Chapter 11 – Implementation in England

11.1 This guidance aims to update and replace previous contract guidance but only so far as the 2006/07 changes are concerned. Where no change has occurred the original nGMS guidance applies.

Legislative changes and implications for local GMS contracting
Regulations
11.2 There are no changes to the General Medical Services (GMS) Regulations required by virtue of the 2006/07 agreement; however, as normal, a set of routine amending regulations will be issued in the spring, possibly May, though no final date has been set at the time of finalising this guidance.

11.3 A variation notice produced by the Department of Health will support those GMS regulatory changes. This notice will be published alongside the planned amending regulations and a consolidated copy of the GMS standard contract on the Department’s website. However these amendments are not due to changes from this agreement.

Statement of Financial Entitlements
11.4 A revised Statement of Financial Entitlements (SFE) for 2006/07 will be published by the Department of Health to enact the appropriate payment changes for 1 April 2006. These will not affect the local GMS contracts entered into between practices (contractors) and Primary Care Trusts (PCTs) where the GMS standard contract has been used.

11.5 Where the standard contract has not been used PCTs will need to consider whether SFE changes lead to contractual changes but this is a local matter.

11.6 Those SFE changes will not include any changes that are necessary as a consequence of the new directed enhanced services or directions as to payment.

Directed enhanced services directions
11.7 The main element of the 2006/07 agreement which impacts on local GMS contracting are changes arising from the introduction of the four new directed enhanced services (DES). Directions covering these new services including directions as to payment are planned to be in place by 1 July 2006.

11.8 As with current directed enhanced services, contractors who are to participate in these schemes will require either a stand-alone contract or a variation to their main contract reflecting not only the requirements of the directions but also any elements that fall to be locally determined.

Implementing directed enhanced services
11.9 Directions on PCTs to implement the new directed enhanced services are expected to be in place by 1 July 2006. However it is agreed these schemes will apply and be implemented from 1 April 2006.

11.10 PCTs should therefore work with their practices to develop and implement plans in line with the published DES specifications for implementation from 1 April 2006. PCTs should therefore seek to:
(i) by end of February. Offer all practices the opportunity to participate in Access, Practice Based Commissioning, Choice and Booking and information management and technology (IM&T) DES’s and have provisional agreements in place
(ii) by end of March. Have agreed initial plans in place for action from 1 April.

11.11 PCTs will wish to note that Directions applying by 1 July will give full year effect to payments due under the agreed schemes. PCTs will therefore wish to ensure that practices are able to participate in these new arrangements from 1 April by undertaking the necessary agreed actions.

Implementing revised Quality and Outcomes Framework
11.12 A revised Quality and Outcomes Framework (QOF) for 2006/07 has been published.

11.13 From April 2006, Quality and Outcomes Framework Management and Analysis System (QMAS) will not display achievement reports for the year 2006/07 whilst the system is being upgraded to reflect the revised QOF indicator set. Practices will be able to continue to make submissions and complete the approval process to ensure payments are made for the year 2005/06.

11.14 Following the completed implementation of changes, QMAS will commence displaying achievement reports for the year 2006/07.

Implementation Coordination Group
11.15 The Implementation Coordination Group (ICG) provides Local Medical Committees (LMCs) and Strategic Health Authorities (SHAs) with a route for determining local disagreements on GMS contract implementation issues where these cannot be resolved locally and which are inappropriate for formal dispute resolution procedures.

11.16 The ICG in considering cases, on the information presented, make a final recommendation to the parties concerned. The ICG meets monthly and comprises of a negotiator from the three key stakeholders for England Department of Health, NHS Employers and the General Practitioners Committee (GPC).

11.17 LMCs should direct concerns via the GPC-LMC Liaison Officers in the first instance and PCTs should direct concerns via their SHA with the support of their local Primary Care Contracting Advisor.

Implications of this agreement for other providers
11.18 Separate guidance is being prepared by the Department of Health for PCTs on the implications of this agreement for PMS, Alternative Provider Medical Services (APMS) and Primary Care Trust Medical Services (PCTMS) providers, whose contracts continue to be locally negotiated.

© British Medical Association 2008

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