BMA GPC (GP committee) Wales has negotiated an update to the Welsh GP contract for 2020/21, successfully concluding an agreement with Welsh Government and NHS Wales. The contract will:
- allow contractor and salaried GPs in Wales to receive the 2.8% pay uplift as recommended by the DDRB
- enable Welsh GPs to pass on a 2.8% uplift to their staff budgets.
A summary of the agreement is set out below.
The full directions, statement of financial entitlement and guidance will be online in the near future.
COVID contract changes
Safety of our members during the pandemic has been the absolute priority, whilst also ensuring that practices could adapt to these changes in a stable economic environment.
Following extended discussions with BMA GP committee Wales, Welsh Government have announced a series of measures to relax elements of the GMS contract during the second wave of the pandemic. This announcement from Welsh Government has not been a wholly negotiated position with GPC Wales.
These contract relaxations are directly related to mitigating against the workload pressures in general practice during this escalating phase of the pandemic.
The following funding arrangements having been reached for 2020-21:
- DDRB recommendation of pay uplift of 2.8% for GPs
- £4.5m to the pay element of GMS contract in global sum
- an uplift of £4.1m to the expenses element of the contract to fund a 2.8% pay uplift for all practice staff
- mandated as a minimum uplift to practice staff pay budget
- agreed health board audit of implementation
- funds recovered from non-compliant practices
- a £1.5m expenses investment to fund ongoing revenue telephony costs related to post COVID ‘telephone first’ model
- a further £0.4m expense uplift towards inflationary pressures
- the inactive AF indicators and disease register indicators will be removed from QAIF, with disease registers becoming a core function
- the associated funding of £4.125m is transferred into global sum.
The £3.765m that was within the global sum in 19/20, specifically allocated towards access standards infrastructure, has been ‘redistributed’ to the additional funding streams. It is retained in the global sum, as per the 19/20 contract agreement.
The new global sum payments will initially be uplifted to a value of £93.81 per weighted patient and backdated to 1 April 2020 (in comparison to £91.77 for 2019/20).
At 1 October 2020, the global sum payment will be made at £95.07 per weighted patient to reflect the transfer of QAIF funds.
The payment systems will be updated by NHS Shared Service Partnership (with the new rates and arrears due from 1 April) and payment will be made to practices at the end of October.
Whilst we recognise that the transfer of QAIF funding to global sum is a transfer, not new investment - all the increases in global sum value as detailed above are consolidated funding and will be repeated.
Historically, uplifts to the global sum have been applied using the average EER (expenses to earnings ratio) calculated from NHS Digital average GP earnings estimates.
This is usually GP pay at 40% and practice expenses (including staff costs) at 60% of the contract value.
However, the EER has gradually increased over last 10 years, away from this traditional split. Therefore over the coming year a working party will be established to consider methods of future expenses.
Without a ‘ring-fenced’ staff pay award uplift, any pay increase given to staff would be funded from the DDRB uplift. This means that GP partners would not see any pay increase as the DDRB intended.
This element of this year’s uplift does have a contractually enforceable element, which has been built into the SFE (statement of fees of entitlements). This allows recovery of funds if the GMS contractor has not increased the remuneration of their practice staff budget by at least 2.8% for the financial year 2020/21.
We have reached agreement on a number of activities as part of the reformed contract. The changes this year are aligned to the Primary Care Strategic Program and include:
- an agreement to improve data quality and availability, helping to better demonstrate the rising activity levels and workload in general practice
- improving access to and from GMS services
- focusing on quality and prevention
- strengthening the primary care workforce.
There is a continued commitment for further work on premises in 2020-21, to address the wider premises issues faced by practices which are known to affect sustainability. This work had commenced prior to the COVID outbreak but could not be completed and will resume as a priority.
The review of enhanced services will also be restarted in the coming months.
QAIF (quality assurance and improvement framework)
QAIF was introduced as part of last year’s contract reform, replacing the quality and outcomes framework.
QAIF achievement at the end of the 19/20 cycle will be counted at a full 100% and paid in full in December 2020.
The current value of QAIF points will be kept at £179 per point. This is given the temporary relaxations made to QAIF around reporting arrangements, and with the contractual uplift being applied through the consolidations in global sum.
The inactive AF indicators and disease register indicators will be removed from QAIF, with disease registers becoming a core function.
There is a new QI project, worth 60 QAIF points, related to COVID learning with a focus on planning for urgent care across clusters under the new ways of working. This will replace the existing requirement to undertake QI training based on the assumption that most practices will have already undertaken this training in 2019.
Improving access to and from services
The two-year phase of access standards will remain in place for the remainder of 2020-21, following their introduction in 2019. There are a few minor changes to the required standards:
- the pre-bookable appointments measure will be removed from the framework
- the demand and capacity planning requirement of the standards will be reactivated.
A new phase of standards will be introduced for 2021 onwards and continually discussed in future negotiations.
In line with the primary care strategic program 24/7 work stream we reached an agreement in principle to enable referrals from unscheduled care into GMS workloads, with GPs taking the ultimate decision how to treat the referred patient.
Further work with all parties working together to support the integration of the primary care system on a 24/7 basis will be undertaken and detailed guidance issued at a later date.
The key aim of this work is to provide more streamlined access arrangements for patients to and from in-hour GMS services.
However, we were very clear that direct booking by 111 into GP appointment books was not an option at present, and that GPs would retain the ultimate control of how any redirection would be handled. There is also agreement on robust quality assurance of any such mechanisms.
The removal of the patient charge for the completion of mental health and debt evidence Forms has been agreed.
This is a relatively simple and short form that states whether or not a patient in debt has a mental health problem. It is two pages, only the first of which is mandatory to complete.
To minimise the impact on practices, a digital form for integration into GP clinical systems is being created and will be available when the new form becomes contractual at the end of September.
Direction of appropriate patients to and from the urgent care system and Primary care
Following a commitment of the last GMS contract agreement to look at access to and from primary care and the urgent care system, a working group was set up with representatives from Welsh Government, GPCW, WAST and unscheduled care services to review the current arrangements. The group has agreed proposals to develop an integrated system, where services are aligned through an agreed triage process.
This process does not seek to enable direct access to GP appointment systems by urgent care providers. Crucially, it also provides for direction of patients to 111 of OOH providers during the transition between core GMS hours and OOH periods.
Guidance has been created in support of the goal of the Welsh Government and GPCW’s Direction project. It is designed to give clarity on who should be transferred between services and the appropriate process to be followed. We anticipate that this will be widened in the future to accommodate direction to and from other primary care providers such as dentists.
Strengthening the primary care workforce
Partnership premium scheme
The partnership premium scheme was introduced in 2019 to highlight partnership as an attractive career option.
Guidance on the partnership premium, published by Welsh Government, provides a summary of and guidance on both the existing seniority payment and the new partnership premium scheme.
There is an agreement to scope out an extension of the partnership premium to non-GP partners in practices, recognising the vital role and partnership risk these individuals have.
Seniority payment scheme
The seniority payment scheme will remain in place but is now closed to new applicants. The seniority scheme payment scales will be frozen at their current levels with no future uplifts applied. This will not prevent members moving up the scale as years of service increase.
After a motion from the Welsh LMC (local medical committee) conference, an agreement was reached to widen the current SFE arrangements for reimbursement of sickness cover to include practice employed staff with independent prescriber status. This might include practice employed pharmacists, advanced nurse practitioners and other allied health professionals.
Given the difficulty in finding AHPs to act as ‘like for like’ locums, it was agreed that backfill of these individuals can be undertaken by GPs on a locum basis, similar to GP sickness arrangements in the current SFE.
A review of available resources will be undertaken to allow all practice staff to access health board occupational health services. Details will be confirmed and circulated when available.