ࡱ> y ObjbjEE 3''gE8tbt"???~~~wayayayayayaya$c2fJaSz~SSa??;a."""S??wa"Swa""2 [`?pJ~-/|\.caa<b]|f|f\`|f`P~"g~~~aa"~~~bSSSS|f~~~~~~~~~ :  Somerset Local Medical Committee East Reach House East Reach Taunton TA1 6EN Tel No (01823) 344314 Fax No (01823) 344390 E-mail lmcoffice@somerset.nhs.uk Or: jill.hellens@somerset.nhs.uk Website http://www.somersetlmc.co.uk SOMERSET ENHANCED SERVICES FOR 2007/8 LMC SERVICE AGREEMENT DETAILS FOR PRACTICES General Comments: Contractors agreeing to provide any of the ES are required to give the PCT 3 months' notice of their intention to cease providing the service. The PCT is also required to give contractors 3 months' notice of its intention to cease to commission any of the ES from contractors. This period of notice may be altered by mutual agreement. This document provides details of the service agreements relating to the Enhanced Services (ES) that the LMC has negotiated with the PCT on behalf of practices for the current financial year. This ES agreement will be valid for the 2007/8 financial year only. The PCT will be producing comprehensive Service Level Agreements (SLAs) for each ES, which will be sent to practices in due course. These will reflect the information detailed in this document. The PCT will not commission all the services specified in this document from each practice. The PCT will inform each contractor of the services that it wishes to commission from them for this year. For the majority of ES, the price for this year includes an inflationary uplift on last year. The remaining services attract a new tariff. The LMC strongly recommends that each contractor ensures that an individual ES agreement is completed for the practice, which is signed by both the contractor and the relevant PCT director. This is particularly important if the contractor does not agree to provide all of the ES being commissioned from the contractor. Unless otherwise specified, service agreements should be based on the relevant National Service Specification (NSS) detailed in Investing in General Practice: Supporting Documentation, referred to as the blue book. Indicative payments, based on activity in 2006/7, unless otherwise specified, will be paid in 12 monthly instalments during 2007/8. The PCT will produce a payment schedule for each contractor detailing the indicative amounts payable and timescale for payment for each of ES. Payments relating to ES will be backdated to 01/04/07, unless otherwise stated. Actual payments to the contractor for 2007/8, for those services paid monthly on an indicative basis, will relate to final achievements as calculated in April 2008 subject to target population / number of patients treated, depending on the service. This will be reconciled against indicative payments made to the contractor and a reconciliation payment will be paid to the contractor (or by the contractor) by the end of the first financial quarter of 2008/9. Payments specified below relate to an average practice with a list size of 5891 as defined in the GMS contract, except for IOS payments, or unless otherwise specified. Practices should note that all ES are voluntary. A practice may therefore agree to provide a limited number of the ES specified below, depending on the service details and associated financial reward agreed with the PCT. The PCT has a statutory duty to commission alternative services for the practice population in relation to those DES that a practice chooses not to provide. DIRECTED ENHANCED SERVICES (some funded as a LES): Access ES: The Access ES will continue in Somerset as a LES, as there has been no national agreement on the continuation of the DES. The LES will be commissioned on the same basis as the DES. Implementation plan to be agreed between the contractor and the PCT. This will be monitored via the monthly Primary Care Access Survey, in accordance with the information provided in the Access DES. First component includes payment of 69.5p per patient. This payment is dependent on the agreement of a written Access Implementation Plan, and on continuing to participate in the monthly surveys. The PCT expects practices to reflect on the results of National Patient Experience survey as part of the preparation of the access plan. Payment should be received by the contractor within one month of the practice plan being submitted and agreed and the practice confirming its continued participation in the surveys. Final component includes payment of 1.39 per patient, paid pro rata according to the results of national Patient Experience Survey to be conducted in the second half of 2007/8. Payment should be received by the contractor by the end of June 2008, following confirmation of the contractors achievement. Childhood Vaccinations and Immunisations DES: Payments as detailed below are based on the typical practice as defined in the blue book (page 2 of specification). The weighting for the achievement targets will be: 50% for Pediacel uptake, 25% for MMR uptake and 25% for Meningitis C uptake. Payment for childhood immunisation will be 2,829 for the typical practice meeting the lower target and 8,537.94 for meeting the higher target. Payment for pre-school boosters will be 881.13 for the typical practice meeting the lower target and 2,642.32 for meeting the higher target. Quarterly information regarding the eligible children and contractors achievement to be submitted by the contractor. This will be used to calculate the end of year payment reconciliation as detailed above. The pneumococcal and additional HiB vaccination programme is not included in this DES. These will be paid under an item of service arrangement, with a payment of 15.11 for each child given the full course and 7.56 for each child given vaccinations under the catch-up programme. Influenza and Pneumococcal Vaccination DES: Payment will be 7.56 per immunised patient. Target population for this year will be patients >65 for both influenza and pneumococcal vaccination, influenza at risk patients <65 and pneumococcal at risk patients <65 as agreed by the CMO. The contractor will provide quarterly information to the PCT regarding activity. This will be used to calculate the end of year payment reconciliation. Hepatitis B immunisation for those at risk, MMR catch up, and other immunisations as recommended by the CMO during the year are included in this DES, paid on the same basis. Minor Surgery DES: Payment for each eligible cutting procedure will increase to 87.21 to reflect the additional cost of utilising single use instruments. The new fee will be payable from 1st April 2007 for those practices already utilising single use instruments, and for other practices from the date that the practice confirms that it has moved to single use instruments (until then the fee will remain at 85.24). The PCT will be expecting all practices to move to single use as soon as possible. The list of eligible cutting procedures will be as defined in the SLA agreed between the LMC and PCT. The list will include ingrown toenail excision this year, where the podiatry service is unable to perform this within a reasonable timescale. Oestrogen implants will be included as an eligible cutting procedure. Payment will be restricted to these eligible procedures and contractors should continue to manage patients on the same basis of clinical need as per 2006/7. Payments for each eligible injection will be 42.88 per injection. The injection fee will be payable for 3-monthly Zoladex and Prostap injections for those patients currently on these medications or specifically recommended these medications by consultants in secondary care. Testosterone injections are included in this DES, in addition to the previously agreed eligible injections. The PCT has agreed with the urologists across the county that Triptorelin will henceforth be used as the LHRH of first choice in prostate carcinoma. In addition, there will be a gradual shift of existing patients on other LHRH analogues to Triptorelin. In view of the different indications for Triptorelin in the BNF, the PCT will arrange for a letter from the urologists to be sent to the LMC to be forwarded to practices, confirming that they consider Triptorelin to be as efficacious as the other LHRH analogues, in order to ensure that GPs are clinically protected when switching patients over to Triptorelin. Triptorelin may be given by standard injection every 3 months, and is given by practice nurses in many practices. The injection fee for Triptorelin for this year will be 7.56 per patient. Contractors activity target will be the 2006/7 activity levels +/- 10%. Activity outside of this range will be subject to review by the PCT. Activity above the 10% ceiling may not be funded (patients may then be referred to 2 care). The contractor will provide quarterly information to the PCT regarding activity. This will be used to calculate the end of year payment reconciliation. Choose and Book ES: The CAB ES will continue in Somerset as a LES, as there has been no national agreement on the continuation of the DES. The contractor will be paid 4p per patient (based on the practice population as at 1st April 2007) for each month that the contractor achieves 75% of referrals being made using CAB, measured against an agreed practice trajectory. Individual practice trajectories will be calculated by the RMC/BMS by the end April 2007, benchmarked against April performance, and then agreed with each practice. This payment will be based on referrals made, not converted bookings. The contractor will be paid monthly based on the previous months achievement. The contractor will receive a report of referrals made against trajectory within one week of the end of each month. The contractor will receive an additional incentive payment of 5p per patient (based on the practice population as at 1st April 2007), if the contractor achieves the target of an average 75% referrals made via CAB during the 2007/8 financial year. Practice Based Commissioning ES: The PBC ES will continue in Somerset as a LES, as there has been no national agreement on the continuation of the DES. Details of the LES have not been finalised and will be sent to practices once final agreement is reached between the LMC and PCT, with the involvement of the countywide PBC consortium and those practices outside the consortium. Information Management and Technology DES: This is a 2 year DES initiated last year and will continue on the same basis in 2007/8. Violent Patients DES: The PCT will be continuing the existing area services and is considering expressions of interest from practices in the Mendip area. NATIONAL ENHANCED SERVICES: Anticoagulation Monitoring NES: Funding for a level 3 service will be 96.48 per patient per year. Funding for a level 4 service will be 124.61 per patient per year. The PCT is considering commissioning a Level 4 service from those practices that are situated outside the towns where the Acute Trusts are based, in order to improve patient compliance and safety. The PCT will contact practices individually once a plan for moving to level 4 has been produced. Practices that move from level 3 to a level 4 service in year will be paid pro rata. Patients requiring home monitoring will attract an additional fee of 3 per home visit required for INR testing, where practice employed staff undertake the visit. Specification is as defined in the blue book. The contractor will provide quarterly information to the PCT regarding the number of eligible patients. The number of eligible patients used to calculate the end of year payment reconciliation will be based on the average of the number of eligible patients indicated in the quarterly submissions from the contractor. The cost of test strips is not included in the level 4 service. The contractor will purchase the strips and invoice the PCT, or the PCT will purchase the strips centrally. IUD Services NES: The fitting fee will increase to 88.13 per patient to reflect the additional cost of utilising single use instruments. The new fee will be payable from 1st April 2007 for those practices already utilising single use instruments, and for other practices from the date that the practice confirms that it has moved to single use instruments (until then the fee will remain at 79.92) The follow-up fee will be 20.77 per eligible patient per year. Payment for follow-up care will be based on 1/3 of the contractors population with IUDs in situ as at 1st April 2007 being eligible for this payment. Service is as specified in the blue book. The fitting fee includes payment for the initial 6 week follow-up review. If a contractor is performing less than 12 insertions per year, evidence of clinical competence must be submitted to the PCT Insertion and follow-up care of Implanon will be included in this NES and paid on the same basis. The contractor will provide quarterly information to the PCT regarding insertion activity and yearly information on the practice population with IUDs/Implanon in situ. This will be used to calculate the end of year payment reconciliation. Near Patient Testing NES: Funding for this service will be 91.11 per patient per year. Medicines qualifying for inclusion under this NES are: Penicillamine, Sulphasalazine, Myocrisin, Auranofin, Methotrexate, and Azathioprine as per previous years. In addition, leflunomide has been included in the list of qualifying medicines under the ES for this year. Monitoring arrangements for any medicines not specified in the blue book to be agreed between the PCT and LMC based on shared care protocols between primary and secondary care. The contractor will provide quarterly information to the PCT regarding the number of eligible patients. The number of eligible patients used to calculate the end of year payment reconciliation will be based on the average of the number of eligible patients indicated in the quarterly submissions from the contractor. Minor Injury Services NES: Funding will be based on an annual retainer fee of 1072.19, and an activity fee of 53.59 per patient seen. Service specification will be as detailed in the blue book or as agreed between the contractor and the PCT. The PCT and contractor will agree an activity ceiling for this service. The contractor will provide quarterly information to the PCT regarding the number of patients seen. This will be used to calculate the end of year payment reconciliation. First Response NES: Funding will be based on an annual retainer fee of 1393.31, an in hours fee of 74.77 per call and an out of hours fee of 137.07 per call. Service as specified in the blue book or as agreed between the contractor and PCT. LOCAL ENHANCED SERVICES: Drug Services Shared Care LES: Funding will be 384.86 per patient case managed under shared care arrangements in the practice. Service specification is as defined in the Shared Care Monitoring specification agreed between the LMC PCT, and DAAT. The DAAT has also allocated 30,000 on an ongoing basis for the initial and ongoing training of GPs participating in this LES. The contractor will provide quarterly information to the PCT regarding activity. Payments will be made quarterly in arrears. Neonatal Baby Checks LES: Funding will be 51.92 per check. Payable eligible for checks performed on neonates born at home or discharged from hospital prior to a formal neonatal baby check having been completed. The contractor will provide quarterly information to the PCT regarding activity. This will be used to calculate the end of year payment reconciliation. Pre-and Post-op. Care LES: Funding will be 1006 per 1,725 patients per year pro rata The activity in this LES relates to all activity generated, irrespective of provider. The LES includes activity historically provided in Primary Care. The LES does not fund activity newly transferred from Secondary to Primary Care. No specific activity information is required from the contractor in relation to this LES. Amiodarone Monitoring LES: Funding will be 45.55 per patient per year. Patients in this LES should be under shared care arrangements, including specification of the duration of amiodarone therapy. The PCT is commissioning a monitoring service involving twice yearly blood monitoring only. Patients under this LES should be seen regularly (every two years as a minimum) in secondary care and should have their lung function, ophthalmological and other monitoring arranged in secondary care at that time. The contractor will provide quarterly information to the PCT regarding the number of eligible patients. These will be patients initiated on amiodarone in secondary care but monitored by the contractor as specified above. The number of eligible patients used to calculate the end of year payment reconciliation will be based on the average of the number of eligible patients indicated in the quarterly submissions from the contractor. Compression Dressings LES: Funding for this will be 180 per leg for up to 13 weeks of treatment. Funding will be based on the management of the whole episode of care following appropriate assessment confirming the need for treatment. Service is to be provided for patients who are unable to be managed by PCT provided community services for compression dressings. Detailed service specification to be produced by the PCT. The contractor will provide quarterly information to the PCT regarding activity. This will be used to calculate the end of year payment reconciliation. Smoking Cessation LES: The PCT is producing a new LES proposal for smoking cessation, which will be sent to practices once the service specification and funding details have been agreed between the LMC and PCT. 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