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NEW GMS CONTRACT
Stephen NewellStephen Newell
Linda TurnerLinda Turner
Susan WattsSusan Watts
WHEN?
COMMENCES 1.4.04COMMENCES 1.4.04
WHY DID GP’S VOTE YES?
No “Red Book”No “Red Book” No Items of Service (IOS)No Items of Service (IOS) No over 75 or 3 yearly checksNo over 75 or 3 yearly checks No Staff reimbursementNo Staff reimbursement No Saturday morningsNo Saturday mornings No out of hours (OOHs) – can opt outNo out of hours (OOHs) – can opt out No permission required for new partnersNo permission required for new partners
SOME IMPROVEMENTS
Increased investment in primary careIncreased investment in primary care Incremental payments for qualityIncremental payments for quality Exception reporting for quality paymentsException reporting for quality payments 100% reimbursement of computer costs100% reimbursement of computer costs Opt in to enhanced servicesOpt in to enhanced services End of 24 hour responsibilityEnd of 24 hour responsibility GP pensionsGP pensions GP seniority paymentsGP seniority payments
SOME CONCERNS
FundingFunding TransitionTransition ITIT Lack of clarityLack of clarity
CLINICAL SERVICES
EssentialEssential AdditionalAdditional Directed EnhancedDirected Enhanced National EnhancedNational Enhanced Local EnhancedLocal Enhanced
ESSENTIAL
• Medical management of patients who are Medical management of patients who are (or believe themselves to be) ill, health (or believe themselves to be) ill, health promotion advice and referral as promotion advice and referral as appropriate – reflecting patient choiceappropriate – reflecting patient choice
• General management of terminally ill General management of terminally ill patientspatients
• Management of chronic disease – in Management of chronic disease – in discussion with patientdiscussion with patient
ADDITIONAL
• SERVICESSERVICES Cervical screeningCervical screening Contraceptive servicesContraceptive services Vaccs and ImmsVaccs and Imms CHSCHS Maternity ServicesMaternity Services Minor SurgeryMinor Surgery
OPT OUT
Can opt out of additional services but will Can opt out of additional services but will loose approximately 10% of global sum if loose approximately 10% of global sum if you opt out of all additional services.you opt out of all additional services.
DIRECTED ENHANCED
Access to GMSAccess to GMS Childhood Vaccs & ImmsChildhood Vaccs & Imms Influenza Vaccs (over 65’s and at risk)Influenza Vaccs (over 65’s and at risk) Quality Information Preparation (1Quality Information Preparation (1stst 2 years 2 years
only)only) Services to support staff dealing with Services to support staff dealing with
violent patientsviolent patients Enhanced minor surgeryEnhanced minor surgery
NATIONAL ENHANCED
Patients who are alcohol misusersPatients who are alcohol misusers Anti coagulant monitoringAnti coagulant monitoring IUCD fittingsIUCD fittings Specialised care for patients with depressionSpecialised care for patients with depression Patients suffering from drug misusePatients suffering from drug misuse Provision of immediate care and first Provision of immediate care and first
response careresponse care
Enhanced care of the homelessEnhanced care of the homeless Intra partum careIntra partum care Minor injuries servicesMinor injuries services More specialised services for patients with More specialised services for patients with
MSMS Provision of near-patient testing, etc etc. Provision of near-patient testing, etc etc.
LOCAL ENHANCED
PCT will decide what is neededPCT will decide what is needed Local terms and conditionsLocal terms and conditions Developed in response to local needs, e.g. Developed in response to local needs, e.g.
diabetic servicediabetic service
OUT OF HOURS
COVERS 18.30 – 08.00 EVERY DAYCOVERS 18.30 – 08.00 EVERY DAY WEEKENDSWEEKENDS BANK HOLIDAYSBANK HOLIDAYS
IF YOU OPT OUT YOU LOSE ABOUT IF YOU OPT OUT YOU LOSE ABOUT 6% OF GLOBAL SUM6% OF GLOBAL SUM
4 QUALITY DOMAINS
CLINICALCLINICAL ADDITIONAL SERVICESADDITIONAL SERVICES ORGANISATIONALORGANISATIONAL PATIENT EXPERIENCEPATIENT EXPERIENCE
PLUSPLUS
CONTRACTUAL & STATUTORY CONTRACTUAL & STATUTORY REQUIREMENTSREQUIREMENTS
CLINICAL
AsthmaAsthma CancerCancer CHD (including LVD)CHD (including LVD) COPDCOPD DiabetesDiabetes EpilepsyEpilepsy HypertensionHypertension HypothyroidismHypothyroidism Mental HealthMental Health Stroke or TIAStroke or TIA
Additional Services
Cervical ScreeningCervical Screening Child Health SurveillanceChild Health Surveillance Contraceptive ServicesContraceptive Services Maternity ServicesMaternity Services
EXCEPTIONS
Patients who refuse to attend on 3 occasionsPatients who refuse to attend on 3 occasions New or recently diagnosed patientsNew or recently diagnosed patients If treatment is not clinically appropriateIf treatment is not clinically appropriate Patient has refused (given informed dissent)Patient has refused (given informed dissent) Patient cannot tolerate treatmentPatient cannot tolerate treatment Patient already taking maximum medicationPatient already taking maximum medication Patient has another condition that affects treatmentPatient has another condition that affects treatment
ORGANISATIONAL
Records and informationRecords and information Patient communicationPatient communication Education and trainingEducation and training Practice managementPractice management Medicines management Medicines management
PATIENT EXPERIENCE
Length of consultationLength of consultation Annual patient questionnairesAnnual patient questionnaires
CONTRACTUAL AND STATUTORY REQUIREMENTS
NO POINTS ATTACHEDNO POINTS ATTACHED NO CHOICENO CHOICE MUST DOMUST DO
EXTRA PAYMENTS
Holistic Care paymentsHolistic Care payments Encourages breadth of clinical careEncourages breadth of clinical care
Quality Practice payments Quality Practice payments Encourages achievement across the Encourages achievement across the
whole range of indicators, not just whole range of indicators, not just clinical.clinical.
ACCESS
Extra points Extra points
Maintaining access targetsMaintaining access targets Maintaining qualityMaintaining quality
REPORTING
LARGELY BASED ON TRUST:LARGELY BASED ON TRUST: Data entry during consultation including Data entry during consultation including
telephone calls / consultationstelephone calls / consultations Audit generated by normal workAudit generated by normal work Virtually no claims or paperworkVirtually no claims or paperwork Annual report on computerAnnual report on computer Annual visit from PCT to check report Annual visit from PCT to check report Appeals process if disagree with PCTAppeals process if disagree with PCT
PATIENT FLOWS
Practice AreaPractice Area Patient choicePatient choice RemovalsRemovals AllocationsAllocations
SUMMARY
There are:There are: 76 Clinical indicators76 Clinical indicators 10 standards for Additional Services10 standards for Additional Services 56 Organisational indicators56 Organisational indicators 4 Patient Experience requirements4 Patient Experience requirements 26 Contractual and Statutory requirements 26 Contractual and Statutory requirements
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