The Five Year Deal - Changes to the GP Contract

The changes announced in the five-year deal by NHS England and the BMA are the most significant since the introduction of the new contract in 2004. Primary care and community care will be boosted by £4.5billion by 2023/24. The introduction of Primary Care Networks is intended to increase resources in primary care over the next five years which will hopefully reduce the workforce problem currently facing general practice today.

Global Sum Funding

There will be an overall investment in core funding over the next five years of £1bn. The Doctors’ and Dentists’ Review Body will no longer make recommendations for increases in the global sum. These increases will be fixed for the next five years. The current global sum amount per weighted patient is £88.96, the increases will be as follows: -

*In 2019/20 the global sum will not increase by the full 1.4% as a one-off permanent deduction has been made to fund the state indemnity.

There will be two changes to the Carr-Hill formula which is used to calculate a practice’s weighted list. The rurality index payments will be applied to patients living within the catchment area, rather than to all patients. The London weighting, which is £2.18 per registered patient, will be applied to patients living in London as opposed to the practice registered list.

From April 2019, the opt out deduction for out of hours will be 4.82% of the global sum.

Quality and Outcomes Framework (QOF)

The QOF framework currently comprises 559 points. 28 low value indicators worth 175 points will be retired. 101 points will be recycled into 15 new clinical indicators and the remaining 74 points will be used to introduce two new quality improvement domains (each worth 37 points) for prescribing safely and end of life care.

Exception reporting will be replaced with a more precise “Personalised care adjustment”.

The current value of a QOF point is £179.26 (for an average practice list of 8,096), this will increase to £187.74 in 2019/20 to reflect population changes.

Enhanced Services

Network Participation DES

Practices are required to be signed up to a Primary Care Network (PCN) by 1st July 2019. As a result, a network participation DES will be paid from July 2019. The amount of this DES is £1.76 per weighted patient and is expected to be paid in monthly instalments. This is funding for the practice and they can decide how this is spent.

Extended Hours DES

From July 2019, the extended hours DES worth £1.45 per patient will be transferred to Primary Care Networks (PCN) who will be responsible for providing extended hours. It will be up to the PCN to decide who to commission extended hours to, but practices providing this should be paid.

Vaccinations

All Vaccinations will be paid at £10.06.

State Indemnity

From April 2019 there will be a state indemnity which will cover general practice and out of hour for all staff groups. Locums will no longer need to pay indemnity when working for GP practices or networks. A permanent one-off deduction has been made from the global sum in 2019/20. All future increases in the cost will be paid centrally.

GPs and staff will still need to take out some indemnity cover for private work and cover for GMC hearings. It is expected that this cover will cost a full time GP about £1,000.

Private Work

As a result of GDPR and subject access requests practices have been faced with a drop in private income but an increase in work for dealing with such requests. There will be funding of £20m added into the global sum over the next three years to cover the cost of subject access requests.

From April 2019, it will no longer be legal for any NHS GP Provider either directly or via proxy to advertise or host private paid for GP services that are offered for free on the NHS.

Pension Changes

From April 2019, the employer’s contribution for all staff will increase from 14.38% to 20.6%. However, for 2019/20 this will be centrally funded and practices will continue to pay over 14.38% as usual.

Please refer to the Pension Issues article on proposed changes affecting individual GPs - https://www.rbp.co.uk/news/pension-issues-affecting-gp-practices-and-individual-gps

Staff

The increase in funding for 2019/20 is based on the assumption that staff, including salaried GPs, will receive a 2% pay increase. However, practices will need to consider the position with respect to salaried GPs who were previously paying their own indemnity costs. These GPs are likely to have been paid at a higher sessional rate and will now be saving on the indemnity costs they had paid personally, which effectively means that they have already received an indirect pay increase.

An Additional Roles Reimbursement Scheme for Primary Care Networks, is being introduced, starting with clinical pharmacists and social prescribing link workers. Please see the article on Primary Care Networks for further information - https://www.rbp.co.uk/news/have-you-joined-a-primary-care-network-pcn-yet

Published Earnings

Currently GP practices are required to publish a mean average earnings figure based on the head count of the number of GPs that work in the practice. The changes announced include the requirement for individual GPs, with total NHS earnings above £150,000 per annum, to be listed by name and earnings in a national publication starting with 2019/20 income.

Digital Technology

There are various new digital improvement requirements for GP practices including access by patients to full online records and from July 2019 all practices will be required to ensure at least 25% of appointments are bookable online.