Contracts and Contractual Issues

Contract Changes for 2015/16

Information about the contract changes for 2015/16 can be found on the BMA website.

Further guidance is available on the NHS Employers website.

DES specifications for 2015/16 are published on the NHS England website here.

Contract Changes for 2014/15

Full details are available in this Guidance and Audit Requirements document.

These changes include:

  • QOF is reduced by 341 points, of which 238 will be transferred to core funding and 103 to Enhanced Services
  • Seniority will be removed over a six-year period, with a redistribution of released funds to all practices as an addition to core funding
  • The introduction of a new Enhanced Service on unplanned admissions
  • Three of the four imposed Enhanced Services from 2013-14 have been removed
  • New IT systems requirements have been introduced, including the ability for patients to book appointments online and access their Summary Care Record
  • Every patient aged 75 and older will be assigned a named accountable GP to ensure coordinated care

Enhanced Services for 2014/15

From 1st April 2014 enhanced services will be commissioned as follows:

Primary Medical Services Assurance Framework

From April 1st 2013, GMS, PMS and APMS contracts in Beds, Herts and Luton are held by NHS England and locally managed by the Hertfordshire and South Midlands Area Team. The national process for performance managing the contracts is set out in a policy document called Primary Medical Services Assurance Framework. In summary, you need to be aware of the following:

  1. The Assurance Framework is based on a national agreed set of high level indicators and outcome standards for general practice. These use publicly available data from a number of different sources and enables the area team, CCGs and practices to compare practices nationally against a number of different measures. The data is not necessarily up to date but uses the most recent available information. This is NOT a balanced scorecard, and it has been explicitly stated by NHS England that there is no intention to use this for performance management; rather it is intended to highlight variation that can then be discussed with the practice. Practices can access this webtool at www.primarycare.nhs.uk/.
  2. Each year you will have to complete a self-declaration regarding your contractual requirements via the above website. Details of the questions you will have to answer can be found in Annex 3 (pages 20 – 29) of the Primary Medical Services Assurance Framework. More information about this is in the Self-declaration Letter.

More information about all of this can be found in the following documents and letters:

Directed Enhanced Services (DES)

The following DESs will continue to be commissioned from practices by NHS England via the area team:

  • Childhood immunisations
  • Seasonal Flu
  • Minor surgery
  • Learning Disabilities
  • Alcohol risk reduction
  • Learning Disabilities
  • Extended opening hours
  • Patient participation
  • Dementia

In addition, one new DES will be commissioned:

  • Avoiding Unplanned Admissions

Find out more details of the Enhanced Services 2015-2016.

Local Enhanced Services (LESs) and National Enhanced Services (NESs)

Services that had been commissioned as LESs or NESs will be commissioned in future either by the CCGs or by the Public Health Departments of the local authorities.

Public Health LESs: Public Health departments will commission services for Chlamydia, Stop Smoking, Annual Health Checks, and Sexual Health.

All other LESs: Everything else will be commissioned by CCGs. For 2013/14 they can continue to be commissioned as LESs while the CCGs review these services, but from April 2014 this contract route will end and if these services are to continue to be commissioned, CCGs will have to develop a different way of commissioning them.

Further information about specific enhanced services can be found in the library below:

  • Library
  • Enhanced Services
5299Extended Opening Hours
added 48 years ago
6291Patient Participation
added 6 years ago
17928Enhanced Services Guidance 2013/14
Type: html, 34567, added 5 years agoThis guidance includes the two extended Clinical Directed Enhanced Services and other new/existing ESs. The guidance provides primary care organisations with information to help support the continuation or introduction of these services.
AuthorNHS Employers and the NHS England
AudienceGPs and Practice Managers
SynopsisThis guidance includes the two extended Clinical Directed Enhanced Services and other new/existing ESs. The guidance provides primary care organisations with information to help support the continuation or introduction of these services.
13565Extended Hours Access Directed Enhanced Service
Type: html, 14497, added 5 years agoThe GPC and the NHS Employers have agreed to extend the extended hours access directed enhanced services in England by one year to 31 March 2013, the requirements that will apply for 2012-2013 will be the same as those in 2011-2012.
AuthorBMA
AudienceGPs
PurposeLink to BMA Website
SynopsisThe GPC and the NHS Employers have agreed to extend the extended hours access directed enhanced services in England by one year to 31 March 2013, the requirements that will apply for 2012-2013 will be the same as those in 2011-2012.
17776New DESs 2013/14
Type: html, added 5 years agoLinks to resources
AuthorNHS Commissioning Board
AudienceGPs and Practice Managers
SynopsisLinks to resources

General Medical Services (GMS)

The GMS contract is the most common way locally for the NHS to make provision for primary medical services to patients. The model GMS contract is agreed nationally with the details negotiated between the General Practitioners Committee (GPC) of the BMA on behalf of GPs and the NHS Employers, but is based upon the NHS (General Medical Services Contracts) Regulations 2004 and subsequent amendments. It is standard across the whole of England. GMS contracts are ‘life-long’. The funding for GMS contracts is based on each practice’s list size, with a certain amount of funding coming to the practice for each patient. The amount of funding associated with each patient is “weighted” for a number of factors, e.g. age and sex, because of the different health needs of different groups. All GMS practices are automatically members of the LMC.

It is divided into two main parts regarding the services provided by GMS practices:

  • ‘Essential Services’, which must be provided by all GMS GP practices – known in the contract as ‘Providers’
  • ‘Additional Services’, which are provided by all practices in Bedfordshire and Hertfordshire, although practices do have the option to opt out of providing these services with a commensurate drop in their income. These services include, for example, contraception, childhood vaccinations and child health surveillance, cervical screening and a number of other services.

Certain areas of the GMS contract and the funding of the contract are re-negotiated annually.

Personal Medical Services (PMS)

The PMS contract allowed PCTs to negotiate local contracts with practices for the provision of primary medical services to patients in line with the NHS (Personal Medical Services) Regulations 2004 and subsequent amendments. Note that PMS contracts, by their nature, vary from practice to practice, however, throughout Bedfordshire (including Luton) and Hertfordshire the core contract was written by Lockharts Solicitors (known colloquially as ‘The Lockharts Contract’) with appropriate locally agreed variations and amendments. Because PMS contracts are negotiated locally, the GPC is unable to enter into negotiations with the NHS Employers about any aspect of the PMS contracts. However, generally, when alterations to the GMS contract are agreed at a national level, when appropriate, these have been replicated in local PMS contracts. All PMS contracts contain a clause enabling PMS practices to revert back to GMS at any time. Throughout Bedfordshire (including Luton) and Hertfordshire PMS practices are automatically members of the LMC.

APMS (Alternative Provider Medical Services)

APMS is one of the other routes available for the NHS to make provision for primary medical services to patients. It was introduced as part of the amendments to the NHS Act in 2004, (paragraph 83(2)(b)). The existence of the APMS route has broadened the range of potential providers from whom the NHS can commission services and thereby introduced significant competition to general practice.

The NHS may commission APMS to provide essential services, additional services, including where GMS/PMS practices opt-out, enhanced services and out-of-hours services. APMS may be used where specific needs arise, such as through practice vacancies, or in areas with rapidly expanding populations where extra capacity is needed. It also opens up the provision of essential services to providers other than GMS and PMS practices.

APMS providers are not automatically members of the Bedfordshire and Hertfordshire LMC. If they have contacted the LMC and let us know that they want to become members and, therefore, pay levies in common with all practices throughout Bedfordshire and Hertfordshire, we welcome them and encourage their involvement with the committees.

Enhanced Services

There are a number of other optional services which GMS and PMS practices may provide, known as Enhanced Services. Generally they are time limited, usually for one year only, but several have been offered year after year.

From April 1st 2013, commissioning arrangements for enhanced services changed. Some enhanced services will be commissioned by NHS England, some by the Public Health departments, and some by CCGs.

Quality and Outcomes Framework (QOF)

The Quality and Outcomes Framework (QOF) rewards practices for the provision of quality care and helps to standardise improvements and to fund further improvements in the delivery of clinical care. QOF is a voluntary process for all surgeries in England and was introduced as part of the GP contract in 2004. QOF sets activities and standards across a number of clinical domains. It also used to include non-clinical domains, such as patient experience, organisation and quality and productivity, however the organisational domains were removed in 2013 and the other non-clinical domains in 2014.

The National Institute for Health and Clinical Excellence (NICE) is responsible for managing an independent and transparent approach to developing the QOF clinical and health improvement indicators. As part of this process, NICE prioritise areas for new indicator development, develop and select indicators for inclusion on the NICE menu of indicators, make recommendations for the retirement of indicators and consult with individuals and stakeholder groups. The recommendations made by NICE are based on current clinical evidence and cost-effectiveness.

The NICE menu of indicators is published in July/August each year and the recommendations are used to inform national contract negotiations between NHS Employers and the GPC on changes to the QOF.

NHS Employers and the GPC use this menu and the associated guidance to agree which indicators should be implemented across the UK and what point value and threshold ranges should apply. The QOF guidance continues to be jointly produced and published by NHS Employers and the GPC and reflects the outcome of these negotiations.

The BMA produces updated guidance on QOF as it changes available at BMA QOF.  Additionally, information is available at NHS Employers QOF Guidance.

Further information about specific enhanced services can be found in the library below:

  • Library
  • QOF
17882BMA QOF Guidance 2014 - 2015
Type: html, 25492, added 3 years ago
AuthorBMA
AudienceGPs
13399Focus on QOF Payments
Type: pdf, 42312, added 5 years agoThis guidance note gives a full breakdown of the methods used to calculate and make payments earned through the Quality and Outcomes Framework. The information within it is drawn from the Statement of Financial Entitlements which can be accessed on the Department of Health website at www.dh.gov.uk
AuthorBMA
AudienceGPs
SynopsisThis guidance note gives a full breakdown of the methods used to calculate and make payments earned through the Quality and Outcomes Framework. The information within it is drawn from the Statement of Financial Entitlements which can be accessed on the Department of Health website at www.dh.gov.uk
5464GP Contract QOF Database
added 3 years agoLinks to the results for 2013 but can access previous years
AuthorGP Contract
PurposeLink to the website
SynopsisLinks to the results for 2013 but can access previous years

Performers List Regulations

As well as being registered with the GMC, all GPs must be on the Performers List. The Performers List Regulations sets out a number of requirements with which GPs must comply in order to remain on the list, including a requirement to declare any criminal convictions, to inform the Commissioning Board if s/he becomes the subject of performance procedures, and to participate in the appraisal process. Practices should make sure any GP they employ, whether permanently or as a locum, is on a Performers List.

For further information go to the Performers Lists and GPs’ Obligations’ page.

Advice on Contracts and Contractual Issues

Further advice on contractual issues can also be found in the Library under a number of different headings. If you do not see a relevant heading, please type a keyword into the Search facility on this website. The General Practitioners Committee (GPC) of the BMA also produces guidance on a number of issues for GPs and practices. A selection of these can be found in the Library under Contract and Contractual Issues.

  • Library
19695Contracts Monitoring 2013
added 4 years ago
5313Contractual Issues
added 48 years ago
7915Dispute Resolution
added 6 years ago
19918NHS England Policies
added 4 years ago
25832Out of Area Registration
added 3 years ago
5324Overseas Visitors
added 48 years ago
2611115.03.12 GPC guidance on list closures - FINAL
Type: pdf, 135.9KB, added 3 years ago
260792015 contractual timetable
Type: doc, 1.2MB, added 3 years ago
22377BMA General Contract Changes 2014-15
Type: html, 22978, added 4 years agoFull details of the agreed changes to the GP Contract by the BMA and NHS Employers
AuthorBMA
AudienceGeneral Practitioners
PurposeThe BMA and NHS Employers have agreed changes to the GP contract for 2014 2015
SynopsisFull details of the agreed changes to the GP Contract by the BMA and NHS Employers
25181Dispensing Doctors Fee Scale Changes 2013-14
added 3 years agoAn agreement has been reached between the GPC, the Dispensing Doctors Association, NHS England, the Welsh Government and NHS Employers around the changes for the dispensing doctors feescales from 1 October 2013 and onwards for England and Wales
AuthorBMA
AudienceGPs
SynopsisAn agreement has been reached between the GPC, the Dispensing Doctors Association, NHS England, the Welsh Government and NHS Employers around the changes for the dispensing doctors feescales from 1 October 2013 and onwards for England and Wales
22202Focus on - How Your Practice is Funded
Type: html, 16985, added 4 years agoThis guidance note has been produced by the General Practitioners Committee to help GPs, practice managers and LMC staff understand how individual practices receive funding under the GMS contract, and is one of a series of guidance notes on the GMS contract
AuthorBritish Medical Association
AudienceGPs and Practice Managers
SynopsisThis guidance note has been produced by the General Practitioners Committee to help GPs, practice managers and LMC staff understand how individual practices receive funding under the GMS contract, and is one of a series of guidance notes on the GMS contract
25583Framework for PMS Contracts Review
Type: pdf, 181.8KB, added 3 years ago
AuthorNHS England
Released5th November 2014
25184General Medical Services Contract 2014/15
added 3 years agoThis document provides guidance for NHS England area teams and also for practices that hold a GMS contract and for all practices subject to the new contractual requirements or which are offering enhanced services nationally, commissioned by NHS England.
AuthorGPC, NHS and NHS Employers
AudienceGPs and Practice Managers
SynopsisThis document provides guidance for NHS England area teams and also for practices that hold a GMS contract and for all practices subject to the new contractual requirements or which are offering enhanced services nationally, commissioned by NHS England.
22408General Practice Funding
Type: html, 25641, added 4 years agoEssential guidance, information and practical advice on the contractual conditions affecting general practice finances and funding.
AuthorBMA
AudienceGPs and Practice Managers
SynopsisEssential guidance, information and practical advice on the contractual conditions affecting general practice finances and funding.
22402Letter from Dame Barbara Hakin
Type: html, 73570, added 4 years agoExplaining the context for the Department of Health's proposals regarding the GMS Contract, 2013/14 and to provide further information
AuthorNational Managing Director of Commissioning Development
AudienceGPs
SynopsisExplaining the context for the Department of Health's proposals regarding the GMS Contract, 2013/14 and to provide further information
7275Model GMS Contract
Type: html, 25856, added 6 years agoThe GMS Contract Regulations have been amended by the National Health Service (Primary Medical Services) (Miscellaneous Amendments) Regulations 2010 (SI 2010/578). As a result, the standard GMS contract has been redrafted and is available in both PDF and Word formats. This document supersedes the earlier document which will be withdrawn in due course. The new document should be used for all new GMS contracts signed after 1 April 2010.
AuthorDepartment of Health
SynopsisThe GMS Contract Regulations have been amended by the National Health Service (Primary Medical Services) (Miscellaneous Amendments) Regulations 2010 (SI 2010/578). As a result, the standard GMS contract has been redrafted and is available in both PDF and Word formats. This document supersedes the earlier document which will be withdrawn in due course. The new document should be used for all new GMS contracts signed after 1 April 2010.
13585NHS (General Medical Services Agreements) Regulations
Type: html, added 5 years ago
AudienceGPs and Practice Managers
PurposeLink to legislation.gov.uk website
25187Out of Hours GP Services in England
added 3 years agoThis report, from the National Audit Office, examines the performance, oversight and assurance arrangements, and integration of out of hours GP services
AuthorNational Audit Office
AudienceGPs and Practice Managers
SynopsisThis report, from the National Audit Office, examines the performance, oversight and assurance arrangements, and integration of out of hours GP services
14232Primary Medical Contracts - who can hold what?
Type: pdf, 83935, added 5 years agoThis guidance explains the eligibility criteria for holding different types of primary medical services contract and eligibility to be a member of the NHS Pension Scheme. The guidance also sets out the circumstances under which more than one contract may be held.
SynopsisThis guidance explains the eligibility criteria for holding different types of primary medical services contract and eligibility to be a member of the NHS Pension Scheme. The guidance also sets out the circumstances under which more than one contract may be held.
13562Reviewing PMS Contractual Arrangements
Type: html, 15419, added 5 years agoThis guidance note sets out the options available to PMS practices when PCTs seek to change PMS contracts e.g. when PCTs propose a review of existing contractual terms; when PCTs threaten to terminate the contract; and/or when PCTs offer new contracts.
AuthorBMA
AudiencePMS Premises
SynopsisThis guidance note sets out the options available to PMS practices when PCTs seek to change PMS contracts e.g. when PCTs propose a review of existing contractual terms; when PCTs threaten to terminate the contract; and/or when PCTs offer new contracts.
13558Revised Formula for Dispensing GPs
Type: html, 14329, added 5 years agoGP leaders and NHS Employers have agreed a revised formula for payment to dispensing doctors.
AuthorBMA
AudienceGPs
PurposeLink to website
SynopsisGP leaders and NHS Employers have agreed a revised formula for payment to dispensing doctors.
20260Statement of Financial Entitlements Directions 2013
Type: html, 1046993, added 4 years agoGeneral Medical Services Statement of Financial Entitlements Directions 2013
AuthorNational Health Service
AudienceGPs and Practice Managers
SynopsisGeneral Medical Services Statement of Financial Entitlements Directions 2013
6782The Model GMS Contract
Type: html, 25856, added 6 years ago
6383The National Health Service (Performers Lists) Regulations 2004
Type: html, added 6 years agoAlso, check the Department of Health website: http://www.dh.gov.uk/en/index.htm
AuthorGovernment
PurposeTo give access to the original version
SynopsisAlso, check the Department of Health website: http://www.dh.gov.uk/en/index.htm

Because the PMS contract closely follows the GMS contract in many areas, most of these guidance documents are also relevant for PMS practices and may also be relevant for APMS providers.

Meanwhile, the Beds and Herts LMC Ltd is always willing to advise practices on contractual issues, if you are unable to find the answer to a question about a contractual issues on our website please call us on 01438 880010. Ultimately, we can also advise practices on informal and formal dispute resolution should this be necessary.

More information can be found on the Dispute Resolution page.

Other useful links

Last reviewed on 8th December 2015 (HB)