Title: The New General Medical Services Contract for General Practice An
1The New General Medical Services Contractfor
General PracticeAn Enabling Contract Nigel
McFetridgeHead of clinical governanceHampshire
and Isle of Wight Strategic Health Authority
2Outline of Presentation
- The current contract
- Why change?
- The new contract
- - Extra Services
- - Quality and Outcome Framework
- Role of PCT Public Health function
3Primary Care
- General Practice
- New GMS contract
- Primary Care Nursing
- Liberating the Talents
- Oral health
- Ready for PCT commissioning Dentistry - April
2005 - Pharmacy
- A Vision for Pharmacy
- Vision and eye care
- Vision 2020
- chronic eye disease management - care pathways
4Features of current GP contract
- Most GPs are self-employed independent
contractors - GPs own the capital required to practice their
craft - Patients register with individual GPs
- Provide all necessary and appropriate personal
medical services of the type usually provided by
general medical practitioners - Daily Public Health work
- health advice, primary, secondary and tertiary
prevention, immunisation, cervical screening,
sexual health and contraception, occupational
health, prevention of infection, monitoring of
patients health, collection of data
5Some Problems
- Not enough doctors
- 13 staff near retirement age, more part-time,
recruitment too low - Poor work-life balance
- Wide variations in quality - Inverse care law
- Oxfordshire has twice as many GPs as S.Derbyshire
- Money follows doctors investment decisions, not
patients needs - 10 premises are sub-standard
- Patient access and choice
- Contract rewards volume, not quality
- Contract too rigid
- More could be done in Primary Care - technology /
skills - Good care requires more multi-disciplinary
team-work - PCTs have little power to shape general practice
to meet patients requirements - Younger people less satisfied with service
6The new contract is a strategic tool to
- Give PCTs more ability to shape services
- Expand primary care capacity to meet local needs
- Deliver wider range of services close to patient
- Improve the quality and range of services for
patients - Improve convenience and choice to patients
- Reduce pressure on acute services
- Make General Practice a more attractive and
family-friendly place to work - new career structure, protected time for skill
development, family friendly working practices
7- Key Features -1
- Negotiated between the BMA and the NHS
Confederation - Maintains independent contractor status of GP and
preserves existing practices as providers - Over 8 billion UK investment over three years
- (33 increase between 2003/04 and 2005/06)
- making primary care the biggest growth area in
the NHS - PCTs responsible for securing the provision of
primary medical services - So much greater flexibility in boundaries between
primary, intermediate and secondary care - GMS
- PMS
- Alternative Providers
- (eg voluntary sector, commercial providers, NHS
Trusts, other PCTs) - Direct PCT provision
8- Key Features -2
- Contract is practice-based
- Patients register with a practice not a GP for
essential services - (but can choose who they see)
- Allows greater flexibility in staff skill mix -
so will affect all staff - Practices have greater flexibility to determine
the services they provide - Reinforces multi-disciplinary nature of primary
care - Encourages new services and GPs / Nurses with
special interests - Practices can control workload
- Practices paid by simplified Global Sum
- PLUS additional resources/reward for
- Extra services - Enhanced Services
- Quality - Standards of care in contract
- - Quality and Outcomes Framework
9Extra Services
10- Essential Services
- ALL PRACTICES MUST PROVIDE
- Management of patients who are ill or believe
themselves to be ill - General management of patients who are terminally
ill - Management of chronic disease
- Additional Services
- ALL PRACTICES EXPECTED TO PROVIDE
- Cervical screening
- Contraceptive services
- Childhood vaccinations and immunisations
- Child health surveillance
- Maternity services excluding intra-partum care
- Minor surgery
11- Enhanced Services
- 1. Essential or Additional services specified to
a higher standard - e.g. minor surgery
- 2. New Primary Care Services
- Optional
- Range of providers
- Directed Enhanced Services
- PCTs must commission
- Minor Surgery
- Staff support for dealing with violent patients
- Quality information preparation (patient medical
records) - Influenza immunisation
- Childhood Immunisations
- Access (achieving national targets)
12National Enhanced ServicesPCTs may commission if
not currently provided
- Drug misuse services
- Alcohol misuse services
- Specialised sexual health services
- Enhanced care of the homeless
- Specialised depression services
- Specialised services for patients with multiple
sclerosis - Intra-partum care
- Immediate care and first response care services
- Minor injury services
- Near-patient testing
- Anti-coagulation monitoring
- Intra-uterine contraceptive device fitting
13Local Enhanced ServicesExamples
- Enhanced co-ordinated care for older people in
residential care / nursing homes - Diabetic care
- Services for Asylum Seekers
- Cardiology care
14Quality and Outcome Framework(QOF)
15- QOF - Principles
- Voluntary system of additional funding
- Major funding stream for new money
- Rewards participation in an
- annual quality improvement cycle
- based on a quality points system
- Adjusted for practice size and disease
prevalence - Requires high data quality and IT support
- QOF will be updated
16Quality and Outcomes Framework
- Comprises indicators grouped into areas within
the following four domains - Clinical - 10 disease areas
- Organisational
- Patient experience
- Additional services
17Principles for selecting disease areas
- Indicators based on the best available evidence.
- The number kept to the minimum number compatible
with an accurate assessment - Only data which are useful in patient care should
be collected. - Data never collected twice
- Diseases selected if
- responsibility for ongoing management rests
principally in primary care - there is good evidence of the health benefits
likely to result from improved primary care - disease is a national priority (eg NSFs)
18- Clinical Domain - 10 disease areas
- Coronary Heart Disease and Left Ventricular
Disease - Hypertension
- Diabetes
- Stroke or TIA
- Hypothyroidism
- Epilepsy
- Asthma
- COPD
- Mental Health
- Cancer
19Indicators grouped into three Levels - e.g.
Hypertension
- Level 1 Records
- The practice can produce a register of patients
with established hypertension (9) - Level 2 Diagnosis and initial management
- The percentage of patients with hypertension
whose notes record smoking status at least once
(max 10) - The percentage of patients with hypertension who
smoke whose notes contain a record that smoking
cessation advice has been offered at least once
(max 10) - The percentage of patients with hypertension in
which there is a record of blood pressure in the
last nine months (max 20) - Level 3 Ongoing management
- The percentage of patients with hypertension in
whom the last blood pressure (measured in the
last nine months) is 150/90 or less (max 56)
20- Organisational Domain - 5 Areas
- Records and information about patients
- Communication with patients
- Education and training
- Practice management
- Medicines management
- Patient Experience Domain - 2 Areas
- Patient Surveys
- Length of consultations
- Additional Services Domain - 4 Areas
- Cervical Screening
- Child Health Surveillance
- Maternity Services
- Contraceptive Services
21- Quality Points
- Clinical 550
- Organisational 184
- Patient experience 100
- Additional services 36
- Holistic care 100
- Quality Practice 30
- Access 50
- Total points 1050
- 1 point 75 for an average practice
- (Corrected for practice size and disease
prevalence)
22Role of PCT Public Health functionQOF
- Support practices and the PCT on issues of data
quality (e.g. monthly returns, annual quality
review visits and prevalence adjustment
arrangements). - Analysis of monthly data returns from practices
to support health status and health needs
assessment work. - Ensure focus on QOF does not divert activity from
other public health issues. - Advise the UK-wide independent expert group on
changes to the indicators, workload implications
and aspects of the prevalence adjustment
arrangements.
23Role of PCT Public Health function
- Ensure that the development of primary care takes
place within a strategic framework that - maximises health improvement and minimises health
inequalities - promotes integration of primary care with other
health and social care services. - Development of a long term primary care strategy.
- Help encourage population based and Public Health
thinking in general practice. - Advise on service redesign e.g. commissioning of
enhanced services. - Identify and manage possible information holes
that might be created during the changeover. - Ensure implementation of NSFs in primary care and
help improve chronic disease management. - Ensure appropriate provision of services for
- vulnerable groups
- e.g. homeless people, drug/alcohol abusers
- areas where there are major inequalities
- e.g. sexual health, coronary heart disease,
cancer, mental health, child health).
24Reference
- New General Medical Services Contract
http//www.doh.gov.uk/gmscontract/index.htm