2 GP contractual Models GMS (contract in perpetuity) PMS (contract in perpetuity)APMS (time limited contract subject to procurement rules)
3 GMSNationally negotiated contract for core and additional services Capitation funded based on Carr Hill formula Global Sum (£64.59 at 2010/11 prices) Funding discrepancy address by a Minimum Practice Income Guarantee (MPIG) Further services funded under enhanced services – DES, NES & LES Quality and Outcomes Framework Core Hours to (out of hours responsibility transferred to PCT)
4 Original PMSLocally negotiated contract that offered additional flexibilitesPre dates the current GMS contractRecent guidance that the two contracts should be treated the samePMS practices have access to NES and LESPMS practices have access to QOF with 105 point abatementAllowed to opt out of OOH when new GMS implemented
5 New PMSSome PCTs have introduced updated versions of PMS contracts where providers would not accept APMS contract but PCT wanted to commission additional flexibilities
6 APMS Alternative Provider Medical Services Locally negotiated Does not have to be GP led/owned often companies who used salaried GPsOften has some contract values linked to Key Performance indicatorsCore hours service only but may be more than standard core hours
7 QOF Points make prizes 20 Clinical Domains 6 Organisational Domains 4 Additional Services DomainsThresholds and achievements set£ per point based on an average list size (5981)Takes account of disease prevalence in clinical domainsPatients can be excepted from the counts but PCTs monitor this closely
8 Other funding Premises costs (rent, rates etc.) Seniority allowances Discretionary funding for locums to cover maternity/paternity leave and in some cases
9 Key Performance Indicators QOF could be viewed as a form of KPIMainly linked to APMS contractsWill definitely be linked to any services commissioned from Primary Care outside of “normal” servicesOutcome measures
10 The FutureAll of the NHS is going to have to generate efficiencies to survive and Primary Care is included in this.The new regimeGPs being responsible for 80%-90% of NHS budget in real termsNegotiation of new GP contractGP contracts to be held by the NHS board not PCTsRemoval of SHA’sPCTs to concentrate on Public Health and residual commissioning
11 Practices as a business Need to look for efficiencies would Federated models of GPs offer thisWhat is a federation?Mergers?What opportunities are there for delivering a wider range of services that may attract more funding?By expanding services do we threaten core servicesHave GPs and their teams the knowledge and skills to move forward in a new structure?
12 Individual GPs Do you want to be a partner? Would you want to be in a salaried position?Do you want to work totally in primary care?Would you want to have a portfolio career with different interests and responsibilities in different areasClinical Leadership/engagement very important
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