Funding in General Practice Dr Andy Withers Grange Practice Allerton.
-
Upload
seth-farrell -
Category
Documents
-
view
218 -
download
0
Transcript of Funding in General Practice Dr Andy Withers Grange Practice Allerton.
![Page 1: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/1.jpg)
Funding in General Practice
Dr Andy Withers
Grange Practice Allerton
![Page 2: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/2.jpg)
Aims & Objectives
Aims• Increase understanding of how General
Practice is financed
Objectives• Know how :-
• Practice income is calculated and received
• Budgets are set
• The difference between NHS & Private income
![Page 3: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/3.jpg)
Questions
How do GPRs get paid in practice? How do salaried GPs get paid? How do GP Partners get paid? What is the difference between a GMS & PMS
practice? Are all my earnings pensionable? What is PBC? How can I earn more?
![Page 4: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/4.jpg)
What do we get paid for?
Core General Practice(= Essential Services)
Additional Services Enhanced Services QOF
![Page 5: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/5.jpg)
NHS IncomeBreakdown of Practice Funding
Essential Services
Additional Services
QOF
LoQOF
Enhanced Services
Other
![Page 6: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/6.jpg)
GP Funding Budget BAtPCT
Essential Services 42027354 63.6
Additional Services 1879730 2.8
QOF 10174089 15.4
LoQOF 1118611 1.7
Enhanced Services 7481849 11.3
Other 3429216 5.2
66110849
![Page 7: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/7.jpg)
Premises Budget
Brought forward 66110849
Premises 8453145
74563994
![Page 8: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/8.jpg)
Essential Services (63.6%)
MANDATORY - common to all practices1) The management of patients who are ill or believe
themselves to be ill, with conditions from which recovery is generally expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever practicable
2) The general management of patients who are terminally ill
3) Management of chronic disease in the manner determined by the practice, in discussion with the patient
![Page 9: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/9.jpg)
Essential Services (63.6%)
Either paid as “Global Sum” or MPIG in GMS practices (MPIG = GS +correction factor)
Government want to get rid of MPIG Basic Contract in PMS practices
![Page 10: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/10.jpg)
Additional Services (2.8%)
Normally expected of all practices but OPT-OUT possible
•Cervical cytology
•Child health surveillance
•Maternity services (not intrapartum care)
•Contraceptive services
![Page 11: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/11.jpg)
Enhanced Services (11.3%)
3 types•Direct
•National
•Local
![Page 12: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/12.jpg)
DES (2.8%) Obligatory for each PCO National specifications No one practice has to do:
• Services to violent patients• Childhood vaccinations and immunisations financial incentives• Minor surgery• Flu immunisations• Improved access• IMT• Choice & Booking• (PBC)• “New clinical DESs” Heart Failure, Osteoporosis, LD,
Ethnicity, Alcohol
![Page 13: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/13.jpg)
NES (1.7%)
OPT-IN - national terms and conditionsAnticoagulant monitoring IUCD
Sexual health MS
Drug and alcohol misuse Terminally ill
Depression Learning disabilities
Intra partum care Minor injuries
Near-patient testing Homeless
Immediate/first response care
![Page 14: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/14.jpg)
LES (6.8%)
OPT-IN
Response to specific local requirements
Local terms, conditions and standards
Possibly, innovative services for piloting and evaluation
![Page 15: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/15.jpg)
LES (6.8%)
Choice & Booking (to 31/3/09) IM&T Sexual Health Minor Primary Services
• ECG
• Minor Surgery (various levels)
• Spirometry
![Page 16: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/16.jpg)
GMS v PMS
Little difference now PMS probably slightly higher earning
practices due to historic funding. Both practice based contracts GMS nationally negotiated
• Either global sum via Formula
• Or Minimum practice income guarantee (MPIG)
PMS (potentially) locally negotiated
![Page 17: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/17.jpg)
Range of Practice Funding in BAtPCT
Weig hted Inc ome P er Head
-10.0010.0030.0050.0070.00
90.00110.00130.00150.00
P ra c tic e C ode
Pri
ce H
er H
ead
![Page 18: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/18.jpg)
Seniority
Begins from start of NHS service Annual increments
![Page 19: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/19.jpg)
QOFTHE FOUR DOMAINS OF QUALITY
ClinicalOrganisationalPatient experienceAdditional services
![Page 20: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/20.jpg)
Total Points 1000
Clinical 650
Organisational167.5
Additional Services 36
Patient Experience146.5
![Page 21: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/21.jpg)
CLINICAL AREAS
Asthma 45 AF 30 Cancer 11 CKD 27 COPD 28 CHD 89 Dementia 20 Depression 33 Diabetes 93 Epilepsy 15
Heart Failure 20 Hypertension 83 Hypothyroidism 7 Learning Disabilities
4 Mental health 39 Obesity 8 Palliative Care 6 Smoking
68 Stroke & TIA
24
![Page 22: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/22.jpg)
ORGANISATIONAL AREAS
Records and information
Patient communication
Education and training
Practice management
Medicines management
![Page 23: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/23.jpg)
PATIENT EXPERIENCE
Standardised approved patient questionnaires
General Practice Assessment Questionnaire (Manchester)
Improving Practice Questionnaire (Exeter)
Length of consultation - 10 mins appts
![Page 24: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/24.jpg)
QOF Changes 2009/10
End of “Square rooting” Move to true prevalence
![Page 25: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/25.jpg)
QOF Changes 2009/10
Heart Failure (9 new points) One new indicator (which moves the current HF DES for England into QOF): HF 4: The percentage of patients with a current diagnosis of heart failure due to LVD who are
currently treated with an ACE inhibitor or Angiotensin Receptor Blocker, who are additionally treated with a beta-blocker licensed for heart failure, or recorded as intolerant to or having a contraindication to beta-blockers. (9 points; thresholds 40 – 60%)
Chronic Kidney Disease CKD (11 new points) Five additional points will be allocated to existing indicator CKD 5: CKD 5: The percentage of patients on the CKD register with hypertension and proteinuria who are
treated with an angiotensin converting enzyme inhibitor (ACE-1) or angiosten receptor blocker (ARB) (unless a contraindication or side effects are recorded). (5 additional points (so the indicator will be worth 9 points in total); thresholds 40 – 80%) While this indicator will not change, the guidance will be changed.
One new indicator: CKD 6: The percentage of patients on the CKD register whose notes have a record of an albumin:
creatinine ratio (or protein: creatinine ratio) value in the previous 15 months. (6 points; thresholds 40 – 80%)
![Page 26: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/26.jpg)
QOF Changes 2009/10 Sexual Health - contraception (8 new points plus 2 points from current CON indicators,
CON 1 and 2 which will be removed) Three new indicators, as recommended in the 2008 expert panel report: SH 1: The practice can produce a register of women who have been prescribed any method of
contraception at least once in the last year. (4 points) SH 3: The percentage of women prescribed an oral or patch contraceptive method in the last year
who have received information from the practice about long acting reversible methods of contraception in the previous 15 months. (3 points; thresholds 40 – 90%)
SH 4: The percentage of women prescribed emergency hormonal contraception at least once in the year by the practice who have received information from the practice about long acting reversible methods of contraception at the time of, or within one month of, the prescription. (3 points; thresholds 40 – 90%)
Anxiety and Depression (20 new points) One new indicator: DEP 3: In those patients with a new diagnosis of depression and assessment of severity recorded
between the preceding 1 April to 31 March, the percentage of patients who have had a further assessment of severity 5 – 12 weeks (inclusive) after the initial recording of the assessment of severity. Both assessments should be completed using an assessment tool validated for use in primary care. (20 points; thresholds 40 – 90%)
![Page 27: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/27.jpg)
QOF Changes 2009/10
Cardio Vascular Disease CVD – Primary Prevention (13 points) Two new indicators: PP 1: In those patients with a new diagnosis of hypertension (excluding those with pre-existing CHD, diabetes,
stroke and/or TIA) recorded between the preceding 1 April to 31 March: the percentage of patients who have had a face to face cardiovascular risk assessment at the outset of diagnosis using an agreed risk assessment treatment tool. (8 points; thresholds 40 – 70%) For the purposes of QOF measurement, ‘at the outset of diagnosis’ is defined as within three months of the initial diagnosis.
PP 2: The percentage of people diagnosed with hypertension diagnosed after 1 April 2009 who are given lifestyle advice in the last 15 months for: increasing physical activity, smoking cessation, safe alcohol consumption and healthy diet. (5 points; thresholds 40 – 70%)
Diabetes (7 new points plus 28 current points) There are currently two indicators with HbA1c targets (DM7 and DM 20) which have been subject to changes. We
will also introduce a new indicator. The three indicators are as follows: DM 23: Replaces DM 20 (which has a HbA1C target of 7.5 or less and is worth 17 points) The percentage of
patients with diabetes in whom the last HbA1c is 7 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months. (17 points; thresholds 40 – 50%)
DM 24: New The percentage of patients with diabetes in whom the last HbA1c is 8 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months. (8 points; thresholds 40 – 70%)
DM 25: Replaces DM 7 (which has a HbA1C target of 10 or less and is worth 11 points) The percentage of patients with diabetes in whom the last HbA1c is 9 or less (or equivalent test/reference range depending on local laboratory) in the previous 15 months. (10 points: thresholds 40 – 90%)
![Page 28: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/28.jpg)
QOF Changes 2009/10 COPD (2 new points) One revised indicator: COPD 13: Replaces COPD 11: The percentage of patients with COPD who have had a review,
undertaken by a healthcare professional, including an assessment of breathlessness using the MRC dyspnoea score in the preceding 15 months. (2 additional points
so the indicator would be worth 9 points; thresholds 50 – 90%)
Reallocation of Points The following points will be removed: Indicator Current value New value Points removed PE2 25 0 25 PE6 30 0 30 SMOKING 3 33 30 3 SMOKING 4 35 30 5 BP 4 20 18 2 CHD 6 19 17 2 AF 3 15 12 3 CON 1 1 0 1 CON 2 1 0 1 Total 72
![Page 29: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/29.jpg)
Pensions
All NHS income pensionable
• delivering GMS / PMS
• delivering services under delegation including locum work
• board, advisory and other work for NHS bodies
• collaborative arrangements work
• education
• statutory certification
• work for GP cooperatives that are NHS bodies All locum pay pensionable from 1.4.2002
![Page 30: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/30.jpg)
PBC
Practice Based Commissioning• Voluntary
• Devolved budgets to all practices
• Virtual Money – you can’t take it home
• For:
• Prescribing
• Secondary care, acute & elective
• Community Staff
• Can spend (up to) 70% of Freed up resources (FURs note not savings) on patient care. Pct takes rest.
• Only get FURs you predict (no serendipitous FUR)
• Idea is to provide innovations in services to produce FUR
• Usually done through commissioning alliances
![Page 31: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/31.jpg)
Other Income
Teaching & Training Amount NHS Pension?
• GPR £7.5k Y
• FY2 £10k Y
• Medical Students £15-20k N
NHS related work• GPwSI c £10k/session Y
• PCT Y
• LMC N
• DH Y Private N
• Reports
• Medicals etc
![Page 32: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/32.jpg)
Getting Paid
Turnover
Running Costs
Staff
Profit
![Page 33: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/33.jpg)
Getting Paid 2 (This is real money)
Typical Middle sized practice (approx 5500 patients)
Total amount £875k• Less running expenses (36%) £315k
• Less Staff costs (including salaried GPs & GPRs) £260k
Profit (34%) £300k
Divided between partners = income £100k
• Need to pay 20% superannuation £80k
• Need to pay Income tax
![Page 34: Funding in General Practice Dr Andy Withers Grange Practice Allerton.](https://reader036.fdocuments.in/reader036/viewer/2022062417/551612bb55034694308b53b7/html5/thumbnails/34.jpg)
Premesis
Lift PFI variants DIY
Guaranteed income stream from PCT About 11% return for developer