Update to GP Contract 23/24

On 2nd February 2023, the GP contract offer proposed by the Department of Health and Social Care and NHS England (NHSE) was rejected by the General Practice Committee of the British Medical Association (GPCE). Despite subsequent lobbying and discussions, the government ministers did not present any acceptable alternative offer to facilitate agreement between NHSE and GPCE.

NHSE, representing the ministers and DHSC, shared a letter with GPCE Officers on Monday, 6th March, formally concluding the discussions. Surprisingly, NHSE proceeded to publish the imposed contractual changes even before their confirmation by the committee.

These contractual changes will be implemented starting from 1st April 2023.

NHSE (National Health Service England) has provided a comprehensive set of documents, which can be accessed on their official website: NHSE GP Contract. These documents cover various aspects of the contract and offer valuable information for practitioners. To make it easier for you to navigate, I have provided direct links to specific sections below:

Furthermore, the BMA (British Medical Association) has provided guidance on the GP Contract changes for 2023/24. They have also conducted informative webinars on this topic. To access the recorded webinar and additional information, visit the BMA website: BMA GP Contract Changes 2023/24.

Feel free to explore these resources for a comprehensive understanding of the GP contract and its changes.

Key Changes and Requirements of the GP Contract 2023/24

  1. Access Requirements: The GMS Regulations have been updated to emphasize that patients should receive an assessment of their needs or be directed to an appropriate service during their initial contact with the practice.
  2. Access to Records: The deadline for implementing prospective patient online access to their medical records will be extended until 31st October.
  3. Cloud-Based Telephony: Practices will be required to obtain their telephony solutions exclusively from an NHS framework once their current telephony contracts expire.
  4. GP Registration Requirements: The GMS contract regulations will undergo amendment to remove the use of the term “medical cards” within the registration requirements.

Funding

The document “Investment and Evolution: A five-year Framework for GP contract reform” outlines the funding arrangements for the GP contract. It specifies a 2.1% pay uplift for all GPs, practice staff, and practice expenses. However, despite presenting strong evidence, including survey results and case studies highlighting the significant pressures faced by practices, the request for additional funding in line with current inflation rates was rejected by government ministers.

Vaccination and Immunisations

The GP contract will undergo updates to incorporate upcoming changes to the routine vaccination schedule as recommended by the Joint Committee on Vaccination and Immunisation (JCVI). These updates specifically pertain to the Human Papillomavirus (HPV) and Shingles programmes.

Childhood Immunisations

The childhood Vaccinations and Immunisations (V&I) programme will undergo several changes, including:

  • Removal of the V&I repayment mechanism for practices with under 80% coverage.
  • Adjustments to the V&I Quality and Outcomes Framework (QOF) thresholds, lowering the lower thresholds to 81% – 89% (depending on the indicator) and raising the upper thresholds to 96%.
  • Clarification in the Standard Financial Statement (SFE) that an Item of Service (IoS) fee will be paid for vaccinations related to medical reasons and cases of incomplete or unknown vaccination status (referred to as the ‘evergreen offer’).

QOF (Quality and outcomes framework)

In the upcoming year, all disease register indicators will be income protected, with funding based on 2022/23 performance and paid monthly once the 2022/23 Quality and Outcomes Framework (QOF) outcomes are finalized.

Two new cholesterol indicators and a new overarching mental health indicator will be added to the QOF, funded by retiring an indicator related to rheumatoid arthritis and reducing the value of the annual dementia review indicator.

Indicator AF007 will be replaced with the former IIF indicator CVD-05 (as AF008).

The Quality Improvement (QI) modules for 2023/24 will focus on workforce wellbeing and optimizing demand and capacity. Additionally, there will be minor changes to indicator wordings and values in 2023/24.

The BMA has developed a helpful guidance document for the QI module on Workforce Wellbeing that you may find valuable.

PCN DES (Primary Care Network Directed Enhanced Service)

  • Practices are reminded that the PCN DES and its associated services, Investment and Impact Fund (IIF), and access requirements are optional.
  • Practices have the option to opt-out of the PCN DES if they determine that it is no longer viable for them and believe that their patients would receive better support and their practice would operate more effectively and safely outside of the PCN.
  • The next opt-out window will take place when the contract is updated on 1 April, running until 30 April 2023.
  • Further information about the impact of opting-out of the PCN DES can be found below.

Full suite of documents at NHS England » Network Contract Directed Enhanced Service (DES)

Opting out of the PCN DES

  • Practices have the right to opt-out of the PCN DES as specified in the PCN DES Specification.
  • The next regular opt-out period is scheduled to take place from 1 to 30 April 2023.
  • There may be additional opt-out periods throughout the year if further changes to the DES are implemented.

ARRS (Additional Roles Reimbursement Scheme)

The ARRS (Additional Roles Reimbursement Scheme) will undergo several changes.

  • The cap on Advanced Practitioners will increase from two to three per PCN for list sizes below 100,000, and from three to six for list sizes of 100,000 or more.
  • PCNs will be reimbursed for the time spent by First Contact Practitioners on education and training to become Advanced Practitioners, including Advanced Clinical Practitioner Nurses.
  • Apprentice Physician Associates (PAs) will be introduced as a reimbursable role.
  • Recruitment caps on Mental Health Practitioners will be removed, and they will have the ability to support first contact activity.
  • The Clinical Pharmacist role description will be amended to clarify that Clinical Pharmacists can be supervised by Advanced Practice Pharmacists.
  • NHS England has confirmed that a review of the ARRS will take place in 2023/24.

IIF (Investment and Impact Fund)

In 2023/24, the Investment and Impact Fund (IIF) will undergo several changes:

  • The number of indicators will be reduced to five, focusing on key national priorities: flu vaccinations, learning disability health checks, early cancer diagnosis, and the 2-week access indicator. These indicators will have a value of £59 million.
  • The remaining IIF funds, totalling £246 million, will be dedicated to enhancing the patient experience when contacting and being assessed by their practice within appropriate timeframes.
  • 70% of the total funding (£172.2 million) will be provided as monthly payments to PCNs throughout the year, similar to monthly QOF aspirational payments.
  • The remaining 30% (£73.8 million) will be assessed against ‘gateway criteria’ by ICBs in March 2024. PCNs demonstrating improvements in patient access will receive this portion of the funding.

The Learning Disability Health Checks Indicator will be modified to include the recording of ethnicity for individuals with learning disabilities.

The FIT testing indicator (CAN-02) will incorporate a Personal Care Adjustment (PCA) to prevent incentivization of referring for FIT testing in cases of rectal bleeding. Additional support, such as a national ‘supply chain’ escalation system, will be established to address local supply issues. Regional cancer alliances can offer assistance in funding FIT kits where necessary.

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Updated on March 7th, 2023