During this protracted period of negotiations, BMA GPC have fought hard to ensure the best deal possible for GPs in Wales.

Subsequent to the completion of formal negotiations a GMS Contract Implementation Group was established to take forward the agreed negotiation outcomes and facilitate their implementation into the GMS contract. This group has now concluded its work.

Work is ongoing in Welsh Government to develop a webpage specifically for resources relating to the GMS Contract, including the statement of financial entitlement, guidance and relevant directions. In the meantime, relevant documents can be found on this page and also the Primary Care portal under the resources section.

Financial changes

The following funding arrangements having been reached for 2021-22:

• DDRB pay uplift of 3% for independent contractor GPs and salaried GPs
• An uplift of 3% to the Staff pay expenses element of the contract to ensure that ‘all existing practice staff receive a 3% uplift to their gross pay’. This uplift covers the employers on-cost contributions.
• GP uplift at 3% equates to £4.7m. Staff pay at 3% equates to £4.8m.
• Continued Investment of £9.2 million for the implementation of the ‘Access to In-hours GP Services’ standards.
• An in-year investment of up to £2 million towards Capacity funding to support access over the remaining period of this year and in readiness for the new arrangements from 1 April 2022.
• A new funded Partnership Premium Scheme for non-GP partners will be introduced. No changes to Seniority and no uplift of existing Partnership Premium rates.
• Enhanced Shared Parental leave arrangements will be enabled for all salaried GP’s in Wales. The SFE will be extended to enable the reimbursement of costs, up to an agreed limit, where Independent Prescribers are providing cover for GP’s on parental leave.

Taking into account the above changes, the new Global Sum payments will be made at a value of £98.51 per weighted patient and backdated to 1 April 2021 (in comparison to £95.65 for 2020/21).

The SFE amendment directions came into force as of 30 March 2022.

Non-financial changes

Coupled with the financial changes, we have reached agreement on a number of activities as part of the reformed contract. The changes this year include:

• A renewed focus on the role of clusters, working collaboratively to plan and deliver services locally. GP cluster networks will be redefined as GP Collaboratives. Practices are now automatically members of a GP Collaborative through the terms of the core contract.
• The cluster domain in QAIF will be revised. Points in QAIF domains have been redistributed. However, the total points will remain at 510, which will each continue to be paid with current value being £179 per point. (This point value will be confirmed within the upcoming SFE).
• The QI domain structure will be restructured and expanded to include projects to improve standardised data quality.
• Reactivation of inactive QAIF clinical indicators.
• Protected Learning time - Six funded protected learning time sessions per annum will be made available and targeted at all staff within the practice.
• Funding of ongoing training to upskill practice staff as care navigators via HEIW.
• GPC Wales has agreed to engage with national developments in the ‘Prevention Agenda’ to focus on GMS response to prevention of obesity and pre-diabetes.
• GPC Wales will work jointly with colleagues in NHS Wales and Welsh Government to explore and establish the GMS role in supporting the wider system and patients, particularly GMS role in referrals management plus GMS input into national pathway development.

QAIF (quality assurance and improvement framework)

An updated Quality Assurance and Improvement Framework Guidance for the GMS Contract Wales has been published by Welsh Government, concerning the detailed changes to the various domains within QAIF.

The QAIF will still consist of three domains, remunerated via a points system.

There is a total of 510 pts for the three QAIF domains, together with 125 pts for the Access QAIF. Points continue to have a value of £184 per patient.

The three domains of QAIF are:

• Quality Assurance – Active Clinical Indicators: 125pts - Reactivation of certain clinical indicators
• GP Collaborative: 100 pts - Redefinition of GP cluster networks as GP collaboratives
• Quality Improvement- QI Projects & Cluster: 285 pts - Series of new QI projects including the activity/appointment data project.

The annual QAIF cycle for the Quality Assurance and Quality Improvement domains is 1 October - 30 September.

Access QAIF

Access Domain for 2021/22

The Access standards system, incentivised via QAIF points, was originally set to end at 31 March 2021, but it has been agreed it will continue into a third year. The fundamentals of the domain remain although there are a number of in year changes to reflect COVID pressures. The total value of this domain is 125 points.

Details of the Access Standards, groupings, evidence, reporting, payment arrangements and achievement are set out in the Access guidance published by the Welsh Government.

Achievement for the Access domain will be assessed at 31 March each year, with achievement payments paid at 30 June.

There are two groups of standards, with each Access standard as its own QAIF indicator. Practices can receive full or partial payment depending on achievement:

The following changes have been agreed for 2021/22:

• Standard 2 – 2-minute response time - For the 2021-22 cycle (this year), practices will not be assessed on their achievement of Standard 2 with achievement assumed and counting towards Group 1 payments (min. of 3 in order for payment to be made).
• Standard 8 (demand and capacity and patient satisfaction) - For the 2021-22 cycle (this year) practices will not be assessed on their achievement of Standard 8, with achievement assumed and counting towards Group 2 payments.

Access Commitment for 2022/23

Access Standards phase 1 remain as pre-qualifiers for phase 2 which will be introduced from 1 April 2022. All practices are expected to achieve phase 1 by end of March 2022 but will (as part of pre-qualifier status) then be required to maintain and embed those working practices in order to make any claim for achievement of phase 2 standards.

A new Access Commitment forms the basis of the new phase 2 standards for one year, to the value of £7.2m overall (with monies reallocated to the Additional Capacity scheme - see below). Subject to review, and testing of the blended model of access, there is a joint commitment to establish future core contract access requirements, as part of the Unified Contract work stream.

The phase 2 access standards guidance has now been published by the Welsh Government.

Enhanced services

There have been no changes to the Direct Enhanced Services during this round.

Seniority and partnership premium

The existing GP Partnership Premium Scheme was established in October 2019 as a means of incentivising newer GPs to take up partner roles in order to support the sustainability of services. This scheme continues unchanged, as does the Seniority scheme.

A new funded Partnership Premium Scheme for non-GP partners will be introduced, in recognition of the vital role these staff play in the sustainability of GMS. This scheme will be rolled out in phases, with phase 1 being open to those who had signed a Partnership Agreement prior to 31 March 2021.

Guidance notes and claim forms relating to the eligibility requirements and operation of this new extended scheme are available.

Parental leave

The SFE will be extended to enable the reimbursement of costs, up to an agreed limit, where Independent Prescribers are providing cover for GPs on parental leave. This will widen the available pool of professional cover to replace GP on parental leave or sick leave.

Enhanced Shared Parental leave arrangements will be enabled for all salaried GPs in Wales with the SFE amended to enable this to allow for the reimbursement of additional costs.

Practices will be entitled to claim back locum cover costs, as for parental leave cover, and this is reflected in the amendments to the Welsh SFE which came into force on 30 March 2022. We will be issuing letters to practices and salaried GPs reflecting this change alongside updating the Salaried GP Handbook in due course.

Arrangements for GP Partners will continue to be a matter for the Partnership Agreement.

Additional capacity

2021/22 Scheme

£2m has been made available to support additional capacity within GMS over the winter period. The funds were allocated to Health Boards and distributed to practices as an indicative spend, on a pro-rata basis, to enable 100% reimbursement of the total costs (salary / sessional fee & on-costs) of either additional posts upon appointment or additional hours worked by existing post holders.

2022/23 Scheme

From 1 April 2022, capacity funding of £4m will be made available recurrently for three years, accessible to practices via Health Boards.

• This scheme from April 2022, will facilitate match funding of up to 50% of the cost of either additional posts upon appointment (including those in post from December 2021 under the 2021/22 scheme) or additional hours worked by existing post-holders, enabling GP practices to take on additional administrative and clinical resource.
• This money will be available to all practices based on evidence of additional hours worked at the practice.
• There are no pre-determined staffing ratios or other eligibility criteria