Practice boundaries are relaxed but pay is static in GMS 2012-13 agreement

Practice boundaries will be loosened, with pilot schemes allowing patients to visit a general practice outside their local area, and GPs’ pay will not be increased, the BMA and NHS Employers have said in their announcement of changes to the general medical services (GMS) contract.

The changes for April 2012 onwards, negotiated by the BMA’s General Practitioners Committee (GPC) and NHS Employers on behalf of the English, Scottish, Welsh, and Northern Irish health departments, have been agreed by the four departments.

In the first of two measures on practice boundaries, patients in England who move a short distance will be able to stay registered with their current general practice, saving up to three million people who move locally every year from having to register with a new practice.

The second measure comprises several one year pilots that will allow patients to visit a GP away from where they live, such as one near where they work. The £2m pilots, planned for two or three cities in England, will test two models, one that will allow patients to register at a practice outside their area and another that will allow people to visit a practice as a non-registered patient from outside the practice’s area, similar to the current arrangements for temporary residents.

“Most GPs were against the complete abolition of practice boundaries, because of the potential negative impact on continuity of care, so we’re pleased that we have been able to agree this alternative, which will help commuters,” said Richard Vautrey, deputy chairman of the General Practitioners Committee.

However, there is uncertainty over what would happen when patients registered at a practice near their office are too ill to go there and need to visit their local GP or when patients registered outside the area where they live need care out of hours.

“There is lots of detail to be worked out, and we will be doing that over the coming weeks and months,” Dr Vautrey said. “The important thing about the agreement is that these are proper pilots that will be done in a limited way and evaluated independently. We will then look at the conclusions before deciding which of the two options, if any, is going to be suitable for long term use.”

The GMS contract for 2012-13 has no increase in pay for GPs, to reflect the pay freeze currently in effect for hospital doctors and the “difficult financial climate,” the BMA has said. However, practices will receive a 0.5% uplift in the overall value of GMS contract payments to help them meet rising expenses. The full 0.5% expenses increase will be delivered through an increase in the value of a Quality and Outcome Framework (QOF) point and will therefore also apply to practices on a personal medical services (PMS) contract.

“I think GPs didn’t expect a pay rise, but neither did they expect to be singled out for another pay cut compared with other doctors,” said Dr Vautrey. “Without the expenses increase, GPs would have faced a real terms cut, and this is an attempt to mitigate that.”

A number of changes to QOF will come into place from April 2012, including the introduction of two new disease areas—osteoporosis and peripheral arterial disease—and increases in upper and lower thresholds for many indicators.

The quality and productivity prescribing indicators introduced for 2011-12 will end on 31 March 2012. However, the General Practitioners Committee has said that all practices in the UK “should continue to ensure cost effective prescribing when compared to peers.” Those practices that remain significant outliers will be expected to continue to participate in external peer review of their prescribing during 2012-13.

The quality and productivity prescribing indicators will be replaced by three new organisational indicators aimed at reducing avoidable visits to accident and emergency departments, in particular by older patients with complex health needs at high risk of admission, children with minor illness or injury, and patients who often reattend accident and emergency departments.

The extended hours access direct enhanced service (DES), first introduced to the contract in 2011-12, has been extended for another year, as have the alcohol reduction and learning disabilities clinical DESs in England. The osteoporosis DES will no longer be available from 1 April 2012, and the funding released will be reinvested in the global sum in England and into the GMS contract in Scotland and Northern Ireland.

The new version of the GMS contract will also make it a contractual duty for practices to be members of a clinical commissioning group.