With its status as an ‘imposed contract’ slated to take effect from April, a referendum saw 99% of GPs vote ‘no’ to accepting its terms. And possible industrial action is earmarked for November and December later this year.
This imposition combined with proposed levels of investment has led the BMA to deem the contract ‘non-viable’ and an ‘ideological dismantling’ of general practice that could result in less access for patients and more closures of GP practices up and down the country.
While the long-term impact remains to be seen, it is understandable that some of its terms have raised eyebrows. General practice is already facing immense pressure and financial constraints, with many GP surgeries struggling to make ends meet. Here, we delve deeper into the contract, what it could mean for general practice and where some potential opportunities may lie.
Under the terms of the new contract, general practice will see a 2.23% total increase in funding with £259m extra allocated.
As the cost-of-living crisis continues to impact operating costs, the GP community has highlighted that these increases are not in line with inflation. Furthermore, this additional investment accounts for population growth and rise in patient numbers as opposed to an increase in payment per patient.
The new minimum wage is set to pour further strain on cash-strapped practices and commentators have highlighted that the contract does not reflect the reality of what many GP surgeries are facing. For many, it will be a case of doing more with less once more.
Updates to QOF are more positive and may present some potential opportunities.
Of the 76 QOF indicators, 32 will be ‘income protected,’ representing 212 points. These indicators will be suspended so practices will receive QOF points ‘based on their performance in previous years.’
With all QI indicators included, this may help to ease some of the administrative burden on practices, and give teams more time to ‘focus on those that have the biggest impact on health outcomes’ to quote the NHS Confederation. QOF aspiration payments will also rise to 80%.
The move marks another concerted step by NHS England to simplify QOF. And further changes are sure to come as a result of the consultation on the role of incentive schemes in general practice.
For now though, it’s worth highlighting that this move was informed by a clinical and technical reference group based on feedback. One may speculate that this type of co-creation is something the GP community would like to see extended to other areas of the contract in future years.
The Additional Roles and Reimbursement Scheme (ARRS) will see a 2% uplift and be expanded to include a new role, that of ‘enhanced’ practice nurses.
While a full definition of this role has yet to materialise, it is expected that such nurses will be experienced to a level seven or above postgraduate certification or have a diploma in one or more specialist areas of care. One enhanced nurse can be employed per PCN, rising to two should list size meet or exceed 100,00 patients.
Restrictions on the number of direct patient care-related roles that ARRS can be used for is to also be completely removed. This increased flexibility presents another opportunity for PCNs to further build out multidisciplinary teams and increase capacity. As any ARRS funding not spent will be taken away, this makes it even more imperative to get the most out of the scheme in 2024/25.
Finally, changes to the Investment and Impact Fund (IIF) will see three of its indicators incorporated into the Capacity and Access Payment (CAP). These are for flu and access.
This marks yet further streamlining of the IIF. Previously reduced from 36 to five indicators last year, the IIF now retains just two for learning disability health checks and faecal immunochemical testing.
£292m will be available for CAP, 70% of which will be paid in 12 payments throughout the year with the remaining distributed via the Capacity and Access Improvement Payment (CAIP). The latter will now start to be paid at any point in the year, once all practices within a PCN have implemented one or more of the three components of Modern General Practice Access such as faster navigation, assessment and response.
Finally, the PCN DES will merge eight of its service specifications into one.
We understand the pressure facing general practice and concerns at the level of investment outlined in the contract. Teams need more support and Suvera stands ready to help where needed. Within its scope, the removal of caps on patient care-related ARRS roles may be a silver lining. This provides flexibility to mature MDTs even further and could help to relieve some of the capacity pressures facing services.
Certainly, one thing we’ve seen work first hand is the implementation of virtual clinics in building out enhanced care teams. Working across a PCN, this provides a platform to implement a structured, standardised approach to chronic disease management focused on earlier intervention and more preventative, proactive models of care.
Taking hypertension as an example, we have helped PCNs to fully manage their register, delivering over 80% target achievement across all practices. While 70% of patients reach normal blood pressure control within 28 days of enrolling in one our virtual clinics.
Furthermore, in line with Modern General Practice Access, patients can engage in management of their condition via a web app, submit clinical information, and receive consultations to review their condition where necessary. And all consultations are fully coded and completely up to date with practice records, ready to achieve all Quality Outcomes Framework targets.
With a need to get the most out of ARRS budgets, we can help. To find out more, contact our team via partnerships@suvera.co.uk.
For more information on maximising the efficiency of ARRS roles watch our webinar, or see a collection of our case studies.
