The New GP Contract (GMS2) (or how GPs are to be paid) One GP Practice Perspective

Transcription

1 The New GP Contract (GMS2) (or how GPs are to be paid) One GP Practice Perspective

2 Who we are: Tony Ging Business/Practice Manager. Lampeter Medical Practice, Ceredigion. Mainly rural with 8,400 patients. 5 GPs (partners). 1.5 nurse practitioners. 4 nurses/health care assistants. Modern large premises. We cover a 450 square mile area. 20 plus miles from nearest acute hospital.

3 What it s all about we need to make money GPs are mainly self employed. Practices are small businesses. Profits equals GP income. The new contract is more money focussed. Quality points mean prizes. Contract makes the bottom line more visible. In future if we are not paid enough we don t do it.

4 Things we did before the contract - the vision thing Purchased a good clinical IT system four years ago (EMIS). Became a paper-lite practice with all clinicians read coding consultations. Invested in more nursing hours, nurse training, nurse practitioners and a health care assistant. Reorganised nursing and now have two specialist nurses handling most of main quality indicators. Made extensive use of templates to enter data.

5 Our overview of GMS2 Very complicated. The launch was a shambles. Clinically challenging (in parts). Should be better for patients. Will probably increase workload. GPs like the out of hours opt out option. Should deliver better profits, particularly in year two. Accurate cash flow prediction still not possible. Seems to be being implemented much better in Wales than England time will tell.

6 The New Contract affects all areas of a practice Communications involving the team. Services what do we wish to do and what will be commissioned by LHBs? Clinical practice the quality & outcomes framework. Infrastructure & organisation how best to organise resources. Finance how much will we earn and what can we afford? Information technology quality computer system vital coupled with good staff training & use. Premises are developments needed?

7 Communications Involved all PHCT, including community, in contract presentations and have had four away meetings. Nominated a lead Partner for each quality indicator and established clinical teams. Bought a computer projector for training and group sessions (a good 1k investment). Introduced contract reviews into practice meetings. Shown members of staff how to use the contract monitoring software (EMIS Population Manager). Regularly publish contract statistics.

8 Services we wish to provide Directed Enhanced Access to general medical services Yes Childhood immunisations. Yes Quality information preparation Yes Influenza vaccinations Yes Minor surgery. Yes Violent patients No Worth about 30k per annum approximately = 6k per GP

9 Other services National Enhanced Services Patients who are alcohol mis-users. Intra-uterine contraceptive device fittings. Specialised care of patients with depression. Patients suffering from drug misuse. Provision of intermediate care & first response care. Enhanced care of the homeless. Intra partum care. (home births) Minor injury service. More specialised sexual health services. More specialised services for patients with MS. Provision of near patient testing. Will LHBs commission these fully? Yes Yes Yes Yes No No No Yes Yes Yes Yes Total ( 40k) 8k per GP

10 Quality & Outcomes Framework maximum points in each category clinical indicators 550 organisational indicators. 184 patient experience 100 holistic 100 quality 30 additional services 36 access 50 Total 1050 points Possible 100k in first year = 20k per GP

11 Progress on Quality & Outcomes Reviewed each indicator, worked out where we are and decided our aspiration target. Held clinical meetings with partners and nurses to discuss changes required in recording consultations to meet contract. Involved community nurses to cover house bound and elderly patients i.e. blood pressure, blood tests etc. Updated our read codes inline with contract. Started using contract management software to prioritise and identify patients for follow up. Identified and started to meet any gaps in non clinical indicators.

12 Our quality aspiration - (1050 points max) Over 700 points now. Our aspiration will be 900 plus points. Monthly monitoring in place.

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17 Resource implications Do we have enough staff to do all this we think so but may need more nursing. Do we need to change individual s roles done it. Can we work smarter yes, doing it. Do nursing services need reorganising done it.

18 Finance???????? Two months to go and we still don t know our global sum, all of the pricing, what services we can provide, the rate for the work and if there will be financial caps anywhere. Some other finance issues will PCDF staff funding continue = 30k? will the LHB allow us to provide the Enhanced Services we have requested = 40k? what effect will disease prevalence have on quality payments (won t be known until early 2005), will they go up, down or stay the same, who knows? We envisage potential cash flow problems if our worst scenario occurs since we only get a third of our aspiration paid monthly during the first year.

19 Premises No developments planned.

20 IM&T IT savvy with a good clinical system. Making sure clinical codes specified in contract are used. Reviewing old clinical coding anomalies. Considering exemption reporting codes and their use. Starting to use MSD Clinical Audit & Contract Manager software. Reporting errors in contract monitoring software.

21 Still to do Submit and agree aspiration. Agree final indicative budget. Agree DES & NES to be commissioned. Agree and sign practice contract. Submit outstanding claims under Red Book. Probably lots more that we don t know about yet?

22 Future practice developments Salaried doctor? More nurse triage. Integrated reception/health care team. Pray the government does not keep moving goal posts. Hope the LHB will macro, not micro, manage the contract.

23 My GPs thoughts to doing well with the new contract A well trained and motivated nursing team (they believe nurses are better at this style of medicine than doctors). An outstanding computer system. A good team and a super Practice Manager to make sure it is all happening.

24 Our nurses these ladies are good Two Nurse Practitioner degrees. One Nursing degree. Two CHD diplomas. Two Diabetes diplomas. Two Asthma diplomas. Two Family Planning diplomas. One COPD diploma. One Counselling Certificate. Four Sisters (one ex. A&E). One nurse prescriber.