16 / 6 / 2014 00:00 AM
NHS Employers and the General Practitioners Committee (GPC) of the British Medical Association have agreed changes to the General Medical Services contract for 2014/15 for England.
A number of documents have been published to support commissioners in the implementation of the 2014/15 contract changes:
The Technical Requirements for 2014/15 GMS Contract Changes is available here.
NHS England, NHS Employers and the HSCIC are seeking to finalise the arrangements to support the Avoiding Unplanned Admissions enhanced service as soon as possible. Initial Read2 and CTV3 codes to support this service are included in this document and further details will follow by the end of May 2014.
The codes for recording patients named GP for this ES will be the same as those already published for ‘Named GP for over 75s'.
GMS and PMS regulations for 2014/15
The new GMS and PMS regulations for 2014/15 have been laid before parliament and will come into force on 1 April 2014. This gives effect to those aspects of the 2014/15 contract agreement that are core contractual requirements for all GP practices.
Avoiding unplanned admissions and proactive case management
The introduction of a new ES, for one year, that aims to improve services for patients with complex health and care needs, who may be at high risk of unplanned admission to hospital. In particular, to:
- provide timely telephone access, via ex-directory or bypass number, to relevant providers to support decisions relating to hospital transfers or admissions, in order to reduce avoidable hospital admissions or A&E attendances
- case manage vulnerable patients (both those with physical and mental health conditions) proactively through developing, sharing and regularly reviewing personalised care plans, including identifying a named accountable GP and care coordinator
- improve access to telephone or, where required, consultation appointments for patients identified in this service
- review and improve the discharge process, sharing relevant information and whole system commissioning action points to help inform commissioning decisions.
- undertake internal reviews of unplanned admissions/readmissions.
The ES will be funded using £162 million taken from the retirement of the QOF QP indicators and the discontinuation of the Risk Profiling Enhanced Service.
It has been agreed that 341 points from QOF will be retired. Of these, 238 points will be reinvested into core funding of General Practice. The remaining 103 points will be reinvested elsewhere in the contract with 100 points used to fund the new ES for Avoiding Unplanned Admissions and Proactive Case Management and 3 points to fund improvements to the Learning Disabilities ES.
The planned changes in QOF thresholds from April 2014 will be deferred for one year.
The retirement of indicators from QOF will reduce bureaucracy, allow GPs and practice staff more time to focus on the needs of individual patients and avoid unnecessary annual recall and testing of patients. GPs will use their professional judgement and continue to treat patients in accordance with best practice guidelines.
Seniority payments will cease on 31 March 2020. In the meantime, those in receipt of payments on 31 March 2014 will continue to receive payments and progress as currently, but there will be no new entrants from 1 April 2014. It is intended that there will be a 15 per cent reduction in spend each year. Any money released will be reinvested in core funding.
Named GP for patients aged 75 and over
As part of the commitment to more personalised care for more patients with long term conditions all patients aged 75 and over will have a named accountable GP.
Quality of out of hours services
GP practices who have opted out of Out of Hours services will have to monitor the quality of those services and report any concerns they may have.
Publication of GP earnings
All practices will publish GP NHS net earnings in 2015.
Friends and Family Test
It will be a contractual requirement for practices to undertake the Friends and Family Test from December 2014.
Choice of GP practice
From October 2014, all GP practices will be able to register patients from outside their traditional practice boundary areas without any obligation to provide home visits for such patients. Commissioners will be responsible for arranging in-hours urgent medical care when needed at or near home for patients who register with a practice away from home.
Patients needing access to a practice clinician after assessment
Where a patient has been assessed as needing contact with a practice clinician, the practice will ensure that when the patient contacts the practice, a practice clinician will agree appropriate next steps having regard to the patient’s condition and circumstances.
When the CQC’s new inspection arrangements are introduced, practices will be required to display the inspection outcome in their waiting room(s) and on the practice website.
Work is continuing to strengthen the weighting of Deprivation in the GP funding formula to be implemented from April 2015.
Patients and information
During 2014/15 all practices will:
- Use the NHS Number in all clinical correspondence
- Provide the ability for all patients to book appointments online
- Allow all patients to order repeat prescriptions online
- Update the Summary Care Record daily
- Transfer patient records using the GP2GP facility
- Allow patients to access online the data contained in their Summary Care Record
- The Patient Participation scheme will continue for another year with the requirement to carry out a local survey removed due to the introduction of the Friends and Family Test.
- The Extended Hours Access scheme is extended for another year with a number of flexibilities included to allow practices to work together to provide the most appropriate service for their patients.
- The Dementia, Alcohol and Learning Disabilities schemes will be extended for a further year with some changes made.
It has been agreed that the Patient Online (£24m) and Remote Care Monitoring (£12m) ES will cease on 31 March 2014 and the associated funding reinvested into core funding.
GP pay and expenses
The Government has accepted the Doctors and Dentist Review Body(DDRB) recommendation to uplift GMS contracts by 0.28 per cent. This will be delivered through an uplift to the global sum.
A set of FAQs has been developed to support commissioners in delivery of the GMS contract.