Funding in General Practice

1
Funding in General Practice

• Dr Andy Withers
• Grange Practice
• Allerton

2
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

3
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

4
What do we get paid for?

• Core General Practice( Essential Services)
• Additional Services
• Enhanced Services
• QOF

5
NHS Income
6
Essential Services

• MANDATORY - common to all practices
• 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

7
Essential Services

• Either paid as Global Sum or MPIG in GMS
  practices
• Basic Contract in PMS practices

8
Additional Services

• Normally expected of all practices but OPT-OUT
  possible
• Cervical cytology
• Child health surveillance
• Maternity services (not intrapartum care)
• Contraceptive services

9
Enhanced Services

• 3 types
• Direct
• National
• Local

10
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

11
NES

• OPT-IN - national terms and conditions
• Anticoagulant 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

12
LES

• OPT-IN
• Response to specific local requirements
• Local terms, conditions and standards
• Possibly, innovative services for piloting and
  evaluation

13
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

14
GLOBAL SUM OR MPIG
UNIFIED BUDGET
ASSURED QUALITY MONEY
ESSENTIAL ADDITIONAL
PROTECTED TIME
LOCAL ENHANCED
PCO-MANAGED FUNDS
DIRECTED AND NATIONAL ENHANCED
PREMISES
PCO
GUARANTEED FUND(S)
ALTERNATIVE PROVIDER
PRACTICE
15
Seniority

• Begins from start of NHS service
• Annual increments

16
QOFTHE FOUR DOMAINS OF QUALITYClinicalOrganisa
tionalPatient experienceAdditional services
17
Total Points 1000

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

18
CLINICAL AREAS

• CHD LVD
• Hypertension
• Diabetes
• Stroke or TIA
• Hypothyroidism
• AF
• Depression
• Hypertension
• Obesity

• Epilepsy
• Asthma
• COPD
• Mental Health
• Cancer
• CKD
• Dementia
• Learning Disabilities

19
ORGANISATIONAL AREAS

• Records and information
• Patient communication
• Education and training
• Practice management
• Medicines management

20
PATIENT EXPERIENCE

• Standardised approved patient questionnaires
• General Practice Assessment Questionnaire
  (Manchester)
• Improving Practice Questionnaire (Exeter)
• Length of consultation - 10 mins appts

21
BREADTH v DEPTH

• Holistic Payments
• Across Clinical Domain
• Performance in 3rd lowest area
• Quality Practice Payments
• Across all domains

22
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

23
PBC

• Practice Based Commissioning
• DES for 1 year (approx 1.90/pt)
• Voluntary
• Devolved budgets to all practices
• Virtual Money you cant 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

24
Other DESs

• IT
• Using the IT
• Access
• Patient Evaluation Survey (PES)
• Choice Book
• evaluation

25
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

26
Getting Paid
27
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