Investing in general practice - the new general medical services contract
Supporting information for Scotland
16 May 2003
This document should be read in conjunction with “Investing in General Practice : The New General Medical Services Contract”, published in February 2003 and the additional UK-wide information pack published 6 May 2003.
Introduction
1. If accepted by the profession, the new GMS contract will represent a landmark development for Scottish general practice. There are aspects of the new contract which, subject to the outcome of the ballot, will be taken forward in Scotland in ways which reflect distinctive Scottish circumstances and approaches relative to the rest of the UK. These are outlined in this paper. In some cases these are specific issues relating closely to the contract itself; in others they relate to broader key areas where policy in Scotland may differ from the rest of the UK (in these cases some background information is included). In order to realise the full benefits of the new contract for Scottish patients, GPs, primary care and NHSScotland as a whole, it is important that the new GMS contract integrates and operates effectively with Scotland’s overall approach to healthcare delivery.
2. In summary, this document covers the following aspects of the new GMS contract (with identified chapters) which have a Scottish dimension:
· Human resource management and improving working lives (Chapter 4)
· Modernising information management and technology (Chapter 4)
· Premises (Chapter 4)
· Scottish adjustments to the UK allocation formula (Chapter 5)
· Specific arrangements for remote and rural areas of Scotland (Chapter 5)
· Responsibilities of patients and demand management (Chapter 6)
· Working in partnership (Chapter 6)
· Dispute resolution and appeals (Chapter 7)
· Legislation (Chapter 7)
· Implementation (Chapter 8)
In addition it also includes a specific Scottish Glossary of Terms and a detailed breakdown of the Scottish Funding Envelope.
Human resource management and improving working lives (Chapter 4)
3. Chapter 4 of the contract outlines ways in which the new arrangements will support practices through the management of human resources. Background information on Scottish Executive policy in this area can be found in the following publications:
· Towards a New Way of Working, Scottish Executive Health Department, April 1998
· Our National Health, Scottish Executive Health Department, December 2000
· Staff Governance Standard, Scottish Executive Health Department, April 2002
· Partnership for Care, Scottish Executive Health Department, February 2003
Modernising information management and technology (IM&T) (Chapter 4)
4. Scotland has taken a different approach to the provision of IM&T compared to the other UK countries due to the presence of the publicly-funded GPASS system, currently used by over 80% of Scottish practices. SEHD has undertaken that GPASS will be developed to meet the demands of the new contract, as well as the Ritchie review, whilst also ensuring that Scottish practices have a choice of RFA-accredited GP clinical systems. The option for GP practices to use UK-standard software under the contract will be supported, subject to that software being modified to work with NHSScotland's IM&T systems.
5. The IM&T provisions outlined at Chapter 4 of the contract formalise a four-country approach to IM&T but allow for implementation to be customised across the four countries to deliver compatibility with national and local IM & T strategies, which themselves extend well beyond GP IM& T.
6. Further work will continue with GPC/SGPC and NHSScotland working groups to ensure that detailed implementation arrangements are workable and build on existing Scottish arrangements, enshrining the spirit of the provisions outlined at Chapter 4 and delivering value for money. It is intended therefore to make optimum use of the Common Services Agency to co-ordinate and help deliver the new GMS IM&T challenges which NHS Boards will face in Scotland.
7. It will also be important to progress more effective co-operative arrangements across all the UK countries to help ensure that the demanding IM&T programme arising from the new contract is delivered in Scotland as expeditiously and beneficially as possible. The Scottish IM&T strategy will in due course be refreshed to include the arrangements set out in the new GMS contract
8. The Read Code guidance published on the BMA website has unfortunately been found to require further work. Specific guidance for Scottish practices is near completion and, when finalised, will be available to all Scottish practices on the Scottish Clinical Information Management in Primary Care (SCIMP) website.
Premises (Chapter 4)
9. Chapter 4 sets out a broad package of revised premises quality standards and new flexibilities, some of which are already in place in Scotland. However there may be a need to customise some of these to suit specific Scottish circumstances.
10. Furthermore, given differences in local NHS structures and organisations across the four UK countries a different funding flow for GP premises will be required in Scotland.
11. All premises funding will in due course be locally managed within cash limited Unified Budgets. In the interim period Scottish transitional arrangements will provide an identified funding stream dedicated to premises expenditure. This will ensure that existing commitments to GMS providers are met, new investment is targeted in the most appropriate localities, and that third party landlords or developers are not exposed to undue risk.
Existing commitments
12. Existing spend and additional funds needed to support new projects that have already been agreed between practices and NHS Boards, will be guaranteed to NHS Boards as a baseline. This baseline will be uprated annually for inflation, based on the Valuation Office Agency’s (VOA's) knowledge of the local market in each NHS Board area in Scotland.
New investment for growth
13. In principle decisions in Scotland on allocating recurring growth money over and above existing commitments will be taken centrally after consultation with NHS Boards.
14. Decisions will need to be informed by the relative sums available and therefore it may be that not all new nominated projects will be fundable in any particular year.
15. The guiding principles for allocating growth monies will be:
· The actual need identified by NHS Boards as demonstrated by the projects listed in their local plans.
· NHS Boards’ own prioritisation and timing of projects within their local plans.
· Relative need between NHS Boards as determined by the Scottish Allocation Formula (the needs-based formula for GMS funding in Scotland – see paragraphs 25 to 40).
Given variations in existing standards of premises across the country and the differing degrees of readiness of local development plans, we believe that this arrangement is likely to deliver the most effective additional short-term programme of new investment.
16. To inform this process effectively NHS Boards will be expected to maintain, as part of their overall Property Strategies and in conjunction with all local partners, rolling 3-year GP practice premises development programmes.
17. Once agreement has been reached for a programme to go ahead, funding will be allocated recurrently to the NHS Board to meet the revenue consequences of new capital investment as each project comes on stream.
18. This will provide GP practices and the private sector with assurances on the availability of funding on an ongoing basis to support premises developments already agreed by NHS Boards.
19. To parallel NHS Board plans, allocations will be firm for Year 1 and indicative for Years 2 & 3. Mechanisms will also be put in place to ensure that the full value of the growth monies is achieved (as experience suggests that there may be slippage in some projects) by bringing forward other developments already approved, or by starting new opportunistic projects which are important local priorities.
Arrangements for 2003-4
20. In 2003-04 premises expenditure will be funded through existing funding streams. Thus both existing and new investment on actual and notional recurring rental payments will continue to be met from GMS non-cash-limited funding, having regard to the principles and approval process outlined above for new investment. It is also intended that the costs of all the new flexibilities that involve a payment to GPs should, transitionally, be met in 2003-4 from the existing GMS non-cash limited funding stream. Cost rents, Improvement Grants and grants to surrender leases will continue to be met from NHS Boards’ cash-limited unified budgets.
Next Steps
21. Work is already in hand in Scotland, on the basis of initial advice from NHS Boards, to model the resource implications of existing and planned investment. NHS Boards will, however, be invited to confirm development plans before budgets are finalised.
Branch surgeries
22. Certain other provisions relating to branch surgeries are also outlined at Section 4.53 to 4.58 of the contract. Implementation of the new contract may have implications in Scotland for the funding of branch surgery provision and practices may need to consider the reconfiguration of services to best meet the needs of both patients and the practice.
23. Branch surgeries can improve access to health services for isolated communities and have the potential to act as a focus for wider outreach services. It will therefore be necessary to ensure that branch surgery closure decisions are taken only after full consultation with local communities and other interested parties; and that they are not taken in isolation from other local strategies designed to improve patient access to services.
24. By way of background, ‘Partnership for Care’ includes the following references which are relevant to all Primary Care premises planning: Chapter 4 paragraphs 11 to 30 cover Health Services in the Community ands Partnership with Social Care; Chapter 5 paragraphs 50 to 56 cover Public Involvement.
Scottish adjustments to the UK allocation formula (Chapter 5)
Introduction
25. The following note is an explanation of the Scottish Allocation Formula (SAF) for General Medical Services (GMS) as part of the new contract. Under the terms of the new contract, the SAF will replace the current ‘Red Book of Fees and Allowances’ as an important element in determining remuneration for GMS in Scotland.
26. The SAF is a resource allocation formula that will allocate resources to practices on the basis of the relative needs of their patients and the associated workload for GPs. The SAF will be responsible for the allocation of a global sum to each practice. The global sum will account (on average) for 50-55 per cent of practices’ current fees and allowances in Scotland. The remainder of the resources available to GMS will flow through NHS Boards (including premises, IT and seniority), the quality-outcomes framework and enhanced services.
The Scottish Allocation Formula
27. The Scottish Allocation Formula (SAF) determines how the global sum in Scotland is distributed between GP practices; it does not inform the total size of the Scottish budget for the global sum. The SAF is a population based formula, at GP practice level, with a series of ‘weightings’ to reflect the relative needs of GMS patients and the additional costs of providing an adequate service in remote and rural areas of Scotland. The components of the SAF are:
· The GP practice population (total practice list size).
Adjusted for ‘weightings’ to reflect:
· The age and sex structure of the practice population (demography).
· The additional need of the practice population (morbidity and deprivation).
· The rurality and remoteness of the practice population.
There are other weights - set at a UK level - to reflect nursing and residential home patients, new registrations and staff costs, but these combined have for most practices a relatively minor effect compared with the above set of ‘weightings’.
GP Practice Population
28. The SAF uses a nominal list as the basis for each GP practice population. The nominal list is based on the registered list (information held by PSD) of the GP practice deflated to reflect ‘list inflation’ List inflation is the difference between registered list information and actual population data.. Unfortunately due to list inflation, registered list information is not an accurate population record. In addition, list inflation is not uniformly distributed between GP practices. Using registered list information as a basis of the SAF would disadvantage GP practices with accurate lists and effectively reward those with list inflation. At a UK level it has been agreed that registered lists should not be used as the basis for resource allocation until the problem of list inflation has been resolved. There is a commitment under the new GMS contract to eliminate the problem of list inflation from registration data, and to move to registered lists as the basis for allocation as soon as possible thereafter.
29. The deflation factor is applied at Local Authority (LA) level adjusted by age and sex. This means that even for GP practices within the same LA the deflation factor will differ because of the different age and sex characteristics between GP practice populations. Because of this adjustment for ‘list inflation’ the overwhelming majority of GP practices will receive a nominal list that is smaller than their registered list. This method is universally applied to all GP practices, but the intention is to move to registered list information as soon as all GP practice lists are free from the problem of ‘list inflation’.
30. It is important to understand that this method of list deflation will not affect the amount of money allocated to GMS through the global sum. At a patient level, the payment for a nominal patient is greater than for a registered patient.
Demography
31. The relative need for GMS will, to a significant extent, depend on the age and sex structure of the GP practice population. The population groups that are relatively intensive users of GP services are children, young women and older patients. The SAF includes a series of age and sex ‘weightings’ to allocate a greater share of resources to practices with greater proportions of high user patient groups than the Scottish average. The SAF age-sex consultation weights are based on data from the Continuous Morbidity Recording (CMR) practices Approximately 70 practices in Scotland provide monthly consultation returns to the CMR database..
Additional Need
32. The relative need for GMS will also depend on the socio-economic status of the GP practice population. People from deprived backgrounds typically have poorer health outcomes, higher morbidity and greater health needs. The SAF includes an index of deprivation and mortality to ‘weight’ the GP practice population on the basis of the following indicators:
· The unemployment rate.
· The proportion of elderly people claiming income support.
· The standardised mortality rate amongst people under the age of 65.
· Households with two or more indicators of deprivation.
A GP practice population with a higher proportion of high user patient groups - as defined by the above set of indicators - will receive a greater additional need ‘weighting’ under the SAF. The adjustment is based on evidence about the extent to which deprivation leads to increased needs for GMS.
Remote and Rural Areas
33. The costs of providing GMS in remote and rural locations are generally greater (per patient) than in urban population centres. The SAF therefore attempts to reflect this by ‘weighting’ practices for their remoteness and rurality. The three indicators that are used to reflect remoteness and rurality in the SAF are:
· The population density (hectares per resident) of the GP practice population.
· The population sparsity (the percentage of the population living in settlements of less than 500 residents) of the GP practice population.
· The percentage of patients in the GP practice population attracting road mileage payments.
This adjustment recognises the extra costs incurred in providing GMS services in remote and rural areas.
The Weighted Practice Population
34. The ‘weighted’ practice population or list is the nominal GP practice population adjusted to reflect the Scottish ‘weights’ for age-sex, additional need and remoteness and rurality. In earlier documents the ‘weighted’ practice population was sometimes referred to as the ‘notional’ practice population; the terms can be used interchangeably. The following illustrative example shows how the adjustments for age-sex, additional need and remoteness and rurality impact on the GP practices’ final allocation.
35. Suppose we have two practices A and B:
· Practice A is a small practice with 2,000 registered patients.
· Practice B is larger with 8,000 registered patients.
Practice A is in a poorer rural area, which is serving an ageing population. Practice B is located in an affluent urban area, serving a relatively young population. If a budget of £10,000 was divided between practices A and B on the basis of their registered lists, then practice A would receive £2,000 and practice B £8,000.
36. However, the basis for the allocation is not the registered but the ‘weighted’ lists of the two practices, A and B. Possible adjustments for practices A and B are shown in the following table:
Table - Illustrated Example
 | Practice A | Practice B | Total |
| | | |
| Registered List | 2,000 | 8,000 | 10,000 |
| Adjusted for ‘List Inflation’ | 1,800 | 7,600 | 9,400 |
| | | |
| Nominal List | 1,800 | 7,600 | 9,400 |
| | | |
| Age-Sex Adjustment | 1.10 | 0.95 | - |
| Deprivation Adjustment | 1.15 | 0.95 | - |
| Remote/Rural Adjustment | 1.20 | 0.97 | - |
| | | |
| Weighted List | 2,732 | 6,668 | 9,400 |
The nominal lists for practices A and B have been ‘deflated’ to reflect the impact of ‘list inflation’. Practice A has 10 per cent ‘list inflation’ and has lost 200 patients; practice B has 5 per cent ‘list inflation’ and has lost 400 patients.
The ‘weighted’ list for practice A is equal to (1,800 x 1.10 x 1.15 x 1.20 = 2,732 ‘weighted’ patients) and for practice B the relevant calculation is (7,600 x 0.95 x 0.95 x 0.97 = 6,668 ‘weighted’ patients). Practice A with 2,732 ‘weighted’ patients out of a total of 9,400 receives a final allocation of £2,900 (29 per cent of £10,000). Practice B receives £7,100 (71 per cent of £10,000).
37. The effect on the allocations for practices A and B is that £900 has been redistributed from practice B to practice A compared with what they would have received on the basis of their registered lists. Therefore, it is on the basis of the ‘weighted’ list that your practice’s indicative allocation for its share of the Scotland-wide global sum has been calculated.
Minimum Practice Income Guarantee (MPIG)
38. The minimum practice income guarantee (MPIG) will apply to all Scottish GP practices that qualify for this funding supplement. The method of calculation of MPIG in Scotland is identical to the rest of the UK, the only difference is that Scottish practices’ indicative allocations are based on the Scottish Allocation Formula. Any practice in Scotland with an indicative allocation, which is less than their equivalent ‘global sum’ fees and allowances would receive a MPIG after a deduction of the value of 100 quality points in 2004/05 (150 points in 2005/06).
Summary
39. In summary the main points are:
· The Scottish Allocation Formula (SAF) is a population-based formula that allocates resources according to relative patient need for GMS. The SAF will allocate a global sum for each practice in Scotland. There is no direct read across between the indicative global sum and current fees and allowances.
· The SAF uses registered practice population data, deflated to mitigate the problem of list inflation. The resultant nominal list is further ‘weighted’ for variations in demography, deprivation and remoteness and rurality between GP practice populations. The ‘weighted’ list is used to calculate the share of global sum resources that are allocated to the GP practice.
40. On a broader, more general note: in addition to the new funding streams outlined in the new contract, SEHD will ensure that existing funding flows to practices from NHS Board Unified Budgets will continue.
Specific arrangements for remote and rural areas of Scotland (Chapter 5)
41. As an accompaniment to Chapter 5 this section sets out the specific funding arrangements which will address the particular needs of rural and remote areas of Scotland.
Background
42. Scotland has traditionally borne excess costs to deliver GMS in remote and rural areas. These include, inter alia, payments under Section 10.5, rural practice and inducement. These payments have compensated for the fact that the existing SFA fees and allowances alone have not been sufficient to maintain GMS services in remote and rural areas. Despite these payments, recruitment and retention difficulties have arisen in these areas.
43. The Inducement Scheme in particular supports "essential" practices in particularly remote and sparsely populated areas by guaranteeing a level of income that is directly linked to the Intended Average Net Income (IANI) as set annually by the Doctors’ and Dentists’ Review Body (DDRB).
44. One of the major, and probably the single most important, disincentive to working in remote and rural areas is the out-of-hours commitment. However there are other issues related to the provision of a number of other services that are not usually provided by GPs in urban or semi-rural areas, such as first responder; mental health officer; major incident officer; minor injuries; and community hospital services. It is also the case that payment to inducement practitioners undertaking these services does not increase net practice income.
45. The new GMS contract, with the end of IANI, would see the replacement of the Inducement Practitioner Scheme with new contractual options.
46. Under the new GMS contract the following options are available:
a) independent contractor status under the new GMS contract, on the assumption that there is adequate funding for the practice through the standard arrangements applied across the UK (global sum, MPIG, quality payments, enhanced services payments and any additional out-of-hours payments (see paragraph 48));
b) a salaried GMS option under the new contract with UK-determined terms of service and pay scale, subject to local job evaluation;
In addition, the existing non-GMS contractual alternatives will continue to remain available.
Out-of-hours services
48. The aim in Scotland is to redesign services in an integrated way such that all (or virtually all) practices will be able to opt out of out-of-hours services. For the very few practices in the most isolated areas where, after local determination and after any appeal process, this is not possible the following specific arrangements will apply:
· retention by the practice of the agreed out-of-hours abatement for opting out;
· payment of the weighted capitation population share of what currently constitutes the Out-of-Hours Development Fund and any increased investment by NHS Boards for providing OOH services;
· additional payment to cover any differential between the total of these and the locally determined premium payable to salaried GMS practitioners for providing out-of-hours services. This additional differential payment will constitute the specific payment for practices deemed unable to exercise their right to opt-out of out-of-hours services.
· other measures to support practices who cannot opt out will be provided by the PCO as described in the framework document.
49. These proposals are consistent with the agreed principles that wherever possible remote and rural practices should be subject to exactly the same arrangements as other practices, and that any specific payment arrangements should reflect the additional costs of providing and maintaining services in remote and rural practices.
Responsibilities of patients and demand management (Chapter 6)
50. There are already a number of established Scottish approaches and mechanisms for addressing the areas detailed at paragraph 6.36 of the contract, which will continue to be taken forward. They include:
· the intended roll-out of minor illness management schemes, focusing particularly on effective linkages with community pharmacy services;
· the implementation of the Scottish Executive’s Patient Focus and Public Involvement Framework (2002) , which will see the development of a resource to support the d delivery of quality assured information for patients, accessible locally and Scotland wide.
· the provision of health education in schools through the 5-14 Health Education National Guidelines for Scottish schools; Health Promoting Schools; New Community Schools and the Scottish Framework for Nursing in Schools (2003).
51. These initiatives involve the direct engagement of a number of key stakeholders, including the Scottish Executive Health Department, NHS Health Scotland and the Scottish Executive Education Department.
Working in partnership (Chapter 6)
52. At its heart the new contract will enable the development of a new contractual arrangement between NHS Boards and their constituent GMS practices. A commitment to partnership working will be founded on existing arrangements such as NHS Boards, LHCCs (to become Community Health Partnerships), Managed Clinical Networks (MCNs) and regional service and workforce groups.
53. The new contract will support more effective integration and joint working between all relevant stakeholders in the wider ‘NHS family’.
Dispute resolution and appeals (Chapter 7)
54. The specific mechanisms, organisations and procedures for dispute resolution and appeals described at Chapter 7 do not apply to Scotland. Scottish arrangements for dispute resolution and appeals will be introduced in consultation with SGPC, based on the principles set out at Chapter 7, which the Scottish Executive Health Department is fully committed to, and will be taken forward as part of primary legislation required to deliver the contract.
Legislation (Chapter 7)
55. If the profession votes to accept the new contract, it cannot be implemented in full without changes to primary and secondary legislation.
56. Subject to the agreement of the new Administration after the Scottish Parliamentary Election in May 2003 primary legislation will be introduced in the summer of 2003. This will be followed by secondary legislation to make the necessary amendments to the GMS Regulations.
57. Subject to Parliamentary approval, it is intended that the changes will come into force by 1st April 2004.
Implementation (Chapter 8)
58. If the new contract is approved by GPs its implementation in Scotland will be part of a UK-wide programme adhering to common standards, principles and overall objectives. Implementation will also require the flexibility to reflect the different circumstances existing across the four UK countries, and delivery in Scotland will need to be responsive to this country’s unique characteristics in terms of size, geography and organisational structures;
59. Implementation will be pursued according to two timeframes:
- immediate introduction of the elements of the contract to be phased in from 2003-04, such as allocation of quality preparation resources, establishment of new arrangements for IM&T and premises, new seniority payments, and commissioning of enhanced services;
- implementation of the new contract in its entirety from April 2004, once the necessary primary legislation is in place, which will involve far-reaching changes over the medium to long term to the way primary care is delivered in Scotland.
60. Implementation will be taken forward through the active commitment and collaboration of all relevant players acting in partnership, including SEHD, NHSScotland, the profession and other bodies such as the Scottish NHS Confederation, not forgetting front-line staff themselves.
61. Delivery of the contract will be pursued at both national and local level, with close inter-play between the two. Activity at local level will be key to successful implementation, supported by the development of new relationships, organisational development, practical problem-solving and front-line ownership. This will be underpinned by national leadership, expertise and help, which will lend support to local efforts through the sharing of good practice, model templates and the provision of expertise.
62. In the following areas there will be a need for clear national direction on the approach to implementation:
- Scotland’s approach to the IM&T elements of the new contract;
- development and funding of GP practice premises;
- approaches to managing patient demands on GP practice services;
- modelling of new financial flows, including arrangements for payment to practices;
- the establishment of a Scotland-wide appeals process to cover various aspects of the contract;
63. This activity will be supported by a national reference group comprising key stakeholders, including from NHSScotland, the relevant professional representative bodies and SEHD. This group will also commission advice and ‘toolkits’ for the sharing of ideas and good practice on key issues arising from the contract. This advice would not be prescriptive, but would aim to respond flexibly to local needs by offering the Service model templates as guides to help inform the development of local mechanisms. Key project areas might include:
- development of model arrangements for maintaining services 24 hours a day, seven days a week;
- modelling arrangements for introduction, maintenance and monitoring of the Quality and Outcomes Framework;
- undertaking organisational development work, for example to help identify new stakeholder functions and relationships in local health systems. This could aid GP practice development and inform the role of Primary Care Trusts/NHS Boards and LHCCs in helping to deliver the contract;
- work to support the changes required to deliver the new financial arrangements underpinning the contract;
- work to model arrangements for handling the opportunity that GP practices will have to opt out of some services, or opt in to other services;
- work to model arrangements for rural and remote areas;
- work to inform arrangements for public and patient involvement.
65. The legislative changes needed to support implementation of the new contract will be undertaken by SEHD, in consultation with the relevant professional representative bodies and NHSScotland.
APPENDIX A
Investing in general practice
The New General Medical Services Contract
Scottish Glossary
This document is intended to be read in conjunction with the glossary to the UK contract and the Scottish annex : Supporting information for Scotland. It sets areas where definitions are different in Scotland.
Commission for Health Care, Audit and Inspection
Paragraph 3.38 (vi) refers to the role that the Commission for Healthcare Audit and Inspection will play in providing an independent inspection of achievement against the Quality & Outcomes framework. In Scotland, this role will fall to the Audit Commission and NHS Quality Improvement Scotland.
FHSAA and FHSAA(StHA)
Chapter 7 of the contract sets out the process for dispute resolution and appeals. It describes the roles of the FHSAA and FHSAA(StHA). Neither of these bodies have a remit in Scotland. Paragraph 44 of the Scottish annex makes it clear that separate arrangements will be required, underpinned by legislation. A fuller description of these arrangements will be issued as soon as is practicable.
LMC
In Scotland this refers to the Area Medical Committee GP sub committee.
PCOs
In Scotland the Primary Care Organisation will be the body with statutory responsibility for ensuring that services are provided. It will be the NHS Board in due course but the PCT or NHS Board in the interim.
Legislative references
The contract contains a number of references to primary and secondary legislation for England and Wales. The Scottish equivalents are listed below.
Non–NHS Work
Paragraph 2.29 of the contract refers to Paragraph 38 of the existing Terms of Service. In Scotland, this reference should be to Paragraph 36.
Service Changes
Paragraph 6.39 refers to section 11 of the Health & Social Care Act 2001 which governs how to inform patients of service changes. In Scotland the equivalent is the draft interim guidance on consultation and public involvement on service change, issued on 21st May 2002 under cover of HDL(2002)42.
Providers of Services
Paragraph 7.7 (ii) refers to the definition of ‘experienced;’ set out in the NHS Act 1977. In Scotland the equivalent is section 21 in the NHS (Scotland) Act 1978.
Indemnity Cover
Paragraph 7.35 refers to the section 9 of the Health Act 1999. In Scotland the equivalent is section 56 of the same Act.
Health Service Body
Paragraph 7.45 refers to section 4 of the NHS & Community Care Act 1990 and the NHS Contracts (Disputes Resolution) Regulations 1996. The equivalent provision in Scotland is section 17A of the 1978 Act.
APPENDIX B
Scottish Funding Envelope for the new GMS Contract
(£ million)
| Expenditure type | | | | | |
| | | | | |
| 2002/03 | 2003/04 | 2004/05 | 2005/06 | |
| | | | | |
| GMS Fees & Allowances | 325.0 | 335.5 | - | - | |
| GMS Cash Limited Payments (including IT, premises) | 101.1 | 102.7 | - | - | |
| Global Sum Payments | - | - | 279.6 | 283.7 | |
| Quality Payments | - | 8.0 | 68.2 | 110.2 | |
| Enhanced Primary Care Services | - | 11.9 | 34.9 | 43.9 | |
| Premises | - | 6.0 | 55.5 | 71.1 | |
| IT | - | 3.0 | 11.0 | 11.0 | |
| Other PCT Administered Funds | - | - | 34.7 | 37.1 | |
| MPIG | - | - | 20.0 | 10.0 | |
| Remote & Rural | 1.0 | 1.0 | - | - | |
| Out of Hours Development Fund | 5.9 | 6.3 | 6.8 | 8.0 | |
| Demand Management | - | - | - | - | |
| | | | | |
| Total expenditure | 433.0 | 474.4 | 510.7 | 575.0 | |
| | | | | |
| | | | | |
| Enhanced Primary Care Services - Further Breakdown | 2002/03 | 2003/04 | 2004/05 | 2005/06 | |
| | | | | |
| 1. Changing Patterns of Service Delivery | 0.0 | 9.9 | 16.7 | 23.5 | |
| | | | | |
| 2. Other Elements* | 0.0 | 2.0 | 18.2 | 20.4 | |
| | | | | |
| Total | 0.0 | 11.9 | 34.9 | 43.9 | |
| | | | | |
| * Includes existing LDS, Flu for over 65’s, childhood and pre-school vaccinations and immunisations | | | | | |
| | | | | |