GMS contract changes that will take effect from April appear largely unchanged from proposals set out in a consultation earlier this year.
MPIG top ups to core pay will be phased out over seven years from 2014, and this funding will be redistributed through practices' global sum payments. Accountants and senior GPs have warned that the move could trigger six-figure swings in GP practice income.
The DH announced last week that it would increase GMS funding by 1.32% in 2013/14, despite advice from the independent Doctors and Dentists Review Body that general practice should be awarded a 2.29% rise.
Practices will receive an additional element of funding as part of plans to make them responsible for paying employers' superannuation contributions for locums. This will take the total increase practices receive to 1.47%, the DH has said.
The DH response to the consultation on GMS contract changes says the funding will be 'distributed to practices through increasing global sum equivalent payments' - suggesting all practices are likely to benefit equally.
However, in previous years funding added to global sums has led to huge variation in the degree to which practices benefit because uplifts for practices reliant on MPIG have been capped.
The DH will press ahead with plans for the largest overhaul of QOF since its inception, scrapping organisational indicators worth around £20,000 per practice and implementing the vast majority of QOF changes proposed by NICE.
Practices will still be expected to carry out the work covered by the 'retired' indicators, but will now have to fulfil four new enhanced services to earn back the £164m England-wide that they brought to general practice.
The enhanced services will cover:
- a more proactive approach to patients who may have dementia.
- better care management to support at-risk patients and cut hospital admissions.
- ensuring patients can book appointments and order repeat prescriptions online.
- arranging remote monitoring for patients with long-term conditions.
Full detail of the schemes will be published by the NHS Commissioning Board shortly.
GP leaders have warned that pressing ahead with the plans to make practices responsible for employers' superannuation payments for locums will trigger five-figure losses for some practices and skew the job market in favour of locums who have already claimed their pensions.
The DH has suggested GPs will be able to earn more funding through planned rotavirus and shingles vaccination campaigns worth £10m across England.
Health secretary Jeremy Hunt said: 'Improving care for patients has always been my priority. The GP contract needs to change to make sure the excellent care enjoyed by some patients is more consistent across the country.
'Providing better treatment for people with long-term conditions helps save lives and I know GPs will rise to the challenge to make sure standards of care in this country are world class and continuously striving to improve.
'We have listened to GPs and stakeholders and made some changes to our proposals to reflect these views and now feel we are in the right place to go forward.
'I am committed to ensuring that we improve quality of life for people with long-term conditions – and I want GPs to lead this change from within their own practices.'