1. The Provision of General Medical Services Ian Dodge, Head of GMS, Department of Health

2. Objectives for the session Key points from chapter 2 of Delivering Investment in General Practice (except OOHs) What PCTs need to do, why, and when Q&A Not a substitute for reading chapter 2

3. Five Themes Using the four contracting routes Understanding essential services and related statutory requirements How patient registration, list-closure and forced assignments will work Understanding additional services Using enhanced services to deliver whole system change

4. The Four Contracting Routes (1) New Primary Medical Services duty PCT must from 1st April commission or provide primary medical services to the extent that it considers necessary to meet all reasonable requirements PCTs must ensure sufficient alternative provision in place at the time additional service/OOHs opt-outs take effect

5. The Four Contracting Routes (2)

6. The Four Contracting Routes (3) Obligations & rights with GMS contract: –essential services: must provide –additional services: right & expectation to provide for own population –enhanced: right to provide 3 DES: access, QUIP, CVI –GMS and PMS contractors do not have preferred provider status for other enhanced services (para 2.13, page 22) Greenfield sites (significant population expansion): expectation PCT could advertise and seek applications through a two stage process Brownfield sites: no preferred provider status

7. Essential Services (1) Understanding is pre-requisite to effective commissioning of enhanced services Management of all patients suffering from disease as defined in the ISCD- eg disabilities, long-term conditions, infertility, depression etc Contractors must provide appropriate ongoing treatment and care for all registered patients and temporary patients, including advice about health promotion

8. Essential Services (2) Enhanced services specifications: no part of the specification by commission, omission or implication defines or redefines essential or additional services Para 2.19: GMS contractors are funded through the global sum and MPIG to provide the equivalent services for which they were previously funded under existing GMS Exceptions are flu; CVI; cervical cytology and minor surgery (part); intra-partum care; intrauterine contraceptive devices and implants

9. Essential Services (3) Core hours: contractor responsible for ensuring provision 8am-6.30pm, Monday to Friday except public and bank holidays Normal surgery hours: must be to the extent necessary to meet reasonable needs Replaces 26 hour a week face to face commitment on an individual GP

10. Essential Services (4) Temporary patients obligations remain Home-visiting if the patients medical condition is such that, in the reasonable opinion of the contractor, it is necessary to do so Newly registered patients Three-year rule and over 75 checks at patient request

11. Patient registration (1) Obligation to ensure lists are accurate Choice of practitioner subject to availability, appropriateness, reasonableness New PCT Guide to Primary Care Services Contractors to review patient leaflets before April PCTs and contractors agree practice areas before April

12. Patient registration (2) Open/closed status: discuss with practices before end of February Open list: –must accept any application … unless it has fair and reasonable grounds for not doing so –must not discriminate & give reasons for refusal in writing and keep a record (same applies for all removals) –PCT can assign patients

13. Patient registration (3) Closed list: –must not accept new patients save immediate family –new patient assignment procedure applies Formal closure and assignment procedures from 1st April: –rejecting closure notice/application to assign patients to contractors with closed lists leads to Assessment Panel determination –appeal is to the SHA (not the FHSAA(SHA)) PCTs cannot assign to closed lists from 1st April other than through this procedure; may need to develop applications, and put panel arrangements in place Open list: –must accept any application … unless it has fair and reasonable grounds for not doing so –must not discriminate –must give reasons for refusal in writing and keep a record –PCT can assign patients

14. Additional services (1) PCTs must ensure sufficient in place from 1st April Contractors do not have to provide if not already doing so PCT discretion to agree opt-outs before April 2004 when opt-out procedure applies; ascertain intentions in January, decide in February Tariff for opt-out (% of global sum, not GS+MPIG) No fixed price for recommissioning additional services

15. Additional services (2) Purpose of opt-outs is to manage contractor workload PCT can reject opt-outs if the contractor is providing any enhanced services If it approves the opt out, but then cannot find alternative provision despite best endeavours, PCTs can seek SHA approval that there are exceptional circumstances

16. Using enhanced services (1) Expanding range, improving choice, convenience, VFM, & reducing pressures on hospitals Local floor from 2004/05 monitored nationally Initial plans during February - to include the 6 DES PEC sign off proposals and must seek LMC agreement that spend counts to floor

17. Using enhanced services (2) Tighter definition of spend Includes: –DES, NES, LES from any provider –PWSI –Plus in PMS Plus, Specialist in PMS specialist –Local incentive schemes from GMS & PMS providers –Recommissioned services ONLY if contestable for GMS & PMS contractors & could reasonably be provided by them Excludes any baseline spend on trusts/other providers simply rolled forward, or anything funded through other primary care routes

18. Using enhanced services (3) PCT must commission 6 DES from 1st April, and offer 3 of the DES to GMS contractors PCT commissions as primary medical services, decides when, from whom & how it commissions other enhanced services Bear in mind definition of essential services PCTs may wish to be guided by NES but commissioning decisions are entirely a matter of local negotiation (para 2.84)

19. Summary New duty & four commissioning routes Understand essential services New patient registration, list closure & assignment arrangements Additional services commissioning & opt outs Understand enhanced services commissioning rules, spend, and use to deliver strategic change

20. PCT actions Strategy for commissioning primary care 1st Jan: offer 2003/04 access & QUiP DES End Jan: reviewed additional services commissioning & contractor intentions 1st Feb: commission violent patients DES End Feb: agreed practice areas, open/closed status, discussed normal hours, offered 3 DES, agreed early additional service opt-outs End Feb: drawn up initial plans for commissioning enhanced services Apr: set up assessment panels & proposals for assignments if need be

21. Questions