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Implementation of new general medical services and personal medical services contracts in primary care

Transforming primary care

Implementation of new general medical services (nGMS) and personal medical services (PMS) contracts in primary care is under way, with nGMS contracts to be agreed and signed by 1 April 2004.

During February both primary care trusts (PCTs) and practices will put in place a series of agreements to ensure the smooth implementation of the nGMS and any revised PMS contracts.

The contracts are intended to improve and expand primary care services for patients, and improve the recruitment of GPs by making their working lives more attractive. They are supported by a one-third increase in funding.

At the end of the reform process, which is devolving spending powers from Whitehall to local health organisations, PCTs will be responsible for three-quarters of the total health budget.

The new contracts are, for the first time, between PCTs and practices rather than individual GPs. Practices will also, for the first time, be paid for improving quality, while PCTs will have full responsibility for commissioning primary care services for patients.

In the past six years PCTs have also been able to enter into direct contracts with some GPs under pilot PMS arrangements.

These are now confirmed as a permanent alternative to GMS, enabling individual GPs or practices to offer specific services locally that would otherwise not have been available.

Content of the new GMS contracts

The new contracts, which replace all previous GMS contracts from 1 April, are structured to release most funds to practices agreeing to supply all the elements of primary care. They are also the legal framework through which investment can be directed into improving buildings, facilities and IT equipment.

GP practices will be expected to be the main provider of most services but there will be opportunities for others, such as practice nurses, to develop and lead additional services. PCTs will be responsible for the strategic overview of provision of all primary medical care in their areas.

GPs will continue to provide a range of 'essential' services. They will be obliged to look after those who are or believe themselves to be ill. They must treat chronic diseases and look after terminally-ill patients. They must make home visits when considered medically necessary.

Also, they must provide immediate necessary and urgent treatment to temporary residents; annual health checks to the over- 75s where requested; and invitations to health checks for newly-registered patients and patients not seen within three years where requested.

Essential services must be available between 8am-6.30pm on weekdays and surgery hours must be long enough to meet reasonable demands.

"Additional" services are: minor surgery, vaccinations, and immunisations, contraceptive services, cervical screening, child health surveillance and maternity services. Practices will have a preferential right to provide additional services and will normally do so but they will have an ability to opt out within set rules.

From December 2004 GPs will also be able to opt out of out-of-hours (OOH) care without the agreement of their PCT and PCTs will become responsible for OOH services. These services will not disappear - PCTs are expected to negotiate suitable alternative arrangements so that all patients can continue to access these services.

PCTs must also commission six Direct Enhanced Services (DES) which are designed to sustain the existing range of services available in primary care. They cover: preparing patient information ready for computerisation; improved access; the childhood immunisation programme; minor surgery; protection of GPs, their staff and other patients from violent patients; and flu protection for the over-65s and at-risk patients.

PCTs will also have new powers to commission or provide any other enhanced services to expand the range of services to meet local needs, improve choice and convenience for patients and give better value for money for the NHS.

Finance arrangements

The global sum which practices will receive funds the provision of essential and additional services and is based on patient need and practice costs. A Minimum Protection Income Guarantee correction factor may then be applied if that sum is less than the historic equivalent spend. Additional service opt-outs will reduce the global sum by a set tariff.

There is also the opportunity for practices to substantially increase their income by participating in the Quality and Outcomes Framework.

This framework lists evidence-based best practices in health care provision, including treating patients with chronic conditions. Practices can also earn additional income by contracting with the PCT to provide enhanced services.

PCTs will be responsible for carrying out annual reviews of the contract and must start planning and scheduling the first in their series of annual visits during summer 2004.

Guidance

Guidance setting out the priorities and timetable for action on the new GMS contract was issued in December. It looks at the flexible provision of services, quality, infrastructure, finance, and the contracting process.

The guidance has been published alongside new draft regulations on the legal aspects of the contract; a draft standard contract on which to base local agreements; and a Statement of Financial Entitlements.

A guide on the improved PMS contract has also been issued.

Regional conferences are taking place in February for all PCTs and a national helpline 0845 9000008 has been set up.

Guidance on the GMS and PMS contracts and supporting documents are at:

For the latest information, contract documents, implementation guidance, briefing pack and prospectus of support, visit General Medical Services (GMS) contract.

Further information on PMS at Primary Care

Timetable to delivery

Guidance was issued in December 2003 which sets out the priorities and timetable for action for PCTs and practices to agree new contracts from April.

These have been amended in the light of the slight delay in making allocations to PCTs.

One week after allocations are made to PCTs

All GMS practices should have received indicative budgets from PCTs showing how much they can expect to receive, depending on what services they plan to provide.

By end of February

GMS and PMS contractors taking part in the Quality and Outcomes Framework will have agreed their quality aspiration level with their PCT.

PCTs will have sent versions of the standard GMS contract to every GMS contractor, tailored to reflect the provisional agreements reached with each contractor PCTs will have offered default contracts if provisional agreement has not been reached on new GMS contracts.

By 31 March

GMS contracts or default contracts must have been signed

On 1 April

PMS contracts become a permanent feature of primary care provision and the need to apply to Department of Health for new contracts is abolished

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