From your BMA GPs committee chair
The 2017/18 GMS Contract is now live – make sure you know how the changes affect you
I am writing to remind you that the revised 2017/18 GMS contract is now live as of April 1st 2017.
GPC has worked hard to negotiate with NHS Employers changes we believe offer significant improvements to the contract and will benefit and better support GPs and practice teams.
You can read more about the details of the contract in our dedicated contract webpage here, but I have summarised below the main changes, and highlighted the actions which you and your practice may need to take:
Discontinuation of Avoiding Unplanned Admissions DES (AUA)
The AUA DES has now been discontinued. You no longer need to collect reporting data regarding care plans or submit claim forms. The corresponding £156.7m has been transferred to global sum, and which will be reflected in your monthly G/PMS statements from April onwards.
From 1 July 2017 practices will use an appropriate tool to identify patients aged 65 and over who are living with moderate and severe frailty. For those patients identified as living with severe frailty, the practice will deliver a clinical review providing an annual medication review and where clinically appropriate discuss whether the patient has fallen in the last 12 months and provide any other clinically relevant interventions. In addition, where a patient does not already have an enriched Summary Care Record (SCR) the practice will promote this seeking informed patient consent to activate the enriched SCR.
Action: Further guidance from GPC and NHS England will be available shortly regarding how to implement this requirement as of 1st July 2017
We have secured, for the first time, full reimbursement of practices’ total CQC fees. A system of direct reimbursement will be introduced whereby practices will submit their paid invoices to NHS England or their CCG (under delegated commissioning) and will receive full reimbursement of their actual costs.
Action: Once you have paid your CQC fees, proof of payment will need to be submitted to your local NHS England team or CCG in areas of delegated commissioning. Full details of the process will be provided to local areas shortly.
We have agreed £30m to cover the rises this year in indemnity insurance costs. This has been based on figures received from medical indemnity organisations, to cover GMS work. This is being paid to practices on a non-weighted per patient basis (i.e. not subject to the Carr-Hill formula).
Action: A figure of £0.516 per head should have been received by practices as part of the March G/PMS monthly payments – please check your statement. Practices are contractually required to ensure that principal and salaried GPs who are paying for part or all of their indemnity costs, are reimbursed, from the payment received, an appropriate proportion of the amount which the GP has paid for their cover. The reimbursement amount should be based on the proportion of GMS services which the GP is providing for the practice.
Locum GPs will need to ensure that their invoices/agreements with practices are uplifted appropriately to take account of this business expense if they have not already done so.
See our indemnity payment briefing for further details.
Sickness cover reimbursement for GPs
From 1 April 2017, sickness cover reimbursement will no longer be a discretionary payment, but a practice entitlement. The qualifying criteria based on list size has been removed. Restrictions of cover being provided by a locum has been removed- and cover can now be provided from an existing practice GP who is not working full time. Payments will be made after 2 weeks of a GP being absent from the practice due to sick leave. The maximum amount payable has been increased to £1734.18 per week. We have also negotiated ending pro-rata payments – practices will be paid on their invoiced cover up to the maximum allowable.
Action: Practices should notify NHS England of an absent GP due to sick leave, using relevant claim forms as presently. Practices may wish to review their locum insurance policies in light of these changes.
Maternity cover reimbursement
From 1 April 2017, maternity payments will no longer be subject to a pro-rata application. Practices will be paid the full invoiced amount up to the maximum payable.
Action: No change to current process – practices to continue to complete relevant documentation and submit invoices to their CCG or NHS England area team for maternity cover payments.
Learning Disabilities DES
We have negotiated that payments for the Learning Disabilities DES health check will increase from £116 to £140. NHS England has also developed a voluntary template, which is available for practices to use should they choose to do so, but there is no obligation to use this.
No action to take
Expenses and pay uplift
We have agreed an increase in expenses that should deliver a pay uplift of 1%, which will be added to global sum. There will also be an uplift of £3.8 million to recognise increased superannuation costs of 0.08% as a result of changes to the NHS pension scheme to take effect in April 2017.
Agreement has also been reached for eligible practices to be reimbursed for all costs relating to levies incurred as a result of being in a Business Improvement District. The reimbursement is to be made via the Premises Costs Directions.
Payment for completion of workforce census
We have agreed that from 1 July 2017 completion of the workforce census will be a contractual requirement for every practice. This is something that most practices are already doing, and which was already a requirement on practices. We have however negotiated that £1.5 million will be added to global sum to recognise the workload involved.
GPC has raised concerns regarding the practicality for practices to provide the level of detail on locums working/who have worked at their practice. As a result, practices will be asked to provide the same information which has previously been required. Once a simplified mechanism for the effective capture of locum data has been developed, guidance materials will be issued.
Action: From 1 July, all practices will need to ensure that they have added the necessary information for their practice to allow extraction of the Workforce Minimum Dataset.
Quality and Outcomes Framework (QOF)
There will be no changes to the indicators in QOF or the total number of points. The value of a QOF point will increase by £6.02 (3.6%) from £165.18 in 2016/17 to £171.20 in 2017/18.
No action required
Core opening hours and Extended Hours DES
We have committed to working with NHS England to ensure locally responsive, safe and appropriate access to general practice for all patients in England during contracted hours, with a particular focus on the minority of practices which currently close for a half day on a weekly basis. Local Medical Committees should be integral partners in working with local commissioners in ensuring practices are fulfilling their contractual requirements.
New conditions will be introduced from October 2017 which will mean that practices who regularly close for a half day, on a weekly basis, will not ordinarily qualify to deliver the Extended Hours DES.
Action: Further guidance will be provided shortly. Those practices which regularly close for a half day on a weekly basis, should start planning for October 2017, and consider whether they wish to to cease closing for a half day (and be eligible for extended hours DES payments) or to end participating in the extended hours DES.
Access to healthcare
We have agreed with NHS Employers contractual changes that will help to identify patients with a non-UK issued EHIC (European Health Insurance Card or S1 form or who may be subject to the NHS (Charges to Overseas Visitors) Regulations 2015. New recurrent investment of £5 million will be added to global sum to support any associated administrative workload.
Once available, practices will use a revised GMS1 form for new patient registrations. This will require patients to self-declare that they hold either a non-UK issued EHIC or a S1 form. Once a practice has manually recorded that the patient holds either a non-UK issued EHIC or a S1 form in the patient’s medical record, they will then need to send the form and supplementary questions to NHS Digital (for non-UK issued EHIC cards) or the Overseas Healthcare Team (for S1 forms) via email or post. Details will be provided shortly about how to do this.
No action required at present. The new GMS1 form and copies of the patient leaflet will be provided to practices by NHS England once available, and supporting guidance will be published.
National diabetes audit (NDA)
From 1 July 2017 all practices will be contractually required to allow collection of data relating to the NDA.
No action required at present – guidance will be published on steps which practices will need to take.
Most practices are already enabling the extraction of data collection for a selection of agreed indicators no longer in QOF (INLIQ) and retired ESs. From July 2017 this will become a contractual requirement for all practices. This data will not be used for performance management processes and practices should not be focusing on recording data on indicators that are not in QOF unless it is clinically appropriate to do so.
No action required at present – guidance will be published on steps which practices will need to take, which will include those practices who do not already do so allowing data extraction.
Registration of prisoners
From 1 July 2017 prisoners will be able to register with a practice before they leave prison. The intention is for the timely transfer of clinical information, with an emphasis on medication history and substance misuse management plans.
No action required at present – further guidance will be published shortly.
Vaccinations and Immunisations
We have agreed to the following vaccination and immunisation programme changes from 1 April 2017:
− Childhood seasonal influenza – the removal of four year olds from enhanced service patient cohort (transferring to schools programme) and the removal of the requirement to use Child Health Information Systems (CHIS).
− Seasonal influenza – the inclusion of morbidly obese patients as an at-risk cohort and a reminder for practices that it is a contractual requirement to record all influenza vaccinations on ImmForm. £6.2m has been added to the contract to cover this expansion of the target group.
− Pertussis or pregnant women – a reduction in the eligibility of patients for vaccination from 20 weeks to 16 weeks.
− MenACWY programmes– a reduction in the upper age limit from ‘up to 26th birthday’ to ‘up to 25th birthday’ (in line with the Green Book).
− Shingles (routine) – a change in patient eligibility to the date the patient turns 70 rather than on 1 September.
− Shingles (catch-up) – a change in patient eligibility to the date the patient turns 78 rather than on 1 September.
Action: Practices will need to ensure that the above changes are reflected in their vaccinations and immunisations processes.
GP retention scheme
A new scheme has been agreed to replace the existing retention scheme. In 2016, under an interim scheme, the practice payment rose from £59.18 to £76.92 per session and this will continue in the 2017 scheme. We will shortly be publishing joint BMA, RCGP, HEE and NHS England guidance on the scheme.
Action: Practices should make themselves aware of these changes and make use of this facility where appropriate.
Please do make sure that GPs and relevant staff in the practice are aware of the above changes, and take any necessary action to ensure that you are working appropriately and realising the benefits which have been negotiated through these contract changes. Please also check your G/PMS statements to ensure that you are receiving monies as specified above.
GPC will continue provide you with further contract updates and guidance as they become available.
With best wishes,
BMA GPs committee chair
General Practice Roadshow: London, Wednesday 5th April
GPC is holding a roadshow for GPs in London on Wednesday 5 April 2017 at BMA House at 7 p.m in order to provide a detailed explanation of the 2017/18 GP contract agreement, as well as the General Practice Forward View implementation and the role of LMCs (focusing on funding streams and upcoming initiatives), secondary to primary care interface work, working at scale, issues for sessional GPs, as well as any other matters relevant to GPs.
This roadshow is a valuable opportunity for you to hear from Dr Chaand Nagpaul, chair GPC and members of the GPC Executive team on the key issues affecting general practice with an opportunity to ask questions afterwards.
The roadshow is free to attend and is open to all GPs in London. Registration is from 6.30pm for a prompt start at 7pm. Registration will be based on a first come first served basis as capacity is limited. Please register your interest here by Monday 3 April 2017.