This page sets out guidance and links to further resources to support implementation of changes to General Medical Services (GMS) contractual arrangements that will apply in England.
A short summary of key parts of the contract
- Core general practice funding will increase by £978 million per year by 2023/24.
- A PCN contract will be introduced from 1 July 2019 as a Directed Enhanced Service (DES). It will ensure general practice plays a leading role in every PCN and mean much closer working between networks and their Integrated Care System. This will be supported by a PCN Development Programme which will be centrally funded and locally delivered.
- By 2023/24, the PCN contract is expected to invest £1.799 billion, or £1.47 million per typical network covering 50,000 people. This will include funding for around 20,000 more health professionals including additional clinical pharmacists, physician associates, first contact physiotherapists, community paramedics and social prescribing link workers. Bigger teams of health professionals will work across PCNs, as part of community teams, providing tailored care for patients and will allow GPs to focus more on patients with complex needs.
- A new shared savings scheme for PCNs so GPs benefit from their work to reduce avoidable A&E attendances, admissions and delayed discharge, and from reducing avoidable outpatient visits and over-medication through a pharmacy review.
- A new state backed indemnity scheme will start from April 2019 for all general practice staff including out-of-hours.
- Additional funding of IT which will allow both people and practices to benefit from the latest digital technologies. All patients will have the right to digital-first primary care, including web and video consultations by 2021. All practices will be offering repeat prescriptions electronically from April 2019 and patients will have digital access to their full records from 2020.
- A new primary care Fellowship Scheme will be introduced for newly qualifying nurses and GPs, as well as Training Hubs.
- Improvements to the Quality and Outcomes Framework (QOF) to bring in more clinically appropriate indicators such as diabetes, blood pressure control and cervical screening. There will also be reviews of heart failure, asthma and mental health. In addition there will be the introduction of quality improvement modules for prescribing safety and end of life care.
- Extra access funding of £30 million a year will expand extended hours provision across PCNs and from 2019 see GP practices taking same-day bookings direct from NHS 111 when clinically appropriate.
This contract framework will see billions of extra investment for improved access to family doctors, expanded services at local practices and longer appointments for patients who need them. Watch this video which summarises the key points of the five year contract framework:
New guidance to support practices make at least 25% of their appointments available to book online
The GP contract (NHS Long Term Plan and Investment and Evolution: a five-year framework for GP contract reform) set out that from April 2019, all practices must offer patients an opportunity to book a minimum of 25% of all appointments, online. This figure of 25% can be made up of GP appointments, all nurse appointments or other practice staff, as well as appointments made available online to NHS 111. Whilst practices differ in how they manage their appointment books, there are very few appointment types that are not suitable or adaptable for online booking.
This practice guide, designed to be read within five minutes, contains helpful hints, tips and case study experiences to support general practices to make sure that at least 25% of their appointments are available to book online. Covering, a full list of the types of appointments to include, important things to consider and configuration hints and tips.
Ensuring that appointments are available to book online is just one step in a series to deliver the vision of digital first primary care as set out in the Long Term Plan. Patients can also book and cancel their appointments, order their repeat prescriptions, view their medical records as well as look up their symptoms and register their organ donation preferences using the NHS App.
Download your copy of the Practice guidance: offering 25% of appointments online.
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Patient access to records online: Prospective record access
The NHS Long Term Plan and Investment and Evolution: a five-year framework for GP contract reform commits the NHS to give new registrants with full online access to prospective data, subject to existing safeguards for vulnerable groups and third party and system functionality.
NHS England and BMA General Practitioners Committee (GPC) in England have developed additional guidance and resources to support GP practices in meeting this commitment. These are:
- Joint statement which clarifies the commitment
- Practice guidance including illustrated clinical system setup information
- Practice guidance accessible text version
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Interim findings of the Vaccinations and Immunisations Review – September 2019
The NHS Long Term Plan and Investment and Evolution: a five-year framework for GP contract reform committed to undertake a review of vaccination and immunisation, procurement, arrangements and outcomes in 2019.
This interim report sets out the work of the Advisory Group to date prior to commencing contract negotiations with the General Practitioners’ Committee England and the Pharmaceutical Services Negotiating Committee.
If you would like to make comments on this initial review, please send them to us by 15 November via email to firstname.lastname@example.org.
Improving identification of people with a learning disability
The NHS Long Term Plan commits to improve the care of people with a learning disability. To support practices and to ensure that they have an accurate and complete register of these patients, NHS England and Improvement have published guidance on Improving identification of people with learning disability. Practices should review this guidance and ensure that eligible patients are offered a flu vaccination and flagged for a health check.
Digital-first primary care: response to the policy consultation on patient registration, funding and contracting rules
The NHS Long Term Plan commits that every patient will have the right to be offered digital-first primary care by 2023/24. But the current GP contract rules weren’t designed for digital-first services, and cause problems for existing practices, the NHS and new providers alike.
NHS England and NHS Improvement recently sought views on options and proposals to change patient registration, payment and contracting rules. Following careful review of the feedback received, we have published our response to the consultation – read the full response here.
The response sets out that we will:
- Take forward proposals to disaggregate a patient list and create a new APMS contract when a provider registers a certain number of out-of-area patients in another CCG. This will ensure digital-first services are better connected back wherever possible to local service delivery;
- Make an adjustment to CCG budgets based on the age and gender of the patients registering with digital first practices, plus the practice they were previously registered with;
- Leave arrangements on the new patient registration premium unchanged;
- Create new opportunities for providers to set up new digital-first services in areas of greatest need (e.g., under-doctored areas or areas with poorest access and long waits for a GP practice appointment).
General Practice Premises Policy Review: findings and next steps
Following settlement of the 2018/19 GMS contract, NHS England launched the General Practice Premises Policy Review as agreed with the Department of Health and Social Care (DHSC) and the General Practitioners Committee of the British Medical Association (GPC England).
The Review engaged with key stakeholders to understand the issues currently impacting general practice premises and to explore potential solutions. The outcome is a series of policy responses to the issues which were explored, which are set out in a report which we have published.
As outlined in the document, these policy findings are only one part of what is required. The next stage will be to develop an implementation framework for how NHS capital for estates will be deployed to support the NHS Long Term Plan, developed alongside the forthcoming government spending review.
The findings of the Review are available here: General Practice Premises Policy Review.
GP contract five-year framework
The NHS Long Term Plan committed £4.5 billion more for primary medical and community health services by 2023/24. This will support better care for patients outside hospital in their local communities.
NHS England and the British Medical Association’s General Practitioners Committee have agreed a five-year GP (General Medical Services) contract framework from 2019/20. The new contract framework marks some of the biggest general practice contract changes in over a decade and will be essential to deliver the ambitions set out in the NHS Long Term Plan through strong general practice services.
The contract increases investment and more certainty around funding and looks to reduce pressure and stabilise general practice. It will ensure general practice plays a leading role in every Primary Care Network (PCN) which will include bigger teams of health professionals working together in local communities. It will mean much closer working between networks and their Integrated Care System.
- Read the five-year framework for GP contract reform to implement The NHS Long Term Plan.
- NHS England Letter – January 2019 – Five year GP GMS contract framework from 2019/20.
- NHS England Letter – Five year GP GMS contract framework from 2019/20 – This letter from Ed Waller is in support of the GP Contract Reform which was published on 31 January 2019, it provides further information to the letter dated 19th February 2019.
- NHS England letter – GMS Contract Settlement and Allocation Changes 2019/20 to 2023/24 – This letter provides details of the changes that are needed to allocations resulting from the GP contract settlement from Ed Waller, Director.
- GMS contract changes 2019/20
Standard contract documentation
- Implementing the 2019/20 GP Contract Changes to Personal Medical Services and Alternative Provider Medical Services contracts
- 2019/20 General Medical Services (GMS) contract: Guidance and audit requirements for GMS contract
- General Medical Services (GMS) Ready Reckoner: This is the General Medical Services Ready Reckoner for 2019/20
- Technical Requirements for 2019/20 GMS contract
- Codes for pneumococcal PPV 2019/20
- Personal Medical Services Contract October 2019
- Personal Medical Services Agreement Variation Notice October 2019
- General Medical Services Contract Variation Notice October 2019
- General Medical Services Contract October 2019
- Alternative Provider Medical Services Contract October 2019
- Alternative Provider Medical Services Variation Notice October 2019
General Medical Services Quality and Outcomes Framework
- Improving identification of people with a learning disability: guidance for general practice
- 2019/20 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF)
- Brief introduction to quality improvement
- Quality improvement case studies
- Quality improvement module document: End of Life Care
- Quality improvement reporting template: Safe Prescribing
- Sample retrospective end of life care audit data collection sheet
NHS England Enhanced Service Specifications
These enhanced service specifications outline more specialised services and those additional services provided by all General Medical Services (GMS) practices.
- Enhanced Service Specification Shingles (catch up) vaccination programme 2019/20
- Enhanced Service Specification Pertussis (pregnant women) vaccination programme 2019/20
- Enhanced Service Specification Meningococcal freshers vaccination programme 2019/20
- Enhanced Service Specification Childhood seasonal influenza vaccination programme 2019/20
- Directed Enhanced Service Specification Seasonal influenza and pneumococcal polysaccharide vaccination programme 2019/20
Network Contract Directed Enhanced Service
- Network Contract Directed Enhanced Service (DES) Specification 2019/20
- Network Contract Directed Enhanced Service (DES) Guidance 2019/20
- Network Contract Directed Enhanced Service (DES) Registration Form
- The Network Contract DES and VAT Information Note
- Mandatory Network Agreement
- Network Agreement Schedules
- Template Data Sharing Agreement
- Template Data Processing Agreement
- Primary Care Networks – update to Commissioners: Letter from Robert Kettell
To support the publication of the GP contracting documents, NHS England have also published some frequently asked questions specifically focussing on Primary Care Networks.
The Network Contract DES also outlines transition arrangements for pharmacists employed under/funded by the existing Clinical Pharmacist in General Practice and Medicines Optimisation in Care Homes programmes.
The Network Contract Directed Enhanced Service (DES) Additional Roles Reimbursement Scheme Guidance has now been published. This document provides information to primary care networks (PCNs), GP practices and commissioners to support recruitment of the five reimbursable staff roles under the Network Contract DES. The guidance includes information on how baseline staff are calculated, the methodology for the Additional Roles Reimbursement Sum and a series of frequently asked questions and scenarios to support the Scheme.
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