1	New GP Contract Review background and key features
2	Problems leading to new Contract excessive workload increasing demands no recognition of high quality care repeated unilateral contract changes resource/demand mismatch no control exhaustion disillusion low morale major recruitment and retention problem vicious circle
3	New contract - some of the key principles GP time is a finite resource all GPs should be entitled to a reasonable level of income for a reasonable level of work no new work without new resources control of working life recognition of the value and cost of providing high quality care
4	Control of working life The new contract aims to: enable GPs to take on manageable levels of work provide necessary resources give GPs power to use resources as they see fit
5	What will the new contract look like? Local implementation Contract between a practice and a PCO practice partners will enter contract with PCO together Terms of individual practice contracts from national “menu”
6	The contract “menu” Four types of service “Normal” services: Essential Additional “ Supplementary” services: National enhanced Local enhanced
7	Essential Services MANDATORY - common to all practices “ The management of those who are ill or believe themselves to be ill with conditions from which recovery is generally expected for the duration of that condition, and the general management of patients who are terminally ill ”
8	Additional Services Normally expected of all practices but OPT-OUT possible These will mainly include services which are preventative - e.g. CHS contraception CDM Vaccinations/Immunisations
9	National Enhanced Services OPT-IN - must be available for all patients across all PCOs but NOT by all practices “Services that require specialist skills and/or facilities and/or equipment.” Examples Intra partum care Minor injury services Services to violent patients
10	Local Enhanced Services OPT-IN - offered to all patients across single PCO but not by all practices Response to specific local requirements Examples - care of asylum seekers, the homeless, innovative local schemes
11	Out of Hours Change to current 24 hour responsibility PCO responsible for ensuring provision for OOH period 6.30pm - 8am + weekends and bank holidays PCO to have contingency plans to cover unexpected failure of OOH service
12	Rewards for Quality Substantial new money for quality In addition to the global sum Payment for what many already do
13	What the money is for Encouragement though aspiration payment Support in advance for infrastructure Reward for achievement
14	Infrastructure, Aspiration, Reward and Maintenance Money in advance for computers, equipment and staff A fixed aspiration payment In advance Rising at each level Reward dependent on level of achievement
15	Incentives and Rewards Graded to facilitate quality for all Quality at your own pace The more you do, the more reward The more rapidly you improve quality, the more rapidly you get rewarded Lower list sizes do not inhibit earnings from quality
16	More time for better consulting Higher quality needs longer consulting Longer consulting means better outcome Quality payments will incentivise longer and more thorough consultations Longer consultations are more satisfying and less stressful Patients like longer consultations
17	Don’t panic Don’t have to do it all at once You are already doing it but not recording it Money in advance to record and deliver Safeguards for practices if patients decline Physical constraints to delivery are exempt
18	Phased Clinical Markers Cardiovascular and Cerebrovascular Coronary Heart Disease Congestive Cardiac Failure Hypertension Stroke Atrial fibrillation May be Diabetes later
19	Exception Reporting – you don’t have to count them if… Patients refuse to attend three times They are new patients or recently diagnosed It is not clinically appropriate They have given informed dissent They cannot tolerate medication / therapy They are taking the maximum medication They have another supervening condition
20	High Trust Reporting Data entry as you see patients Audit data generated by normal workload Annual report on computer Almost no claim forms to fill in Very little paperwork Visit from PCO to verify annual report Appeals if you think PCO is unfair
21	How it will work Count data for all the markers you can Decide what level you are at Decide to what level you wish to aspire Agree this with PCO Receive aspiration/infrastructure payment Do the work Receive reward if standards achieved
22	Funding Problem - resources not linked to need or demand Solutions funding will follow the patient patient needs to be weighted Consequence - resources always available to practice, for the practice to decide how to use them
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25	Supply Management Skill mix Nurses Pharmacists
26	Demand Management Doctor-Patient Partnership Expert patients Life Education Centres National Curriculum
27	Career Structure Modular not linear Valuing traditional skills and experience Developing skills Developing special interests Clinical leadership Salaried options Seniority payments
28	New Contract Summary Deliver control back into hands of GPs through: ability to manage workload delivering resources with patients no new work without new resources flexibility in how to provide services and in the services you provide
29	New Contract Summary Recognise and reward existing levels of high quality care Incentives, opportunities and rewards for consistent improvements in quality