1. Briefing on General Practice Julian Spinks

2. Areas to consider The state of general practice New configurations Practice Based Commissioning QOF changes Enhanced services

3. The state of General Practice The ‘New’ Contract ▫Global sum ▫QOF ▫Enhanced services ▫Move towards salaried service ▫MPIG Loss of long term relationship with patients Funding

4. New Configurations Move to APMS ‘Managed’ practices GP-led health centres New practices Extended Hours Out of hours

5. Practice-based commissioning Started 2005 ▫Better clinical engagement ▫Better patient services ▫Better use of resources Initial lack of guidance Variable uptake Resistance ▫PCT ▫GP ▫Trust

6. PBC 2 Relaunch 2009 ▫Clinical commissioning: our vision for PBC DOH Jan 09 Most PBC shaped around ‘clusters’ More commitment from PCTs Still variable buy-in from GPs Still few services commissioned (or decommissioned)

7. PBC 3 Need to get involved ASAP ▫Get on agenda ▫Before the money runs out Making continence a priority area ▫Local approach to PBC groups ▫Possibly support with campaigns or materials provided centrally Working with PBC groups ▫Provider or partner? ▫Make it easy for groups-eg pre-prepared business plans.

8. Quality and Outcomes Framework QOF ▫Part of new GP contract ▫Voluntary! ▫Up to 40% of income Around 180 targets ▫Some administrative ▫Clinical in 15 different areas, some ‘easy’ some difficult

9. QOF 2 Ever-changing scheme ▫Until now decided by committee of BMA and NHSE NICE now central to process ▫88 indicators in scope ▫Reviewed over 3-4 years ▫Around 10 new indicators/year ▫First indicators in 2011-12 ▫More ‘evidence-based’ ▫Old indicators rolled into ‘standard practice’

10. QOF process NICE gathers clinical and cost-effectiveness information to help prioritise new indicators. Interested parties submit potential clinical and public health topics for consideration through the NICE website. An independent Primary Care Indicator Advisory Committee prioritises these topics for inclusion in the QOF. The National Primary Care Research and Development Centre (in collaboration with the Royal College of GPs and York Health Economics Consortium) develops the indicators, testing them in a number of GP practices across the UK. NICE consults on the developed indicators, validates the proposals through the Advisory Committee and publishes them on the NICE website. Each recommended indicator is accompanied by supporting information, such as review date and the supporting cost- effectiveness evidence.

11. QOF doubts Likely to prioritise to areas with high mortality, disabling morbidity, high public profile Government brake on new funding Element of ‘local QOF’ Needs to be workable in a GP context ▫Skills ▫Resources

12. Enhanced Services National, Direct, Local Another way to fund new work in general practice Currently a method to maintain funding in practices hit by removal of MPIG Could be used to improve GP continence care at a local level (eg as part of PBC)