GPC negotiators / LMC meeting

March 2011

Today’s matters

• 2011/12 contract agreement• 2012/13 negotiations• NHS Health & Social Care Bill• Pensions• Seasonal flu vaccination programme• CQC registration• Sessional GP representation• IM&T• The Royal Wedding

2011/12 contract agreement Practice expenses Extended hours DES in England QOF changes including quality and productivity Clinical DESs New patient participation DES in England

Practice Expenses

• No DDRB recommendation for 2011/12• 0.5% increase to the value of the GMS

contract• Will not fully cover expected expenses rise• Delivered through 2.53% increase in the

value of a QOF point from £127.29 to £130.51 (in England)– similar adjustments in Scotland, Wales and NI

• employed staff with a full time equivalent salary of less than £21,000 should be given £250 pay rise

The Extended Hours DES

• One year extension• Appointments may be offered by any health care

professional not just GPs• No restriction on concurrent working • Urgent and routine patients can be seen • Minimum period reduced from 90 to 30 minutes • Significant changes to be reviewed by patient

group and local survey• Payment reduced from £3.01 to £1.90 per patient • Money put into Patient Participation DES

Patient Participation DES

• £1.10 per registered patient– £60m from extended hours DES

• Establish a patient reference group– Could be “virtual”

• Local patient survey to get patients’ views• Agree action plan with PRG• Publicise results and actions taken on

website

Clinical DESs

• Ethnicity and First Language DES ended– practices expected to record patients' ethnicity and first

language in order to be able to demonstrate that practices continue to meet the health needs of their registered population

• One year extensions for- the alcohol reduction DES

- the learning disabilities health check DES- the osteoporosis diagnosis and prevention DES

• Arrangements remain the same

QOF

• 58.5 QOF points for patient access (PE7 and PE8) have been removed

• 58 points removed from other indicators– Depression 2 reduced by 8 points– Depression 3 reduced by 12 points– Diabetes 23 – HbA1c threshold increased from 7 to 7.5

• CHD6, Stroke6 and DM30 upper thresholds increased by 1% to 71%

• Full guidance will be available shortly

QOF Quality & Productivity Indicators

• Using 96.5 freed-up points • Focus on 3 areas each for:

- Emergency admissions (47.5 points)- First outpatient referrals (21 points)- Prescribing (28 points)

• Internal practice review within 3 months• External review in group within 6 months

QOF Quality & Productivity Indicators (2)

• Using concepts from “Better Care, Better Value”– or equivalent in Scotland, Wales and NI

• Looking at referrals and emergency admissions

• Internal review in practice• External review with local peer group• Implementing three agreed care pathways• PCO must agree

QOF Quality & Productivity Indicators (3)

• Cost-effective prescribing based on a range of national and local indicators– Payment on sliding scale based on the level of prescribing

achieved by the practice

• Internal review in practice• External review with local peer group• Implementing three agreed prescribing

changes• PCO must agree• Review of achievements in autumn will

determine if scheme extended for second year

2012/13 Negotiations

• Negotiations yet to begin• NHS Employers’ likely negotiating objectives for

2012/13 may be:– Further efficiency savings– Requirement to be part of a consortium in

England– MPIG– QOF– Removing practice boundaries– Seniority payments– PCO administered funds (e.g. locum payments)

NHS Health & Social Care Bill

• Clinically led commissioning• Flexibility and variability in structures• 185 pathfinders in place, others to follow• Consortia will be responsible for commissioning

secondary care, mental health, maternity services and urgent care services

• DH have now published document detailing the functions consortia will be expected to carry out

• Government has signalled intention to have a single consolidated GP contract, however this is not within the Health Bill and has not been negotiated

NHS Health & Social Care Bill (2)

• Bill at the committee stage in parliament• BMA briefing MPs with proposed

amendments• Government has agreed to remove clauses

relating to price competition and differential pricing between NHS and private providers

• Briefing papers relating to each section of the Bill – available on the BMA website

• Essential for GPs and LMCs to lobby MPs

NHS Health & Social Care Bill (3) Main areas of concern

• Competition and role of Monitor• Independence and role of NHS

Commissioning Board• Role and structure of Commissioning

Support Units• Quality Premium and conflicts of interest• Medical education and training• Confidentiality• Foundation Trusts

BMA Special Representative Meeting

• Supported BMA policy of “critical engagement”

• Called for the Bill to be withdrawn• Keep on talking and working with government

to demand major changes to the Bill• Oppose the many parts we do not like• Focused on priorities for campaigning

– particularly competition agenda

• GPC will continue to issue guidance to GPs• Media largely persuaded• Lib-Dems and some Tories now concerned

Consortium Formation

• LMCs should help shape and develop consortia• Must have the support of local GPs• Must be appropriate for local circumstances• No “leaders” foisted on consortia• All GPs involved in elections for leadership• Sessional GPs should be engaged with, involved

in discussions on forming of consortia, and encouraged to stand for leadership positions

• Essential to work closely with consultants, public health doctors and other health professionals

Larger consortiaor working in federation

• Good management of financial risk• Strong negotiating position with acute

trusts• Larger management allowance to employ

the best staff• Reduce requirement for external

commissioning support• More able to stand up to NHS

Commissioning Board

NHS Commissioning Board

• NHS Commissioning Board will have power to authorise the establishment of consortia, ensuring that they:- are of sufficient size to manage financial risk- allow for accurate budget allocations- have the necessary arrangements and capabilities to fulfil their statutory duties- provide comprehensive coverage of consortia across the country

• Consortia may be allocated practices• Will not approve ‘cherry-picking’ of like-minded

practices

Commissioning Support Units (CSU)

• PCTs forming about 45 - 50 clusters by June • Intended to provide expert commissioning

support• Could also be used by NHS Commissioning

Board for local performance management• Could be social enterprise or private

company• Large consortium or lead consortium could

embed CSU within NHS structure

Education, training & workforce consultation

• Local employer “Skills networks” (inc GP providers) to take on many SHA and deanery functions

• Future survival of deaneries doubtful• Creation of new body to provide national

oversight – Health Education England• All providers “to pay training levy”• Potential domination by teaching hospital

trusts• Fragmentation of national standards

GPC guidance notes

• The principles of commissioning• Legal overview• The role of LMCs• Initial observations on consortia

commissioning• The form & structure of consortia• Shadow consortia leadership• Impact on sessional GPs• Consultant involvement in commissioning

Timetable for change2010/11• Clinically-led commissioning consortia to

begin to form on a shadow basis

2011/12• Shadow clinically-led consortia to be in

place, taking on increased responsibility from PCTs

• NHS Commissioning Board to be established in shadow form as a Special Health Authority from April 2011

Timetable for change (2)

2012/13• Formal establishment of clinically-led consortia,

together with indicative budget allocations• NHS Commissioning Board to be established as an

independent statutory body; SHAs to be abolished• NHS Commissioning Board to announce (in the

third quarter of 2012/13) the allocations that will be made directly to consortia for 2013/14

2013/14• Clinically-led consortia to be fully operational, with

real budgets and holding contracts with providers; PCTs to be abolished

Pensions

Independent Public Service Pension Commission (IPSPC) – chaired by Lord Hutton, which recommends:

• Linking the normal pension age (NPA) to the current state pension ages (SPA). This means that at the very least your NPA will increase to 65 and, depending on your age, to 68

• Replacing final salary with Career Average Revalued Earnings (CARE) for future service

• Maintaining a tiered contribution system.

Pensions (2)

• Lord Hutton assumes that the government will increase employee contributions considerably

• Not giving non-public service workers access to public service pension schemes

• Implementing all of these changes before the end of this Parliament i.e. by 2015 - These are only recommendations at this stage and any implementation will be subject to consultation -

Seasonal Flu vaccination programme

• Practices achieved high levels of achievement again in 2010/11

• Department of Health announced intention to carry out a review of current procedures

• Considering central procurement in England

• Arrangements for 2011 unchanged• Order vaccine now

CQC registration

• Spring 2011 - The GPC’s ‘Registration for NHS GPs’ toolkit to be published

- guidance on applying for registration and complying with the CQC standards.

• 1 October 2011 - Practices to apply for registration with CQC

• Autumn 2011 - CQC will consult on its annual fees for GPs (starting 1 April 2012)

• 1 April 2012 - CQC will start checking compliance with its standards

Sessional GP representation

• Working group report summer 2010• New subcommittee elected November

2010• Subcommittee has increased membership

(16 elected members), regional representation and executive committee

• Has devolved powers to act on matters relating wholly or primarily to sessional GPs

IM&T

• Information Strategy and implementation timetable expected in April

• GPSoC current framework expires August 2011– CFH exploring options including extension of

the supplier call-off agreements to March 2013– Joint GPC RCGP IT Committee engaged with DH

regards GPSoC successor• ‘Good Practice Guidelines for General Practice -

Electronic Patient Records v4’ to be published in Spring 2011

Royal Wedding - 29 April 2011

• Bank Holiday in the United Kingdom• All practices in England, Wales and Northern Ireland

should put in place their normal arrangements for bank/public holidays on that date

• Bank holidays count as out-of-hours periods under both GMS and PMS regulations (England & Wales)

• PCOs rather than practices are responsible for resolving financial issues with contracted OOH providers

• There should be no expectation that opted out practices pay for the OOH cover on the day of the Royal Wedding

How the BMA can help LMCs and practices

Employer Advisory Service Experienced advisers on hand for issues with:

• Recruiting and employing staff• Contracts and terms and conditions of service• Performance management• Disciplinary procedures and dismissals

How the BMA can help LMCs and practicesBMA Law Dedicated team of barristers, solicitors to advise you on:

• Bidding and tendering• Contract reviews of APMS, PMS and other local agreements• Limited Liability business structures• Negotiation and Disputes with PCTs and Basic Contract Law• Partnership Splits• Directors’• Duties and Company Law Reform• Competition Law

Coming soon…Developing new services to support you throughout the changes ahead and to protect your practice

Any Questions?