This article first appeared in the Spring 2023 issue of the AISMA Doctor Newsline.
As the 2023-24 financial year gets underway, GP practices must be fully aware of contract changes and the impact these could have on funding and workload. Deborah Wood, Healthcare Services Partner and AISMA Chairman, gives an expert round-up and commentary.
At the time of writing this article the BMA GP committee had reached a stalemate in their 2023-24 contract negotiations with NHS England (NHSE), rejecting what they described as an ‘insulting’ offer.
Subsequently, on 6 March 2023, NHSE published a letter setting out the contract changes to be imposed from 1 April 2023.
The letter largely confirmed arrangements in line with the previously agreed five-year framework published in 2019, together with some new proposals.
The BMA had hoped to see some additional investment to assist with practices’ ongoing inflationary pressures, particularly linked to staff and energy costs. It believes the lack of support for this will mean more practices risk being discontinued.
The existing contract framework will end on 31 March 2024, with a default position for it to be rolled over ‘as is’, unless anything else is negotiated meanwhile for it to be changed.
NHSE has committed to continue to work with GP leaders during the next 12 months to develop a contract that the BMA wants to see working for patients and general practice teams.
The main financial aspects of the core contract, with specific reference to changes implemented for 2023-24, are:
Practice level funding
The practice contract baseline funding will increase by 2.7% based on predicted inflation rates in April 2019. Clearly inflationary pressures are much greater at the current time (see Table 1).
| 2019-20 | 2020-21 | 2021-22 | 2022-23 | 2023-24 | |
|---|---|---|---|---|---|
| Practice contract baseline | 8,116m (£) | 8,323m (£) | 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% |
The uplift to the global sum payment from £99.70 per weighted patient has not been announced as I write but is expected to be in the order of £3 per patient. The out of hours adjustment is expected to remain at 4.75%
Core global sum funding in 2022-23 included £20m to support workload costs for Subject Access Requests. It is not yet known if this funding will continue or be removed.
The £237m uplift to the contract is intended to cover pay rises at 2.1% for practice staff and GPs and practice expenses.
The new to partnership premium funding is due to end on 31 March 2023.
The weight management directed enhanced service will continue at £11.50 per referral.
Additional Roles Reimbursement Scheme (ARRS)
The available funding will rise from £1,027m to £1,412m (see Table 2).
At 31 December 2022 there were 25,262 additional full time equivalent staff in the scheme, with the target of 26,000 expected to be achieved by 31 March 2023, a year earlier than anticipated.
| 2019-20 | 2020-21 | 2021-22 | 2022-23 | 2023-24 | |
|---|---|---|---|---|---|
| Additional roles reimbursement baseline | 110m(£) | 257m(£) | 415m(£) | 634m (£) | 9,029m (£) |
| Further funding | 173m (£) | 331m (£) | 393m (£) | 521m (£) | |
| Total available | 110m (£) | 430m (£) | 746m (£) | 1,027m (£) | 1,412m (£) |
Several changes to the scheme have been announced:
*The number of advanced practitioners per PCN is increased to three where list size is under 100,000, and to six if more than 100,000.
*PCNs will be reimbursed for the time that first contact practitioners spend in education and training to become advanced practitioners.
*Apprentice physician associates is added to the list of reimbursable roles.
*All recruitment caps for mental health practitioners are removed and they are eligible to support first contact activity.
*The clinical pharmacist description is amended to clarify that they can be supervised by advanced practice pharmacists.
NHSE will review the scheme during 2023-24 and staff employed through it are confirmed to be considered as part of the core general practice cost base to assist with offering permanent contracts.
Quality and Outcomes Framework (QOF)
Disease register indicators will be income protected for 2023-24, with funding based on 2022-23 performance paid monthly to practices once the outturn is finalised. The number of indicators will reduce from 74 to 55.
£36m for 30 new points for cholesterol indicators is added to the QOF, together with a new mental health indicator.
This funding is recycled by retiring a rheumatoid arthritis indicator and reducing the value of an annual dementia review target.
Indicator AF007 will be retired and replaced with the former IIF indicator CVD-05 (as AF008). There will also be other small changes to indicator wordings and values in 2023-24.
Details relating to the points and values and relative list size have not yet been published as I write.
The Quality Improvement modules for 2023-24 will focus on workforce wellbeing and optimising capacity to meet demand.
GP retention scheme
The previous relaxation of the four-session cap has been made permanent.
Investment and Impact Fund (IIF)
This is a reward for PCNs meeting the NHS Long Term Plan objectives and GP contract requirements. Money derived from the IIF must be used for workforce expansion and primary care services.
The IIF indicators are reduced from 32 to five. The remaining ones relating to flu vaccinations, learning disabilities, cancer referrals and waiting times for appointments retain a fund of £59m.
As a result, the freed-up funding will be moved into the Capacity and Access Fund. £172m will be paid monthly to PCNs as a continuation of the support payments introduced in the Autumn of 2022.
£74m will be paid out under the assessment by Integrated Care Boards (ICBs) against an access improvement plan to be agreed in quarter one, and paid out at the end of March 2024, as a local support payment.
Delivering PCN specifications
Practices can opt out of the PCN DES for 2023-24 during the period 1 April 2023 to 30 April 2023.
There have been no service specifications added for the coming year.
NHSE will review enhanced access requirements in 2023-24.
Vaccinations and immunisations
There are some changes to vaccinations and immunisations to reflect updated JCVI guidance covering HPV and shingles. The other programmes remain unchanged.
Childhood immunisations
The repayment mechanism if a practice achieves under 80% coverage is removed.
Lower thresholds are reduced to 81%-89% and the upper threshold is uplifted to 96%.
Some clarification of wording will be made in the Statement of Financial Entitlements relating to item of service fees.
Other 2023-24 changes
The GMS regulations will be updated to clarify that a patient should be offered a needs assessment or signposted to an appropriate service at first contact.
The deadline for full implementation of patient access to their online records is extended to 31 October 2023.
Contract regulations will be amended to remove the ‘medical cards’ reference relating to registration.
Practices will have to procure their telephony solutions only from the Cloud Based Telephony NHS Framework as current contracts expire. A Better Purchasing Framework (BPF) has been developed by NHSE to provide recommended suppliers and assure value for money.
NHSE will review dispensing fee scales alongside general contract changes for 2024-25.
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.
What now
As ever practices must be fully aware of these changes and their impact on practice funding and workload.
It follows that they 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.
