Wales Update: Revised GMS contract package for GP practices

GPC Wales recently announced completion of negotiations with the Welsh Government on a revised GMS contract package for GP practices in Wales.

Rather than amending details such as thresholds and withdrawing and replacing indicators, the changes announced appear to indicate an element of rethinking and fresh approaches towards QOF, which is very welcome.

The main themes of the changes are: firstly that many of the organisational indicators have been removed, which should reduce the feelings of imposed bureaucracy experienced by many practice managers; secondly a number of clinical indicators have been removed to reflect the fact that the work behind the indicators is, and has been for some while, embedded in good practice within primary care and should not included as targets to be met; and thirdly other clinical indicators have been removed, which previously required patients to be recalled for appointments in order to achieve targets rather than meet their clinical needs.

Announcing the changes, the chair of GPC Wales, Dr Charlotte Jones, emphasised the fact that the current work pressures being experienced by GP practices through both complexity and demand levels, which are causing significant and unsustainable strain on the profession, were a factor in the arguments put to the government.

In turn, the government had a few sticking points, which they would not give way on: a phased reduction in MPIG; work to aid a reduction in unplanned admissions and A&E presentations; and work to develop pathways to facilitate early diagnosis of cancer.

A brief summary of the changes is:

  • 344 points removed from QOF

  • The value of 300 of those points transferred directly into the Global Sum – ensuring that any future uplifts benefit from being based on a larger element of core funding

  • Of the 44 remaining points

  • 14 points move into the QP domain (re-titled Locality Development Scheme)

  • 30 points allocated to the completion of the Clinical Governance Self Assessment Toolkit (CGSAT), the completion of which has been promoted to practices in previous years to varying degrees by health boards

  • In addition, 7 QOF lower thresholds will be increased (covering indicators for atrial fibrillation, asthma, COPD, diabetes, heart failure, stroke/TIA and smoking status)

  • MPIG is to be removed over a period of 7 years, starting in 2015. An income loss cap will be put in place for those practices, which will suffer the greatest reduction in income. GPC Wales believe that 60% of practices will gain from this change, the remaining 40% suffering a reduction in income

  • The contractor population index will be rebased annually and changes written into the Statement of Financial Entitlements, which will also allow the value of QOF points to be rebased as practice populations rise

  • £200K of locum employers superannuation payments from 2013/14 (arising from the difference between actual and estimates) will be distributed to practices

  • Formation of a working party to review the publication of GP earnings (in line with proposals underway in England)

Further detail of the changes can be found on the local LMC website. In addition, GPC Wales is running a series of roadshow presentations on the contract changes during February – details to be found on the local LMC website.


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