GPs will be invited to respond to a consultation on the new deal between 7 December 2017 and 4 January 2018, with the Scottish GPC to decide on 18 January whether to accept the deal. A special LMCs conference for Scotland will meet on 1 December to debate the new contract and BMA roadshows will be held to inform practices.
The deal aims to 'reduce workload pressures and re-establish general practice as an attractive career choice', by extending the use of multidisciplinary teams, offering GPs a basic guaranteed income, and radically reducing practices' responsibility for premises.
A new funding formula will be introduced under the deal, which aims to reflect practice workload more accurately by weighting more for older patients and deprivation. A £23m fund has been agreed to deliver extra funding to practices that earn more under the new deal, while protecting other practices.
Every practice in Scotland will receive a letter this month setting out how the contract would affect them individually.
What's in the contract offer?
Below is a summary of the 2018 Scottish GMS contract proposal:
The GPs' role
- GPs will continue to run their practices to deliver GP care to their list of patients. However, practices will now be expected to carry less risk compared to previous contracts and be more embedded in the wider health and social care services in their communities.
- GPs will play a critical role as expert medical generalists and senior clinical leaders within those services.Training will be available to help support GPs to take on this leadership role.
- GPs will focus on three key tasks: undifferentiated presentations, complex care in the community and whole system quality improvement and clinical leadership.
- To support this new primary care staff will be employed by NHS boards and attached to practices and clusters.
- GP time will be freed up for longer consultations where needed (see workload below)
- GP clusters will have a clear role in quality planning, quality improvement and quality assurance.
- Instead of the current opt-out arrangement for out of hours a new opt-in enhanced services will be developed for practices that choose to provide out-of-hours services.
- There is an agreed principle not to expand the number of enhanced services under the new contract. Locally determined enahnced services will still be agreed between NHS boards and local practices.
- A new practice income guarantee will ensure practice income stability. There will be phased approach.
- From April 2018 a new funding formula based on workload will be introduced backed by £23m of additional funding. The formula gives greater weight to older patients and deprivation. Practices will be protected from any potential losses.
- From April 2019 the government will introduce a minimum income level for a full-time GP partner of £80,430, including pension contribitions.
- From April 2020 an income range that is comparable to consultants will be introduced and practice expenses will be directly reimbursed (including staff costs and those associated with staff sickness, maternity, paternity and adoption leave). These steps will be subject to further negotiations and a second poll of the profession before being introduced.
- Vaccinations will move from GP practices to NHS boards, however the funding previously available for vaccinations will remain with practices.
- Every practice will receive pharmacy and prescribing support under the new contract. Additional funding will go twards increasing the number of pharmacist training posts to help achieve this.
- Community and treatment care services will provide management of minor injuries, phlebotomy, ear syringing, suture removal and chronic disease monitoring among other services. There will be a three-year transition period to allow the responsibility for providing these services to pass from practices to health and social care partnerships (HSCPs). By April 2021 these services will be commissioned by HSCPs and delivered in collaboration with NHS boards.
- Urgent care services will be redesigned to reduce GP workload and free up GP capacity to focus on their new role.This will involve developing more advanced practitioners (nurses or paramedics) who will be first response for home visits. It is likely these practitioners would work across a number of practices.
- HSCPs will develop models to embed physiotherapists and musculoskeletal services within practice teams.
- Community clinical mental health professionals, based in general practice, will work with individuals and families assessing their mental health needs, providing support for conditions such as low mood, anxiety and depression.
- More community link workers will be rolled out in practices - these are non-clinical practitioners who work with patients to help them navigate and engage with wider services.
- The Scottish government and Scottish GPC have agreed a National Code of Practice for GP Premises, which sets out how the government will support a shift, over 25 years, to a new model in which GPs will no longer be expected to provide their own premises.
- GP partners will be offered interest-free 'GP sustainability loans' worth up to 20% of the 'existing use value' of their premises - even if they are in negative equity, with additional loans from regional NHS boards in exceptional circumstances. These loans will be made available to every partner who owns their premises by 31 March 2023.
- The loans will allow partners to release capital without destabilising their practice and reduce the up-front cost of becoming a GP partner. They will be repayable if the premises are sold or no longer used for provision of GP services. The loan will have no effect on notional rent or borrowing cost payments.
- The Scottish government plans to end the current model in which many GPs lease premises from private landlords. Regional NHS boards in Scotland will gradually take control of these leases, and will take responsibility for ensuring that GP practices have 'fit-for-purpose accomodation'.
- For existing leases due to expire by 1 April 2023, boards are likely to negotiate a new lease for practices' premises naming the board as tenant, or to provide new premises.
- For leases expiring after April 2023 boards will take on the existing lease for practices if a series of criteria are met - including suitability of the premises, value for money of the lease, and agreement of the landlord.
- All GP practices will transition to cew clinical IT systems by 2020. GPs will continue to have the right to choose a clinical IT system from those that have been approved by the government.
- The current arrangements for dispensing in Scotland will not change under the proposed new contract.
- The challenging behaviour scheme DES will be revised to introduce greater consistency across NHS boards ensuring that practices and staff are protected from patients who have been violent or threatening.
- The new contract will clarify how practice areas should be agreed as part of the contract between NHS boards and practices.
- Under new regulations around practice list closures if NHS boards have not completed discussions concerning support with practices within three months, a closure notice will be considered as accepted.
- The contract will provide a list of certificates which, through primary legislation, GPs are entitled to charge for providing. The regulations will be clear that other work falls outside of the GMS contract.