The new GP contract deal for the next four years has been agreed by NHS England and the BMA GP Committee. Pulse Intelligence outlines the headline changes below.
Global Sum payment is increasing to £93.46 per weighted patient – a £3.58 (4%) increase from £89.88 in 2019/20.
Value of a QOF point will be £194.83, up from £187.74 in 2019/20.
An above inflation pay uplift for staff is indicated, as agreed in the 2019/20 deal.
Extra investment to employ 6,000 extra staff to expand the Additional Roles Reimbursement Scheme – providing £150m in 2020/21, £300m in 2021/2022, £300m in 2022/23 and £300m in 2023/24.
Funding of £94m to address recruitment and retention issues, including a ‘partnership premium’ – a one-off payment of £20,000 available to new partners (which could include pharmacists or nurses), with additional funding for training support that extends to practice managers and other staff.
£173m for Primary Care Networks (PCNs) to employ a wider range of professionals to help manage workload and provide appointments. These are additional to the five previously agreed additional roles (social prescribing link workers, clinical pharmacists, physiotherapists, paramedics, physician associates).
Reimbursement to be increased so that 100% of costs of employing all additional staff recruited via PCNs will be reimbursed – including all the extra roles, namely pharmacy technicians, care co-ordinators, health and wellbeing coaches, dietitians, podiatrists and occupational therapists from 2020; mental health professionals from 2021.
This move to 100% reimbursement should free up the existing £1.50 a head administration payment for PCN management support.
Three services – Structured medication review and medicines optimisation, Enhanced health in care homes and Supporting early cancer diagnosis – will go ahead this year, with revisions to the draft requirements published in December.
A new care home premium payment, worth £120 per bed per year, will be introduced when the service goes live from 30 September 2020. A delivery plan for the new service will be agreed by 31 July. The earlier proposed requirement for fortnightly face-to-face medical input to care home reviews has been dropped, with medical input to be ‘appropriate and consistent’ based on local clinical judgement by the PCN.
The volume of structured medicines reviews undertaken will be ‘determined and limited by the clinical pharmacist capacity of the PCN’.
The two other service specifications due to be introduced this year – Anticipatory Care and Personalised Care – are to be deferred until 2020/21, alongside the remaining two – CVD diagnosis and prevention, following negotiation with GPC England.
This is funding related to NHS long-term plan goals, which will operate in a similar way to QOF.
Eight indicators are included in 2020/21, relating to seasonal flu vaccination, health checks for people with a learning disability, social prescribing referrals, and prescribing.
The fund will be worth £40.5m in 2020/21.
In 2021/22 existing practices and PCNs will be auto-enrolled to the Network Contract DES, with an annual one-month window in which practices will be able to opt-out, or opt-in if they are not currently participating.
Vaccinations/immunisations to be brought under essential services in 2020, with new core contractual standards. Standardised item of service payments are to be introduced over the next two years, and new incentive payments as part of QOF will replace the Childhood Immunisation DES.
The asthma, COPD and heart failure domains have been overhauled, with 97 points recycled into 11 more clinically appropriate indicators. £10m worth of funding will support a new indicator on non-diabetic hyperglycaemia worth 18 points. This brings the total number of available QOF points to 567.
Maternity services become an essential service – with £12m funding to support practices to deliver a 6–8 week postnatal health check for new mothers.
From April 2020, GPs on the Induction and Refresher Scheme with children aged under 11 will be able to claim £2,000 towards childcare costs for each child (or £1,000 for those on the Portfolio Route).
There will also be enhanced shared parental leave arrangements for salaried GPs.
GP trainee places are to increase to 4,000 a year from 2021 – up from the current 3,500.
From 2022, 24 months of the 36-month training period will be spent in general practice, instead of the current 18 months.
The Targeted Enhanced Recruitment Scheme (TERs) offering a one-off £20,000 payment to GP trainees who take up roles in under-doctored areas, will be expanded: from 276 places now, to 500 in 2021, and 800 in 2022.
All international medical graduates entering GP training from 2020/21 will be offered a fixed five-year NHS contract.
As agreed in the five-year deal, a new, ‘as close to real time as possible and transparent’ measure of patient experience will be designed and tested in 2020, for nationwide introduction by no later than 1 April 2021.
At least £30m of the £150m PCN Investment and Impact Fund in 2021/22 will support improved access for patients, rising to at least £100m of the £300m Fund in 2023/24.
Progress against the new patient reported experience metric will be supported by the new PCN Investment and Impact Fund in 2021/22, when at least £30m of the £150m Fund will be directed at improving access. The measure is to be introduced ‘as early as possible’ across all practices in England during 2020/21, and to begin incentivising performance against it at the equivalent rate of £30m/annum pro-rata.
From October 2020 there will be an update to GMS regulations regarding the right of practices to remove a patient from their list if they become aware the patient has previously been removed from another GP practice list for committing or threatening an act of violence. The change will clarify that patients should not be removed from the list if, having been previously removed from a GP practice list and entered into a Special Allocation Scheme for violent patients, they have subsequently been discharged for reintegration into mainstream primary care.
Source: NHS England – Update to the GP contract agreement 2020/21 – 2023/24. Published 6 February 2020.
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