GP contract IM&T incentives announced

GPs are to be offered incentives worth up to £70m in total across England to embrace NHS information and management technology changes. There will also be extra money to implement choice and booking.

The proposed changes to the national GPs’ contract, which are due to take effect from 1 April 2006, were published today. The investment in IM&T and Choice and Booking comes in the form of two new Direct Enhanced Services (DES). An additional new DES will cover Practice Based Commissioning.

The other main proposed changes unveiled by negotiators at the British Medical Association (BMA) are in the Quality and Outcomes Framework (QOF). QOF points will be redistributed in several areas including: dementia, depression, chronic kidney disease and palliative care.

Announcing the proposals, chair of the BMA general practitioners committee, Dr Hamish Meldrum, pointed out that participation in QOF and the new DESs was voluntary but he said: “Most practices have shown they want to be moving forward on IT.”

He was less sure of how the new DES on Choice and Booking would be received by the profession. “I think there still quite a lot of work to be done on choice and booking, though the choice and booking DES is not just about delivering the electronic Choose and Book system.

“There’s maybe a feeling that people are not so enthusiastic about that, though I don’t think anyone would argue that it’s not right and proper for people to be offered choice.”

Asked whether GPs should offer choice from 1 January 2006 – the government’s target date – or wait until they received resources via the new DES on 1 April 2006, Dr Meldrum said: “I believe most GPs do offer patients choice. They’ve been offering them choice for years.”

However, he added that in the move towards a system of Choose and Book there were a particular set of circumstances where resources were involved and it was these resources that the negotiators had been looking at.

“My feeling is that most practices won’t really want to get involved until they’ve got the resources to do that. That will be 1 April. Though that’s not to say that we won’t be offering choice before that,” he said.

Proposals for Scotland, Wales and Northern Ireland will be announced soon by the respective countries’ GPCs, the BMA said. There was an assurance that all four countries would benefit from additional investment in DESs. Full details of the contract amendments will be available towards the end of January, Dr Meldrum said.

The proposals announced so far are:

Direct Enhanced Services

Choice and Booking

There will be two separate components with an approximate value of £1 per patient for offering choice and booking (not necessarily electronically).

The “choice” component will comprise a 50% aspiration payment and a further 50% measured by patient questionnaire.

The “booking” component will comprise a 50% aspiration payment and a further 50% based thresholds of referrals.

IM&T

There are four separate components for this DES with a total value of £1.30 per patient. They relate to:

– getting practices ready for IT developments, particularly those practices that want to go, or have already gone, ‘paperlite’

– coming on stream with GP2GP transfers

– preparing practices for the electronic transfer of prescriptions

– moving practice systems to hosted servers.

The IM&T DES has been agreed for one year although the BMA says it is not expected that the majority of practices will complete all components in one year and that some elements are likely to be repeated in future years.

The DES is linked to Connecting for Health initiatives and designed to support time for training and preparation – but it does not include Choose and Book.

Practice Based Commissioning

This DES is designed to last for one year with all practices eligible. It offers approximately £2 per patient for producing a plan for practice based commissioning and successfully meeting its objectives. Any existing arrangements must be upgraded to the DES and work over and above the DES can receive additional funds from the overall commissioning budget.

Quality and Outcomes Framework

A total of 168 points were identified for redistribution and of these 138 were released for new work in dementia (20 points), depression (33), chronic kidney disease (27), atrial fibrillation (30), palliative care (6), setting up obesity and learning disability registers (12), mental health (9), recording ethnicity when registering a patient (1). The remaining 28 points have been redistributed among existing indicator sets.

GPC negotiator, Dr Laurence Buckman said that many services remained outside QOF either because the evidence about them did not reach acceptable standards or because “you will never have enough to do everything.”

Dr Meldrum and Dr Buckman revealed that the QOF points for good handwriting had been traded in the deal with the UK health departments. With so much work in practices being done electronically the drive for legibility in handwritten notes has become a less pressing problem, it seems.

Doctors will not be able to return to their legendary scrawl, however. Dr Meldrum said good handwriting was now seen as part of good practice and was important in the areas where it was still used.