1. The Future for General Practice Dr Richard Vautrey Deputy Chair BMA GP committee

2. Why GPs are unhappy? Contract imposition Increased workload Reduced quality Reduced income Government and media attacks Fear that worse is yet to come

3.  Phase out correction factor payments over 7 years  Review PMS funding to reduce variability in practice funding  Implement all changes to QOF recommended by NICE  Reduce the time period for achieving most indicators from 15 to 12 months Contract changes

4.  Increase upper thresholds for QOF indicators to match upper quartile achievement  Remove the whole organisational domain leaving 900 point QOF  Reform the QOF Contractor Population Index (CPI)  New immunisations  rotavirus added to childhood immunisations  shingles for patients aged 70 and catch-up programme  flu for 2 year olds  MMR catch up  Introduce significant new work through DESs Contract changes (2)

5.  More box ticking  unworkable and underpriced new work in QOF  Shifting the goal posts  chasing points at QOF margins  reducing time available to meet targets  requirements for additional training  Impact on access  Impact on secondary care Why GPs are unhappy: workload

6. Clinical problems with clinical QOF changes:  Unworkable new indicators, unavailable services  Changed blood pressure targets + higher thresholds  polypharmacy  Repetitive or inappropriate questioning  Rise in exception reporting  Less time for holistic patient care Why GPs are unhappy: Quality of QOF

7.  Online patient access DES –Risk of e-consultations and inappropriate on-line access to records. –Could widen health inequalities  Case finding for dementia DES –Evidence for dementia screening lacking and could cause harm –Will come at cost of other patient care –Real problem is lack of services  Risk profiling –Volume planned in gift of CCG – could be unmanageable  Remote care monitoring –Preparation for next year Why GPs are unhappy: Quality and workload of DESs

8. Why GPs are unhappy: Uncertainty about LESs Local authority commissioning Standard contract Impact of LA budget cuts? Any Qualified Provider

9. Some (slightly) good news Rotavirus Shingles –for 70 year olds + catch up programme –£7.64 per dose Seasonal flu for 2 year olds –could be extended next year MMR catch up –additional services 10-15 years olds –£7.64 for 16 years + –£1.50 per invitation letter

10. Average practice 2014-2015, threshold QOF loss + organisational point loss = £11,300 + £19,800 = £31,100 Potentially bigger loss from PMS and CF changes Why we should all be concerned: funding

11.  Major redistribution of funding from 2014  Difficult to predict new global sum figure  Not clear whether PMS money will be re-invested in GMS  Some practices will be seriously destabilised, others will gain –High funded PMS practices – almost certainly under current plans –Practices with large correction factors – probably depending on global sum increases –Not clear what will happen for legitimate outliers. Funding redistribution: Good news for some, bad news for many

12.  Responsibility for locum superannuation payments to move to practices  Transfer of funds into contract to cover this  Practices use locums differently, likely to have disproportionate impact on small practices  Likely to be bad for younger locums  Removal of locum appraisal payments Unhappy locums and practices

13.  Commissioning and CCGs  CQC registration  Revalidation  Pension changes  NHS 111  7 day working  Commercialisation and fragmentation of the NHS  Recruitment and retention crisis And to add to the woe…

14.  Protect their patients  Not chasing targets that put patients at risk  Limit workload to maintain quality  Avoid skill-mixing that undermines quality  Prioritise their practice  Do important QOF areas in 9 months  Consider cost of external engagement  Say no to unresourced workload shift What might practices do?

15. What might practices do? (2)  Develop their practice  AQP provider services  Work with others  Federations, larger practices  Shared staff  Shared training  Protect GPs  Work-life balance  Partnership v salaried GP  Retirement

16. Conclusion Increased workload Decreased income Impact on quality Increased stress and burnout So…. Time to become more business-like Time to protect patients, GPs and practices

17. Questions and discussion