The Future for General Practice

Dr Richard VautreyDeputy Chair

BMA GP committee

Why GPs are unhappy?

• Contract imposition• Increased workload• Reduced quality• Reduced income• Government and media attacks• Fear that worse is yet to come

Phase out correction factor payments over 7 years

Review PMS funding to reduce variability in practice funding

Implement all changes to QOF recommended by NICE

Reduce the time period for achieving most indicators from 15 to 12 months

Contract changes

Increase upper thresholds for QOF indicators to match upper quartile achievement

Remove the whole organisational domain leaving 900 point QOF

Reform the QOF Contractor Population Index (CPI) New immunisations

rotavirus added to childhood immunisations shingles for patients aged 70 and catch-up programme flu for 2 year olds MMR catch up

Introduce significant new work through DESs

Contract changes (2)

More box ticking - unworkable and underpriced new work in QOF

Shifting the goal posts - chasing points at QOF margins- reducing time available to meet targets- requirements for additional training

Impact on access Impact on secondary care

Why GPs are unhappy: workload

Clinical problems with clinical QOF changes:

Unworkable new indicators, unavailable services

Changed blood pressure targets + higher thresholds polypharmacy

Repetitive or inappropriate questioning Rise in exception reporting Less time for holistic patient care

Why GPs are unhappy: Quality of QOF

Online patient access DES– Risk of e-consultations and inappropriate on-line access to

records. – Could widen health inequalities

Case finding for dementia DES– Evidence for dementia screening lacking and could cause harm– Will come at cost of other patient care– Real problem is lack of services

Risk profiling– Volume planned in gift of CCG – could be unmanageable

Remote care monitoring– Preparation for next year

Why GPs are unhappy: Quality and workload of DESs

Why GPs are unhappy: Uncertainty about LESs

• Local authority commissioning

• Standard contract

• Impact of LA budget cuts?

• Any Qualified Provider

Some (slightly) good news

• Rotavirus• Shingles

– for 70 year olds + catch up programme– £7.64 per dose

• Seasonal flu for 2 year olds– could be extended next year

• MMR catch up– additional services 10-15 years olds– £7.64 for 16 years +– £1.50 per invitation letter

Average practice 2014-2015, threshold QOF

loss + organisational point loss =

£11,300 + £19,800= £31,100

Potentially bigger loss from PMS and CF changes

Why we should all be concerned: funding

Major redistribution of funding from 2014 Difficult to predict new global sum figure Not clear whether PMS money will be re-invested

in GMS Some practices will be seriously destabilised,

others will gain– High funded PMS practices – almost certainly under

current plans– Practices with large correction factors – probably

depending on global sum increases– Not clear what will happen for legitimate outliers

.

Funding redistribution: Good news for some, bad news for many

Responsibility for locum superannuation payments to move to practices

Transfer of funds into contract to cover this Practices use locums differently, likely to

have disproportionate impact on small practices

Likely to be bad for younger locums

Removal of locum appraisal payments

Unhappy locums and practices

Commissioning and CCGs CQC registration Revalidation Pension changes NHS 111 7 day working Commercialisation and fragmentation of

the NHS Recruitment and retention crisis

And to add to the woe…

Protect their patients Not chasing targets that put patients at risk Limit workload to maintain quality Avoid skill-mixing that undermines quality

Prioritise their practice Do important QOF areas in 9 months Consider cost of external engagement Say no to unresourced workload shift

What might practices do?

What might practices do? (2) Develop their practice

AQP provider services

Work with others Federations, larger practices Shared staff Shared training

Protect GPs Work-life balance Partnership v salaried GP Retirement

Conclusion

• Increased workload• Decreased income• Impact on quality• Increased stress and burnoutSo….• Time to become more business-like• Time to protect patients, GPs and

practices

Questions and discussion