Contract changes for 2017/8
Date sent: Tuesday 7 February 2017
Email sent by Wessex LMCs, on Tuesday, 7 Feb 2017
The contract changes have been announced today for 2017/8. These will apply to both GMS and PMS practices.
In previous years the changes have been kept to a minimum because of the pressures that all practices face.
We know that for most practices the major factors that are having a negative impact are workload and workforce.
These contract changes will help all practices and are aimed at supporting practices and to take a further step to address these important factors. Alone, these contract changes will not address all the issues but they should be considered in the context of other important developments including the GP Forward View and the New Models of Care (also know as MCP or Vanguards).
If this years changes help with the rising expenses, supports the development of the work in terms of training additional members of the practices team (GPFV), adds additional funding to the global sum from a retired DES and requires the STP to deliver transformation that supports the out of hospital model and provides a focus on general practice via the new models of care, then this must be a positive. Next year we need additional recurrent resources to expand the workforce to add capacity both at practice level and at the level of a natural community of care.
Below are a summary of the changes
Changes to the global sum for 2017/8
The estimated £238.7 million investment into the contract for 2017/18 covers a number of elements, including:
- an increase to the global sum for all practices to account for expenses and to result in an intended 1% pay uplift for GPs and practice staff
- £3.8m to cover increased superannuation costs of 0.08% pension admin charges
- £5 million to cover workload associated with the overseas visitors administration changes
- £1.5 million to cover workload involved in completion of the workforce survey
- £2 million to cover increased workload for bagging/labelling of records as a result of changes to the Primary Care Support England Service
- an estimated cost of £58.9 million to cover the increase in population growth
In addition global sum will increase as a result of further recycling of correction factor and seniority funding
Directly reimbursed to practices
- £22.5 million to reimburse full CQC fees
- £1 million to cover costs for those practices subject to Business Improvement District levies
Paid through SFE
- £30 million to cover increases in GP indemnity costs
- £6.2 million to include morbidly obese in eligible cohort for influenza vaccinations
- Estimated £8 million to cover increases in payments for locum reimbursement to cover maternity and sickness leave
- £1 million for the new GP retainer scheme
Avoiding Unplanned Admissions (AUA) a DES
This will be discontinued on 31st March 2017 and the funding for this (about £157m) will be added to the global sum. Practices will be expected to focus more on managing patients who are identified as living with severe frailty. There will not be any claim forms to complete as this will now form part of the practices core funding.
In place of the AUA DES, practices should focus on providing clinically appropriate care to a much more limited group of patients of 65 years and over who are living with severe frailty. Practices will need to use an appropriate tool of their choosing, for example the Electronic Frailty Index (eFI) to identify patients who are living with moderate or severe frailty. For those patients identified as living with severe frailty, the practice will deliver a clinical review providing an annual medication review and where clinically appropriate discuss whether the patient has fallen in the last 12 months and provide any other clinically relevant interventions.
In addition, where a patient does not already have an enriched Summary Care Record (SCR) the practice will promote this seeking informed patient consent to activate the enriched SCR.
NHS England will collect data on these patients. This data will not be used for performance management in any way. There is no requirement to record patients with moderate frailty but where this is done this data will be collected.
The key element to this is that practices are able to apply their own clinical judgment in the management of this group of patients with significant clinical needs.
LMC Comment: This is a positive move especially with the rising number of elderly patients in our area, so that many practices are being faced with significant issues relating to frailty.
It is true to say that CQC has not been the most popular initiative that has been imposed on general practice but what has caused widespread outrage has been the proposal to increase the fees for CQC by 7 fold. From April 2017 there will be full reimbursement of practices' total CQC fees.
LMC Comment: This will mean any significant fee increase will be met by the Government. It is therefore hoped that there will be a review and rationalisation of the whole reporting and inspection regime.
Indemnity fee rises
An additional £30m will be added to practice budgets based on a per patient basis and not weighted. This is intended to cover the increase in indemnity costs for all GPs working in the practice including salaried GPs.
LMC Comment: Practices will need to ensure additional funding is given to those salaried GPs where the cost of indemnity is borne by the individual. The expectation is that locum GPs cover their indemnity fee increases in there fees that cover their expenses. Although this helps with the cost of Indemnity it does not provide an answer to the historic problem of indemnity costs.
Expenses and Pay uplift
The agreed expenses uplift is expected to provide a pay uplift if 1% which is in line with the public sector pay increases for 2017/8. An amount will be added to the global sum to deliver this. There will be £2m added to the global sum to take account of the additional work undertaken by practices relating to record transfer by the primary care support services provide by Capita. There has been much publicity about the additional costs to the employer in relation to teh NHS Superannuation which although is only 0.08% amounts to a cost pressure of £3.8m across England and this sum will also be added to the global sum. Most practices currently contribute on a voluntary basis to the workforce census, this will now become a contractual requirement and to fund this an additional £1.5m will be added to the global sum.
LMC Comment: This has taken into account a number of issues, recognised the impact and addressed these with additional funding.
This will no longer be discretionary but will become a practice entitlement. The qualifying criteria based on list size, which has often prevented practices being able to claim a payment to cover locum costs will be removed. Payment will commence after 2 weeks absence. GPs within the existing practice can provide cover. So this now mirrors existing maternity cover arrangements.
The amount payable will be up to £1734.18 per week again in line with current maternity cover arrangements. This should reduce the need and costs of locum insurance and help meet the costs of salaried GPs sickness cover.
LMC Comment: This is a significant development, not only supporting practices who have a GP off sick but helps with the costs of locum insurance. In addition there has been much discussion about the reduction in access to Occupational health Services for GPs. NHS England have an increased incentive to maintain a health workforce as they will now be responsible for funding sickness cover.
This will no longer be pro rata reimbursement. Practices will only need to submit an invoice and they will receive either the full amount or the maximum payable sum.
LMC Comment: Maternity reimbursement had improved but this remained an anomaly with different areas interpreting the guidance in their own way, it is welcomed that the variation has now been addressed.
Learning disability DES
The payment is to undertake an annual health check for this vulnerable group. The fee increases from £116 to £140. It is hoped the uptake will increase.
LMC Comment: The LMC is engaging with CCGs to try and ensure the process can be streamlined, have clinical value and a significant amount of this can be nurse led.
Extended hours DES
You will have all read the headlines about the practices that close for 1/2 a day a week yet get paid extra to open in the evening and weekends. We apparently have 4 in Wessex and on further investigation the majority are not practices who have closed for a 1/2 day but practices who work from 23 sites where one site is closed for 1/2 a day and full access to services is delivered from the other site.
New conditions will be put in place that will mean practices who regularly close for 1/2 a day per week, will not ordinarily qualify to provide the DES (exception as will be branch sites). This will be implemented in October 2017.
LMC Comment: This seems a sensible approach and I do not think will adversely affect Wessex practices.
Access to healthcare
As part of the agreement last year to take this forward, the GPC has agreed to help identify patients with a non-UK EHIC (European Health Insurance Card) or S1 form. This will allow the NHS to claim back fees for hospital based care from the countries or origin where the UK has reciprocal arrangements. Patients will not be charged themselves. An additional £5m will be added to the global sum recurrently to support this contract change. New patients will be asked to self declare whether they hold a non-UK issued EHIC or a S1 form on a revised GMS1 form, his information will be added to the patient's medical record and a copy of the form and supplementary questions will be sent to NHS digital.
LMC Comment: I know practices and GPs are concerned that they may be used as the Boarder control police but this agreement will help the NHS get paid for care it provides to foreign nationals and funds GPs for the work it undertakes. The LMC would support this.
GP retainer scheme
There is a new and improved retainer scheme which will commence in April. The aim will be retain GPs especially those towards the end of their career.
LMC Comment: The additional funding and flexibility are welcomed and more details will be shared shortly.
Retired QoF Indicators
The LMC has supported the GPC and asked practices to continue to provide this data, accepting that it will have limited value as practices will only code information that has clinical value. The vast majority of practices in Wessex have supported this approach. The provision of this data will now become a contractual requirement.
Practices will not be assessed against these indicators or retired enhanced services in any way.
LMC Comment: This is aligned with the LMC's views.
Registration of former prisoners
It is planned to improve the communication between prisons and practices to enable an earlier transfer of clinical information about a registering patient. This should improve the initial management of these patients when they first present to the practice, as they practice should know what they have previously been prescribed and treated for whilst in prison.
LMC Comment: More details are needed but this has been an issue the LMC had supported for some time as many practices have contacted us expressing their frustration when they are unable to access this information in a very vulnerable group who often have complex health issues.
Business Improvement District Levy
Some local councils have imposed a local levy on all businesses in their area, called the business improvement district levy. Practices in these areas have been required to pay this. From April 2017 practices will be able to claim a reimbursement for the payments that they make.
LMC Comment: This is great new as we are one of the areas where practices have been subject to this unfair funding requirements.
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
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