GP contract reform

01/03/2019
by Garreth

Since the NHS Long Term Plan (LTP) was published on 7 January 2019 a new document, Investment and evolution: A five-year framework for GP contract reform to implement The NHS Long Term Plan, has been released which includes the roll out of the Primary Care Networks model. Here’s a summary of the relevant MSK elements.

The publication covers the following areas:

  • Addressing the workforce shortfall
  • Solving Indemnity Costs
  • Improving the Quality and Outcomes Framework (QOF)
  • Introducing the Network Contract DES
  • Going ‘digital-first’ and improving access
  • Delivering new network services
  • Guaranteeing investment
  • Supporting research and testing future contract changes
  • Schedule of future contract changes and development work

Workforce

Workforce is identified as the priority for primary care. Various steps are set out to enable recruitment of an additional 5,000 doctors and 1,000 nurses.

There is a reimbursement scheme for additional roles to enable increased multi-disciplinary teams. Five roles are listed as being eligible for reimbursement:

  • clinical pharmacists,
  • social prescribing link workers,
  • physician associates,
  • first contact physiotherapists
  • first contact community paramedic.

ARMA has raised with NHSE the fact that the role is First Contact Practitioner, not physiotherapist. If reimbursement is only available for physiotherapists in the role, we are concerned this will mean other professional training does not see FCP as something worth investing in, so reducing a potential source of suitable FCPs. This would be counterproductive in the context of a measure designed to address a workforce shortfall.

Primary Care Networks

Primary Care Networks (PCNs) are intended to bridge the divide between primary and community services. They focus on provision of services, not on commissioning. They will become the foundation of integration to deliver the ‘triple integration’ of primary and specialist care, physical and mental health services, and health with social care.

They are about primary care practices contracting to work together. A PCN should cover a population of around 50,000 patients (minimum 30,000) so that it is large enough to support a multidisciplinary team.

Networks will have a network agreement. Delivery will require collaborative working by members. Members of a network will be GP practices plus specialist, physical and mental health services and secondary care in the area.

Each PCN must have a clinical director and one lead practice which receives the funding for the network. NHS England will provide a range of support to PCNs.

Delivering new network services

There will be seven service specifications to be delivered in 2019/20:

  1. Structured Medications Review and Optimisation;
  2. Enhanced Health in Care Homes, to implement the vanguard model;
  3. Anticipatory Care requirements for high need patients typically experiencing several long term conditions, joint with community services;
  4. Personalised Care to implement the NHS Comprehensive Model;
  5. Supporting Early Cancer Diagnosis;
  6. CVD Prevention and Diagnosis; and
  7. Tackling Neighbourhood Inequalities.

Anticipatory care – Based on individual needs and choices, under the Anticipatory Care Service, people identified as having the greatest risks and needs will be offered targeted support for both their physical and mental health needs, which include musculoskeletal conditions, cardiovascular disease, dementia and frailty. Typically, this involves a structured programme of proactive care and support in which patients with multi-morbidities will have greater support– including longer GP consultations where appropriate – from the wider multidisciplinary team.

For more detail see the full document.

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