News - Handy FDA guide: GMS Contract Changes for 2017/18Date:
Thanks to our Practice Manager in the know, Johanne Shorrock, from Roman Road Health Centre, for her distillation skills!
Overview of GP Contract 2017-2018
a) Avoiding Unplanned Admissions DES (AUA)
AUD DES will continue on 31st March 2017 and £156.7 million will be added to the global sum.
Contractual requirement to focus on the management of patients with severe frailty.
From 1st July 2017 Practices will:
- use an appropriate tool to identify patients aged 65 and over who are living with moderate and severe frailty.
- Deliver a clinical review and code appropriately
- Provide an annual medication review and code appropriately
- Where clinically appropriate – discuss whether the patient has fallen in last 12 months
- Provide any other clinically relevant interventions and code appropriately
- If patient does not already have an enriched Summary Care record (SCR) the practice should promote this seeking informed consent to activate the enriched SCR.
There will be NO additional reports to produce or claims to make as the coded data will be collected (using an automated extraction) based on the number of patients recorded with:
- A diagnosis of moderate frailty (read code: 2Jd1 )
- A diagnosis of severe frailty (read code 2Jd2)
- A diagnosis of severe frailty with an annual medical review coded (read code - not yet available)
- A diagnosis of severe frailty who are recorded as having had a fall in the preceding 12 months (read code – not yet available)
- A diagnosis of severe frailty who have provided explicit consent to activate their enriched SCR. (read code - not yet available)
b) CQC Fees
The entire CQC Practice fee will be fully reimbursed by NHS England. Practices will submit their paid invoice to NHS England and will receive full reimbursement for their actual costs.
c) Indemnity Costs
Funding to cover the rise of indemnity insurance costs will be paid directly to Practices on a per patient basis.
Practices must ensure that the appropriate amount of funding is allocated to:
- Salaried GPs
- Locum GPs will need to ensure that their invoices/agreements with practices are uplifted appropriately to take into account this business expense.
d) Sickness Cover Reimbursement for GPS
Sickness cover payments will be made after 2 weeks of a GP being absent from the Practice due to sick leave. Existing GPs within the Practice can be used to cover their sickness absence.
The amount payable for sickness cover is £1734.18 per week.
e) Maternity Cover Reimbursement
Maternity payments will not be subject to a pro-rata application. Practices will only need to submit an invoice and will either be paid the full amount or the maximum payable.
f) Learning Disabilities DES
£140 will be paid per health check carried out under the LD DES.
NHS England have developed a voluntary template to use should Practices wish to do so, but there is no obligation to use this.
g) Expenses and Pay Uplift
Pay uplift of 1% will be added to the global sum to take into account increase in expenses.
Also other national uplifts are:
- 3.8 million to recognise increased superannuation costs of 0.08%
- 2 million to account for increases in practice workload as a result of changes to the primary care support services provided by Capita.
- 58.9 million to cover the estimated cost of increased population growth.
- Business Improvement District – eligible Practices will be reimbursed all costs relating to levies incurred as a result of BID.
h) Workforce Census
Completion of the workforce census will be a contractual requirement for every Practice.
i) Quality & Outcomes Framework (QOF)
There will be NO changes to the indicators in QOF or the total number of points.
There will be an increase to the value of a QOF point as a result of the Contractor Population Index (CPI) to take into account growth in population as well as any increase in average practice list size.
j) Core Opening Hours and Extended Hours DES
Core contractural opening hours are: 8am – 6.30 pm Mon – Friday.
Extended hours DES – New conditions will be introduced in October 2017 which will mean Practices who regularly close for a half day, on a weekday basis, will not ordinarily quality to deliver this DES.
k) Access to Healthcare
5 million will be added to the global sum to support any associated administrative workload to help identify patients with a non-UK issued EHIC (European Health Insurance Card or S1 form), who may be subject to the NHS (charges to overseas Visitors) regulations 2015.
A revised GMS1 form for new patient registrations will be introduced. This will require patients to self-declare that they hold either a non-UK EHIC or a S1 form. For these patients practices will be required to record that the patients holds either a non-UK issued EHIC or a S1 form in the patient’s medical record and then send the form and supplementary questions to NHS Digital (for non-UK issued EHIC Cards) or the Overseas Healthcare Team for (S1 forms) via email or post. Practices will be provided with hard copy patient leaflets which will explain the rules and entitlements for overseas patients accessing the NHS in England.
The patient’s country of origin will be charged where relevant. Patients themselves will NOT be charged.
An automated process will be put in place to replace the manual process to support the collection of GP appointment data for these patients.
l) National Diabetes Audit (NDA)
From July 2017 all Practices will be contractually required to allow the collection of data relating to the NDA.
m) Data Collection
From July 2017 Practices will be contractually required to enable extraction of data collection for a selection of agreed indicators no longer in QOF (INLIQ) and retired ESs.
n) Registration of Prisoners
From 1st July 2017 a contractual change will be introduced to allow prisoners to register with a Practice before they leave prison.
o) Vaccinations and Immunisations
From April 2017 the following vaccination and immunisation programme changes have been agreed:
a) Childhood seasonal influenza – the removal of 4 yr olds from enhanced service patient cohort (transferring to schools programme) and the removal of the requirement to use Child Health Information Systems (CHIS)
b) Seasonal influenza – the inclusion of morbidly obese patients as an at-risk cohort and a reminder for Practices that it is a contractual requirement to record all influenza vaccinations on ImmForm.
Funding to cover this new cohort will be from Section 7A.
c) Pertussis of pregnant women – a reduction in the eligibility of patients for vaccination from 20 weeks to 16 weeks.
d) Men ACWY programmes – a reduction in the upper age limit from ‘up to 26th birthday’ to ‘up to 25th birthday’ (in line with the Green Book).
e) Shingles (routine) – a change in patient eligibility to the date the patient turns 70 rather than on 1st September.
f) Shingles (catch up) – a change in patient eligibility to the date the patient turns 78 rather than on 1st September.
p) GP Retention Scheme
A new scheme has been agreed to replace the existing one, with the key changes being:
a) Tighter criteria for those joining the new scheme. Aimed at GPs seriously considering leaving or have left general practice due to personal reasons, approaching retirement, or require greater flexibility.
b) In 2016, under an interim scheme the practice payment rose from £59.18 to £76.92 per session. NHS England will fund the 2017 scheme wholly from within the primary care allocation budget and the practice payment and professional expenses supplement will remain the same as the 2016 scheme. The Practice payment is to be used by the Practice as an incentive to provide flexibility for the retained GP and should be used towards the retained GPs salary, to cover HR admin costs and to provide funding to cover any educational support required from the Practice, including course fees where relevant.
c) Professional expenses supplement will be payable to the GP via the Practice (on a sliding scale) and is to go towards the costs of the GPs indemnity cover, professional expenses and Continuing Professional Development (CPD) needs.
d) Option of reducing the Practice payment back to the original amount of £59.18 per session has been discounted as the Practice payment for the 2016 scheme was agreed as a suitable amount to cover the Practice expenses, contribution to retained GPs salary, cover educational support for the retained GP. Keeping the remuneration the same as the 2016 scheme avoids there being 2 different retainer schemes running with differing payments.
e) Strong element of future scheme is around education and CPD. The retained GP would be entitled to the pro rata full time equivalent of CPD as set out within the salaried model contract. The CPD aspects would be based on the needs of the individual as established at their appraisal and in discussion with the educational supervisor.
f) GPs can be on the scheme for a period up to 5 years. In exceptional circumstances an extension can be make for up to a further 24 months.
q) GMS digital – non contractual BMA have agreed the following non contractual changed for 2017-18 which will be promoted in guidance:
- Practice compliance with 10 new data security standards in the National Data Guardian Security review.
- Practice completion of the NHS Digital Information Governance toolkit including attainment of level 2 accreditation, and familiarization with the July 2016 Information Governance Alliance guidance.
- Increased uptake of electronic repeat prescriptions to 25% with reference to co-ordination with community pharmacy.
- Increased uptake of electronic referrals to 90% where this is enabled by secondary care.
- Continued uptake of electronic repeat dispensing with reference to CCG use of medicines management and co-ordination with community pharmacy
- Uptake of patient use of one more online service to 20% including where possible apps to access those services and increased access to clinical correspondence online.
- Better sharing of data and patient records at local level, between practices and between primary and secondary care.
r) Further work
GPC and NHS England have committed to take forward discussions on a national programme of self-care and appropriate use of GP servicesand information sharing between Practices.