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New GP GMS contract – How to help practices increase quality and income

Paul Midgley of the Healthcare Partnership looks at the new GP GMS contract and examines how a ‘yes’ vote will help medical representativeswork more closely with practices to their mutual benefit.

Introduction
The results of the delayed ballot should be announced shortly on the new UK-wide General Medical Services contract, negotiated between the BMA’s General Practitioners Committee, the NHS Confederation and the Department of Health over the last 18 months. This will affect all GPs currently operating under a GMS contract – about 70% of the GP practice-based population (the other 30% work under PMS contracts). The implications of a ‘yes’ vote will be far-reaching for all parties involved in primary care – practices, GPs, PCOs, StHAs – and you as a representative. Preparations to implement these changes will start immediately and the switch over to the new funding arrangements will commence in April, 2004. Read on to find out what changes are afoot – this is important information if you sell in General Practice.

New contract – more flexible provision of services
For the first time, practices will be able control their workload by choosing what level of service they wish to provide. These fall into 3 categories:

Essential services (all practices) e.g. patient consultation; management of the terminally ill; chronic disease management as determined by the practice in agreement with the PCO
Additional services (optional – most practices will provide some, if not all) e.g. cervical screening, contraceptive services, vaccinations, child health surveillance, maternity services, and minor surgical procedures
Enhanced services (commissioned by PCOs) e.g. essential or additional services delivered to a higher standard such as extended minor surgery; services not covered by the above, such as those addressing specific local health needs; and innovative services being piloted/evaluated.

These may be delivered by GPs, nurse specialists, or other health professionals at the primary/ secondary care interface. PCOs may also commission enhanced services from other NHS bodies, non-NHS bodies – an opportunity for PPP (and pharma companies?), or provide services themselves.

Out-of-hours cover (6.30pm-8am weekdays, plus weekends and bank holidays) will also switch from a practice’s responsibility to the PCO by the end of 2004).

A new way of paying practices uses a formula (the ‘Carr-Hill formula’) to determine a ‘Global Sum’ payment for the PRACTICE (not individual GPs as currently). This recognises workload generated by the numbers of patients resulting from different factors such as age, sex, disease status, patient turnover and % of patients in care homes. This sum will also take account of the range of additional and enhanced services that a practice proposes to offer. Currently, this is causing a huge furore as many practices feel their ‘notional list size’ payment (according to the Carr-Hill formula) will lose them money over the existing system of ‘capitation fees’. As a result, alternatives are being considered to ensure no practice is worse off under the new contract.

Rewarding quality and outcomes
Additional practice income will be achievable by practices attaining agreed quality standards in various aspects of care/management. A total of 1050 quality points is available with each point being valued at £25 for the ‘average’ GP. Below is a summary of how these Quality Indicator points break down (for a full detailed list, contact HCP – see details below):

Clinical – 550 points
Organisational – 184 points
Patient experience – 100 points
Additional services – 36 points

Clinical points
CHD and LVD – 121
• Stroke of TIA – 31
• Hypertension – 105
• Diabetes – 99
• Epilepsy – 16
• COPD – 45
• Asthma – 72
• Hypothyroidism – 8
• Cancer – 12
• Mental health – 41

Other quality points
• Records and patient information – 85
• Patient communication – 8
• Education & trg -29
• Practice mgmt – 20
• Medicines mgmt -42
• Length of consultation – 30
• Patient Surveys 1 – 40
• Patient Surveys 2 (reflections/proposals) – 15
• Patient Surveys 3 (evidence of actions to PCO) – 15
• Cervical screening – 22
• Child health surveillance – 6
• Maternity services – 6
• Contraception – 2

Additional points for:
Holistic care – 100

Quality practice bonus – 30
Access to service bonus – 50

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