Preparation for DRC 26 May 2003
This weeks topic is on contracts more specifically the new one.
Before you get to grips with the new one its probably prudent to understand how
you are contracted at the moment
GMS general medical services. This the contract of employment set down about
10yrs ago and is reviewed annually by representatives of the General Practice
Committee. The key to the GMS contract is the red book which lays down the rules
about what can be claimed for in the practice Statement of Fees and
Allowances. It is a large red folder housed somewhere in your practice even
if you are PMS and states how the practice gets paid. For example 1)
capitation payments how much money you get per person on your list depending
on various things like rural situation, depravation in the area 2) service
payments how much money you get for doing contraception, minor ops etc 3)
target payments how much money you get for imms and smears . Then there is the
complex matter of staff reimbursement, buildings reimbursement, equipment etc.
There is an excellent book called Making Sense of the red book - worth a look.
PMS most of your practices are likely to now be PMS personal medical
services. This was introduced in waves several years ago. The key difference is
that you estimate how much work you will be doing over the next year bases on
growth and how much you did the year before and are paid accordingly this does
away with all the individual claims that the admin staff had to do under GMS.
The other major difference is in that you are now contracted to the local PCT
rather than the National Contract this is supposed to give more local
flexibility and individuality.
QUESTIONS FOR YOU TO THINK ABOUT AND DISCUSS WITH YOUR TRAINERS OR OTHER
FINANCIALLY MINDED PARTNERS -
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Why did you go or not go PMS?
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what if any have been the financial benefits of PMS in terms of cash flow in the practice and available monies for services? Has it affected partners pay packets they may wish to be general on this point!
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Over the last couple of years have the benefits of PMS lived up to expectations or have services suffered as a result if so how?
THE NEW CONTRACT This is what you have all been waiting for a comprehensive
discourse on the contract well if you think I'm qualified to give that you are
over estimating my abilities!
Basically the contract has been floating around now for about 18 months and has
been generating lots of discussion some very positive and some very negative.
It is a version of the general medical services contract so that practices will
be nationally governed little change there for those already doing GMS but a
change back for those with a PMS contract. Last year a draft copy was available
and voted on this was unpriced at the time.
The key areas of change where Quality of care one would be funded on meeting
quality targets for areas of care such as chronic disease such as CHD, diabetes,
asthma. There would be levels of quality and these would take into account what
you felt your area could reasonably achieve for example if you had an inner
city population with high incidence of CHD but poor motivation, depravation, low
levels of English speakers you wouldnt be penalised for achieving a lower
quality of care than in a very motivated population as long as you showed
improvement in the service you offered and your results. Sounded quiet good I
think you'll agree.
Other areas of change were very appealing to doctors as they offered the
possibility of opting out of out of hours care such that the local PCT would
have to find alternatives such as a deputising service etc. Also the
possibility of opting out of all out of surgery care all together e.g. home
visits etc.
The vote passed the contract in principle and then the pricing commenced and
this is where the problems have really hit the fan! The pricing of the contract
is very complex and passed on the practice meeting certain percentages in the
records and notes they keep lots of practices feel they will be financially
significantly worse off. There has been somewhat of a revolt and the story
continues
A lot of what you feel of the contract may be based on how your partners feel
talk them and get there opinions. The comics have comment on comment on the
contract get familiar with the general feelings. See if you can find a
partner who feels the contract is a good thing there may be one closer than
you think hushed into submission.
Most importantly have a look at the contract yourself available on the BMA
website or in your practice www.bma.org.uk
Written by: Jane Savage
Last update: 29 August 2007