The funding for the 659 points that were available in the QOF will be transferred into each practice's global sum, based on the practice's average achievements over the previous three years. There will be no out-of-hours deductions on the transferred funding.
£20m of the money transferred to core funding (about 25% of the full amount being transferred) will be designated 'continuous quality improvement' funding and will be used to support key elements of a transitional quality arrangement (TQA) for 2016/17. The outcome of this will be reviewed by the Scottish government and the Scottish GPC at the end of 2016/17 to shape arrangements from 2017 onwards.
Under the TQA practices will be required to maintain disease registers and code patients based on diagnosis. Practices are also required to provide 'appropriate lifestyle advice'.
GP cluster working
From 2017 onwards GP practices and GP clusters should have direct involvement in improving the quality of health and social services to registered patients. This will include chronic disease management programmes and use of secondary care services.
Changes in 2016/17 will start this process:
- Practices will need to form into GP clusters during 2016/17.
- Each GP practice should nominate a GP as practice quality lead and each cluster should have a cluster quality lead.
- Every GP and 'relevant others' in the practices should consider data provided by the practice quality lead and provide the quality lead with reflections on that data, as well as a view on what future data might be required to support improving quality.
- The practice quality lead should share data provided by the quality cluster lead within the practice and collate a response from the practice to support future 'quality acitivites'. This is expected to require about two hours a month and the capacity from this should come from time freed up due to the dismantling of the QOF.
- Cluster quality lead work and any additional work by the practice quality lead (i.e. any work not mentioned above) will attract additional funding.
- Every practice should have a process for ensuring that GPs and 'relevant others' can be fully involved in 'quality work'.
Other contract requirements for 2016/17
- The flu vaccination DES will continue.
- GP clusters should reflect upon access reports provided by GP practices over the past two years to consider what can be done to improve access arrangements.
- Exiting arrangements for anticipatory care plans (ACPs) will continue in 2016/17. GP clusters will review how well ACPs are being used.
- Practices will be provided with an agreed dataset on high need patients and be expected to review the list and agree which patients should beneft from an ACP.
- Practices should review a proportion of their ACPs annuallynand then reflect on this within their cluster.
- Practices should continue to work with NHS Board prescribing advisers to agree appropriate actions related to prescribing and seek to evidence change.
If practices do not have a cluster quality lead
GPC Scotland says in areas where a cluster quality lead role is not in place in 2016/17 practices will be required to:
- Maintain disease registers and provide appropriate lifestyle advice.
- Continue the flu DES.
- Review the past two practice access activity reports for evidence of recurring themes and take appropriate action.
- Review a random selection of their ACPs using a national template.
- Continue working with their NHS board prescribing advisers.