Following extensive tripartite negotiations, we have reached a GMS contract deal with Welsh Government. We have fought hard to ensure the best deal possible for GPs in Wales. We are pleased that hard-working practice staff are finally able to receive a pay uplift.

The package resulting from this year’s set of negotiations was unique in the sense that it encompasses both financial and non-financial in-year changes for 2022-23. It also lays the groundwork for the proposed Unified Contract reforms which are set to begin next year. The agreement is about more than pay alone. The pay uplift is below inflation but is balanced by reduced bureaucracy in the contract. This means a lighter administrative burden and frees up GPs to do what they are trained to do – to treat and see patients.

Since the agreement was announced in October 2022, the contract implementation group (CIG) has been hard at work producing relevant contractual guidance, templates and other material. Quality Improvement project specifications and templates for the current QI cycle (until March 2024) have been finalised and issued to practices as of 17 February 2023. The accompanying letter can be found below, which also illustrates payment schedules.

You will be able to find full contractual materials on the Welsh Government GMS Contract website.

Financial changes

The following funding arrangements having been reached for 2022-23:

• Contractor GP pay uplift of 4.5% backdated to April 2022. This equates to £7.4m overall
• An uplift of 4.5% to the Staff pay expenses element of the contract ensuring ‘all existing practice staff receive a 4.5% uplift to their gross pay’ backdated to April 2022. This includes the salaried GP pay award of 4.5% as recommended by DDRB. This equates to £7.5m overall.
• A General Expenses uplift of £2.718m.
• Clinical QAIF domains will transfer into Core contract from 1 October 2022, resulting in a transfer of £9m into Global Sum (GSUM). This quantum represents full achievement in all indicators for all practices moving into total GSUM and then distributed to practices via the Carr-Hill formula. The removal of Assurance indicators from the framework means that QAIF will become QIF (Quality Improvement Framework).
• Continued Investment of £7.2m for the implementation of the ‘Access to In-hours GP Services’ standards with Access QIF.
• As agreed in 2020-21, the £4m Capacity Fund will continue for a further two financial years.
• Completion of CGSAT & IG Toolkit to transfer to Core contract from 1 October 2022, with achievement funding for completion of these (80 points total) at £5.7m to transfer into GSUM.
• The current cluster domain indicators in QAIF will be moved into the contract and mandated for all practices as of 1 October 2022. The respective 100 points, equating to £7.2m, will be transferred into GSUM.
• The current QI project in relation to activity data will, in part, move into the contract from 1 October 2022, supported by a transfer of £2.5m (35 points) into GSUM.
• There have been no changes to the Direct Enhanced Services during this round.

The agreement represents a total financial uplift to the GMS contract of £17.618m as well as a transfer of 340 QAIF points, valued at £24.4m, into global sum.

With these elements considered, the new Global Sum payments will be made at a value of £103.91 per weighted patient for the period beginning with 1 April 2022 and ending with 30 September and £111.40 from 1 October 2022 (in comparison to £98.51 for 2021/22.) This represents a 13.1% increase in the global sum value compared to the 21/22 value.

The points that are remaining in the Quality Improvement domains, namely Access (100 pts) and the newly drafted mandatory QI projects (170 pts), will be revalued at £189 per point for 2022/23.

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:

Workforce and sustainability

• Agreement to a tripartite meeting taking place within 24 hours at the request of the Minister for Health, in an emergency situation. This meeting will identify possible responsive measures within GMS which may include temporary contractual amendments.
• Agreement to extending the notice period for single handed GP contracts to six months. A reasonability factor will also be included to mitigate impact on single-handed GPs in extenuating circumstances. This cannot be legally enforced until brought in with the proposed Unified Contract regulations (from October 2023), however, we would encourage any members in this situation to have early discussions with their health board in the interests of patients and the wider local health system.

• Pre-employment checks for new practice staff with minimum requirements as mandatory.

• Continuation of the Protected Learning Time agreement, this provision will continue at six sessions per year on a 2:2:2 ratio (2 x health board or locality wide with cover arranged by LHB, 2 x GP Collaborative/Cluster, 2 x practice) running on an October to September cycle. A national solution towards cover is being actively discussed.

• Reinforcement of the need for a partnership agreement that meets minimum requirements to be in place.  This is non contractual but strongly encouraged.

• Reinforcement of the need for practices to have in place a business continuity plan, with consideration given to GP Collaborative solutions (but no duty to support neighbours). This is non-contractual but strongly encouraged

Embedding previous agreements in regulations

• Mandating of data recording and submission to Wales National Workforce Reporting System (WNWRS) through the contract
• Mandating of completion of the GP Escalation Tool through the contract
• The removal of the patient charge for completion of the Mental Health and Debt Evidence Form (agreed in 2021-22) will be embedded through the GMS Contract Regulations.

Access to and from primary care

• Core and normal service opening hours will be clarified to prohibit half day/lunch time closures Mon-Fri (with the exception of branch surgeries). Physical access to reception for patients between 08:30 and 18:00 will be made explicit in Regulations. This allows 30 minutes either side of the day to support set-up/close down of the practice although practices must be contactable by telephone in that time.
• Delineation in any advertising between any private, non-NHS services that practices offer and GMS services.
• Enabling the Digital authorisation of prescriptions where directed by the health board which will support the future rollout of E-Prescribing.
• Practices should take reasonable steps to ensure patients who contact the practice during the out of hours period are provided with information about how to obtain services during that period (e.g., how to access 111) including how those services should be used.
• Practices should ensure the clinical details of all out of hours consultations received from the out of hours provider are appropriately care navigated within the practice on the same working day as those details are received, or exceptionally, on the next working day.
• Practice should ensure that any information requests that upload a special note are responded to appropriately in the practices on the same working day as received, or exceptionally, on the next working day.

Head of terms agreements

A number of contractual items have been prioritised for wider discussions in the forthcoming year. These have been identified by all parties as areas of interest and therefore have been included in the contract agreement as ‘Heads of Terms Agreements’ with indicative content for discussion.

Task and finish groups according to the following themes will be established to consider the proposals.

• Workforce and Sustainability
• Recovery and Transformation
• Data and digital
• Premises
• Vaccs and ImmsQuality

Quality improvement framework

Moving forwards, QAIF will be transformed to provide a greater focus on quality improvement. The removal of Assurance indicators from the framework means that QAIF will become the Quality Improvement Framework (QIF).

Through the course of negotiations this year, we have agreed:

• All remaining clinical indicators within QAIF will transfer into the core contract and be mandated for all practices from 1 October 2022. Monitoring will be supported through the Assurance Framework when introduced. Those indicators are: Dementia (DEM002), Diabetes (DM002,003,007,012,014), COPD (CPD003), Mental Health (MH011), Palliative Care (PC002), Flu (FLU001,002)
• The requirement for practices to provide data on all clinical indicators will remain and will sit alongside other sources in the Assurance Framework.
• Dataset and business rules for data collection will be maintained with a requirement for annual reporting
  Aspiration and Achievement funding for the indicators which are transferring will transfer into GSUM at 1 October 2022 totalling £9m.
• The requirement to undertake demand and capacity planning and evidencing of effective clinical governance (completion of CGSAT and IG Toolkit on an annual basis) will move into the contract as of 1 October 2022. Practices will be required to submit annually from 1 April 2024 onwards.

Quality improvement framework

As part of the reconfiguration to the Quality Improvement Framework, there is a need to strengthen a number of areas, including:

• How QI projects are developed, valued and included in the QI domain
• Clarity on the scope and purpose of a QI project to ensure we maximise on learning and outcome
• Removing delays in project rollouts to ensure practices are able to fully meet the requirements of the project within the QI cycle

Through a Heads of Terms approach, and a Task and Finish Group we will develop a clear framework which addresses those key issues and with a view to realigning QI delivery to a financial year cycle from 1 April 2024. Transition funding arrangements for the next 18 months, which mitigates any negative financial impact on practices have been agreed.

For the upcoming cycle, the QI basket will be revised to include:

• Mandatory prevention of unhealthy behaviours project
• Mandatory data project
• Mandatory phase 2 green inhaler project

Guidance and templates for all QI projects can be found on the Welsh Government GMS contracts webpage.

Access QAIF

The existing Access Commitment guidance and Supplementary guidance 2022-23 remains in place for this financial year with no changes.

• Access Commitment guidance for 2022-23 
• Access Commitment supplementary guidance 2022-23 

Future of Access in the Unified Contract

Building on the significant progress already seen in this area, which includes the Access Commitment and Phase 2 standards introduced on 1 April 2022, we have agreed a number of additional changes this year regarding the future of access in the contract.

We have continued to focus on strengthening the access to information and data within GMS to ensure there is a robust an accurate picture of the activity being undertaken.

• To embed the positive progress made to date and to ensure there is consistency in patients accessing their GP practice, the current pre-qualifier access standards (previously Phase 1) will be mandated through the contract as of 1 April 2023 and will form part of Unified Services (subject to Ministerial approval and the Senedd legislative procedures).
• To support this move, a heads of terms approach will be taken to identifying any possible national solution to the provision of digital tools in the longer term. This includes an agreement in principle to enhance the centrally funded My Health text bundles currently utilised by practices.
• The current Phase 2 Standards will remain in QAIF (100 QAIF points) for the 2023/24 cycle to allow for evaluation of achievement and impact during 2023.
• Subject to evaluation, the Phase 2 Standards are intended to be mandated through the contract forming part of Unified Services with 40 QAIF points transferred into GSUM as of 1 April 2024. The requirement for an annual access report will be retained in QAIF with 60 points payable upon achievement.
• The current QI project in relation to activity data will, in part, move into the contract from 1 October 2022. The collection and sharing of GMS activity/appointment data will be mandated through the contract supported by a transfer of £2.5m (35 points) into GSUM. The QI project will be refined and enhanced for 2022/23 cycle.

GP collaborative domain

We have agreed the transfer of the current cluster domain indicators in QAIF moved into the contract and mandated for all practices as of 1 October 2022. The respective 100 points, equating to £7.2m, will be transferred into GSUM as at 1 October 2022.

Unified contract

Tripartite work involving GPC Wales, Welsh Government and NHS Wales has been underway for the last twelve months, to take forward the development of a new streamlined and simplified GMS contract. Emphasis has been placed on clinical judgement with a focus on those things which only GMS can and should do at an individual practice level. It is proposed that the new contract takes effect from October 2023 subject to Ministerial approval and Senedd legislative procedures.

As the Unified Contract will be underpinned by new legislation, there will be a formal consultation during 2023. We will lead upon engagement with the profession.