As the 2022-23 financial year gets underway, practices must be fully aware of contract changes and the impact these could have on funding and workload. AISMA Chairman Deborah Wood* gives an expert round up and commentary.
*Deborah Wood is healthcare services partner at MHA Moore and Smalley
Doctors’ representatives of the BMA’s GPC had reached a stalemate in their negotiations with NHSE regarding the 2022-23 contract. On 1 March 2022 NHSE/I published a letter setting out the contract changes effective from 1 April 2022 which have not been agreed by the doctors’ union.
The letter largely confirms arrangements in line with the previously agreed five-year framework published in 2019, together with some new proposals.
Doctors’ leaders had hoped to see some of their proposals taken on board around resources pressure, long-term conditions, QOF reforms and a general overhaul of the contract, but this has not yet been brought to fruition.
As I write, the existing contract framework will end on 31 March 2024, with a default position for it to be then rolled over ‘as is’ unless any changes are negotiated in the meantime.
The main financial aspects of the contract, with specific reference to changes implemented for 2022-23, are:
Practice level funding
The practice contract baseline funding will increase by 2.5% based on predicted inflation rates in April 2019. Clearly current inflationary pressures are much greater at the current time.
Table 1
| 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023/24 | |
|---|---|---|---|---|---|
| £ | £ | £ | £ | £ | |
| Practice contract baseline | 8,116m | 8,233m | 8,576m | 8,792m | 9,029m |
| Cumulative increase | 109m | 207m | 253m | 216m | 237m |
| % annual increase | 1.4% | 2.6% | 3.0% | 2.5% | 2.7% |
This means a 3% uplift to the global sum payment from £96.78 to £99.70 per weighted patient. The out of hours adjustment will remain at 4.75%.
The core global sum funding includes £20m rolled over for a further year to support workload costs for Subject Access Requests.
The £216m uplift to the contract is intended to cover pay rises at 2.1% for practice staff and GPs and practice expenses.
The weight management enhanced service introduced in 2021 has had a 97% take up from practices and will be continued into 2022-23 at an £11.50 referral payment. The overall funding for this has, however, been reduced from £20m in 2021-22 to £11.5m in 2022-23.
Additional Roles Reimbursement Scheme
The available funding will increase from £746m to £1,027m.
This will include the increase to two whole time equivalent mental health practitioners (previously one).
Overall the guaranteed investment in the scheme is:
Table 2
| 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023/24 | |
|---|---|---|---|---|---|
| £ | £ | £ | £ | £ | |
| Additional role reimbursements baseline | 110m | 257m | 415m | 634m | 891m |
| Further funding | 173m | 331m | 393m | 521m | |
| Total available | 110m | 430m | 746m | 1,027m | 1,412m |
Quality and Outcomes Framework
There will be no changes to the content of the Quality and Outcomes Framework (QOF) beyond changing the topics for the Quality Improvement (QI) domain which will relate to optimising access and prescription drug dependency.
The QOF will be fully re-started from April 2022 with no further pandemic-linked protections.
The value of a QOF point will be adjusted in 2022-23 to reflect population growth and relative changes in average practice list size using data on 1 January 2022. The value of a QOF point will rise by 3.2% from £201.16 to £207.56.
Investment and Impact Fund
This is a reward for PCNs meeting the NHS Long Term Plan objectives and GP contract requirements. Money derived from the Investment and Impact Fund (IIF) must be used for workforce expansion and primary care services.
The IIF funding is increased from £150m to £260m, of which £75m was as previously planned and a further £35m is included for additional specific purposes. An IIF point has a value of £200.
NHSE published the IIF indicators in August 2021 for implementation from April 2022. These relate to Structured Medication Reviews and online consultations.
Three new indicators relating to oral anticoagulants, FIT testing and cancer referrals are introduced within the additional £35m funding.
Delivering PCN specifications
The total for the clinical director (CD) funding pot increases to £87m, including £43m for general leadership and management on top of the core £44m CD reimbursement. The additional £43m is also being provided for 2023-24.
Funding streams for PCN DES extended hours of £1.44 per patient and the CCG commissioned enhanced access of £6 per patient are being combined under the PCN DES into a nationally uniform access offer with updated requirements to be delivered by PCNs.
The transfer of the previous CCG element was deferred due to the pandemic and is now due to start from October 2022, with preparation from April 2022.
This will involve PCNs providing a range of practice services in the evenings and on a Saturday. The funding will be a total of £7.46 per weighted patient.
The early cancer diagnosis service will be simplified.
Planned implementation of the digitally enabled personalised care and support planning for care home residents is deferred with only preparatory work needed in 2022-23.
Other elements of the personalised care service are due to be delivered in 2022-23 (more details are given in the 1 March 2022 letter from NHSE/I).
The BMA has reminded practices that they can opt out of the PCN DES and the opt out window is expected to be from 1 April 2022 to 30 April 2022.
Vaccinations and immunisations
There are some changes to vaccinations and immunisations covering HPV and MMR.
*a move from a three-dose schedule to a two-dose schedule (with doses given at least six months apart), for both those aged 15 and over, and for the national HPV MSM vaccination programme.
*cessation of the 10 and 11-year-old catch-up programme along with practice participation in a national MMR campaign as per the current contractual requirement for practices to take part in one catch up campaign per year.
The MenACWY Freshers programme ceased at 31 March 2022.
Other 2022-23 changes
Online patient registration will see the removal of the need for wet signatures and hard copies.
The GP registration service (in development via a pilot) will be made available to adopt on a voluntary basis. Alternative locally developed online solutions may be put in place.
Online appointment booking will see the removal of the 25% minimum. Directly bookable appointments that do not require triage will be made available, for example flu vaccination appointments.
Deceased patient records no longer have to be printed and sent to PCSE. Practices will have to process access requests. Practices can use PCSE to store physical records.
Health and Social Care (National Insurance) Levy
No specific funding has been made available within the contract to cover this additional 1.25% liability for staff and partners across general practice.
Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS)
Any changes announced to the core GMS contract are expected to be mirrored via PMS and APMS.
Please note: all the above information relates to contracts in England only.
Northern Ireland/Scotland/Wales
Information can be obtained from your local AISMA accountant.
NHS Pension Scheme Tiered Rate Contributions
While not directly related to the contract changes it is worth remembering that the proposed changes to the tiered rate contributions have been deferred from April 2022 to commence from 1 October 2022 and will be phased in over the period to March 2024.
Conclusion
As ever practices must be fully aware of these changes and their impact on practice funding and workload.
It follows that practices need to take a careful look at future strategy and work on finding the best and most profitable way of using time and resources.
Collaboration across networks will continue to be fundamental and advice should be taken at an early stage regarding how best to make the network arrangements work for your practice.
Reference material:
NHSE/I letter 1 March 2022
https://www.england.nhs.uk/publication/letter-general-practice-contract-arrangements-in-2022-23/
BMA GP contract Changes 2022-23
https://www.bma.org.uk/pay-and-contracts/contracts/gp-contract/gp-contract-changes-england-202223
NHS Pension Scheme Tiered Rates
https://www.gov.uk/government/consultations/nhs-pension-scheme-proposed-changes-to-member-contributions/outcome/nhs-pension-scheme-proposed-changes-to-member-contributions-consultation-response
This article first appeared in the Spring 2022 issue of AISMA Doctor Newsline
