Update to GP Contract 20/21 - 23/24
NHS England GP Contract Documents
BMA Update April 2021 - NHSEI has confirmed that the temporary changes to the GP contract under the pandemic regulations which were due to lapse at the end of March have now been extended until 30 June 2021.
As with previously, this means:
- a continued suspension of the Friends and Family Test requirement
- a continued suspension of the requirement for individual patient consent for electronic repeat dispensing (eRD)
- a continuation of the amendment to NHS 111 direct booking - sufficient slots available for NHS 111 to refer into a triage list; for most practices offering 1 per 3000 is likely to be sufficient but this can increase to 1 per 500 if demand requires.
January 2021 - GPC England have supported the agreement the BMA have secured with NHSE/I for minimal contract changes for 2021/22 whilst retaining the significant increases in funding already planned. There was a further update letter for QOF 10th March 21. Some of the previous agreements due to start in April will be delayed. This is to give practices support and stability through the continued pandemic and whilst practices are playing such a significant role in the COVID-19 vaccination programme.
Some of these changes will be implemented throughout 2021/22 depending on the pandemic, and will be agreed later in the year.
Practices will then be provided with adequate time to prepare.
The recordings of the recent GPC GP contract 2021/22 update webinars are now available, including question and answer sessions. There is also a slide set to accompany the webinars that can be downloaded here.
Further details are available on the BMA website, but in summary, from April 21:
- Global Sum will increase to £96.78 an increase of £3.32 (3.5%) Amended from early figures the BMA shared as it now takes in to account the full impact of the final MPIG correction factor recycling.
- Qof point value will increase to £201.16 an increase of £6.33 (3.3%)
- Out of Hours adjustment will increase to £4.59 an increase of £0.14 (3%)
- Funding increases previously agreed will be honoured
- Funding increase to global sum to allow a 2.1% uplift in pay
- QOF will be largely the same as for 2020/21 with some amendments to cancer and SMI domains to assist with the impact of the pandemic, and changes to vaccinations and
- immunisations as previously planned to continue with the move to an item of service payment arrangement for childhood vaccinations – these will see additional funding go into QOF
- QI modules from 20/21 to be repeated and slightly amended and the work already done will count towards this
- The core digital offer to patients has been defined, largely based on how practices are already operating due to the pandemic
- New ARRS roles will come on stream, with additional funding being made available to enable mental health practitioners to be part of the PCN workforce
- London weighting can be paid as part of ARRS max reimbursement amounts
- IIF 2020/12 indicators will remain unchanged. GPCE and NHSEI will have further discussion on other planned indicators for 2021/22, as the length and impact of the pandemic becomes clearer, utilising the additional investment to the IIF
- No new PCN service specifications from April (will be phased in later in the year with dates to be agreed depending on the pandemic), and current PCN services to receive minor amendments
- GPC England and NHSE/I will discuss the introduction (in-year) of a new enhanced service related to obesity and weight management
NHSE have provided a useful GMS Ready Reckoner that can be used for both practice and PCN puposes.
NHSE Quality and Outcomes Framework Guidance for 2021/22
Practice Index have also published QOF guidance for 21/22 and included a table on the new IOS reimbursements arrangements. The LMC also assisted with the table and think you may find it helpful.
NHS Digital - QoF Busness Rules - This webpage also includes details on business rules for enhanced services, vaccs and imms and also indicators no longer in QOF.
Primary care system development funding (SDF) and GPIT funding guidance: Analysis of programmes and funding in 2021/22
This guidance outlines all the funds available to primary care via regions, systems and CCGs, including workforce growth and development, technology and practice and PCN resilience and development. This large and vital investment in primary care will help to support general practice both now, as the onus shifts to recovery, and in the future.
The RCGP continues to support general practice carry out this QOF activity by producing learning material for the QOF QI module topics supporting people with learning disability and early diagnosis of cancer. Additionally, guidance has been produced to support effective and sustainable QI within a primary care network (PCN). These resources are available on the RCGP’s website.
Vaccination & Immunisation
NHSE also sent an update letter specific to vaccination and immunisation changes for 2021/22. From 1 April 2021 the provision of vaccination and immunisation services will become an essential service for all routine NHS-funded vaccinations with two exceptions:
- childhood and adult seasonal influenza, which will continue as enhanced services, and
- COVID-19 vaccination
There will be five core contractual standards will be introduced to underpin the delivery of immunisation services. These are described in more detail in Annex A of the letter.
A single item of service fee (IOS) will be fully implemented for all doses delivered in vaccination programmes funded through the GMS contract - More detail in Annex B (of above letter)
The Childhood Immunisation Target DES will be retired on 31 March 2021 and a new vaccination and immunisation domain in the Quality and Outcomes Framework (QOF) introduced for 2021/22. The vaccination and immunisation indicators in this domain were referenced in the letter of 21 January 2021.
There was a further letter on 7th Jan 2021 from NHSE entitled "Freeing up practices to support COVID vaccination" (and an update to this letter to clarify with further details on 3rd Feb 2021). The letters further amended the previous contract requirements (as below) with added income protections. This includes income protection for QOF QI and prescribing indicators, meaning the vast majority of QOF is now income protected, income protection for minor surgery for this quarter, a direction to CCGs to suspend LESs and to take a supportive pragmatic approach to contract management, and crucially, providing additional funding to support the work of PCN clinical directors and those who have worked so hard in the initial delivery of the COVID-19 vaccination programme, with an increase in payments from 0.25 WTE to 1 WTE for those PCNs where at least one practice is taking part in the vaccination programme. We have created a webpage to detail the changes made through 20/21 during covid-19.
NHSE published a letter with the revised updates to the GP Contract for 20/21 that come into force on 1st October.
The QOF (2020/21 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF) Guidance) element of the contract, for the remainder of 2020/21 has since been revised in light of Covid-19. The BMA have produced the following helpful brief summary: -
• support practices to reprioritise aspects of care not related to COVID-19
• serve those patients most in need of long-term condition management support
• guarantee significant income protection and the relaxing of some requirements for practices.
There are 567 points available in 2020/21 (compared to 559 in 2019/20), valued at £194.83 per point.
QOF 2020-21 COVID-19 adjustments
Practices should continue to prioritise care that is clinically necessary, relevant and possible. It should be delivered primarily by phone or virtually, or by face to face consultation (with appropriate PPE) where required.
Income-protected indicators (310 pts) – Other than areas outlined below, indicators will be subject to income protection. For these indicators, practices will be credited with points based on historical achievement (2018/19) but should nonetheless make efforts to deliver against these indicators as clinically appropriate. Practices will need to decide their approach to patient prioritisation and service delivery with their CCG during Oct-Nov 2020.
Quality improvement (74 pts) – These indicators have been simplified to focus upon a set of national actions in the agreed topic areas of learning disability and early cancer diagnosis. This in order to support and contribute to the delivery of these services, rather than wider QI activities. It will enable practices to learn from the experience of others within their PCN. Peer network support for delivery and sharing of best practice will need to continue to be provided by the PCN.
Immunisation and screening (58 pts) – The points allocated to flu vaccination and cervical screening are doubled in 2020/21. This is to highlight the priority placed on the delivery of these services and the renewed focus upon flu vaccination as part of NHS England’s COVID-19 plans.
It has been agreed that the points for these two domains will be weighted differently to the usual QOF processes, whilst the thresholds remain the same. Practices will accrue a higher number of points at the lower achievement threshold, with the remaining points being achieved in a linear manner between the upper and lower threshold.
Disease registers (81 pts) – Points associated with maintaining accurate disease registers in QOF will be conditional on the ongoing maintenance of registers and associated disease prevalence.
Prescribing named medications (44 pts) – Eight indicators optimising pharmacological management of patients with specific conditions and the prescribing of specified medications will remain conditional upon.
At the beginning of the year, NHSE published the Update to the GP Contract 20/21-23/24 as follows.
- QOF Points – up to 567 points at £194.83 per point
- Global Sum – uplifted by 4% to £93.46 (includes 1.8% intended for rises in staff costs)
- £20k + on cost partnership loan for new 1st time clinical partner. Plus, an additional £3k for new clinical partner training – Total available £25.5k
- Expansion of the Targeted Enhanced recruitment Scheme (TERS) in under-doctored areas.
- A new 1st time partner could have both the new partnership loan and the TERS payment.
- Big moves in Vaccs and Imms – Previously an additional service, this will now be an essential service in the global sum. There will be a new phased payment mechanism of an IOS payment of £10.06 for each vaccine given. This will be phased in over the next two years, starting this year with MMR. (The 70%/90% target payments will be removed in 21/22). Practice achieving less than 80% of their target cohort will not receive the IOS payment for the first 50%.
- The global sum funding for vaccs and imms has been fully retained and from 2021/22 childhood imms will also become part of QOF. This will give 3 incentive and income streams for this activity, Global Sum, IOS and QOF.
- Pensions – The increased employer contribution will continue to be topped up centrally as per last year and this will continue to be the case for the duration of the contract deal (i.e. to March 2024). Practice employer will pay 14.38% and the extra 6% will be paid centrally.
- PCN – ARRS. All roles to be reimbursed at 100% up to a max limit. There are also more roles to choose from when looking at your skills mixing. Our webpage for the PCN workforce has been updated to reflect the new changes. The 100% re-imbursement claims can be made for all new posts commencing on or after 17th Feb 2020, practice do not need to wait until 1st April 2020, however they cannot be back dated to last year.
- PCN – ARRS Addressing employment liabilities. Funding is now guaranteed for these staff in those practices that continue to participate in the DES. Furthermore, if all practices in a PCN decide to hand back the DES, the commissioner must arrange an alternative provider of services and in this circumstance the law and TUPE would apply.
- PCN funding 20/21 is as follows and is per registered patient (unless otherwise stated)
- £1.50 Core funding
- £0.722 CD contribution
- £1.45 Extended Hours
- £0.67 Impact & Investment Fund (IIF assumes 100% achievement)
- £60.00 per care home bed for 20/21 as the EHCH starts from Oct 20 (£120 per year will be paid 2021/22)
- ARRS – equates to £7.131 available per weighted patient
There are also a number of contractual requirements for 2020/21 – These are notably but not limited to
- Maternity and Child health will now move from additional to essential services
- Appointments data – all practices and PCNs will be required to participate in NHS Digitals “Appts in General Practice” data collection.
- Digital – From 1st April 2020 GP practices must offer all patients online access to all prospective data on their patient record unless exceptional circumstances apply. In addition, GP practices will make online access to the full historic digital record available to patients on request. NHSE will look at how third-party redaction software could be made available to general practice as a matter of course to further support practices deliver full historic online access to records for their patients.
NHSE have also published a document on Implementing the 2020/21 GP Contract for Personal Medical Services(PMS) and Alternative Provider Medical Services(APMS) contracts.
The LMC held a number of roadshows, to present this contract update, one of which was presented by Mark Sandford-Wood from the GPC. Mark's powerpoint presentation from the roadshow can be viewed via this link
New to Partnership Payment Scheme (N2PP)
This is a new commitment from the February 2020 ‘Update to the GP Contract agreement 2020/21–2023/24’, forming part of the suite of interlocking GP recruitment and retention initiatives. The overarching aim of the scheme is to grow the number of partners – and individuals with equivalent status – working in primary care, stabilising the partnership model and helping to increase clinicians’ participation levels so that primary medical care and the patients it serves have access to the workforce they need.
The scheme gives eligible participants a sum of up to £20,000 plus a contribution towards on-costs of up to £4,000 (for a full time participant) available to support establishment as a partner, as well as up to £3,000 in a training fund to develop non-clinical partnership skills. In order to participate in the scheme, applicants will be required to ensure that they submit an application form and supplementary evidence to NHSEI and meet the eligibility criteria.
To be eligible to participate in the scheme, the applicant must:
- be a Health Care Professional working in general practice who are registered with their respective professional body and delivering clinical care to patients in general practice through a GMS/ PMS/ APMS contract
- not have been a partner in a GP practice before
- hold a profit-shares, legally-liable partnership
- commit to remaining a partner in a GP practice for five years (or pay back a portion of the loan)
- deliver a minimum of two clinical sessions per week in their partnership practice throughout the five year period
- have signed a partnership agreement on or after 1 April 2020 and before the scheme closes
- have a minimum of two years remaining in their contract.
Full information is available here: