Update to GP Contract 20/21 - 23/24
NHS England GP Contract Documents
NHSE published a further letter on 23rd August 21 with PCN plans for 21/22 - 22/23. This details the NHSE plan for the gradual introduction of new service requirements for PCNs and confirming how PCNs will access the funding available for their activities through the IIF across the second half of 2021/22 and 2022/23. The main implementation focus is 2022/23 rather than 2021/22, so that PCNs have the maximum possible time to prepare. In addition, NHSE also confirm new funding for PCN leadership and management support, of £43m in 2021/22.
Recognising current pressures in general practice, service requirements will not be introduced in full from October 2021, but phased over the coming eighteen months in a gradual way.
|Requirements in 2021/22||Requirements in 2022/23|
|Cardiovascular disease (CVD) prevention and diagnosis||From October 2021, the requirements on PCNs will focus solely on improving hypertension case finding and diagnosis, where the largest undiagnosed prevalence gap remains and where the greatest reductions in premature mortality can be made.||Requirements on PCNs to increase diagnosis of atrial fibrillation, familial hypercholesteremia and heart failure will be introduced from April 2022.|
|Tackling neighbourhood health inequalities||PCNs will be asked to work from October 2021 to identify and engage a population experiencing health inequalities within their area, and to codesign an intervention to address the unmet needs of this population. Delivery of this intervention will commence from March 2022.||Continued delivery of the co-designed intervention|
|Anticipatory care||Introduction of requirements for this service are deferred.||By 30 September 2022, PCNs will be required to agree a plan for delivery of Anticipatory Care with their ICS and local partners with whom the service will be delivered jointly – in line with forthcoming national guidance.|
|Personalised care||Introduction of requirements for this service are deferred.||From April 2022 there will be three areas of focus for personalised care: further expansion of social prescribing to a locally-defined cohort which are unable or unlikely to access through established routes; supporting digitised care and support planning for care home residents; and shared decision making training.|
- Extended access - From April 2022, PCNs will deliver a single, combined extended access offer
- Investment and Impact Fund (IIF) - Annex B sets out a comprehensive description of the IIF indicator set, together will a full list of the indicators, valuations and thresholds. Annex C summarises the IIF indicator set for 2021/22 and 2022/23, and how the PCN service requirements and IIF indicators fit together.
BMA Update July 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 September 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%)
- QOF has increased from 567 to 635 points in 2021/22
- 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
- A further Update to Contract Letter in June 2021 advised two new enhanced services have been launched relating to Weight Management and also Long Covid.
WEIGHT MANAGEMENT ENHANCED SERVICE SPECIFICATION 2021/22 (Please click on the image below for our Summary of Key Points) NHSE have also produced a GP Toolkit for the NHS Digital Weight Management Programme.
LONG COVID SERVICE SPECIFICATON 2021/22 (Please click on the image below for our Summary of Key Points)
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.
Contract Resources and Documents
NHSE have provided a useful GMS Ready Reckoner that can be used for both practice and PCN puposes.
NHSE Quality and Outcomes Framework (QoF) Guidance for 2021/22
NHSE have published the QOF Quality Improvement (QI) reporting templates for 2021/22
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.
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.
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. See https://www.wessexlmcs.com/newtopartnershippaymentschemen2pp for further details
General Practice Fellowship Programme It is a two-year programme of support, available to all newly-qualified GPs and nurses working substantively in general practice, with an explicit focus on working within and across a Primary Care Network (PCN). Further details are available at:- https://www.wessexlmcs.com/generalpracticefellowshipprogramme