The new GP Contract, which comes into effect on April 1st is a five-year contract, containing what have already been described as the 'most significant' contract changes in 15 years. Broadly speaking, the main changes are as follows:
- Overall funding in excess of £2.8bn over a five-year period, through practices and networks
- Pay & expenses uplift each year through global sum, in line with predicted inflation
- Creation of a new Primary Care Network, built up over the five years of the contract
- Additional workforce & linked funding through a new Primary Care Network
- Indemnity state backed scheme introduced
- Amendments to QOF
- Resources for IT and digital, including greater digital access for patients
- Delivery of the NHS Long Term Plan ambitions through the additional funding and workforce
Below, we look at the key points in more detail.
The deal will increase practice funding by almost £1bn over five years, with a further £1.8bn to support the formation of primary care networks of 30,000-50,000 patients, which all GP practices will be expected to join by July this year.
Network funding will be delivered via a directed enhanced service (DES) and allow networks to employ one social prescribing worker and a clinical pharmacist (see below for more details).
For 2019 the GP contract will increase by 1.4% in addition to funding through networks, which includes a 2% uplift for GP and staff pay and expenses, an uplift for funding to develop networks, an adjustment for state-backed indemnity and an increase in the value of some vaccinations to bring them all up to £10.06.
£20m recurrent funding to cover the costs associated with subject access requests now practices have to provide them for free under the GDPR
£30m for practices to make appointments available to NHS111 (see below for more details).
In 2020/21 core funding will see a 2.3% uplift, 2021/22 will deliver a 2.8% uplift, 2022/23 will see a 2.5% uplift and in 2023/24 funding will increase by 2.7%.
This is probably the most significant part of the new contract and marks the formalisation of the “working at scale” concept.
Network funding will be delivered via a DES, which will go live on 1 July 2019. The DES specification setting out what practices and networks need to do will be published in March.
Networks will receive 100% recurrent funding to employ social prescribers and 70% funding for clinical pharmacists in 2019/20. In future years they will receive 70% funding for physiotherapists and physician associates (from 2020/21) and paramedics (from 2021/22) as they are introduced.
Each network is expected to be led by a local GP in a clinical director role.
Funding for the DES will be paid to a nominated provider, which should be set out in the network agreement.
There will be six funding streams.
- Network engagement funding will be paid directly to practices for engagement with the network via the Global Sum. Contract documentation says that a typical practice will receive over £14,000 each year from April 2019 'in return for their initial and then continued active participation in a primary care network'.The other five streams, which will be paid to the nominated provider, are:
- Network administration payment - a recurrent £1.50 per patient from CCG funding
- Workforce funding as specified above
- Clinical lead funding - the clinical lead post will be funded on the basis of 0.25 WTE GP per 50,000 patients. Practices in each network can make their own choice in how they wish to appoint a clinical lead. There is no proscribed model.
- Extended access – from 2019/20, the extended access DES will be transferred into the network DES, offering £1.45 per patient in 2019/20; going forward from 2020, networks will absorb the £6 per patient in access funding delivered through the GP Forward View.
- Services - From 2020 networks will be expected to take on national network service specifications. Five will start by April 2020: structured medication reviews, enhanced health in care homes, anticipatory care (with community services), personalised care and supporting early cancer diagnosis. The other two start by 2021: cardiovascular disease case-finding and locally agreed action to tackle inequalities.
As with all enhanced services, practices are not obliged to take part. However, more than half of new funding available to practices through the new five-year contract deal is linked to engagement with networks. If practices choose not to join a network this funding will be unavailable to them - and the network covering their area will deliver some 'network-level services' to their patient population. This could include enhanced services, which will be awarded through networks rather than to individual practices in future.
The state-backed indemnity scheme will begin in April 2019 and cover all practice staff and those working in out-of-hours for clinical negligence claims.
All GPs will continue to need cover from a medical defence organisation for non-NHS work, such as GMC or coroner’s court representation or private work.
Another significant part of the contract sees major changes to QOF. From April 2019, 28 ‘low value’ indicators worth 175 points in total will be retired, including annual cholesterol check for diabetes, dementia bloods, annual FEV1, osteoporosis and peripheral artery disease indicators. 101 points will be recycled into 15 'more clinically appropriate indicators'. The remaining 74 points will cover a new quality improvement domain, made up of two modules each worth 37 points. The first two quality improvement modules will focus on prescribing safety and end-of-life care.
There will also be changes to exception reporting, which will be replaced with 'a more precise "personalised care adjustment". Practices will be able to select one of five different reasons for adjusting care and removing a patient from the indicator, thus:
- The QOF-prescribed care being unsuitable for the patient
- Patient choosing not to receive the prescribed care
- Patient not responding to invitations
- Where the specific service is not available (in relation to a limited number of indicators only)
- Newly-diagnosed or newly registered patients, as per existing rules.
- There will be no threshold increases in 2019/20.
Changes are planned in 2020/21 for heart failure, asthma and COPD indicators and mental health changes will be introduced in 2021/22.
Changes to resources for IT and digital
IT is being pushed to the fore as part of the new contract thus:
- Practices will be expected to make 25% of appointments bookable online from July 2019.
- All new patients should have access to their digital records as standard from April 2019.
- All patients should be able to order repeat prescriptions electronically from April 2019.
- From April 2019 NHS 111 will begin direct booking in to practice appointments. Practices will be expected to make one appointment per 3,000 patients available each day for this. NHS111 will only book the appointment after triage.
- From April 2020 all practices should provide online consultations.
- From April 2020 all patients should have online access to their full record, including the ability to add their own information and be able to access online correspondence.
- From April 2020 practices should no longer use fax machines for NHS work or patient correspondence.
- HPV vaccination catch-up for girls will be extended to those aged 25. HPV vaccination will commence for boys in September 2019 (via the school scheme) and catch-up arrangements for boys will mirror those for girls.
- Practices will receive an item of service payment of £5 per patient for a catch-up campaign for the MMR vaccine for 10 and 11-year olds.
- Practices will no longer be able to advertise or host private GP providers who provide the same core GP provisions that are offered free on the NHS.
- GPs whose NHS earnings are over £150,000 will be required to make this public, beginning with 2019/20 earnings. This will replace the original obligation, which commenced in 2014/15, that practices calculate the mean total earnings of all relevant GPs and display the overall figure on the surgery website, including salaried GPs and locums who have worked in the practice for six months or more in the financial year.
- Practices will have access to a data protection officer through their CCG to provide support on GDPR issues.
- NHS England will reimburse the cost of locum cover for GPs taking shared parental leave in the same way as for those taking maternity leave.
- The BMA and NHS England have agreed to put forward proposals to the government to tackle the problem created by the pension annual allowance, which is leading to GPs retiring early or cutting the number of sessions they work.
The new contract is a positive move forward for general practice, but it adds to the complexity of the landscape in many ways, both financially and operationally. With our unique offering of operational practice management support services, our specialist medical team will be able to provide you with all of the advice that you need to navigate that landscape.