Primary Care 2010

GP contractual Models GMS (contract in perpetuity) PMS (contract in perpetuity) APMS (time limited contract subject to procurement rules)

GMS Nationally negotiated contract for core and additional services Capitation funded based on Carr Hill formula Global Sum (£64.59 at 2010/11 prices) Funding discrepancy address by a Minimum Practice Income Guarantee (MPIG) Further services funded under enhanced services – DES, NES & LES Quality and Outcomes Framework Core Hours 08.00 to 18.30 (out of hours responsibility transferred to PCT)

Original PMS Locally negotiated contract that offered additional flexibilites Pre dates the current GMS contract Recent guidance that the two contracts should be treated the same PMS practices have access to NES and LES PMS practices have access to QOF with 105 point abatement Allowed to opt out of OOH when new GMS implemented

New PMS Some PCTs have introduced updated versions of PMS contracts where providers would not accept APMS contract but PCT wanted to commission additional flexibilities

APMS Alternative Provider Medical Services Locally negotiated Does not have to be GP led/owned often companies who used salaried GPs Often has some contract values linked to Key Performance indicators Core hours service only but may be more than standard core hours

QOF Points make prizes 20 Clinical Domains 6 Organisational Domains 4 Additional Services Domains Thresholds and achievements set £127.29 per point based on an average list size (5981) Takes account of disease prevalence in clinical domains Patients can be excepted from the counts but PCTs monitor this closely

Other funding Premises costs (rent, rates etc.) Seniority allowances Discretionary funding for locums to cover maternity/paternity leave and in some cases

Key Performance Indicators QOF could be viewed as a form of KPI Mainly linked to APMS contracts Will definitely be linked to any services commissioned from Primary Care outside of “normal” services Outcome measures

The Future All of the NHS is going to have to generate efficiencies to survive and Primary Care is included in this. The new regime GPs being responsible for 80%-90% of NHS budget in real terms Negotiation of new GP contract GP contracts to be held by the NHS board not PCTs Removal of SHA’s PCTs to concentrate on Public Health and residual commissioning

Practices as a business Need to look for efficiencies would Federated models of GPs offer this What is a federation? Mergers? What opportunities are there for delivering a wider range of services that may attract more funding? By expanding services do we threaten core services Have GPs and their teams the knowledge and skills to move forward in a new structure?

Individual GPs Do you want to be a partner? Would you want to be in a salaried position? Do you want to work totally in primary care? Would you want to have a portfolio career with different interests and responsibilities in different areas Clinical Leadership/engagement very important