With several documents related to the contract being released on Thursday (28th March) afternoon, we’ve taken a look at the contract updates to give you a head start on the requirements of the contract so you’re up and running quickly.
Contract highlights
From 1st April, there will be changes to the GMS contract with equivalent changes applied to PMS and APMS contracts. You can see more information about the contract changes here.
The global sum will be a figure of £107.57 per patient based on the contractor weighted population figure.
Practices under GMS, PMS and APMS contracts will all see an uplift of £2.84 per weighted patient unless the contract specifies the raw list.
Adjustments for not providing minor surgery are 0.6% of the initial global sum monthly payment, and the opt-out figure for out-of-hours provision is 4.75% of the initial global sum monthly payment.
The average number of patients registered with a practice in England is just short of 10,000 patients, at 9,964 patients on average.
QOF Aspiration payments will be made at 80% of the prior year’s Unadjusted Achievement Payment.
The value of each QOF point will be £220.62; this increase relates to the increase in the average practice list size.
The Network Participation Payment will be £0.147 per weighted patient.
Payment for the Learning Disabilities Health Check will be £140 per completed health check.
Payments for vaccination and immunisations remain at an item of service fee of £10.06.
There are changes to the amount paid for both dispensed and personally administered items.
QOF changes 2024/25
In the 2024/25 QOF guidance, there are a number of changes.
In particular, the guidance makes it clear that if you have no patients in the cohort, then there will be no points available for that indicator/area.
As outlined in the letter about contract changes for 2024/25 there have also been changes to the number of protected indicators for QOF. A further 13 indicators will be protected, bringing the total number of protected indicators to 32. These indicators are worth a combined 212 points and are worth a total of one third of the available income under QOF.
Income protection for 2024/25 will be set at the same level of achievement as in 2023/24, but this means that while practices will not be penalised for any fall in achievement, neither will they benefit from any improvement. It is also made clear that any income protection may vary with prevalence and list size, with these being based on 2024/25 figures, and that this therefore means the amount received by practices will not necessarily remain the same.
Practices will need to continue with diagnosis and other associated activity, as failure to do so will mean that prevalence figures may be affected and this may affect practice income at the end of the financial year.
Income protection now applies to the following additional indicators:
AST008, COPD014, MH021, DEP004, SMOK005, CAN004, CAN005, QI domain (including former QI indicators QI013, QI014, QI016, QI017, QI018 and QI019).
Changes to indicators
CHOL001 is replaced by CHOL003 (no wording change).
CHOL002 is replaced by CHOL004 with wording as follows:
CHOL004. Percentage of patients on the QOF Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), or Stroke/Transient Ischaemic Attack (TIA) Register, who have a recording of LDL (Low-density Lipoprotein) cholesterol in the preceding 12 months that is 2.0 mmol/L or lower, or where LDL cholesterol is not recorded, a recording of non-HDL (High-density Lipoprotein) cholesterol in the preceding 12 months that is 2.6 mmol/L
or lower.
PCN DES
PCN funding
Core PCN funding: £2.916 per patient, with £2.218 being multiplied by the PCN registered list size as at 1st January 2024 and £0.698 multiplied by PCN adjusted population as at 1st January 2024. This combines the funding that was previously labelled as Core PCN Funding, Clinical Director Payment and PCN Leadership and Management Payment.
Enhanced Access Payment: £7.674 multiplied by the PCN’s Adjusted Population at 1st January 2024.
Care Home Premium: £120 per bed.
Capacity and Access Support Payment: £3.248 multiplied by the PCN’s Adjusted Population at 1st January 2024.
The Local Capacity and Access Payment is in addition to the Capacity and Access and Support Payment and requires activity around Modern General Practice Access including digital telephony, simpler online requests and faster care navigation, assessment and response. The PCN Clinical Director must (before 31st March 2025) assess all practices against the improvements, and if all practices across the PCN have met the improvements, a payment of £1.392 multiplied by the PCN’s Adjusted Population and each of the requirements represents one third of the amount.
A PCN’s Additional Roles Reimbursement Sum equates to £22.894 multiplied by the PCN Contractor Weighted Population as at 1st January 2024.
Other PCN DES highlights
Emphasis is placed on the importance of the PCNs as part of the wider Integrated Neighbourhood Team.
The PCN Clinical Director is accountable, on behalf of member practices, for ensuring that the PCN delivers the PCN DES, including by:
- Effective allocation of funding and ARRS roles across the PCN
- Deployment of the Capacity and Access payment
- Confirming delivery of the Local Capacity and Access Improvement Payment criteria
- Working with local partners to establish and ensure the PCN works effectively within the Integrated Neighbourhood Team
PCN Clinical Directors must be a practicing clinician from within the PCN’s Core Network Practices. They must be able to undertake the role and represent the needs of the PCN’s patients. They must also be able to work effectively with other stakeholders.
PCNs must agree to share digital telephony data where available.
PCNs must record and submit any data required as part of the “Workforce Minimum Dataset” including ARRS roles. This data must be coded, reviewed and updated at least monthly and PCNs must submit this data using the National Workforce Reporting Service.
ARRS roles
From within the allocated Additional Roles Reimbursement Sum, PCNs may appoint other direct patient care roles as agreed with the commissioner. When considering the recruitment of an alternative role, the commissioner may require confirmation that the role is additional to those already working in the PCN’s practices and is demonstrably different to the other roles available through the ARRS. The commissioner may also seek assurance that the role has a clear scope of practice and appropriate training, is reimbursed at a rate in accordance with the scope of practice and fits with local care pathways/services while not duplicating provision.
PCNs can claim reimbursement for an adult mental health practitioner service from within the ARRS Sum. PCNs can claim up to 50% reimbursement for the first role recruited with the remaining 50% being funded by the local community mental health provider. Up to 100% can be claimed for any additional mental health practitioners where this approach has been agreed between the PCN and the community mental health provider. The commissioner must also support the arrangement.
All mental health practitioners must support community mental health transformation initiatives and patients with complex mental health needs.
PCNs may claim one WTE Enhanced Practice Nurse (or two where PCN list size exceeds 100,000) from within the Additional Roles Reimbursement Sum.
Where a PCN employs or engages an Enhanced Practice Nurse under the Additional Roles Reimbursement Scheme, the PCN must ensure that the Enhanced Practice Nurse holds an appropriate nursing degree, is registered with the NMC and has a postgraduate qualification at Level 7 or above relevant to their area of enhanced practice, for example: wound care, diabetes plus respiratory and CVD, dementia, women’s health and public health and population health management.
PCNs must also ensure that the Enhanced Practice Nurse is working at an enhanced level of practice, as described in the Primary Care and General Practice Nursing Career and Core Capabilities Framework, and works across the PCN in services that enhance the core general practice offer.
PCN service requirements
PCNs have four core functions:
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