The new General Medical Services (GMS) (GP) Contract: so what will be different?

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This post comes as the Health and Sport Committee are presented with the Regulations that bring in the new GMS (General Medical Services) contract. The new contract has been several years in the making, with the Scottish Government negotiating with the Scottish General Practitioner’s Committee of the British Medical Association (BMA) – the UK doctors’ union.

The new contract is the first phase in the process of a broad transformation in how GPs will work and be paid. Phase 2 will follow in 2020 – 21, and will require further negotiations and another poll of GPs.

Most people experience their GP surgery as a seamless entry point to NHS services. Some might not realise that the majority of GP practices are run as private businesses, operating in many respects like any other small business. GP practices are unusual in that most of their income comes from the health board they have a contract with. This contract forms the basis of the services they provide as a GP.

This current model has meant that there has only been limited transparency with regard to practice finances (how much of the income goes on salaries for example), and primary care data (GPs have been data controllers for their practice, making it challenging to share patient data across the different health organisations).

Negotiating the new contract

BMA Objectives for the new contract

  • stabilise general practice funding and GP income,
  • reduce risk for GP partners (eg around owning and upkeep of premises) and
  • reduce workload for GPs.

Scottish Government Objectives

  • New vision with GPs to focus on complex cases and to act as clinical lead for a multi-disciplinary team (eg. pharmacists, nurses and allied health professionals such as occupational therapists, and physiotherapists).
  • Improve patient experience, for example, longer consultations when required.
  • Reduce health inequalities through a new funding formula indexing funding to age and deprivation.
  • More efficient and transparent use of resources – income, expenses, employees and patient consultations will be better understood by government and ultimately health boards in order to allocate resources more effectively.
  • Better integrated and co-ordinated health and social care services with health boards and councils working to the same local objectives through integration joint boards.

So what is the detail of the final contract?

The role of GPs will focus on their diagnostic expertise, their ability to manage complex care, quality improvement of local primary care (everything outside of hospital) and their clinical leadership in local health care.

Tasks currently carried out by GPs will be carried out by members of a wider primary care multi-disciplinary team. This will be one of the major transformations linked to the contract. For example, how vaccinations, pharmacy, mental health services, urgent care and physiotherapy services are organised will change.

There will be a new funding formula, based more accurately on actual workload. £23 million is to be invested by Scottish Government to provide practice income stability and to improve services where GP workloads are highest. The Report on the new model describes how the formula will be indexed to population need rather than population numbers or services provided.

GP income will be guaranteed with new minimum earnings of £80,430 for GP partners for full-time hours from April 2019. (The average taxable earnings for UK GPs is £90,100 according to the latest data). Deloitte produced a Review of GP Earnings and Expenses in November 2017. This will help the government to understand differences in GP incomes and expenses across the country, and to inform the new funding formula.

Workload will decrease and refocus, with, for example, GP pharmacists working more autonomously, taking on acute and repeat prescribing and doing medication reviews. This will be dependent on the multi-disciplinary ‘hub’ model becoming well-embedded and understood.

GPs will be more involved in local health service planning by health boards and integration authorities. Health boards, Integration Joint Boards, the BMA and the Scottish Government will agree the principles of service redesign, with local and national oversight arrangements put in place.

There will be a new GP Premises Sustainability Fund, with £30 million invested over three years to support a long-term shift away from GPs owning their own premises. Boards will increasingly negotiate and take on leases for premises, and therefore the risk.

It will be easier and safer for GPs to share patient information when required, as GPs will no longer be the sole data controller for their patients. Instead, the responsibility will be shared with health boards.

GP practices will produce and use data with support from NHS Information Services Division in order to improve their response to local need to assist quality improvement and practice sustainability. This GP level data will be gathered for the first time via a new resource, SPIRE.

As part of the planned service redesign, longer consultations will be possible when someone has complex health conditions.

GPs will be expected to work with other local practices in a ‘cluster’, taking a lead in improving care through peer review and service quality across local areas. This again is part of the transformation, linking practices into local planning, and beyond their own practice.

Practice nurses will be supported by the contract to become expert nursing generalists, providing acute and chronic disease management

Issues raised by the contract

  1. According to Rural GP practices, they will be worse off under the new formula.
  2. How will the multidisciplinary team model work in practice when all involved are professionals with their own codes of conduct, autonomy etc. and when some are employed by the board and some by the practice? See the submission to the Health and Sport Committee from the Allied Health Professions Federation of Scotland. They argue that they are underrepresented at every level in the NHS.
  3. Will it actually cut down on the amount of administrative tasks for GPs? See this GP’s blog.
  4. How much of the substance of the contract is reliant on the goodwill of GPs? Will they be able to adhere to some aspects and ignore others? Are there enough measures in place to encourage compliance?

For more information, see ‘The 2018 GMS Contract in Scotland

Anne Jepson, Senior Researcher, Health and Social Care