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GP Contract changes 2014/15

Summary of changes to the GP contract in 2014/15, including modifications to DESs, QOF changes, named accountable GP, OOH monitoring, and more. Aims to enhance clinical freedom and reduce workload.

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GP Contract changes 2014/15

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  1. GP Contract changes2014/15

  2. Summary Outline • QOF changes • Removal of DESs • Modifications to current DESs • Contractual requirements • Named accountable GP • OOH monitoring • IT changes • Publication of earnings • Friends and Family Test • Choice of practice • Seniority • Transfer of money to Global Sum • Vision for general practice

  3. What is not included • OOH 24/7 responsibility • 8-8 7 days a week opening • Additional extended hours • Full electronic record access (yet) • Additional money • Evidence submitted to the DDRB for resource uplift

  4. QOF – Aims of negotiation • Reverse imposed QOF indicators • Reduce micromanagement and box-ticking • Reduce workload • Transfer money to global sum/PMS baseline • Increase clinical freedom and professionalism to enable patients to be treated holistically according to clinical need AIMS ACHIEVED

  5. QOF headline changes • 238 points to global sum/PMS baseline • no 6% OOH rebate but Carr-Hill will apply • 100 QP points to new admission avoidance ES • No 2nd year imposed threshold changes • Almost all imposed indicators removed • BP target 140/90 returned to 150/90 (and timeframe changed from 9-12 months + points reduced) • No new NICE changes accepted (except LD indicator)

  6. QOF indicators removed • Hypertension • GPPAQ survey + intervention • 140/90 target • 150/90 target remains but with 20 points, 12 months rather than 9 months to achieve and reduced 45-80% threshold • Annual cholesterol checks • CHD, PAD, Stroke/TIA, mental health • retained for diabetes • Diabetes • erectile dysfunction questions • albumin:creatinine test • retinal screening • dietary review by suitably qualified professional

  7. QOF indicators removed (2) • AF - % with CHAD score (but treatment remains) • Thyroid disease– whole domain removed • Depression • Bio-psychosocial assessment removed • Depression review timeframe increased to 2-8 weeks • Mental health • HDL/cholesterol and glucose annual checks • BMI • LD – record of TSH check

  8. QOF indicators removed (3) • Epilepsy • Rheumatoid Arthritis • Public Health • QP Domain • Patient experience/length of consultation • Other QOF agreements • Cancer reviews returned to 3-6 months • Extended timeframe for flu immunisations • No 2nd year threshold changes • No new NICE indicators • PMS points off-set will be reduced in line with changes

  9. QOF points summary

  10. Avoiding unplanned admissions enhanced service • Risk stratification to identify 2% of adult population at risk of admission to form a “case management register” • Care plans for all on register to include • a named accountable GP • a care co-ordinator (any person in multidisciplinary team) is main point of contact/responsible for delivery of the plan • review post hospital discharge • Same day telephone consultations for patients on the register with an urgent need • Timely telephone access for A+E, ambulance, care homes • Monthly reviews of the case management register • Review unplanned admissions and A+E attendance

  11. Extended Hours ES • Increased flexibility to work with other practices if the practice/s want to • Other specifications remain the same • No increased amount of extended hours • Funding remains the same

  12. Other Enhanced Services • Dementia • additional development of care plan • Learning disability • to be offered to 14yr and older • development of a care plan • money from LD QOF • amount per medical increased to £116 • Alcohol • Patients identified as drinking excessively to have brief mental health assessment (eg PHQ9)

  13. Imposed Enhanced Services • Patient Online • ended • £24m transferred to global sum • Remote care monitoring • ended • £12m transferred to global sum • Risk profiling • ended • £42m transferred to new admission avoidance enhanced service • Dementia • continues

  14. Named GP for patients 75 & older • A contractual requirement • Provide a named GP to all patients 75yr and older by 30 June 2014 • Encourages continuity of care and closer oversight of care • Contract remains with the practice, not the named GP • Does not prevent patients seeing any GP or nurse in the practice • Does not mean 24 hour responsibility

  15. Out of Hours • Contractual requirement to monitor the quality of care provided OOH and report concerns to NHS England • Requirement to cooperate with requests for information & reviews from OOH providers on same working day (exceptionally following working day). • No contractual requirement to work outside current working hours • No contractual requirement to open 8-8, 7 days a week

  16. Patients needing access to a practice clinician after assessment • Relates to patients being advised to contact practice by NHS 111 or A+E • “The practice will ensure that when the patient contacts the practice, a practice clinician will agree appropriate next steps having regard to the patient’s condition and circumstances.”

  17. IT • Contractual requirements • Include NHS number in all clinical correspondence • Offer and promote on-line booking and repeat prescription ordering • Upload SCR daily (or plans to achieve this by 31.3.15) • Use GP2GP transfer (or plans to achieve this by 31.3.15) • Offer and promote electronic access to SCR • GPC and NHS England to work during 2014/15 on: • Electronic communication by patients with practice • Access to detailed care record from other care settings

  18. Publication of earnings “NHS Employers and the GPC have agreed to form a working group with NHS England, to develop proposals on how the publication of GP NHS net earnings relating to the contract should be implemented for 2015/16. “The working group will ensure that the calculation and publication of GP net earnings is on a like for like basis with other healthcare professionals. “Publication of this information will be a contractual requirement (in line with arrangements for others in the NHS).”

  19. Friends and Family Test • A contractual requirement from December 2014 • “How likely are you to recommend our practice to friends and family if they needed similar care or treatment?” • One follow-up question chosen by practice • Monthly feedback to NHS England • Replaces survey in Patient Participation DES • PP DES funding reduced to £20m and £40m added to core funding

  20. Choice of GP practice • Government committed to roll out of current pilot from October 2014 despite GPC, RCGP and CCGs concerns • Pilots showed very small uptake from patients • Not just commuters – more likely to be patients moving outside practice boundary wishing to stay with a practice • No obligation to visit these patients • Practice involvement voluntary • May be reduced global sum for these patients • NHS England responsible for in-hours urgent medical care for these patients if unable to attend their registered practice • Full details still to be developed

  21. Seniority • All those in receipt of payments on 31.3.14 will continue to receive payments and progress as currently set out in the SFE • No new entrants • Scheme will end in 6 years on 31.3.20 • Commitment to reduce overall amount by 15% each year • All savings put in to core funding

  22. Seniority (2) • 2 years before figures available to show whether 15% saving made from retirements • If less than 15% NHSE and GPC to agree process for achieve this • Seniority funding has been static for 9 years and real-terms value eroded by inflation • Transferred funding to global sum not subject to 6% OOH rebate and could increase with DDRB awards

  23. Transfer to global sum • Value of 238 QOF points • Based on 12/13 achievement and 13/14 price • Circa £80m from seniority funding by 2020 • £40m from patient participation DES • £12m from remote care monitoring DES • £24m from patient online DES • No 6% OOH rebate • No change to correction factor

  24. NHS funding invested in general practice

  25. Vision for General Practice • GPs Committee has published vision document for General Practice: • Developing General Practice today - Providing healthcare solutions for the future • Sets out the ways in which it can help provide solutions to some of the most difficult challenges the NHS faces • Can be found on BMA website: bma.org.uk/gpc

  26. Conclusion • QOF reduced from 900 to 559 points • Most imposed QOF points and DESs removed • No 2nd year imposed QOF threshold changes • Major transfer of money to Global Sum without 6% OOH rebate • New admission avoidance enhanced service • New contractual requirements • Named accountable GP • OOH monitoring • IT changes • Friends and Family Test • Publication of earnings • Minor modifications to current DESs • Removal of seniority over 6 years • Voluntary engagement in patient choice of practice • No 24/7 OOH or 8-8 7 day commitment

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