30 / 9 / 2014 9.30am
On 30 September 2014, NHS Employers and the General Practitioners Committee of the BMA announced changes to the GMS contract in England for 2015/16.
The focus of the changes is on a named, accountable GP for all patients, publication of GPs' average net earnings and commitment to expand and improve the provision of online services.
Seniority payments - changes in October 2015
As part of the 2014/15 GMS contract agreement, NHS Employers and the GPC agreed that seniority payments would cease on 31 March 2020. Leading up to that date there will be an annual reduction in seniority payments year on year, with an equivalent and simultaneous transfer into core funding. A retrospective mechanism for achieving the annual reduction has been agreed, starting in October 2015.
Each annual reduction in seniority payments will be achieved via the combined net effect of attrition (due to retirement and closing entrants to the scheme), progression (recipients moving up the seniority scale each year) and a reduction to the seniority payment scales (evenly across all increments). These sums will be simultaneously reinvested into global sum.
Based on the known seniority spend for 2014/15, it has been calculated that seniority payments will reduce by £11,526,000 in 2015/16 and by approximately the same amount in April 2016, April 2017, April 2018 and April 2019, with that amount being simultaneously reinvested into global sum, and a final reduction of the balance made in March 2020. There will be an assessment each year as to whether the reduction is sufficient to deliver the full phasing out of payments by 2020. If not, seniority payments will be adjusted accordingly.
New seniority tables show the amended payment amounts for 2015/16 and are available in the SFE. Accordingly the global sum will increase from £75.77 to £76.51 from 1 October 2015.
What this means for practices and commissioners
There will be an adjustment to global sum and seniority tables in October 2015 as set out above. It will be for practices to allocate those funds.
Practices and commissioners will still need to make minor reconciliations to seniority payments that have already been made, as is the case now, as Final Seniority Factors (FSF) are confirmed by HSCIC. The 2019/20 FSF is expected to be confirmed in 2024.
The following documents are now available:
NHS England has published a letter setting out how the changes are to be applied to PMS contracts and standard contract implementation documentation which are available here.
The changes include the following:
- a named, accountable GP for all patients (including children) who will take lead responsibility for the co-ordination of all appropriate services required under the contract
- publication of GP net earnings - practices will publish average net earnings (to include contractor and salaried GPs) relating to 2014/15, as well as the number of full and part time GPs associated with the published figure
- further commitment to expand and improve the provision of online services for patients, including extending online access to medical records and the availability of online appointments
- changes to the Quality and Outcomes Framework (QOF): adjustment of point value for 2015/16 taking account of population growth and relative changes in practice list size for one year from 1 January 2014 to 1 January 2015; deferment for one year of changes in thresholds planned for April 2015. Discussions around any clinical changes to QOF within the current QOF envelope will continue
- the avoiding unplanned admissions (AUA) enhanced service will be extended for a further year from 1 April 2015, with changes including revisions to the reporting process and changes to the payment structure
- the patient participation enhanced service will end and associated funding will be reinvested into global sum. From 1 April 2015, it will be a contractual requirement for all practices to have a patient participation group (PPG) and to make reasonable efforts for this to be representative of the practice population
- the alcohol enhanced service will end and associated funding will be reinvested into global sum. From 1 April 2015 it will be a contractual requirement for all practices to identify newly registered patients aged 16 or over who are drinking alcohol at increased or higher risk levels
- GPC, NHS England and NHS Employers will work together to develop more consistent guidance for the provision of enhanced minor surgery services
- the extended hours and learning disabilities enhanced services will be extended and unchanged for a further year
- changes to registration regulations will allow for armed forces personnel to be registered with a GP practice
- there will be a 15% reduction in the total seniority payments as agreed in 2014/15
- assurance on out of hours provision has been agreed to ensure that all service providers are delivering out of hours care in line with the National Quality Requirements (or any successor quality standards)
- improved maternity/paternity arrangements have been agreed, to cover both external locums and cover provided by existing GPs within the practice who do not already work full time
- NHS England and GPC will work together on workforce issues including the retainer /returner scheme, the flexible careers scheme, and recruitment problems in specific areas
- GPC, NHS Employers and NHS England will have a broader strategic discussion about the primary care estate, especially to support the transfer of care into a community setting
- NHS England and GPC will re-examine the Carr-Hill formula with the aim of adapting the formula to better reflect deprivation
- correction factor funding moving into global sum will be reinvested, with no out of hours deduction applying; NHS England has agreed that any funding released from PMS reviews will be invested in primary medical care services.
A set of FAQs has been developed to support commissioners in delivery of the 14/15 GMS contract. The FAQs can be found on our non-clinical FAQs page.