contracts OUT OF HOURS
In order to address the increasing pressures placed on accident and emergency departments around the country, NHS England has turned to primary care to help share the load. This means GPs making themselves more accessible to patients requiring treatment outside of practice hours – and perhaps taking full responsibility for their out-of-hours services, if government proposals go through. Contract changes in 2004 meant that GPs were allowed to opt out of providing out-of-hours care, resulting in the current situation of patients having to talk to a doctor they aren’t familiar with, often based miles away from them. Health Secretary Jeremy Hunt has suggested that GPs now take back full 24-hour responsibility for their patients. But Dr Clare Gerada, chair of the RCGP, has suggested a middle ground whereby GPs take on this responsibility for a small number of patients who are heavy users of the service, for example the elderly or those with chronic illnesses.
PHASING OUT THE MPIG From April, minimum practice income guarantee (MPIG) correction factor payments for any practice will be phased out over a seven-year period – and the funds released reinvested into global sum payments – with the aim that by the end of the seven-year period all practices will receive the same amount of funding per patient. Critics have said that rather than making the system fairer, this could have a negative impact on outliers – practices that require extra funding per patient because of demographic differences between areas.
LOCUM PENSIONS New pension changes in place since April have meant GPs are now responsible for paying for the employer’s pension contribution when contracting locums. These changes should be cost-neutral to practices and any additional pension contributions should be compensated through the global sum, in theory. The funding that PCTs were given for GMS locum employer pension costs will be transferred to GMS practices so that – assuming locums increase their fees to cover these costs – GP practices can meet those costs as the ‘employer’ of the locum.
QOF INDICATORS
There have been a number of changes implemented to the QOF this year, with new indicators recommended by NICE including:
20 october 2013
• raising thresholds for existing indicators • setting up a public health domain with indicators across clinical and health improvement areas such as smoking and obesity
• retaining for a further year the quality and productivity (QP) indicators that reward practices for work to reduce unnecessary emergency admissions
• removing the remaining organisational indicators that represent basic standards that all practices will be expected to meet as part of CQC registration
• removing the current overlap of QOF years by reducing the time period for most indicators from 15 to 12 months
• reforming the list size weighting so that the price of a QOF point is more transparent for practices.
VACCINATIONS A new vaccination and immunisation programme for rotavirus and shingles, as recommended by the Joint Committee on Vaccination and Immunisation, is planned to commence in September. A new item of
service fee of £7.63 will be introduced for a completed course of rotavirus for infants and the same fee will be paid for routine shingles immunisation for patients aged 70 or over.
DES The DH will be continuing the current DESs of extended hours, patient participation, the alcohol-related risk reduction scheme and learning disabilities health check in 2014. In addition, the government intends to develop a new DES using £120m of funding – some of the money removed from the QOF organisational domain. As most of the organisational work must be continued, these new initiatives would effectively be introduced to the contract without any extra funding. The new DESs include: testing for dementia in at-risk groups; a risk-profi ling scheme to anticipate the needs of physically and mentally vulnerable patients; online access to practice services (booking, ordering, prescriptions, test results and medical records) and supporting people with long-term conditions to monitor their health remotely.
primary provider
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