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SDF Conference

THE NEW GMS ENHANCED CONTRACT Professor Richard Simpson Specialist in Addiction September 30 th 2004. SDF Conference. 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

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SDF Conference

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  1. THE NEW GMS ENHANCED CONTRACT Professor Richard Simpson Specialist in Addiction September 30th 2004 SDF Conference

  2. 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?

  3. 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]

  4. Some Figures on Drug treatment

  5. Principles of New Contract • Designed to deliver Quality • Designed locally • Audited locally

  6. Depression Anticoagulant Depression Alcohol Drugs TOPICS FOR NATIONAL ENHANCED CONTRACTS • Sexual health • IP • IUCD • Homeless • Minor injury • MS • Anti-coagulant

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. Transitional Access Prescribing Service • Created April 1st 2004 • Resource 5 sessions doctor 2 sessions nurse • Six weeks to created tools and pilot

  14. 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

  15. Transitional Access Prescribing Service Problems • Allocated patients • New patients on treatment • Patients from prison • DTTO completers • Homeless • Patients completing residential treatment

  16. 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

  17. 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 ]

  18. 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

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