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 including:
- Improved access to services by local people through Health and Social Services Boards 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 follows the GPs in post rather than the needs of patients and the local community;
- GPs were able to manage their workloads by enabling 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 which provided better records, more effective communication with patients and conducted 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.
- GP practices were able to opt out of providing out-of-hours care. The responsibility for ensuring such services are provided rested with the 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.
- Health and Social Services Boards were responsible for working with others in designing new arrangements and ensuring that they are put in place. Boards worked with hospitals, community trusts and GPs to ensure 24-hour care was available to all patients.
- People still got access to high quality services. Care was delivered to specific quality standards and in an integrated way with Accident and Emergency Units, etc.
- Opt outs began from 1 April 2004 but only where the Health and Social Services Board has 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 decide not to opt out of such services they can still do out-of-hours work for their patients
Information and management technology
The new contract brought substantial investment into the provision and maintenance in computer systems or general practice.
Computers were essential to facilitate delivery of the new services and standards that were provided.
Health and Social Services Boards were responsible for making sure 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 modern equipment and good premises and significant new funding was available to improve premises.
Health and Social Services Boards needed to work with practices and others to undertake a survey of what needed to be done to improve premises.
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 targeted were –
- Stroke or transient ischaemic attacks
- Chronic Obstructive Pulmonary disease
- Mental health
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 are 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.
- Health and Social Services Boards also commissioned a range of Directed Enhanced Services to provide –
- Improved access to medical services for patients
- Quality Information Preparation
- Care and treatment for violent patients
- Childhood vaccinations and immunisations
- Flu immunisations
- Minor surgery
- Health and Social Services Boards could also commission from a range of National Enhanced Services to provide –
- Anti-coagulation monitoring
- Enhanced care of the homeless
- Intra partum care
- 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 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.