Briefing on General Practice

1. Briefing on General Practice Julian Spinks

2. Areas to consider • The state of general practice • New configurations • Practice Based Commissioning • QOF changes • Enhanced services

3. The state of General Practice • The ‘New’ Contract • Global sum • QOF • Enhanced services • Move towards salaried service • MPIG • Loss of long term relationship with patients • Funding

4. New Configurations • Move to APMS • ‘Managed’ practices • GP-led health centres • New practices • Extended Hours • Out of hours

5. Practice-based commissioning • Started 2005 • Better clinical engagement • Better patient services • Better use of resources • Initial lack of guidance • Variable uptake • Resistance • PCT • GP • Trust

6. PBC 2 • Relaunch 2009 • Clinical commissioning: our vision for PBC DOH Jan 09 • Most PBC shaped around ‘clusters’ • More commitment from PCTs • Still variable buy-in from GPs • Still few services commissioned (or decommissioned)

7. PBC 3 • Need to get involved ASAP • Get on agenda • Before the money runs out • Making continence a priority area • Local approach to PBC groups • Possibly support with campaigns or materials provided centrally • Working with PBC groups • Provider or partner? • Make it easy for groups-eg pre-prepared business plans.

8. Quality and Outcomes Framework • QOF • Part of new GP contract • Voluntary! • Up to 40% of income • Around 180 targets • Some administrative • Clinical in 15 different areas, some ‘easy’ some difficult

9. QOF 2 • Ever-changing scheme • Until now decided by committee of BMA and NHSE • NICE now central to process • 88 indicators in scope • Reviewed over 3-4 years • Around 10 new indicators/year • First indicators in 2011-12 • More ‘evidence-based’ • Old indicators rolled into ‘standard practice’

10. QOF process • NICE gathers clinical and cost-effectiveness information to help prioritise new indicators. Interested parties submit potential clinical and public health topics for consideration through the NICE website. • An independent Primary Care Indicator Advisory Committee prioritises these topics for inclusion in the QOF. • The National Primary Care Research and Development Centre (in collaboration with the Royal College of GPs and York Health Economics Consortium) develops the indicators, testing them in a number of GP practices across the UK. • NICE consults on the developed indicators, validates the proposals through the Advisory Committee and publishes them on the NICE website. • Each recommended indicator is accompanied by supporting information, such as review date and the supporting cost-effectiveness evidence.

11. QOF doubts • Likely to prioritise to areas with high mortality, disabling morbidity, high public profile • Government brake on new funding • Element of ‘local QOF’ • Needs to be workable in a GP context • Skills • Resources

12. Enhanced Services • National, Direct, Local • Another way to fund new work in general practice • Currently a method to maintain funding in practices hit by removal of MPIG • Could be used to improve GP continence care at a local level (eg as part of PBC)