From April, the £157m that funded the unplanned admission DES will be added to the global sum. However, from 1 July 2017 it will become a contractual requirement for practices to focus on the management of patients with severe frailty.
Practices will be expected to use an appropriate tool to identify patients over 65 living with moderate and severe frailty and provide a clinical review, including an annual medication review, and any clinically-relevant intervention. There will be no additional reports or claims to make for this.
The global sum will increase by 5.9%, from £80.59 to £85.35 per weighted patient. The value of a point will increase from £165.18 to £171.20 to take account of population growth. A working group will examine the future of the QOF after April 2018.
The total increase in funding for general practice in the 2017/18 deal is £238.7m, which is a 3.3% increase on 2016/17 funding.
There will be no change to the QOF in 2017/18. A working group will examine the future of the QOF after April 2018.
Although no indicators have been retired this year, practices are expected to continue to undertake clinically apporpriate work for indicators no longer the QOF (INLIQ). From 1 April 2017 it will be a contractual requirement for practices to allow data collection on these indicators. A full list of these indicators can be found here.
A full summary of the QOF for 2017/18 can be found here.
The other main points of the contract are:
- Full reimbursement of practices' CQC fees for 2017/18. Practice will pay their CQC fees and then send the paid invoice to their local NHS England team. The amount will be reimbursed in line with local payment arrangements.
- £30m for rising indemnity costs - this will be paid to practices on a per-patient basis. Partners should ensure the appropriate amount of funding reaches salaried GP colleagues. A letter from the BMA setting out the details of the contract suggests that locums will 'need to ensure that their invoices/agreements with practices are uplifted appropriately to take account of this business expense'.
- An increase in the global sum to cover rising expenses and to deliver a pay increase of 1% for GPs and practice staff.
- £3.8m uplift to recognise increased superannuation costs as a result of changes to the NHS Pensions Scheme.
- £58.9m for population growth.
- £2m extra to cover additional costs of medical records handling created by primary care support services.
- Eligible practices will be reimbursed for all costs relating to levies incurred as a result of being in a Business Improvement District via the Premises Costs Directions.
- Changes to sickness cover reimbursement mean payments will no longer be discretionary. Payments will be made after two weeks of a GP being absent for sick leave. Cover can be provided by external locums or existing GPs already working in the practice and the maximum amount payable will increase from £1,131.74 to £1,734.18 per week. Full details here.
- Maternity cover reimbursement will not be made on a pro-rata basis - practices will only need to submit an invoice and either the full amount or maximum payable will be paid. Full details here.
- The sum paid per health check in the learning disability DES will increase from £116 to £140.
- Practices regularly closing for half a day in the week, on a weekly basis, will be ineligible for extended hours DES funding from October 2017. There will be some exceptions for this.
- Practices collaborating to provide additional appointments outside core hours will receive extra funding, although there is no detail on how much and how this will work.
- Practices will be required to check new patients’ eligibility for NHS care and identify those with non-UK EHICs or S1 forms. All new patients should be provided with a revised GMS1 form, which will include supplementary questions to determine a patient's eligibility to healthcare. The practice will be required to manually record that the patient holds either a non-UK issued EHIC or a S1 form in the patient’s medical record and then send the form and supplementary questions to NHS Digital (for non-UK issued EHIC cards) or the Overseas Healthcare Team (for S1 forms) via email or post. The patient's country of origin will be charged, not patients themselves. This will be supported by recurrent funding of £5m to cover practices' administration costs.
- The workforce census will become a contractual requirement with £1.5m added to core funding to cover the workload.
- A new GP retainer scheme with an additional £1m investment will have tighter criteria for joining. Practice payments will remain the same as the 2016 interim scheme to be used towards the GP's salary, admin costs and any additional education requirements. Payment details are here.
- All practices will be required to allow collection of data for the national diabetes audit and a selection of agreed indicators retired from QOF and enhanced services.
- From 1 July 2017, prisoners will be allowed to register with a practice before leaving prison to enable better care.
From April 2017 the following changes will be introduced:
- Seasonal flu - morbidly obese patients will be included as an at-risk cohort. £6.2m has been added to the contract to cover the expansion of the target group.
- Childhood seasonal flu - 4-year-olds are removed from the enhanced service patient cohort and transferred to the school programme.
- Pertussis - pregnant women wil be eligible for vaccination from 16 weeks pregnant (eligibiliy is currently at 20 weeks).
- MenACWY - a reduction in the upper age limit from 'up to 26th birthday' to 'up to 25th birthday'.
- Shingles - a change in eligibility to the date the patient turns 70. The shingles catch-up has a change in eligibility to the date the patient turns 78.
A series of non-contractual changes will be taken forward through non-contractual working arrangements. These include:
- Practice compliance with the 10 new data security standards.
- Practice completion of the Information Governance toolkit including attainment of level 2 accreditation.
- An increased update of electionic repeat prescriptions to 25%.
- An increased update of electronic referrals to 90% where possible.
- Continued uptake of electronic repeat dispensing.
- Uptake of patient use of one or more online service to 20%.
- Better sharing of data and patient records at a local level.