Core funding and contract changes
- Maternity medical services will become an essential service with a universal 6-8 week post-natal check for new mothers. Some £12m of additional funding will be added to the contract.
- Child health surveillance and vaccinations and immunisations will also become essential services (see vaccinations section below for more on this).
- The global sum will increase from £89.88 to £93.46 per weighted patient. The value of a QOF point will increase from £187.74 to £195.83.
- From October 2020 practices will be required to support NHS England to maintain an accurate and up to date list of patients.
- From October 2020 GPs will need to declare if their NHS superannuable income is over £150,000. This limit will rise each year in line with inflation. This will also apply to salaried GPs and locums. From February 2021 those earning over £150,000 will be 'listed by name and earnings band in a national publication'. More on this here.
- £10m of funding has been added to the QOF for the introduction of a new indicator relating to non-diabetic hyperglycaemia, which is worth 18 points.
- The asthma, COPD and heart failure domains will change, with 97 points recycled into 11 more clinically appropriate indicators.
- The total number of available QOF points will rise to 567.
- The quality improvement modules for 2020/21 will cover learning disabilities and supporting early cancer diagnosis.
Primary care networks
- PCNs will receive 100% funding for any roles recruited via the network contract DES additional roles reimbursement scheme (ARRS) - previously only social prescribers were funded at 100% all other roles received just 70% funding.
- The ARRS will also cover new roles. Along with social prescribers, first contact physiotherapists, clinical pharmacists, paramedics (from April 2021) and physician associates that had previously been included, PCNs will also be able to recruit pharmacy technicians, care co-ordinators, health coaches, dietitians, podiatrists and occupational therapists. Mental health professionals will be added to the scheme from April 2021.
- A further 6,000 staff will be covered by the scheme, taking the total number of additional staff working in general practice by 2023/24 to 26,000.
- To cover these changes, funding for the ARRS will increase by £173m in 2020/21, £331m in 21/22, £393m in 2022/23 and £521m in 2023/24. Total funding for the ARRS will be £430m in 2020/21, rising to £1.4bn in 2023/24.
- Staff employed under the scheme will be treated as part of the core funding for general practice beyond 2023/24.
The controversial five draft service specifications that went out for consultation over Christmas have been pared back - the changes are:
- The personalised care and anticipatory care specifications have been postponed until April 2021 and will be part of next year's contract negotiations.
- GPs will no longer be required to undertake fortnightly visits as part of the enhanced health in care homes service, weekly visits can be provided by staff from within the multidisciplinary team.
- PCNs will receive £120 per care home bed for the care homes service to reflect the variation in the number of residents per network.
- PCNs will only be required to deliver structured medication reviews in line with the capacity of their clinical pharmacists under this service.
- The service on supporting early cancer diagnosis will be introduced from April.
Funding for networks
The Investment and Impact Fund (IIF) will start from April. It aims to 'reward' PCNs for 'delivering objectives' from the NHS long-term plan and GP contract agreement.
- It will operate in a similar way to QOF and be a points-based system, with lower and upper performance thresholds. It will have aspiration payments from 2020/21.
- Eight indicators are included in 2020/21, relating to seasonal flu vaccination, health checks for people with a learning disability, social prescribing referrals and prescribing. The fund will be worth £40.5m in 2020/21, increasing to £150m in 2021/22, £225m in 2022/23 and £300m in 2023/24.
- Money earned from the fund will have to be spent on staff or services delivered by the network.
- At least £30m of the IIF will be spent on improving access.
Recruitment and retention initiatives
There will be £94m in 2020/21 to support additional recruitment and retention schemes – this will rise to 103m in 2023/24. It will cover:
- A Partnership Premium, which is a one-off payment of £20,000 available to new partners with additional training support. The payment would also be available to non-GPs who become partners and the scheme will run for three years in this initial phase.
- A two-year fellowship in general practice will be offered as a guaranteed right to all GP trainees on completion of training. From 2021 GP trainees will automatically be enrolled in the programme and be expected to enter the fellowship programme on qualification. The fellowship will also be available to all newly-qualified nurses.
- The Targeted Enhanced Recruitment Scheme (TERS), which offers a one-off payment of £20,000 to attract trainee GPs to under-doctored areas will be expanded. Places on the scheme will increase from 276 this year, to 500 in 2021, and 800 in 2022.
- GPs on the Induction and Refresher Scheme with children aged under 11 will be able to claim up to £2,000 towards the cost of childcare for each child whilst on the scheme. GPs on the portfolio route will be able to claim £1,000. This will apply until the 1 September after each child's 11th birthday.
- A new Locum Support Scheme will allow locums to receive a funded session of CPD per month in exchange for a minimum contribution of sessions per week to a group of PCNs.
- There are also plans to introduce enhanced shared parental leave arrangements for salaried GPs.
- A new national mentor scheme will provide reimbursement of a session a week to allow experienced GPs to mentor newly qualified GPs.
- From 2022 GP trainees will spend 24 months of their 36 months' training in general practice (up from the 18 months they do now).
- From April 2020, all international medical graduates entering general practice training will be offered a fixed five-year NHS contract.
- From 2021, the number of GP training places will increase to 4,000 a year.
- Vaccinations will become an essential service.
- A new item of service fee of £10.06 will be introduced for the delivery of each dose of all routine and annual vaccines, starting with MMR in 2020/21. It will include all childhood vaccinations from 2021/22.
- From 2021 vaccinations will be a new domain in the QOF and practices will receive incentive payments for achieving specified levels of coverage. This is likely to happen via current indicators for flu being moved into the IIF, but will be subject to contract negotiations next year.
- From 2021 the current 70% and 90% immunisation targets will be removed. Practices will need to achieve 80% coverage in order to receive the full item of service value for childhood vaccinations. Where practices are not achieving a minimum of 79% coverage a repayment of a proportion of earnings will be triggered. The BMA says that all practices, apart from a handful of very low performers, should gain from this new arrangement.
- All practices will need to have a named lead for vaccinations.
- Practices should participate in catch-up campaigns but in these cases an item of service fee will be paid per vaccine delivered – it will no longer be linked to call/re-call activity.
- A transparent measure of patient experience will be designed and tested in 2020 for introduction by April 2021 at the latest. This will provide 'as close to real time as possible' a measure of patient experience. Progress against this measure will be supported by the PCN investment and impact fund – at least £30m of the fund for 2021/22 will be dedicated to access, but a proportionally equivalent amount will be available in 2020/21 based on when the measure is introduced.
- NHS England is to establish a new GP access improvement programme in 2020 and work with PCNs to identify best practice and ways to improve access.
- An improved appointment dataset will be introduced in 2020 under the GP contract as soon as possible - it will help practices to understand how long patients are waiting and which healthcare professional is providing care.
- The digitisation of Lloyd George files will start in 2020.
- There are changes to the Premises Costs Directions - commissioners can now award improvement grants up to 100% of project value; VAT will be reimbursed on rent payments; Stamp Duty will be reimbursed on acquiring land or premises; practices will not be required to undertake their own valuation for rent reviews.
- NHS England will establish a new GP access programme this year. It will work with PCNs to identify best practice to improve appointment booking and reduce waiting times.
- Practices will be contractually required to participate in NHS Digital's appointments in general practice data collection and to support improvements of the data quality collected.
Talking General Practice
You can listen to the pilot episode of our new podcast Talking General Practice below, where the GPonline team discuss the key changes in the GP contract. The podcast will be launching in mid-March.