1. Primary Care 2010

2. GP contractual Models GMS (contract in perpetuity)
PMS (contract in perpetuity)
APMS (time limited contract subject to procurement rules)

3. GMS
Nationally 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 PMS
Locally negotiated contract that offered additional flexibilites
Pre dates the current GMS contract
Recent guidance that the two contracts should be treated the same
PMS practices have access to NES and LES
PMS practices have access to QOF with 105 point abatement
Allowed to opt out of OOH when new GMS implemented

5. New PMS
Some 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 GPs
Often has some contract values linked to Key Performance indicators
Core 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 Domains
Thresholds and achievements set
£ per point based on an average list size (5981)
Takes account of disease prevalence in clinical domains
Patients 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 KPI
Mainly linked to APMS contracts
Will definitely be linked to any services commissioned from Primary Care outside of “normal” services
Outcome measures

10. The Future
All of the NHS is going to have to generate efficiencies to survive and Primary Care is included in this.
The new regime
GPs being responsible for 80%-90% of NHS budget in real terms
Negotiation of new GP contract
GP contracts to be held by the NHS board not PCTs
Removal of SHA’s
PCTs to concentrate on Public Health and residual commissioning

11. Practices as a business
Need to look for efficiencies would Federated models of GPs offer this
What 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 services
Have 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 areas
Clinical Leadership/engagement very important