1. Funding in General Practice
Dr Andy Withers
Grange Practice
Allerton, Bradford

2. 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

3. 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?

4. What do we get paid for? Core General Practice(= Essential Services)
Additional Services
Enhanced Services
QOF

5. NHS Income

6. GP Funding Budget BAtPCT
Essential Services
63.6
Additional Services
2.8
QOF
15.4
LoQOF
1.7
Enhanced Services
11.3
Other
5.2

7. Premises Budget
Brought forward
Premises

8. Essential Services (63.6%)
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

9. Essential Services (63.6%)
Either paid as “Global Sum” or MPIG in GMS practices (MPIG = GS +correction factor)
Government want to get rid of MPIG
Basic Contract in PMS practices

10. Additional Services (2.8%)
Normally expected of all practices but OPT-OUT possible
Cervical cytology
Child health surveillance
Maternity services (not intrapartum care)
Contraceptive services

11. Enhanced Services (11.3%)
3 types
Direct
National
Local

12. DES (2.8%) 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
Improved access
IMT
Choice & Booking
(PBC)
“New clinical DESs” Heart Failure, Osteoporosis, LD, Ethnicity, Alcohol

13. NES (1.7%) 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

14. LES (6.8%) OPT-IN Response to specific local requirements
Local terms, conditions and standards
Possibly, innovative services for piloting and evaluation

15. LES (6.8%) Choice & Booking (to 31/3/09) IM&T Sexual Health
Minor Primary Services
ECG
Minor Surgery (various levels)
Spirometry

16. 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

17. Range of Practice Funding in BAtPCT

18. Seniority Begins from start of NHS service Annual increments
Soon to be removed

19. QOF THE FOUR DOMAINS OF QUALITY Clinical Organisational Patient experience Additional services

20. Total Points 1000 Clinical 650 Organisational 167.5
Additional Services 36
Patient Experience

21. CLINICAL AREAS Asthma 45 Heart Failure 20 AF 30 Hypertension 83
Cancer 11
CKD 27
COPD 28
CHD 89
Dementia 20
Depression 33
Diabetes 93
Epilepsy 15
Heart Failure 20
Hypertension 83
Hypothyroidism 7
Learning Disabilities 4
Mental health 39
Obesity 8
Palliative Care 6
Smoking 68
Stroke & TIA 24

22. Records and information Patient communication Education and training
ORGANISATIONAL AREAS
Records and information
Patient communication
Education and training
Practice management
Medicines management

23. General Practice Assessment Questionnaire (Manchester)
PATIENT EXPERIENCE
Standardised approved patient questionnaires
General Practice Assessment Questionnaire (Manchester)
Improving Practice Questionnaire (Exeter)
Length of consultation - 10 mins appts

24. QOF Changes 2009/10
End of “Square rooting”
Move to true prevalence

25. 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

26. PBC Practice Based Commissioning 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
Usually done through commissioning alliances

27. 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 Y
Private N
Reports
Medicals etc

28. Getting Paid

29. Getting Paid 2 (This is real money)
Typical Middle sized practice (approx 5500 patients)
Total amount £875k
Less running expenses (36%) £315k
Less Staff costs (including salaried GPs & GPRs) £260k
Profit (34%) £300k
Divided between partners = income £100k
Need to pay 20% superannuation £80k
Need to pay Income tax

30. Premesis Lift PFI variants DIY Guaranteed income stream from PCT
About 11% return for developer