The New General Medical Services Contract and Personal Medical Services

1
The New General Medical Services Contract and
Personal Medical Services

• Mr Sarb Basi
• Director of Primary Care
• Heart of Birmingham Teaching PCT

2
A Reminder of the key objectives

• over 8 billion UK investment over 3 years
• movement to practice-based contract
• management of workload
• incentivising delivery of high quality care
• expansion of primary care sector
• modernisation of infrastructure and management
  process

3
A Reminder of the key benefits

• Patients choice, access, quality
• Practices resources, workload, autonomy,
  outputs
• Practitioners teams, HR, training
• PCOs relationships, infrastructure, services

4
THE MONEY

• Global sum payments
• 300k 04/05per av. practice ( av. Per patient
  of 53)
• 305K 05/06 per av. practice ( av. Per patient
  of 54)
• Investment in enhanced services unified budget
• 315m 03/04
• 518m 04/05
• 586m 05/06
• Transitional protection
• 297m 04/05
• 197m 05/06

5
HUMAN RESOURCES

• GP Career structure
• Protected time
• Salaried option
• Seniority payments
• Family-friendly policies
• Practice Management competency framework

6
MODERNISED INFRASTUCTURE IMT

• 100 Funding
• PCO Ownership and liability
• Choice of systems
• Development, implementation, support
• Education training
• Implementation

7
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 in the manner
  determined by the practice and in discussion with
  the patient

8
Additional Services

• ALL PRACTICES EXPECTED TO PROVIDE BUT CAN OPT
  OUT EITHER TEMPORARILY OR PERMANENTLY
• Cervical screening
• Contraceptive services
• Childhood vaccinations and immunisations
• Child health surveillance
• Maternity services excluding intra partum care
• Minor surgery
• Out Of Hours

9
Enhanced services

• tPCT COMMISSIONED FROM PRACTICES OTHERS
• Directed ( national specifications and benchmark
  prices
• Violent patients, improved access, childhood
  vaccinations and immunisations, flu vaccinations,
  enhanced minor surgery, quality information
  preparation ( 2 years only )
• National (model national specifications and
  benchmark prices )
• E.g. intra-partum care, anti coagulant
  monitoring, intra uterine contraceptive device
  fitting drug and alcohol misuse, sexual health
  services, depression services, homeless care,
  minor injury
• Local (local terms and conditions)
• Developed in response to local need e.g. diabetes
  

10
Out of Hours

• End of current 24 hour responsibility
• PCO responsible for ensuring provision- 6.30pm to
  8am, plus weekends and bank holiday
• To start from 1 April 2004 Expected end date 31
  Dec 2004
• Price for Opting out av. 6,000 per GP
• tPCT have OOH development fund

11
QUALITY OUTCOMES

• Funding
• - Preparation (for 3 years)
• - Aspiration (one third up front)
• - Achievement ( two thirds at end of year
• Exception reporting
• High trust monitoring by tPCT- annual practice
  report and visit

12
The four domains of quality

• Clinical fully functional clinical systems
• Organisational records information, practice
  management
• Patient experience standardised approved
  patient
• - length of questionnaires consultation 10
  mins
• Additional services
• ( plus contractual and statutory criteria)

13
Rewards for Quality

• 1.3bn for the UK quality
• Non discretionary
• In additional to the global sum
• Payment for what many already do
• All work converts to points
• 1050 maximum points
• of income will vary

14
What about PMS?

• Locally owned and developed by local GPs
• Local Flexibilities
• Local Contract based on quality of service
• A Heart of Birmingham Initiative works for
  small practices
• Reduces Bureaucracy
• Local targets
• Increased GP and Nurse resources
• GMS NO growth

15
A quality of service contract

• P.M.S.
• Can afford to lose patients at no cost! (removal
  of ghosts to up target attainment)
• Monitoring framework (minimum of 3 clinical
  audits per year)
• Proof that my practice provides a quality
  service. using local sensitive indicators for
  measuring performance
• Achievable for Small practices unlike the new GMS
  Contract

16
The Future

• A combination of the best things from both
• Growth quality framework pulled together
  funded
• Incentives for enhance primary care
• Diabetes, CHD
• Proactive OOHs development
• Primary care emergency services

17
NEXT STEPS Opportunities

• Single Agreement - similar contract and QO
  framework for both PMS and GMS practices
• Practice based contracts not GP based
  incorporating practice staff and community
• Quality and Outcome Framework Introduction of
  league tables, star ratings
• Recruitment Retention IWL, new career
  structures, new roles, workforce planning

18
NEXT STEPS Opportunities

• Creative Commissioning Greater control over
  workload greater flexibilities. Ward./practice
  based commissioning
• Growth -Opportunities to use growth differently
• Developing alternatives models of care e.g.
  Foundation practices

19
NEXT STEPS Local Responbilities

• All Directors / leads must understand the new
  arrangements and work together
• Everyone needs to support practices in
  understanding what it means for them

20
NEXT STEPS Local Responsibilities

• Everyone needs to understand work with practices
  in implementing the contract (hold local
  workshops if necessary)
• Everyone needs to understand and respect the
  views of GPs and practice staff on the ground