Welsh and Scottish GP leaders reveal GMS contract plans

GP leaders in Wales and Northern Ireland are close to deals to recycle hundreds of QOF points into core funding in 2014/15, but pay for quality and productivity (QP) targets scrapped in England will remain in the framework.

Dr Charlotte Jones and Dr Tom Black: nearing deals on 2014/15 GP contract

GPs in Northern Ireland will be polled over proposals to split appointments into five-minute slots bookable on the day, and 10-minute pre-bookable visits, and could see QOF thresholds change and out-of-hours funding increased.

MPIG – which starts to be phased out from 2014 in England – is likely to remain, but GPC Northern Ireland is open to a deal to phase out the top-up as part of an increase spread across changes to funding streams including seniority pay and the expanding population supplement.

In Wales, practices may be paid to work in clusters and see some existing QOF targets relaxed.

GP leaders for both countries said contracts would remain fundamentally the same UK-wide despite emerging national variations.

In Northern Ireland, 245 QOF points – worth almost £40,000 to the average practice – will move into core funding from April.

In Wales, GP leaders have yet to confirm the exact total that will move into core funding. GPC chairwoman Dr Charlotte Jones told GP negotiations were at a ‘critical stage’ and formal agreement had not yet been reached.

But she said: ‘We will lose more points, it will be more like England than Northern Ireland.’

In England, a total of 341 QOF points – 38% of the total 900 on offer in 2013/14 – will be scrapped from April 2014.

However, 100 of the QOF points to be scrapped in England are from the quality and productivity domain, and funding released from these will fund a directed enhanced service for GPs to case-manage vulnerable patients.

In Wales, 116 QOF points are currently allocated to quality and productivity indicators.

Dr Jones said this funding would remain within the QOF, but rebadged to incentivise practices to join networks.

‘The QOF QP targets, worth 116 points in Wales, are likely to become more to do with practice engagement in networks,’ she said.

Dr Jones said networks were clusters of around six practices that would work together on ‘sharing services, sharing ideas for service delivery and developing how community services are delivered for patients’ in their local area.

Additional points could yet be added to the existing 116 for QP targets to pay for this, she told GP.

Dr Jones added that timeframes for completing regular checks on patients – currently required at 15-month intervals in Wales, could be relaxed for some indicators.

GPC Northern Ireland chairman Dr Tom Black said QP indicators would remain in Northern Ireland.

He told GP: ‘QP in Northern Ireland is seen to be working well. GPC Northern Ireland and the health and social care board are keen to continue with it – it fits with the ‘Transforming Your Care’ reform agenda.’

He said there were no plans to adopt the ‘named clinician’ for elderly patients policy or vulnerable patients DES being rolled out in England.

Dr Black said the Northern Ireland government had recognised in recent meetings that out-of-hours care was underfunded compared with other parts of the UK.

He said: ‘I expect them to increase funding by 10%, but if we want to reach the levels in other countries, we need 70%.’

GPs in Northern Ireland will be polled on workload with a view to drawing up plans to improve demand management and encourage patients to self care, Dr Black said.

Consultations could be radically changed to ease pressure on GPs, he added.

‘One of the issues we’ll look at is to redesign the consultation. We are going to survey GPs to see if we need to differentiate between same day and booked appointments.’

He said plans to remove the QOF requirement for 10-minute minimum appointment length presented an opportunity to ‘rejig appointments’.

‘Maybe we should move to five-minute same day ones and booked appointments lasting 10 minutes,’ Dr Black said. ‘We will ask GPs if they would consider this reasonable. We need to get the message across to the public that demand is outstripping provision.’

Lower thresholds on a number of indicators could rise under the deal, Dr Black said.

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