Planned GP contract changes 2013-2014 and beyond

1. Planned GP contract changes 2013-2014 and beyond Place and date of road show Name of negotiator

2. Presentation outline • Where are we? • How did we get here? • Outline of the changes • Why we should all be concerned – workload, quality and funding • Changes to locum superannuation • Redistribution of funding • What can you do? • What are we doing? • Also coming our way… • Questions and discussion

3. Where are we? • Government is consulting on changes it intends to impose to GP contracts • Changes are far reaching and potentially damaging • GPC will respond robustly and you should too • Very different arrangements across the UK

4. How did we get here?

5. Proposed contract changes • Phase out correction factor payments over 7 years • Review PMS funding to reduce variability in practice funding • Implement all changes to QOF recommended by NICE, including those rejected for good reasons by GPC • Reduce the time period for achieving most indicators from 15 to 12 months

6. Proposed contract changes (2) • Increase upper thresholds for QOF indicators to match upper quartile achievement • Remove the whole organisational domain. Will then be a 900 point QOF • Reform the QOF Contractor Population Index (CPI) • New immunisations • rotavirus added to childhood immunisations • shingles for patients aged 70 • Introduce significant new work through DESs

7. Why we should all be concerned: workload • More box ticking • unworkable and underpriced new work in QOF • Shifting the goal posts • chasing points at QOF margins • reducing time available to meet targets • Requirements for additional training • Impact on access • Impact on secondary care

8. Why we should all be concerned: quality QOF Clinical problems with clinical QOF changes: • Unworkable new indicators, unavailable services • Changed blood pressure targets + higher thresholds  polypharmacy • Repetitive or inappropriate questioning • Rise in exception reporting • Less time for holistic patient care

9. Why we should all be concerned: Quality DESs • Online patient access DES • Risk of e-consultations and inappropriate on-line access to records. • Could widen health inequalities • Case finding for dementia DES • Evidence for dementia screening lacking and could cause harm • Will come at cost of other patient care • Real problem is lack of services • Risk profiling • Volume planned makes this unworkable • Remote care monitoring • What is this really? Unclear

10. Why we should all be concerned: funding Average practice 2014-2015, threshold QOF loss + organisational point loss = £11,300 + £19,800 = £31,100 = Biggest pay cut yet for some GPs

11. Funding redistribution • Major redistribution of funding from 2014 • Impossible to predict new global sum figure • Some practices to be seriously destabilised, others will gain • High funded PMS practices – almost certainly under current plans • Practices with large correction factors – probably depending on global sum increases • Not clear what will happen for legitimate outliers • Not clear whether PMS money will be re-invested in GMS.

12. Changes to locum superannuation • Responsibility for locum superannuation payments to move to practices • Transfer of funds into contract to cover this • Practices use locums differently, likely to have disproportionate impact on small practices • Likely to be bad for locums

13. What can you do? • Protect your patients • don’t chase targets that put your patients at risk or treats them inappropriately • Speak to the commissioner - say NO to unresourced workload shift from secondary care • Prioritise your practice • Think 2013 – times have changed since ‘04

14. What can you do? (2) • Start to plan for the changes • look at the bottom line of your accounts not the top line and consider the cost of your services and work, especially high funded practices • Do not allow government to divide and rule – GMS/PMS, locums/practices • Engage all members of your practice, involve all GPs • Be fair to your locums – pay promptly • Keep up to date on the BMA website bma.org.uk/gpcontract

15. What can you do? (3) ACT NOWto stop this happening again • Complete the BMA survey • Contact the Department of Health by 26 February • Write to your MP if your services will be affected • Tell your CCG

16. What are we doing? • Meeting the Department of Health and NHSE • Talking to MPs • Talking to patient groups • Working with the media • Gathering your views – survey and road shows • Responding to the consultation – trying to ameliorate the imposition • Developing guidance for GPs • Preparing for the future

17. Also coming our way… • Commissioning and CCGs • CQC registration • Revalidation • Pension changes • Commercialisation and fragmentation of the NHS • Retention crisis?

18. Questions and discussion Remember: • Use the BMA website to understand the proposals in detail and calculate your potential losses • Respond to BMA survey bma.org.uk/gpcontract • Write to Secretary of State and your MP. If these changes will hurt your practice, tell them