The New General Medical Services Contract and Personal Medical Services

1. The New General Medical Services Contract and Personal Medical Services Mr Sarb Basi Director of Primary Care Heart of Birmingham Teaching PCT

2. A Reminder of the key objectives • over £8 billion UK investment over 3 years • movement to practice-based contract • management of workload • incentivising delivery of high quality care • expansion of primary care sector • modernisation of infrastructure and management process

3. A Reminder of the key benefits • Patients – choice, access, quality • Practices – resources, workload, autonomy, outputs • Practitioners – teams, HR, training • PCOs – relationships, infrastructure, services

4. THE MONEY • Global sum payments £300k 04/05per av. practice ( av. Per patient of £53) £ 305K 05/06 per av. practice ( av. Per patient of £54) • Investment in enhanced services – unified budget £315m 03/04 £518m 04/05 £586m 05/06 • Transitional protection £297m 04/05 £197m 05/06

5. HUMAN RESOURCES • GP Career structure • Protected time • Salaried option • Seniority payments • Family-friendly policies • Practice Management competency framework

6. MODERNISED INFRASTUCTURE IM&T • 100% Funding • PCO Ownership and liability • Choice of systems • Development, implementation, support • Education & training • Implementation

7. Essential Services ALL PRACTICES MUST PROVIDE • Management of patients who are ill or believe themselves to be ill • General management of patients who are terminally ill • Management of chronic disease in the manner determined by the practice and in discussion with the patient

8. Additional Services ALL PRACTICES EXPECTED TO PROVIDE BUT CAN OPT OUT EITHER TEMPORARILY OR PERMANENTLY • Cervical screening • Contraceptive services • Childhood vaccinations and immunisations • Child health surveillance • Maternity services – excluding intra partum care • Minor surgery • Out Of Hours

9. Enhanced services tPCT COMMISSIONED FROM PRACTICES & OTHERS Directed ( national specifications and benchmark prices • Violent patients, improved access, childhood vaccinations and immunisations, flu vaccinations, enhanced minor surgery, quality information preparation ( 2 years only ) National (model national specifications and benchmark prices ) • E.g. intra-partum care, anti coagulant monitoring, intra uterine contraceptive device fitting drug and alcohol misuse, sexual health services, depression services, homeless care, minor injury Local (local terms and conditions) • Developed in response to local need e.g. diabetes

10. Out of Hours • End of current 24 hour responsibility • PCO responsible for ensuring provision- 6.30pm to 8am, plus weekends and bank holiday • To start from 1 April 2004 – Expected end date 31 Dec 2004 • Price for Opting out = av. £6,000 per GP • tPCT have OOH development fund

11. QUALITY & OUTCOMES • Funding - Preparation (for 3 years) - Aspiration (one third up front) - Achievement ( two thirds at end of year • Exception reporting • High trust monitoring by tPCT- annual practice report and visit

12. The four domains of quality • Clinical – fully functional clinical systems • Organisational – records information, practice management • Patient experience – standardised approved patient - length of questionnaires consultation – 10 mins • Additional services ( plus contractual and statutory criteria)

13. Rewards for Quality • £1.3bn for the UK quality • Non – discretionary • In additional to the global sum • Payment for what many already do • All work converts to points • 1050 maximum points • % of income will vary

14. What about PMS? • Locally owned and developed by local GPs • Local Flexibilities • Local Contract based on quality of service • A Heart of Birmingham Initiative – works for small practices • Reduces Bureaucracy • Local targets • Increased GP and Nurse resources • GMS = NO growth

15. A quality of service contract P.M.S. • Can afford to lose patients at no cost! (removal of ghosts to up target attainment) • Monitoring framework (minimum of 3 clinical audits per year) • `Proof that my practice provides a quality service….’ using local sensitive indicators for measuring performance • Achievable for Small practices unlike the new GMS Contract

16. The Future • A combination of the best things from both • Growth & quality framework pulled together – funded • Incentives for enhance primary care • Diabetes, CHD • Proactive OOHs development • Primary care emergency services

17. NEXT STEPS – Opportunities Single Agreement - similar contract and Q&O framework for both PMS and GMS practices Practice based contracts not GP based – incorporating practice staff and community Quality and Outcome Framework – Introduction of league tables, star ratings Recruitment & Retention – IWL, new career structures, new roles, workforce planning

18. NEXT STEPS – Opportunities Creative Commissioning – Greater control over workload & greater flexibilities. Ward./practice based commissioning Growth -Opportunities to use growth differently Developing alternatives models of care – e.g. Foundation practices

19. NEXT STEPS – Local Responbilities • All Directors / leads must understand the new arrangements and work together • Everyone needs to support practices in understanding what it means for them

20. NEXT STEPS –Local Responsibilities • Everyone needs to understand work with practices in implementing the contract (hold local workshops if necessary) • Everyone needs to understand and respect the views of GPs and practice staff ‘on the ground’