The Pharmaceutical Journal
Vol 272 No 7286 p195
14 February 2004

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UK Drug Utilisation Research Group

Why the new GMS contract will lead to a culture change in primary care

Primary care will be changed beyond recognition by the introduction of the new general medical services contract, according to Linda Dodds, pharmaceutical adviser, Ashford Primary Care Trust. “It is very exciting, but I think there are going to be some real problems for primary care organisations and for the health economy as a whole in England,” she said.

Ms Dodds told participants about the PRICCE (primary care clinical effectiveness) project, a quality improvement programme designed by East Kent Health Authority to increase the quality of care for 14 chronic conditions. The project sets standards that must be met by GP practices, which are above those normally expected. Participating GPs receive payment providing the practice continues to meet the agreed outcomes. The results of the PRICCE project give a foretaste of the prescribing implications of the new GMS contract.

Ms Dodds pointed out that in cardiovascular prescribing, a key area, prescribing costs are not slowing much. “As you get an evidence-based culture, if good evidence comes out that people should be treated more aggressively and more groups of people should be treated for individual things, and you have disease registers, and you are seeing these people on a regular basis, you implement the evidence.”

She said that prescribing does not stop when the target is reached, new evidence is implemented. “You are driving quality fantastically, it is a wonderful thing for patients but it is not going to be good for the budgetary implications to the NHS,” she warned.

The new contract will make practices systematically identify and treat patients, she said. “It changes the way a practice works. To do this you have to have your multidisciplinary teams. This is not something that GPs can achieve on their own. Most of our practices have nurse-led chronic disease management clinics, and are starting to have pharmacist-led ones.”

Ms Dodds went on to talk about disease registers. “What you will find in a quality-based culture is that once you have geared everybody up to be much more adept at finding patients ... what you see is your disease prevalence is going up.” In East Kent, over the past three years there has been an increase of 4,500 in the number of diabetes patients. This has implications for workload, prescribing, laboratory tests and referrals. “It has a whole systems effect on what is going to happen in primary care,” she said. It is great for patients but it does make a difference to your commissioning, she added.

Ms Dodds pointed out that although disease registers provide a great tool for PCOs and GPs, they can also benefit the pharmaceutical industry. Companies could recommend switching to a product that might not fit with local PCT policies, or implementing an evidence base that the PCT might not have otherwise supported, and a disease register would facilitate the switch.

Supplementary prescribing update

Paul Robinson, Department of Health, told participants that work has already started on extending supplementary prescribing to physiotherapists, podiatrists, radiographers and optometrists. “We expect that it will be 2005 before training programmes are in place. But it might well be early 2005 and we may well have another consultation that begins about April or May, which should cover the principle of supplementary prescribing by these four other professions,” he said.

New primary care trusts commonly lack some of the infrastructure to put [supplementary prescribing] in place,” said Beth Taylor, specialist principal pharmacist, London Pharmacy Services. “We are going to have these accredited new prescribers in our organisations very soon and less than half the organisations [in London] are ready to do that,” she said during a presentation in which she described her experiences of implementing supplementary prescribing for pharmacists.

Another area that the London supplementary prescribing support team has identified it needs to work on is the promotion of supplementary prescribing to doctors at a local and national level. “Many doctors have been extremely supportive ... but sometimes the doctors have said to candidates that they are delighted that they are doing this, but they have been less interested in the process, in terms of getting a clinical management plan in place.”

Prize winning research

Caroline Morris, University of Manchester, and colleagues conducted a retrospective review of 49,658 electronic patient records in nine GP practices. They identified indicators for preventable drug-related morbidity and found that four indicators accounted for almost 60 per cent of the total number of potential events (302/507). These were the use of non-steroidal anti-inflammatory drugs in patients with congestive heart failure or hypertension, lack of monitoring of creatinine and potassium levels in patients prescribed angiotensin-converting enzyme inhibitors and the use of hypnotic/anxiolytic agents. These data can be used to generate feedback via facilitated, multidisciplinary discussion groups at each practice in order to prevent future events.

The researchers were awarded the McGavock bursary (£500 to further their research) for the best abstract submitted.