About the GP Contract
In June 2003, GPs voted throughout the United Kingdom to accept a new contract for the delivery of general medical services. This contract was the culmination of protracted negotiations which had lasted for approximately 2 years and represented a landmark in the development of general practice. The new contract which came into effect on 1 April 2004 was accompanied by substantial uplift in investment of 33% a year over the next three years.
The new contract was designed to bring about a range of improvements in primary care in providing demonstrable benefits to general practitioners, to other healthcare professionals, to the health service in general and most importantly to patients. The new contract included:
- Improved access to services for local people through the commissioning enhanced services, to encourage the development of a wider range of services closer to home.
- Fairer funding to remove historic anomalies in the current system, where funding had followed the GPs in post rather than the needs of patients and the local community.
- Enabling GPs to manage their workloads by allowing them to opt out of providing some services, for example, out-of-hours.
- Better management of chronic diseases through a new framework which provided significant rewards to practices to recognise improvements in clinical standards.
- Improved organisational standards by rewarding practices for better records keeping and more effective communication with patients, the latter gauged by carrying out patient surveys.
The major changes introduced by the contract were in terms of:
- Out-of-hours services
- Information and management technology
- Focus on quality
- Patient experience
- Range of services provided
The key issues in relation to each of these main areas of change are highlighted below. At the time of introduction of the new contract, there were 4 Health and Social Services Boards (HSSBs); on 1st April 2009 these were replaced by the regional Health and Social Care Board (HSCB). In what follows, the HSSBs are referred to as “legacy” HSSBs. Changes for which the legacy Boards had responsibility continue to be the responsibility of the regional HSCB.
- GP practices were able to opt out of providing out-of-hours care. The responsibility for ensuring the provision of out of hours care rested with the legacy Health and Social Services Boards.
- Out-of-hours are defined as 6:30 pm to 8:00 am on weekdays and the whole of weekends, bank holidays and public holidays.
- Legacy Health and Social Services Boards were responsible for working with others in designing new arrangements and ensuring that they were put in place. The legacy Boards worked with hospitals, community trusts and GPs to ensure 24-hour care was available to all patients.
- People still had access to high quality services. Care was delivered to specific quality standards and in an integrated way with Accident and Emergency Units.
- Opt outs began from 1 April 2004, but only where the legacy Health and Social Services Board had an accredited alternative scheme in place. With effect from 31 December 2004, GPs were no longer personally responsible for providing out-of-hours services.
- It was expected that a number of GPs would still be involved in providing elements of out-of-hours services and if practices decided not to opt out of such services they could still do out-of-hours work for their patients
Information and management technology
The new contract brought substantial investment into the provision and maintenance of computer systems in general practice.
Computers were essential to facilitate the delivery of the new services and standards that were to be provided.
Legacy Health and Social Services Boards were responsible for ensuring that practice systems were updated on a regular basis.
The investment in computer systems brought about a range of improvements including disease registers, all/recall systems and the monitoring of services provided to patients.
Modern practice required both modern equipment and good premises and significant new funding was made available to improve these.
Legacy Health and Social Services Boards needed to work with practices and others to undertake a survey of what was required to improve premises and equipment.
Focus on quality
- A significant proportion of the new money tied to the contract was available to reward practices for providing higher quality services.
- A new framework based on the latest available research set out a range of clinical and organisational standards and practices were rewarded for achieving those standards.
- The clinical areas initially targeted were –
- Stroke or transient ischaemic attacks
- Chronic Obstructive Pulmonary disease
- Mental health
In 2006/07, a further 10 clinical areas were added to the framework. In later years, the framework has gone through a number of restructures to allow refocussing and adherence with national clinical guidance. Restructuring has included the introduction of other clinical areas and public health indicators, removal of indicators no longer deemed appropriate for monitoring, increasing thresholds for payment to improve clinical performance and removal of payment in respect of register maintenance, which transferred into core funding.
Practices were rewarded for reaching set standards in relation to organisational factors such as better records and information about patients, education and training, and practice and medicines management.
Incentives were offered to encourage practices to use accredited questionnaires to gain patient views and make appropriate improvements. Providing feedback to patients on such questionnaires was also encouraged.
Range of services provided
Under the new contract –
- Practices had to provide essential services – these services were provided to people who were sick or perceived themselves to be sick with conditions from which recovery was generally expected, chronic disease management and general management of patients who were terminally ill.
- Practices were expected to provide additional services, covering cervical screening, contraceptive services, vaccination and immunisation, child health surveillance, maternity services (including intra partum care) and some minor surgery procedures.
- A range of Directed Enhanced Services was commissioned –
- Improved access to medical services for patients
- Quality Information Preparation
- Care and treatment for violent patients
- Childhood vaccinations and immunisations
- Flu immunisations
- Minor surgery
- In addition, a range of Local Enhanced Services were available for commissioning, including –
- Anti-coagulation monitoring
- Enhanced care of the homeless
- Intra-uterine contraceptive devices
- Minor injury services
- More specialised services for patients with multiple sclerosis
- More specialised sexual health services
- Patients who are alcohol mis-users
- Patients who are suffering from drug abuse
- Provision of near-patient testing
- Provision of immediate care and first response care
- Specialised care of patients with depression
- Enhanced schemes were also developed in response to local need for which terms and conditions were discussed locally between the legacy Health and Social Services Board and the provider.
- All enhanced services could be commissioned from GP practices or from elsewhere and a practice did not have to provide any of the enhanced services unless it wished to do so.
Legislation, Directions, Related Guidance and Statements of Financial Entitlements
Guidance relating to the above are accessible via the links below.