The GPC and NHS England have announced details of a five-year contract, described as the 'most significant' contract changes in 15 years. GPonline highlights the key points.
The deal will increase practice funding by almost £1bn over five years, with a further £1.8bn to support the formation of primary care networks of 30,000-50,000 patients, which all GP practices will be expected to join by July this year.
Network funding will be delivered via a directed enhanced service (DES) and allow networks to employ one social prescribing worker and a clinical pharmacist (see below for more details).
For 2019 the GP contract will increase by 1.4% in addition to funding through networks, which includes a 2% uplift for GP and staff pay and expenses, an uplift for funding to develop networks, an adjustment for state-backed indemnity and an increase in the value of some vaccinations to bring them all up to £10.06.
The contract increase also includes £20m recurrent funding to cover the costs associated with subject access requests now practices have to provide them for free under the GDPR and £30m for practices to make appointments available to NHS111 (see below for more details).
In 2020/21 core funding will see a 2.3% uplift, 2021/22 will deliver a 2.8% uplift, 2022/23 will see a 2.5% uplift and in 2023/24 funding will increase by 2.7%.
A 'one-off permanent adjustment' to practices' global sum payments will pay for the state-backed indemnity package. However once an overall uplift for 2019/20 is taken into account, the adjustment leaves GP practices with a 1.4% increase in contract funding.
All GPs will continue to need cover from a medical defence organisation for non-NHS work, such as GMC or coroner’s court representation or private work.
Network funding will be via a DES, which will go live on 1 July 2019. The DES consists of a network agreement between practices – a template agreement has been developed by NHS England and GPC England, which will be available in the coming weeks - and a DES specification.
The DES specification setting out what practices and networks need to do will be published in March.
Networks will receive 100% recurrent funding to employ social prescribers and 70% funding for clinical pharmacists in 2019/20. In future years they will receive 70% funding for physiotherapists and physician associates (from 2020/21) and paramedics (from 2021/22) as they are introduced.
The deal says that by 2023/24 there will be 22,000 additional staff working in primary care networks. By 2024 a typical network will have five clinical pharmacists (equivalent of one per practice), three social prescribers, three first contact physiotherapists, two physician associates and one community paramedic.
Each network is expected to be led by a local GP in a clinical director role.
Funding for the DES will be paid to a nominated provider, which should be set out in the network agreement.
There will be six funding streams. One of these (network engagement funding) will be paid directly to practices for engagement with the network via the statement for financial entitlement. The other five streams will be paid to the nominated provider.
The other streams are:
network administration payment - a recurrent £1.50 per patient from CCG funding
workforce funding as specified above
clinical lead funding - the clinical lead post will be funded on the basis of 0.25 WTE GP per 50,000 patients
extended access - the extended access DES will be transferred into the network DES
services - From 2020 networks will be expected to take on national network service specifications, which will include standard national processes, metrics and expected benefits for patients. Five will start by April 2020: structured medication reviews, enhanced health in care homes, anticipatory care (with community services), personalised care and supporting early cancer diagnosis. The other two start by 2021: cardiovascular disease case-finding and locally agreed action to tackle inequalities. The specifications will be developed by the GPC and NHS England as part of annual contract negotiations.
From April 2019, 28 ‘low value’ indicators worth 175 points in total will be retired. 101 points will be recycled into 15 'more clinically appropriate indicators'. The remaining 74 points will cover a new quality improvement domain, made up of two modules each worth 37 points.
The first two quality improvement modules will focus on prescribing safety and end-of-life care.
There will also be changes to exception reporting, which will be replaced with 'a more precise "personalised care adjustment". Practices will be able to select one of five different reasons for adjusting care and removing a patient from the indicator.
There will be no threshold increases in 2019/20.
Changes are planned in 2020/21 for heart failure, asthma and COPD indicators and mental health changes will be introduced in 2021/22.
Practices will be expected to make 25% of appointments bookable online from July 2019.
All new patients should have access to their digital records as standard from April 2019.
All patients should be able to order repeat prescriptions electronically from April 2019.
From April 2019 NHS 111 will begin direct booking in to practice appointments. Practices will be expected to make one appointment per 3,000 patients available each day for this. NHS111 will only book the appointment after triage.
From April 2020 all practices should provide online consultations - further guidance will be made available on this.
From April 2021 all practices will be expected to provide video consultations.
From April 2020 all patients should have online access to their full record, including the ability to add their own information and be able to access online correspondence.
From April 2020 practices should no longer use fax machines for NHS work or patient correspondence.
NHS England has said there will be additional funding of IT to help patients make use of these technologies.
Practices will be expected to ensure that data relating to activity, capacity and waiting times is accurately recorded so that it can be captured by NHS England.
NHS England will also develop a new measurement of patient reported satisfaction with access and data will be published by 2021.
HPV vaccination catch-up for girls will be extended to those aged 25. HPV vaccination will commence for boys in September 2019 (via the school scheme) and catch-up arrangements for boys will mirror those for girls.
Practices will receive an item of service payment of £5 per patient for a catch-up campaign for the MMR vaccine for 10 and 11-year olds.
Practices will have access to a data protection officer through their CCG to provide support on GDPR issues.
NHS England will reimburse the cost of locum cover for GPs taking shared parental leave in the same way as for those taking maternity leave.
The BMA and NHS England have agreeed to put forward proposals to the government to tackle the problem created by the pension annual allowance, which is leading to GPs retiring early or cutting the number of sessions they work.