Funding for GMS contracts

For anyone new to the strange Wonderland that is GMS Contracts please see a table summarising funding streams for GMS contract holders. Lewis Carroll could not have imagined byzantine payment systems.

Funding stream	Details
The global sum	This funds a practice for delivering ‘essential’ and ‘additional’ services to its registered list of patients. £75.77 per patient from April 1st 2015 The increase in global sum is related to the 1.16% ‘pay award’, the reinvestment of MPIG and the scrapping of alcohol and patient participation DESs. An ‘in year’ adjustment will be made in October 2015 when the impact of seniority changes are calculated. The bulk of Global sum payments are determined by an allocation formula – the ‘Carr-Hill Formula’ which was intended to fund practices based on practice workload and circumstances including patient demographics such as expected need, age and gender.
Minimum Practice Income Guarantee (MPIG)	MPIG was a financial protection scheme devised to provide protection to practices, which would have suffered significant financial losses under the 2004 GMS contract. NHS England plan to phase out MPIG by March 31st 2020 in a move towards ‘equitable funding.’
The Quality and Outcomes Framework (QOF)	The QOF is a voluntary performance management scheme with 559 points for key performance indicators. The intention of the scheme was to support achievement of a range of quality standards, by resourcing practices for the volume and quality of care delivered to their patients. It is supposed to measure practice achievement against evidence based clinical, public health, quality and productivity and patient experience indicators. As QOF remains a significant, though diminishing, proportion of practice resourcing the majority of practices participate. Payments vary according to the practice ‘weighted list size’ and the prevalence of medical conditions. From April 2016 it is anticipated that CCGs in LLR may review whether QOF is the best way to resource practices and alternative local arrangements may be negotiated.
Enhanced service payments	These fund practices to provide special services that are not covered within the essential services of the contract.   Acute hospital providers previously provided some enhanced services.
Seniority payments	These were intended to reward a GP for experience and time-served. Phasing out will add some complexity to global sum funding especially in the first year from April 2015. An unintended consequence may be further disincentivisation for senior GPs to remain in partnership roles.
Premises Payments	Many GP partnerships own their premises and make these available to the NHS for patient care. GP partners have usually borrowed the capital to build or buy into premises. There are schemes that compensate the partnership for this, for example borrowing costs known as cost rent or notional rent reimbursement. Payments to contractors are calculated on the amount of rent the practice would pay if renting the premises and this is agreed with the District Valuer (DV). Other contractors rent their premises, in which case they receive rent reimbursement for actual leasehold rent. The level of reimbursement is calculated by the DV in relation to local current market rents (CMR). From April 1st 2015 NHS England regional teams and CCGs as co-commissioners will be responsible for rent reimbursement payments to GP contractors.
Dispensing payments	Payments to practices that provide dispensing services.
Private services	Practices provide private services for the administration of travel vaccinations and other medications, life insurance medical reports and certificates and letters outside normal NHS services.

Dr Saqib Anwar is working with NHS England and local CCGs to provide top tips and guidance for practice managers to deal with the transition from PMS to GMS - April is likely to be a hectic month - including strategies to deal with changes in monthly payment dates, whom to invoice when for what and how to manage additional turbulence in cashflow.

A template called 'Transfer of PMS to GMS data,' which has been populated, will go out with the contract variations. It is important to note this has not been finalised but will give practices prior to the contracts going out a description of how the income will be received and any differences with PMS can be understood.