GP Contract Update 2017/18
NHSE has announced in consultation with the GPC key changes to the GMS Contract in England for 2017/18. This sees investment of £238.7 million. So what does this entail? Below is our summary of the contract and what it could mean to your practice in the coming year.
A pay uplift of one per cent and general expenses uplift of 1.4 per cent. NHS England and GPC have also agreed the new global sum figure for 2017/18. The value per weighted patient is set to rise from £80.59 in 2016/17 to £85.35 in 2017/18, a rise of 5.9 per cent
A change in the value of a Quality and Outcomes Framework (QOF) point as a result of a Contractor Population Index (CPI) adjustment. There will be no changes this year to the number of QOF points, indicators or thresholds. The value of a QOF point will increase by £6.02 or 3.6 per cent from £165.18 in 2016/17 to £171.20 in 2017/18.
The Avoiding Unplanned Admissions Directed Enhanced Service (DES) will be discontinued as of 31 March 2017, the 2016/17 spend of £156.7 million will be transferred into global sum, without the OOH deduction applied, and used to support work on frailty.
Identification and management of patients with frailty
From 1 July 2017 at the earliest, practices will use an appropriate tool e.g. Electronic Frailty Index (eFI) to identify patients aged 65 and over who are living with moderate and severe frailty. For those patients identified as living with severe frailty, the practice will deliver a clinical review providing an annual medication review and where clinically appropriate discuss whether the patient has fallen in the last 12 months and provide any other clinically relevant interventions. In addition, where a patient does not already have an enriched Summary Care Record (SCR) the practice will promote this, seeking informed patient consent to activate the enriched SCR.
Practices will code clinical interventions for this group appropriately. Data will be collected on the number of patients:
— recorded with a diagnosis of moderate frailty
— with severe frailty
— with severe frailty with an annual medication review
— with severe frailty who are recorded as having had a fall in the preceding twelve months
— severely frail, who provided explicit consent to activate their enriched SCR.
NHS England will use this information to understand the nature of the interventions made and the prevalence of frailty by degree among practice populations and nationally. This data will not be used for performance management purposes.
The Extended Hours Access DES will continue unchanged until 30 September 2017.
However, new conditions will be introduced from 1 October 2017 which will mean that practices who regularly close for a half day, on a weekly basis, will not ordinarily qualify for the DES. This change is to support the joint commitment to ensure locally responsive, safe and appropriate access to general practice for all patients in England during contracted hours. Local Medical Committees should be integral partners in working with local commissioners in ensuring practices are fulfilling their contractual requirements.
An increase in the payment for Learning Disabilities Health Check Scheme, up from £116 to £140. A new template has been designed to comply with this DES.
Funding to cover expenses relating to submission of data for the NHS Digital Workforce Census (£1.5 million), contractual changes relating to overseas visitors (£5 million) and pensions administration levy (estimated £3.8 million). This funding will be added to the global sum allocation without the out-of-hours (OOH) deduction applied.
Estimated costs to support changes to payment arrangements for parental leave and sickness absence.
Funding to cover expenses relating to Care Quality Commission (CQC) costs (estimated £22.5 million), indemnity fee increases equivalent to 52p per patient on your current list.
What an average practice with a patient list of 7000 can expect as part of the new GP contract?
£1,640 to cover the costs of the new work associated with the contract, such as checking the immigration status of new patients and the workforce census
£20,900 recycled from the unplanned admissions DES and put into the global sum to fund a new frailty checks scheme
This leaves around £11,500 to spend on pay uplifts and practice expenses, including staff costs, the general running of practice, accountancy fees and bank charges
The practice will also receive £4,526 to pay its CQC fees in full
And an extra £3,640 to cover the costs of increases in indemnity fees.
In terms of QOF Practices achieving full points will see an increase of £3365.
How do the changes affect you and your practice? Are you confident that these uplifts will ease the pressures currently faced in general practice? Is now the right time to consider your options in general practice?
I’m sure that you’ll agree that whilst the contract changes are a welcome boost to GP’s we are aware that there are a number of practices, despite this uplift that will continue to struggle with the demand from patients to deliver effective and timely care whilst balancing the income streams required to earn an acceptable living for their services.
Is a Federation the answer?
There are many practices that are consuming practices under the guise of Federation and collaboration without considering the assets of the practices being consumed. This has also led to many GP’s being unhappy about their working arrangements under the federated model and in some cases GP’s have suffered a loss and not an increase in their sustainable income.
These arrangements, in some circumstances are being ‘forced through’ for practices to work at scale and are in some cases letting GP’s down and increasing their already burdensome workload.
However, there is an argument that when collaboration is thoroughly thought through it does work and can have a real positive effect on patient services and ease workloads for clinical staff. New models of care, being implemented by some of the vanguards have demonstrated that a new approach in delivering patient services is cost effective and dare I say it profitable. What the successful vanguards report is that they had a clear vision of what they wanted to achieve with strong leadership driving new initiatives. Do you and your colleagues have the appetite to grow and access additional funding for services through tendering and working at scale? Are you the pioneers in your area? We can support you in achieving your goals to effect real change within primary care.
Additionally, we can help you make informed decisions that will help and support you through these times of uncertainty and enable you to realise the asset that you have worked for throughout your career is rewarded in real cash terms. We can demonstrate the true value of your business and have investors, whom all are successful in the healthcare industry willing to take on board the management of your practice and realising time to enable you to focus on being a great GP, whilst at the same time realising a premium for you and your practice.
Are looking to retire soon? With a dearth of new partners entering the primary care sector, how can you ensure that you will have a suitable return on your investment generated throughout your career. Again, we can help you plan your exit strategy and work with you to ensure that you reap the rewards of your career within primary care.
Please do not hesitate to contact us and arrange a free, no obligation healthcheck for your practice, where we would be only too happy to work with you to deliver informed solutions for your practice.