GMS/PMS Contract 2018/19
Technical Requirements for 2018/19 GMS Contract Changes August Version 3
GPC England has concluded negotiations with NHS Employers for amendments to the 2018/19 GMS (and PMS) contract.
The agreement reached will provide some stability to GMS/PMS contractors, securing £256m of funding to address practice pressures, including practice expenses and a long-overdue pay increase.
GP pay and expenses
The GPC have not agreed to accept a further pay uplift of 1% this year. Instead they have agreed that from 1 April 2018, an interim payment for GP pay and expenses will be made whilst they await the outcome of the DDRB process.
Therefore, pay will be initially uplifted by 1% and expenses funding will be uplifted in line with Consumers Prices Index. This will mean that, together with the annual recycling of correction factor and seniority payments, global sum with initially rise from £85.35 to £87.92.
The BMA’s submission to the DDRB calls for a significant uplift to GP pay and expenses, of Retail Prices Index plus 2%. Any increased uplift secured through the DDRB process will be back-dated to 1st April 2018.
Indemnity increase cover
The GPC have agreed a sum of £60m to cover the average uplift in indemnity for the last two years. This will both be paid to practices in 2018/19 on a per-patient (unweighted) basis. Practices should ensure that an appropriate equivalent amount is passed on to any salaried GP and/or partner that pays for some or all of their indemnity cover.
As with last year, locum GPs should ensure their charges reflect their costs (including indemnity costs).
In order to ensure all real expenses are covered, the GPC have agreed that vaccinations and immunisations that are reimbursed through the SFE will be uplifted by CPI. The item of service fee for these immunisations will be uplifted from £9.80 to £10.06. It is the GPC's intention to secure a similar inflationary increase for other immunisations as soon as possible.
Amendments to V&I schedule
In addition there some amendments to the clinical aspects of vaccinations and immunisations through the SFE.
These are summarised below:
• the three month dose of pneumococcal has been removed from the targeted childhood immunisations scheme, based on the recommendation from the JCVI. The funding for this element of the childhood immunisation will be unaffected.
• Meningococcal ACWY (MenACWY) completing dose - the date of eligibility has changed from 1/4/15 to 1/4/12 therefore all patients within the age range are now eligible. Practices are not required to proactively offer or encourage patients to be vaccinated. Vaccination of 14-16 years is only where the patient has missed schools provision.
• Meningococcal B – there are no changes to the vaccinations programme, however the requirements are now defined in the SFE rather than in a service specification.
Amendments to reimbursements for locum cover for parental and sickness leave
The GPC have agreed that these payments should both be increased to avoid their value eroding with inflation.
Parental leave payments will increase from £1,131.74 to £1,143.06 for the first week and £1,734.18 to £1,751.52 for subsequent weeks and the upper amount for sickness payments will increase from £1734.18 to £1751.52.
In addition to this, the GPC have clarify the rules for locum cover reimbursement such that from 1 April 2018, if a contractor chooses to employ a salaried GP on a fixed-term contract to provide cover, NHS England will reimburse the cost of that cover to the same level as provided for locum cover, or a performer or partner already employed or engaged by the contractor.
Electronic referral service
From October 2018 hospitals will only receive payment for standard referrals if they are made through e-RS.
It is expected that CCGs to work with LMCs and practices to resolve local system issues.
While it will be a contractual requirement to use e-RS for all GP practice referrals to 1st consultant led outpatient appointments, agreement has been reached with NHS England that they will take a supportive not punitive approach where circumstance dictates that practices are unable to realise this.
Guidance will be clear that this does not mean that individual GPs have to use the e-RS system themselves. There are a variety of models that practices could adopt, and it is for practices to determine how much of the e-RS process is done by administrative staff.
The GPC have secured £10m investment into the contract this year to ensure practices are financially supported to implement the system. NHS England and GPC England have also agreed guidance for practices.
There are many issues that need to be resolved to ensure practices have a better referral system in the future than they currently do now including:
local contingency processes,
appropriate referral pathways,
delays in hospitals dealing with referrals and
inappropriately declining referrals
These are just some of the many issues the GPC and LMC will be working to resolve.
There will be no changes to QOF indicators for the coming year.
The contractor population index (CPI) will be adjusted to reflect the changes in list size and population growth, with the value of a QOF point being adjusted to take account of this.
This will mean the value of a QOF point increasing from £171.20 to £179.26.
Violent patient removal provisions
There has been agreement to clarify the regulations that already allow for patients to be refused registration where there are ‘reasonable grounds’ for doing so – having a violent patient flag on the patient’s record is consider to be a reasonable ground for refusing to register.
Premises Cost Directions
There are many positive changes to the premises cost directions (PCDs) which are outlined in the FAQ see link below and will be expanded upon in a specific ‘Focus on changes to the PCDs’ to be published shortly.
The GPC have secured agreement on two areas that frequently arise as problems. These are for Hepatitis B immunisations for renal patients and for medical students.
• NHS England has committed to work with specialised commissioning and secondary care colleagues, to ensure that it is clear that the responsibility to deliver hepatitis B vaccination to renal patients lies with the renal service and not with general practice.
• GPC, NHS England and HEE will work together to ensure all medical schools provide services for the provision of hepatitis B vaccines for medical students, to ensure that this burden does not fall to practices without appropriate funding arrangements being in place.
Finally, the GPC have agreed to work with NHS England on:
• a replacement for NHS Digital’s General Practice Extraction Service (GPES)
• use of GP appointments data which is already being extracted
• support for practices wishing to work at scale
• the potential of a basic practice allowance
• the implications of the EU falsified medicines directive
• reducing the administrative burden on practices
• research into locum usage (working with GPC’s Sessional GPs subcommittee)
• appropriate and agreed systems for ‘freedom to speak up’ whistleblowing arrangements
Our Thanks to Dr Nigel Watson Chief Executive of Wessex LMCs for this summary