Funding in General Practice Dr Andy Withers Grange Practice Allerton

Aims & Objectives Aims –Increase understanding of how General Practice is financed Objectives –Know how :- Practice income is calculated and received Budgets are set The difference between NHS & Private income

Questions How do GPRs get paid in practice? How do salaried GPs get paid? How do GP Partners get paid? What is the difference between a GMS & PMS practice? Are all my earnings pensionable? What is PBC? How can I earn more? Money & referrals/admissions Seniority payments

What do we get paid for? Core General Practice (= Essential Services) Additional Services Enhanced Services QOF

NHS Income

Essential Services MANDATORY - common to all practices 1)The management of patients who are ill or believe themselves to be ill, with conditions from which recovery is generally expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever practicable 2) The general management of patients who are terminally ill 3) Management of chronic disease in the manner determined by the practice, in discussion with the patient

Essential Services Either paid as Global Sum or MPIG in GMS practices Basic Contract in PMS practices

Additional Services Normally expected of all practices but OPT- OUT possible Cervical cytology Child health surveillance Maternity services (not intrapartum care) Contraceptive services

Enhanced Services 3 types –Direct –National –Local

DES Obligatory for each PCO National specifications No one practice has to do: –Services to violent patients –Childhood vaccinations and immunisations financial incentives –Minor surgery –Flu immunisations –Quality information preparation –Improved access

NES OPT-IN - national terms and conditions Anticoagulant monitoringIUCD Sexual healthMS Drug and alcohol misuse Terminally ill DepressionLearning disabilities Intra partum careMinor injuries Near-patient testingHomeless Immediate/first response care

LES OPT-IN Response to specific local requirements Local terms, conditions and standards Possibly, innovative services for piloting and evaluation

GMS v PMS Little difference now PMS probably slightly higher earning practices due to historic funding. Both practice based contracts GMS nationally negotiated Either global sum via Formula Or Minimum practice income guarantee (MPIG) PMS (potentially) locally negotiated

PRACTICE GLOBAL SUM OR MPIG PCO UNIFIED BUDGET ESSENTIAL & ADDITIONAL PROTECTED TIME DIRECTED AND NATIONAL ENHANCED LOCAL ENHANCED GUARANTEED FUND(S) ASSURED QUALITY MONEY ALTERNATIVE PROVIDER PCO-MANAGED FUNDS PREMISES

Seniority Begins from start of NHS service Annual increments

QOF THE FOUR DOMAINS OF QUALITY Clinical Organisational Patient experience Additional services

Total Points 1000 Clinical655 Organisational181 Additional Services 36 Patient Experience108 Holistic Care 20

CLINICAL AREAS CHD & LVD Hypertension Diabetes Stroke or TIA Hypothyroidism AF Depression Hypertension Obesity Epilepsy Asthma COPD Mental Health Cancer CKD Dementia Learning Disabilities

ORGANISATIONAL AREAS Records and information Patient communication Education and training Practice management Medicines management

PATIENT EXPERIENCE Standardised approved patient questionnaires General Practice Assessment Questionnaire (Manchester) Improving Practice Questionnaire (Exeter) Length of consultation - 10 mins appts

BREADTH v DEPTH Holistic Payments Across Clinical Domain Performance in 3 rd lowest area Quality Practice Payments Across all domains

Pensions All NHS income pensionable –delivering GMS / PMS –delivering services under delegation including locum work –board, advisory and other work for NHS bodies –collaborative arrangements work –education –statutory certification –work for GP cooperatives that are NHS bodies All locum pay pensionable from

PBC Practice Based Commissioning DES for 1 year (approx £1.90/pt) Voluntary Devolved budgets to all practices Virtual Money – you cant take it home For: –Prescribing –Secondary care, acute & elective –Community Staff Can spend (up to) 70% of Freed up resources (FURs note not savings) on patient care. Pct takes rest. Only get FURs you predict (no serendipitous FUR) Idea is to provide innovations in services to produce FUR

Other DESs IT –Using the IT Access –Patient Evaluation Survey (PES) Choice & Book –evaluation

Other Income Teaching & Training AmountNHS Pension? GPR £7.5k Y FY2 £10k Y Medical Students £15-20k N NHS related work GPwSI c £10k/session Y PCTY LMCN DH? PrivateN Reports Medicals etc

Getting Paid

Getting Paid 2 (This is real money) Typical Middle sized practice Total amount£1m Less running expenses£300k Less Staff costs (including salaried GPs)£400k Profit£300k Divide between partners = income £100k Need to pay 20% superannuation£80k Need to pay Income tax on this