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Funding in General Practice
Dr Andy Withers Grange Practice Allerton, Bradford
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Aims & Objectives Aims Objectives
Increase understanding of how General Practice is financed Objectives Know how :- Practice income is calculated and received Budgets are set The difference between NHS & Private income
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Questions How do GPRs get paid in practice?
How do salaried GPs get paid? How do GP Partners get paid? What is the difference between a GMS & PMS practice? Are all my earnings pensionable? What is PBC? How can I earn more? Money & referrals/admissions Seniority payments
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What do we get paid for? Core General Practice(= Essential Services)
Additional Services Enhanced Services QOF
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NHS Income
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Essential Services MANDATORY - common to all practices
The 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 2) The general management of patients who are terminally ill 3) Management of chronic disease in the manner determined by the practice, in discussion with the patient
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Essential Services Either paid as “Global Sum” or MPIG in GMS practices Basic Contract in PMS practices
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Additional Services Normally expected of all practices but OPT-OUT possible Cervical cytology Child health surveillance Maternity services (not intrapartum care) Contraceptive services
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Enhanced Services 3 types Direct National Local
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DES Obligatory for each PCO National specifications
No one practice has to do: Services to violent patients Childhood vaccinations and immunisations financial incentives Minor surgery Flu immunisations Quality information preparation Improved access
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NES OPT-IN - national terms and conditions
Anticoagulant monitoring IUCD Sexual health MS Drug and alcohol misuse Terminally ill Depression Learning disabilities Intra partum care Minor injuries Near-patient testing Homeless Immediate/first response care
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LES OPT-IN Response to specific local requirements
Local terms, conditions and standards Possibly, innovative services for piloting and evaluation
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GMS v PMS Little difference now
PMS probably slightly higher earning practices due to historic funding. Both practice based contracts GMS nationally negotiated Either global sum via Formula Or Minimum practice income guarantee (MPIG) PMS (potentially) locally negotiated
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PCO PRACTICE GLOBAL SUM OR MPIG UNIFIED BUDGET ALTERNATIVE PROVIDER
ASSURED QUALITY MONEY ESSENTIAL & ADDITIONAL PROTECTED TIME PCO-MANAGED FUNDS DIRECTED AND NATIONAL ENHANCED LOCAL ENHANCED PREMISES PCO GUARANTEED FUND(S) ALTERNATIVE PROVIDER PRACTICE
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Seniority Begins from start of NHS service Annual increments
Soon to be gotten rid of
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QOF THE FOUR DOMAINS OF QUALITY Clinical Organisational Patient experience Additional services
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Total Points 1000 Clinical 655 Organisational 181
Additional Services 36 Patient Experience 108 Holistic Care
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CLINICAL AREAS CHD & LVD Hypertension Diabetes Stroke or TIA
Hypothyroidism AF Depression Obesity Epilepsy Asthma COPD Mental Health Cancer CKD Dementia Learning Disabilities
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ORGANISATIONAL AREAS Records and information Patient communication Education and training Practice management Medicines management
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PATIENT EXPERIENCE Standardised approved patient questionnaires
General Practice Assessment Questionnaire (Manchester) Improving Practice Questionnaire (Exeter) Length of consultation - 10 mins appts
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BREADTH v DEPTH Holistic Payments Across Clinical Domain
Performance in 3rd lowest area Quality Practice Payments Across all domains
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Pensions All NHS income pensionable
delivering GMS / PMS delivering services under delegation including locum work board, advisory and other work for NHS bodies collaborative arrangements work education statutory certification work for GP cooperatives that are NHS bodies All locum pay pensionable from
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PBC Practice Based Commissioning DES for 1 year (approx £1.90/pt)
Voluntary Devolved budgets to all practices Virtual Money – you can’t take it home For: Prescribing Secondary care, acute & elective Community Staff Can spend (up to) 70% of Freed up resources (FURs note not savings) on patient care. Pct takes rest. Only get FURs you predict (no serendipitous FUR) Idea is to provide innovations in services to produce FUR
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Other DESs IT Access Choice & Book Using the IT
Patient Evaluation Survey (PES) Choice & Book evaluation
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Other Income Teaching & Training Amount NHS Pension? NHS related work
GPR £7.5k Y FY2 £10k Y Medical Students £15-20k N NHS related work GPwSI c £10k/session Y PCT Y LMC N DH ? Private N Reports Medicals etc
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Getting Paid
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Getting Paid 2 (This is real money)
Typical Middle sized practice Total amount £1m Less running expenses £300k Less Staff costs (including salaried GPs) £400k Profit £300k Divide between partners = income £100k Need to pay 20% superannuation £80k Need to pay Income tax on this
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