SDF Conference

THE NEW GMS ENHANCED CONTRACT

Professor Richard SimpsonSpecialist in Addiction

September 30th 2004

Content

● GMS- what is is?● Size of drug user in primary care● The new GP contract● What is happening across Scotland● Glasgow Fife Grampian● Lothian the new TAPS service● Is there a way forward?

A Brief History of GMS● GMS was created in 1948.

– Major amendment 1966– Major amendments 1992- fundholding/first quality

initiative for diabetes/asthma/health improvement – New Contract 2004

● “-heralds fundamental and far reaching changes both within primary care and in the contribution that p.c can make to the NHS”

● “these changes will lead to higher quality care for patients” [John Turner Pay modernisation director GMS NHS Scotland]

Some Figures on Drug treatment

PLACE In treatment Specialist GP Lanark 378Fife 806Glasgow 3392 7300 1300 5450Grampian 978Lothians 2093 3500 485 2700Tayside 401 400

Scotland

New *

11742*

Principles of New Contract● Designed to deliver Quality● Designed locally● Audited locally

TOPICS FOR NATIONAL ENHANCED CONTRACTS

● Sexual health ● IP ● IUCD ● Homeless ● Minor injury ● MS

● Depression ● Anticoagulant● Depression● Alcohol ● Drugs

Overview of contracts for Enhanced service

● Glasgow -one year contract only● Forth Valley Lanarkshire Ayrshire and Arran No

contract● Fife temporary contract one year● Tayside unclear ● Lothian , Argyl and Clyde full contract ● Grampian temporary contract

Glasgow Shared Care Scheme● 129 out of 209 Practices in scheme● Audit showed

– 2% completing treatment– 87% retention in treatment– Mortality 0.7%* [patients in treatment 5891]

* lowest recorded level in published literature

Glasgow● Shared care team cocerns about future● if negotiations don't succeed

–All gains in improving Primary care based approach may be abandoned

–New integrated CATS teams to manage all drug and alcohol misusers.

–New centralised prescribing support to replace both GP and GPDS service

Fife

● £250● Graduated payments according to work done● Potential for practices stopping service● Insufficient capacity in current service● Increased waiting times

– Only Kirkaldy defininite 6weeks up to 26 weks

Grampian

● Previous shared care scheme – £120 for treatment – £80 if referring for support

● Temporary new NES contract in place – £240 for maintenance only

● Concerns not enough funding ● Other work in primary care preferable

Lothian ● 97/131 practices in old shared care scheme● 15 opting out with new contract● 13 opting in● New total 96/131 in enhanced contract● New TAPS service to provide for estimated 315

patients displaced by opting out● New integrated services developing in West

Lothian and Mid Lothian and East Lothian

Transitional Access Prescribing Service

● Created April 1st 2004● Resource 5 sessions doctor 2 sessions nurse● Six weeks to created tools and pilot

Transitional Access Prescribing Service

● 16 weeks on – 100 patients transferred to TAPS– 5 discharged– 200 await transfer

● Average frequency of appointment 2.3 weeks● Discharge strategy

– Locality clinics– GMSnes practices for Drug treatment only

Transitional Access Prescribing Service Problems

● Allocated patients● New patients on treatment● Patients from prison● DTTO completers● Homeless● Patients completing residential treatment

Problems and Solutions in Lothians

● Specialist services silting up– Referral in from opted out practices– No referral out

● GMS nes practices reaching cap in numbers of drug users

● Locality clinics● Transfer to GMSnes practices for drug

services only

Benefits and Risks Nationally

● +ve Payment for Quality● +ve Locally determined priorities● -ve Not part of a worked out strategy

promoting integration● - ve No guidance [HDL]● -ve No core requirements for contract ?value

for money. Quality too variable● -ve Funding inadequate and takes up to high a

proportion of the total enhanced servise monies [may be over 25% in Glasgow ]

ConclusionsEnhanced contracts are a great idea

BUT

Needs to be integrated in overall drug services

Should be a tailored service to fit local need

Payment at different levels to suit GP skills and capacity [fife and grampian models]

Part of a national strategy with national guidance needed now