NEGOTIATORS REPORT for the GPC MEETING 18 May 2006 s1

Appendix 1

NEGOTIATORS’ REPORT FOR THE GPC MEETING – 19 April 2007

Access DES and Choice and Booking DES from April 2007 (England) The status of the Access and Choice and Booking DESs from April 2007 remains unclear. Whilst these were one year DESs with a commitment to review for 2007/08, the current negotiating situation means that we have not, as yet, had formal discussions with NHS Employers about the future of these DESs. We have asked for an urgent decision one way or the other from NHS Employers about whether these will be rolled over in either their current or a different form and will wait until we see what is offered before making a final GPC decision. We are aware, however, that some PCTs are seeking meetings with LMCs to negotiate LESs for Access and/or Choice and Booking. In this circumstance we would recommend that LMCs only negotiate local arrangements that are adequately and appropriately resourced and with the option that, should any national solution be agreed, there is an option to move to the national arrangements at that point.

We are also aware that some PCTs are asking practices to continue to participate in the PCAS survey in 2007/08. The ‘Safeguarding patient services, maintaining cost- effectiveness’ released this week made it clear that there is currently no funding to support the work previously paid for under the Access and Choice and Booking DES. Practices should feel under no obligation to co-operate with surveys or use Choose and Book, particularly if they feel these do not advance patient care. It is for every practice to make their own decisions based on their specific circumstances.

The position of the Access DESs in Wales is still unclear and Northern Ireland is unlikely to make any decision until their new minister is in place – likely to be towards the end of May. It is anticipated that the Scottish Access DES will remain as agreed for 2006-07 but we are still awaiting final clarification.

Safeguarding patient services, maintaining cost-effectiveness Guidance for GP practices on safeguarding patient services and maintaining cost- effectiveness was released on 4 April. This makes clear that GPs’ first priority will be to safeguard patient services from the effects of a reduced practice income and that despite financial pressures they will also wish to continue to reward practice staff fairly. Moreover, the guidance, as well as having input from the full negotiating team and the subcommittee chairmen, was agreed with lawyers and a QC who specialises in industrial relations law, to ensure that neither the BMA nor practices were being put at risk of breaching that very complex area of legislation.

Practices were advised that while it may not be possible to bridge the gap between rising costs and a zero increase in practice income, it is likely that GPs will want to review their practice workload and costs to explore decisions and actions they could take when trying to balance the practice’s books. In much the same way that tight NHS budgets have resulted in pressure on hospitals to review their services, primary care providers will now need to take tough, business-minded decisions to minimise the effects on both the practice and patient services. This guidance identifies a number of measures to help practices with their business planning and we hope that many practices will take on board what is said.

The guidance can be accessed here: www.bma.org.uk/ap.nsf/Content/safepatientserv0407

1 Patient Experience Survey – publication of results (England) The Department of Health has issued further guidance on how the results of the patient survey to measure Access and Choice and Booking will be released and used. This can be accessed at the following link: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D H_073623

Whilst the exact method for reporting results is currently being developed, each PCT will have access to the results for all of the participating practices in their areas. We believe that PCTs should inform individual practices of their results as soon as possible after receiving them and this is reflected in the guidance. However, it is worth noting that, following receipt of results data, PCTs will need to authorise and process payment to practices as soon as possible, which could take up to two weeks.

New plans for patient choice On 11 April Patricia Hewitt announced a package of measures to help patients in the most disadvantaged communities to make choices about their healthcare and empower them to shape services around their needs and experience. This includes a range of new initiatives including the launch of a new website NHS Choices, Choice Library pilots and, from July, a 'free' choice of any hospital provider in the country for patients needing orthopaedic treatments. When the service goes live in the summer, patients will be able to search comprehensive directories on GPs, hospitals and care homes. They will be able to access information on waiting times, readmission rates and cleanliness, and have access to approved medical literature previously only available to clinicians. Whilst some of this could be valuable for patients, including the 'knowledge base' aspect of the scheme which will encourage patients to become better educated and take more responsibility, there are concerns about the information section that will be open to interpretation and may lack professional input from clinicians. There are also concerns that the system will exclude some of the most needy patients - in particular elderly and disabled people - who may not be comfortable or able to use the Internet. Dr Foster Intelligence has been awarded the contract to design and develop the website and has suggested it should meet with the BMA to discuss development of the website. Practice based commissioning (PBC) in 2007-08 – GPC guidance The Department of Health (DH) published ‘Practice based commissioning (PBC): practical implementation’ in November 2006. This latest DH guidance applies to the 2007-08 financial year and can be found online - visit the DH website.

Apart from certain sections, it replaces the 2006-07 guidance ‘Practice based commissioning: achieving universal coverage’ published in January 2006. In addition, it builds upon the DH publication ‘Health reform in England: update and commissioning framework’ issued in July 2006. The GPC guidance released on 19 March is based on the latest DH guidance and gives a detailed analysis of policy and guidelines for PBC and the rules around service provision and procurement for 2007-08. We have also produced a shorter ‘key issues’ guidance note for those GPs who are less heavily involved in PBC. Both documents are available here: www.bma.org.uk/ap.nsf/Content/Hubpracticebasedcommissioning

APMS developments in under-doctored areas On 19 March the Department of Health, as part of the ‘Fairness in Primary Care Procurement’ programme, revealed the first four areas taking part in the new programme aimed at tackling long-standing inequalities in GP services; Hartlepool, County Durham, Ashfield and Great Yarmouth. This is a further programme that encourages plurality of provision in ‘under-doctored areas’ that will utilise the Alternative Provider Medical Services (APMS) contract to attract a range of providers.

2 The Department press release stated that these services will offer extended GP opening hours, including evening and Saturday morning surgeries, and that the Department of Health will centrally manage the procurement process for Primary Care Trusts (PCTs), while PCTs will own, manage and sign-off their local contracts. It states that the programme aims to attract a broad range of providers from existing entrepreneurial GPs to social enterprises and corporate independent providers and that the new services are expected to open to patients by the end of 2007.

Details of the procurement and the level of funding available will be made clear in due course but we have made it clear that existing GPs have a cost effective track record of providing top quality services for patients and that they must be allowed to bid for the new resources on an equal footing with newcomers such as private providers. What we do not want to see is any attempt to use this announcement as a back door way of privatising the NHS.

Practices and LMCs areas may wish to be reminded of our guidance on APMS (available to members only – link below) which includes advice on tendering and bidding for contracts. www.bma.org.uk/ap.nsf/Content/apms0406~bidforapms