1. nGMS Contract: a general overview Nicola Walsh, NatPaCT

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3. nGMS Contract: a general overview Nicola Walsh, NatPaCT

4. GMS GMS Individual GP National contract focused on IoS payment Payments are retrospective Rule bound model Discourages skill mix

5. GMS PMS pilot Individual GP National contract focused on IoS payment Payment made retrospectively and depends largely on activity Funding discourages skill mix Provider organisation Locally based contract focused on health priorities Payment agreed in advance and paid monthly Encourages skill mix

6. PMS nGMS PMS nGMS Provider contract Locally focused Payment agreed in advance PMS budget ring- fenced Provider contract National and local Payment agreed in advance nGMS budget ring- fenced

7. New GMS Contract Managing workload: Essential services Additional services Enhanced services Out of hours services

8. Essential Services Management of patients who are ill or believe themselves to be ill. General management of patients who are terminally ill Management of chronic disease in the manner determined by the practice

9. Additional Services Cervical screening Contraceptive services Vaccinations and immunisations Child health surveillance Maternity services Minor surgery

10. Enhanced Services Essential or additional services delivered to a higher standard New more specialised services nationally directed specifications national specification but not directed locally determined

11. Out of Hours Services from 6.30pm to 8.am on weekdays, whole of weekend and bank holidays Until April 2004 responsibility of GP Between April - December 2004 classified as an additional service By 31 December 2004 responsibility of the PCT ……but language changing

12. Funding Global sum of money allocated to provider to cover essential services additional services infrastructure (not IT or premises) staff costs

13. Additional funding Minimum Practice Income Guarantee Enhanced services Quality payments Preparatory payments

14. Quality and Outcomes Framework Framework has 4 domains clinical standards organisational standards additional services patient experience

15. Quality and Outcomes Framework Framework has 4 domains clinical standards 550 organisational standards184 additional services 36 patient experience 100 other bits180 TOTAL 1050

16. Quality payments Aspirational payment Achievement payment

17. Monitoring Annual report to PCT Visit by PCT monitoring team Follow up letter sent to practices Appeal process

18. Implications for nurses Different contractual relationship Greater focus on a team based approach Greater use of skill mix within the team Opportunities to work with the wider team

19. Implications for nurses PCTs will commission primary care Different patterns of provision across PCT and practices New career opportunities Legislation allows nurses to become partners Legislation allows nurses to set up their own limited companies

20. Implications for Nurses Incentive structure linked to improved quality and outcome Nurses will have an important role in developing disease registers, collecting data and delivering services. Practice/Provider based contract so all the team to participate in demonstrating improvements

21. Implications for Nurses Improved working conditions Nurses must be eligible to perform services Development needs must be supported Nurses should have access to clinical supervision, appraisal and CPD

22. The Future... Nurses running practices Nurses winning contracts to provide services Multi-professional partnerships GPs employing/subcontracting nurses to run a branch surgery PCTs employing nurses to run specialist services or/and practices

23. In Summary New GMS Contract provider based contract much more than a way of paying GPs a shift in mindset improved employment conditions improved patient care

24. Programme of support Two conferences to be held for all nurses on new GMS and new PMS A network of SHA and PCT lead nurses to advise on implementation Regular updates on new GMS/nPMS on CNO and NatPaCt websites Nine regional workshops Support for nurses interested in partnerships

25. Useful contacts Queries can be inserted via helpline 0845 900 0008 gmspms.queries@ndpt.nhs.uk www.natpact.nhs.uk www.bma.org.uk www.nhsconfed.org