Transcript SDF Conference

SDF Conference
THE NEW GMS ENHANCED
CONTRACT
Professor Richard Simpson
Specialist 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
New * In treatment Specialist
Lanark
378
Fife
806
Glasgow 3392
Grampian 978
Lothians 2093
Tayside
401
Scotland 11742*
GP
7300
1300
5450
3500
485
2700
400
Principles of New Contract
●
Designed to deliver Quality
●
Designed locally
●
Audited locally
TOPICS FOR NATIONAL
ENHANCED CONTRACTS
●
Sexual health
●
Depression
●
IP
●
Anticoagulant
●
IUCD
●
Depression
●
Homeless
●
Alcohol
●
Minor injury
●
Drugs
●
MS
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 ]
Conclusions
Enhanced 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