Guidance

Introduction

As we know, the 24/25 Contract was imposed by NHSE despite lobbying from GPC England.

We have put together a summary document to bring together and highlight the main points of the 24/25 Contract with our comments.

 

 

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GMS Contract 24/25

NHSE have a suite of documents covering the contract for 24/25 that can be seen at NHS England » GP Contract

For ease of navigation, the following links go direct to the documented sections

As we know The BMA held a referendum regarding the Contract for 24/25 and Members have overwhelmingly voted to reject the Government and NHS England’s 2024/25 GP contract changes. You can read more on that here.

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Funding

GPC England suggested an uplift to the core contract by 8.7%, it is hugely disappointing that this was nowhere near forthcoming.

  • Global Sum £107.57
  • OOH adjustment remains at 4.75%
  • QoF point £220.62
  • IIF £198.00 per point (dependent upon PCN performance).
  • IOS £10.06 (no change)
  • Weight Management ES £11.50 (no change)
  • Practice Network Participation payment (payable to practices participating) £1.761 (no change)

Disappointingly, yet again, no change to payments associated with maternity & sickness reimbursement.

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Contract Amendments

Digital Telephony data requirements

The amendments to the 2023/24 GP Contract require that when practices enter into any new digital telephone contract, it must be procured through the national framework.

In 2024/25 the GP Contract will be amended to require practices to provide data on eight metrics through a national data extraction, for use by PCN Clinical Directors, ICBs and NHS England.

These eight metrics are:

  • call volumes
  • calls abandoned
  • call times to answer
  • missed call volumes
  • wait time before call abandoned
  • call backs requested
  • call backs made
  • average call length time

This data will be used by ICBs and NHS England to support service improvement and planning, for example:

  • better insight into patient demand and access trends which systems can use to support understanding of operational pressure in general practice; and
  • better understanding patterns of demand and period of surge activity to inform commissioning of local services.
Performers list
  • Flexibilities similar to the COVID-19 amendment will be made permanent. Doctors that are employed or registered with bodies designated by the Medical Profession (Responsible Officers) Regulations 2010 (Schedule, Part 1 only) will be able to deliver primary care services without being on the Medical Performers List (MPL). There will be a corresponding change to the GP contract regulations.
  • These changes will permit GP practices and PCNs to employ doctors who are already employed, for example, by an NHS trust, NHS foundation trust or health board without the requirement for the doctor to also be registered on the MPL.
  • Please Note :- Supporting guidance will also be issued to clarify that non-GP doctors should not see undifferentiated patients, and that they continue to be required to operate within their sphere of competence.
Registering with a GP

NHS England has co-developed a new registration solution with patients and practices to make registering with a GP easier, simpler and standardised. Over 2000 practices have already adopted the solution which consists of an online registration service and a new paper form.

The NHSE letter says that “Practices will be contractually required to adopt and offer both formats”. However, we understand many practices are currently using, and some paying for, other online registration software that is equal to or better than the NHSE solution. We are seeking clarity on whether the NHSE solution is mandatory or if other solutions are acceptable.

There will be a mobilisation period with both formats to be in place from October 2024.

Recognising the importance of continuity of care

Provisions in the GP Contract Regulations will be amended to explicitly require continuity of care to be considered when determining the appropriate response when a patient contacts their practice.

Changes to workforce data collection

Practices and PCNs will be required to submit workforce information on a quarterly basis to the National Workforce Reporting Service (NWRS) via changes to the GP contract and the Network Contract DES.

Digital tools for catchment areas

The GP Contract Regulations will be amended to require GP practices to use digital tools provided by NHS England to reproduce a digital copy of their practice boundary (including any branch site areas, whether coterminous or not).

Practices will also be required to review and where necessary update GP practice boundaries where data quality is insufficient for the intended purpose.

Practices will also be required to produce a digital copy of a practice’s agreed practice boundary where a new practice is established or merged or a catchment area change is agreed, either as part of a new contract or variation procedures.

Armed forces veterans

The GP Contract will be updated so that practices must have due regard for the requirements, needs and circumstances of Armed forces veterans when offering services and making onward referrals.

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Vaccination and Immunisations

April 2024 – NHSE have published the General practice vaccination and immunisation services: standards and core contractual requirements. It is recommended that practices familiarise themselves with this is full.

Update for this year, in brief

  • The IOS Fee remains at £10.06 (despite the GPC suggestion this should be raised to £12.19)
  • share vaccination status (both vaccinated and unvaccinated) with the local Child Health Information Services (CHIS), and any other system nationally required, and support CHIS data cleansing.
  • improve data recording of vaccination status for all patients, including where they have arrived from overseas and where there is an unknown or incomplete history to offer vaccinations in line with the UK Schedule and Green Book.
  • improve data quality for vaccination events. Supported through a rationalisation of SNOMED codes used for vaccination event recording, ensuring practices are using the relevant codes within their clinical system templates; and
  • maintain accurate and up-to-date patient vaccination records, including correcting vaccination records as and when they are made aware of any errors.

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QOF Overview

This year, as previous, brings further changes to the Quality and Outcomes Framework (QOF), to streamline and reduce bureaucracy, 32 indicators (out of the total 76 QOF indicators) will be income protected in 2024/25.

NHSE – QoF guidance

  • 635 points available
    • 212 points income protected.
    • 423 performance related.
  • QOF aspiration payments will be increased from 70% to 80% in 2024/25 to support practice cash flow.
  • On income protection, we note that the QoF guidance (pg6) says:-

ii. For the indicators that are income protected, practices will have their 2024/25 achievement in points set at the same level as that achieved in 2023/24.

It should be noted that this means practices will not be penalised for falling performance within the income protected indicators, but neither will they be rewarded for improvements in those indicators.

iii. Income protection does not mean that the payment amount will be the same in 2024/25 as in 2023/24. QOF earnings will continue to be subject to prevalence adjustments, list size variation, with these being based on 2024/25 figures. Therefore, the final payment amount may be different.

iv. Practices will continue to be expected to maintain the registers and accurately code patient records with up-to-date information on diagnoses, as this activity performs an important role in maintaining clinical quality. There will continue to be a GPES extract of diagnosis which is used to calculate prevalence adjustments for indicators. Failure to maintain the registers will have an impact on prevalence adjustments and therefore will impact on practice income at the end of the financial year.

  • Indicator CHOL002 will be updated so that it is aligned with the new NICE NM252 indicator definition from 1 April 2024, ensuring that QOF maintains its strong link to the latest evidence-based guidance.

The Quality Improvement (QI) module for Workforce and Wellbeing, retains 74 points and is income protected.

The BMA have produced a guidance document to aid Workforce Wellbeing that you might find useful.

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PCN DES

Full suite of documents can be found here.

The Network Contract DES service requirements

There are currently nine service requirements which are detailed in the Network Contract DES. A number of these are supported by non-contractually binding guidance documents.

Eight of the current PCN service specifications will be replaced by one simple overarching specification with a greater outcomes-focus. See the NHS guidance here.

The Enhanced Access specification will remain as a separate specification with the arrangements unchanged in 2024/25.

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Capacity and Access Payment (CAP)

Details can be found in Network Contract DES Part B Guidance.

The CAP consists of two parts:

  1. National Capacity and Access Support Payment (CASP): 70% of funding will be flexible in focus to improve access for patients and paid unconditionally to PCNs, proportionally to their Adjusted Population, in 12 equal payments over the 2024/25 financial year, an average of ~£13,354/month/PCN; and
  2. Local Capacity and Access Improvement Payments (CAIPs): part or all of 30% of the funding.

This will be paid to PCNs in 2024/25 based on the PCN’s progress in implementing the Modern General Practice Access (MGPA) model and specifically in delivering against three priority domains (see pg 52 table 1 in section 11).

The maximum a PCN could earn is £1.392 multiplied by the PCN’s Adjusted Population as of 1 January 2024.

It is recommended that you take a look at the details in full for both of these payment opportunities and they can be found on Page 50 onwards of the above guidance.

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IIF

In 2024/25 the number of IIF indicators will be reduced further from 5 to 2 and worth 58 points. (Details on Page 54 onwards). The remaining funding from the IIF has been allocated to Capacity and Access funding.

Retained indicators:-

  • Learning disability health checks 36 ptsHI03: Percentage of patients on the QOF Learning Disability register aged 14 or over, who received an annual Learning Disability Health Check and have a completed Health Action Plan in addition to a recording of ethnicity.
  • FIT testing 22 ptsCAN02: Percentage of lower gastrointestinal urgent suspected cancer referrals accompanied by a faecal immunochemical test result, with the result recorded in the 56 | Part B guidance for 2024/25 Area Indicators twenty-one days leading up to the referral.

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ARRS

The following changes for 2024/25 are intended to the increase the flexibility of the scheme by widening the reimbursable roles and removing role restrictions where possible:

  • Enhanced practice nurses will be included in the roles eligible for reimbursement. As a new role, this will initially be capped at one per PCN (two where the list size is 100,000 or over).
  • PCNs will be able to recruit other direct patient care non-nurse and non-doctor MDT roles, if agreed with their ICB.
  • Where PCNs already have one mental health practitioner (MHP) in place, 50:50 funded by the PCN and the mental health provider, funding arrangements for subsequent MHP roles will be for agreement between the PCN and the mental health provider, subject to ICB approval. This could include additional MHPs being up to 100% funded through ARRS. All mental health practitioners will continue to be employed or engaged by the mental health provider.
  • Caps on advanced practitioners will be removed.
  • PCNs will be able to claim reimbursement for the time personalised care roles spend out of practice undertaking training or apprenticeships to obtain a level three occupational standard.

In 2024/25 the mechanism which allows commissioners to redistribute unclaimed funding from the Additional Roles Reimbursement Sum between PCNs will be removed from the Network Contract DES. NHSE continue to encourage PCNs to recruit up to their individual entitlements.

Full details for the ARRS can be found in Network guidance Part B page 21-35

PCN Clinical Directors requirements and funding

The PCN Clinical Director role description will be simplified and refocussed in 2024/25.  (See page 21 5.3).

It will focus on the following key responsibilities: co-ordination of service delivery, allocation of resources, supporting transformation towards Modern General Practice and supporting the PCN role in Integrated Neighbourhood Teams.

A more flexible funding pool will also be created for PCNs by rolling the Clinical Director Payment and PCN Leadership and Management funding into Core PCN funding. See PCN Ready Reckoner for more detail.

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Weight Management Enhanced Service

The Weight Management Enhanced Service will continue into 2024/25, and the £11.50 referral payment remains the same.

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Last Reviewed Date
04/04/2024