Transcript GPC negotiators/LMC meeting

GPC negotiators / LMC meeting
September / October 2010
Today’s matters
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2011/12 contract negotiations
DDRB
QOF
NHS White Paper
White Paper consultations
GPC guidance on the White Paper
Striking a balance consultation
EEQ results
Revalidation
Care Quality Commission
Summary Care Record
Dispensing
2011/12 contract
negotiations
• Negotiations at preliminary stage
• NHSE no mandate yet, but we do know:
- no new money for GP contract
- efficiency savings wanted in line with rest of
NHS - the nature of consortia will automatically
create efficiency savings
- Trusts make savings by moving work into
primary care – not an option for GPs
DDRB
• Government have told DDRB not to report on
income or expenses for next two years
• Will still report on recruitment, retention, morale
and motivation – GPC will be submitting
evidence on these areas
• Raised concerns about this decision with the
Secretary of State
QOF
• QOF subgroup discussing NICE
recommendations for 2010/11 and 2011/12
– Retirements, replacements, new indicators
– Also discussing changes to the organisational domain
– Maintaining 1000 point QOF
• Many changes would be welcomed by GPs
• Changes dependant on progress of contract
negotiations
• Facility to suggest further changes to existing
indicators on NICE website
NHS White Paper
Headlines
• Passing control for NHS decisions away from
Ministers
– towards patients and professionals
– “No decision about me without me”
• Changing the top of the NHS
• GP-led commissioning consortia
– with abolition of PCTs by 2013
• Single GP contract “over time”
NHS White Paper
Headlines (2)
• Development of an economic regulator –
Monitor
• A new provider landscape – “any willing
provider”
• Shift of Public Health to Local Authorities
• Health Watch – part of Local Authorities
• Workload shift from secondary to primary care
• Government spending review with cuts to social
care funding – impact on general practice
New Structure
Government
Key:
Dept of Health
Funding:
Accountability:
Other relationship:
Local
Authorities
Local
HealthWatch
Local
partnership
NHS Commissioning
Board
GP
Commissioning
Monitor
(economic
regulator)
Care Quality
Commission
Licensing
Contract
Consortia
GP Practices
Patients and Public
Providers
GP commissioning
consortia
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Consortia to replace PCTs and will be statutory bodies
Will have Accountable Officer and Chief Financial Officer
Responsible to NHS Commissioning Board
Commission most services, including emergency and
OOH services, except:
– GMS/PMS
– Pharmacy, dental, opticians, maternity
– Specialised regional services
• All practices required to join
GP commissioning
consortia
• Hold contracts with providers
• May choose a lead commissioner model e.g. for
dealing with large teaching hospitals
• Duty to determine local health needs
• Duty to promote equalities
• Duty to work with local authority (public health,
social care, safeguarding)
• Duty of public and patient involvement
• Government insists there will be ‘no bail-outs’
Timetable for
GP commissioning consortia changes
• GP consortia in place in shadow in 2011/12
– taking on increasing delegated responsibility from PCTs
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Health Bill passed
Consortia responsible for commissioning in 2012/13
Financial allocations direct to GP consortia in late 2012
Full financial responsibility from April 2013
PCTs abolished April 2013
White Paper consultations
• 3 month consultation period
• Main White Paper consultation plus 4 further
consultations
• Still time for LMCs and GPs to respond – the
main White Paper consultation closes on 5
October, with the 4 additional consultations open
until 11 October
Equity and excellence:
Liberating the NHS - BMA Response
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Remain opposed to commercialisation agenda
Proposals expensive at ‘time of austerity’
Transfer of PCT functions – crucial to sort out
Oppose localised education and training
Welcome reduction in top-down targets, but should
retain some process targets
• Sceptical about foundations trusts and social enterprise
• Oppose Monitor’s role in promoting competition
• Oppose local pay determination
Liberating the NHS:
Commissioning for patients - BMA Response
• ‘Local commissioning groups’ rather than
‘consortia’
• Joined up decision making required –
commissioning board, consortia and secondary
care specialists
• Maternity services should be commissioned at
consortia level
• Consortia federations & commissioning board
outposts?
Liberating the NHS:
Commissioning for patients - BMA Response (2)
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Importance of designing effective care pathways
Statutory role for LMCs
Commissioning / procurement split
Commissioning performance indicators should
not detriment patient care
Liberating the NHS: Local
democratic legitimacy in health- BMA Response
• Support in principle aim of increasing local
democracy
• Would like to see HealthWatch groups working
in conjunction with existing patient participation
groups
• ‘Choice’ emphasis could increase inequalities
• Health and wellbeing boards – should promote
integration across service
Liberating the NHS: Transparency
in outcomes – a framework for the NHS -BMA response
• Would not support the wholesale replacement of
process targets and indicators with clinical and
patient reported outcomes measures
• Clinical decisions should take precedence
• 150 standards with possible 1,500 targets –
potentially time consuming and bureaucratic
• Outcomes framework has potential to be overly
bureaucratic and risk averse – value for money?
Liberating the NHS: Regulating
healthcare providers - BMA Response
• Cannot support the abolition of cap on amount of income
foundation trusts can earn from other sources - incentive for
foundation trusts to undertake more private practice - two-tier
health service
• Statutory controls on borrowing should be retained - ensure that
financial risk can be properly managed
• Patient care should be paramount concern when considering
structural or governance changes
• Not convinced by merits of staff-only membership model
• Pressure on Trusts to reach Foundation Trust status potentially
detrimental
• Joint role of CQC and Monitor will be overly-bureaucratic and
costly
• Cannot support the unnessary enforcement of competition
White Paper proposals risks…
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Damage to doctor/patient relationship
Privatisation by the back-door
Funding formula not accurate
GPs blamed for cuts
GPs accused of making excessive profit
Enough local leaders with the right skills?
Enthusiasts without a mandate setting an
inappropriate agenda
…more risks…
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Some GP Consortia will fail – what then?
How to handle inherited or new debt
PCT implosion, loss of key staff and skills
Competition v collaboration
Conflict between practices
BMA therefore adopted position of “critical
engagement”
– Learn the lessons of PCG/PCT mergers
– Learn lessons of Fundholding
…and opportunities?
• Clinical leadership
• Real involvement in re-designing services and
improving services for patients
• New OOH services, 111 and life after NHS Direct
• Developing practices
• Developing meaningful partnerships between
consortia, LA, hospital trusts and consultants
• Reducing bureaucracy – how long will it last?
• Can we avoid the re-creation of PCTs?
Next steps?
• LMCs, PCT and existing PBC groups should work
together
• Resist PCT/SHA interference in consortium formation
• All practices in an area should be involved in discussions
about future arrangements
• Identify local skills and expertise
• Early collaboration with local consultants and public
health physicians
• Use BMA advice and support guides
• Respond to the White Paper consultation
GPC guidance on the
White Paper
- The GPC is producing a series of guidance
notes on the White Paper – 4 have been
published so far:
1. The Principles of Commissioning – A GPC
statement in the context of Liberating the NHS
Identifies a set of fundamental principles with regard to GP
commissioning which will define policy, inform debate and
negotiations, and ensure that good medical practice is enshrined
within these enhanced responsibilities
GPC guidance on the
White Paper (2)
2.Legal overview view and guidance on the
commissioning proposals
An introduction to issues that GPs may have to consider in terms of
legalities, education and training in preparation for the outcome of
the current consultation on the White Paper.
3.The Role of Local Medical Committees in
supporting the development of GP Consortia
Identifying a number of specific actions that the GPC believes LMCs
can and should takeover the next few months, in three main areas:
• Communication with GPs and Practices
• Support GPs in planning future consortia
• Build wider relationships
GPC guidance on the
White Paper (3)
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4.GP consortia commissioning – initial observations
a set of principles and practical observations that GPs
and LMCs should consider when beginning to explore
how these ideas will be put into practice. The document
covers:
formation of consortia
the size of a consortium
responsibilities and governance of consortia
funding of consortia and budget setting
importance of commissioning/contracting &
procurement split
working with specialists
Striking a balance
consultation
• Productive meetings held with a number of
patient organisations to discuss our consultation
document
• Seeking patient views on:
- the make-up of the general practice team
- appointments and service
- care outside of normal working hours
- continuity and coordinating care in the NHS
• Early 2011 – plan to launch document with our
results and findings
EEQ 2008/09 results – contractor GPs
• £99,200 for GMS GPs (a decrease of 1.2% since 2007/08)
– £95,900 for GMS non-dispensing GPs (a decrease of 0.3% since 2007/08)
– £116,500 for GMS dispensing GPs (a decrease of 4.3% since 2007/08)
• £116,300 for PMS GPs
– £113,900 for PMS non-dispensing GPs
– £132,200 for PMS dispensing GPs
• £105,300 for all GPMS GPs (a decrease of 0.7% since 2007/08)
• 6.35% GPMS average increase per year 2002/03 to 2008/09
• 4.35 %GPMS average decrease 2005/06 to 2008/09 (-6.6% GMS
non-dispensing)
EEQ 2008/09 results
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(2)
Average net profit for contractor GPs in 2008/09 by country
was:
£109,600 in England (a decrease of 0.5% since 2007/08)
£89,700 in Northern Ireland (a decrease of 1.5% since 2007/08)
£86,500 in Scotland (a decrease of 1.0% since 2007/08)
£90,700 in Wales (a decrease of 2.9% since 2007/08))
Salaried GPs
• For all UK GPMS GPs identified as being salaried in 2008/09
(having more employed income than self-employed income)
average pre-tax earnings from all sources of income reported were
£57,300, an increase on the 2007/08 figure of 2.7%
Revalidation
• Future of revalidation less certain under new government
• Letter from Andrew Lansley to GMC – piloting period to
be extended by 12 months
• GMC to “simplify and streamline” revalidation proposals
following consultation – further news expected in early
Autumn
• RCGP pilots suggest some problems, particularly for
distinct groups – eg sessional, part-time GPs
• Abolition of PCTs adds further uncertainty – eg where
will ROs sit?
Care Quality Commission
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NHS GP practices will need to be registered by 1st
April 2012
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CQC is engaging the GPC and other stakeholders
in the development of its requirements for registration
and mechanisms for compliance monitoring
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A quality and risk profile for each registered provider
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QOF organisational indicators that will support CQC
registration need to be kept
IM&T
• Information Strategy expected in early October
• DH confirmed National Programme to be locally
managed/implemented BUT
• National standards/accreditation for IT systems
e.g. GPSoC, GP2GP, Choose & Book
• Joint GPC/RCGP IT Committee will continue to
be consulted on national standards/accreditation
Summary Care Record
• Ministerial Review to be completed by 30
September
• Review in two parts & GPC represented on both
• 1st review group is examining what the content
of the SCR should be
• 2nd review group is examining the patient
information and preference/choice i.e. the
consent model
• no date for ministerial announcement
Dispensing
• Cost of Service Inquiry (COSI) now completed
• COSI will inform future negotiations on the
feescale
• Feescale to be cut from 1st October due to
"over-delivery"
• Work ongoing on new Pharmaceutical Service
Regulations (PhS)
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
practices
BMA 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?