ࡱ> FHE[@ qbjbj44 &ViViq|||||||  f#2 * * * * * * * """""""$$R&f #| * * #||* * # "|* |* " "  ||a"*  h@ . !"6#0f#"\P' :P'(a"||||a"P'|u"\* h $ Tx * * * # #$ $   Somerset LMC Notes on Contracting to provide Medical Services to a Community Hospital This paper should be read in combination with the GPC guidance paper (Focus on Community Hospital GPs July 2005), available on the LMC website at  HYPERLINK "http://www.somersetlmc.co.uk" www.somersetlmc.co.uk Background to Medical Services to Community Hospitals One of the reasons that central advice has been so long delayed is that the care of patients in community hospitals (CH) is not part of GMS or PMS. PCTs running community hospitals may therefore provide medical input in any way that they choose. For historical and practical reasons this means that there are entirely different arrangements in all the CHs in Somerset. Until the establishment of PCTs, community hospitals operated as part of acute hospital trusts, and GPs working in them would have had contracts with the trust and not the PCT. We do not yet know what kind of organisation will be responsible for CHs after 2008, only that it will not be the PCTs. However, you do now need to make a decision on whether your practice wishes to seek a contract with the PCT to provide a service to your CH for the next 2-3 years. Because it is neither practical nor desirable to establish a single contract format for all CHs in the county, much of the negotiation will need to be continued on a practice or locality level Contract types The GPC and LMC favour a Service Level Agreement (SLA) along the lines of the GPC draft. PCTs are likely to seek one contract holder for each CH, so practices may wish to form a provider group to negotiate the contract, or perhaps one practice may hold the contract and subcontract with other local GPs. But the contract will generally specify attendance at certain times, or within a time bracket, rather than the care of individual patients, and it may therefore be difficult to arrange to see only your own patients as was the case in the past. It is very important that you are entirely clear whether you have an employment contract in which case the PCT is responsible for employers rate superannuation, holiday & sickness benefits, and so on; or whether you have a contract for service provision in which case all of these elements must be included in the contract price. As a general rule we do not commend a bed fund/points based contract as these tend to perpetuate historically low rates of payment for CH work. Replacing existing contracts We are aware that some practices do not have a valid current contract at all, and that they are being paid on the basis of a customary arrangement. It is also not always clear who is the other party to the contract, but you should assume that it is whoever is responsible for payment. In some cases this an acute trust, but do check that they are not simply acting as the payment agent for a PCT. This is important, because if you have an employment contract at present, you may be entitled to redundancy payments if the PCT wants to replace your contract with an SLA. Remember that current contracts are nearly all with individuals so that even if the practice becomes part of a new contract arrangement redundancy may be payable. BMA members should contact the Bristol office for advice on this very technical area. Out of Hours At one stage the PCTs sought to reduce payments under existing contracts because GPs were no longer providing a service out of hours. In theory, the PCT could hold you to the terms of your current contract and require you to attend out of hours and hold you in breach if you do not. In practice, the LMC and PCTs have accepted that this area was under negotiation and the new SLA will make clear exactly where and when services are required. Action The LMC suggests that practices review their existing contracts, and any new one proposed by the PCT, against the draft SLA. The LMC will seek to identify a lead GP for each community hospital, either by local consensus or by giving the local LMC member the job. Please can you keep the LMC office informed of any contract discussions you hold, so that we can try and ensure a consistent approach within each PCT. 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