Summary of GP Contract changes for 2017/18
These apply to GMS and PMS practices and they are an improvement on the current contract but more needs to be done to address the existing workload and workforce issues. In the context of the additional resources coming with the GP Forward View (GPFV) and the New Models of Care (also known as MCP or Vanguards) more funding is being directed towards general practice. But, practices still need to receive additional recurrent resources to expand the workforce to add capacity both at practice level and at local community level to deliver any of the out of hospital care put forward by the Sustainability and Transformation Platform for Suffolk and NE Essex (STP).
Changes to the global sum for 2017/18
An estimated £238.7 million investment into the contract for 2017/18 for elements, including:
an increase to the global sum for all practices for expenses and an intended 1% pay uplift for GPs and practice staff
£3.8m for increased superannuation costs of 0.08% pension admin charges
£5 million for workload associated with the overseas visitors’ administration changes
£1.5 million for workload involved in completion of the workforce survey
£2 million for increased workload for bagging/labelling of records as a result of changes to the Primary Care Support England Service
an estimated cost of £58.9 million to cover the increase in population growth
The global sum will also increase because of further recycling of MPIG correction factor and seniority funding tapering.
Directly reimbursed to practices
£22.5 million to reimburse full CQC fees
£1 million to cover costs for those practices subject to Business Improvement District levies
Paid through SFE
£30 million for increases in GP indemnity costs
£6.2 million to include morbidly obese in eligible cohort for influenza vaccinations
Estimated £8 million for increases in payments for locum reimbursement to cover maternity and sickness leave
£1 million for the new GP retainer scheme
Avoiding Unplanned Admissions (AUA) DES
will be discontinued on 31st March 2017 and the £157m funding for will be added to the global sum. Practices will be expected to focus more on managing patients who are identified as living with severe frailty. There will not be any claim forms to complete as this will now be part of the practices core funding.
In place of the AUA DES, practices should focus on providing clinically appropriate care to a much more limited group of patients of 65 years and over who are living with severe frailty. Practices will need to use an appropriate tool of their choosing, for example the Electronic Frailty Index (eFI) to identify patients who are living with moderate or 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.
NHS England will collect data on these patients. This data will not be used for performance management in any way. There is no requirement to record patients with moderate frailty but where this is done this data will be collected.
The key element to this is that practices can apply their own clinical judgment in the management of this group of patients with significant clinical needs.
From April 2017 there will be full reimbursement of practices' total CQC fees.
Indemnity Fee rises
An additional £30m will be added to practice budgets based on a per unweighted patient basis. This is intended to cover the increase in indemnity costs for all GPs working in the practice including salaried GPs.
It is expected that locum GPs will include their indemnity fee increases in their locum fees.
Expenses and Pay Uplift
The agreed expenses uplift added to the global sum is to provide a pay uplift of 1% in line with public sector pay increases for 2017/8. £2m will also be added to the global sum to take account of the additional work undertaken by practices relating to record transfer by the primary care support services provide by Capita. A further £3.8m will be added to the Global Sum to address the 0.08% additional costs to the employer for NHS Superannuation.
Most practices currently contribute on a voluntary basis to the workforce census, this will now become a contractual requirement and an additional £1.5m will be added to the global sum.
Sickness Cost Reimbursement
This will no longer be discretionary but will become a practice entitlement. The qualifying criteria based on list size, which has often prevented practices being able to claim a payment for locum costs will be removed. Payment will commence after 2 weeks of absence. GPs within the existing practice can provide cover, so this now mirrors existing maternity cover arrangements.
The amount payable will be up to £1,734.18 per week again in line with current maternity cover arrangements. This should reduce the need and costs of locum insurance and help meet the costs of salaried GPs sickness cover.
Maternity Costs Reimbursement
This will no longer be a pro rata reimbursement. Practices will only need to submit an invoice and they will receive either the full amount or the maximum payable sum.
Learning Disability DES
The payment to undertake an annual health check for this vulnerable group will increase from £116 to £140. Further work is needed to make this more practical for practices to deliver.
Extended Hours DES
New conditions will be put in place that will mean practices who regularly close for 1/2 a day per week, will not ordinarily qualify to provide the DES (exceptions will be made for branch sites). This will be implemented in October 2017.
Access to Healthcare
As part of the agreement last year to take this forward, the GPC has agreed to help identify patients with a non-UK EHIC (European Health Insurance Card) or S1 form. This will allow the NHS to claim back fees for hospital based care from the countries where the UK has reciprocal arrangements. Patients will not be charged themselves. An additional £5m will be added to the global sum recurrently to support this contract change. New patients will be asked to self-declare whether they hold a non-UK issued EHIC or a S1 form on a revised GMS1 form, this information will be added to the patient's medical record and a copy of the form and supplementary questions will be sent to NHS digital.
GP Retainer Scheme
There is a new and improved retainer scheme which will commence in April. The aim will be retaining more GPs especially those towards the end of their career.
Retired QoF Indicators
The provision of data for the retired QoF indicators will now become a contractual requirement. Practices will not be assessed against these indicators or retired enhanced services in any way.
Registration of Former Prisoners
It is planned to improve the communication between prisons and practices to enable an earlier transfer of clinical information about a registering patient. This should improve the initial management of these patients when they first present to the practice, as they practice should know what they have previously been prescribed and treated for whilst in prison.
Business Improvement District Levy
Some local councils have imposed a local levy on all businesses in their area, called the business improvement district levy. Practices in these areas have been required to pay this. From April 2017, practices will be able to claim a reimbursement for the payments that they make.