Update to GP Contract 23/24

As we know, this is the last year of the five year framework to the Long Term Plan . The 23/24 Contract was imposed by NHSE despite lobbying from the GPC England.

We have put together a summary document to bring together and highlight the main points of the 23/24 Contract. It contains funding details and links to the relevant national guidance, along with some comments from the LMC and GPC. We do hope you find this useful to have in an easy access document.

GMS Contract 23/24

NHSE have a suite of documents covering the contract for 23/24 that can be seen at https://www.england.nhs.uk/gp/investment/gp-contract/

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

• NHSE Letter setting out changes to the GP Contract
• GP Contract 2023/24 financial information
• Practice and PCN ready Reckoner
• QoF guidance
• PCN DES (including the new Capacity and Access Payment )
• Weight Management Enhanced Service
• General practice pay transparency

The BMA have also published guidance on the changes to the GP Contract 23/24 and have run a number of webinars on this topic. The webinar recording is also available on the contract webpage. See https://www.bma.org.uk/pay-and-contracts/contracts/gp-contract/gp-contract-changes-england-202324

In summary, the core contract changes and requirements :-

• Regulation update 2023 - Access

It is worth noting that there is an update to the GMS Regulations this year (2023) around access. The NHSE letter says that it "will make clear that patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice. Practices will therefore no longer be able to request that patients contact the practice at a later time”. The BMA/GPC England say that whilst they agree with the aspiration of this amended regulation, it believes that this requirement is not achievable for many practices with current resource and workforce.

We would strongly recommend that you look at this requirement in more detail on the BMA webpage - GP Access and meeting the reasonable needs of patients . It highlights what the regulations will now say and also how this may affect safe working guidance.

Patient Access to Online Health Records

The deadline for full implementation of prospective patient online access to their records will be extended to 31 October 23.

NHS Digital have a webpage with details on this topic with a number of resources to aid the process, including a GP Readiness Checklist .

Cloud-based telephony

A requirement will be introduced for practices to procure their telephony solutions only from an NHS framework once their current telephony contracts expire.

GP registration requirements

The GMS contract regulations will be amended to remove the reference to the term ’medical cards’ within the registration requirements.

Funding

The funding this year provides for a 2.1% pay uplift for practice staff including on costs.

GPC England sought additional funding in line with the current rate of inflation. Despite presenting significant evidence, including findings from a representative survey of practices and a series of case studies highlighting the extreme pressure practices are facing, the case for additional funding was rejected by Government ministers.

Global Sum £102.28

OOH adj remains at 4.75%

QoF point £213.43

IIF £198.00 per point

IOS £10.06 (no change)

Weight Management ES £11.50

Disappointingly, no Change to payments associated with maternity & sickness reimbursement

Vaccination and Immunisations (V & I)

Vaccinations and immunisations requirements will be amended to reflect updated JCVI guidance. This includes changes to the Human Papillomavirus (HPV) and Shingles programmes.

Childhood Immunisations

There will be a number of changes to the childhood V&I programme. These include:

• Removal of the V and I repayment mechanism if a practice achieves under 80% coverage
• Changes to the childhood V & I QOF thresholds, so that lower thresholds are reduced to 81% – 89% (dependent on indicator) and the upper thresholds raised to 96%
• Clarification of the wording in the SFE that an Item of Service fee will be payable for vaccinations for medical reasons and incomplete or unknown vaccination status (‘evergreen offer’).
• A new Personalised Care Adjustment will also be introduced for patients who registered at the practice too late (either too late in age, or too late in the financial year) to be vaccinated in accordance with the UK national schedule (or, where they differ, the requirements of the relevant QOF indicator).

The IOS Fee remains at £10.06.

QOF

NHSE - QoF guidance

Disease register indicators will be income protected for the year, with funding paid to practices based on 2022/23 performance monthly once the 2022/23 QOF outturn is finalised.

There are two new cholesterol indicators (worth 30 points) that will be added to QOF along with a new overarching mental health indicator.

• Cholesterol Control and Lipid Management (CHOL) CHOL001 and CHOL002 ( See page 31 of QoF guidance )

These will be funded by

• retiring indicator RA002 (the percentage of patients with rheumatoid arthritis, on the register, who have had a face-to-face review in the preceding 12 months) and
• reducing the value of DEM004 (annual dementia review).

Indicator AF007 will be retired and replaced with the former IIF indicator CVD-05 (as AF008):

 

The Quality Improvement (QI) modules for 2023/24 will focus on

• workforce wellbeing and
• optimising demand and capacity

Details for both of these can be seen on Pg 100 of guidance, along with a number of resource links for this indicator.

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

There will also be other small changes to indicator wordings and values in 2023/24.

Weight Management Enhanced Service

The Weight Management Enhanced Service will continue into 2023/24, and the £11.50 referral payment remains the same.

GP Retention Scheme

The four-session cap within the GP retention scheme was lifted during the pandemic and will now be removed permanently. Sessions worked above the cap will be funded by the employing general practice. Any further potential changes to the scheme will be picked up as part of the current review of GP recruitment and retention scheme being led by NHS England.

See https://www.wessexlmcs.com/gpretainerscheme

PCN DES

Full suite of documents at https://www.england.nhs.uk/gp/investment/gp-contract/network-contract-directed-enhanced-service-des/

ARRS

NHSE say a number of changes have been made to the ARRS to support PCNs to recruit the teams they need.

• increasing the cap on Advanced Practitioners from two to three per PCN where the PCN’s list size numbers 99,999 or fewer, and from three to six where the PCN’s list size numbers 100,000 or over.
• reimbursing PCNs for the time that First Contact Practitioners spend out of practice undertaking education and training to become Advanced Practitioners.
• including Advanced Clinical Practitioner Nurses in the roles eligible for reimbursement as Advanced Practitioners (APs).
• introducing apprentice Physician Associates (PAs) as a reimbursable role.
• removing all existing recruitment caps on Mental Health Practitioners, and clarifying that they can support some first contact activity.
• amending the Clinical Pharmacist role description to clarify that Clinical Pharmacists can be supervised by Advanced Practice Pharmacists.
• During 2023/24 the ARRS will be reviewed to ensure that it remains fit for purpose and aligned to future ambitions for general practice.

IIF

Indicators have been reduced to five.

• Vaccs & Imms – Flu (2 indicators VI-02 18-64 yr olds and VI-03 2-3yr olds)
• Learning Disabilities (LD) Health Checks
• Early Cancer Diagnosis
• 2 week Access – Booking to appt 2 weeks or less

The remaining IIF funds are to support the capacity and access payment.

• There will be two parts to this payment
  • National Capacity - 70% will be unconditionally paid to PCNs proportional to their adjusted population over the 23/24 financial year
  • Local Capacity - 30% paid to PCN based on Commissioner Assessment of PCN Improvement in three areas. The maximum a PCN could earn is £1.185 x PCN Adjusted Population as at 1st Jan 23. PCNs can check their adjusted population at https://www.england.nhs.uk/publication/network-contract-des-pcn-adjusted-populations-spreadsheet/
  • PCN will need to agree an access improvement plan with the ICB by 30 June 23. There is a template that needs to be completed and can be found at Annex B of guidance.