General Practitioners Committee General practitioner England

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GP contract agreement England 2018/19 - FAQs

GPC England has concluded negotiations with NHS Employers for amendments to the GP contract England 2018/19 for GMS (and PMS) contracts.

Read our FAQs below to help you understand the changes.


  • PMS and GMS practices

    Do the changes apply to PMS practices as well as GMS?

    Yes, the changes will be reflected in the PMS contract and regulations, as well as GMS.


  • Funding

    What does the DDRB pay uplift announcement mean?

    An additional £61.5m will be put into global sum, for the extra 1% for GP and staff pay (backdated to 1 April 2018). This will see the value of global sum increase further to £88.96 (backdated to 1 April 2018).


    Have you only agreed a 1% pay and expenses uplift?

    No, we have not agreed a 1% uplift this year. We have agreed an interim minimum of 1% uplift for pay and CPI uplift for expenses whilst we wait the outcome of the DDRB process.

    Once the DDRB recommendation and subsequent government decision around pay and expenses for GPs is known this should be added to the interim payment. The BMA's submission to the DDRB asks for RPI + 2% for all pay and expense for GPs (RPI at Jan 2018 was 4%).


    What is the new global sum price per weighted patient?

    Taking into account the pay uplift, expenses uplift, recycling of MPIG and seniority funding agreed in previous years, and other funding put into the contract, will see Global Sum rise from £85.35 to £87.92 per weighted patient.


    Are there changes for QOF?

    While there are no clinical or threshold changes to QOF for 2018/19, as the QOF system remains under review, due to changes in population, the value of a QOF point will increase from £171.20 to £179.26 (4.7% in total).


    Are there any changes to the Vaccination and Immunisation programmes funding?

    Item of service payments for all V&I programmes delivered via the SFE[1] will be uplifted from £9.80 to £10.06. There are also minor clinical changes to some programmes, details of which can be found in the full letter.


    What is changing for reimbursements for covering maternity, parental, adoption leave and sickness absence?

    We have agreed an uplift to the reimbursement schemes for parental and sickness cover.

    The uplifts will be as follows:

       2017/18  2018/19
    First two weeks of parental leave cover / ceiling amount for sickness leave cover  £1,131.74  £1,143.06
    Subsequent weeks of parental leave cover  £1,734.18  £1,751.52


    In addition, practices will now be able to claim for reimbursement for a cover provided via a fixed term salaried contract, as well as via locums and existing partners or employees of the practice.


    [1] Increase to £10.06: Hepatitis B at-risk (new-born babies), HPV completing dose, Meningococcal ACWY freshers, Meningococcal B, Meningococcal completing dose, MMR, Rotavirus, Shingles routine, Shingles catch-up.

    Remaining as previously: Pneumococcal (PCV – remaining at £15.02), Childhood seasonal influenza, Pertussis, Seasonal influenza and pneumococcal polysaccharide.


  • Indemnity

    Will the indemnity payment be the same as last year, or will it go into global sum?

    The indemnity payment will be made as a separate capitation-based payment via the SFE, as it was for 2017. This year we have agreed an extra £30m to last year, bringing the total up to £60m, which equates to £1.017 per patient.


    How will the funding for indemnity be passed on to salaried GPs and locums?

    As this funding will be paid direct to practices, GP principals must ensure that the appropriate amount of funding reaches their salaried GP colleagues. Locum GPs already have the ability to uplift their fees appropriately to take account of this business expense.


    Is there a progress update on the state-backed indemnity scheme?

    GPC is working with NHS England and other stakeholders in designing the new scheme, which is on track to be implemented for April 2019. We expect further detail to be announced in early summer 2018.


  • Premises

    What are the changes to the premises cost directions?

    Below is a summary of the main changes that were agreed to the premises cost directions (PCDs), which will come into effect when the updated PCDs are published. We will publish a specific Focus on Changes to the PCDs when they are published. PCDs are currently being drafted by DHSC at the moment and we cannot yet confirm when they will be in place, but are pushing to have them published as soon as possible.

    • All new terms will be prospective (i.e. they cannot be retrospectively applied)
    • Rent reviews will not lead to varying lease terms
    • Rent reviews will not require contractors to undertake their own valuation, just evidence of a negotiation with the landlord; if the negotiation is unsuccessful the DV will assess
    • Contractors must attempt to ensure VAT for rent is not passed on to them, but where it is the Board will reimburse
    • More formalised arrangements for third party use of premises, with no financial disadvantage to the contractor
    • Improved provisions for minimum standards reviews
    • Contractual rights to reclaim overpayments (from the time the PCDs are published)
    • If in receipt of a grant and the Board and Contractor agree to relocate, the Board will waive the grant agreement and any restrictions and requirements thereof
    • PCD funding will be for anyone providing general medical services (as determined by the Board), currently anyone holding a GMS contract
    • Improvement grants will now be permitted to purchase land to build an extension to existing premises
    • Grants representing 100% of the project cost will be allowed (currently only 66% of the project cost is permitted)
    • Amended abatement/use periods have been agreed:
    Current abatement /use period
    (up to 66% borrowed)
    New abatement / use period
    (up to 100% borrowed)
    Up to £100k: 5 years Up to £120k: 6 years
    £100k - £250k: 10 years £120k - £300k: 9 years
    Over £250k: 15 years £300k - £550k: 12 years
      £550k - £1m: 15 years
      Over £1m: 18 years

    Last partner standing (owner-occupier)

    • Explicit options if an owner-occupier is in receipt of a grant and hands back core contract during the abatement period:
      • Remove premises from NHS use, sell and repay the rest of the grant
      • Remove premises from NHS use, retain and repay the rest of the grant
      • Offer continued use of premises for another practice to lease (in this situation the new practice would have lease amended to repay the rest of the grant)

    Last partner standing (leaseholder)

    • Explicit options if a leaseholder is in receipt of a grant and hands back core contract during the abatement period:
      • Assign the lease (and any grant agreement) to another practice
      • Relinquish the lease if landlord agrees (possibility of assistance with any related repayments)
      • Potential for the Board to assign the lease to their nominee
      • If in receipt of a grant, possibility for the Board to waive grant repayment

    What is the premises review?

    We have agreed for a wide review of premises, which will commence in early summer 2018. The review will be led by Department of Health and NHS England, working closely with GPC England and other key stakeholders.

    The aims of the review are to:

    • Provide a better picture of the overall position on primary care estates
    • Address some outstanding issues from the PCD review, including:
      • Development grants
      • Last partner standing situations
    • Ensure that premises are fit for purpose into the future
    • Take into account likely service and other developments
    • Promote recruitment and retention of GP contractors
    • Ensure GP premises represent value for money
    • Help inform a better integration of services into the future

    Recommendations from the review will be taken into account in any further national premises negotiations.


  • Other contractual changes

    I currently don't use e-RS, will I be required to use it for 100% of my referrals by October?

    From October 2018 there will be a requirement for GP practices to use e-RS for all their practice to 1st consultant-led outpatient appointment only. It is for the practice to determine how they use e-RS and this could include the practice's administrative team doing this and not the GP.

    NHS England and CCGs will not take a punitive approach where circumstance dictates that the implementation is not possible by 1 October, instead a supporting action plan will be agreed. CCGs should work with LMCs and practices to ensure local system issues are resolved appropriately.

    GPCE will be working with NHS England over the next year to ensure the system is working correctly and making amendments where appropriate at national level. Given the wide variation across local health economies we will be monitoring implementation challenges, including workload implications, bandwidth issues, local contingency processes, referral pathways are appropriate, referrals are not refused unnecessarily etc.

    If practices experience problems with local hospitals or with the e-RS system, they should contact their LMC and the GPC.


    How do I get more information about the e-RS system or how to implement etc?

    GPC England and NHS England are working together to produce joint guidance on e-RS. In the meantime, we are producing a Focus on ERS for GPs, to help practices understand the implications and considerations.

    We are aware that some areas of the country have already implemented e-RS and use it for most of their referrals. GPC England will be contacting such practices and LMCs in order to share best practice in dealing with issues and implementing appropriately.


  • Non-contractual changes and other agreements

    How will the non-contractual changes and other agreements affect practices?

    Non-contractual agreements in the deal set out aims and joint workstreams between GPC and NHS England. These will not be contractual requirements for practices, but practices are encouraged to take note of them and should action when appropriate.

    For detail of these, see the full letter