In August 2015 we announced a period of contractual stability until 1 April 2017 but with the proviso that changes judged to be beneficial would be open to negotiation.
After the discussions that followed with the Scottish GP Committee and the Cabinet Secretary for Health, Well being and Sport, we announced in October 2015 that the Quality and Outcomes Framework (QOF) should be discontinued.
Following an intense period of negotiation the Scottish GP Committee and Scottish Government reached agreement on changes for introduction from 1 April 2016.
This agreement, which includes the end of QOF, the creation of GP clusters and the beginnings of new arrangements for quality demonstrate the direction of travel for the Scottish GP contract.
Key changes for 2016 - 2017
- The Quality and Outcomes Framework will be dismantled from 1st April 2016 - the remaining 659 points will be retired and the funding will be transferred to practice core funding.
- The QOF funding will be transferred to each practice's Global Sum, as in previous years (based on a practice's average achievement for those points over the previous three years, so it is important that practice maintain high achievement in 2015/16). As with previous transfers, there will be no OOH deductions and future uplifts to the Global Sum will apply.
- The Clinical Core Standard Payment and Organisational Core Standard Payment will be combined with this new transfer to form a single "Core Standard Payment".
- Practices are not required to continue the administration of the QOF.
- GPs and their practice staff will be expected to provide all of the elements of care and clinical coding, that the practice considers clinically appropriate and are encouraged to consider how they will continue to deliver an appropriate standard of care for their patients.
- QOF data will no longer be extracted for payment purposes but it will continue to be available to practices for their own internal processes. In future, data extractions will be agreed with SGPC and your local GP cluster will also agree data extractions.
- £20 million of the resource transferred to core (approximately 25% of the amount being transferred) will be designated Continuous Quality Improvement funding, to support key elements of a Transitional Quality Arrangement (TQA) for 2016/17. The intended outcomes of this TQA will be jointly reviewed by SG and SGPC at the end of 2016/17 and this will inform the direction of travel from 2017 onwards.
Transitional Quality Arrangement (TQA)
Registers, coding and lifestyle advice
- Practices will still be required to maintain disease registers and code patients based on diagnosis. Practices will also be required to provide appropriate lifestyle advice (definition of "appropriate" and exact timing to be determined by the GP practice).
Integration and GP Cluster working
- From 2017 onwards it is expected that GP practices and GP clusters will have oversight and direct involvement in improving the quality of all health and social care services provided to patients registered within their locality, including the current chronic disease management programme and use of secondary care services. The 2016/17 agreement introduces changes that start this process.
- Beginning with the agreement for 2016/17 - arrangements for quality under the contract will be based on professionalism and require GP practices to undertake that work in a cluster basis; a locally agreed grouping of practices.
- GP clusters will need to be formed during 2016/17 (they do not need to be in place from 1 April 2016).
- Every GP will be involved in Quality, each GP practice will nominate a GP as a Practice Quality Lead (PQL), and each practice cluster will have a Cluster Quality lead (CQL).
- Every GP, and relevant others in the practice, will be expected to consider data provided by the Practice Quality Lead and to provide the PQL with their reflections on that data, as well as a view on what future data might be required to support quality in the practice.
- The PQL will be expected to share the data provided via the CQL with relevant members of the practice and to collate a practice response to it and form a view, on behalf of the practice, of the data required to support the future Quality activities of the practice and its GP cluster. The capacity to undertake this activity will come from the dismantling of QOF and is expected to require approximately two hours per month.
- Each GP cluster group will nominate a Cluster Quality Lead (CQL) who will have a local leadership role. CQL activity (and PQL activity above the level described above), will be funded from outside of the GMS contract.
- CQLs will have a mandate from their colleagues to improve quality in the wider health and social care system, including the use of secondary care, partially based on input from each practice in the cluster. CQLs will provide data to their clusters, partly based on national agreed data extractions between SGPC and SG.
- Each GP practice will develop a process for ensuring that GPs and relevant others in the practice can be fully involved in quality work such as, eflection on materials and discussion on a practice level response to the CQL.
- The PQL will also fulfil the role of liaison GP to link to a specified liaison person from the Health and Social Care Partnership. This may be a different GP member of the practice at different times.
- Activity associated with flu vaccination outlined in the Directed Enhanced Service (DES) will continue.
- GP clusters will reflect upon the individual access reports provided by local GP practices over the past two years (alongside any board wide or national learning from aggregated reports that might add value) to consider what could be done to further improve access arrangements locally. This could include sharing of local and national good practice; and how other health professionals should respond to patient demand.
Anticipatory Care Plans (ACPs)
- Existing arrangements for ACPs will continue in 2016/17. GP clusters will review how well ACPs are being used following admission to hospital or other use outside GP practices (e.g. in an OOHs setting).
Datasets for Continuous Quality Improvement
- GP practices will be provided with an agreed dataset on high need/risk/cost/time patients and be expected to review that list and agree which patients would most benefit from the provision of an ACP. In addition GP practices will be expected to review existing ACPs in a way that they determine is appropriate.
- GP practices in the GP cluster will be engaged in an annual review of a proportion of their ACPs, which will include an assessment of their quality (via the use of a nationally agreed quality template) and be expected to reflect upon that report within their GP cluster. Any GP practice with a consistently poor quality review will be supported by the local system to improve their standard.
- GP practices will continue to work with the NHS Board prescribing advisors and prescribing support pharmacists, where available, to agree appropriate actions related to prescribing and seek to evidence change.
In areas where a CQL role and function is not in place during 2016/17, some of the prescribed activity above will not be possible.
In these areas, practices will be required to:
- Maintain disease registers and provide appropriate lifestyle advice (as above)
- Continue the activity associated with the current Flu Directed Enhanced Service
- Review the past two Practice Access Activity Reports for evidence of recurring themes and take appropriate actions using a national template
- Review a random selection of their ACPs using a national template
- Continue to work with NHS board prescribing advisors and prescribing support pharmacists (where available) to agree appropriate actions related to prescribing and seek to evidence change
Contact GPC Scotland
We will continue to provide updates on developments as more details on the agreement are finalised. In the meantime, if you wish to contact SGPC, please get in touch.
Tel: 0131 247 3000
Email GPC Scotland