Briefing on General PracticeJulian Spinks

Areas to consider

•The state of general practice•New configurations•Practice Based Commissioning•QOF changes•Enhanced services

The state of General Practice

•The ‘New’ Contract▫Global sum▫QOF▫Enhanced services▫Move towards salaried service▫MPIG

•Loss of long term relationship with patients

•Funding

New Configurations

•Move to APMS•‘Managed’ practices•GP-led health centres•New practices•Extended Hours•Out of hours

Practice-based commissioning•Started 2005

▫Better clinical engagement▫Better patient services▫Better use of resources

•Initial lack of guidance•Variable uptake•Resistance

▫PCT▫GP▫Trust

PBC 2

•Relaunch 2009▫Clinical commissioning: our vision for PBC

DOH Jan 09

•Most PBC shaped around ‘clusters’•More commitment from PCTs•Still variable buy-in from GPs•Still few services commissioned (or

decommissioned)

PBC 3• Need to get involved ASAP

▫Get on agenda▫Before the money runs out

• Making continence a priority area▫Local approach to PBC groups▫Possibly support with campaigns or materials

provided centrally• Working with PBC groups

▫Provider or partner?▫Make it easy for groups-eg pre-prepared

business plans.

Quality and Outcomes Framework•QOF

▫Part of new GP contract▫Voluntary!▫Up to 40% of income

•Around 180 targets▫Some administrative▫Clinical in 15 different areas, some ‘easy’

some difficult

QOF 2•Ever-changing scheme

▫Until now decided by committee of BMA and NHSE

•NICE now central to process▫88 indicators in scope▫Reviewed over 3-4 years▫Around 10 new indicators/year▫First indicators in 2011-12▫More ‘evidence-based’▫Old indicators rolled into ‘standard

practice’

QOF process• NICE gathers clinical and cost-effectiveness information to

help prioritise new indicators. Interested parties submit potential clinical and public health topics for consideration through the NICE website.

• An independent Primary Care Indicator Advisory Committee prioritises these topics for inclusion in the QOF.

• The National Primary Care Research and Development Centre (in collaboration with the Royal College of GPs and York Health Economics Consortium) develops the indicators, testing them in a number of GP practices across the UK.

• NICE consults on the developed indicators, validates the proposals through the Advisory Committee and publishes them on the NICE website.

• Each recommended indicator is accompanied by supporting information, such as review date and the supporting cost-effectiveness evidence.

QOF doubts

•Likely to prioritise to areas with high mortality, disabling morbidity, high public profile

•Government brake on new funding•Element of ‘local QOF’•Needs to be workable in a GP context

▫Skills▫Resources

Enhanced Services

•National, Direct, Local•Another way to fund new work in general

practice•Currently a method to maintain funding in

practices hit by removal of MPIG•Could be used to improve GP continence

care at a local level (eg as part of PBC)