Changes to Primary Medical Services Contracts

The National Health Service (General Medical Services Contracts and Personal Medical Services Agreements) (Amendment) Regulations 2015 (the Regulations) come into force on 1 April 2015. The Regulations introduce new mandatory contractual terms that must be included in general medical service (GMS) contracts and personal medical services (PMS) agreements made between NHS England and GMS or PMS contractors (contractors).

Which terms are being introduced and why?

  • All patients under the age of 75 must be provided with a named accountable GP. This term requires contractors to assign an accountable GP for every patient under the age of 75 except where the patient does not want one to be assigned to them. The accountable GP will take lead responsibility for coordination of all services provided to the patient at the contractor's practice. Introduction of this mandatory term follows on from the introduction in 2014 of a named accountable GP for those patients aged 75 and over.
  • Provision of NHS Primary Medical Services to certain armed forces personnel. This term enables a contractor to accept a member of HM armed forces as a patient for a maximum of two years if authorised in writing by the Defence Medical Services and the contractor is satisfied that he/she is living or working within the contractor's practice area. Currently patients who join HM armed forces are removed from the list of GPs providing NHS primary medical services.
  • Publication of earnings information. This term requires contractors to publish details of mean net earnings of GPs who are party to a GMS contract or PMS agreement or who are employed or engaged by the contractor whether on a full time or part time basis for a specified minimum period in their practice for the previous financial year. This information must be published annually for the preceding financial year on the practice website (or on the NHS Choices website where the practice does not have a website) and in the practice leaflet. Contractors will also be required to publish the number of full and part time GPs associated with the published figures.
  • Extension of the scope of online access to medical records and improvement in online appointment booking. This term requires a contractor to provide patients with online access to their medical records except in certain limited circumstances. In addition it also requires the contractor to act to increase the number of appointments available for its registered patients to book online where this is necessary to meet the reasonable needs of those patients.
  • Mandatory contractual terms requiring:
    • Contractors to establish and maintain a Patient Participation Group for the purposes of obtaining reviewing and acting on feedback from the contractor's registered patients about the services provided by the contractor.
    • Contractors to offer alcohol screening to newly registered patients over the age of 16 and to offer appropriate interventions to any such patient who is identified as drinking at increasing higher or dependent levels.
    • Currently contractors have the option to establish a Patient Participation Group or offer alcohol screening as both are directed enhanced services.
  • Provision of information on out-of-hours services. This term introduces a requirement on contractors who provide out-of-hours services to their registered patients to comply with any requests for information about the provision of such services which are made by or on behalf of NHS England.
  • NHS contracts and NHS disputes. Currently contractors can chose whether their GMS contract or PMS agreement is to be either an NHS contract or a non-NHS contract. Disputes arising from an NHS contract are determined by the NHS Litigation Authority. Disputes arising from non-NHS contracts are determined through the courts unless the contractor opts to use the NHS disputes procedure. Contractors may alter the status of their contract if they wish.

    Currently if the holder of an NHS contract changes the status of the contract to non-NHS contract any disputes relating to the period when the contract was an NHS contract may not be determined by the NHS Litigation Authority. This new term provides in effect that disputes under a GMS/PMS contract or agreement that is not an NHS contract but which relate to a time when the contract was an NHS contract may be referred to the NHS dispute resolution procedure by either the contractor or NHS England.
  • Responsibility for out-of-area patients. Currently a GMS/PMS contractor is unable to remove a patient from their list of registered patients on the ground of the patient's medical condition. This new mandatory term allows contractors who have registered patients from outside of their practice area to remove them from their list if there is a change in the patient's medical condition which means it is in the opinion of the contractor no longer clinically appropriate or practical to continue to provide services to them on a basis which does not include home visits.
  • Friends and family test. The requirement that a contractor gives patients the opportunity to provide anonymous feedback about the service received from the practice through the friends and family test was introduced in October 2014. Practices were required to report the results of their friends and family test to NHS England and publish the results of completed tests at a local level (although NHS England guidance was not specific about the manner of publication). The amended term dealing with the friends and family test effectively removes the requirement for a contractor to publish the results of completed tests at local level.
  • Practice leaflet. Finally the amended Regulations now require that contractors include in their practice leaflet information on the new mandatory contractual terms namely the Patient Participation Group and the alcohol screening service.

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