Funding in General Practice

1. Funding in General Practice Dr Andy Withers Grange Practice Allerton

2. Aims & Objectives • Aims • Increase understanding of how General Practice is financed • Objectives • Know how :- • Practice income is calculated and received • Budgets are set • The difference between NHS & Private income

3. Questions • How do GPRs get paid in practice? • How do salaried GPs get paid? • How do GP Partners get paid? • What is the difference between a GMS & PMS practice? • Are all my earnings pensionable? • What is PBC? • How can I earn more? • Money & referrals/admissions • Seniority payments

4. What do we get paid for? • Core General Practice(= Essential Services) • Additional Services • Enhanced Services • QOF

5. NHS Income

6. Essential Services MANDATORY - common to all practices • The management of patients who are ill or believe themselves to be ill, with conditions from which recovery is generally expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever practicable 2) The general management of patients who are terminally ill 3) Management of chronic disease in the manner determined by the practice, in discussion with the patient

7. Essential Services • Either paid as “Global Sum” or MPIG in GMS practices • Basic Contract in PMS practices

8. Additional Services • Normally expected of all practices but OPT-OUT possible • Cervical cytology • Child health surveillance • Maternity services (not intrapartum care) • Contraceptive services

9. Enhanced Services • 3 types • Direct • National • Local

10. DES • Obligatory for each PCO • National specifications • No one practice has to do: • Services to violent patients • Childhood vaccinations and immunisations financial incentives • Minor surgery • Flu immunisations • Quality information preparation • Improved access

11. NES • OPT-IN - national terms and conditions Anticoagulant monitoring IUCD Sexual health MS Drug and alcohol misuse Terminally ill Depression Learning disabilities Intra partum care Minor injuries Near-patient testing Homeless Immediate/first response care

12. LES OPT-IN • Response to specific local requirements • Local terms, conditions and standards • Possibly, innovative services for piloting and evaluation

13. GMS v PMS • Little difference now • PMS probably slightly higher earning practices due to historic funding. • Both practice based contracts • GMS nationally negotiated • Either global sum via Formula • Or Minimum practice income guarantee (MPIG) • PMS (potentially) locally negotiated

14. GLOBAL SUM OR MPIG UNIFIED BUDGET ASSURED QUALITY MONEY ESSENTIAL & ADDITIONAL PROTECTED TIME PCO-MANAGED FUNDS LOCAL ENHANCED DIRECTED AND NATIONAL ENHANCED PREMISES PCO GUARANTEED FUND(S) ALTERNATIVE PROVIDER PRACTICE

15. Seniority • Begins from start of NHS service • Annual increments

16. QOFTHE FOUR DOMAINS OF QUALITYClinicalOrganisationalPatient experienceAdditional services

17. Total Points 1000 • Clinical 655 • Organisational 181 • Additional Services 36 • Patient Experience 108 • Holistic Care 20

18. CHD & LVD Hypertension Diabetes Stroke or TIA Hypothyroidism AF Depression Hypertension Obesity Epilepsy Asthma COPD Mental Health Cancer CKD Dementia Learning Disabilities CLINICAL AREAS

19. ORGANISATIONAL AREAS • Records and information • Patient communication • Education and training • Practice management • Medicines management

20. PATIENT EXPERIENCE • Standardised approved patient questionnaires • General Practice Assessment Questionnaire (Manchester) • Improving Practice Questionnaire (Exeter) • Length of consultation - 10 mins appts

21. BREADTH v DEPTH • Holistic Payments • Across Clinical Domain • Performance in 3rd lowest area • Quality Practice Payments • Across all domains

22. Pensions • All NHS income pensionable • delivering GMS / PMS • delivering services under delegation including locum work • board, advisory and other work for NHS bodies • collaborative arrangements work • education • statutory certification • work for GP cooperatives that are NHS bodies • All locum pay pensionable from 1.4.2002

23. PBC • Practice Based Commissioning • DES for 1 year (approx £1.90/pt) • Voluntary • Devolved budgets to all practices • Virtual Money – you can’t take it home • For: • Prescribing • Secondary care, acute & elective • Community Staff • Can spend (up to) 70% of Freed up resources (FURs note not savings) on patient care. Pct takes rest. • Only get FURs you predict (no serendipitous FUR) • Idea is to provide innovations in services to produce FUR

24. Other DESs • IT • Using the IT • Access • Patient Evaluation Survey (PES) • Choice & Book • evaluation

25. Other Income • Teaching & Training AmountNHS Pension? • GPR £7.5k Y • FY2 £10k Y • Medical Students £15-20k N • NHS related work • GPwSI c £10k/session Y • PCT Y • LMC N • DH ? • Private N • Reports • Medicals etc

26. Getting Paid

27. Getting Paid 2(This is real money) • Typical Middle sized practice • Total amount £1m • Less running expenses £300k • Less Staff costs (including salaried GPs) £400k • Profit £300k • Divide between partners = income£100k • Need to pay 20% superannuation £80k • Need to pay Income tax on this