Investing in General Practice The New General Medical Services Contract

1.Vision & Summary 2.Workload Management 3.Quality and Outcomes 4.HR & Infrastructure 5.Funding Flows 6.Benefits to Patients 7.Implementation & Next Steps 8.NatPaCT Workshop

A few things to remember NO Red Book – throw it away! NO Items of Service NO reimbursements NOT England only THEREFORE …….. SOMETHING COMPLETELY NEW, DIFFERENT AND EXCITINGSOMETHING COMPLETELY NEW, DIFFERENT AND EXCITING

VISION What it isnt a new mechanism for paying GPs What it is a new platform for a step change in improved health and health services, improved morale and which creates greater and fairer rewards for GPs

SUMMARY over £8 billion UK investment over three years (av. uplift 11% per year) movement to a practice-based contract between PCO and practice fairer allocation formula quality and outcomes framework management of workload strategy to expand and develop the primary care sector overhaul and modernisation of the infrastructure and management processes programme of financial support for transition

WORKLOAD Categorisation of services -Essential -Additional -Enhanced Out of Hours

Essential Services ALL PRACTICES MUST PROVIDE :- Management of patients who are ill or believe themselves to be ill, with conditions from which recovery is generally expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever practicable 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

Additional services ALL PRACTICES EXPECTED TO PROVIDE BUT CAN OPT OUT Cervical screening Contraceptive services Childhood vaccinations and immunisations Child health surveillance Maternity services – excluding intra partum care Minor surgery – curettage, cautery and cryocautery of warts and verrucae, and other skin lesions

Opting Out Either: temporary (emergencies) permanent (long-term problems) PCOs and practices working together Maximum 9-month process Alternatives – sub-contracting, other practices, PCO, other providers e.g. walk-in centres Money removed from practice global sum Patient access to services protected – Patient Services Guarantee

Enhanced services PCO 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. diabetology services

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

QUALITY & OUTCOMES FRAMEWORK A bold initiative to improve quality of care With one mighty leap, the NHS vaults over anything being attempted in the United States, the previous leader in quality improvement initiatives Paul Shekelle, professor of medicine, University of California Los Angeles BMJ, Vol 326, 1 March 2003: 457-8

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

Quality Principles evidence-based criteria compatible with coverage of important aspects of patient care data should never be collected purely for audit purposes fully functional clinical software system is needed disease should affect a significant number of people criteria must be measurable demonstration of change in a reasonable period of time

The four domains of quality Clinical Organisational Patient experience Additional services (plus contractual and statutory criteria)

Clinical Areas CHD & LVD Hypertension Diabetes Stroke or TIA Hypothyroidism Epilepsy Asthma COPD Mental Health Cancer

Organisational Areas Records and information Patient communication Education and training Practice management Medicines management

Patient Experience Standardised approved patient questionnaires –General Practice Assessment Questionnaire (Manchester) –Improving Practice Questionnaire (Exeter) Length of consultation - 10 mins appts

Points = Prizes Preparatory Payments – 03/04, 04/05, 05/06 - £9000 per average practice PLUS Point = £ Point = £120

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 PCO – annual practice report and visit

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

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

MODERNISED INFRASTRUCTURE PREMISES Protected Resources New flexibilities Improved quality standards Branch/split-site surgeries

FUNDING FLOWS Global Sum (new allocation formula) Enhanced Services (unified budget) Quality Transition Premises IT Pensions Seniority PCO-administered e.g. HR

CARR-HILL FORMULA Components: age and sex, including patients in nursing and residential homes additional needs of the population - morbidity and mortality list turnover unavoidable costs - staff Market Forces Factor and rurality tailored version for Scotland

THE MONEY (England) Global sum payments £300k 04/05 per 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

PRACTICE GLOBAL SUM PCO UNIFIED BUDGET ESSENTIALADDITIONAL Directed and National ENHANCED LOCAL ENHANCED GUARANTEED FUND(S) ASSURED QUALITY MONEY ALTERNATIVE PROVIDER TOP-SLICED ALLOCATION PREMISES IT

SO WHATS IN IT FOR US? P atients – choice, access, quality P ractices – resources, workload, autonomy, outputs P rimary Care Workforce – teams, HR, training P COs – relationships, infrastructure, services

NEXT STEPS - National NHS Confed and GPC roadshows – Feb/March GP ballot - 20 March to 11 April If YES…… Primary & Secondary Legislation Topic-specific Briefings – April National conference (London) - May NatPact roadshows – early summer Implementation guidance – late summer

HOW TO FIND OUT MORE READ THE DOCUMENT – LOTS MORE IN DETAIL US WITH ANY QUESTIONS – QUICK TURNAROUND LOOK AT WEBSITE FOR: –SUPPORTING DOCUMENTATION (quality evidence, salaried contracts, enhanced services specifications, ready reckoner and lots more) –SLIDES –Q&A –ON-LINE VIRTUAL PRESENTATION