nGMS Contract: a general nGMS Contract: a general overviewoverview

Nicola Walsh, NatPaCT

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nGMS Contract: a general nGMS Contract: a general overviewoverview

Nicola Walsh, NatPaCT

GMSGMS

Individual GP National contract

focused on IoS payment

Payments are retrospective

Rule bound model Discourages skill mix

GMS GMS PMS pilotPMS pilot

Individual GP

National contract focused on IoS payment

Payment made retrospectively and depends largely on activity

Funding discourages skill mix

Provider organisation

Locally based contract focused on health priorities

Payment agreed in advance and paid monthly

Encourages skill mix

PMSPMS nGMS nGMS

Provider contract

Locally focused

Payment agreed in advance

PMS budget ring-fenced

Provider contract

National and local

Payment agreed in advance

nGMS budget ring-fenced

New GMS ContractNew GMS Contract

Managing workload:Essential servicesAdditional servicesEnhanced services

Out of hours services

Essential ServicesEssential Services

Management of patients who are ill or believe themselves to be ill.

General management of patients who are terminally ill

Management of chronic disease in the manner determined by the practice

Additional ServicesAdditional Services

Cervical screeningContraceptive servicesVaccinations and immunisationsChild health surveillanceMaternity servicesMinor surgery

Enhanced ServicesEnhanced Services

Essential or additional services delivered to a higher standard

New more specialised servicesnationally directed specificationsnational specification but not directedlocally determined

Out of HoursOut of Hours

Services from 6.30pm to 8.am on weekdays, whole of weekend and bank holidaysUntil April 2004 responsibility of GPBetween April - December 2004 classified as

an additional serviceBy 31 December 2004 responsibility of the

PCT

……but language changing

Funding Funding

Global sum of money allocated to provider

to cover essential servicesadditional servicesinfrastructure (not IT or premises)staff costs

Additional fundingAdditional funding

Minimum Practice Income Guarantee

Enhanced services

Quality paymentsPreparatory payments

Quality and Outcomes Quality and Outcomes FrameworkFramework

Framework has 4 domains

clinical standardsorganisational standardsadditional servicespatient experience

Quality and Outcomes Quality and Outcomes FrameworkFramework

Framework has 4 domains clinical standards 550

organisational standards 184additional services 36patient experience

100other bits 180

TOTAL 1050

Quality paymentsQuality payments

Aspirational payment

Achievement payment

MonitoringMonitoring

Annual report to PCTVisit by PCT monitoring teamFollow up letter sent to practicesAppeal process

Implications for nursesImplications for nurses

Different contractual relationship

Greater focus on a team based approachGreater use of skill mix within the teamOpportunities to work with the wider team

Implications for nursesImplications for nurses

PCTs will commission primary care

Different patterns of provision across PCT and practices

New career opportunitiesLegislation allows nurses to become partnersLegislation allows nurses to set up their own

limited companies

Implications for NursesImplications for Nurses

Incentive structure linked to improved quality and outcome

Nurses will have an important role in developing disease registers, collecting data and delivering services.

Practice/Provider based contract so all the team to participate in demonstrating improvements

Implications for NursesImplications for Nurses

Improved working conditions

Nurses must be eligible to perform servicesDevelopment needs must be supportedNurses should have access to clinical

supervision, appraisal and CPD

The Future...The Future...

Nurses running practicesNurses winning contracts to provide

servicesMulti-professional partnershipsGPs employing/subcontracting nurses to

run a branch surgeryPCTs employing nurses to run specialist

services or/and practices

In SummaryIn Summary

New GMS Contractprovider based contractmuch more than a way of paying GPsa shift in mindsetimproved employment conditionsimproved patient care

Programme of supportProgramme of support

Two conferences to be held for all nurses on new GMS and new PMS

A network of SHA and PCT lead nurses to advise on implementation

Regular updates on new GMS/nPMS on CNO and NatPaCt websites

Nine regional workshopsSupport for nurses interested in partnerships

Useful contactsUseful contacts

Queries can be inserted viahelpline 0845 900 0008gmspms.queries@ndpt.nhs.uk

www.natpact.nhs.ukwww.bma.org.ukwww.nhsconfed.org