1 / 24

Investment and evolution:

Investment and evolution: A five year framework for GP contract reform to implement The NHS Long Term Plan. A five year framework for the GP services contract. Summary of agreement Addresses workload issues Brings a permanent solution to indemnity costs and coverage

murchison
Download Presentation

Investment and evolution:

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Investment andevolution: A five year framework for GP contract reform to implement The NHS Long Term Plan

  2. A five year framework for theGP servicescontract • Summary ofagreement • Addresses workloadissues • Brings a permanent solution to indemnity costs andcoverage • Improves the Quality and Outcomes Framework • Introduces a new Network ContractDES • Helps join-up urgent careservices • Enables practices and patients to benefit from digitaltechnologies • Delivers new services to achieve NHS Long Term Plancommitments • Gives five-year funding clarity and certainty forpractices • Tests future contract changes prior to introduction • Published in January 2019 by NHS England and the BMA General Practitioners Committee inEngland • Five year framework: 2019/20 GMS Contract changes and joint proposals for the four subsequentyears • The Framework sets direction for primary care and seeks to address the core challenges facing general practice. 2

  3. Investment • Resources for primary medical and community services will increase by over £4.5 billion by 2023/24. • Funding for the core practice contract is fixed for each of the next five years, and increasesby • £978 million in2023/24. • In 2019/20, indemnity expenses are removed and there is a 1.4% uplift to practice contract funding. Thisincludes: • Pay uplift Expenses uplift, including £20m for subject accessrequests • 1% linked to 2018/19 pay uplift and contract agreement in 2019, viaSFE • £105m Funding for practices to engage in establishing networks, via theSFE • £30m into GS as part of extended access changes and NHS 111 directbooking • £5 per patient MMRcatch-up • Uplift to S7a immunisation programmes (e.g. flu) in line with otherimmunisations • Up to £1.799 billion will flow nationally through the Network Contract DES by 2023/24. This will include funding for the new additional role reimbursement scheme, network support andaccess 3

  4. PrimaryCare Networks

  5. Primary CareNetworks • Practices will be offered a new Network Contract – this is a Directed Enhanced Service (DES). • The DES will provide funding for practices to form and develop networks, as well as for additional workforce and services to be delivered by thenetwork. • Networks will cover a typical population of 30-50,000 patients. There will be flexibility if required over or below this (forrurality). • Networks can be structured in a number of ways depending on how the network members wish to employ staff and worktogether • All Networks will have a Network Agreement. It will outline how the practice will work together, how funding will be allocated and how services and workforce will be shared. A template will be provided forthis. • CCGs and Integrated Care Systems will play a role in approving the formation of networks and commissioning services they will provide as well as providing ongoingsupport. • CCGs to provide £1.50/head in cash to support PCN development from the general allocation • 19/20 is a set upyear. 11

  6. New networkworkforce “£4.5 billion of new investment will fund expanded community multidisciplinary teams aligned with new primary care networks based on neighbouring GP practices” NHS Long TermPlan • Through a new Additional Roles Reimbursement Scheme, Networks will be guaranteed funding for an up to estimated 20,000+ additional staff by2023/24: • Clinical pharmacists (from2019/20) • Social prescribing link workers (from2019/20) • Physiotherapist (from2020/21) • Physician associates (from2020/21) • Community paramedics (from2021/22). • The scheme will meet a recurrent 70% of the costs of additional clinical pharmacists, physician associates, physiotherapists, and community paramedics; and 100% of the costs of additional social prescribing linkworkers. • Each network appoint a Clinical Director, chosen from within the network. Funding will be provided for this role based on the network size; 0.25 WTE funding per 50,000 populationsize. • Funding will be set nationally based on Agenda for Change scales, but there is no requirement locally to employ on the AfCcontract • The network can agree how the new workforce is employed and deployed acrosspractices.

  7. New networkservices • Seven new services will be introduced in line with the NHS Long Term Plan primary care goals, and phased into the DES over the coming years. The specifications for these will be developed with stakeholders during 2019/20 and negotiated with GPC in annual contractnegotiations. • 2019 • Extended Hours access integrated into networks – same requirements as the DES, for 100% of networkpopulation • 2020 • Structured medicationreview • Enhanced health in carehomes • Anticipatory care (with communityservices) • Personalisedcare • Supporting early cancerdiagnosis • 2021 • Cardiovascular disease prevention and diagnosis, through casefinding • Action to tackleinequalities

  8. Timeline for establishingPCNs

  9. Networkinvestment • Up to £1.799 billion will flow nationally through the Network Contract DES by 2023/24. This will include funding for the new additional role reimbursement scheme, network support, access and new Investment and ImpactFund.

  10. Indemnity

  11. Indemnity • The new Clinical Negligence Scheme for General Practice will start from 1 April 2019. It will be operated by NHSResolution. • From 1 April 2019 everyone working in general practice will be automatically covered for all liabilities from clinical negligence in general practice. There are no membership or registrationrequirements. • Coverage of the scheme will extend to all GPs and all other staff working in delivery of primary medical services. This covers all GPs (including salaried and locum) and all other staff working in general practice (including the new networkworkforce) • All NHS work is covered. This includes out-of-hours, local authority, public healthetc. • Individuals will still need MDO cover for private work, professional services and additional advice. • There will be a one-off permanent adjustment to the global sum figure that takes account of the existing contributions from general practice forindemnity. • Investment in the practice contract overall will still rise by 1.4% in 2019/20, accounting for the indemnitychange. • As per last two years, payments will be made direct to practices to fund the increase in fees for the previous year (i.e. via SFE on an unweighted per patientbasis). 5

  12. QOF

  13. QOF indicatorsremoved • In line with the findings of the QOF review (published July 2018), 28 indicators will be retired from April 2019. These account for 175 points and 31% ofQOF: • COPD (annual FEV1 and O2stats) • Dementia (testresults) • Diabetes (middle HbA1c target, see nextslide) • Mental health (cervical screening test, lithium) • Osteoporosis (bothindicators) • Stroke and transient ischaemic attack (record of referral) • Palliative care (3 monthly MDT case reviewmeetings) • Peripheral arterial disease (BP,anti-platelet) • Smoking (providing literature andtherapy) • Contraception (removed infull) • Cervical screening (protocol andaudit) 13

  14. QOF indicatorsintroduced • In line with the findings of the QOF review (published July 2018), 15 indicators will be added or amended, accounted for 101points: • Blood pressure (CHD, HYP, STIA) – split for ≤79 (140/90), ≥80(150/90) • Diabetesindicators • amended to account for moderate and severefrailty • cholesterol target replaced by prescription ofstatin • Mental Health indicator to record BMI instead of alcoholconsumption • COPD – offer of referral to pulmonaryrehabilitation • Cervical screening – split for ages 25-49 and 50-54 – in line with 3 and 5 year recall frequency. • The QOF point value will increase by 4.7% to £187.74. This is to reflect increased list size and populationgrowth. 14

  15. QOF personalisation and quality improvement • Personalised care adjustments will be introduced, replacing exception reporting. This will allow practices to differentiate between five reasons for adjusting care and removing a patient from the indicatordenominator. • Practices will be required to use more personalised correspondence with patients when sending invitations for care, including using the patient’s preferred method of communication. Practices will be required to send two invitations for care, rather than three as presently (except for a fewexceptions). • 74 points will be used to create a new Quality Improvement domain. For 2019/20, the modules will cover prescribing safety and end of life care. These topics will change on an annualbasis. 15

  16. Digital

  17. Digital – requirements andsupport • Requirements • all patients have online access to their full record, as the default position from April 2020 with new registrants having full online access to prospective data from April2019. • at least 25% of appointments available for online booking by July2019. • all patients to be able to access online correspondence by April2020 • no longer use fax machines for NHS work or patient correspondence by April2020 • offer and promote electronic ordering of repeat prescriptions and using electronic repeat dispensing for all patients for whom it is clinically appropriate by April2020 • have an up-to-date and informative online presence by April2020 • Support • Changes to the GP IT Operating Model, including provision of Data Protection Officers from CCGs • GP IT Futures will replace the current GP Systems of Choice (GPSoC) framework from December 2019. This will include capability for digitisation of records, cyber security and transfer of patientrecords.

  18. Digital-first “Digital-first primary care will become a new option for every patient improving fast access to convenient primary care ” NHS Long TermPlan • All patients will have the right to online and video consultation by April2021. • Amendment to rurality index so that it applies to only those patients within the practice boundary • Amendment to London Adjustment so that it applies to only those who are resident in London (rather than those who are registered with a London-basedpractice) • Out of Area registrations and digital first access will be reviewed in2019.

  19. Access and otherchanges

  20. Improvingaccess • The current Extended Hours Access DES will continue until 30 June 2019. From 1 July 2019, the funding will transfer into the Network Contract DES and PCNs’ constituent practices will deliver extended hours access to their collective registeredpopulation. • By April 2021 we intend that the funding for the existing Extended Hours Access DES and for the wider CCG commissioned extended access service will fund a single, combined access offer as an integral part of the Network Contract DES, delivered to 100% of patients including through digital services such as the NHSApp. • NHS England will work with stakeholders including GPC England on a single coherent access offer that PCNs will make, for both physical and digital services. This will deliver convenient appointments ‘in hours’, reduced duplication and better integration between settings such as 111, urgent treatment centres and generalpractice. • The review will start in 2019, for full implementation by 2021/22, but we expect local Integrated Care Systems and their Primary Care Networks to go faster and we encourage them to doso. • In addition in 2019/20, 1 practice appointment per day, per 3,000 patients will be made available for direct appointment booking byNHS111. 20

  21. Other contractualchanges • From 2019 it will no longer be legal for any NHS GP provider, either directly or via proxy, to advertise or host private paid for GP services that fall within the scope of NHS-funded primary medicalservices. • A review of Vaccination and Immunisation procurement, arrangements and outcomes will take place in 2019 with its output implemented through the 2020 and 2021contracts. • From 2019-20 GP practices will be required to support six national marketing campaigns on an annual basis, where the GP contractor will be required to put up and display in their premises, campaign materials six times every 12months. • From October 2019, where GPs choose to apply the NHS primary care logo in relation to their NHS provided services, they will be required to adhere to the NHS Identify guidelines and apply the NHS primary care logo to all information and materials about their NHS services. • Transparency of Earnings: GPs with total NHS earnings above £150,000 per year will be listed by name and pay (NHS income before tax) in a national publication, starting with 2019/20income. • Shared parental leave will be added to the SFE reimbursements for locumcover • The contraceptive services Additional Service will cease and its requirements rolled into EssentialServices

  22. GP Contractdocumentation • By the end of March 2019, NHS England and DHSC will havepublished: • A new Statement of Financial Entitlements amendment covering the global sum, QOF £ per point and the network participationpayment • New DES directions including the new Network Contract DES • Network Contract DES service specification and NetworkAgreement • Revised V&I servicespecifications • GMS guidance covering all of the contract agreement for 2019/20 • Guidance to commissioners on implementing changes in PMS and APMScontracts • Technical guidance on coding • Regulations and Directions will come into force in October 2019, and new contract documentation will be publishedafterwards.

  23. Questions

  24. Discussions

More Related