Non-clinical FAQs

SAVE ITEM
GMS FAQs

This section includes FAQs for the following areas:

General questions 

Friends and family test (FFT)

NHS England has published a number of FAQs relating to the friends and family test which can be found here.

Named accountable GP for over 75s 

Seniority

Publications of Earnings 

Identification and management of people with frailty

General questions 

Q: Where can I find the information I need to be able to implement the changes to the GMS contract for 2016/17?

A: NHS Employers provides details of the GMS contract changes and also supporting guidance.

The documents available to support the 2016/17 GMS contract changes are:

The legal requirements underpinning the GMS contract can be found on the NHS England and Department of Health (DH) websites.

The nationally defined Service Specifications for Enhanced Services can be found on the NHS England website.

The Statement of Financial Entitlements (SFE), DES Directions and the Regulations can be found on the DH website:

General questions

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Q:   Can I buy copies of guidance/books, or can you send me copies?

A:  All GMS support publications are available to download and print only. It is not possible to purchase hard copies. The exception is the FFT guidance which is available online, but if you require a hard copy please email gmscontract@nhsemployers.org

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Q:   Where can I find Business Rules and Read codes for QOF, enhanced services and vaccination programmes?

A:  Where a service is supported by Business Rules they are available to download from the Health and Social Care Information Centre.

Read codes for enhanced services and vaccination programmes are available in the ‘technical requirements for 2016/17 GMS contract changes’ document.

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Q:  If the guidance and supporting documents have not answered my question, where can I direct my query? 

A:  The process for queries can be found on our queries process webpage. 

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Q:  How long are practices required to retain evidence regarding work completed which is related/attributed to ES achievement? 


A:  Practices are required to retain evidence of work completed which is attributed or related to payment, for up to six years. This evidence could reasonably be requested by any local commissioner or NHS England. Some of this evidence would be available from practices clinical systems but hard copies would need to be filed or digitised and held electronically. 


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Named accountable GP for over 75s 

Q:  Is there a template for practices to use to notify patients of their named GP?

A: Yes. A template is available to download from our 2014/15 GMS contract changes page.

Named accountable GP for over 75s questions 

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Q:  Where a practice is a single handed practice, does the practice have to contact all patients aged 75 and over to advise who their named GP is? 

A: A practice does have to inform patients of their named GP even if it is a single-handed practice. However, there is no need to write individually to them all. The guidance allows flexibility to let patients know in the most appropriate way, including at their next routine consultation. 

Named accountable GP for over 75s questions 

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Q: When do patients need to be allocated a named GP, and how and when should then be informed?

A: Patients should be allocated a named GP and practices should use the code ‘patient allocated named accountable general practitioner’ to confirm the practice has allocated a named GP to each patient  within 21 days if aged 75 or over or newly registered. 

Patients should then be informed of that at the earliest convenient time, such as their next appointment, or if they contact the practice to find out. The patient record should then be updated with the relevant Read codes (see the technical requirements document). Practices have been obliged to provide information to patients on the allocation of named GPs on the practice website and leaflet since 31 March 2016. 

Practices should remember that patients who turn 75 within the year 2016/17 should be informed of their named GP within 21 days. Also patients who are on the ‘case management register' under the Avoiding Unplanned Admissions enhanced service should also be informed within 21 days. 



Named accountable GP for over 75s questions 

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Seniority

Q: Where a contractor was formerly eligible to receive seniority payments, but was temporarily ineligible on the cut-off date of 31 March 2014, would they then qualify to receive payments if they subsequently became eligible again?

A: Where possible, the guidance should be interpreted to encourage doctors to remain/return as a partner GP. For that reason, NHS England has confirmed that contractors in the following scenarios should be eligible to receive payments:

  • where a GP is a contractor who was transferring from one partnership to another over 31 March 2014 they should continue receiving payments as normal.

  • where a GP was a contractor receiving seniority payments prior to 31 March 2014, was employed as a salaried GP or in another relevant clinical position over 31 March 2014, and subsequently returns to being a contractor GP, then they should resume receiving payments.

  • where a GP is a contractor who has previously received payments, and was eligible on 31 March 2014 to receive payments in terms of their length of service, but was not doing so because their earnings did not meet the required threshold, then if their earnings rise to that threshold they will resume receiving payments.

  • where a GP was on a PMS contract on 31 March 2014 and had a seniority equivalency entered into their contract, then if they subsequently transfer to a GMS contract they should receive payments in line with their previous equivalency.

The principle will remain that there will be no new entrants to the scheme, and only contractors who have previously received payments prior to 31 March 2014 can be considered. Local teams should contact NHS Employers for advice on any specific queries.  

Seniority questions 

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Q:  If a GP undertakes 24-hour retirement and they are currently in receipt of full seniority allowance will they still be entitled to seniority payments when they return to work?

A: 24-hour retirement will not affect GPs’ seniority payments as long as they continue to meet the eligibility criteria set out in section 19 of the SFE. 

Seniority questions 

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Publication of earnings

Q:  At my practice we have a different year end, not 31 March, so to supply earnings information for a 1 April-31 March year we would need to use two different years’ datasets. Would it be acceptable to provide earnings information using our existing year end?

A: Yes. The Regulations and guidance require information for the previous financial year. This can mean the practice financial year so if, for example, a practice year end date is 30 June it would be acceptable to submit earnings data for 1 July-30 June. 

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Q:  How is the practice to split the costs between income that is included and excluded?  Two practices with similar income and expenses could come out with different results and the work involved could be onerous for the practice?

A: Practices should apportion variable costs as far as is reasonably practicable. Where practices experience significant difficulties doing this (identifying the level of expenditure to attribute and deduct from income sources), they should use the same basis for apportionment as they do for fixed costs. This will vary from practice to practice, but is typically around 60% fixed: 40% variable 

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Q:  Not all practices use 8 sessions as a basis for full-time equivalent- some may use 7, or 9.  And under these guidelines a practice would have to declare that a GPC working 7 sessions per week is part time, the same as a GP who works 1 or 2 sessions. How can we ensure more consistency in definitions of full and part-time?

A: Because there is this variation between practices, it was agreed to allow some flexibility in full and part-time definitions. Practices are recommended to follow the definition of full-time provided within the 2006/7 UK General Practice Workload Survey, namely that those GPs that work 8 sessions or more are considered full-time, and any GPs working less than this are considered part-time. However there would be nothing to prevent the practice from issuing some information clarifying how many sessions each GP worked. 

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Q:  Is it intended that this information will be included in a certificate of some kind or will it be left to practices to prepare this as they think best?

A: There is no standard certificate or template for practices to prepare- the guidance suggests the format and also states that compliance may be monitored through the annual eDec. 


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Identification and management of people with frailty

Q:  Why use the eFI?

A: The eFI  has been externally validated, is widely available (from April will be available in 99 per cent of practices ie those using EMISweb, SystmOne or Vision) and uses existing primary care data from the health record so requires no further data collection. 

The development of the eFI is outlined in a paper published in 2016 on the ‘Development and Validation of an electronic Frailty Index using routine primary care electronic health record data’ . This describes how the eFI has been developed and validated using data from over 900,000 UK primary care patients. The key points from the paper are:
  • International guidelines recommend routine identification of frailty.
  • Other currently available tools require additional resource and may be inaccurate.
  • The eFI has been developed and validated using routine primary care data. It can be automatically populated with routinely collected primary care Electronic Health Record (EHR) data
  • The eFI has robust predictive validity for outcomes of nursing home admission, hospitalisation and mortality. 
  • Routine implementation of the eFI could:
    • enable better targeting of evidence-based interventions, 
    • improve planning of health services utilisation, and 
    • Facilitate the development of more appropriate, proactive, goal- orientated care for older people with frailty.
In addition, use of the eFI is supported in the NICE 2016 clinical guideline on multi-morbidity

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Q:  Does the eFI tool provide a score for all patients, or does the GP need to review and add the outcome after the score?

A: The eFI has been validated using routinely available primary care electronic health record data using large internal and external validation cohorts. The GP (or another appropriate clinician) needs to review the results of the eFI before this is recorded. Like any tool, the eFI is not 100 per cent sensitive or specific so the subsequent clinical review of the score helps to prevent false negatives and false positives.

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Q:  Is the eFI tool automated?

A: Yes. The tool can be used in an automated way using existing data in the patient record.

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Q:  Some reports suggest the available tools are not sensitive to identify people with moderate or lesser degrees of frailty. Does this include the eFI?

A: No tool is sufficiently sensitive, which is why the clinician review is an important part of this process. However, validation of the eFI against 900,000 health records has shown that it has sensitivity or specificity to discriminate degrees of frailty including moderate and mild frailty.

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Q:  Which clinical systems are able to use an electronic tool which will allow for automated searches?

A:  The eFI is currently available to 90 per cent of general practices (SystmOne and EMIS software). From April 2017, it is expected this will increase to 99 per cent of practices having access (ie implemented in Vision).

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Q:   What other tools are available and are they automated for use in general practice?

A:  There are no other similar tools currently available. Since the tool is based on a well-defined cumulative deficit model of frailty it requires systematic collection of routine health data. Other models using greater numbers of deficits have been worked on elsewhere in the world but are not validated on this scale or available for automated use. The NHS in England is the first country to have the opportunity of a consistent and validated approach which uses routine primary care data.

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Q:   Why falls?

A:  Effective, planned, evidence based approaches to falls and fracture risk reduction are of key importance to the health and wellbeing of people living with frailty. The routine identification of those most vulnerable of falling will allow GPs to target those patients who are most likely to benefit from interventions.

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Q:   Why medications?

A:  The use of multiple medications by older people living with frailty is likely to increase the risk of falls, adverse side effects and interactions, hence the need to individualise the interpretation of national guidelines for single long term conditions in the context of multi-morbidity in general and frailty in particular.

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Q:   Why the SCR?

A:  Having access to appropriate patient information is vital. Summary Care Records enriched with additional information offer this opportunity. The SCR is created automatically through clinical systems in GP practices and uploaded to the Spine and therefore available to other clinicians when required. It is automatically updated when further changes are made to the GP record. Additional information can be added to the SCR, with explicit patient consent, by the GP. The information can be included automatically by changing the patient's SCR consent status.

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Q:   Additional Information

A: Further supporting frailty information and frailty guidance can be found on NHS England’s Older People’s webpage.

Information on the recommended coding and data collections can be found in the ‘Technical Requirements for 2017/18 GMS Contract Changes’ document, via NHS Employers GMS Contract Changes page.

If practices have any queries in relation to the clinical identification and management of people living with frailty please email NHS England’s long-term conditions team at england.longtermconditions@nhs.net. If practices have any queries in relation to the contractual requirements please email NHS Employers at GMScontract@nhsemployers.org.

Where a query relates to both the clinical and contractual elements, NHS England, NHS Employers and the GPC will work together to respond.

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