Contracting for General Medical Services Ian Dodge Head of GMS Department of Health

1. Contracting for General Medical ServicesIan Dodge Head of GMSDepartment of Health

2. Objectives for the session • Key points from chapter 6 of Delivering Investment in General Practice • What PCTs need to do, why, and when • Q&A Not a substitute for reading chapter 6 - or the regulations

3. Five Themes • Getting contracts in place by 1st April • Understanding rules about contractor form and conditions • Managing disputes • Termination breach and sanctions • Review and variations

4. Getting contracts in place (1) • Local contract not a national arrangement • National rules - GMS Regulations and Standard Contract • Big bang: old GMS ends 31st March 2004, new starts 1st April 2004 • Reach provisional agreements by end of February or offer the default contract

5. Getting contracts in place (2) • Use the Standard Contract - daft not to • Draft; final version coming in February • PCTs must complete and send to contractors by end of February following discussions • Contractors decide whether to become Health Service Bodies - 13th February milestone

6. Getting contracts in place (3) • Pre-contract disputes should be kept to a minimum: • resolve aspiration in line with QOF guidance • additional service & OOHs opt-out rules don’t start until April • open/closed status: contractor can put in a notice from April anyway • enhanced services: can be a separate contract, and right is clear - 3 DES • MPIG/GS is only indicative: wait to have the argument (if need be) once the actual figures come in • premises, IT, PCT-admin monies: SFE is clear • Formal procedure but use local efforts or local implementation protocol

7. Getting contracts in place (4) • Sign something (GMS, PMS, or default) by 1st April otherwise GPs lose transitional rights to a new contract • Default contract is short-term, inflexible, allows payments to be made on account, not expected to be used save exceptional circumstances eg single-hander who is sick. Details coming in February

8. Contractor form & conditions (1) • Contractor conditions in Regulations 4 & 5: eg qualifications, criminal history, financial status. Based on PCT board member requirements. Contractors advised to confirm by 13th February • In addition to performer conditions under the new integrated Primary Care Performer List • 3 forms: single-handers, partnerships, limited companies. • Non-GPs can be in partnerships: eg consultants, dentists etc

9. Contractor form & conditions (2) • Rolling contract, unaffected by routine partnership changes, but contractor must give written notice and confirm that providers conditions are still met • If “in the reasonable opinion of the PCT, the change in membership is likely to have a serious adverse impact on the ability of the contractor or the PCT to perform its obligations”, PCT may serve a termination notice • Disputes about provider conditions go to FHSAA

10. Managing disputes • Pretty much anything can be disputed - but not placing of contracts eg other enhanced services • Use of procedure is a failure of relationship • Legal requirement to make all reasonable efforts first • Appeals mainly determined by FHSAA(SHA)

11. Termination, breach, sanctions (1) • Termination notice: can be served immediately if provider conditions no longer satisfied • Contracts can be terminated where partnership split means impossible to determine which partner continues • PCT expected to enter into short-term temporary contracts but can make alternative arrangements eg new premises costs, or otherwise to the detriment of NHS efficiency • Temporary contracts normally become permanent

12. Termination, breach, sanctions (2) • Must consult LMC if refuse to turn temporary contract into permanent one • PCT can also terminate contract immediately if serious risk of patient safety or material financial loss • Contractors must provide 6 months notice before withdrawing, 3 months for single-handers

13. Termination, breach, sanctions (3) • If PCT believes contractor in default, can issue breach or remedial notice (if capable of remedy) • If more than two breach or remedial notice, PCT can serve termination notice; but be sensible, and consult LMC. Cannot terminate unless “prejudicial to the efficiency of NHS services to allow the contract to continue” • PCT may consider withholding monies relating to the breach action • Notices can be disputed & be careful of termination if in doubt seek legal advice - risk of big damages • Must consult LMC if refuse to turn temporary contract into permanent one • PCT can also terminate contract immediately if serious risk of patient safety or material financial loss • Contractors must provide 6 months notice before withdrawing, 3 months for single-handers

14. Contract review & variations • Annual review with proforma • Informal relationship key • Standard contract information system to be developed • Can agree local variations • Unilateral variations to reflect regulation changes; revised text of Standard Contract will be produced

15. Summary • Provisional agreement end of Feb, sign by end of Mar; & use standard contract • Pre-contract disputes should be minimised • Contractors must meet standard conditions • New flexibility about form • Obligation to try to resolve locally before using dispute resolution • Breach or remedial notices; after two, termination notice possible, but NHS efficiency test as well • Sanctions possible • Annual review, proforma & IT system coming

16. Questions