GPC negotiators / LMC meeting

GPC negotiators / LMC meeting September / October 2010

Today’s matters • 2011/12 contract negotiations • DDRB • QOF • NHS White Paper • White Paper consultations • GPC guidance on the White Paper • Striking a balance consultation • EEQ results • Revalidation • Care Quality Commission • Summary Care Record • Dispensing

2011/12 contract negotiations • Negotiations at preliminary stage • NHSE no mandate yet, but we do know: - no new money for GP contract - efficiency savings wanted in line with rest of NHS - the nature of consortia will automatically create efficiency savings - Trusts make savings by moving work into primary care – not an option for GPs

DDRB • Government have told DDRB not to report on income or expenses for next two years • Will still report on recruitment, retention, morale and motivation – GPC will be submitting evidence on these areas • Raised concerns about this decision with the Secretary of State

QOF • QOF subgroup discussing NICE recommendations for 2010/11 and 2011/12 • Retirements, replacements, new indicators • Also discussing changes to the organisational domain • Maintaining 1000 point QOF • Many changes would be welcomed by GPs • Changes dependant on progress of contract negotiations • Facility to suggest further changes to existing indicators on NICE website

NHS White PaperHeadlines • Passing control for NHS decisions away from Ministers • towards patients and professionals • “No decision about me without me” • Changing the top of the NHS • GP-led commissioning consortia • with abolition of PCTs by 2013 • Single GP contract “over time”

NHS White PaperHeadlines (2) • Development of an economic regulator – Monitor • A new provider landscape – “any willing provider” • Shift of Public Health to Local Authorities • Health Watch – part of Local Authorities • Workload shift from secondary to primary care • Government spending review with cuts to social care funding – impact on general practice

New Structure Government Key: Funding: Accountability: Other relationship: Dept of Health Monitor (economic regulator) Care Quality Commission NHS Commissioning Board Licensing GP Commissioning Consortia Providers Local Authorities Local partnership Contract Local HealthWatch GP Practices Patients and Public

GP commissioning consortia • Consortia to replace PCTs and will be statutory bodies • Will have Accountable Officer and Chief Financial Officer • Responsible to NHS Commissioning Board • Commission most services, including emergency and OOH services, except: • GMS/PMS • Pharmacy, dental, opticians, maternity • Specialised regional services • All practices required to join

GP commissioning consortia • Hold contracts with providers • May choose a lead commissioner model e.g. for dealing with large teaching hospitals • Duty to determine local health needs • Duty to promote equalities • Duty to work with local authority (public health, social care, safeguarding) • Duty of public and patient involvement • Government insists there will be ‘no bail-outs’

Timetable for GP commissioning consortia changes • GP consortia in place in shadow in 2011/12 • taking on increasing delegated responsibility from PCTs • Health Bill passed • Consortia responsible for commissioning in 2012/13 • Financial allocations direct to GP consortia in late 2012 • Full financial responsibility from April 2013 • PCTs abolished April 2013

White Paper consultations • 3 month consultation period • Main White Paper consultation plus 4 further consultations • Still time for LMCs and GPs to respond – the main White Paper consultation closes on 5 October, with the 4 additional consultations open until 11 October

Equity and excellence:Liberating the NHS - BMA Response • Remain opposed to commercialisation agenda • Proposals expensive at ‘time of austerity’ • Transfer of PCT functions – crucial to sort out • Oppose localised education and training • Welcome reduction in top-down targets, but should retain some process targets • Sceptical about foundations trusts and social enterprise • Oppose Monitor’s role in promoting competition • Oppose local pay determination

Liberating the NHS: Commissioning for patients - BMA Response • ‘Local commissioning groups’ rather than ‘consortia’ • Joined up decision making required – commissioning board, consortia and secondary care specialists • Maternity services should be commissioned at consortia level • Consortia federations & commissioning board outposts?

Liberating the NHS: Commissioning for patients - BMA Response (2) • Importance of designing effective care pathways • Statutory role for LMCs • Commissioning / procurement split • Commissioning performance indicators should not detriment patient care

Liberating the NHS: Local democratic legitimacy in health- BMA Response • Support in principle aim of increasing local democracy • Would like to see HealthWatch groups working in conjunction with existing patient participation groups • ‘Choice’ emphasis could increase inequalities • Health and wellbeing boards – should promote integration across service

Liberating the NHS: Transparencyin outcomes – a framework for the NHS -BMA response • Would not support the wholesale replacement of process targets and indicators with clinical and patient reported outcomes measures • Clinical decisions should take precedence • 150 standards with possible 1,500 targets – potentially time consuming and bureaucratic • Outcomes framework has potential to be overly bureaucratic and risk averse – value for money?

Liberating the NHS: Regulating healthcare providers - BMA Response • Cannot support the abolition of cap on amount of income foundation trusts can earn from other sources - incentive for foundation trusts to undertake more private practice - two-tier health service • Statutory controls on borrowing should be retained - ensure that financial risk can be properly managed • Patient care should be paramount concern when considering structural or governance changes • Not convinced by merits of staff-only membership model • Pressure on Trusts to reach Foundation Trust status potentially detrimental • Joint role of CQC and Monitor will be overly-bureaucratic and costly • Cannot support the unnessary enforcement of competition

White Paper proposals risks… • Damage to doctor/patient relationship • Privatisation by the back-door • Funding formula not accurate • GPs blamed for cuts • GPs accused of making excessive profit • Enough local leaders with the right skills? • Enthusiasts without a mandate setting an inappropriate agenda

…more risks… • Some GP Consortia will fail – what then? • How to handle inherited or new debt • PCT implosion, loss of key staff and skills • Competition v collaboration • Conflict between practices • BMA therefore adopted position of “critical engagement” • Learn the lessons of PCG/PCT mergers • Learn lessons of Fundholding

…and opportunities? • Clinical leadership • Real involvement in re-designing services and improving services for patients • New OOH services, 111 and life after NHS Direct • Developing practices • Developing meaningful partnerships between consortia, LA, hospital trusts and consultants • Reducing bureaucracy – how long will it last? • Can we avoid the re-creation of PCTs?

Next steps? • LMCs, PCT and existing PBC groups should work together • Resist PCT/SHA interference in consortium formation • All practices in an area should be involved in discussions about future arrangements • Identify local skills and expertise • Early collaboration with local consultants and public health physicians • Use BMA advice and support guides • Respond to the White Paper consultation

GPC guidance on theWhite Paper - The GPC is producing a series of guidance notes on the White Paper – 4 have been published so far: 1. The Principles of Commissioning – A GPC statement in the context of Liberating the NHS Identifies a set of fundamental principles with regard to GP commissioning which will define policy, inform debate and negotiations, and ensure that good medical practice is enshrined within these enhanced responsibilities

GPC guidance on theWhite Paper (2) 2.Legal overview view and guidance on the commissioning proposals An introduction to issues that GPs may have to consider in terms of legalities, education and training in preparation for the outcome of the current consultation on the White Paper. 3.The Role of Local Medical Committees in supporting the development of GP Consortia Identifying a number of specific actions that the GPC believes LMCs can and should takeover the next few months, in three main areas: • Communication with GPs and Practices • Support GPs in planning future consortia • Build wider relationships

GPC guidance on theWhite Paper (3) 4.GP consortia commissioning – initial observations a set of principles and practical observations that GPs and LMCs should consider when beginning to explore how these ideas will be put into practice. The document covers: • formation of consortia • the size of a consortium • responsibilities and governance of consortia • funding of consortia and budget setting • importance of commissioning/contracting & procurement split • working with specialists

Striking a balanceconsultation • Productive meetings held with a number of patient organisations to discuss our consultation document • Seeking patient views on: - the make-up of the general practice team - appointments and service - care outside of normal working hours - continuity and coordinating care in the NHS • Early 2011 – plan to launch document with our results and findings

EEQ 2008/09 results – contractor GPs • £99,200 for GMS GPs (a decrease of 1.2% since 2007/08) • £95,900 for GMS non-dispensing GPs (a decrease of 0.3% since 2007/08) • £116,500 for GMS dispensing GPs (a decrease of 4.3% since 2007/08) • £116,300 for PMS GPs • £113,900 for PMS non-dispensing GPs • £132,200 for PMS dispensing GPs • £105,300 for all GPMS GPs (a decrease of 0.7% since 2007/08) • 6.35% GPMS average increase per year 2002/03 to 2008/09 • 4.35 %GPMS average decrease 2005/06 to 2008/09 (-6.6% GMS non-dispensing)

EEQ 2008/09 results (2) Average net profit for contractor GPs in 2008/09 by country was: • £109,600 in England (a decrease of 0.5% since 2007/08) • £89,700 in Northern Ireland (a decrease of 1.5% since 2007/08) • £86,500 in Scotland (a decrease of 1.0% since 2007/08) • £90,700 in Wales (a decrease of 2.9% since 2007/08)) Salaried GPs • For all UK GPMS GPs identified as being salaried in 2008/09 (having more employed income than self-employed income) average pre-tax earnings from all sources of income reported were £57,300, an increase on the 2007/08 figure of 2.7%

Revalidation • Future of revalidation less certain under new government • Letter from Andrew Lansley to GMC – piloting period to be extended by 12 months • GMC to “simplify and streamline” revalidation proposals following consultation – further news expected in early Autumn • RCGP pilots suggest some problems, particularly for distinct groups – eg sessional, part-time GPs • Abolition of PCTs adds further uncertainty – eg where will ROs sit?

Care Quality Commission • NHS GP practices will need to be registered by 1st April 2012 • CQC is engaging the GPC and other stakeholders in the development of its requirements for registration and mechanisms for compliance monitoring • A quality and risk profile for each registered provider • QOF organisational indicators that will support CQC registration need to be kept

IM&T • Information Strategy expected in early October • DH confirmed National Programme to be locally managed/implemented BUT • National standards/accreditation for IT systems e.g. GPSoC, GP2GP, Choose & Book • Joint GPC/RCGP IT Committee will continue to be consulted on national standards/accreditation

Summary Care Record • Ministerial Review to be completed by 30 September • Review in two parts & GPC represented on both • 1st review group is examining what the content of the SCR should be • 2nd review group is examining the patient information and preference/choice i.e. the consent model • no date for ministerial announcement

Dispensing • Cost of Service Inquiry (COSI) now completed • COSI will inform future negotiations on the feescale • Feescale to be cut from 1st October due to "over-delivery" • Work ongoing on new Pharmaceutical Service Regulations (PhS)

How the BMA can help LMCs and practices Employer Advisory Service Experienced advisers on hand for issues with: Recruiting and employing staff Contracts and terms and conditions of service Performance management Disciplinary procedures and dismissals

How the BMA can help LMCs and practices BMA Law Dedicated team of barristers, solicitors to advise you on: Bidding and tendering Contract reviews of APMS, PMS and other local agreements Limited Liability business structures Negotiation and Disputes with PCTs and Basic Contract Law Partnership Splits Directors’ Duties and Company Law Reform Competition Law Coming soon… Developing new services to support you throughout the changes ahead and to protect your practice

Any Questions?

GPC negotiators / LMC meeting