GP contract changes 2019/20: three top things to emerge

The five-year GP contract framework to deliver on the NHS Long Term Plan has been launched and long it is, clocking in at 103 pages! We’ll be looking in more detail at what it contains over the days and weeks to come but for now, here’s my take on three big news items and a brief look at the other commitments that will be of interest.

1. IT infrastructure. Going digital and improving access.

NHS England and the BMA General Practitioners Committee are to agree a new standard specification for IT systems within primary care. This will be an important step to ensuring that the drive towards digitising primary care occurs in a relatively consistent manner across the country.

Other notable digital improvements include:

• All patients will have the right to online and video consultation by April 2021. This chimes with the NHS LTP and crucially lays the foundations for the so called option for a patient to see a “digital GP provider” to be a part of existing GP practices (ie they offer traditional face-to-face and digital services under one roof – the digital aspect could either be supplied directly or sub-contracted).
• All GP practices are to make at least 25 per cent of appointments available to book online by July 2019.
• New patients will have access to online records from April 2019 and all patients will have access online to correspondence by April 2020.

2. Primary Care Networks. The new kids on the block.

The outcome of the contract negotiations provide the much anticipated flesh on the bones of the new primary care model that has hit the headlines recently, within both the NHS Long Term Plan and GP Partnership Review. PCNs are the new service vehicles designed to extend the scope of primary and community services and develop bottom up integration.  

But, what makes a PCN?

The constituent elements of a PCN that emerge from the contract negotiations are:

• GP practices need to commence discussions and cluster with neighbouring practices in PCNs by July 2019. The expectation is that all areas within England will be covered by a PCN covering between 30 – 50,000 patients.
• Every practice will have the option to take a new PCN Directed Enhanced Service contract (a bolt on contract to the core GMS contract) – those that do not opt to be involved will have their patients covered by a PCN established by other providers locally. The aim is to realise a target that every patient in the country is covered by a PCN (previously the target deadline for this was the end of the contract year 2018/19).
• The legal structure and format of the PCN will not be prescribed. This will be at the discretion of each PCN, but it is likely that PCNs will largely mirror each other in localities to enable further integration possible with relative ease.
• The specification of the DES will be published in March 2019; but initially, it is expected to focus on the creation and development of the PCNs structure and governance etc. This specification will evolve over time.
• Constituent practices are to:
  1. enter into a pro forma Network Agreement (that will, amongst other things, establish the working arrangements between constituent practices and map out/ identify their network area); and
  2. nominate a Clinical Director and nominate a central point to which funds are to be directed (this does not necessarily need to be the practices themselves and could be a federation or NHS trust).

     The Network Agreement is likely to cover data sharing and PCNs will, it is understood, have access to a pro forma Data Sharing Agreement to facilitate the same.

• The requirement and funding for GP extended hours access (formerly a DES in its own right) will phase out and be moved into the PCN DES.
• PCNs will be able to obtain funding to cover the cost of engaging one clinical pharmacist and one social prescribing link worker. The funding will increase to allow additional pharmacists / social prescribers to be funded for each additional 50,000 patients (which shows the intention that these will be bottom up integration that are expected to scale upwards).
• Over time, other healthcare professionals will be added to the scheme and funded (examples include, community paramedics and first contact physiotherapists).

How will the funding work in a PCN?

Here’s the details so far.

• Individual practices will receive an additional payment known as a Network Engagement Funding (amount TBA) for engagement with a PCN (this will be paid via the Statement of Financial Entitlements and is the only funding that will be paid to the practices direct).
• Networks will receive a recurrent Network Administration Payment of £1.50 per patient to use in such manner as the PCN decides.
• PCNs will be able to claim 70 per cent of the cost of a whole-time equivalent clinical pharmacist and 100 per cent for a whole-time equivalent social prescribing link worker. This equates to a maximum amount that PCNs are capable of obtaining reimbursement of £37,810 for a clinical pharmacist and £34,113 for a social prescriber.
• Networks will be eligible to claim funding to cover their nominated clinical director (in reality, this is funding to cover the locum cost cover for the chosen GP lead). The maximum amount that they can recover will be on a sliding scale depending on the size of the network but will be up to a maximum of £34,379 (being 0.25 whole-time equivalent of a GP) for a 50,000 patient PCN.
• From 2019/20 PCNs will receive £1.45 per patient as and when they take over extended access. The intention is that by 2020 the £6 per patient funding under the GP Forward View Improving Access scheme will be diverted to Networks. If the £6 per patient transfers into PCNs, then Networks could be looking at recurring funding of circa £513,000 per annum.

3. First state indemnity scheme for GPs starting in April 2019.

This is the other big news. A new centrally-funded clinical negligence scheme for all GPs (partners, salaried GPs, locums and includes out-of-hours). The scheme will be operated by NHS Resolution. The specifics of the scheme will require careful consideration as there are gaps in the cover. Indeed, GMC representation, private work are not covered and items that will need to be covered by GPs via their chosen medical defence body.

Other key headlines.

• Pay and expenses uplifted each year in line with predicted inflation.
• There will be a prohibition on advertising or hosting private GP providers who provide the same core GP services offered free on the NHS. How this will operate in circumstances where private providers are in situ under leases (whether with the GP contractor or a shared private landlord) remains to be seen.
• From 2019, GP contractors are to provide an email and mobile number for Medicines and Healthcare Products Regulatory Agency alerts - these generally cover issues with medicines available on the NHS.
• There will be changes to the Quality and Outcomes Framework including the creation of a new “Quality Improvement” domain.
• A promise to review out-of-area regulations to overcome issues seen as a result of digital providers and the automatic de-registration caused by patients who signed up to them.
• BMA General Practitioners Committee to work with NHS Digital to establish a framework for a new GP data service to replace the General Practice Extraction Service.