Transcript Slide 1

GENERAL PRACTICE
The General Medical Services Contract and
the Key Documents
Marion Foster
Practice Manager
Objectives
Understand:
The Structure And Content Of The
nGMS Contract
Relevant Key Documents
Private trader at Work
Before the 20th century general practitioners worked as private traders, treating patients only if
they had the means to pay
National Insurance Act 1911
Lloyd George - Chancellor of the Exchequer
National Insurance Act 1911
Lloyd George Chancellor of the Exchequer
 National Insurance Act - Health insurance became compulsory for
working people on a low income.
 Patients paid Weekly contributions to The Club - Local insurance
committees administered the scheme
 Contracted Doctors were paid an annual capitation fee for every
insured patient on their panel.
Cronin’s novel “The Citadel” –
exploitation.
 Outliers’ prescribing - cod liver oil and malt instead of cod liver oil –
fined a year’s income.
Lord Beveridge
 Created the NHS
 Everyone became eligible for free primary care taxpayer funded medical treatment.
 National 'social security' benefit system introduced
- population would be protected from the 'cradle
to the grave'.
 The new system was partly built on the National
Insurance scheme set up by Lloyd George in 1911
1948
Key Dates
1952: College of General Practitioners is founded
1966: Family doctor charter facilitates payments for nursing staff and
buildings
1976: Primary care act requires general practice principals to do
vocational training
1990: General practice contract – HP Clinics- fundholding is introduced
1999: Fundholding is replaced by primary care groups and trusts
2004: nGMS Contract - Doctors are allowed to stop providing out of
hours care
nGMS CONTRACT DOCUMENTATION
 Not a single Document
 A collection of legal, practical, contractual,
financial and regulatory documentation and
guidance.
 National variations
The Key Documents
Investing in General Practice: the New Medical
Services Contract:
 “New GMS Contract”.
nGMS
UK profession was balloted on in June 2003.
The Key Documents
Standard GMS Contract:
 National standard contract template
 Used by PCOs and practices when drawing up GMS
contracts locally
 Contains all of the mandatory legal terms.
 Individual practice contracts with PCOs set out what
services are to be provided, the level of quality, the support
arrangements to be provided, and the financial resources.
The Key Documents
Statement of Financial Entitlements:
 The GMS contract’s financial arrangements
 Relates to the payments to be made by PCOs
to a contractor/practice.
Other The Key Documents
Partnership Agreement Guidance
Practice Financial Statements
Document Hierarchy
The GMS Contract
Contractual and
Statutory Requirements
Practice Policies and
Procedures
General Practice Contracting
Arrangements
 LOCAL ADMINISTRATION LEVEL:
 Scotland – PCO - Primary Care Organisations
 England - PCT - Primary Care Trusts
 Wales -
HB - Local Health Boards
 FOUR CONTRACTUAL METHODS:
 General Medical Services Contract (GMS)
 Personal Medical Services agreements (PMS)
 Alternative Provider Medical Services (APMS), and
 Primary Care Led Medical Services (PCTMS).
A contract between whom?
• Contract between a practice and a PCO
– all practice partners will enter contract with PCO
• Individual practice contractual terms come
from national “menu”
Practice Lists
Patients Registered with Practice not GP
New Patient Right to See GP of Choice- Wait longer
Refer to another clinician if doesn’t provide service
Patient’s Choice & Expectations
Practice Lists
Discuss
The nGMS Contract included specific rules on:
Registering patients
Refusal to Register
Removal from the Practice list
Who May Receive Primary Medical
Services?
REGISTERED PATIENTS
What is a TEMPORARY RESIDENT (TR)?
If the practice is very busy and the TR has an urgent
problem, is it reasonable to advice the TR to try
another practice who may have an earlier
appointment?
Immediate Necessary Treatment
Must also provide primary medical services
required in core hours for any person (to whom
the practice has been requested to provide
treatment) owing to accident or emergency at any
place in practice area
This includes any medical emergency not just
services provided under this contract.
The Contract “Menu”
Five Types Of Service
“Normal” services
1. Essential
2. Additional
“ Supplementary”
services
1. Directed Enhanced
2. National Enhanced
3. Local Enhanced
Essential Services - Mandatory
 Practices must provide the following services during core hours (8am6.30pm)
 Management of its registered patients & temporary residents (TR) who
are:
 ill, or believe themselves to be ill, with conditions from which recovery in
generally expected
 terminally ill
 suffering from chronic disease
 Delivered in the manner determined by the practice in discussion with
the patient.
Additional Services
 Normally expected of all practices but OPT-OUT possible
 These will mainly include services which are preventative:
 CHS
 Non-IUD contraception
 Non-intra partum maternity
 Childhood vaccinations and immunisations
 Cervical screening
 Curettage, cautery and cryocautery
Opting-out
 Temporary (emergencies) or permanent (long-term problems)
 PCOs and practices working together
 Maximum 9-month process
 Alternatives – other practices, PCO, other providers e.g. walk-in
centres
 Money removed from practice global sum
 If practices opt out of additional services, it’s global sum will change
but not it’s correction factor
 Patient access to services protected
Directed Enhanced Services - DES
OPT-IN for practice
OBLIGATORY for each PCO
National specifications
No one practice has to do but someone has to
 Services to violent patients
 Childhood vaccinations and immunisations financial
incentives
 Minor surgery
 Flu immunisations
National Enhanced Services - NES
 OPT-IN for each PCO - national terms and
conditions
e.g.
 Anticoagulant monitoring
 IUCD
 Drug and alcohol misuse
 Intra partum care
 Near-patient testing
 Minor injuries
Local Enhanced Services
OPT-IN for each PCO
Response to specific local requirements
Local terms, conditions and standards
Possibly, innovative services for piloting and
evaluation
Payments
Seniority & Other Payments
Quality & Outcome Framework
Enhanced Services
Global Sum or
Minimum Practice Income Guarantee
3
GLOBAL SUM
ESSENTIAL
&
ADDITIONAL
PREMISES
PROTECTED
TIME
QOF - ASSURED
QUALITY
MONEY
UNIFIED BUDGET
FUNDS
DIRECTED AND
NATIONAL
ENHANCED
PCO
£
PCO-MANAGED
LOCAL
ENHANCED
GUARANTEED
FUND(S)
IT
PRACTICE
ALTERNATIVE
PROVIDER
GMS Contract Case Studies
4 discussion groups
Assign a note taker and presenter
1. What are the “Must Knows” or Key Points?
2. What are the potential risks and how can the risk be limited? What is
the relevant legislation if any?
3. What Policies and Procedure should be in place?
Case Studies
4 discussion groups
Assign a note taker and presenter
1. Statement of Financial Entitlement Case Studies
2. Partnership Agreement Case Studies
3. Practice Accounts Case Studies