GP financial and contract changes for 2020 to 2022

Practice Index has created a guide to the GP financial and contract changes effective from 2020-2022

NHS England (NHSE) is trying to keep pace with the needs of patients – and the ability of general practice to meet those needs – in an abnormal situation as the pandemic continues to impact services. Pressure on consulting times – combined with technology that hasn’t always kept pace with changes in the outside world – left general practice under immense pressure during the initial wave of the pandemic. General practice has evolved at an incredible pace, and it is a testament to practice staff that they have completely changed their models of delivery in a very tight time-frame exacerbated by the challenges that COVID-19 has presented.

In addition to the GP contract changes for 2020/21, discussed here, there have been further updates from NHSE that confirm the arrangements for 2020 to 2022 – though not all arrangements can be clarified fully due to the changing picture in primary care.

Practice Index has summarised the changes below, so you don’t need to wade through pages and pages to find the information you need.

In the letter dated 7^th January 2021, Freeing up practices to support COVID vaccination, NHSE clarified that CCGs should:

• Minimise local contract enforcement around routine care.
• Suspend any locally-commissioned services unless in support of COVID vaccination, or providing COVID support to the local healthcare system.
• Review whether CCG staff who are clinical could be deployed in support of practices or PCN work.

Nationally:

• PCN funding increased to cover the equivalent of 1 WTE clinical director, to be used flexibly where one practice is participating in the COVID vaccination DES (for more information, please see our PCN DES guidance [PCN PLUS]).
• Minor surgery DES income protected until March 2021.
• QI domain in QOF protected until March 2021.
• 8 prescribing indicators to be income-protected on the same basis as the existing 310 points.

In the letter dated 21^st January 2021, Supporting General Practice in 2021/22, NHSE has confirmed the following:

The priorities for general practice will be:

• The COVID vaccination programme.
• Responding to the pandemic, including offering accessible healthcare to all.
• Dealing with the backlog of care caused by the disruption to services and the potential impact of long COVID.
• Supporting the general practice workforce.

Contract arrangements for the whole of 2021/22 cannot be confirmed yet, but some guidance can be given now.

• The funding for the ARRS scheme will increase in 2021/22.
• ARRS funding increase will start from April 2021, but the additional services will not begin at that time.
• General practice needs to retain GPs using the GP recruitment and retention initiatives.
• PCN clinical director funding will be increased in Q4 of 2020/21, and the need for additional funding for 2021/22 will be kept under review.
• QOF 2021/22 will have very limited changes from the framework agreed for 2020/21.
• The incorporation of the childhood immunisation DES into QOF will go ahead.
• No new quality improvement modules will be added in 2021/22.
• Quality improvement modules on early cancer diagnosis and learning disabilities are subject to full income protection for 2020/21. There will be some changes in 2021/22 to account for the impact of the pandemic on care.
• Support will be increased for the serious mental illness (SMI) physical health check indicator set.
• There are minor changes to the cancer care, asthma and heart failure domains (this may include coding changes).
• The ARRS will continue to expand, and be more flexible, incorporating roles including paramedics, advanced practitioners and mental health practitioners. Annex B describes the requirements for these roles.
• There will be a joint model for funding community mental health support, with FTE mental health practitioners funded jointly by the PCN and their local provider of community mental health services. This will increase in 2022/23 and 2023/24 and, for PCNs with more than 100k patients, this entitlement will be doubled.
• PCNs in London will be able to offer London weighting. This does not mean there will be a change in funding, just more flexibility.
• Further opportunity for pharmacists on the clinical pharmacists in general practice scheme to transfer to the PCN and be reimbursed under ARRS. This is 1^st April 21 to 30^th September 2021. Limits on numbers of pharmacy technicians and physiotherapists will be removed.
• PCNs should make use of their ARRS as soon as possible.
• Part of the funding for IFF in 2021/22 will incentivise improvements in access.
• IFF and PCN service requirements will be phased due to the impact of the ongoing pandemic.
• Extended access transfer to PCNs does not now need to happen until April 2022, but where PCNs can demonstrate they are ready, transfer can happen earlier.

Changes to QOF indicators 2021/22

NM197, NM198, NM199 and NM201 are NEW indicators, all related to vaccinations, including childhood immunisations and shingles for those aged 70-79.

MH007, and two new indicators, now form part of the SMI domain.

Other changes for 2021/22

NHSE and GPC England will carry out work around terms and conditions for the employment of general practice staff and the gender pay gap. This is to develop and inform guidelines on good practice.

There is further clarity around the core digital offer which practices will be expected to put in place. Most practices will already be offering these services.

Practices operating total triage/triage first do not need to offer 25% online booking requirement.

There are changes around the functionality of changing patient details online, to extend removal of consent to eRD and a commitment to timeliness for transfer of patient records.

The cervical screening additional service will become an essential service and there will be minor updates to the structured medication review and early cancer diagnosis services within the network contract DES.

To see further details of QOF changes for 2020/21 please click here.

Practice Index is the UK’s leading provider of support and services to GP Practice Managers.