PMS Contract Service Specification

PMS Contract Service Specification

Version 12 – July 2009

Introduction

This service specification sets out the PCT’s requirements of PMS contract holders, and includes details of how those requirements will be measured and funded, as well as how practices can deliver the requirements and what support they can expect.

It is the PCT’s intention that PMS practices provide accessible services, achieve a high level of clinical quality and help to improve the health of their practice population. As a result, this specification goes beyond the requirement of the GMS contract and of QOF, but it also clarifies the PCT’s expectations of standard ‘GMS’ type services. Some elements of the requirements have separate funding attached, whereas others are included within a baseline contract value. Regardless of funding, the PCT attaches importance to these requirements and to the indicators and therefore includes within this specification a performance management framework which specifies when the PCT considers practice performance to be acceptable and when improvements are required. Indicators are intended to be challenging for practices, but achievable, and to reflect patient needs. Requirements will be reviewed on a regular basis so as to ensure that they continue to reflect PCT and patient needs, and also that they remain achievable.

Indicators have been chosen, ideally, where data is already available, for example via QOF, although some items will require practices to collate and submit information to the PCT. The PCT will provide standard searches and train practice staff on how to use the searches. However, it is a key requirement of the specification that practices should be capable of providing the information that the PCT needs in order to manage the contract. Where practices do not submit information, the PCT will be entitled to assume that the practice does not comply with the contractual requirement.

It should be noted that many indicators will require practices to improve performance over time. This is intended to ensure that practice workload is not concentrated in the early years of the contract, and also allows practices to gradually develop their approach to achieving the indicators.

In the case of conflict or ambiguity, the order of precedence for this agreement and the schedules and documents attached to it shall be first this schedule (number), and then the Agreement.

Services to be provided

The practice is required to provide or participate in the following:

·  Essential medical services as defined in regulation 15(3), (5), (6) and (8) of the National Health Service (General Medical Services Contracts) Regulations 2004. For the avoidance of doubt the following are included as essential services: Primary care based phlebotomy services to registered patients, Booking of ambulances for patients referred to hospital and other appropriate locations, Provision of primary medical services in core hours for the immediate necessary treatment to any person to whom the contractor has been requested to provide treatment owing to an accident or emergency within the practice area.

·  Additional medical services as defined in the National Health Service (General Medical Services Contracts) Regulations 2004, except where the PCT agrees with the practice that it will opt-out of those services. It is agreed that the practice is opted out of the provision of Out of Hours services. Further detail is given separately. Additional services provided by the practice include:

o  cervical screening services

o  contraceptive services

o  vaccinations and immunisations

o  childhood vaccinations and immunisations – Note – the Health Visitor role is to follow up patients who repeatedly do not attend or have complex roles. The Health Visitors role does not involve delivery of routine immunisations

o  child health surveillance services.

o  maternity medical services (excluding intra partum care)

o  minor surgery (cryotherapy, curratage and cautery). If a Practice has not opted out of delivery of this service then there should be no referrals to Tier 2 services for procedures within the scope of this additional service.

(if a Practice has opted out of delivery of any of the additional services detailed above, this section will be amended accordingly)

·  Participate in the Quality Outcomes Framework

·  Provide enhanced services as required by the PCT and as defined within separate agreements

·  Provide services beyond essential, additional and enhanced in order to achieve the Key Performance Indicators specified elsewhere in the contract

·  Provide data to the PCT in order for the PCT to perform its statutory duties and also to monitor this contract. Data must be provided to the timescale set out by the PCT. Required data will be clearly specified with templates provided and clear timescales and dates of submission.

·  Allow PCT staff to enter the practice premises in order to collect data to monitor this contract and also in order to perform statutory duties. This should be done by pre-agreed dates.

·  Allow access, by prior arrangement to the practice for organisations that inspect or comment upon health services, and in particular, give access to organisations that represent patients’ interests. The Practice will ensure that patient confidentiality is not breached by any such visit. The PCT will set out a process for approving organisations to visit Practices. The Practice will not be visited more than three times per year under this requirement.

·  Allow the PCT to undertake post payment verification as may be necessary to verify claims made for payment under this contract

·  Meet with the PCT to review performance under this contract annually or, more frequently where required under the terms of the performance management section of this specification.

·  Work to agreed national and local guidance and standards

Since the practice is opted out of Out of Hours services the following applies:

The Out-of-Hours period is defined as from 6.30pm to 8.00 am on weekdays, and the whole of weekends, Bank Holidays and Public Holidays, and at other times as arranged between the PCT and its Out of Hours Provider. The practice will not be providing Services during the Out-of Hours period, other than as agreed for extended hours, but will co-operate with the PCT’s commissioned Out-of-Hours provider and will comply with any requirements determined by the Out of Hours provider to ensure the safe and effective running of that service.

Practices will be required to transfer phones to the out of hours provider no earlier than 6.30pm, and ensure that phones are taken back from the out of hours service no later than 8am.

Enhanced services

For the avoidance of doubt all current enhanced services have been excluded from this specification and will be commissioned separately. The Provider may sign up to the following Enhanced Services provided the criteria is met for delivery of that service:

·  Drugs misuse

·  Access/Extended hours

·  Heart failure

·  Minor surgery

·  Osteoporosis

·  CVD At-Risk (to be replaced by Vascular Screening in due course)

·  IUCD

·  Learning Disabilities

·  HPV Vaccination

·  Influenza Vaccination

·  Alcohol Misuse

·  Ethnicity recording

·  Childhood immunisations and vaccinations

·  Anticoagulation monitoring

·  Near patient testing

·  Practice Based Commissioning

·  Choose & Book

The list of enhanced services above applies to 2009/10 and is subject to change at the discretion of the PCT following discussions with the LMC. Inclusion to deliver a service in the above list does not constitute a guarantee that the PCT will continue to commission that service.

Where enhanced services have performance standards set out their specific service level agreement any unsatisfactory performance will be counted within the performance management procedure outlined separately in this specification.

In the event that a Practice chooses not to deliver an enhanced service, the Practice must co-operate with any alternative Provider identified by the PCT.

Finance schedule

The Provider will receive payments as set out below. Payments will be calculated quarterly based on the list size and performance at the end of the previous quarter and will be split into monthly payments.

Service / Notes / Payment per annum / Payment arrangements
Essential services / Weighting of the practice population is calculated through the Exeter system based on the Carr-Hill formula
For the avoidance of doubt – growth funding will cease to apply from the date of implementation of the new contract. / £64.80 per weighted registered patient / The payment will be adjusted each quarter to reflect the practice’s actual weighted patient numbers at the start of the quarter. For example, this means that monthly payments will be made at the end of January, February and March based on the weighted patient numbers at the end of December.
Additional services / For each service that the practice is opted out of a deduction will be made as set out in the table below
Additional Service / Deduction / How deduction is calculated
Child Health Surveillance / £2.60 / Per patients aged 0-15 years
Minor Surgery (cryotherapy, curettage and cauterisation) / 0.6% / % reduction of weighted price per patient as GMS
Childhood immunisations and
pre-school boosters / £10.49 / Per patients aged 0-4 years
Out of Hours Services / 6% / % reduction of global sum weighted price per patient as GMS
Costs have not been calculated for opting out of the following services since no contractors are opted out:
·  Cervical Screening Services
·  Maternity Medical Services excluding intra partum care
·  Contraceptive Services
·  Vaccination and Immunisation Services / The payment will be adjusted each quarter to reflect the practice’s actual relevant patient numbers at the start of the quarter. For example, this means that monthly payments will be made at the end of January, February and March based on the relevant patient numbers at the end of December.
Quality and Outcome Framework / As per the statement of financial entitlement (SFE) There will be no deductions of points made from the QOF points achieved by the practice. / Not applicable / The PCT will agree with the practice an aspiration level for QOF achievement. This will be used to calculate an expected year end achievement and 70% of this expected achievement level will be paid in monthly instalments over the year. Once the practice submits its monitoring data to QMAS at year end an achievement amount will be calculated. The PCT will then calculate the balancing figure to be paid equal to the amount that the practice is entitled to less the total of the monthly instalments paid during the year.
Enhanced Services / Practices will be paid as per the Service Level Agreement for each enhanced service that the practice has agreed to provide. / Not applicable / The PCT will agree with the practice an aspiration level of enhanced service payments for each financial year. The PCT will pay the practice 70% of this aspiration level in monthly instalments with a balancing amount based on claims received by a date after the end of financial year.
Performance indicators / Payments will be made as set out for each individual indicator. It should be noted that a practice achieving “Excellent” on all the Key Performance Indicators” that have funding attached will, on average, receive around 6.5% extra on the funding for essential and additional services. / Not applicable / The PCT will agree with the practice an aspiration level for achievement of the performance indicators. This will be used to calculate an expected year end achievement and 70% of this expected achievement level will be paid in monthly instalments over the year. Once the practice submits its monitoring data at year end an achievement amount will be calculated. The PCT will then calculate the balancing figure to be paid equal to the amount that the practice is entitled to less the total of the monthly instalments paid during the year.
Premises / As per the GMS Premises Costs Directions, the PCT will reimburse Notional Rent, Business Rates, Water & Sewerage charges and Collection & Disposal of clinical waste
Special leave / Practices will receive payments as per the SFE for Sickness, Maternity, Adoption, Paternity and Suspension. In addition, payment will be made for Jury Service to the level set out for sickness payment provided that the GP requests to be on service for trials lasting less than two weeks.
Superannuation / Included in contract value / Where the practice uses a sessional or locum GP for more than 6 weeks the costs of their superannuation will be deducted from the Provider’s payments
Transitional relief / Practices that have reduced payments as a result of implementation of this new contract will receive transitional relief payments. Relief payments will be calculated as follows:
·  Based on list size at end of September 2009
·  Assumption that all practices achieve 100% Excellent on all KPIs
·  Finance Department to calculate full year entitlement under previous contract arrangement and full year entitlement under new specification
·  Each practice whose funding reduces will receive 75% of the loss during 2010/11 and 25% of the loss during 2011/12 / The transitional relief will be a fixed sum of money and will not be adjusted for inflation or for list size changes that occur after the end of September 2009. The relief payments will be paid in 1/12ths on a monthly basis.
Seniority / As per Statement of Fees and Entitlements / Seniority follows the individual
Appraisals / Paid separately
Personally administered drugs / Paid separately as per regulations
Courier service / This will be deducted from the contract price
Statutory and voluntary levies / This will be deducted from the contract price

It should be noted that the above does not include any funding that the practice may receive for Assistant or Trainee Assistant Practitioners. This item is currently subject to review and will be dealt with separately.