The Future for General Practice

Dr Richard Vautrey Deputy Chair BMA GP committee

Why GPs are unhappy?

• Contract imposition • Increased workload • Reduced quality • Reduced income • Government and media attacks • Fear that worse is yet to come

Contract changes

 Phase out correction factor payments over 7 years  Review PMS funding to reduce variability in practice funding  Implement

all

by NICE changes to QOF recommended  Reduce the time period for achieving most indicators from 15 to 12 months

Contract changes (2)

     Increase upper thresholds for QOF indicators to match upper quartile achievement Remove the whole organisational domain leaving 900 point QOF Reform the QOF Contractor Population Index (CPI) New immunisations  rotavirus added to childhood immunisations  shingles for patients aged 70 and catch-up programme   flu for 2 year olds MMR catch up Introduce significant new work through DESs

Why GPs are unhappy: workload

   More box ticking - unworkable and underpriced new work in QOF  Shifting the goal posts - chasing points at QOF margins - reducing time available to meet targets - requirements for additional training Impact on access Impact on secondary care

Why GPs are unhappy: Quality of QOF

  Clinical problems with clinical QOF changes:  Unworkable new indicators, unavailable services  Changed blood pressure targets + higher thresholds  polypharmacy Repetitive or inappropriate questioning Rise in exception reporting  Less time for holistic patient care

Why GPs are unhappy: Quality and workload of DESs

 Online patient access DES – Risk of e-consultations and inappropriate on-line access to records. – Could widen health inequalities   Risk profiling – Volume planned in gift of CCG – could be unmanageable  Case finding for dementia DES – Evidence for dementia screening lacking and could cause harm – Will come at cost of other patient care – Real problem is lack of services Remote care monitoring – Preparation for next year

Why GPs are unhappy: Uncertainty about LESs

• Local authority commissioning • Standard contract • Impact of LA budget cuts?

• Any Qualified Provider

Some (slightly) good news

• Rotavirus • Shingles – for 70 year olds + catch up programme – £7.64 per dose • Seasonal flu for 2 year olds – could be extended next year • MMR catch up – additional services 10-15 years olds – £7.64 for 16 years + – £1.50 per invitation letter

Why we should all be concerned: funding

Average practice 2014-2015, threshold QOF loss + organisational point loss =

+ = £11,300 £19,800 £31,100

Potentially bigger loss from PMS and CF changes

Funding redistribution: Good news for some, bad news for many

    Major redistribution of funding from 2014 Difficult to predict new global sum figure Not clear whether PMS money will be re-invested in GMS Some practices will be seriously destabilised, others will gain – High funded PMS practices – almost certainly under current plans – Practices with large correction factors – probably depending on global sum increases – Not clear what will happen for legitimate outliers .

Unhappy locums and practices

 Responsibility for locum superannuation payments to move to practices   Transfer of funds into contract to cover this Practices use locums differently, likely to have disproportionate impact on small practices  Likely to be bad for younger locums  Removal of locum appraisal payments

And to add to the woe…

        Commissioning and CCGs CQC registration Revalidation Pension changes NHS 111 7 day working Commercialisation and fragmentation of the NHS Recruitment and retention crisis

What might practices do?

 Protect their patients    Not chasing targets that put patients at risk Limit workload to maintain quality Avoid skill-mixing that undermines quality  Prioritise their practice    Do important QOF areas in 9 months Consider cost of external engagement Say no to unresourced workload shift

What might practices do? (2)

 Develop their practice  AQP provider services  Work with others    Federations, larger practices Shared staff Shared training  Protect GPs    Work-life balance Partnership v salaried GP Retirement

Conclusion

• Increased workload • Decreased income • Impact on quality • Increased stress and burnout So….

• Time to become more business-like • Time to protect patients, GPs and practices

Questions and discussion