The New GMS Contract

1. The New GMS Contract

2. The New Contract The Old Contract Background Provision of services Quality Investment

3. The Old Contract Between GP and PCO Capitation fees Item of service payments Rural practice allowance Basic practice allowance Postgraduate education allowance Seniority payment

4. The Old Contract No account of practice population demographics No reward for quality GPs responsible for out of hours cover Reduction in practice income if GP left

5. The Old Contract Between GP and PCO Capitation fees Item of service payments Rural practice allowance Basic practice allowance Postgraduate education allowance Seniority payment

6. Background Negotiations for new contract began late 2001 New contract documentation February 2003 Vote Result 20/06/03: 70% turnout 79.4% yes vote

7. Provision of services Essential services - all practices Additional services - most practices although can opt out under certain circumstances Enhanced services - responsibility of PCO, may be commissioned from practices Out of hours - responsibility of PCO

8. Provision of services Essential services Management of patients who are ill or believe themselves to be ill with conditions from which recovery is generally expected Management of patients who are terminally ill Management of chronic disease

9. Provision of services Additional services Cervical screening Contraceptive services Vaccinations and Immunisations Child Health surveillance Maternity services Certain minor surgery procedures e.g. cryocautery of warts

10. Provision of services Additional services Opting out temporary ( <1 year) permanent lack of available skills practice struggling e.g. short staffed conscientious grounds UK wide tariff adjusted by Carr - Hill formula will apply for opting out

11. Provision of services Enhanced services Nationally directed treatment of violent patients improved access childhood vaccinations and immunisations (provided to higher specified standard) flu immunisation extended minor surgery quality information preparation

12. Provision of services Enhanced services With national minimum standards intra partum care anticoagulant monitoring IUD fitting more specialised services for substance misuse, sexual health, depression, multiple sclerosis, terminally ill, the homeless, those with learning disability immediate care, first response care and minor injuries

13. Provision of services Enhanced services in response to local need ? Services for immigrants

14. Provision of services Out of hours Defined as: 1830-0800 on weekdays The whole of weekends, bank holidays and public holidays Practices retain the option provide out of hours services Routine surgeries possible in evening or at weekend but only get extra funding if agreed as enhanced service with PCO

15. Provision of services Out of hours PCOs can use alternatives e.g. NHS Direct/24 Walk in centres GP co-ops community nursing teams commercial deputising services In remote areas may be no alternative to practice provision

16. Provision of services Out of hours Opting out a fixed UK wide tariff will apply - adjusted by Carr- Hill formula Will cost on average �6000 per GP per year

17. Quality and outcomes framework Practices awarded points for achieving certain standards Total of 1050 points available 1 point = �75 on average this year, �120 next year Four �domains� Clinical Organisational Additional services Patient experience

18. Clinical Domain Coronary heart disease including left ventricular dysfunction Stroke and transient ischaemic attacks Hypertension Hypothyroidism Diabetes Mental Health Chronic Obstructive Pulmonary Disease Asthma Epilepsy Cancer

19. Clinical Domain Example The percentage of patients with coronary heart disease, in whom the last blood pressure reading (measured in the last 15 months) is 150/90 or less. 70% 19 points A proportion of the points score will be awarded in a direct linear relationship for achievement between the minimum (25%) and the maximum (in this case 70%)

20. Organisational Domain Records and information Communication with patients Education and training Medicines management Clinical and practice management

21. Organisational Domain Example The practice has arrangements for patients to speak to GPs and nurses on the telephone during the working day. 1 point

22. Additional services domain Cervical screening Child health surveillance Maternity services Contraceptive services Example The practice has a system to ensure abnormal smears are followed up. 3 points

23. Patient experience domain Patient survey Consultation length Example The practice will have undertaken an approved patient survey each year. 40 points

24. Investment Global sum and MPIG Quality payments Payments for enhanced services Others - premises, seniority, PCO payments (e.g. for mat leave), dispensing Pensions

25. Global Sum Payment for essential and additional services Staff costs Locum reimbursement Average UK practice to receive �300,000 Based on practice population weighted using Carr-Hill formula

26. Carr-Hill formula

27. MPIG

28. Quality payments

29. Pensions Under old contract not all work was pensionable Under new contract locum work and work for out of hours co-operatives will be pensionable

30. Current issues Dispute over payments for flu vaccinations for at risk under 65s Some difficulty in obtaining quality preparation payments Problems with enhanced services payments -PCTs not making minimum floor payments as they claim the money has already been allocated this year