1. NEW GMS CONTRACT Stephen Newell Linda Turner Susan Watts

2. WHEN? COMMENCES 1.4.04

3. WHY DID GP’S VOTE YES? No “Red Book” No “Red Book” No Items of Service (IOS) No Items of Service (IOS) No over 75 or 3 yearly checks No over 75 or 3 yearly checks No Staff reimbursement No Staff reimbursement No Saturday mornings No Saturday mornings No out of hours (OOHs) – can opt out No out of hours (OOHs) – can opt out No permission required for new partners No permission required for new partners

4. SOME IMPROVEMENTS Increased investment in primary care Increased investment in primary care Incremental payments for quality Incremental payments for quality Exception reporting for quality payments Exception reporting for quality payments 100% reimbursement of computer costs 100% reimbursement of computer costs Opt in to enhanced services Opt in to enhanced services End of 24 hour responsibility End of 24 hour responsibility GP pensions GP pensions GP seniority payments GP seniority payments

5. SOME CONCERNS Funding Funding Transition Transition IT IT Lack of clarity Lack of clarity

6. CLINICAL SERVICES Essential Essential Additional Additional Directed Enhanced Directed Enhanced National Enhanced National Enhanced Local Enhanced Local Enhanced

7. ESSENTIAL Medical management of patients who are (or believe themselves to be) ill, health promotion advice and referral as appropriate – reflecting patient choice Medical management of patients who are (or believe themselves to be) ill, health promotion advice and referral as appropriate – reflecting patient choice General management of terminally ill patients General management of terminally ill patients Management of chronic disease – in discussion with patient Management of chronic disease – in discussion with patient

8. ADDITIONAL SERVICES SERVICES  Cervical screening  Contraceptive services  Vaccs and Imms  CHS  Maternity Services  Minor Surgery

9. OPT OUT Can opt out of additional services but will loose approximately 10% of global sum if you opt out of all additional services. Can opt out of additional services but will loose approximately 10% of global sum if you opt out of all additional services.

10. DIRECTED ENHANCED Access to GMS Access to GMS Childhood Vaccs & Imms Childhood Vaccs & Imms Influenza Vaccs (over 65’s and at risk) Influenza Vaccs (over 65’s and at risk) Quality Information Preparation (1 st 2 years only) Quality Information Preparation (1 st 2 years only) Services to support staff dealing with violent patients Services to support staff dealing with violent patients Enhanced minor surgery Enhanced minor surgery

11. NATIONAL ENHANCED Patients who are alcohol misusers Patients who are alcohol misusers Anti coagulant monitoring Anti coagulant monitoring IUCD fittings IUCD fittings Specialised care for patients with depression Specialised care for patients with depression Patients suffering from drug misuse Patients suffering from drug misuse Provision of immediate care and first response care Provision of immediate care and first response care

12. Enhanced care of the homeless Enhanced care of the homeless Intra partum care Intra partum care Minor injuries services Minor injuries services More specialised services for patients with MS More specialised services for patients with MS Provision of near-patient testing, etc etc. Provision of near-patient testing, etc etc.

13. LOCAL ENHANCED PCT will decide what is needed PCT will decide what is needed Local terms and conditions Local terms and conditions Developed in response to local needs, e.g. diabetic service Developed in response to local needs, e.g. diabetic service

14. OUT OF HOURS COVERS 18.30 – 08.00 EVERY DAY COVERS 18.30 – 08.00 EVERY DAY WEEKENDS WEEKENDS BANK HOLIDAYS BANK HOLIDAYS IF YOU OPT OUT YOU LOSE ABOUT 6% OF GLOBAL SUM IF YOU OPT OUT YOU LOSE ABOUT 6% OF GLOBAL SUM

15. 4 QUALITY DOMAINS CLINICAL CLINICAL ADDITIONAL SERVICES ADDITIONAL SERVICES ORGANISATIONAL ORGANISATIONAL PATIENT EXPERIENCE PATIENT EXPERIENCE PLUS PLUS

16. CONTRACTUAL & STATUTORY REQUIREMENTS CONTRACTUAL & STATUTORY REQUIREMENTS

17. CLINICAL Asthma Asthma Cancer Cancer CHD (including LVD) CHD (including LVD) COPD COPD Diabetes Diabetes Epilepsy Epilepsy Hypertension Hypertension Hypothyroidism Hypothyroidism Mental Health Mental Health Stroke or TIA Stroke or TIA

18. Additional Services Cervical Screening Cervical Screening Child Health Surveillance Child Health Surveillance Contraceptive Services Contraceptive Services Maternity Services Maternity Services

19. EXCEPTIONS Patients who refuse to attend on 3 occasions Patients who refuse to attend on 3 occasions New or recently diagnosed patients New or recently diagnosed patients If treatment is not clinically appropriate If treatment is not clinically appropriate Patient has refused (given informed dissent) Patient has refused (given informed dissent) Patient cannot tolerate treatment Patient cannot tolerate treatment Patient already taking maximum medication Patient already taking maximum medication Patient has another condition that affects treatment Patient has another condition that affects treatment

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

21. PATIENT EXPERIENCE Length of consultation Length of consultation Annual patient questionnaires Annual patient questionnaires

22. CONTRACTUAL AND STATUTORY REQUIREMENTS NO POINTS ATTACHED NO POINTS ATTACHED NO CHOICE NO CHOICE MUST DO MUST DO

23. EXTRA PAYMENTS Holistic Care payments Holistic Care payments  Encourages breadth of clinical care Quality Practice payments Quality Practice payments  Encourages achievement across the whole range of indicators, not just clinical.

24. ACCESS Extra points Extra points  Maintaining access targets  Maintaining quality

25. REPORTING LARGELY BASED ON TRUST: LARGELY BASED ON TRUST:  Data entry during consultation including telephone calls / consultations  Audit generated by normal work  Virtually no claims or paperwork  Annual report on computer  Annual visit from PCT to check report  Appeals process if disagree with PCT

26. PATIENT FLOWS Practice Area Practice Area Patient choice Patient choice Removals Removals Allocations Allocations

27. SUMMARY There are:  76 Clinical indicators  10 standards for Additional Services  56 Organisational indicators  4 Patient Experience requirements  26 Contractual and Statutory requirements