Dr Nigel Watson answers readers’ questions on opting out of providing out-of-hours cover and cervical cytology payments
Opting out of out-of-hours
Q The PCT agreed that our practice could opt out of out-of-hours cover; however, about 2 weeks before the opt-out date the PCT said that the service may not be "robust enough” to go ahead. Can they ‘pull the plug’ at this stage? Also, once the opt-out date has passed, can the PCT hand back responsibility for outof- hours cover to the practice?
AThe PCT has accepted your practice’s intention to opt out of out-of-hours cover. The contract which I presume you have signed states clearly that the PCT must give one month’s notice before the opt out date of a failure to find an alternative out-of-hours provider. So the simple answer is that they cannot go back on their agreement without breaching the terms of the contract with your practice.
Once the PCT has taken over responsibility for out-of-hours cover they cannot hand it back to the practice.
Some practices are concerned that the cost to them, which is 6% of the global sum in year 1, may be increased in future years; however, it will remain at this percentage and PCTs will not be able to increase it.
Cervical cytology payments
Q Payment for the cervical cytology indicators amounts to less than the practice used to receive under the Red Book. Why is this? Should we stop providing this service?
A Under the new contract, 50% of the payment for cervical cytology has been transferred into the global sum equivalent while the rest is payable through the quality and outcomes framework. Practices that opt out of providing a cervical cytology service will lose 1.1% of their global sum (the agreed amount for cervical cytology) as well as the payment for achieving the 22 points available in the quality and outcomes framework. The reason your practice may receive slightly less in 2004/5 is because the quality points this year are valued at £75 each; however, next year their value will rise to £120. So my answer would be to look at the medium and long term and not just the short term situation.