hey GP loers and welcome to this episode with myself and Andy are live together first time in quite a while and we are going to be talking about the draft suggested changes to the GP contract for 2526 these have tentatively been approved by the GPC we're going to go through everything in the letter from the NHS England as well as the GPC responses show some of the detail you haven't heard about because it's not been covered in any of the media and then also give you all the stuff about what's missing what the future may be and basically everything you need to know about this contract so let's get cracking with te inhance your primary care and learning say hi [Music] Andy hello G Learners and thank you all for joining us on this brisk Saturday morning I know it's out of schedule for what we normally do but when the GP contract information drops it's one of those things you have to cover and you have to cover well and quickly and that's what we're hoping to do for you live this morning morning how we doing there andy yeah pretty good just had a last minute um laptop restart as those who joined us for the soft start will be aware but I think we're all up and running now and and good to go really excited so I I guess just to cover in brief what we're going to go through in this particular session so um we obviously have the draft contract that's now been confirmed we've been waiting for this for several months um and the official version was released uh yesterday morning um on NHS by NHS England and obviously this has been negotiated and Tena Lively and the word Tena Lively agreed by the GPC as of Thursday evening so what we're going to do is have a look at the letter from NHS England go through it stage by stage we're then going to share with you some information from our chair GP of GPC Dr Casey Bram stainer highlights a few of those points and stuff um we're going to do a bit jumping around showing you different parts we've analyzed some of this we've found some interesting points that other people haven't comment Ed on and plus there's some stuff in this letter that hasn't been mentioned in any of the media as well so you need to make sure that you are watching the whole of this episode otherwise you're going to miss those key points and then yeah and then then I guess we'll have a little bit of Reflections so we've had some conversations and thoughts but I'm sure things will occur to Us online things will occur to you as well as we go through or if you've had a look at the at the uh at the contracts so please pop your Reflections as we go through and when we get the reflections um section in the comments how to think about what's missing there as well um and you know look to the Future because um there is um on ongoing negotiations for a more substantive and more change contract um next year so um we'll look to the Future at the end but shall we get started I think we will um so first point we're going to go to is have a look at the letter so Andy just bring it up for us good are we sharing my screen Gandy we are not that would help and there we are now so um first thing we're going to do like we said is have a look at the draft offer so this is the letter that's come through from NHS England um uh it's about 19 pages I think in total was it it is yeah there there's three pages which are the letter and then there's two annexes Annex a which um is a textual Annex that gives a lot more detail about changes and actually there are some things in no G says which aren't in the um main sort of summary part of the letter so it's worth sort of reading through and having a look at the whole letter and then there are some tables that give details to changes to the qua thresholds and and all sorts of other things that are better expressed as as tables so that's what the document looks like um just also with com I think this is the the first time in the last four years that we've had a contract that has the support of the BM GPC I think three years I believe years we had two years of imposed contract I believe it was and but clarify our memories are getting a little bit we've covered so many imposed contracts I think we're getting confused what is but auspicious in that in in in that way it's the first time that this is but tenative and we're going to come to one we keep mentioning tentatively in a second because there are a couple of points that are still not agreed and and again just for clarity the full detail of the contract is not out this is just the offer the detail that will probably still come out in the next few weeks and I suspect it will as usual be the last week of March so you may be seeing us live again in a few weeks time but yeah right so shall we start going through I mean there's there's a brief introduction with some context setting which I don't think really tells us anything new um so it's probably with going to the points and I think there's 12 or 13 points and um I guess we'll sort of we'll go through them read them some people might be listening in audio and then we'll react and give a bit of thoughts on them really so do you want to take us with point one yeah so I guess the headline point is the fact there is a significant increase in the cost um the funding within the contract so in total there's an 889 million uplift of the contract and there's a separate increase which is the 180 million being given to do the advice and guidance part that myself and Andy covered a few weeks back when we heard about it and stuff um this pictogram is really good at sharing I guess a lot of the details sorry that we've covered slight part of that um what you can't see uh so this so this breaks down the um the 889 million um to show you kind how much is going in different places to give you a sort visual idea of where like the weight of the funding is going really so as you can see most of it um is going into the global sum I think it might be about 0% so I think people Ed on the proportion the bit that you and then I guess it's wor articulated gpn RS 104 they're kind of including that there but it's also included in ours isn't it as well um the advice and guidance um Les which we'll talk about later that's 80 enhance service they haven't called it a Les and we don't because it's not local yeah um and we don't know if it's an N it's just an as an enhanced service and the interesting thing we saw in this is it keeps saying the opportunity option it's optional and opportunity yeah um well it says opportunity that's the word so we're thinking you know as this letter stands it's not necessarily compulsory which I think might cause some headaches at icbs if they have some practices that participate in this element of the contract and others that that that don't but maybe we'll talk about that a bit more we get there yeah um vaccin IMS fee uplift that's worth 18 million um very very small uplift to PCN Workforce streams of 13 million and the B you can't see is um up lists of 12 million but we'll talk about all of those um individually as we go through but SF means because I think a lot of people may not know that's the statement of financial entitlement so that's technically the stuff that backs up the GP contract in terms of payments and things so um I have to go and check that myself so just to clarify that for everybody out there in GP learning Landers and we'll talk about which elements they draw our attention to in the letter that have changed in there but always with looking the actual changes in the in the annex yeah so that's the total increases that we're seeing that is a significant increase um in terms of the contract value um I don't know how much that would Crees in terms of percentage of the NHS budget we haven't had a chance to look at that yet and I guess we will probably look at that in time for when the full review comes out um in we assume to be later on in March um and the only reason for doing that is there may be some small adjustments that tend to happen but it is a significant increase you'll hear from Katie bramin in a bit as to how much of an increase that might be in terms of equivocal previous contracts so we'll let her explain yeah of course um but in point two they say well this is a 7.2% cash increase um in the um GP contract funding envelope um they also estimated 4.8% real growth from last year's contract so they're um applying us a modest amount of um inflation to that um to say real terms probably a 4.8% growth so it's it's good to see that there for transparency um so it's biggest investment in general Practice in over a decade and again KBS talks about that in the video which we'll show and we'll let her Express that um in her own words but I guess the question I've seen on a lot of the forums the channels and stuff what does that mean in terms of Pence per patient or pounds per patient and stuff so um as ever this is going to vary depending on your practice your car Hill formula you know the prevalence and all the other kind of stuff but approximately if your car Hill 1.0 if you have no significant change in terms of your populations and that kind of stuff it's approximately ound and4 Pence increase in your P pounds per patient that's registered with you which I believe takes it up to just over 121 pounds per patient for the GMS contract value um so that's the increase that we're dealing with um so the 7.2 % is a slight misnomer because don't forget some of these increases are outside of the GMS itself but in terms of GMS contract value it effectiv takes us to about 121 pounds you'll then have obviously all your leses your prevalence all that kind of stuff that modifies the P practice but hopefully that gives you a rough estimate and the reason why that's important what we'll come to that in a second okay so next point so in addition to the 189 million practor will have the opportunity to participate in this advice and guidance yeah enhan service which is worth 80 million so people have talked about this uh before and I think we're still awaiting the details of that scheme and we'll talk about that when we have more details but there is talk of 20 PS per advice and guidance from practice to secondary care and talk of using that um uh in a much more extensive way I guess to manage referrals but we need to see what that will look like so when we get to the detail the interesting part as well that they put in this is it says pre-referral viice and guidance so they've added this extra phrase in there and I don't know what the significance that is we will find out when the actual contract comes out but I think that's the key point to be aware of there is also some local ICB adjustments that can be made but they have also recommended this information needs to be this funding needs to be used as well from what we can tell from the the current offer so important to recognize it looks like this funding is going to be to General practices through the icbs at their discretion but and about protecting that for this purpose within ICB budgets fact you said the ICB can't use it for other things key point there good and that's just this word opportunity which is there so practice will have the also have the opportunity to take part in a new enhance service for advice and guidance so just interestingly the opportunity is there it didn't need to be there in that sentence next one so Gand do you want to lead us off with the four um there's this plan of reducing bureaucracy where streeten keeps talking about you know his take bureaucracy changes and all this kind of stuff and one of those is retiring some quo indicators to basically recycle them um into basically how that will flow so they're going to retire 32 qua indicators and the list of that is in this document it's in Annex I want to say b um we'll check when we get down to it and stuff but it is in the lower pages so that they're basically clearing those out and then that funding effectively equates to 212 qu points and so I'm I'm going to bring on one of the comments we've already had Hannah Robbins and ke to understand whether the retired qu income is being recycled as IM back up and SF loc payments and Co points Etc or actual droing income of the Aggregates so these are being recycled will explain how they're being recycled in shortly but it is effectively that it's not necessarily increased funding that's going into this they have just changed the way that you get them um and that's explaining the next Point Okay so uh 212 points involved 71 points with a total of 100 million um will be removed outright and invested back into the global sum okay um uh and that's to basically from the SF payments that we talked about earlier so these come in two parts number one which is the increase in terms of locom and maternity reimbursements and that kind of stuff and that will vary between I forgot the numbers 15.1 17 point something perc uh yeah 15.9 and 17.1% uh you can probably see our notes on the screen as well but it's small for gandley to read so that will um be recycled to pay for those adjustments and those reimbursements um and then the other part that's being recycled to do is to pay for the increase in item of service charge for vaccinations as part of qu um taking that up to by an extra2 to a total of 126 the question is which vaccinations is that and this is where we're going to have a look at the table isn't it table yes and the table was on page uh 51 51 okay not this one of course we have the other document ah now in the computer restart did that get queued up Gandy I don't think it did is the link in the private chat in the private chat shall we stop sharing the screen for a seconds yes we shall okay so um apologies all so this is down to the slight Tech m we've had whilst Andy's finding that one thing I'm just going to say because our regular eers will know I love to do this um because I think it's amazing that we can do this and I'm just bring it up so we have well over a 100 plus live viewers in fact we've had well over a 100 plus live viewers since about five minutes into this live stream we're currently about 160 odd uh so thank you everybody for joining us we've had loads of people say hi to us I'm just going to bring on some of those comments Gandy just while you're doing that could you resend in the private chat because you sent it to me before the start of the computer so I'm this is the correct one hope this will be worth it this is the chaos of going live sometimes you just have to accept that things go right and sometimes things go wrong so let's have a quick look so we had loads of people saying hi and stuff thank you to everybody who has been doing so you're definitely gonna make quick shout outs to Friend of the channel Dustin Saint from primary care it Lisa Drake From redm Hell um ranes getting a little bit frustrated with the fact can we just get to the meat of the stuff we're definitely we're going to get to that and stuff I think I think we were filling time because of technical difficulties apologize that we had some tech difficulties this morning and stuff and things um and yeah Dustin's already got a comment in there which I'm going to bring on so we'll be interested to see the detail on this and what impact of prevalence for disease registers as a register themselves are completely retired completely but will the kpi still be based on them so it's an interesting point that Dustin Rays is that obviously quap is based on prevalence if you're not keeping the registers in the same way does that fect your problems but also how are they monitoring that to make sure that those payments work so you know depending on what system you use I know in system one there is a separate part that gives you your uh cost per qu Point based on your prevalence and obviously your prevalence is based on your coding if you don't have the reges how does that work moving forward will be interesting to see it's a good point isn't it because I guess there that probably we do need to keep the register still or at least the coding that supports the register so I guess we still need to do that work but they're not paying as to do it so we're going to get to the list of table um items that are included so I'm going to switch this around to a slightly better on so you can see um but this is the table from the SF and TI so the standard Financial entitlements that general practice has this lists the immunizations vaccinations that the increase of the two pounds for the is service will apply to okay so this is the table um this might be slightly off because I think this is the 2020 giv the old the old contract value of 1066 so this is not the new details because that will come out again at the end of March um when they refresh it but this is the list of items that has that is included except there are two additions into this that's not on this table so that is the hepb immunization schedule which is I forgot I think it's month six months and one year I believe and MMR plus six oh was it one two years I can't remember now I'm afraid I I can't remember I will will check in fact I can tell you I've got it here so um he B immunizations at Birth sl4 weeks and 12 months and then MMR for those six and over I'm assuming that's six years because it doesn't mention um but yeah okay so those are the ones where you'll get the increasing item of service payment um for giving the vaccinations hopefully that helps yeah good good detail um excellent and we're at number six now yeah so the question then comes in terms of what happens with the remaining C points so we talked about the 71 out of that 212 well the next part is the remaining 141 so these are going to be recycled and added to basically cardiovascular prevention items um so this is both the CBD qua but also throughout some of the other qua criteria so in terms of diabetes cholesterol management or those they are being plumped up to increase in terms of the number of points they're eligible for however with that there is an increase in the criteria to meet them so the percentages that you'll need to do so they are harder to achieve and again that detail is in the annex below and we will show you that when we get towards it and things it's a little bit more complicated they haven't actually included Your percentages earlier no I it's just a new percentages isn't it so um and we did didn't have time to compare that with the old percentages so essentially they've um changed the threshold which the minimum threshold when you start to get your payments is the same but the maximum threshold is higher so you can actually achieve a you know a higher percentage um of achievement within your population and um be rewarded for that I guess but it will be harder to get those maximum rewards I guess to answer AR yoga's question interested to know if the IM quo targets made realistic or achievable so we just heard that the cardiovascular ones are actually High harder to achieve I guess one of the key things will come to Reflections is the fact that the actual achievement of the IM ones hasn't changed it's just the item of service we'll come to our reflection as to why that's really important and stuff but it is a bug bear for many of us um but yeah should we crack on then yeah so um point seven is sort of the main point that grabbed all the headlines I think when this letter dropped uh because for patients out there this is probably the most sort of visible change that they might anticipate so it say we want patients to contact their practice by phone online or by walking in and for people who have an equ and for people to have an equitable experience across these access M so this is modern general practice there will be a key intervention in the government's and this will be a key intervention in the government's admiss to end the 8 a.m. scramble from the 1 of October 2025 practices will be required to keep their online consultation to tools open for the duration of core hours for nonurgent appointment requests medication queries and aditt requests uh and this will be subject to necessary safeguards in place to avoid urgent clinical requests being erroneously submitted online guidance will be displayed on practice websites and reflected in the wording and reflects reflecting the wording of the patient Charter which is something which we couldn't find that they updated or released that wording for practice websites what we think is going to happen is that NHS England will publish a patient Charter um it does specify that when this comes out practi will be required to place this public access so you're waiting room your website and this is what practice will be agreeing to in terms of access so um an interesting thing isn't it Andy in that sense it is yeah so um and I guess this was um what was interpreted in the mainstream media as you will be able to make a routine appointment by submitting a request for a routine appointment online that's how it was characterized and I guess that's what is enabled by these forms of words um here um it'll be really interesting to see what the patient say and how that's implemented and um KBS has something to say about that in her video which we'll go to after we've covered the main points um here because it remains a point of negotiation for the BMA as we move towards the final um version of this contract running hopefully sometime before April and definitely before the first of October when all of this needs to happen um so we've got some extra comments coming on sorry I'm just trying to find a video that's going to be useful for us to show in a second um but a couple of comments we had so Dustin Saint um key Point here maximum thresholds really high 90% which means realistically more maximum tolerances pcas will need to be used potentially that's quite clear in terms of how that will work um Lisa Drake coming in with how does the requirements it would be a main their Collective action guidance we're coming to that so don't worry um any indication from Josh Perry uh how soon routine is be no there is no detail on this whatsoever this is not coming until October so there is still time till that happens wow comments coming in Fast and Furious everyone uh morning all interesting Li combo uh this a live conversation I think about not maintaining LTC registers how that impacts publish data prevalence and impact may have impact on um Health analysis I'm just going to make this a little bit better uh okay Dustin back again intr non-urgent appointments only quite a change from complete total triage yeah I'm gonna mention something on in a second uh Mike nille from um uh igpm uh upper limits cvd title phenomenally high so this is I think one of the things many people are concerned about that the qua criteria for those reconcile recycled sorry and qu points is considerably higher than what it was again we've not been able to figure out how high so if somebody does know please let us know because we've not unfortunately with all the stuff we' had to doal we've got to that particular analysis part well we can we can look at the new thresholds but we we just forgot the old and absolutely we will cover that in more detail when the final contract Alpha comes out in the in the document but if you've got that now that that would be useful to know deprivation a key thing here in terms of factoring that in though and that's definitely the case when it comes to the IM vaccines which again there's been no changes in terms of the the achievement levels which I know has frustrated many particularly those working deprived areas uh Trisha NHS we moved this model in April it's taking a long time for PTI to grasp the changes online is quicker so this is talking about total triage wow guys you're going crazy on there it'll be interesting to see how exactly they Define opening keep y we don't know the definition of that yet from Health VI 24 and further how do you define non urgent further question y interesting to point um uh Mike is in the annex on H yes so there's the changes but I couldn't see the the percentage Chang that might be my weird viewer but we'll get to that in the second uh trilon I'm jumping wording players must be during core hours yep we agree on that Connor backing there's no mention of neighborhoods no no mention of neighborhoods in this contract and Steve I'm loving this I love this okay thank you oh gosh okay so we're gonna carry on with the document feel free to jump in with the comments guys we will come back to them as quickly as we can but we are going to crack on with the rest of this because there's still loads for us to get through um so uh it says GP connect functionality yes people may remember this this so I was looking back at this because I was doing some review of our views recently and this was when GP connect update record hit the news cycle round about I think it was summertime it was the end of summertime um that video I put out telling people about the change and what the GPC was recommending the housewi it off hit over 4,000 views um so you guys really really really watch that one um but I think it's important to recognize because of the fact that this is one of the changes that they are agreeing to in the contract to adjust that and what that means do you want to go through it Andy yeah so by no later than the 1 of October 25 practice will also be required to ensure the functionality in GP connect is enabled which allows read only access to Patient Care records uh this will apply to other non to other NHS commissioned providers for direct patient care and also to Providers patient Health Care where the private provider obtains explicit permission from the patient to access the NHS GP care record and they are providing Direct Care to the patient so and um Katie Bala has some comments about about this in her video which we we will show eventually which is what I've just been doing so I've not been doing so we just realized that video is not public so that's why I'm just oh you made public good yeah um and allow allow Community Pharmacy registered professionals to send consultation summaries into the GP practice workflow which will reduce administrative burden for general practice teams so yeah some two-way communication and I guess the key point with this so this is allowing pharmacies as it says to write into the record appropriately there's still some detail on that that needs to happen I think the more interesting one that's going to concern people is the um third party access so I guess this would be you know for example Services common ones that we I think many people are possibly frustrated and concerned about will be your weight management clinics that prescribing gp1s and your ADHD clinics that are you know recommending patients start on particular medications where will that line sit obviously other private providers other you know third party providers including that some online pharmacies as well because it does mention about this being the original one being NHS registered pharmacies um obviously not all phes are NHS registered pharmacies just again is that is that full um read access to full patient record details not there but the question is how far do you go in terms of the detail that you share in order for them to work safely and actually manage that risk themselves versus patient consent and share in all that information which is as ever one of the challenging Parts when it comes to being the data controllers but us the GPS in terms of sharing this data and the liability that sits with that and Katy gives a great example of that in her comments that we're going to come to um when we've got through this yeah 10 more points and stuff yeah because we protect certain data don't we from from what I sharing but um actually where is the line given that patients might be going for quite specific fairly minor things to to to private providers do they really need to see um as much information as they might have access to and do we really have a way of um identifying which things they can't see at the moment which which we don't so um anyway let's get on to to point nine so so uh that's the patient Charter that we said that's going to be coming out from NHS England they haven't published it yet we don't know when that will come we will probably cover it when it comes out and stuff but whether that'll also come out with the formal GP contract itself or afterwards still unclear key point this will need to be on your websites this is something that you are going to agree to sign up to as part of the offer as part of the contract yeah part 10 so now we're into the PCN stuff okay so for those of you who are involved in PCN and want to know what's going on this is where we get into it and then we're going to go back to some of the comments after we've covered the next couple of sections about pcns um yeah should we do the comments first um you want to get to comments now yeah okay we're GNA switch that everyone so just before we get to PCN stuff and there is loads to know there um we're just going to go back to some of these comments actually yet some of these are relevant so um first of all Health you love seeing us together on the couch yeah it's new for us we're kind of enjoying it I I don't think this is g to be every live stream just because it took us a little bit of time to set it up and stuff and things um and obviously requires Andy's house to be empty and stuff at the time but yeah we're hoping you like the setup if you do leave us a like down below because that would be really appreciative or comments in terms of how we can change it as well what would better for you um heard the comments earlier from I think J about the audio not being as good uh I think he said that he could hear us but actually was not as good as normal that probably it's because the quality of mics we're using compared to obviously our fixed mics are far better quality and stuff but hopefully it's okay give us feedback yeah um Dustin saying as ever Dustin with a figures so Cole uh so these are the the changes in terms of the criteria for um the reconcile qua um changes so call 004 35 to 50% hype 04 77 to 85% hype 9 80 to 85% STI which is the the stroke one um 14 73 to 90% SDI 15 which is another criteria on that 86 to 90% CHD 015 77 to 90% And CHD 1686 to 90% and diabetes 036 36 there's loads of diabetes ones 78 to 90% significant changes that we seeing there crazy isn't it and yes so Health view B let's go back to the different view because this is a bit more engaging hopefully vo you BM summ document that confused the real wi GP connect update record and GP connect access records that made me smile little things Lisa wonder if any of us discussed the medical liability of this took ages just to get GP online access off the ground who supporting these other contributors lots of stuff to go through as we said in terms of how that's going to work um Nicola laon Cape uh we're g to come requirement item two was prec with the cor yes I think I know what you mean we're going to come to that in the next section which is about the cape changes yes that's coming yeah Jamie thank you both implications you have for the contract for pcns we're coming to that so that's in the r section so don't worry stick around Jamie for that Conor we should be using Pharmacy a lot more part of the health ecosystem absolutely enables that doesn't it or and interesting many of us obviously know about GPS doing Collective action there is lots of noise that pharmacies are about to do a similar form of collective action which will impact patient care um in different ways so they are struggling in completely different ways but similar times in terms of how general practice is um and definitely hearing lots of um coming through the collective action for pharmacies will be starting soon because of how they've been cannibalized with their contracts and services and stuff um is there an indicator labor except want self-funded private patient Health Care to be integral long-term player of the NHS sustainability that's that's an interesting question I'm not I think that this certainly um enables more engagement with the um independent sector they say private here was independent um the other week so um so quite possibly they're enabling it AR they possibly um Steve hen your question your comment is great unfortunately massive I'm going to share it but I don't think we can cover it all because it's huge um but effectively talk about different models and different healthc carees um and that GP England in England are trapped in an unsustainable system and therefore maybe the payment systems need to change com to that in a second uh Trisha in the NHS GP connect info being written GP record and GP being responsible for that data yeah that's going to make it harder and things um uh yeah exactly in terms of blood pressures rupesh um what does it mean qu income will be 16,000 for average list size and historically practi world so I think this is because of the change in criteria there have been some comments that some practices will suffer because they won't achieve as much of that c points as result of it and there's a potential Health Equity um inequality deprivation um issue around these changes I I would suggest y um Dustin coming in with no mention of if at all also no in very light on PCN details yes I suspect that will be in the full contract details um because they tend to slip in quite a few things when that happens and stuff yeah and of course the de contract might drop or change separately it's not necessarily part of the same negotiation round potentially make SE it's interesting last year when the contract came out there's very little talk about the PCN side of things it was obviously many people focus on the GP contract but actually there were quite a few changes that incorporated some of that and we coming on to talk about that right now okay good yeah so point 10 so this is another one of the the big ones that I think caught a lot of attention in the general practice sphere so the additional roles reimbursement scheme will increase in flexibility to support PCN to respond to their loc local Workforce requirements we will combine the funding in the two ours parts so I think that's GPRS and practice nursing RS and standard RS integrate a single part for reimbursement of patient facing staff costs with no restrictions on numbers or type of Staff who are covered including GPS and practice nurses so that's quite a big one G isn't it it is so just to clarify what that means so um in summer just after the government took over one of West reading's big things that he created was obviously the the gpn AR now it had a more professional name but that's basically what everybody calls it um and as a result of that that allowed the newly qualified doctors to um employed under the our scheme it was very restrictive um and there were a couple of criteria with that that meant that they had to be within two years of work you not have to have substantial post before and obviously one of the comments that many people particularly those working in PCN had was that the funding just wasn't commensurate in order to make it happen that's why many places have really struggled to get it up and and why even a month ago and H England pretty much put out plea telling PCN to crack on and hire more people because the money was wasn't being used this is interesting because of two reasons number one they have increased the amount of funding um to a more modest level so they've increased it by1 isn't it so uh yeah so so the increas is from um 73113 uh which is the bottom of the salary GP range to 82418 so this is the I think the full fulltime equivalent yet rate for these roles um which is which represents the lower quartile of the celer GP range I guess these are um less experienced um newer GPS so that's an uplift of uh 9,35 PS which I guess is more than more than 10% yeah which takes us from more some places were saying about 7,300 session to about 8,000 plus session so it is an increase um it's still I think many people probably say it's still not where people would want it to be but let's be honest there's an increase an increase is you useful the big thing about this is the fact that it's now being Amalgamated with the full RS pot and the restrictions on how many GPS you can have per PCN are gone so this will be interesting as primare networks are looking to their next few years potentially looking at reconfiguring their Workforce there's now the opportunity to um uh employ potentially more core general practice roles in terms of practice nurses and GPS Al there's restrictions on what type of Staff they are and with nurses it particularly needs to be additional um work that is not currently being done or covered by practice nurses U but it's really interesting to have that flexibility and Y that might have quite far-reaching implications for how PCN choose to structure themselves and focus on potentially and I guess also the inclusion of practice nurses into ours is also a significant change now important to note that we don't have the detail on what they mean by practice nurses the reason why that's important is many people remember last year they included enhanced nurses into the ARs funding Arrangements that was the main ARS part but actually it was very restrictive because very few people qualified under the term of an enhanced nurse because you required you to have particular types of training that was very minimal in terms of availability and stuff so um we still don't have the detail on what they mean by a practice nurse does that mean um what level exactly we qualified unclear but yeah yeah I what imagin that will be some restrictions um on it but um that's interesting the other thing also they're now clear that a proportionate employer on cost will also be included within the overall maximum reimbursement am which pcns will be able to claim for those roles I guess so that's so that's actually a significant amount as insurance pension contributions um so that's that's quite a lot I think that's quite a big deal as well yes I think important to recognize that this is going to create some level of anxiety I think in PCN um because of the fact that because the um total cap in terms of the number of GPS that can be employed is gone there's potential for some practices some networks to say actually we don't want any of the other roles we just want GPS um and that's going to be a concern for many people involved in Primary Care networks absolutely the our staff absolutely the PCN clinical directors even the practice because there are obviously employment liability aspects that come into play if that was to be done I personally don't think that's the right decision to make for many networks I think for certain places they absolutely can work um but I think you know the RS have had benefit my perspective I know that I'm not you know there are many people who don't believe the same thing important to recognize though that the restrictions on the GP in ours still apply newly qualified within two years of qualification cannot have had a substantive role within the PCN Network that same role applies to the nurses as well so they couldn't have worked in that PCN before for them to be employed or for any of the practice our constituents within that PCN as well um and there was another one um I forgotten apologies I can't remember maybe it'll come to you um maybe it'll come to you later but that's you're describing quite a restricted kind of pool of potential people particularly on the general prct still need some additional support and supervision as well so it's not that it's you know off you go and Realties they're probably not going to stay if you said that as well so there are these considerations to make and stuff and things okay but flexibility is what a lot of people yeah were asking for it's also a question I mean this is expanding RS and GP and there's the question as to whether actually that's been successful and whether that's the the right place to employ GPS many people might say I just rather just employ GPS just through the through the practice that's how we've always done it that's how it works better that's how we integrate better with our teams rather than working across a group of practices absolutely and I wasn't going to jump to the comments but J's made a great one which actually I don't still know the answer to so after two years post qualification do the GPS have to give up their role if they're enroll or can they continue I should know this I don't know this I'm really sorry so any of our and I'm gonna point this out any of our 240 plus live viewers know the answer to this question please stick it in the comments and stuff love to know um I keep meaning to check the answer on this and I keep foret is the answer no is it is it checkable or is this is it an oversight that people haven't looked that far I I don't know yeah I I think problem I can't the point of employing them yeah it's two years at point of employment I can't remember the terms of what happens when they get to two years I think originally from the original criteria they said they could continue but I don't know if that will still apply because what happens if you employ someone at one year and 11 months which you could which you could have done already and they could have already gone beyond that one hopes they can continue to be employed but but worth checking it's a very good practical question Y and comment here TBL Master PCN I not been of the general practice was much much better before I think there's difference in opinions like I said I I think some of the roles have been really beneficial of primary care I think some of them have not proven their worth everywhere um but I completely understand why people also feel they may not have been as beneficial and stuff but we'll come to that in a second um and Jamie that's a very good point from Jamie yeah so think out loud my trainers hand could be an excellent opportunity to retain GPS locally from training yes absolutely key thing that's not mentioned in this there is no comment as an uplift to the actual RS budget that pcns hold so remembering that most pcns are probably at and possibly even over their RS allocated budget with the shift of having GPS now unrestricted they may not actually have the budget to employ more um and without potentially restructuring well without restructuring without you know changes and stuff things and I think that's an important point to note there's possibility of natural drift that you might have with people leaving and moving but yeah this is a question that's harder for us to answer but one that we will be trying to tackle and answer for you at the PCM plus conference in April which 23d of April yes which is sold out which is sold out I'm afraid so if you were planning on joining us live at the moment there are no tickets we are there's a reserve list right there is that's being operated so I you can still um it may not be set up yet but I believe you can still go to um either of the websites the business of primary care or Ben Island's podcast and sign up for the reserve list I think that's going live soon but you can join us online online are available yeah so me and Andy will be running the hybrid aspects of it making it virtual as well and I guess the reason why we're mentioning this right now is a actually we haven't mentioned on the channel but as of yesterday we were completely sold out in terms of face to- face tickets secondly um that we are going to be including a session in that conference talking about employment aspects and and various other changes that are going to happen and really for Tous that we decided to check that in given the fact that this is going to be a Hot Topic I think for many PCN as they having to look at how they might have to restructure employment all the kind of stuff Tara absolutely is going to be a powerful voice in that so if you do want to hear more about that and more in-depth analysis because obviously this will be and here what the hear what the other delegates have to say because there'll be Lively chat and networking um aspects even online networking is a feature of the online conferences that we run so there an opportunity to see how other people handling this across the country and the delegates tend to be um Prim Network clinical directors Network managers people from um ICB and place positions so it's really kind a good caliber of of people there and just before we get to the cap stuff so comments coming from others so Sarah a I understand that R GP can be kept on as long as they under two years at the start of the contract someone to which I agree Sarah theit I'm not quite sure on is how long past two years you can keep having them on because I suspect there may be something coming through at some point that says you know what happens in potentially three years time yeah 10 time that's the bit I don't think I've seen an answer to maybe it's not been planned for um yet and we'll need planning for in the future okay so next Cape so this is the other big part of the PCN um Dez changes or adjustments shall we say that comes through um and this is with the cape funding so just as a reminder to everybody out there in EGP learning and general practice land um so the capacity and access Improvement plan is now going to be going into its third year of running um this was when they reconciled a lot of the ifif payments and made them available as capacity and access um year one was focused very much along um basically getting um practices at nets to Gear Up For Better telefony of the um better purchasing framework and crowd based Ley sorry better purchasing framework um as well as various other changes to infrastructure last year was more around basically a bit of a fudge to provide some resources through the PCN for practices just to manage access and a big chunk of that was paid um unqualified you didn't have to do anything for it you just had to sign up to the de and the 30% was the local payment um which equated to 87 million OD so there was then Val validate against three different criteria which was care navigation online access and making sure that you've got signed up to the DPN notices for the better telepan and stuff so many practicing networks hopefully have been able to achieve proportion if not most of those um and things obviously the online access one is the one I think many people had issues with that's changed that's the key point so how has it changed you going to do this Andy um you will I I will a go Gandy and then you can break it down but essentially so so it'll continue to be worth 87.6 million and we actually to do some fishing around to see whether that was the same value as it was before and ultimately I we agreed that it that it was yeah um and so now it's going to be split um into uh two domains so one of them is focused on supporting modern general practice access so so supporting access that'll be 58.4 and then the other 29.2 um will be focused on work for PCN to undertake around population Health Management particularly risk stratifying patients in accordance with need to identify those that would most benefit from continuity of care yep and we don't have details in terms of what that will what that will look like but it's just interesting in it's focus on population Health Management risk ratification and Di menion of continuity of care there because this is something that was trailed as being part of the new GP contract this would be important um and I think I think this is the only place where it's mentioned if I'm wrong so this is currently how they intend to address continuity of care which quite a small part of the contract but yeah but still a meaningful amount of money yeah so I guess the headlines from all of that in summary so the cape total pot hasn't changed it took us a while to figure that out actually um so the total pot hasn't changed it's still at 292 million of which 70% of that will be paid direct to practice I think that's about 204 million um and then out of the remaining 30% um 2third of that will be paid as per modern general practice and again we don't have criteria detail on what that looks like yet but that was the three criteria I mentioned earlier from this financial year so they will probably change in some way and then a third of that so 33.3% of the 30% is then going to be paid as this um payment for pcns doing some stratification work to focus on continuity of care so okay so that's how that's Landing so we need to await the details um to see what um what the focus of mon practice looks like and the um the RIS ratification activity will look like um they then mentioned there's going to be some further changes to SF payments so we talked a bit about some of those and stuff that was the loc payment changes and that kind of stuff which aren't identified in that particular section um and then they then talk about the process of contract change and stuff and things that come from from there I think that was the main executive summary if I remember rightly yeah that that's it you're sincerely amander Doyal yep okay so what we're going to do now is we're going to show you a response video from Katy brol stainer our chair of the GPC and the reason why we're showing you this is a couple of points one because Katie summarizes um quite a lot of what we just talked about I've put it in the private chat thanks Gand um and what I will also do for everybody watching with us live is I'm gonna sck this in the chat as well for you to have a look at if you want to separately so we've just uploaded this this morning it's from Katie herself um and it is on The egb Learning Channel so you're welcome to have a look at it and stuff to do that live won't see that it won't come up it will only come up on the YouTube Facebook watching but we will show you that video on screen as well if you want to watch it in addition to that um it's about five minutes long and I know that sometimes showing videos and stuff people feel well why are you showing it I think it's important to hear from Katie it tackles some of the key points and we will then give you our Reflections on this and following that we'll then show you the detailed stuff is not mentioned anywhere else so you do need to come back and watch this because otherwise you're gonna miss out on the stuff that no one's talked about and things but yeah shall we bring it on Andy yeah and if people could just just let us know that they can hear the sound when it starts as well so that we can we're going to stay in the Corner watching it with you so yeah let go for it hi colleagues I just want to explain a bit more behind today's headlines in case you've been stuck in surgery all day GPC England has tentatively agreed a deal for 25 and 26 but only if West treating rights to all of us setting out his intention to go to treasury to ask for funds to negotiate a wholesale new NHS GP practice contract within this Parliament which needs to do before the conference on the 19th of March because that's what we need if we're genuinely going to save and rebuild our profession back from the brink I spoke to wreting Steven kinck and Senior civil servants yesterday we are on the same page but we still need those written assurances so too do we need the special Conference of lmc's because this is still a fragile deal with a lot of Hope and Goodwill needed three areas going we should next steps ones around online consultation excess which is a red line for the Secretary of State it's given him the headlines this morning that he wanted about fixing the front door to the NHS and ending the 8 AM scramble it does not mean that we're going to have to find unlimited capacity to forame day urgent care we have warned government repeatedly this policy risks leading diminished GP access and increased GP waiting lists we've got a work working group that's going to look at how this can be safely managed and what's needed from online platforms to safely mitigate the risks and manage the demand and capacity mismatch if we aren't there by the 1 of October then we'll need to return to the negotiating table number two GP connect the plan is for NHS registered pharmacists to gain access to writing the record for pharmacy first their clinical decisions mean their liability and for third parties to be private providers working under NHS contracts but we need to be very careful around defining Direct Care my sex worker patient who gets her ears micros suctioned at Specsavers is not going to want her full history shared we're going to need to embed calicot principles here before we can be sure it's safe to switch on in October the Joint gpit Committee will be taking this forward with GPC England and finally GPS in ours yes it's still crap it was NHS England's red line and no it's not improved do you want it to improve we want money going into core so that more GPS can be recruited into practices as salar GPS and partners not spread across God knows how many practices and 50,000 patients there's now a single ours pot split it equally between your practices spend it on the roles you need if you decide in the future that you want to restructure your teams on the back of this then please follow strong HR principles and sound employment law the BMA Canon will help but just take stock first and don't rush the money the headline money is helpful it's 889 million 88% of that is going into practice baselines and then there's the 80 million around advice and guidance on top all in one year that 969 million headline in one year Compares very well to a very similar number that was spread across the five years in the PCN de but the big deal is a new substantive contract so what does this mean for Collective action well much of the collective action menu will be superseded if 2526 goes as planned so we'll need to update it reframe it and consolidate it around safe working guidance principles which have been our policy for the past decade which is still our policy and local contracts and commissioning gaps where your LMC is vital in galvanizing collective bargaining we're no longer in dispute with government but that cannot and should not get icbs who are perpetuating these commissioning gaps off the hook so we shall shift our Focus accordingly when you drill down to an average practice assuming a car Hill of 1.0 assuming an average list size of just over 10,000 you're looking at an additional 940 per patient now we reckon the budget pressures representing the bull Park of just under3 per patient so let's not get carried away the corrected SF reimbursement erosion is great to hire locom and get cover the increase two quid on childhood IMS is welcome but we need proper contract change because the 2004 GMS contract is broken qua yeah it's much simpler but it will be quite tough but it has been modeled to correct for deprivation and there are other minor little bits of flexibility which will be really welcome and which we will explain in due course so ultimately this is a promising start we are on the train towards recovery we are not yet at the destination in fact we are Miles off but at least we are now finally heading in the right direction with a government that is listening and a government that is acting on what we've said enjoy your weekends and we'll speak soon hi there so everyone we have just gone through and heard from Katy bramer our chair of GPC and she talks about a variety of different things I need to get rid of that so that we can see us again and we're going to talk about some of the comments that she's made there um so um there's a variety of information that she's given um I think the key thing that when we listen to this video a couple of times was just simply the fact that this is step one in terms of the contract changes that that's the thing I took from this that um it very much is um seeing the shoots of possibly some changes happening the general practice but it's not the end stage this is the initial phase and this is very much with the view for having wholesale contract negotiation for next year yeah so things I I took Casey's video I mean I don't want to repeat what she said but you know that um that there is still still some areas of ongoing discussion that she was commenting on and that actually um she feels that this is a good start but it's contingent on agreement at the um MC conference on the 19th of March I think she that she said um feels on the same page as the Department of Health uh feels the government is is listening um which was good to hear in terms of how negotiations are going at the end still some areas of ongoing discussion around that online consultation access for routin appointments yeah what does that mean and that doesn't mean unlimited um capacity and that came through as an an anxiety when we were looking at it and and in the comments today um also some concerns about um GP connect and record sharing and we thought the her example of a a sex worker going to to have their ears syringed um at a private Prov and quite how much of their history is relevant really really powerful way actually of expressing that that issue about how much data is it necessary to share to deliver care and appropriate to share um and um also I think the BMA generally not been a fan of GP in ours and that was reiterated there as well um uh around GP and rs she said um or the the combining of the RS funding uh take time and um follow strong HR principles so it's anticipating maybe some rash decisions from primary care potentially you know encouraging people to absolutely that's the thing that we felt came across quite strongly that you know there is this potential emotion for many practices and networks to shift how they currently use their RS budget from April onwards I think mindful of the fact that there are significant questions and concerns around employment aspects and stuff that need to be answered before practice make that reflex to say right off we go kind of thing because actually I'm not these are people's lives um and also again how much value is that going to bring under the current restrictions that also apply with those GPS that can be um employed versus um you know the current service that sometimes is often not seen I think in some places you know in terms of what's happening the stuff um and obviously where that liability of that employment sits as well so is that with the practices is that with employment organizations is that with a lead employer which could be one of the practices or another organization there's lots to and we will be doing that for PM Plus 25 as well there you go yeah yeah I just just just to say I mean a lot of the the population Health ambition that the government have is quite dependent on personalized care roles in my opinion in coordination so you know there's a there's a there's a risk that or that is at risk if um general practice moves more towards practice noing and GP roles I think we're all trying to articulate that in one way or another um I also heard the words we are no longer in dispute with the government I think I heard that so officially Collective action is changed I don't think it's over and as Katie mentioned certain aspects of what many people assume to be Collective action is not going to change from the gpc's perspective so particularly safe working that is not changing that Katie mentioned that's been the bma's policy for the past you know few years decade or whatever as you mentioned but important to note that some aspects of you know the collective action changes are going to change because they have been addressed in this particular contract and being brought forward key thing in this is that there's still a time frame for this not to happen so she mentioned that the special Conference of lmc's which is on the 19th of March is still going ahead and that's still planned to happen um and if they haven't had in writing from West streeting that there will be a wholesale negotiation of the GB contract then actually this may still end up becoming an imposed contract that that's what I took from her comments in that that you know this is not a we have accepted this this is all Rosy there are still some stages that need to happen um and until they happen we miss the Lan in the usual situation that we thought we weren't in a have it's good it creat a bit of a deadline for the for the for the government to to get things in place by them which is is good negotiating positioning I think um so we so we look at the annexes next and there's quite a number of pages of them how do you tle this Gandy there is quite a few just before we do I'm going to go back to just a couple of these comments just because I really want to go through so um Steve mentioned that we need to cut our own sound apologies um so Andy did tell me to do that and I stopped him and the reason for that is is that I've realized if we take ourselves off streamyard then you won't hear the screen share but but but but I'm not sure that's true and we'll talk about that afterwards okay um and secondly um mention from healthy 24 it feels like goggle box so definite shout out to Shan Shan and stuff who's doing some amazing work down in London and stuff um but yeah absolutely um need some biscuits on a coffee well I'm fasting second yeah day two of fasting second yeah that's a bit trickier but absolutely next time we can look at that um so yeah back to the um contract so there's still stuff to go through you know this is the stuff that is basically um being missed basic oh no so more detail so we wanted to cover some more detail that's in here now we've covered a lot the headline stuff absolutely that's there but if we go down um uh so I think if we just scroll over some of these um we can cover them so it talks about 7.2% cash growth it gives you the details of the 2.8% um increase in salaries um in 2A um now um we're going to talk about National Insurance rises in a second that's in the what's missing part but I think it is important to be aware of the fact that there's a question about this and even Katie mentioned it when she talked about the 9 and 4 P off lift per practice but from the bm's calculations ni increases and stuff will be approximately three pound per patient so this is potentially looking at being included in the uplift so actually you've got about six pounds per patient to play with in terms of increase I mean interesting people might have noticed that in the House of Lords I think yesterday on Thursday um the House of Lords voted to make an amendment to the um budget changes around ni to exempt general Practice in the same way or protect general Practice in the same way that the rest of the NHS um would be protected uh the House of Lords is not don't have the final say in terms of legislation a revising house it goes back to the House of Commons so that might not happen but that's just some things I think the concern many people have that the reality is that it may not still happen because the final decision will be the House of Commons which obviously labor have majority and they previously voted it down so whether it will go through or not I think this is a key point to contact your local P to say make it happen otherwise this is going to be an issue um but there is potentially some slit leeway in that and stuff and things but yeah there is a question um and Steve has put it in the chat so I'm going to bring it on so I need to switch my screen Dr Steve Taylor if you haven't seen Dr Steve Taylor's stuff his infographics are Bonkers amazing um hoping that H I'm can't House of Lords House of Lords will be accepted but then they will take the three pound back well maybe maybe not because I don't think the timing of that works to be honest um but we will see um it'd be interesting to see what happens at that point um so they then talk about the core practice contract and um can I just highlight so point three here further uplift may be made following the government's response to the docor and dentist pay review body for 2526 so they're assuming a 2.8% I guess inflationary increasing salaries and they're maybe more on top of that they say because you know in in previous years they were warding 6% l last year for example and then there was an additional um change to funding came through to support that yep absolutely so core PR practice contract changes um so then it talks about um the qua changes that we mentioned so the fact that they're getting rid of 32 qu criteria um reconciling and those points will then be changed into different aspects to both cover the um increasing cost uh increase of payments for the vaccinations as well as the SF payments about look and reimburse ments um and um unfortunately part of that is also making the CBD criteria um um more difficult at the higher end of those points are being allocated to so there are more points available but on compensation they are harder to achieve which we talked about in a great summary there from um Dustin say that we mentioned earlier that showed the percentage changes and stuff that come so so does that means kind of in in the wash for the same achievement we'll get more more money is that the correct way to interpret it no so because I think that the change is you will need to achieve better but you potentially will get more money if you do make that achievement if you do the same achievement what you've had I still think it equates a loss okay so the distribution is to the higher end rather than across the board I believe so but again we will need to look at the detail which we coming to in a second and things um in order to support um so this talks about cvd prevention stuff um and then those s technical changes to quop bring indates in line with nice guidance um we that's in anxd which we'll get to in a second these often tend to be very minor changes which we've analyzed in more detail when we've had the full contracts just because they tend to change if I'm being honest so there's sort of repetition and expansion on the main points isn't there yeah generally as we go through the annex so this is the SF payments changes that it talks about in terms of the adjustments so we talked about 15.9% 17.1% shift in terms of remuneration um and this is around sickness um absence prolonged study Le for example and various other aspects and things um and that they're adjusting them from there there's 12 million allocated that then talks about the vaccine changes I think there was something a little bit more detailed in this um is it two changes to the VAC yeah here we are so part A so two changes to the childhood vaccination schedule driven by the discontinuation of MX vaccine including an additional dose of Hib containing a sixin one vaccine offered at new humanization visit at 18 months of age that's that is new visit isn't it Andy I think so I'm not deep in the vaccinations of my practice okay and the second yeah 18 mon three two years four months yeah so it looks like there's a new vaccination Point yes yeah possibly um practice managers out there nurses out there tellers me unfortun not 100% up to dat in the actual schedule I leave that to my amazing practice nurses to deal with um and practice manager but it looks like there is an extra vaccination point now being included I don't know if that was planned or not but okay um the second dose of M vaccine brought forward from three years and four months to a new immunization visit 18 months to improve the coverage I guess that's something that's very key that we obviously improve our MMR vaccination rates and stuff exchange men being PCV vaccines with each childhood schedule subject to ministerial agreements that's yet to happen a change to the adult shingles program affecting new evidence on the evidence of the vaccination broader severely know so I think that's different criteria people um and the potential introduction of a varisella vaccine so Chickenpox vaccine that they have in other countries um again that's pending ministerial Ascent um an amendment to record the dried blood spot test at risk babies allowing the recording to F Place between 12 and 18 months so reconciliation things so so those details are not been covered elsewhere there's more more to come don't worry there's still more data um but these changes I think are going to be part of the the contract and then obviously mentions about the uplifting the item of service payment which for childhood hims would be very valued not for flu Jabs which is I guess the key one that there's all this question about flu vaccinations and what that means for practices because some of you may or may not remember we covered this a couple of weeks back that actually um flu vaccination in particular and potentially all immunizations been delegated the icbs to manage so the concept of particularly having vaccination centers instead of it being general practice it delivers this is a possibility um and obviously that raises questions in terms of some of the data Shar so whether the GP update record changes will have an implication in that as well but I think there's you know these aspects to be mindful of in terms of how that works and stuff I've got to stop saying that stuff yeah um so the total increase is there and then it mentions about the I can't remember this paragraph I'm being afraid so there's I mean there's a lot of information in the annexes isn't it it maybe that we have to out yeah so just confirmation from Liam man thank you for that um the 18 month vaccine will be a new extra appointment oh thank you so there is some extra stuff in there so even though the payments are going up um there's a new vaccin does that good thing I don't know I would love to hear from you what you think is that a good thing or not good thing or who knows um very short paragraph next in terms of online consultations which reflects the fact that we have absolutely no detail as to what this means and I think that's important for us to share yeah and it was one of the big headlines of this um sort of announcement to the public as well but um but details to to follow about how that will that will work um similarly I think there just sort of re restating the object the objectives they stated before around enabling GP mhm um connect yeah um to those additional NHS and private providers and Community phes have the ability to write into um the record or or introduce data um into the record but they might need to be acted on by practices of course so that needs to be worked out how that will work um so this is not something that's been mentioned so patient safety strategy so um there was a change that was made in terms of practice being included in more safeguarding aspects of sharing of data and this is confirming that still needs to be there um I have to we haven't read this one in full detail um so yeah I mean this this this dropped a few days ago so we've not we there are some aspects of the appendix we've not quite got ahead of but this is basically continuing that aspect of information sharing that needs to happen and this is part of the new kind of way that information is being shared across Services particularly with a focus on child um safeguarding and that kind of thing so um this is just confirming that still needs to happen um and that practice will need to be able to is individuals recording patient safety events being able to download a copy of the record for purpos of supporting apprais and revalidation that's interesting okay this okay fine okay I didn't know that was a requirement of apprais and revalidation maybe that's a change coming okay Point 17 talks about the patient Charter that we've already mentioned uh a waited awaited effectively yeah Point 18 then talks about registering patients out of area um I don't believe there's any changes in this but we would just going to read it quickly to confirm because some of the more detailed stuff was coming up later uh cont reement to Commissioners to register patient out of area provide safeguards with practice list expanding rapidly which we know is happening in many places I know my practice is going flat yeah we have a right above bear with because we get absolutely no access to section 106 Monies that many practices do anyway um these are contra need seek approval their plans to enable commissioner oversight of safety Effectiveness so some suggestion in there that actually the Commissioners have to have this on board in terms of the the practiceing increases and things um and the trigger for approval being required by the commissioner deemed following consultation with the LMC nice to hear that included at the point such an application required contractor's panel list should be closed to new out of area register until the commission is assure the arrangements with contractor has in place making the decision the commissioner should always be able to seek and maintain patient Choice the GP practice interesting disle of Partnerships this is interesting and I'm need some thought about what the implication of this is but the GP contract regulations we amended to make it clear that the GMS that g that GMS contracts can be terminated in the situation where there is no clear successor when a partnership dissolves so there's lots of different circumstances that that could cover really um I mean I guess when people hand back their contracts you know often um it's I mean sometimes it is dissolved and dispersed but quite often it continues um and you know caretaker is found and then a new provider is found and I guess it says contracts can be terminated in the situation where there's no clear successors so I guess sometimes currently they do sometimes they don't so I guess they they can in some circumstances I guess I wonder whether that might give icbs more control over um successor organizations that might take over Partnerships um it's interesting I think we need there's not a lot of detail there I think what it for me what it probably reflects is the fact that we have had situation of Li practice have had to close ktie talked about that and the fact that you know quarter practices have shut over the past 10 years um and that actually you know does this mean that IBS have more options in terms of what to do with that that they don't necessarily have to find a caretaker um which I think would be a negative situation for the local populations because there's a question of obviously that on map happening and it comes down to I guess the size of the population that happens with okay that will that would be I think that's one to watch it's just interesting yeah that that it's there if we have any GPC people watching us please help us understand that one in a bit more detail I might go and ask David rley this one as usual um violent patience so um it talks then about violent patient schemes and in particular as practices having support um in ter terms of being able to manage patients who are violent um so there's just a little bit more detail in that um the process for removal will be made clearer so at the moment there's a couple of processes of removal based on eight day removals off listing intently or within 30 days um so I think there's going to be some more information come through particularly with the violent patient aspects of things um and um effectively that you know there are steps that you need to go through talks about police reports being made um after this period and that possibly that would need to happen in terms of removals that's the way I'm interpreting it does that sound you yes have it alongside so that you need to do those things together again I think they probably even even more detail when the when the actual cont changes are made clearer to us and then amendments um in terms of M managing patient list um This was um I forgotten this one I'm afraid apologies every uh I'm reading processing a lot of information this morning a smaller part that the time frame for deregistration Will redu from six months to three months in terms of managing this when a patient no longer known to NHS England so I guess this is if they leave care that's interesting because I believe that the requirements for nhsk is the fact that you're only resident in the country for six months so if that Chang to three months okay so people could find themselves deregistered and they're needing to reregister when they return oh that's an interesting one obviously we haven't got into the weeds of this particular one yet um and then Chang to SF Care Home adjustments expensing payments so this was just about adjusting that um the care home I I suspect this is for the care home Les payments that'll only be um paid for now if it's a CQC Registered Nursing and residential homes so if they're not CQC registered they won't count which I think will be a fair minority of places nowadays but I think it's just tying up possibly some loose ends um and enable claims for high volume personally administ vaccines to be returned either via new digital for FL for CR press and I think that's to do with vaccination schedules and stuff and things that are happening so de changes y so it talks about ODS changes that we talked about the uh we've already covered a lot of this in the earlier sections in terms of the detail and particularly it's got more of the information around that ref there some GPS okay so this might be interesting in 31 and um we miss this one um uplift representing low quarter the year refle that some GPS were ENT their second year on the scheme proportionate employer cost will also be included in the overall maximum reimbursement amount as in 2425 the maximum reimbursement of those GPS outside of London and maximum reimbursement including one then waiting which set out the contract SP don't it answers the question no in terms of what happens if people have been in that post for multiple years potentially in the future so a point we still need to get to and stuff um it then talks about the cape which we've already discussed in detail and we've covered that it talks then again enhanced service for the advice and guidance and again very little detail in terms of what it actually means talks about the objectives doesn't it the enhanced service will incentivize even closer working between General practices and secetary care and support the government's commitment to move more more care from uh from secondary care to community settings which is quite an ambition for advice and guidance and does imply um a shift in work in in addition to just advice um potentially or an objective to do that which I think which I think is interesting yeah to today and then finally the weight management in hand Services Contin which seems to be the flavor of every single contract update letter we've had for the past three or four years or so so they seem to include it from there maybe with just showing people what's in yeah the the remaining of the annexes um although we will we will we will leave people I think to to digest that so that's the 30 coming on screen right now it's the 31 um criteria that going to be effectively retired so therefore this is what's now going to make up the 212 C points that is now being made available through the item service payment to vaccinations and through SF payments and the changes to the CHD which is these ones um so actually it does it does have the so apologies the reason why we couldn't see that is when we looked at on my laptop my I don't have the full word I have slight different version and it didn't show us the right column and it chopped off yeah it chopped it off so apologies it is there there you go and it's evident and it shows you the difference in terms of the point values and the criterias and you can see there are some significant changes call4 in particular is a big change there yeah hyp 08 um has a re uplift in terms of that upper criteria um hyper n a slight shift 5% there stio 14 and um 15 have the changes with 14 being quite significant I think of 12% also noting the change in the number of allocated qu points um as well which is the just go to the top so people can see uh which is the the third column for for each year as well so there's actually a significant increase in many of these indicators in terms of those reallocated uh qu points so it may it may be that at a certain um same point of achievement you will be receiving more money for achieving that although of course you might have fully achieved retired qu points so in in the mix it may be that you're not getting the same money to be honest um and then let's just see where bigger sh no that's fine actually that's fine um I was just going to say I think the bigger one was that last one um and these are some of the word changes with in terms of how the mentioned about the nice changes we kind of said we weren't going to look at this in detail just because of the fact that here it's here and these tend to change as well has been our experience before the actual contract comes out and then this is talking about the vaccination the MS um schedule changes that it mentioned and we've covered just briefly as well and I believe that's the end that's it of that letter okay so what we're going to do now um is go back to some of the comments because we've had loads through oh good lord got far too many if we can't do them all it doesn't matter people can read people can read each other's um comments as well yeah if we have time to do them all yeah so Jamie's asking is GP connect the one we all advised to rush off as part action yes so I suspect they'll be switching it back on when that comes through um we've also had those who suggested this have clearly had to pin a toddler down for a second vaccination when they're still screaming from the first okay that's the reduction of the the age easier to pin down it yeah fair enough well well she's saying never had to so actually thinking harder now to do that and stuff but I wonder if sh addition additional one I wonder if Shifting the age range for M I can understand why Shifting the age criteria for MMR if the evidence shows it still works is quite powerful because actually that's the one that people have in association obviously for the timing of it with autism and stuff and things and and potentially whe that has an impact on things um uh shanka mentioning we need improvements to GP connect update record at Pharmacy end choice of snowm codes brief structure templates in the four Pharmacy it systems um yeah I think there's some questions around that how to work with and there's an interesting discussion going on in the chat between shanka Dustin and Connor about some of this so you guys definitely go for that I think if anyone can fix that situation of be u3 and maybe some help from Red more other places increasing Max um RS reimbursement without increasing total allocation will add extra pressure on ours budgets adversely affecting other roles is now want put and this is before any ni impact I think that's the concern many people have right for raising it for shment in terms of what's going on um I think that's it for the comments at that point so this point I know we're about an hour and a half in it's a long episode I apologize but we've had Lads to cover um we did want to just briefly cover what's missing didn't we Andy yes so yeah and people will have opinions um out there as well um what is missing there's a lot I mean there's a there's a lot there and we're digesting this on the Fly primary networks guess but that will come in the Le in the in the Dez so there's a few unanswered questions in terms of what happens with PCN D in particular and and as Phil mentioned just there the question of the uplift in terms of total ours budget because not only will ours have to cope with um the um ni uplifts um because don't forget whil prac have got potentially a baseline increase in GMS funding yeah we haven't seen a commitment for the same thing for pcns so where are pcns going to get that change in Ni uplift for because they are separate contracts remember additionally with that there have been pay increases that many PCN have had to give in order to maintain and retain staff um which potentially not facted into that in addition if there's no increase in the budget how do we make this all fly and this is a a real challenge for PC and Clinic directors myself included as to how you Rectify this without going over budget because then you have to find money from elsewhere which is then means you can do less with what you've got so definite concerns in terms of what there's no detail on that yet we hope that will come in the contract yeah yeah and and hopefully we will see a new uh PC and de as well which will answer some of these questions um I think that's probably the the biggest I guess tension here that's created by the changes in these these contracts um I think the other thing that's missing is Clarity on the national insurance and tax changes that are going to happen so you know there is a suggestion that this is being absorbed into the uplift of the gmss contract but we know that's going to be different for different people and obviously the fact that it's not outright mentioned in the letter I think is a slight misstep for my point of view and raises the question why is that is that they're waiting for other things or not yeah I mean I the within the letter is that um currently the position is that practices are going to eat that or make good that increase and actually the increasing the global sum um we'll have to in part go to supporting that unless something changes that was my interpretation but but some more clarity be good um I mean I I I think um perhaps and perhaps this is looking to next year really is just sort of perhaps this contract didn't go as far as some people think it it could have done in some areas uh potentially around um Health inequalities Health Equity um fairer funding models and um potentially uh improving upgrading replacing the car Hill formula um which does um increase proportion of funding to practices with populations facing some challenges but that's generally a high degree of physical disease burden and um advancing age for example uh rather than um inequalities around uh ethnicity language deps deprivation is a big one which we know has a big impact on how well patient engage with their with their treatment how well people are able to achieve their uh qua um you know there are changes to qua but actually those practices that will be able to achieve those higher qua thresholds at the upper end are probably going to be practices um that in areas that are have better engaged patients potentially not always um so I think there's perhaps some um comments or criis be made around how well this addresses Health inequalities which is a big aim for the government and icbs to address so that's a big missing thing for me and I go further on that in terms of the vaccination and in schedule changes so one of the things that we haven't seen is any adjustments in terms of the the rather punitive aspects that for areas deprivation where they have significant different challenges in trying to have patients vaccinated there's no adjustments being made for that it's been a constant problem many of you may remember my rant from a years ago where I was Furious about the fact that there's still not been any changes on that I'm still livid to be honest because actually this is the no exemption reporting yeah so the fact there's no exemption reporting for patients who are out of sync because they've come from abroad that you know that actually we can't force patients to have vaccinations and you know parental responsibility is part of this and you know you can invite a patient in numerous times try your best spend hours with them they're not going to have them they're not going to give it to their children and actually that just it's possible to achieve thing as well because often if you catch people up you've not achieved it within the correct time windows and you still don't get the payment even though you you've done the additional work of chasing those patient so phasing issues and particularly the case for patients who come from abroad which often happens in areas of higher deprivation as well yeah so you know the fact that there's still no recognition of that I I genuinely feel that's something that's missing it is a mstep from both the GPC and NH not to address this growing disparity they continue to create by not addressing this problem I'm off my R horse and things but yeah um definitely some comments coming through from others in terms of things about how this has an impact so Nat Martin some of you may remember from the live stream a while but not to mention insane visit vers that's comps with rurality coming through in terms of that as well um and uh yeah I think that yeah the comment above is is is is is fair as well guess not non-engaging patients don't come and take all your appointments um like you know welltoo 60 to 80 year olds in some areas I guess so it's it swings roundabouts isn't it so I think um engage in private healthcare and therefore have a different use of the system as well in particular yeah um I think you know there's lots of stuff that's going on that that raises questions I think um we will hope I mean one of the things that's missing I think is in terms of um the qua changes so we've had some CFE change but actually many of you remember there was a wholesale consultation on payments to general practice of quo and other types of things and we've not seen the outcome of that many people thought that would happen for this year and it hasn't I suspect the changeing government has been a huge part of that but again it's stuff that's missing that we were anticipating would happen so okay what's going on there in terms of when will that happen yeah and I guess the other things if we're thinking about Reflections and what's missing um integrated neighborhood working was not really mentioned and obviously we know that it's a big objective with the government to create and shift us towards the Neighborhood Health Service the new NHS um so that will be coming I guess in the in the 10-year plan that may be more about that in updates to the parare network de so it was interesting that that wasn't there and that's something thatd be interested to see well very much and again you know is there an extra part of this we haven't yet to see that's going to come um I mean many of us would hope that this is the limit of the changes because this is what the GPC have agreed to so I think if extra stuff was being put in it raised the question of well they not showing up with the GPC are we heading via another imposed contract which I don't think the government really wants to do this they want to show a different um Flav of what they're doing and achieving with general practice and in order to do that they have to have a different relationships which seems Cas was positive words about the relationship with the government and the negotiations so we can maybe draw some reassurance from that um I think Katie also said this is um actually a really big um increase in in funding you know um similar levels to the Primary Care Network Dez but in core funding I think she said something along those lines yeah so um I'm sort of I guess rechallenging this thing actually we they're going to talk about some of the negative aspects and things that aren't there but actually it's a big headline increas in in funding um and there's a lot of positivity there and some positive um noises from BMA GPC so um and the the government is listening and acting um KBS said so yeah I think like we said this is the potential offshoots and growth opportunities for general practice to change I think the bigger thing will be the contract next year I think that's the clear direction we're seeing from this so you know great point to talk about the future what's going to happen now so timelines I think a really useful Andy to cover this point so um the contract offer is out okay I think the next key point is going to come I guess the details are with the GPC yes entally DET further details with the GPC and with NHS England I think the next key point is actually going to be the LMC special conference on the 19th of March because actually that will be a turning point for many of the lmc's to add into the discussion point and remember that Katie mentioned it's west streeting by the 19th of March she wants written confirmation there will be a wholesale Neo renegotiation of the contract for next year so that I think is a key time frame she has given government at Department of Health a deadline that that needs to happen by that point and if it doesn't then I supect there'll be a question of whether the GPC agrees with the ongoing contract at all at that point because that's what they've committed to that's their big ask from all of this is to do that that's why they've agreed to the online consultation stuff being in there that's why they've agreed to GP update record changes that Jamie mentioned earlier that you know many practice switched off that's why they've agreed to the continuity of care and all these other changes that's why the GPC have agreed to it on the premises that contract negotiation wholesale for the entire GP contract is up for grabs for next year so we to see whether that is committed it would be interesting and be careful what you wish for as well because there's um you know a lot that could change and swing in either direction um I guess the next sort of I guess then um new contract comes into Force at the beginning of the new Financial year so the fifth of April um so we anticipated last week of March there will the detail of the contract happens every year um so that could be really interesting because that's the end of Ramadan for me so we may be a little bit later than planned in terms of coming out with some stuff if that was to be the case so please watch this space yeah watch this space but we apologize if it's a little bit later okay I'm gonna have to give you apologies there because I'm afraid that last week of Ramadan is very very chaotic in so yeah and things that's my excuse right now for everybody although the I guess the next date after that so within the letter um a lot of the new uh changes I think I think the date for all of the um New sort of requirements to do things is the is the 1 of October um so that's sort of a key date within that letter so I guess that's a key date for your calendar as well so there'll be some new requirements to be in place and being delivered by the 1 of October um and then after that I guess as as you say um coming around to this time next year potentially very different contract yeah very much so p p contract somewhere in there do you think when when would be expect to no I all drop like it did last year at the last point so it'll be the last week of March that we will have everything come out in terms of what the details will be so as ever there's going to be a raft of documents that come out typically in that last week that explain the PCN dares there'll be clarifications for you know the the GP contract there'll be clarifications for some of the other stuff that we've talked about in the schedules and things there may even be an extra part who knows yeah and of course we've got other government documents coming out such as the 10y year NHS plan as well so there'll be other documents to kind of look at throughout the year I think we know exactly when they get to drop but that's expected sometime in the spring I think yeah is it and I think recognizing that there are still some other contracts yet to come out which will impact general practice so there's the pharmacy contract that we talked about earlier that's going to be coming out soon um I suspect the detail of the dental review will have an impact on general practice as well in terms of what that will look like for um Healthcare as a whole um and there was one more that I've now unfortunately forgotten uh ddb uh uplift figure will be interesting as well and they've said that there will be an opportunity to make amendments to the contract taking into account of higher pay Awards they've assume 2.8 haven't they within this I guess it's likely to be higher than that in reality for uh doctors and dentists so so we've got some more comments coming through I'm just going to go to those just before I do um I would really appreciate it if you haven't done so if you click the like button um and the reason for doing that is that tells us that this has been really useful given the fact we've now been going for an hour and 38 minutes apologies not be more succinct but hopefully this is the detail that many of you crave and we will do a summary in a second um secondly it basically does better on YouTube which is great for us because then that means it actually gets to more people and stuff and things so please please please hit that like button right now um in terms of other things so Mat made a really good point I think is worth sharing with everybody but the overall summary is this contract will Stave off total death of general practice for a year but if they carry on with the financial envelope they will never get the aims of the 10-year plan that's coming delivered I think that says it all and that's very much what I ktie to be saying as well from some of this yeah abely I guess 7.2% um will not achieve um the large shifts uh in the NHS that they're looking for particularly hospital to community you know it's not a transformational contract and and hopefully if there are big Ambitions we we'll have a contract to match there y yeah Steve 9 pound per patient funding increase needs putting in context of the 25 to 35 pound per patient loss over the past nine years if it kept up with inflation very valid point that you know it is appreciated is's an uplift how appreciative should we be given the fact that actually if we kept to place with inflation actually we would have significant more funds for patients and actually probably doing a lot better job um I think on one of the radio interviews that Katie's given she mentioned that the current pot piece of the pot that the general practice have is about 5% compared to go back to 2007 where it was 11% of the NHS share that is Bonkers Le different and and obviously that is why you can't see a GB you know and stuff I gotta stop saying that sorry Apes everyone um sh so Conor uh I'll take that one off actually because I think they're having an individual discussion in terms what's going on um Steve again mentioned need to make sure patient expectations are managed this won't be bring back family doctor and in Rush as well GPS in media don't need to over EG this true um J coming out and Hannah coming out with a good session thank you guys really appreciate the comments and stuff um I think other things to be aware of that are going to have an impact on this so um I know one of the bits that everyone's concerned about is this whole online consultation shift and stuff and things and I think you know um one of the interesting things is how the system providers are going to adjust to this as well because they will need to if there is a different way that practices are monitored then you would want to assume that an HS s will be putting different Contracting requirements on the providers to help some of the because let's be honest some of the aspects of how we manage online consolation particularly Is Not Great fact that some places still having to add separate appointment slots onto their system you know that the fact that some systems aren't aligned with the NHS app which is a clear direction of the government in terms of access for patients and things so I think we are going to see some changes in terms that that happen I think if people want to know more obviously on the separate part of this channel we cover the providers and I've got really interesting streams coming up on the 12th of March with acur couple of others coming up later in the month with other providers and various other aspects in terms of how to utilize Healthcare from there for you should definitely check those out other thing I think is worth mentioning as well I know mentioned it earlier but we really want you to come and join us PCM plus2 where we're going to be discussing a lot of this in so much more detail not just shs is it no it's also Ben Gand um of the primary care podcast and um and Tara Humphries of the business of primary care is that what the hood podcast is called still called that yeah I think she's got some other sub podcasts as well so really great um great lineup and we'll be having um speakers from around the country talking about topics U like Primary Care development organizational development in general um integrated neighborhood working modern general practice um it's going to be really really good and if people want to um join us we're going to pop some information on the screen it'll be in links down below um I'll put them up and stuff but unfortun I don't have key ready for you I'm afraid oh wait no and got them yeah there screen there we go there we go this is Tara's this is Tara's website um but um but you can go to THC primary. co.uk for pcnen plus hyen live and you can sign up and join us and have a look there's a photo there from from last year when we were at nsing business school we've upgraded to the Crown Plaza Hotel um this year so it'll be a really nice um conference um and there are still tickets available to buy online or to sign up for um a uh a reserve list ticket so we can let you know if advis just before we sign off so we've got some more comments coming through but I we've been asked always to try and give summary because obviously we' going for an hour 43 and we need to get moving soon because you need to go so we're going to do a really quick summary do you want to do this or am I doing this or how we doing this oh gosh gny there's so much I'm gonna say you can do it all right fine let's go so I'm gonna try and remember as much as we can in this summary of the contract changes so the big headline stuff is the increase in funding 889 million that's going in total in terms of delivering the contract changes um an addition to that is an 80 million pot that's going to be for advice and guidance details yet to come um part of those changes will also um incorporate um retirement of certain quo criteria 31 criteria in total which we have shown that to you on the full live stream um of which some of that basically equates to well that equates to 212 C points those 212 C points as part of that some of it is being used to pay for the item of service increased charge of2 per vaccination and the full schedule of that we again we've shown you in the full episode also some SF changes in terms of payments for loc and reimbursements Etc mat cost and then additionally increasing the qua pointage to cardiovascular prevention qua criteria unfortunately the downside to that is achiev most ceria is now harder various changes many some of them going up to 90% as a result of that the next part we talked about was about the changes to the additional roles the PC and dares in particular two aspects of the P are is the additional roles reimbursement scheme which is the amalgamation the gpn RS and the formal RS into one pot and the um addition of practice nurses but we still got into detail what that means but it does mean nurses that have not worked in that PCN or practice representing that PCN also um the loss of the restrictions of the number of GPS available to be hir which does raise some questions for many practices and networks in terms of employment liability um and as one of the comments I think Steve made there's already a um legal Challenge on some of the PA stuff that's going on current currently so being mindful of that the second change for the PCN Des is the changes to the cape payments so the Cass in Access Improvement payments of which the total part is still the same however the local payment that we had from 2425 is now changed instead of being paid in three different parts paid in two parts one which is two-thirds of that payment which is the modern general practice no details yes to what the criteria are for that and the third payment will be for local risk stratification aable continuity of care for your patients by the PCN we will see wow that was again doesn't have any notes here as well that's absolutely incredible memory work um and then the just two additional things that we also covered so one was the um uh requirement of uh practices to open up online consultation tools to request for routine appointments again we're awaiting detail in terms of quite what that will look like and then there was the requirement to switch on GP connect um to enable the facility for other NHS providers and private providers to have read access in order to provide safe patient care with consent being required particularly for those private providers and also the ability for Community uh Pharmacy register professionals to send consultation summaries back into the patient workflow to be coded within the patient records and the potential ups and downs of that facility being available um I think that covers the main point that's the headline stuff there's the detail in the full episode that we've just gone through for the past hour and 46 um I think you know thank you everybody for joining us we've got some really amazing comments in there that's still coming through which is crazy um Serena mentioning about patients being able to book more appointments Online requests as their usual doctor how do you think they'll delivering Prim care I think that will be the online changes that we see I think you know speak to online providers about that and like I said covering some of that definitely if you're using accur or if you want to use acri join us for that live stream on the 12th of March and that'll be coming up at the end of this um and yeah I think that's everything isn't it Andy I think so thanks everyone for for joining us um we have pretty good numbers throughout the whole thing which is great sh 300 of you joining us live I mean I think that may actually now be the largest live stream we've ever done and we've not even got to the full contract review so if this was an hour and 45 God knows how long that was going to be but we're gonna have to do we'll do it we'll do it we'll we'll open up the uh the studio again when that special event happens in the comments please let us know what you thought of the studio we'd love to know your feedback on that because I suspect the contract review will probably do a similar format thank you all hope you had a great time catch you in the next episode wewe Tech command Prim and learning