Transcript Primary Care 2010

Primary Care 2010
GP contractual Models
• GMS (contract in perpetuity)
• PMS (contract in perpetuity)
• APMS (time limited contract subject to
procurement rules)
GMS
Nationally negotiated contract for core and additional
services
Capitation funded based on Carr Hill formula Global Sum
(£64.59 at 2010/11 prices)
Funding discrepancy address by a Minimum Practice
Income Guarantee
(MPIG)
Further services funded under enhanced services – DES,
NES & LES
Quality and Outcomes Framework
Core Hours 08.00 to 18.30 (out of hours responsibility
transferred to PCT)
Original PMS
• Locally negotiated contract that offered
additional flexibilites
• Pre dates the current GMS contract
• Recent guidance that the two contracts should be
treated the same
• PMS practices have access to NES and LES
• PMS practices have access to QOF with 105 point
abatement
• Allowed to opt out of OOH when new GMS
implemented
New PMS
• Some PCTs have introduced updated versions
of PMS contracts where providers would not
accept APMS contract but PCT wanted to
commission additional flexibilities
APMS
• Alternative Provider Medical Services
• Locally negotiated
• Does not have to be GP led/owned often
companies who used salaried GPs
• Often has some contract values linked to Key
Performance indicators
• Core hours service only but may be more than
standard core hours
QOF
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Points make prizes
20 Clinical Domains
6 Organisational Domains
4 Additional Services Domains
Thresholds and achievements set
£127.29 per point based on an average list size (5981)
Takes account of disease prevalence in clinical domains
Patients can be excepted from the counts but PCTs
monitor this closely
Other funding
• Premises costs (rent, rates etc.)
• Seniority allowances
• Discretionary funding for locums to cover
maternity/paternity leave and in some cases
Key Performance Indicators
• QOF could be viewed as a form of KPI
• Mainly linked to APMS contracts
• Will definitely be linked to any services
commissioned from Primary Care outside of
“normal” services
• Outcome measures
The Future
• All of the NHS is going to have to generate
efficiencies to survive and Primary Care is
included in this.
• The new regime
– GPs being responsible for 80%-90% of NHS budget in
real terms
– Negotiation of new GP contract
– GP contracts to be held by the NHS board not PCTs
– Removal of SHA’s
– PCTs to concentrate on Public Health and residual
commissioning
Practices as a business
• Need to look for efficiencies would Federated models
of GPs offer this
• What is a federation?
• Mergers?
• What opportunities are there for delivering a wider
range of services that may attract more funding?
• By expanding services do we threaten core services
• Have GPs and their teams the knowledge and skills to
move forward in a new structure?
Individual GPs
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Do you want to be a partner?
Would you want to be in a salaried position?
Do you want to work totally in primary care?
Would you want to have a portfolio career
with different interests and responsibilities in
different areas
• Clinical Leadership/engagement very
important