GENERAL MEDICAL SERVICES

GENERAL PRACTICE MANAGEMENT GENERAL PRACTICE MANAGEMENT

Learning OutcomesUNDERSTAND:

The Scope of General Practice Management

The various means by which GPs are contracted

Key features of the Contractual and Partnership

Agreements and the Business Plan

General Practice funding streams

Important History of General Practice1948: Lord Beveridge, NHS is established, providing free health care for everyone

1952: College of General Practitioners is founded

1966: Family doctor charter facilitates payments for nursing staff and buildings

1976: Primary Care Act requires general practice principals to do vocational training

Mid 80s: Cost /Notional Rent Scheme, Practice Nurses and Practice Managers started to appear

1990: General practice contract – Health Promotion Clinics. Fundholding introduced

1997: New contract enables general practitioners to choose to be salaried rather than self employed Personal Medical Services. Money ran out

1999: Fundholding is replaced by Primary Care Groups and Trusts

2004: nGMS Contract - Doctors are allowed to stop providing out of hours care

Private trader at WorkBefore the 20th century general practitioners worked as private traders, treating patients only if they had the means to pay

Yesterday v Today 2 groups

GENERAL PRACTICE IS A BUSINESS

General Practice is a small people-centred business

The business is owned by the practice partnership

GPs are “independent contractors”

WHAT DO YOU EXPECT

THE PRACTICE MANAGER

TO KNOW

AND BE

CAPABLE OF DOING?

NES GPMVTS MENU for LEARNING LEARNING NEEDS ANALYSIS D

General Medical Services Contract (2003) Annex C: Competency Framework For Practice Management

Practice Operation and Development Risk management and assessment Partnership Issues Patient and Community Service Finance Human Resources Premises and Equipment IM&T Population Care

“IN A TIME OF TURBULENCE AND CHANGE, IT IS MORE TRUE THAN EVER THAT

KNOWLEDGE IS POWER”

Sir Francis Bacon and J F Kennedy

IMPORTANT DOCUMENTS to know about and use

• Practice GMS Contract

• Statement of Fees and Entitlements (SFE)

• NHS Circulars

• Partnership Agreement

GENERAL PRACTICE CONTRACTING ARRANGEMENTS

LOCAL ADMINISTRATION LEVEL:

◦ Scotland – PCO - Primary Care Organisations ◦ England - PCT - Primary Care Trusts ◦ Wales - HB - Local Health Boards

4 CONTRACTUAL METHODS:

◦ General Medical Services Contract (GMS) – (a new GMS contract has been in place since April 2004)

◦ Personal Medical Services agreements (PMS) ◦ Alternative Provider Medical Services (APMS), and ◦ Primary Care Led Medical Services (PCTMS).

A CONTRACT BETWEEN WHOM?

• Contract between a practice and a PCO– all practice partners will enter contract with PCO

• Individual practice contractual terms come from national “menu”

A PARTNERSHIP AGREEMENT • A contract between the partners and should be kept up to date at all

times in order to be valid and thus effective.

• Although an oral partnership is a valid one, it is not to be recommended.

• In a PARTNERSHIP AT WILL, relations between partners are governed by the Partnership Act 1890, unless some agreement to the contrary can be proved.

• The Partnership Act was designed to cover all partnerships and does not meet the specific needs of individual professions.

Partnership Act 1890.Some consequences of being a partnership 'at will';

• Any partner may dissolve it at any time with no formal procedure

• Death or bankruptcy of a partner will automatically dissolve the partnership

• No partner(s) has the right to expel another for any reason

• No partner(s) has the automatic right to carry on the partnership

• The assets will be frozen immediately on dissolution

• Staff will be made redundant on dissolution

• All partners are entitled to an equal share of the assets

• All partners have equal liability for the debts

• No new partner may be appointed without a unanimous decision

• All partners may take part in the management of the partnership

Partnership Agreements

Document Hierarchy

GMS CONTRACTPractice Based Lists

• Patients Registered with Practice not GP• New Patient Right to See GP of Choice

» Wait longer

• New Rules on Registering Patients» Clinician can refuse (violent patient) » Refer to another clinician if doesn’t provide service» New Rules Removing Patients

WHO are our PATIENTS?

Must provide primary medical services to the following:

REGISTERED PATIENTS & TEMPORARY RESIDENTS• provide appropriate ongoing treatment/care • including provision of advice re patients health

(including health promotion) and referral to other services.

IMMEDIATE NECESSARY TREATMENT

Must also provide primary medical services required in core hours for any person (to whom the practice has been requested to provide treatment) owing to accident or emergency at any place in practice area

This includes any medical emergency not just services provided under this contract.

THE CONTRACT “MENU”FIVE TYPES OF SERVICE

“Normal” services:

1.Essential

2.Additional

“ Supplementary” services:

1.Directed Enhanced2.National Enhanced3.Local Enhanced

ESSENTIAL SERVICES - MANDATORY

Practices must provide the following services during core hours (8am-6.30pm)

Management of its registered patients & temporary residents (TR) who are:(a) ill, or believe themselves to be ill, with conditions from which recovery in generally expected(b) terminally ill (c) suffering from chronic diseasedelivered in the manner determined by the practice in discussion with the patient.

ADDITIONAL SERVICES

• Normally expected of all practices but OPT-OUT possible

• These will mainly include services which are preventative:– CHS– Non-IUD contraception– Non-intra partum maternity– Childhood vaccinations and immunisations– Cervical screening– Curettage, cautery and cryocautery

OPTING-OUT Either:

• temporary (emergencies)• permanent (long-term problems)

PCOs and practices working togetherMaximum 9-month process

Alternatives – other practices, PCO, other providers e.g. walk-in centres

Money removed from practice global sum

Patient access to services protected

LIST CLOSURE process

DIRECTED ENHANCED SERVICES• OPT-IN for practice

• Obligatory for each PCO

• National specifications

• No one practice has to do but someone has to– Services to violent patients

– Childhood vaccinations and immunisations financial incentives

– Minor surgery

– Flu immunisations

NATIONAL ENHANCED SERVICES

OPT-IN - national terms and conditionse.g.

Anticoagulant monitoring IUCD Sexual health MSDrug and alcohol misuse Terminally illDepression Learning

disabilitiesIntra partum care Minor injuriesNear-patient testing Homeless Immediate/first response care

LOCAL ENHANCED SERVICES

OPT-IN

• Response to specific local requirements

• Local terms, conditions and standards

• Possibly, innovative services for piloting and evaluation

PaymentsHow can the practice income be increased?

3

Global Sum or

Minimum Practice Income Guarantee

Enhanced Services

Quality & Outcome Framework

Seniority & Other Payments eg maternity, sickness

PRACTICE

GLOBAL SUM

PCO

UNIFIED BUDGET

ESSENTIAL&

ADDITIONAL

PROTECTEDTIME

DIRECTED ANDNATIONAL ENHANCED

LOCAL ENHANCED

GUARANTEEDFUND(S)

QOF - ASSUREDQUALITYMONEY

ALTERNATIVEPROVIDER

PCO-MANAGED

FUNDS

PREMISES

IT

£

2011-2012 GMS CONTRACT AGREEMENT

Practice Expenses

For 2011-12, in order to reduce the risks of a further net pay cut for GPs, we have agreed to an increase to the overall value of GMS contract payments by 0.5 per cent, to support practices in meeting the costs of increased expenses, including the pay award for employed staff with a full time equivalent salary of less than £21,000. This increase will be delivered in through a 2.53 per cent increase in the value of a QOF point from £127.29 to £130.51.

This increase in the value of a QOF point is intended to deliver the full 0.5 per cent expenses increase agreed with NHS Employers.

Increased expenses – no reimbursement for Commercial waste disposal

BUSINESS PLANNING“Alice's Adventures in Wonderland”

Alice comes to a fork in the road and asks the cat:

• “Would you tell me, please, which way I ought to go from here?”

• “That depends a good deal on where you want to get to”, said the Cat.

• “I don't much care where”, said Alice.

• “Then it doesn't matter which way you go”, said the Cat.

Rudderless, haphazard, reactive, poor communication and teamwork

BUSINESS PLANNeeds:

• People – Personnel & Patients• Organisational • Operational

Plan:• Vision and the Mission• Practice Profile• Running the Business• Finance

ACTIVITYThe Practice Merger

The Task

In groups of 5-6, consider the scenario

Before commencing the exercise, nominate a spokesperson and

a scribe.

You have 20 minutes to brainstorm the issues

You are not expected to solve the problems but to identify the

issues

The issues may be suitable tutorial topics