GP Contract
In June 2003 GPs voted throughout the United Kingdom to accept a new
contract for the delivery of general medical services. This contract was the culmination of protracted
negotiations which had lasted for approximately 2 years. And represents a landmark in the development
of general practice. The new contract which comes into effect on 1 April 2004 will be accompanied by
substantial uplift in investment of 33% year over the next three years.
The new contract is designed to bring about a range of improvements
in primary care in providing demonstrable benefits to general practitioners, to other healthcare professionals,
to the health service in general and most importantly to patients including:
- Improved access to services by local people through Health and Social Services Boards commissioning enhanced services to encourage the development of a wider range of services closer to home.
- Fairer funding to remove historic anomalies in the current system where funding follows the GPs in post rather than the needs of patients and the local community;
- GPs will be able to manage their workloads by enabling them to opt out of providing some services, for example, out-of-hours;
- Better management of chronic diseases through a new framework which will provide significant rewards to practices to recognise improvements in clinical standards:
- Improved organisational standards by rewarding practices which provide better records, more effective communication with patients and conduct patient surveys;
Changes
The major changes in introduced by the contract will be in terms of
- Out-of-hours services
- Information and management technology
- Premises;
- Focus on quality;
- Patient experience;
- Range of services provided
The
key issues in relation to each of these main areas of change are highlighted below.
Out-of-hours services
- GP practices will be able to opt out of providing out-of-hours care. The responsibility for ensuring such services are provided will rest with the Health and Social Services Boards.
- Out-of-hours are defined as 6:30 pm to 8:00 am on weekdays and the whole of weekends, bank holidays and public holidays.
- Health and Social Services Boards will be responsible for working with others in designing new arrangements and ensuring that they are put in place. Boards will work with hospitals, community trusts and GPs to ensure 24-hour care is available to all patients.
- People will still get access to high quality services. Care will be delivered to specific quality standards and in an integrated way with Accident and Emergency Units, etc.
- Opt outs can begin from 1 April 2004 but only where the health and Social services Board has an accredited alternative scheme in place. With effect from 31 December 2004, GPs will no longer be personally responsible for providing out-of-hours services.
- It is expected that a number of GPs will still be involved in providing elements of out-of-hours services and if practices decide not to opt out of such services they can still do out-of-hours work for their patients
Information and management technology
The new contract brings substantial investment into the provision and
maintenance in computer systems or general practice.
Computers will be essential to facilitate delivery of the new services
and standards that will be provided.
Health and Social Services Boards will be responsible for making sure
that practice systems are updated on a regular basis.
The investment in computer systems will bring about a range of improvements
including disease registers, all/recall systems and the monitoring of services provided to patients.
Premises
Modern practice requires modern equipment and good premises and significant
new funding will be available to improve premises.
Health and Social services Boards need to work with practices and others
to undertake a survey of what needs to be one to improve premises.
Focus on quality
- A significant proportion of the new money tied to the contract will be available to reward practices for providing higher quality services.
- A new framework based on the latest available research will set out a range of clinical and organisational standards and practices will be rewarded for achieving those standards.
- The clinical areas targeted are –
- Stroke or transient ischaemic attacks
- Hypertension
- Diabetes
- Chronic Obstructive Pulmonary disease
- Epilepsy
- Hypothyroidism
- Cancer
- Mental health
- Asthma
Patient experience
Practices will also be rewarded for reaching set standards in relation
to organisational factors such as better records and information about patients, education and training,
and practice and medicines management.
Incentives will be offered to encourage practices to use accredited
questionnaires to gain patient views and make appropriate improvements. Providing feedback to patients
on such questionnaires is also encouraged.
Range of services provided
Under the new contract –
- Practices must provide essential services – these services will be provided for people who are sick or perceive themselves to be sick with conditions from which recovery is generally expected, chronic disease management and general management of patients who are terminally ill.
- Practices are expected to provide additional services, covering cervical screening, contraceptive services, vaccination and immunisation, child health surveillance, maternity services (including intra partum care) and some minor surgery procedures.
- Health and Social Services Boards must also commission a range of Directed Enhanced Services to provide –
- Improved access to medical services for patients
- Quality Information Preparation
- Care and treatment for violent patients
- Childhood vaccinations and immunisations
- Flu immunisations
- Minor surgery
- Health and Social Services Boards may also commission a range of National Enhanced Services to provide –
- Anti-coagulation monitoring
- Enhanced care of the homeless
- Intra partum care
- Intra-uterine contraceptive devices
- Minor injury services
- More specialised services for patients with multiple sclerosis
- More specialised sexual health services
- Patients who are alcohol mis-users
- Patients who are suffering from drug abuse
- Provision of near-patient testing
- Provision of immediate care and first response care
- Specialised care of patients with depression
- Enhanced schemes may also be developed in response to local need for which
terms and conditions will be discussed locally between the Health and Social Services Board and the
provider.
All enhanced services may be commissioned from GP practices or from elsewhere and a practice will not have to provide any of the enhanced services unless it wishes to do so.
