Contract Issues

The General Medical Services (GMS) Contract, last negotiated in 2004 on a national basis, contains a number of components. The basic element is the core funding based on each practice’s list size, suitable weighted for age and deprivation to reflect the different health needs and resource requirements of different groups. 

It is divided into two main parts regarding the services provided by GMS practices:

  • ‘Essential Services’ – which must be provided by all practices.
  • ‘Additional Services’ – for which practices do have the option to opt out of providing these services with a commensurate drop in their income. These services include, for example, contraception, childhood vaccinations and child health surveillance, cervical screening and a number of other services. 
  • Quality & Outcomes Framework – in theory voluntary but involving significant extra payments for offering arrange of structured surveillance, monitoring and treatment of chronic health conditions.
  • Enhanced Services – a range of services outside core requirements, often for services previously provided in a hospital setting.

Certain areas of the GMS contract and the funding of the contract or re-negotiated annually.

When the contract was negotiated in 2004 the formula that the Government applied was fundamentally flawed and resulted in many anomalies in that practices would have lost significant income and would have had to curtail services. This was acknowledged by the government at the time and the concept of a “Minimum Practice Income Guarantee” or MPIG was introduced. This applied a “Correction Factor” to those affected practices so they would not have to make staff redundant or cease to provide services.

The range of questions we are asked about what is and isn’t in the contract is huge. We are happy to continue to help practices in this way. We will be developing a Frequently Asked Questions (FAQ) section in due course to help practices pin point the relevant sections quickly. The contract should be read in conjunction with the Statement of Financial Entitlements.

We understand there is plenty of rhetoric but no specific plans nationally to re-negotiate the GMS contract. There has recently been a contract imposition that unilaterally took away certain QOF income whilst expecting practices to continue to do the work unfunded and recycled the money into extra enhanced services.

The PMS contract is more complex as it varies from area to area depending on the specific health needs that the PMS contract was aiming to address. Clearly with PMS contracts there is an element of local negotiation and we are happy to support practices during this process. There have also been regular notices of reviews to the funding of PMS practices, which received extra income to address particular health needs in a community. Currently these are on hold pending a national review of the situation.

There is a major challenge facing practices in the light of the government’s intention to equalise funding to all practices over a 7 year period, starting in 2014. They intend to do this by removing the “Correction Factor” described above. There will be winners and losers in the exercise and the LMC intends to work closely with the NHS England Area Teams and relevant practices to manage this process proactively and not see any practices fall down as a result. We believe that some small practices will be particularly vulnerable.

We are also conscious of the potential for Government to decide to do away with the distinction between GMS and PMS and the effect that this may have on PMS practices. LMC is happy to support practices who wish to plan to minimise the impact of such an event.

Finally we are happy to support GPs working under APMS contracts where the practice pays the levy to us.

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