Transcript NEW GMS CONTRACT

NEW GMS CONTRACT
Stephen Newell
Linda Turner
Susan Watts
WHEN?
COMMENCES 1.4.04
WHY DID GP’S VOTE YES?
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No “Red Book”
No Items of Service (IOS)
No over 75 or 3 yearly checks
No Staff reimbursement
No Saturday mornings
No out of hours (OOHs) – can opt out
No permission required for new partners
SOME IMPROVEMENTS
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Increased investment in primary care
Incremental payments for quality
Exception reporting for quality payments
100% reimbursement of computer costs
Opt in to enhanced services
End of 24 hour responsibility
GP pensions
GP seniority payments
SOME CONCERNS
Funding
 Transition
 IT
 Lack of clarity
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CLINICAL SERVICES
Essential
 Additional
 Directed Enhanced
 National Enhanced
 Local Enhanced
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ESSENTIAL
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Medical management of patients who are
(or believe themselves to be) ill, health
promotion advice and referral as
appropriate – reflecting patient choice
General management of terminally ill
patients
Management of chronic disease – in
discussion with patient
ADDITIONAL
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SERVICES
 Cervical screening
 Contraceptive services
 Vaccs and Imms
 CHS
 Maternity Services
 Minor Surgery
OPT OUT
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Can opt out of additional services but will
loose approximately 10% of global sum if
you opt out of all additional services.
DIRECTED ENHANCED
Access to GMS
 Childhood Vaccs & Imms
 Influenza Vaccs (over 65’s and at risk)
 Quality Information Preparation (1st 2 years
only)
 Services to support staff dealing with
violent patients
 Enhanced minor surgery
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NATIONAL ENHANCED
Patients who are alcohol misusers
 Anti coagulant monitoring
 IUCD fittings
 Specialised care for patients with depression
 Patients suffering from drug misuse
 Provision of immediate care and first
response care
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Enhanced care of the homeless
 Intra partum care
 Minor injuries services
 More specialised services for patients with
MS
 Provision of near-patient testing, etc etc.
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LOCAL ENHANCED
PCT will decide what is needed
 Local terms and conditions
 Developed in response to local needs, e.g.
diabetic service
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OUT OF HOURS
COVERS 18.30 – 08.00 EVERY DAY
 WEEKENDS
 BANK HOLIDAYS
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IF YOU OPT OUT YOU LOSE ABOUT
6% OF GLOBAL SUM
4 QUALITY DOMAINS
CLINICAL
 ADDITIONAL SERVICES
 ORGANISATIONAL
 PATIENT EXPERIENCE
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PLUS
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CONTRACTUAL & STATUTORY
REQUIREMENTS
CLINICAL
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Asthma
Cancer
CHD (including LVD)
COPD
Diabetes
Epilepsy
Hypertension
Hypothyroidism
Mental Health
Stroke or TIA
Additional Services
Cervical Screening
 Child Health Surveillance
 Contraceptive Services
 Maternity Services
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EXCEPTIONS
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Patients who refuse to attend on 3 occasions
New or recently diagnosed patients
If treatment is not clinically appropriate
Patient has refused (given informed dissent)
Patient cannot tolerate treatment
Patient already taking maximum medication
Patient has another condition that affects treatment
ORGANISATIONAL
Records and information
 Patient communication
 Education and training
 Practice management
 Medicines management
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PATIENT EXPERIENCE
Length of consultation
 Annual patient questionnaires
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CONTRACTUAL AND
STATUTORY
REQUIREMENTS
NO POINTS ATTACHED
 NO CHOICE
 MUST DO
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EXTRA PAYMENTS
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Holistic Care payments
 Encourages breadth of clinical care
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Quality Practice payments
 Encourages achievement across the
whole range of indicators, not just
clinical.
ACCESS
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Extra points
Maintaining access targets
 Maintaining quality
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REPORTING
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LARGELY BASED ON TRUST:
 Data entry during consultation including
telephone calls / consultations
 Audit generated by normal work
 Virtually no claims or paperwork
 Annual report on computer
 Annual visit from PCT to check report
 Appeals process if disagree with PCT
PATIENT FLOWS
Practice Area
 Patient choice
 Removals
 Allocations
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SUMMARY
There are:
 76 Clinical indicators
 10 standards for Additional Services
 56 Organisational indicators
 4 Patient Experience requirements
 26 Contractual and Statutory requirements