Funding in General Practice

Dr Andy Withers

Grange Practice Allerton

Aims & Objectives

• Aims– Increase understanding of how General

Practice is financed

• Objectives– Know how :-

• Practice income is calculated and received• Budgets are set• The difference between NHS & Private income

Questions

• How do GPRs get paid in practice?• How do salaried GPs get paid?• How do GP Partners get paid?• What is the difference between a GMS & PMS

practice?• Are all my earnings pensionable?• What is PBC?• How can I earn more?• Money & referrals/admissions• Seniority payments

What do we get paid for?

• Core General Practice(= Essential Services)

• Additional Services

• Enhanced Services

• QOF

NHS Income

Basic

Additional

ES

QOF

Essential Services

MANDATORY - common to all practices1) The management of patients who are ill or

believe themselves to be ill, with conditions from which recovery is generally expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever practicable

2) The general management of patients who are terminally ill

3) Management of chronic disease in the manner determined by the practice, in discussion with the patient

Essential Services

• Either paid as “Global Sum” or MPIG in GMS practices

• Basic Contract in PMS practices

Additional Services

• Normally expected of all practices but OPT-OUT possible

• Cervical cytology

• Child health surveillance

• Maternity services (not intrapartum care)

• Contraceptive services

Enhanced Services

• 3 types– Direct– National– Local

DES

• Obligatory for each PCO• National specifications• No one practice has to do:

– Services to violent patients– Childhood vaccinations and immunisations

financial incentives– Minor surgery– Flu immunisations– Quality information preparation – Improved access

NES

• OPT-IN - national terms and conditionsAnticoagulant monitoring IUCD Sexual health MS

Drug and alcohol misuse Terminally ill

Depression Learning disabilities

Intra partum care Minor injuries

Near-patient testing Homeless

Immediate/first response care

LES

OPT-IN

• Response to specific local requirements

• Local terms, conditions and standards

• Possibly, innovative services for piloting and evaluation

GMS v PMS

• Little difference now

• PMS probably slightly higher earning practices due to historic funding.

• Both practice based contracts

• GMS nationally negotiated• Either global sum via Formula• Or Minimum practice income guarantee (MPIG)

• PMS (potentially) locally negotiated

PRACTICE

GLOBAL SUM OR MPIG

PCO

UNIFIED BUDGET

ESSENTIAL&

ADDITIONAL

PROTECTEDTIME

DIRECTED ANDNATIONAL ENHANCED

LOCAL ENHANCED

GUARANTEEDFUND(S)

ASSUREDQUALITYMONEY

ALTERNATIVEPROVIDER

PCO-MANAGED

FUNDS

PREMISES

Seniority

• Begins from start of NHS service• Annual increments

QOFTHE FOUR DOMAINS OF QUALITY

ClinicalOrganisational

Patient experienceAdditional services

Total Points 1000

Clinical 655 Organisational 181 Additional Services 36 Patient Experience 108 Holistic Care 20

CLINICAL AREAS

CHD & LVD

Hypertension

Diabetes

Stroke or TIA

Hypothyroidism

AF

Depression

Hypertension

Obesity

Epilepsy

Asthma

COPD

Mental Health

Cancer

CKD

Dementia

Learning Disabilities

ORGANISATIONAL AREAS

Records and information

Patient communication

Education and training

Practice management

Medicines management

PATIENT EXPERIENCE

Standardised approved patient questionnaires

General Practice Assessment Questionnaire (Manchester)

Improving Practice Questionnaire (Exeter)

Length of consultation - 10 mins appts

BREADTH v DEPTH

Holistic Payments

Across Clinical Domain

Performance in 3rd lowest area

Quality Practice Payments

Across all domains

Pensions

• All NHS income pensionable– delivering GMS / PMS

– delivering services under delegation including locum work

– board, advisory and other work for NHS bodies

– collaborative arrangements work

– education

– statutory certification

– work for GP cooperatives that are NHS bodies

• All locum pay pensionable from 1.4.2002

PBC

• Practice Based Commissioning• DES for 1 year (approx £1.90/pt)• Voluntary• Devolved budgets to all practices• Virtual Money – you can’t take it home• For:

– Prescribing– Secondary care, acute & elective– Community Staff

• Can spend (up to) 70% of Freed up resources (FURs note not savings) on patient care. Pct takes rest.

• Only get FURs you predict (no serendipitous FUR)• Idea is to provide innovations in services to produce FUR

Other DESs

• IT– Using the IT

• Access– Patient Evaluation Survey (PES)

• Choice & Book– evaluation

Other Income

• Teaching & Training Amount NHS Pension?

• GPR £7.5k Y• FY2 £10k Y• Medical Students £15-20k N

• NHS related work• GPwSI c £10k/session Y• PCT Y• LMC N• DH ?

• Private N• Reports• Medicals etc

Getting Paid

Expenses

Staff

Income

Getting Paid 2(This is real money)

• Typical Middle sized practice• Total amount £1m

• Less running expenses £300k

• Less Staff costs (including salaried GPs) £400k

• Profit £300k

• Divide between partners = income £100k• Need to pay 20% superannuation £80k• Need to pay Income tax on this