practices – it makes it much clearer who is responsible, especially when allocating results, letters and enquiries.
Named GP information should be easily viewed, probably in the ‘Usual GP’ field if possible. The cost of informing patients will be negligible if this is done opportunistically when they are next seen. The named GP needs to be specified by 31 March 2016, but there is no deadline by which patients need to be told.
New costs Admin time for noting ‘usual GP’ on records at a rate of 160 patients per hour.
Dr Graham Gibson is a GP in York
2 Maximise income from the unplanned admissions DES
The avoiding unplanned admissions DES introduced last year in England has been revised. The funding remains the same but there has been a slight reduction in reporting requirements.
The reporting template is now less than half the size of that for 2014/15 and largely requires self-declaration rather than pulling lots of evidence together. More information is available from the BMA’s FAQs.2 It also provides a much clearer process for making commissioning recommendations to the CCG and, importantly, can be submitted twice a year (September and March) rather than quarterly.
All in all, the DES is now a much more attractive proposition. I would suggest practices gather their clinical teams and work through the revised specifications and template in order to scope the requirements (and perhaps start to discuss it with the local CCG).
New costs An hour for a partners’ meeting and one to two hours for a clinical team meeting. But this is more than offset by the reduction in reporting and the potential annual income, which equates to about £20,000 for an ‘average’ 7,000-patient practice (£2.87 per registered patient).
Dr Martin Duerden is a GP in Conwy and a prescribing adviser to the RCGP
3 Introduce a patient survey
When the Department of Health first set out the contract, it said that, subject to a review of feasibility, the unplanned admissions DES ‘may be modified to include a patient survey’. For this, you could pose the Friends and Family Test question ‘would you recommend this service to your friends and family?’ or something similar. You also might prompt patient suggestions for improving the service.
Once the specification for the DES is released, visit free online survey provider Survey Monkey to create the questionnaire.3 Although it is likely you will need to print the survey for your ‘at-risk’ patients, it can be emailed to the rest of your patients to keep costs down.
New costs One hour of admin time to set up the survey.
Daniel Vincent is a practice manager in Bridgwater, Somerset
4 Adapt your QOF strategy to recognise the lower points value
Changes to the QOF from April are relatively small. Still, two areas are different enough to catch out the unwary. All atrial fibrillation patients will need a CHAD2S2-VASc score calculated during the QOF year and those scoring >1 will need anticoagulation. Check patients’ scores and anticoagulation status with the free GRASP-AF audit from PRIMIS.4
All patients with a dementia diagnosis will need a written care plan included in their annual face-to-face review – a big ask, but this will earn 39 points – nearly twice the score for having all hypertensive patients to target. Produce a care plan that meets both the QOF and unplanned admissions DES to save time.
New costs Two hours to change templates and inform the clinical team of changes. Care plans may take up to an hour a week across the team.
Dr Gavin Jamie is a GP in Swindon, Wiltshire
5 Screen patients for alcohol misuse
From 1 April, the alcohol DES is scrapped and the contract requires all practices to identify newly registered patients aged 16 or over who are drinking alcohol at increased and higher risk levels. Practices now doing the DES can carry on, but others will need a system to screen patients at registration.
Moving the DES into the global sum means a small (<£1,000) loss of income for practices who do it now but some – for instance university practices – will lose more.
To do the screening, put the three Alcohol Users Disorders identification Test (AUDIT) C questions on the practice new patient registration form.5 The score can then be calculated by a staff member to identify patients who are potentially misusing alcohol – those scoring >3 (women) or >4 (men). The audit C score needs to be Read coded (38D4 for Read 2 and XaORP for Read CTV3). On most GP IT systems, a task or email notifies the registering GP when the score is raised.
Offer those at risk full screening for alcohol misuse, depression and anxiety at a face-to-face appointment. They may then be advised or referred regarding their alcohol intake and those with anxiety and/or depression should be advised and offered treatment. Read code throughout.
New costs Half a day of admin time to set up a system.
Dr Helen Cotton is a GP in Yeovil and the PMS lead for NHS Somerset CCG
6 Find another provider for fax and SMS
NHS England will end funding for NHSMail SMS and fax services from 1 October this year.
Most practices use NHSMail’s free SMS appointment reminders. It’s not yet clear how SMS services will work from April to September, but start looking now at companies that provide appointment reminders and additional SMS text-back facilities, which are better for some practices. See if your CCG or group of practices can negotiate a bulk service. If you still send NHSMail faxes, switch to print and fax, or emails.
New costs Upwards of 2p per SMS.
Dr Osman Bhatti is a GP in east London and a member of the EMIS National User Group
7 Increase the number of appointments available online
NHS England guidance states the GP contract ‘will be amended to expand the number of appointments patients can book online and to ensure that there is appropriate availability of appointments’.
There is no guidance yet on what ‘appropriate’ means, but if you do not yet offer online appointments you must start now. If you already do, you may need to prepare to offer more appointments or increase the number of clinicians available.6 The latter is more challenging, as GPs will have to tell patients which staff member to book for what. Monitor the system to ensure common problems are resolved.
While there are no direct income or cost benefits, offering more appointments online should save receptionist time.
New costs Half an hour of admin time.
Paul Williams is a practice manager in Bristol
8 Provide online access to all coded information in the GP record
GPs must provide access to this by 2016 for patients who request it, and carry out spot-checks of the system for the first three months. As this is a contractual requirement, there will be little financial reward.
Configure your software to offer all coded data by default – GPs will have the option and tools to withhold coded information in the patient’s interests, or if there is a reference to a third party. If you are worried about patients seeing free text, you can set up a system to prevent it.
New costs Should be relatively easy – ask your service provider for help.
Dr Fiona Cornish is a GP in Cambridge and a former chair of the Medical Women’s Federation
9 Claim locum cover for GPs taking parental leave
In a letter to area teams, NHS England said all practices would be entitled to ‘reimbursement of the actual cost of GP locum cover for maternity, paternity, adoption leave of £1,113.74 per week for the first two weeks and £1,734.18 per week thereafter (or the actual costs, whichever is the lower)’.
The average daily locum rate was recently quoted as £475 plus employers’ superannuation; £1,113.74 and £1,734.18 represent roughly four sessions and six and a bit sessions. Careful planning is necessary to cover all sessions.
The reimbursement is to cover extra shifts by external locums and practice GPs who do not already work full time. If the latter, GP partners must agree the rate and note it in the partnership deed or in a formal minute.
New costs Lawyer’s fee for changing the partnership deed.
David Elliot is a tax manager at BW Medical Accountants
10 Publish average net earnings for partners and salaried GPs
Practices must publish the average practice earnings per GP on the practice website by April 2016, but earnings should only include contractual income from NHS England, CCGs and local authorities. Income from premises, dispensing, private work, out-of-hours or elsewhere is exempt.
The guidance issued thus far is to calculate profit for the practice accounts (as drawn up by the practice accountants) and subtract/add the following costs/income:
• Property expenses.
• Locum costs (for those working more than six months).
• Cost of salaried GPs.
• Non-NHS income.
• Identifiable non-NHS expenses.
The remaining sum (the adjusted total earnings) is divided by the number of GPs working at the practice (including locums employed for longer than six months) to produce an average earnings figure. Note that this is not a true average, as it takes no account of sessions actually worked by each GP.
New costs Fifteen minutes’ admin time.
Keith Taylor is head of medical services at BW Medical Accountants
What will GPs in Scotland, Wales and Northern Ireland need to do?
‘The 2015/16 Welsh GP contract is likely to involve only minimal changes, so GP practices will not need to undertake many tasks to prepare for its arrival. However, the previously signposted work to build on collaboration in GP clusters will continue.’
Dr David Bailey, deputy chair of GPC Wales
‘Negotiations have begun in Northern Ireland and we will be looking for a reduction in the total number of QOF points and an increase in funding for the GMS contract but GPs do not as yet have any specific preparation to undertake for the 2015/16 contract.’
Dr Tom Black, chair of GPC Northern Ireland
‘The BMA’s Scottish GPs Committee has agreed a three-year contract with the Scottish Government that runs from 2014 to 2017, so GPs will not have any specific preparation to undertake before April, apart from rewriting QOF strategies to reflect the new, smaller framework.’
Dr Alan McDevitt, chair of BMA Scotland
3 Survey Monkey free online survey generating tool.
5 SAMSHA. Audit-C overview.