1. PRACTICE MANAGERS ASSOCIATION
NEW CONTRACT AND REMOVAL OF QOF
Wednesday 2nd March, 2016
JOYCE KELLY
LYN PARKINSON
DR ALAN MCGOVERN

2. DATA
GPs and their practice staff will be expected to provide all of the elements of care and clinical coding that the practice considers clinically appropriate.
QOF data will no longer be extracted for payment purposes but it will continue to be available to practices for their own internal processes.
Practices will still be required to maintain disease registers and code patients based on diagnosis. Practices will also be required to provide appropriate lifestyle advice (definition of “appropriate” and exact timing to be determined by the GP practice).”

3. DATA
Activity associated with flu vaccination outlined in the Directed Enhanced Service (DES) will continue.
Existing arrangements for ACPs will continue in 2016/17. GP clusters will review how well ACPs are being used following admission to hospital or other use outside GP practices (e.g. in an OOHs setting).

4. DATASETS FOR CONTINUOUS QUALITY IMPROVEMENT
GP practices will be provided with an agreed dataset on high need/risk/cost/time patients and be expected to review that list and agree which patients would most benefit from the provision of an ACP. In addition GP practices will be expected to review existing ACPs in a way that determine is appropriate.
GP practices in the GP cluster will be engaged in an annual review of a proportion of their ACPs, which will include an assessment of their quality (via the use of a nationally agreed quality template) and be expected to reflect upon that report within their GP cluster. Any GP practice with a consistently poor quality review will be supported by the local system to improve their standard.

5. INTEGRATION AND GP CLUSTER WORKING
Beginning with the agreement for 2016/17 – arrangements for quality under the contract will be based on professionalism and require GP practices to undertake that work in a cluster basis; a locally agreed grouping of practices.
GP clusters will need to be formed during 2016/17 (they do not need to be in place from 1 April 2016).

6. Every GP will be involved in Quality, each GP practice will nominate a GP as a Practice Quality Lead (PQL), and each practice cluster will have a Cluster Quality Lead (CQL).
Every GP, and relevant others in the practice, will be expected to consider data provided by the Practice Quality Lead and to provide the PQL with their reflections on that data, as well as a view on what future data might be required to support quality in the practice.

7. The PQL will be expected to share the data provided via the QL with relevant members of the practice and to collate a practice response to it and form a view, on behalf of the practice, of the data required to support the future Quality activities of the practice and its GP cluster. The capacity to undertake this activity will come from the dismantling of QOF and is expected to require approximately two hours per month.
Each GP cluster group will nominate a Cluster Quality Lead (CQL) who will have a local leadership role. CQL activity (and PQL activity above the level described above), will be funded from outside of the GMS contract.

8. CQLs will have a mandate from their colleagues to improve quality in the wider health and social care system, including the use of secondary care, partially based on input from each practice in the cluster. CQLs will provide data to their clusters, partly based on national agreed data extractions between SGPC and SG.
Each GP practice will develop a process for ensuring that GPs and relevant others in the practice can be fully involved in quality work such as, reflection on materials and discussion on a practice level response to the CQL.
The PQL will also fulfil the role of liaison GP to link to a specified liaison person from the Health and Social Care Partnership. This may be a different GP member of the practice at different times.

9. ACCESS
GP clusters will reflect upon the individual access reports provided by local GP practices over the past two years (alongside any board wide or national learning from aggregated reports that might add value) to consider what could be done to further improve access arrangements locally. This could include sharing of local and national good practice; and how other health professional should respond to patient demand.

10. Is there any update on the role of the CQL including when the position will be advertised?
Are there any forecasted changes to the Enhanced Services for 2016/17?
What’s happening with the Public Health Indicators?
Are we continuing with the full Quality and Safety Domain?
Are we continuing with the Scottish Patient Safety Programme (run by Marie Paterson)?
What changes will there be on the monthly medical services practice payment statement? e.g. OOH, MPIG – removal of these, we would be worse off otherwise

11. SUPPORTING FRAMEWORK(S)
A four stage approach to TQA 2016/17
Stage 1 – first quarter of 2016/17 ( to )
Practices agree who will fulfil the Practice Quality Lead role and that person will work with the local partnership liaison person and LMC representatives to agree the cluster arrangements i.e. which practices are in which cluster.
The practices will start to consider the issues outlined in Annex A, with a view to agreeing what actions arising from them, will be taken forward in stage/quarter 4.

12. Stage 2 – second quarter (01.07.16 to 30.09.16)
Practice Quality Leads* and the partnership/board and LMC, identify, appoint and empower a Cluster Quality lead and agree the time commitment to which this role will need to be resourced and how it will operate locally. The CQL role will be resourced by the partnership/board.
The practice continues considering the issues outlined in Annex A, with a view to agreeing what actions arising from them, or other agreed cluster alternatives, will be taken forward in stage/quarter 4.
* Any activity above 2 hours per month in the practice for the PQL will require additional resourcing by the partnership/board and it is expected that boards and partnerships will want to gain the benefits of fully involving practices, via their PQL, in the appointment of a cluster Quality Lead.

13. Stage 3 – third quarter (01.10.16 to 31.12.16)
The PQLs* and CQLs begin to build relationships locally via the clusters, between and across practices, primary and secondary care, health and social care and between the public and third/voluntary sectors.
Practices and the local system start to consider the issues arising from the activities outlined in Annex A, and any the other issues that might be local priorities, and agree by the end of this quarter which to take action on in quarter 4.
* Any activity above 2 hours per month in the practice for the PQL will require additional resourcing by the partnership/board.

14. Stage 4 – fouth quarter (01. 01. 17 to 31. 03
Stage 4 – fouth quarter ( to ) Practices and the local system take action on the priorities agreed at the end of quarter 3 and agree evaluation/outcome measures that will demonstrate quality improvement.