On 30 September 2014,NHSEmployers and the General Practitioners Committee of theBMAannounced changes to theGMScontract in England for 2015/16.

The focus of the changes is on a named, accountable GP for all patients, publication of GPs’ average net earnings and commitment to expand and improve the provision of online services.

GPCandNHSEngland will separately submit evidence to the Doctors’ and Dentists’ Review Body (DDRB) in relation to the 2015/16 uplift to theGMSContract. The Government will consider theDDRBrecommendations before making a final decision.

The changes include the following:

  • A named, accountable GP for all patients (including children) who will take lead responsibility for the co-ordination of all appropriate services required under the contract.
  • Publication of GP net earnings – practices will publish average net earnings (to include contractor and salaried GPs) relating to 2014/15, as well as the number of full and part time GPs associated with the published figure.
  • Further commitment to expand and improve the provision of online services for patients, including extending online access to medical records and the availability of online appointments.
  • Changes to the Quality and Outcomes Framework (QOF): adjustment of point value for 2015/16 taking account of population growth and relative changes in practice list size for one year from 1 January 2014 to 1 January 2015; deferment for one year of changes in thresholds planned for April 2015.
  • Discussions around any clinical changes toQOFwithin the currentQOFenvelope will continue.
  • The avoiding unplanned admissions (AUA) enhanced service will be extended for a further year from 1 April 2015, with changes including revisions to the reporting process and changes to the payment structure.
  • The patient participation enhanced service will end and associated funding will be reinvested into global sum. From 1 April 2015, it will be a contractual requirement for all practices to have a patient participation group (PPG) and to make reasonable efforts for this to be representative of the practice population.
  • The alcohol enhanced service will end and associated funding will be reinvested into global sum. From 1 April 2015 it will be a contractual requirement for all practices to identify newly registered patients aged 16 or over who are drinking alcohol at increased or higher risk levels.
  • GPC,NHSEngland andNHSEmployers will work together to develop more consistent guidance for the provision of enhanced minor surgery services.
  • The extended hours and learning disabilities enhanced services will be extended and unchanged for a further year.
  • Changes to registration regulations will allow for armed forces personnel to be registered with a GP practice.
  • There will be a 15% reduction in the total seniority payments as agreed in 2014/15.
  • Assurance on out of hours provision has been agreed to ensure that all service providers are delivering out of hours care in line with the National Quality Requirements (or any successor quality standards).
  • Improved maternity/paternity arrangements have been agreed, to cover both external locums and cover provided by existing GPs within the practice who do not already work full time.
  • NHSEngland andGPCwill work together on workforce issues including the retainer /returner scheme, the flexible careers scheme, and recruitment problems in specific areas.
    GPC,NHSEmployers andNHSEngland will have a broader strategic discussion about the primary care estate, especially to support the transfer of care into a community setting.
  • NHSEngland andGPCwill re-examine the Carr-Hill formula with the aim of adapting the formula to better reflect deprivation.
  • Correction factor funding moving into global sum will be reinvested, with no out of hours deduction applying;NHSEngland has agreed that any funding released fromPMSreviews will be invested in primary medical care services.

Summary ofQOFchanges 2015-16

The key changes are:

  • An adjustment to the value of aQOFpoint value for 2015/16 taking account of population growth and relative changes in practice list size from 1 January 2014 to 1 January 2015.
  • The threshold changes planned for 1 April 2015 have been deferred for one year to 1 April 2016.
    Atrial fibrillation
  • The retirement of AF005 (6 points).
  • The introduction ofNICEindicator NM81. The new indicator will be AF006 with a point value of 12 points and thresholds at 40-90%.
  • The replacement of AF004 (6 points) withNICEindicator NM82. The new indicator will be AF007 with a point value of 12 points and thresholds at 40-70%.
  • The two new indicators have been set at 12 points each to reflect the workload involved in the delivery of these indicators.

Coronary heart disease (CHD)

  • The retirement of CHD006 (10 points).

Dementia

  • The amendment of DEM002 to include a care plan with an increase to the number of points from 15 to 39 points to recognise an increase in the number of patients with dementia. The new indicator will be DEM004, the thresholds will remain at 35-70%.
  • A change to the timeframe for DEM003. The new indicator will be DEM005, the points will remain at 6 points and the thresholds will remain at 45-80%.

Chronic kidney disease (CKD)

  • The amendment of CKD001 (the register) to reflect the change in the classification in line with the updatedNICEclinical guideline.
  • The retirement of CKD002 (11 points), CKD003 (9 points) and CKD004 (6 points) (total 26 points).
    Obesity
  • The replacement of OB001 (the register) withNICEindicator NM85. The points will remain at 8 points.
  • The overall number of points inQOFremains at 559 points. The above changes are resourced through the redistribution of points.

This agreement includes a commitment that practices continue to undertake the work for the retired indicators as clinically appropriate and in accordance with best medical practice.

New dementia enhanced service

NHSEngland has said practices will receive £55 for every patient they diagnose with dementia under a new enhanced service.

This new enhanced service has been introduced in-year byNHSEngland and was not part of a negotiated agreement with theGPC. It is time-limited to 31 March 2015 and is designed to operate in addition to the existing dementia enhanced service, not instead of it.GPCdid not have sight of or approve the specification for this enhanced service.

Key points:

  • The enhanced service pays for diagnoses only;
  • No payment for participation in the scheme or for planning;
  • Payment will be based on the net increase in the dementia register on March 31 2015;
  • No payment for newly diagnosed patients who subsequently die or leave the practice;
  • No payment where patients are referred to specialist services before March 31 2015 but diagnosed after this date

Click on the highlighted link to read thespecification.