GMS Contract in Scotland 2014 / 2015

Context for negotiations in Scotland Last year, contract imposition in England, agreed contract changes in Scotland, planned to last 2 years to provide stability, but option to re-open if anything which happened elsewhere in UK was thought to be worthwhile. In negotiations in autumn 2013 agreement reached in England to move a number of points to core, also new IT requirements, choice of practice, and a DES looking at Unplanned admissions . Also publication of earnings, and timeframe for end of Seniority payments Some of these things could be attractive…. Scottish Government didn’t commission NHS Employers this year.

Scottish Agreement for 2014 / 2015 Contract changes overview “The BMA's Scottish GP Committee has agreed changes to the GMS (GP) contract for 2014-2015 with the Scottish Government. We have gone a long way to achieving the aims of our negotiations, building on last year's agreement. We believe the agreement will: Substantially reduce unnecessary targets and bureaucracy, reducing interference in consultations and allowing us to focus more on the needs of the patient Focus primary care resources on the most vulnerable patients in the community Provide greater stability of funding for GP practices Address some GP practice workload concerns Continue to promote a return to the concept of GP professionalism and leadership.” . “Negotiations conducted over very short period” – even shorter this year! Six meetings in six weeks

Contractual uplift SGPC/GPC clear that DDRB should report. Not part of negotiations or agreement DDRB recommendations are being honoured, whatever we may think of them… “The Scottish Government intends to apply uplift to the value of the contract reflecting an element for expenses and a pay uplift but this will also take account of the Scottish Government’s public pay policy. The Scottish Government remains committed to the Doctors’ and Dentists’ Review Body (DDRB) process and will await the DDRB’s recommendation before deciding on the level of the uplift”

Going forward…. Future negotiations In addition, SGPC and the Scottish Government will explore the development of a Scottish Contract as part of a longer term agreement (for three years) to create a stable funding environment for general practice. This will include discussions on how a GP contract in Scotland can be structured, taking account of: Moving toward the 2020 vision for health and social care Strengthening primary health care teams in and around GP practices Addressing issues relating to caring for the elderly population and those within deprived and rural areas Scottish Government proposals around seniority and recruitment and retention incentives. ….. Things that both sides will want to discuss.

So, what’s changing this year? We have agreed that 264 points will be retired from the QOF and moved to a core standard payment within the Global Sum. This includes retirement of disease registers (80 points), patient experience (33 points) and 151 points from clinical QOF areas. This means 659 QOF points will remain for 2014-2015. The transfer will occur in line with the process applied in 2013-2014, based on an average GP practice QOF point achievement for the past three years. As part of the retirement of disease registers, the 2014-2015 QOF guidance will include a general statement advising GP practices to continue to appropriately code diagnoses and provide clinically appropriate lifestyle advice.

A brief word on core standard payment Different from last year (post payment verification) Freezes current achievement Doesn’t recognise changes in size or demographics of practice population Doesn’t affect OOH 6% opt-out etc

So, what are these retired points? AF register CHADS2 scoring (but not what you do with it!) CHD register CHD cholesterol target HF register Hypertension register PAD register PAD cholesterol target Stroke register Stroke cholesterol measurement Stroke Cholesterol target Diabetic register Diabetic cholesterol target Diabetic ACR recorded Diabetic retinal screening Diabetic dietary review Diabetic ED annual questioning & advice Hypothyroid register TFT measurement Asthma register COPD regsiter COPD recording of FEV1 in last 12m Dementia register Biopsychosocial assessments Mental health register Cancer register CKD register Epilepsy register Epilepsy reviews Epilepsy contraception advice LD register TSH in Down’s syndrome Osteoporosis and Dexa register Rheumatoid register Rheumatoid fracture and CVD risk Palliative care register Obesity register Smoking status aged >15 Smear test results Antenetal care Child development Contraception register LARC advice (except EC) 10 minute appointments

Anything else going? Review timeframes The Scottish Government has agreed to return to a 15-month cycle of review (or 27 months for items under two-year review) for the QOF indicators changed in 2013-2014. This is to reduce unnecessary bureaucracy and enable the peak time of this activity to move out of the third quarter of the year, allowing GP practices to deal more effectively with acute winter pressures.

Quality and Safety domain… a new QOF Quality and Safety domain will be introduced to replace the Quality and Productivity domain. IN An indicator requiring GP practices to identify a liaison GP for health and social care integration (5 QOF points) An indicator requiring GP practices to undertake a review of access (25 QOF points) An indicator for setting out a programme for continuous quality development (25 QOF points). The current patient safety indicators (11 QOF points) will transfer to this domain. The current arrangements for Anticipatory Care Plans will continue (45 QOF points) OUT Five previous QOF QP indicators: reviews on outpatient referrals/emergency admissions; external peer review; and care pathways (QP001 to QP005) BUT… GPs will no longer be required to produce a report or Significant Event Review.

Access, integration and practice quality “We have agreed a series of changes with the aim of improving patient access to general practice, maximising workflow, continuing quality improvement and working with wider health services.” So, what does this mean?

Patient access Patient access Practices will undertake an annual assessment of current demand, assessing met and unmet need. This will follow a template and process agreed by the Scottish Government and SGPC. Following the annual assessment, practices will produce a ‘Patient Access Action Report’, which will be submitted to NHS Boards. Practices will be encouraged to involve patients in the process, and share the report with them in an appropriate, understandable way. This report will be discussed every three years at the new quality visits (see 2 slides down).

Integration Liaison with Health and Social Care Partnerships Practices will nominate a liaison GP to link with a specified person from their local Health and Social Care Partnership. These GPs will input into the HSCP's decisions as appropriate. Any additional workload will be funded separately on a local basis between the GP practice and the Health and Social Care Partnership.

quality Quality Practices will produce an annual report, based on an agreed template, to support continuous quality improvement. National clinical and non-clinical data will be available to help NHS Boards and GP practices identify areas to focus on, and to help inform the annual report. Practices will receive a Quality Programme peer review visit once every three years. This will be informed by the annual report. The aim of these visits is for allow constructive discussions, identify areas of priority, share best practice and provide peer support.

Publication of GP earnings An agreement has been reached to increase transparency by publishing GP NHS earnings from 2015-2016. The Scottish General Practitioners Committee and Scottish Government will work together to determine how the publication of net earning relating to the contract should be implemented. The final arrangement will ensure the calculation and publication of 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. The information will be on a national website and there will be consideration of the right to privacy of individuals.

Any questions?

GMS Contract in Scotland 2013 / 2014