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Consultation launched on reformed Welsh GP contract

by Beth Gault
24 April 2023

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Primary care and GP leaders have been invited to respond to proposed changes to the Welsh GP contract, which promise to simplify and streamline the GMS model.

The changes introduce a new ‘unified contract’, that have been negotiated over 18 months by GP Committee (GPC) Wales, the Government and NHS Wales. Regulations underpinning it will come into force on 1 October 2023, replacing the former 2004 regulations.

The reforms include increasing the range of services that all GP practices in Wales must provide, now called ‘unified services’. ‘Additional services’ such as contraception and childhood vaccinations and immunisations, which GPs could previously opt out of, as well elements of the voluntary Quality Assurance and Improvement Framework (QAIF) will transfer into the core GMS offering (see box).

In practice, many of the other changes set out in the regulations have already taken place in surgeries since they were phased in during last year according to the BMA Wales. ‘The new regulations will formalise many of the agreed changes over past few years into a “unified” piece of legislation,’ it explained.

For example, from 1 April this year, Phase 1 Access Standards moved from QAIF and formally became mandatory. However, these requirements, which set out opening hours, the telephone systems practices need to have, and details on appointments, were introduced in QAIF last April, with most practices already achieving on them, said BMA Wales.

Similarly, clinical domains under QAIF transferred into the core contract last October, with points funding moving into the global sum.

In a letter to GP and primary care leaders setting down the new regulations and details of the consultation published earlier this month, the Welsh Government said: ‘The aim of the new Unified Contract is to redefine the core GMS offering, streamlining and simplifying the contract model, taking into account learning from the pandemic and allowing GMS to focus on those activities which can, and should only, be done within GMS and at an individual practice level.’

Under the new regulations, Phase 2 of Access requirements, which is a reflective phase of listening to patient experience and making improvements to access, will remain in QIAF for 2023/24 and  be evaluated later this year, according to BMA Wales.

In addition, QAIF is to be transformed so there is a greater focus on quality improvement, and will be renamed the Quality Improvement Framework (QIF). QIF will remain voluntary and include Access and QI domains, with a total of 270 points available for achievement across both.

There will also be a new Assurance Framework to look at performance management, and monitor  clinical indicators. The BMA Wales said further work was ‘underway’ to finalise this framework.

The changes also include provisions for a digital prescription service, so paper prescriptions are replaced by electronic prescriptions.

GPC  Wales chair, Dr Gareth Oelmann, said: ‘We have worked with Welsh Government and NHS Wales representatives to jointly develop the proposed new Unified Contract, with the aim of simplifying and streamlining the current contract arrangements which have been in place since 2004 – with our focus having been on consolidation of funding mechanisms and reducing bureaucracy.’

However, he added that there were important outstanding issues not covered by the contract changes that are yet to be addressed.

‘There are significant workload, workforce and wellbeing challenges facing general practice in Wales, which will not be addressed by contract changes alone. GPC Wales continues to push for urgent action to address these factors which are behind the major demand/capacity gap,’ Dr Oelmann said.

The consultation is open until 30 April 2023. The BMA added that the new 2023/24 contract is expected to be published in advance of October.

Key changes covered in the new regulations coming into force in October 2023:

  • Services known as ‘additional services’ (cervical screening; contraceptive services; vaccinations and immunisations; childhood vaccinations and immunisations; child health surveillance; maternity medical services; and minor surgery procedures of curettage, cautery, cryocautery of warts, verrucae, and other skin lesions) will become part of the core contract. They will be rebadged as ‘unified services’. They will continue to be funded by the global sum. Previously if a practice opted out, the funding would be recouped by Health Boards. However, now there will be no opt out available.  
  • Directed enhanced services, other than diabetes, will remain as ‘supplementary services’ and continue to be commissioned by health boards.
  • The Diabetes Directed Enhanced Service Gateway module will become a unified service.
  • QAIF to become QIF, with a focus on quality improvement. It will remain voluntary.

Regulations will also underpin changes that have already been implemented in practices:

  • Meeting Phase 1 Access Standards, which became mandatory as of 1 April this year.
  • Clinical indicators, which were part of QAIF, transferred into the core contract. This took place in October 22.
  • Cluster domain indicators moved out of QAIF into unified services (with funds moving into the global sum). This was implemented in October 22.

Practice managers and GPs will be able to hear the latest on all the important changes to the English GP contract for 2023/24 at this year’s Management in Practice event in Birmingham. Register here for free.