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An Overview of the General Practice Contract Changes for 2014-15
The BMA’s General Practitioners Committee (GPC) has voted overwhelmingly to accept the negotiated agreement on changes to the GP contract for 2014-15, and believes that this package as a whole puts general practice and all GPs in a better position to deliver improvements to patient care. Some of the main aims of these negotiations were to reduce bureaucracy, box ticking and chasing of targets, which has added to excessive workload, widespread demotivation and has taken GPs away from attending to patients’ needs and to provide stability with increased resources in core GP budgets, enabling clinical judgment and flexibility in providing care.
Key changes include:
- QOF points will be reduced, many points will be transferred to core funding and some to Enhanced Services.
- Seniority will be removed with a redistribution of released funds to all practices as an addition to core funding.
- The introduction of a new Enhanced Service on unplanned admissions.
- Three of the four imposed Enhanced Services from 2013-2014 will be removed.
- New IT systems requirements will be introduced, including the ability for patients to book appointments online and access their Summary Care Record.
- Every patient aged 75 and older will be assigned a named accountable GP to ensure coordinated care.
Quality and Outcomes Framework (QOF) changes
There have been radical changes to the Quality and Outcomes Framework (QOF) to reduce workload and bureaucracy for GPs. The changes have also resulted in the transfer of QOF points into core GP funding and to provide greater baseline resources for practices to manage patients according to clinical judgement and need.
Most of the imposed changes to the QOF from last year have been reversed. This will significantly reduce the daily box ticking that has forced GPs to spend time looking at their computer screens rather than the patient in front of them and will make a substantial difference to the daily lives of GPs and practice staff. These changes allow free GPs to be doctors, exercising their clinical judgment caring for patients, and reintroducing a sense of professionalism.
NHS Seniority payments will be removed over the next six years. During this time those currently in receipt of seniority payments on 31 March 2014 will continue to receive payments and progress as currently set out in the Statement of Financial Entitlement (SFE). There will be no new entrants to the scheme from 1 April 2014, which will end completely on 31 March 2020. All funding released from the seniority pot will be added into core funding.
Unplanned admissions Enhanced Service
A new unplanned admissions Enhanced Service will be available as part of a move to reduce unnecessary emergency admissions to secondary care. It will place emphasis on practice availability to patients at risk of hospital admission, which many practices already provide. The main work will involve the proactive case management of at-risk patients (as with the current risk profiling), but will require coverage of 2% of the practice population over 18 years of age.
This Enhanced Service will involve a considerable amount of work for practices. However, it contains many of the elements practices are already carrying out as part of the current risk profiling. It also relieves practices of current workload linked with the QP domains, which is inconsistent and particularly onerous in some areas. There will also be no specific requirement for multidisciplinary meetings for case management, a change from the current requirements.
Continuing & redundant Enhanced Services
Although the Dementia, Learning Disabilities, Alcohol, Extended Hours and Patient Participation (PPG) Enhanced Services are continuing for at least another year some changes will be made to the requirements and funding, particularly a payment reduction for PPG.
Remote Care Monitoring, Online Booking of Appointments and Risk Profiling Enhanced Services will cease on 31 March 2014 with this money being transferred into core funding and the unplanned admissions Enhanced Service.
A number of IT-related changes will become part of the GP contract, particularly a commitment to provide all NHS patients with online access to their record and other services by 2015, including electronic appointment booking, cancelling of appointments and ordering of repeat prescriptions, and to work towards a paperless NHS by 2018.
In addition, GP practices will be required to provide an automated upload of their summary information to the Summary Care Record (SCR), or have published plans in place to achieve this, by 31 March 2015.
Named GP for patients 75 and older
Practices will have to ensure there is a named accountable GP assigned to each patient aged 75 years or older. They will need to inform each patient, through the most appropriate means, of the name of their accountable GP. Also, newly registered patients will need to be notified of their named GP within 21 days of registration. All existing patients will need to be notified by 30 June 2014 (three months from the introduction of the requirement).
The Choice of GP practice scheme (for re-registered patients only) will be extended across the whole of England, on a voluntary basis for practices, from either October 2014 or April 2015.
The Friends and Family Test will be a contractual requirement rather than an enhanced service. However, the contract will not include any reference to uptake levels.
GP practices who have opted out of doing out-of-hours (OOH) services will monitor the quality of OOH services offered to their patients and report any concerns to NHS England (or as directed by NHS England to the delegated commissioner of OOH services).
When the CQC’s new inspection arrangements are introduced, practices will be required to display the inspection outcome in their waiting room(s) and on the practice website and the first 12 clinical commissioning group areas that will be inspected under the Care Quality Commission’s new general practice inspection regime between April and June have been revealed.
The problem that most Practices have faced recently is the ploughing through, at short notice, the cumbersome and enormous contracts to provide enhanced services. NHS England said that the NHS Standard Contract must be filled in by all providers of services to CCGs by 31 March, but LMC leaders have warned that some CCGs have not even sent them out yet. The General Practitioners Council (GPC) has dismissed the contracts, which GPs must fill in if they want to provide enhanced services, as ‘unfit for purpose’ and said that the documents contain impenetrable legal language and are almost impossible to understand.
Although there appears to be variations of these contracts across the country, with the scope to include locally-negotiated detail such as services specifications and local prices, the requirements to meet the terms and conditions of these contracts and to deliver the outcomes will be the same. I’m certain most CCGs have been working with practices during this process, recognising that there is a need for flexibility and common sense. Therefore Practices need to organise themselves to share risk and project manage themselves in this new era.
The QCS Management System assists Practices to meet contractual requirements that come under CQC outcomes.
General practice contract changes 2014-2015: