As a result of the pandemic and the COVID-19 vaccination roll out changes to the GP contract for 2021/22 will be 'minimal', NHS England and the BMA have agreed. However, a number of previously-agreed funding uplifts will go ahead and there are some changes to the QOF.
- A 2.1% global sum uplift go ahead as part of the five-year deal that began in 2019 to cover pay and expenses increases.
- The cervical screening additional service will become an essential service.
QOF and childhood immunisations
- Because of changes to immunisations agreed last year, the childhood immunisations DES will be replaced with item of service payments and a new vaccination and immunisation domain will be added to the QOF.
- The new domain will have four indicators, worth 64 points and be funded by transferring almost £60m from the DES to the QOF. The BMA and NHS England says this change does not generate any new workload.
- An additional £24m will be invested into the QOF to bolster the physical health check indicators for people with serious mental illness.
- There are minor changes to the cancer care domain and to specific indicators for asthma and heart failure diagnosis.
- The QI indicators from 2020/21 on learning disabilities and early cancer diagnosis will roll over to become the QI indicators for 2021/22. There may be some minor changes to take account of how the pandemic has affected patient care.
There is more detail on the planned changes to childhood immunisation payments as set out in last year's contract deal here.
Last year's deal revealed that practices will be paid a standardised item of service fee of £10.06 for each dose of the routine vaccinations that they administer. Those that fail to reach 80% coverage will have to pay back a proportion of the item of service fees that they have received on an annual basis. NHS England and the BMA have yet to provide detail of exactly how repayments will be calculated.
Primary care networks (PCNs)
- The additional four service specifications that were put on hold last year, will not be introduced in April 2021 to allow networks and practices to focus on the pandemic.
- The agreement says that 'minor updates' will be made to the structured medication review and early cancer diagnosis services within the network contract DES from April 2021, but there is no detail as to what these are as yet.
- The additional roles reimbursement scheme (ARRS) which funds new staff working in PCNs will increase from £430m in 2020/21 to a maximum of £746m in 2021/22 as per the agreement last year.
- Further roles will be covered by the ARRS from April 2021 - paramedics, advanced practitioners and mental health practitioners.
- From April 2021, PCNs will be entitled to a full-time equivalent mental health practitioner who will be employed and by the PCN’s local provider of community mental health services. Under this new model, 50% of the funding will be provided from the mental health provider, and 50% by the PCN (reimbursable via the ARRS), but the practitioner will work full time in the PCN.
- PCNs in London will be able to offer salaries in line with inner and outer London weighting to staff employed via the ARRS. They will not receive increased funding overall, but the change is intended to allow them more flexibility.
- Limits on the number of pharmacy technicians and physiotherapists that can be employed using ARRS funding will be removed.
- PCNs will be able to transfer over more pharmacists from the Clinical Pharmacist in General Practice scheme to the network between 1 April 2021 and 30 September 2021.
Investment and Impact Fund
- At least £30m of the £150m of the Investment and Impact Fund (IIF) money will be used to incentivise improved access for patients in 2021/22, as agreed last year. There is no decision on how the rest of the funding will be used. The IIF is effectively a QOF for PCNs.
- IFF indicators on flu vaccination, learning disability health checks and social prescribing referrals will continue for 2021/22.
- There will be phased approach to any new IIF indicators introduced in 2021/22.
Under the agreement NHS England has said that additional funding to support practices through the vaccination programme and the rest of the pandemic 'the first months of 2021/22 will be kept under review'.
- The agreement defines the 'core digital offer which all practices must provide to patients':
- They must offer online consultations that can be used by patients, carers and practice staff on a patient's behalf to gather submitted structured information and to support triage.
- They must have the ability to hold a video consultation. Practices are expected to 'use them ordinarily', the agreement says.
- Two-way secure written communication between patients, carers and practices
- An up to date accessible online presence, such as a website, that links to online services prominently
- Signposting to a validated symptom checker and self-care health information via their website, such as to nhs.uk
- Shared record access, including patients being able to add to their record
- Request and management of prescriptions online
- Online appointment booking
- Practices that have implemented a total triage model and continue to do this from April 2021 do not need to meet the 25% online booking contract requirement.
- Patients must be able to inform their practice of a change of address, contact details or of their demographic information, including ethnicity electronically.
- A new contractual requirement for more timely transfer of patient records when patients move between practices will be introduced (there is no detail on exactly what this means as yet).
Possible future changes
- The agreement says that 'a nationally consistent enhanced access service specification will be developed by summer 2021, with the revised requirements and associated funding going live nationally from April 2022'. Commissioners are being encouraged to make local arrangements to transfer services and funding to PCNs before April 2022.
- NHS England and the BMA have agreed to discuss an enhanced service on obesity and weight management with a view to introducing this as early as circumstances allow during 2021.
- Both organisations plan to review and agree terms and conditions for practice staff during 2021/22. They will be surveying practices to find out a baseline of current terms and conditions.