A New Beginning? The 2014/15 GP contract for England.

It’s a big day for GPs in England - at midnight, under the cover of darkness, the government and BMA announced the 2014/15 GP contract for England –believed highly likely to contain sweeping changes in a time of austerity despite a stretched and jaded primary care workforce that would pummel us further in to the ground.  It was splashed all over the TV and in the papers this morning with headline grabbing changes.

Here’s the link to the BMA summary and full report: www.bma.org.uk/gpcontract

 

The reforms actually seem quite positive for what GPs have been saying they want for years: a reduction in bureaucracy to free up time for helping patients.  It helps address many of the issues we have discussed recently on the Hot Topics course such as multimorbidity, end of life care, having time to address complex medical issues and identify and treat malnutrition.

The main reforms are:

• Slashing QOF indicators and removing QP – a total of 341 points will be freed up from QOF
• Amazingly the money will actually be put in to core funding (through the global sum) to pay for the new changes – the contract seems pretty level financially.
• Some QOF targets and timeframes will be relaxed – particularly the removal of HYP003 (the one where BP must be ≤140/90…)

• A named GP for all over 75s
• This seemed to be a big deal for the media and the government – they don’t seem to realise that patients have always had a named GP – but now this will be more formalised with that GP taking responsibility for that patient and co-ordinating care with over health and social care professionals.

• A big section is a new “unplanned admissions Enhanced Service” funded through the money removed from QP. 
•  Older, vulnerable, high risk patients, those needing end of life care or at high risk of hospital admissions will be identified using a risk stratification tool and then pro-actively case managed. 
•  If these patients have urgent queries they will need to addressed on the same day – this can be done over the telephone – and I think most of us try to provide this anyway. 
• Practices will need to have a “hot line” in hours for emergency services and secondary care to discuss patients accessing these services – this doesn’t mean 24hr availability! 
• These patients will need to have a care plan, a named GP and care co-ordinator (evolving roles for our practice nurses?)
• They will need regular reviews and any unplanned admissions will also need review. 
• This will require a change in the way we work with vulnerable patients, but hopefully with the pointless bureaucracy of QP removed we may have some extra time to enable this.  It’s worth noting hese changes have been successfully piloted in Scotland with big benefit to patients and the health service alike (“Anticipatory Care Planning” - BJGP 2012;62;84)

• There’s some sketchy talk about “choice of practice” which basically means forget boundaries but this won’t be in April 2014 and may be “voluntary”.

• Practices which have opted out of OOH will need to monitor the quality of their local service – I can think of a few things to say about 111…

• Seniority will be phased out over 6 years and the money will go into core funding for practices.

This is not a complete account of the contract by any means – other areas include IT (providing online access for prescriptions, appointments and the Summary Care Record), a Friends and Family test (patient feedback through a slightly too simplistic question) and a sneaky bit about publishing GP earnings (I can only hope they explain what we get after all the bloody deductions…).

For GPs in Scotland, a minimal change contract is being negotiated for 2014, Wales is trying to reduce bureaucracy and Northern Ireland is looking to reduce QOF.  It seems the UK has become quite the experiment.

From the clinical perspective in England there are going to be changes, but for now, surprisingly, these might be changes for the better.  As ever, the proof is in the eating, the devil is in the detail and of course, no-one knows what next year may bring.

Neal