GP Contract 22/23

Overview of agreement

Stalemate in negotiations between BMA’s GPC and NHS England
Changes proposed by NHS England not agreed upon or endorsed by BMA
NHSEI aligned with 2019 plan, refuses to discuss GPC England’s proposals outside five-year framework
GPC England negotiators engaged in discussions, but NHSEI didn’t consider them as negotiations
NHSEI shows willingness to understand pressures on GPs but lacks decisive action
No agreement reached; contract changes insufficient for access, safe working, and backlog during the pandemic
Five-year framework concludes in March 2024; existing GMS contract automatically rolls forward unless changed

Core contract changes and requirements

Online patient registration will no longer require wet signatures or hard copies, despite it already being offered by many practices and regions.
Online appointment booking will remove the minimum requirement of 25% and include all directly bookable appointments that do not require triage, surpassing the five-year framework.
This change grants practices the flexibility to decide which appointments are suitable for online booking, such as flu vaccination or COVID vaccination appointments.
Deceased patient records will no longer be printed and sent to PCSE; practices are now legally obligated to process access requests for these records.

Vaccinations and Immunisations

Transition from Gardasil 4 to Gardasil 9 for HPV vaccination in 2022/23
Move from a three-dose schedule to a two-dose schedule for HPV vaccination for ages 15 and over, including the national HPV MSM vaccination program
Cessation of the 10 and 11-year-old catch-up program for MMR vaccination
Practice participation in a national MMR campaign as per current contractual requirement
End of the MenACWY Freshers program on March 31, 2022.

Funding

The ‘Investment and Evolution: A 5 year Framework for GP contract reform‘ outlines the expected funding arrangements, which were amended in 2020 to include full reimbursement of the ARRS (Additional Roles Reimbursement Scheme).

In December 2021, NHSEI published a letter introducing temporary changes to the GP contract to provide support for the COVID-19 vaccination program, including adjustments to QOF and IIF (Investment and Impact Fund) indicators.

The agreed five-year framework included funding for pay uplifts aligned with predicted inflation as of April 2019. This year, the funding allows for a 2.1% pay uplift for all GPs, practice staff, and practice expenses. However, GPC England requested additional funding due to economic changes resulting from the pandemic, but their request was refused.

Global sum to increase by 3% per weighted patient from £96.78 to £99.70
OOH adjustment remains at 4.75%, increasing the value from £4.59 to £4.73
Continued funding in Global Sum (£20 million) for SARs workload in 2022/23
Value of a QOF point to increase by 3.2% from £201.16 to £207.56
ARRS funding increased from £746m to £1.027bn
Additional £43m for leadership and management, bringing total Clinical Director funding to £87m
IIF increased from £150m to £260m, including additional funds for specific purposes
Combination of PCN DES funding streams for enhanced access under the Network Contract DES

Health and Social Care (National Insurance) Levy

GPC England sought agreement to have employer contributions for the National Insurance uplift covered under the proposed 1.25% health and social care levy. However, the Government refused to provide this funding, even though it intends to cover the employer cost for all other public services, including secondary care employers.

QOF

The five-year framework recognized the importance of QOF in providing essential income to cover practice staff pay and expenses. NHSEI has decided to maintain the stability of QOF for 2022/23 by not introducing any changes beyond altering the topics for the Quality Improvement (QI) domain. However, they will fully reinstate QOF and its requirements from April, seemingly overlooking the significant impact of the pandemic on long-term conditions.

Despite GPC England’s requests for additional support in Childhood immunizations, NHSEI has declined to address this in the 2022/23 contracting round, despite data showing achievement variations nationwide. GPC England believes indicators should be modified to enable practices to provide more for their patients without financial penalties. NHSEI has also refused to make in-year changes to these indicators, despite past precedents.

The challenges practices face due to the impact on Item of Service (IOS) payments have been highlighted, but NHSEI has not addressed them in the 2022-2023 contracting round.

The proposed QI modules for 2022/23 focus on improving access to general practice and addressing prescription drug dependency.

Enhanced service on obesity and weight management

GPCE did not previously agree to the weight management enhanced service introduced in 2021, despite high practice signup (97%).
NHSEI has extended the service to 2022/23 with the same £11.50 per referral payment.
Patient’s explicit agreement for referral will now be required.
Previous allocation of £20M for the service was not fully utilized due to lower-than-expected referrals and engagement.
This year, the funding has been reduced to £11.5M, and there is no consideration for increasing the IOS for referrals.
Participation in the weight management enhanced service remains optional for practices.

Friends and Family Test

The requirement to submit Friends and Family Test (FFT) data was suspended in March 2020 but reintroduced into the GP Contract from April 1, 2022.

Practices will only need to submit data from Q2 onwards in the 2022/23 period, and commissioners will be informed about this.

GP practices must implement new FFT guidance, which includes changes to the policy:

Introduction of a new appropriate mandatory question.
Practices have more flexibility in designing how and when they receive feedback from patients.
Reduced emphasis on numerical data.
Increased focus on free-text comments from patients.
The role of the Patient Participation Group (PPG) is emphasized to foster listening rather than data collection.

Network contract DES

NHSEI is planning to implement changes to the Primary Care Network Directed Enhanced Service (PCN DES), with some principles agreed in the five-year framework but many details still pending agreement from GPC England.
Practices have the option to opt out of the PCN DES if they determine that it is not feasible for them or if they believe their patients would be better served outside of the PCN DES, or for any other valid reasons.
The specific opt-out period is yet to be confirmed, but it is anticipated to be from 1st to 30th April 2022.
Further information regarding the implications and impact of opting out of the PCN DES will be provided below.

PCN Enhanced Access

The transfer of CCG-commissioned extended access services was delayed due to COVID-19, starting from October 2022.
The new Access service combines extended hours and enhanced access with unified requirements.
PCNs will deliver general practice services during specific hours, including vaccinations.
PCNs must allocate 60 minutes per week per 1,000 weighted patients, with funding of £7.46 per weighted patient.
GP coverage, leadership, and oversight are required during network standard hours.
The Access service is for routine care, not a replacement for urgent or emergency services.
PCNs can subcontract the service and should offer unused slots to NHS111.

PCN Workforce

NHSEI proposes increasing the limit on Mental Health Practitioner reimbursement from one WTE to two WTE per PCN, subject to agreement between PCN and local mental health provider.
GPC England acknowledges the challenges PCNs face in recruiting Mental Health Practitioners.
NHSEI states that ARRS recruitment is on track, but PCNs experiencing different realities should inform their commissioner and LMC to address inaccuracies.

PCN Services

The Early Cancer Diagnosis service requirements will be streamlined to focus on national diagnosis priorities, specifically addressing lower than expected referral rates for prostate cancer.

The implementation of digitally enabled personalised care and support planning for care home residents will be delayed until 31st March 2024. Preparatory work will take place in 2022/23 for the Personalised Care and Anticipatory Care services.

The start date for Anticipatory Care and extension of the planning period has been deferred to 1st April 2023. In 2022/23, PCNs will contribute to the development of ICS delivery plans and collaborate with other providers for the joint delivery of the Anticipatory Care service.

PCN Leadership and Management payment

NHSEI is extending the funding to support PCN Leadership and Management, for the next two years. This means an additional £43m for each year.

PCN Investment and Impact Fund

In August 2021, NHSEI released indicators for implementation starting from April 2022, despite the lack of agreement from GPCE.
The released indicators include SMR-01, which measures the percentage of eligible patients receiving a Structured Medication Review, and ACC-02, tracking the number of online consultation submissions per 1000 registered patients within the PCN.
NHSE/I plans to introduce three new indicators related to Direct Oral Anticoagulants (DOACs) and Atrial Fibrillation, as well as FIT testing and 2WW cancer referrals.
The funding for these new indicators is in addition to the existing £225m funding envelope for the scheme.
GPCE has not agreed to the changes published in August 2021, which means that a £260M IIF investment embedded in 31 indicators remains unapproved by the BMA.
For more detailed information, please refer to the full details of the current Investment and Impact Fund (IIF) for 2021/22 and 2022/23.

Opting out of the PCN DES

Practices have the right to opt-out of the PCN DES (Primary Care Network Directed Enhanced Service) as stated in the specification. The regular opt-out period is expected to be from 1 to 30 April 2022. Opting out is not considered a breach of the PCN DES or core contract.

Practices that choose to opt-out will:

Cease providing services and fulfilling responsibilities outlined in the PCN DES service specification.
Lose the funding currently allocated through the PCN DES.
Potentially lose ARRS (Additional Roles Reimbursement Scheme) staff, along with the non-DES services they provide, which may increase workload or staffing costs for the practice.
Might still hold liability for ARRS staff, depending on the employment relationship with the PCN, but will not receive associated funding supporting their employment.

NHS England is likely to transfer the funding, requirements, and staff to Trusts or alternative providers via TUPE (Transfer of Undertakings) to maintain continuity of the PCN DES as much as possible outside of general practice.

The decision to opt-out or remain in the PCN DES is individual to each practice. Considering the proposed changes and their impact on the practice and patients, as well as the current effects of the PCN DES, practices have the choice to decide whether to stay within the PCN DES or opt-out.