Changes to the GMS contract in England for 2015/16 were announced on 30 September 2014. The main points were as follows :-
Details of the 2015/16 uplift to the GMS contract are not yet available as the Government’s decision will be made following recommendations from the Doctors and Dentists Pay Review Body in February 2015.
- From 1 April 2015, there will be a new contractual requirement for practices who have not opted out of providing out of hours care to ensure that they provide information to the CCG (to be set out by the CCG) to allow the CCG to ensure that they are delivering out of hours care in line with the National Quality Requirements.
- There will be no reduction in the size of QOF in 2015/16 as the impact of last year’s changes remain to be evaluated. The planned changes in thresholds in QOF from April 2015 will be deferred for a further year. The QOF point value in 2015/16 will be adjusted to take account of population growth and relative changes in practice list size for one year from 1 January 2014.
- The avoiding unplanned admissions (AUA) enhanced service will be extended for a further year from 1 April 2015, with changes including revisions to the reporting process and changes to the payment structure.
- The patient participation enhanced service will end and associated funding will be reinvested into global sum. From 1 April 2015, it will be a contractual requirement for all practices to have a patient participation group (PPG) and to make reasonable efforts for this to be representative of the practice population.
- The alcohol enhanced service will end and associated funding will be reinvested into global sum. From 1 April 2015 it will be a contractual requirement for all practices to identify newly registered patients aged 16 or over who are drinking alcohol at increased or higher risk levels.
- The extended hours and learning disabilities enhanced services will be extended and unchanged for a further year.
- GPC and NHS Employers will work with NHS England to establish a consistent set of standards which commissioners (area teams or CCGs on their behalf) will apply for the provision of enhanced minor surgery services.
- All practices will be entitled to reimbursement of the actual cost of GP locum cover for maternity/ paternity/ adoption leave of £1,113.74 for the first two weeks and £1,734.18 thereafter (or the actual costs, whichever is the lower). Such reimbursement is intended to cover both external locums and cover provided by existing GPs within the practice who do not already work full time.
- There will be a new contractual requirement for GP practices to publish the mean net earnings of GPs in their practice (to include contractor and salaried GPs) relating to 2014/15 financial year on their practice websites by 31 March 2016. Alongside the mean figure, practices will publish the number of full and part time GPs associated with the published figure. The figure will include earnings from NHS England, CCGs and local authorities for the provision of GP services that relate to the contract and which would have previously been commissioned by PCTs. Costs relating to premises will not be included. This is an interim solution until arrangements are finalised for publishing individual GP net earnings in 2016/17.
- A named, accountable GP for all patients (including children) who will take lead responsibility for the co-ordination of all appropriate services required under the contract.
- Further commitment to expand and improve the provision of online services for patients, including extending online access to medical records and the availability of online appointments.
- Changes to registration regulations will allow for armed forces personnel to be registered with a GP practice.
- NHS England and GPC will work together on workforce issues including the retainer /returner scheme, the flexible careers scheme, and recruitment problems in specific areas.
- GPC, NHS Employers and NHS England will have a broader strategic discussion about the primary care estate, especially to support the transfer of care into a community setting.
- NHS England and GPC will re-examine the Carr-Hill formula with the aim of adapting the formula to better reflect deprivation.
- No out of hours deduction will apply to funding moving from the MPIG correction factor or enhanced services into the global sum.
The PMS agreements review was also published in 30 September 2014. The main points were as follows :-
- In January 2014, area teams were asked to review local PMS agreements over a two-year period ending in March 2016.
- Area teams were previously asked to make local decisions on the pace of change for any redeployment of funding arising from PMS reviews. Without prejudice to agreements that have already been reached with practices, but in the interests of greater consistency for future decisions, area teams should – unless there are compelling reasons otherwise – redeploy any freed-up resources over a minimum four year period (year one being 2014/15).
- Any resources freed up from PMS reviews should always be reinvested in general practice services (including, as appropriate, general practice premises developments).
- Except with the agreement of all the CCGs involved, PMS resources should not be redeployed outside the current CCG locality (i.e. the CCG of which the PMS practice is a member).
- Area teams should ensure, wherever possible, that any decisions relating to future use of PMS funding are agreed jointly with CCGs as part of anticipated co-commissioning arrangements.
- Area teams should ensure that there is a case-by-case review of all affected practices to ensure that they are not serving special populations that merit continued additional funding and that they would not be unfairly disadvantaged by the changes.
- Any proposals to reduce current levels of PMS funding for any practices should reflect decisions on how the money freed up will be redeployed, including proposals for reinvestment of resources from area team or CCGs to support local improvement and innovation in primary care. This is to ensure that changes to practice funding reflect the overall net impact of any change, and practices don’t have to manage a reduction of funding, before subsequent reinvestment.
- Where changes to services are proposed which result in different services being available to patients, there is a need to engage with patients and/or patient representative groups, to ensure NHS England complies with its various duties to consider the impact of its decisions on patients. The degree to which area teams should engage depends on the proposal being considered and what is safe and practical within the time and resources available.
- Where, as a result of PMS reviews, practices are likely to move towards levels of funding equivalent to GMS funding, area teams should consider the potential benefits of practices nonetheless having the option of remaining on PMS agreements as a way of preserving future flexibility.
- These principles will not apply retrospectively where agreements between area teams and practices have already been made.