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Contract news - Supporting GPs on the new GMS contract

April 2004

• Look out for your support pack
• Message from Dr John Chisholm, Chairman of the GPC
• Minimum practice income guarantee (MPIG)
• Sale of goodwill
• Updating contract information

Message from Dr John Chisholm, Chairman of the GPC
Much has happened since general practitioners expressed their widespread dissatisfaction with the old Red Book contract in the summer of 2001. You asked for a new national contract that would help you to control your workload and enable you to give your patients a better service. The GPC negotiators and I are hopeful that the new GMS contract will allow you to do this.

The GPC has produced this newsletter as part of our continuing commitment to ensure that all general practitioners are kept fully updated on the progress and development of the new GMS contract. It is being sent to all GPs, and can also be found in a support pack being sent to all practices in the next few weeks.

This message comes to you at an important time in the development and implementation of the new GMS contract. From 1 April 2004, the Red Book will be a thing of the past and GMS practices will start to operate under their new contracts. I know that there will continue to be challenges to be faced, but I am optimistic about this new contract and believe that practices will seize the many opportunities it offers to improve their working lives and the services they provide for their patients.

Over the last few weeks, practices in all four UK countries have been preparing for implementation of the new contract from 1 April. You have been in discussions with your Primary Care Organisations about the services you will provide and the level of quality to which you are aspiring and, with the help of your accountants and LMCs, have been getting to grips with your indicative financial allocations.

I know it has not been easy. A tremendous amount of work has been done both by practices and by Primary Care Organisations in the past few months, and a great deal of progress has been made in a relatively short period of time.

I believe that everyone’s hard work will be worthwhile. The new contract offers many benefits for patients, doctors and their staff. The significant additional resources for general practice will boost the incomes of most GPs substantially over the next three years. Practices will be able to hand over responsibility for out-of-hours care and the new contract offers practices the flexibility to configure services in the way that best meets the needs of their patients and suits the practice team.

Having said this, the contract is not perfect and we are by no means complacent. We will continue to deal with problems and concerns that arise from implementation. One of the major concerns is the unwillingness of some Primary Care Organisations to commission the enhanced services that patients need and practices are willing to provide. The Departments of Health must take steps to ensure patient services are put in place at a local level – this means paying practices to do the work.

The contract is an evolving contract and its development is an ongoing process. Just as the next year brings new challenges for you, so it does for the GPC. Just a few of these include:

- new payments systems to deliver actual global sum and Minimum Practice Income Guarantee allocations
- the Quality Management and Analysis System (QMAS) and its equivalents in the other countries, which will calculate each practice’s quality achievement level
- the collection of disease prevalence data to apply to the clinical quality achievement payments
- the establishment of a quality review group to review and develop the quality and outcomes framework
- the review of the allocation formula
- the level of resourcing for primary care
- the position of GPs who work in community hospitals.

Clearly, we all have a great deal of work to do, and we want to keep you informed about progress and developments through future editions of this newsletter and updates on our website at www.bma.org.uk/gpcontract. We will also continue to provide help and guidance through our series of ‘Focus on’ guidance notes and Frequently Asked Questions, also available at our website.

Please read the rest of this newsletter. It contains important information about how to access information and guidance, as well as useful news and updates.

I want to take this opportunity to thank you for your comments, your constructive criticism and, most of all, your hard work and support. The hard work is not over. There will be implementation issues and reviews, but I believe the new GMS contract marks a turning point in primary care.
I believe it will prove to have been worth waiting for – for you, your practice staff and for your patients.

Look out for your support pack
Over the last two years, so much information has been produced about the new GMS contract that GPs would be forgiven for questioning whether the new contract is, in fact, a less complex and bureaucratic arrangement than the Red Book. We believe that, once the process of change has been completed, that complexity should lessen.

To help you through this, the GPC has produced a support pack, which is being sent to all practices in April. The pack contains a copy of this newsletter and a selection of our series of ‘Focus on…’ guidance notes.

Have a look at Focus on…how to access information. This is intended to help GPs, practice managers and Local Medical Committees manoeuvre around the new contract documents and information sources more easily.

It is available in the support pack and with other ‘Focus on’ guidance notes, from our website at: www.bma.org.uk/ap.nsf/Content /__HubGMScontractguidance

Sale of goodwill
The GPC announced on 25 March that the Government has decided to partially lift the ban on the sale of goodwill. The Department has laid Regulations before Parliament, to come into effect on 1 April 2004. The regulations relax the current ban in relation to enhanced, out-of-hours and additional services, but not in relation to essential services, and apply to all providers, including GMS and PMS practices. The Department intends to review the outcome of this decision in two years.

The GPC believes this will increase the threat to holistic, coordinated, practice-based care and the highly-regarded UK model of general practice, which we know is cost- and clinically-effective, and that it will inevitably damage recruitment into general practice, owing to the resultant increase in the costs of buying into a practice.

While this policy initiative is being led in England, we believe that the other three counties intend to follow in the same direction.

Dr John Chisholm has written to all GPs about this. The letter can be found on the BMA website at: www.bma.org.uk/ap.nsf/Content/saleofgoodwill250304

Minimum practice income guarantee (MPIG)
We have received a number of enquiries about why so many practices (about 80%) need the MPIG when it would be more usual to expect a roughly 50-50 distribution of MPIG and non-MPIG practices.

The MPIG is a guarantee to practices that they will receive at least the same amount for their global sum allocation under the new contract as they currently receive from their equivalent Red Book payments – the Global Sum Equivalent.

If, after the application of the allocation formula, a practice’s global sum is less than its Global Sum Equivalent payments under the Red Book, a Correction Factor will be applied to bring its funding from the global sum into line with its current GSE income.

MPIG = global sum (application of the allocation formula) + correction factor

Those practices that do not need the MPIG following the application of the allocation formula will be practices whose global sum allocation is the same or greater than their Global Sum Equivalent.

The allocation formula, when applied to practices, did produce a roughly 50-50 distribution of those practices who needed the MPIG and those who did not. This distribution has been ‘skewed’ because monies available for the global sum funding stream were transferred into the quality funding stream. This has had the effect of reducing the total amount of money available for the global sum. The GPC has always argued that there was insufficient money in the global sum funding stream, leading to more practices needing the MPIG. The transfer of money into the quality funding stream has exacerbated this problem.

Basically, there is less money available for the global sum, which means that practices which might have made more money than their Red Book equivalent payments (GSE) will now not do so. However, the MPIG is guaranteed. All practices that need the guarantee – and the money that flows from it – will receive it.

The major problem with the global sum is the government’s insistence that it was not prepared to put any of the new money in that particular funding stream. The GPC has already highlighted other factors that may need to be addressed in the allocation formula and the review begins later this year. We will be pressing for changes we know will be beneficial, such as the inclusion of the diseconomies of scale factor that will help smaller practices.

It is worth remembering that the global sum (or MPIG) is only part of practices’ income under the new contract. The global sum covers payments towards the cost of delivering essential and additional services. In addition, practices will receive income from other sources including funding for enhanced services, premises, seniority, PCO-administered payments (e.g. for maternity or sickness absence), and, most importantly, quality. The payments through the quality and outcomes framework provide an opportunity to increase practice income significantly.

It is also worth remembering that the MPIG is there for as long as it is needed and that the existence of MPIG means that practices will be financially stable.

The general feedback we are receiving is that when practices and their accountants have looked carefully at their figures, the contract delivers what was promised.

Updating contract information
We have also included in the support pack information about how to receive free e-mail alerts, if you are a BMA member, every time we update information or produce new guidance as it is added to our website. To ensure you receive e-mail alerts:

- go to www.bma.org.uk/gpcontract
- scroll down the page and click on the orange ‘email alert’ box
- tick the ‘general practitioners’ box, and
- submit

Keep your pack updated by downloading and printing new ‘Focus on...’ guidance notes and updates each time you receive an alert.