GPC Negotiators / LMC Meeting February 2014

Today’s matters GP contract 14/15 PMS Workload, funding and morale Prime Minister’s Challenge Fund Alliances & Federations CCGs Premises CQC registration Revalidation Occupational Health Services Care.data NHS 111 Contract negotiations for doctors in training

GP contract : context of negotiations Backdrop of imposition Grassroots perception & morale Policy by political pronouncement Adverse media publicity re A&E pressures, 8-8, GP OOH opt out

GP contract 2014/15: to sum up A negotiated agreement; give and take on both sides; restored faith in the negotiating process A package with good and bad On balance a step in the right direction Not a panacea for workload, morale crisis and no new funding

GP contract 2014/15: objectives Reverse adverse impact of imposed changes Reduce bureaucracy, box ticking and chasing of targets Increased resources in core GP budgets, provide stability, enabling clinical judgment and flexibility in providing care

GP contract 2014/15: achievements 238 QOF points released to core funding 100 QP points released- > new ES Almost all unacceptable imposition indicators removed Removal of many indicators creating most bureaucracy Threshold increases for retracted New NICE indicators for removed 3 of last year’s imposed DES ended Most removed DES monies into core funding No increase contractual/extended hours or OOH responsibility

Movement to core funding Value of 238 QOF points (based on 12/13 achievement) £40m from patient participation DES £12m from remote care monitoring DES £24m from patient online DES Circa £80m from seniority funding pot by 2020 No 6% OOH deduction ALL practices receive- CF “floats on top” PMS mirrors GMS agreement

What will this mean for GPs & practices? More time to look at patient in front of us Ability to use clinical judgement Freeing up nurse/GP appointments Freeing up admin time Reduced scope for QOF post payment verification More core funding, not vulnerable to annual unpicking

Avoiding unplanned admissions enhanced service (1) Funded from 100 QP points and £42m risk profiling enhanced service = £160m No longer a requirement for external peer review meetings If CCGs want external QP-style meetings to continue they will need to support this with new money No targets for reducing admissions

Avoiding unplanned admissions enhanced service (2) Risk stratification to identify 2% of adult population at risk of admission to form a “case management register” Care plans for all on register to include –a named accountable GP –a care co-ordinator –review post hospital discharge Same day telephone consultations for patients on the register with an urgent need Timely telephone access for A+E, ambulance, care homes Monthly reviews of the case management register Review unplanned admissions and A+E attendance of care home patients

Imposed Enhanced Services from 2013/14 Patient Online –ended –£24m transferred to global sum Remote care monitoring –ended –£12m transferred to global sum Risk profiling –ended –£42m transferred to new admission avoidance enhanced service Dementia –continues

Named GP for 75s & over Contractual requirement to provide a named GP to all patients 75yr and older by 30 June 2014 Named GPs-lead responsibility to ensure services under contract delivered to patients aged 75 + “Usual GP” already in many practices Contract remains with the practice, not named GP Patients can still see any practice GP/nurse Does not mean 24 hour or vicarious responsibility Registration was with individual GP pre-2004

OOH Quality Monitoring Contractual requirement to review clinical details of consultations received from OOH providers same working day; report concerns to NHS England Respond to any information requests OOH providers same working day (exceptionally next working day). Take reasonable steps to work with OOH provider systems for rapid and effective transmission of OOH patient data No contractual requirement to work outside current working hours; no extended 8-8, 7/7 working

I.T. Changes Contractual requirements Include NHS number in all clinical correspondence Offer and promote online booking and repeat prescription ordering Upload SCR daily (or plans to achieve this by ) Use GP2GP transfer (or plans to achieve this by ) Offer and promote electronic access to SCR GPC and NHS England to work during 2014/15 on: –Electronic communication by patients with practice –Access to detailed care record from other care settings

Publication of earnings Working group being formed with NHS England and NHS Employers for publication of earnings from April 2015 Calculation and publication of earnings to be on a like for like basis with other healthcare professionals Published earnings will be GP NHS net earnings relating to the contract

Friends and Family Test Contractual requirement from December 2014 Replaces survey in Patient Participation DES “How likely are you to recommend our practice to friends and family if they needed similar care or treatment?” One follow-up question chosen by practice Monthly feedback to NHS England PP DES funding reduced to £20m and £40m added to core funding

Choice of GP practice Government committed to roll out of current pilot from October 2014 despite GPC, RCGP and CCG concerns –Pilots showed very small uptake from patients Practice involvement voluntary No obligation to visit these patients NHS England responsible for urgent medical care for patients if at home address

Seniority Government commitment to end age-related pay progression across public sector A redistribution - £80m seniority pot will be cemented into core funding to GP practices No new entrants 6 year stability: those in receipt on will continue and progress as per SFE until % value each year to be transferred to core funding, based on expected retirement rate

Seniority (2) If <15% NHSE and GPC to agree process Money in GS will be subject to annual DDRB rises; seniority funding has been static for 9 years and real-terms value eroded by inflation After GPs will be paid equivalent seniority throughout working lives compared to only in latter stages of career

Unfinished Business Guidance & regulations currently being drafted and approved Imposed equitable funding changes for 2014 onwards. MPIG outliers: NHS England letter leaves responsibility for outliers to ATs - unacceptable to GPC. Big role for LMCs Local QOF/contract initiatives PMS

Contract changes to mirror negotiated agreement for 14/15 - further details awaited Equitable funding / PMS review arrangements announced - “Premium” element of PMS expenditure identified as £325m - reduced to £235m as MPIG phased out - Area Teams have two years to review local PMS contracts from April pace of change following reviews left to local judgement - Area Teams to invest premium funding in GP services according to criteria set out by NHS England

What the contract will not resolve Demand exceeds capacity Workload and morale crisis Changing demographics; out of hospital care Need more GPs Need more practice staff Need bigger and more premises Need greater support services Need integration to manage austerity

NHS funding invested in general practice

GPs overworked and demoralised DH commissioned 7 th worklife survey GPs (Aug 2013)  lowest levels of job satisfaction since 2004 contract  highest levels of stress since start of the survey series  substantial increase in GPs intending retiring next 5 yrs BMA GPC GP contract survey (Sep 2013)  9 out of 10 increased workload past year  9 out of 10 say reducing appts and time for patients  Nearly 9 out of 10 reduced morale  1 in 2 GPs less engaged with CCG due to workload

GPC Vision for General Practice “With more GPs, spending more time with their patients, working in bigger and more comprehensive teams built around the practice, based in better quality premises and underpinned by a fairer share of NHS resources, general practice can deliver the healthcare solutions for the future”

Prime Minister’s Challenge Fund Separate to negotiations for 14/15 £50m fund for pilots to help extend access to general practice, including 8-8, weekend access, increased use of technology 9-10 pilots planned Expressions of interest invited from groups of practices –Many practices moving to work in networks / federations to bid Only funding for one year

Alliances & Federations We’d like to hear about emerging local alliances and federations Contact to share examples of activity and your This will help us generate a national picture of activity We have published guidance on Collaborative GP alliances and federations –bma.org.uk/gppracticesbma.org.uk/gppractices

What could CCGs do? Use commissioning levers to move resources to match changing patterns of care out of hospital Sort out primary/secondary interface problems Commission integrated care Limit targets and bureaucracy Support practices working together Limit excessive performance management Support GPs to have manageable workload

Premises GMS Premises Costs Directions 2013 are interim –Further negotiations required e.g. trade waste Joint national guidance on directions once finalised –Agreement on a national template GP lease and Principles of Best Practice guidance very close –This will be followed by process guidance from NHS Property Services (NHSPS) –Agreement on whole package required before publication

CQC Registration Practices required to register from April 2013 Concerns about content and variation in inspection process since then GPC strongly objected to approach to press release at end of 2013 CQC currently looking at re-vamping inspection process, including more GP involvement Ratings will form part of process in the future. GPC objects to simplistic rating system

Revalidation Concerns remain about: –consistency of approach –evidence collection for sessional GPs –approach for informing GPs about revalidation decisions –choice of toolkits GPC has set up revalidation implementation group and is holding regular meetings with NHS England Discussions on remediation funding ongoing

Occupational Health Services NHS England proposed discontinuing dedicated OHS for GP practices GP practices to fund OHS for non-medical practice staff from April GPs with stress or burnout will have to flag the issue with their appraiser or Medical Director’s office Unacceptable situation - we have written to DH to stress need for fully-funded OHS for general practice

Care.data Health & Social Care Act gives powers to Health & Social Care Information Centre to require Personal Confidential Data (PCD) from GP practices, without patient consent Right for patients to object to the extraction of their PCD for care.data was negotiated by the BMA Data Protection Act requires practices to make patients aware of the ways in which information from their record is used and shared beyond their direct care

Care.data (2) Information leaflet being delivered to all households in England Patient information line open until 31/3/14 Patients have a minimum of four weeks to read the leaflet and register their objection at their GP practice before the first extract begin in spring 2014 Ongoing updates provided in GPC News

NHS 111 GPC lobbying NHS England to reduce length and improve quality of post-contact information National 111 service specification to be revised and published in April 2014 –GPC has prepared a paper proposing solutions to improve the problems experienced during initial implementation –GPC key proposal – call handling and OOH provision must not be divorced if services are to be integrated All NHS 111 contracts to be re-commissioned from April 2015

Contract negotiations for doctors in training Negotiations underway for new contract for all doctors in training If agreed, would mean a significant change for GP trainees who have until now had no formal national contractual arrangement Currently a framework contract for GP trainees - maintained and agreed by the GPC and COGPED Negotiations are at an early stage - anticipated they will be ongoing throughout 2014

Questions and discussion Further details about these areas and more are available at You can with further