General Practitioners Committee England General practitioner

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GP contract agreement England 2019/20

 

GPC England has negotiated a deal spanning the next five years. Elements will be introduced throughout the five years – 2019 will focus on building the foundations, creating Networks and starting to expand the workforce; 2020 onwards will see the workforce increase further, additional funding and services reconfigured (as decided by the networks).

The most substantial changes commence from April 2019. The changes should provide much needed support and resources for general practice, expanding the workforce, reducing workload, increasing funding, retaining GP and partnership autonomy and ensuring GPs have a leadership role at the centre of primary care.

 

What practices need to do now

  • Read the below summary of the deal, and the various attachments for each of the specific areas of contract change, which outlines immediate preparation, 2019 requirements and planning for future years
  • Commence discussions with neighbouring practices about forming networks
  • Begin the QOF quality improvement modules
  • Discuss with clinical staff what the pay uplift and indemnity expenses reduction mean on an individual basis
  • Provide the pay uplift to other practice staff
  • Look out for further guidance that will be released shortly

GPC roadshows

Find out more about the reformed contract by coming along to one of our roadshow events

Watch the webcast.

 

Top-line changes

  • Overall funding in excess of £2.8bn over a five-year period, through practices and networks
  • Indemnity state backed scheme introduced
  • Pay & expenses uplift each year through global sum, in line with predicted inflation
  • Creation of a new Primary Care Network, built up over the five years
  • Additional workforce & linked funding through a new Primary Care Network
  • Amendments to QOF
  • Resources for IT and digital, including greater digital access for patients
  • Delivery of the NHS Long Term Plan ambitions through the additional funding and workforce

 

The contract

Full details on all of the aspects of the deal are included in the contract agreement document, produced jointly between GPC England and NHS England.

Read the deal in full

 

GP contract 2019/20

  • Primary care networks

    Practices will form Primary Care Networks through a new Network DES, thereby building on the core contract. Networks will facilitate shared decision making between practices for their total network populations (typically 30-50,000), around funding and workforce distribution, and augmented service provision. Networks will need to be geographically contiguous.

    Read more about PCNs

  • Indemnity

    We have secured a state-backed indemnity scheme to cover clinical negligence for all GPs and staff working in NHS GP providers, both in and out of hours, for NHS work, from April 2019. Run by NHS Resolution, this will come at no direct cost to practices or GPs, and will mean no longer pay spiraling subscriptions.

    Details of the scheme and what’s included in its scope is available here, with further guidance on how the scheme will impact on overall pay available here.

  • Practice funding and pay

    For 2019, the GP contract will increase by 1.4% (in addition to the funding through networks). This includes:

    • 2% uplift for GP and staff pay and expenses.
    • Uplift for practices to establish and develop networks.
    • Uplift due to population increase.
    • Adjustment for indemnity state-backed scheme.
    • Increase to value of some vaccinations and immunisations, including influenza, to bring them all up to the same level of £10.06
    • £20m recurrent for costs associated with SARs.
    • £30m for practices to make appointments available to NHS 111.

     

    Figure

    2018/19

    2019/20

    Global sum price per weighted patient


    £88.96

    £89.88

    Out of hours adjustment

    4.87%

    4.82%

     

    Participation payment


    £105m total


    Annual payment per weighted patient*


    £1.761

     

    When factoring in seniority and MPIG recycling into global sum, the GS is uplifted by 1%, as well as the SFE payment, meaning practices will have an extra £2.68 per weighted patient in 2019/20.

    Together with increases to immunisation fees and the removal of indemnity expenses this means practices will be able to deliver a 2% uplift to practice staff pay.

    Details of the pay uplift for GPs, and its interaction with the indemnity expenses reduction, are available here.

    Beginning with 2019/20 income, GPs whose NHS earnings are over £150,000 will be required to make this public, in a similar way to many senior NHS managers, and the government intends this to also apply to other NHS contractors.

    Following NHS England’s consultation in 2018, we have agreed to amendments to the funding formula so that the rurality index only applies to patients who live within the practice boundary, and that the London Adjustment applies to patients who are resident in London, rather than registered with a practice based in London. There will be no other changes to the funding formula.

    As part of reviewing the arrangements for digital first providers and ensuring equity with other practices we have agreed to review the new patient registration premium (0.46 weighted in first year after registering) and the out of area regulation in 2019.

     

    *This figure will be paid in instalments direct to practices, upon signing up the PCN DES.

     

    20190124

     

  • IT, digital support and access arrangements

    We have secured commitment for a recommended specification for IT and digital for Commissioners, to ensure that all IT and digital support is functional and appropriate.

    Changes to support electronic access, to appointment booking, to consultations and to information, will be phased across the years. A programme to digitalise paper records will commence to enable the creation of a complete electronic record for each patient.

    Practices will be required to offer 1 appointment per 3,000 patients, per day, for NHS 111 to book registered patients in to, following triage. These are existing appointments as decided by the practice, but should be spaced evenly throughout the day.

    We have agreed that practices will no longer use fax machines for either NHS or patient communications.

    Read full details on IT and Digital support covering the five years

  • QOF

    Figure

    2018/19

    2019/20

    Value of QOF point

    £179.26

    £187.74

     

    We have agreed to retire 175 points (from 28 indicators) following extensive analysis of all indicators which identified them as ‘low-value’. 101 of those points will be recycled in more appropriate indicators (15 new indicators) with the remain 74 points creating a new Quality Improvement domain.

    Thresholds have not been changed.

    For 2019, the quality improvement domain will include two modules – end of life care, and prescribing safety.

    We have introduced a new personalised care adjustment to replace exception reporting, which will allow practices to adjust care without losing out financially, for five reasons – the QOF-proposed care being unsuitable for the patient, the patient choosing not to receive that care, the patient not responding to invitations, services not being available, and newly registered or newly diagnosed patients.

    Linked to personalised care, practices should opportunistically identify patients preferred method of communication from the practice and should send the first invitation for care, via that method. Invitations should be personalised and provide the information the patient will need (templates will be provided), however we have agreed to reduce the requirement from three invitations to two.

    See further detail on QOF

  • Other contractual changes

    • Practices will make available 1 appointment for 3,000 patients per day for NHS 111 to book directly into practice appointments.
    • HPV vaccination catch-up for girls will be extended to those aged 25 and HPV vaccination will commence for boys in Sept 2019 (via the school scheme). Catch-up arrangements for boys will mirror those for girls.
    • Practices that choose to use the NHS logo will be require to adhere to NHS guidance on its use.
    • FP10 will be re-designed (including to take account of GDPR) and a new requirement will be introduced to annotate scripts, for example ‘SH’ where patients are legally entitled to free prescription for sexual health purposes. This is a short term solution while a wider digital solution is formalised.
    • Amendments to additional services for child health.
    • V&I MMR catch up for 10-11 year olds.
    • Each practice will be required to provide an email address and mobile phone (for exceptional circumstances) by which they will receive MHRA alerts.
    • £2m invested in 2017 for issues related to Capita will become recurrent, until such time as the negotiations agree that it is no longer necessary.
    • Provisions for GP cover for shared parental leave, in line with cover for maternity/paternity/adoption etc leave, will be added to the Statement of Financial Entitlements.
    • Practices will no longer be able to advertise or host private GP providers who provide the same core GP provisions that are offered free on the NHS. NHS England intends this to expand to include all providers of mainly NHS services.
  • Other agreements

    • NHS England will provide a ‘letter of comfort’ to all practices and CCGs, stating that where a prescriber decides, in line with local and/or national guidance, not to provide a prescription for an over-the-counter medicine, practices will not be deemed to be in breach of their contract. This does not remove GPs professional responsibility to prescribe medications where they are deemed necessary.
    • Practices will be encouraged to take part in NHS campaigns.
    • Review of vaccinations and immunisations standards, funding and procurement, including travel vaccinations and how to manage localised outbreaks will commence.
    • A digital solution to SARs is expected to be developed over the next three years, where patients can access their own data rather than making a request.
    • Associated with the above is progress on digitisation of patient records, which will be prioritised within NHS England.
    • Review of access to primary care arrangements.
    • Review of Temporary Residents payments to commence in 2019.
    • Review of letters and reports commonly written in general practice to commence in 2019.
    • Review of perinatal checks for mothers to commence in 2019.
  • Coverage, blogs and other resources

  • Contact GPC

    If you have any questions about this information, please email us at [email protected]