Written Statement: General Medical Services (GMS) Contract Reform for 2019-20

I am pleased to announce that the negotiations for the 2019-20 General Medical Services (GMS) contract have concluded and agreement reached that will see £25million invested into GMS this year. Further funding will also be made available this year to cover the rising costs of superannuation.

Over the last 18 months we have continued with our ambitious programme of reform to the GMS contract. The approach has been managed through the GMS Contract Oversight Group and operated through a tripartite agreement, including representatives from Welsh Government, General Practitioners Committee (GPC) Wales and NHS Wales.  As the only UK nation to fully involve the Health Service in work on contract reform, I am pleased to see the strong alignment and integration that has been evidenced as a result of this tripartite approach.

This round of negotiations has been significantly challenging and I recognise that the length of time these have taken has caused unrest within the profession. This reflects the difficulty of changing a contract which has been in operation for 15 years and finding changes which meet the needs of all parties involved.  I believe that the agreement reached will deliver the much needed investment into services to improve sustainability and to enable the changes needed in the delivery of GMS. I am pleased that this agreement will see Welsh GPs with a higher £ per patient value than their English counterparts, coupled with the investment being made elsewhere.

In support of delivering on the aims of A Healthier Wales, scaled up working and an increased level of planning and delivery of services at a cluster level has been a core priority for the reform programme. The new contract involves significant changes which will see this marked shift become a reality for specific activities such as Quality Improvement and Enhanced Services, whilst also providing sustainability to GMS and improved access to services and data.

In recognition of these changes, the following funding arrangements having been reached for 2019-20:

• An uplift of 3% to the general expenses element of the contract for general expenses. 

• Investment of £9.2 million for the implementation of the Access to In-hours GP Services Standards published on 20 March. 

• A further £3.765 million going into Global Sum this year, to fund the infrastructure needs of practices in working towards achievement of the in hours access standards.

• An investment of up to £5 million will be made available to incentivise partnership working as the preferred model for GMS and to encourage new GPs to take up partner roles though the introduction of a new Partnership Premium available to all GP partners regardless of length of service.

Coupled with the financial changes, a number of activities have been agreed as part of the reformed contract which will build on the existing maturity and operation of clusters across Wales and bring clarity to the role they have in the healthcare system. We have also taken into account concerns around the Quality and Outcomes Framework (QOF) and the concerns within the profession around the impact of GDPR.

The changes this year include:

• With a clear focus on strengthening the role of clusters in terms of working collaboratively to plan and deliver services locally, practices will now be required to be members of a cluster, through the terms of the core contract.

• An improved cluster planning process with clearly defined output and activity indicators included in the new Quality Assurance and Improvement Framework (QAIF) and a requirement for the delivery of Enhanced Services to be planned at cluster level. The wider strategic context and governance arrangements of Enhanced Services will be reviewed during 2019-20.

• Taking on board the concerns around the value of the existing QOF indicators, this will be replaced with a revised improvement focussed Quality Assurance and Improvement Framework (QAIF), to include the introduction of a “basket” of Quality Improvement Projects to be delivered at a cluster level with a focus on Patient Safety.

• Regulations will be drafted, consistent with General Data Protection Regulations (GDPR), in order to allow for the sharing of patient data for specific purposes.

• Recognising the difficulty partner’s face in the rare instances of “Last Person Standing” agreement has been reached to the scope of the approach LHBs will take in providing support to these practices. Premises as a whole is a key issue which needs to be considered and a commitment has been made to undertake further work in 2019-20 to address the wider premises issues faced in General Medical Services.

I would like to take this opportunity to thank all colleagues in NHS Wales and GPC Wales for their ongoing engagement and commitment to this programme of reform. Whilst progress has been made with a number of items, there is still a substantive body of work to undertake for the forthcoming year and I am confident that the collaborative effort shown this year will continue and stand us in good stead for the future.