Structure of general medical services and pharmaceutical services
contracts
New general medical services contract
The new GMS contract consists of three levels called essential
services, additional services and enhanced services, with the
Quality and Outcome Framework at the core
New pharmaceutical services contract
The new PhS contract consists of three levels of service provision
called essential services, advanced services and supplementary
enhanced services. These are currently under negotiation |
Pharmacists should be aware that the new general medical services contract
has issues of relevance to them, whatever field of pharmacy practice
they are working in.
It is relevant to community pharmacists, who will be able to expand their
role in primary care. They will need to understand how the contractual
framework will fit with the new pharmaceutical services contract, and
help inform patients about the changes.
It is relevant to primary care pharmacists, who will need to understand,
anticipate and manage the prescribing and medicines management aspects
of the new contract, to understand how the new contract will be the conduit
for major NHS transformational change across the health economy, and
to liaise with community and hospital colleagues and patients.
It is also relevant to hospital pharmacists,who will need to understand
and manage how the new contract will affect commissioning of services,
local delivery plans and workforce, as well as to explore opportunities
to act as a provider of primary care services.
The new GMS contract, which comes into effect on April 1, allows practices
to control their workload by providing them with the ability to choose
the services they will provide. The new contract will be held by each
practice, rather than by each individual GP, allowing practices to be
more flexible in meeting targets through better skill mix in the practice
teams. This means making better use of the skills of practice nurses
and bringing pharmacists into the team, as well as tailoring which targets
to aim for and which standards to meet, according to desired GP capacity
and workload.
Where practices choose to opt out of services, their global sum will
be reduced and the primary care organisation (PCO) will be able to use
this money to secure alternative provision from other practices or primary
care providers. This is the case with out-of-hours services, where practices
can give up a portion of their global sum, and opt out of responsibility
for patient care except during normal business hours. PCOs will then
take over responsibility for out-of-hours services and be able to consider
a range of alternative commissioned providers for them, including those
that involve pharmacists.
Further information
· Department of Health website for
new GMS
contract
· NHS Confederation website for new GMS contract (www.nhsconfed.org)
· British Medical Association website for
new GMS contract
· National Primary and Care Trust Development website for
primary care contracting
· NPA website (www.npa.co.uk) |
There is a huge amount of information available
that explains how the contract works (see Panel right). Although the
information is often lengthy,
complex and daunting, pharmacists who work for a PCO or practice, or
who are considering taking up some of these opportunities offered,
will need to pick up and dip into these sources.
Some GP practices already work with a practice pharmacist or community
pharmacist, either funded through practice income or funded by their
primary care organisation, but many do not. In order to cope with the
new contract, all GPs will need to look at which health care professional
or other support is best placed and most cost-effective to help the
practice meet its targets and, therefore, generate income. There are
bound to
be opportunities for pharmacists who can demonstrate that they have
the skills and capability to help a practice achieve its targets cost-effectively.
The contract includes remarkably few, if any, incentives for GPs to
control the costs of their prescribing. This presents a major challenge
to primary
care pharmacy teams but is also a huge opportunity for community and
practice-based pharmacists. Pharmacists needing to engage with and
influence GP practices will need to adopt a new way of thinking tailored
to the
new contract, in order to speak and understand the same language as
the practice.
So what should pharmacists do next? Pharmacists who are not already
working with a practice should:
· Read about the new contract in general so that they can engage with
their local GPs, practice managers and PCO
· Decide in which clinical areas they have the skills to offer their
services now, and read about these areas of the contract in more detail
· Decide where they have continuing professional development needs to
enable them to offer other services in future
· Talk to practices close to them, talk to the PCO pharmaceutical adviser
and head of primary care to find out local needs
· Think about logistics of how they could provide services to the practice — how,
when, where, etc
· Think about drafting a business case, bearing in mind that they need
to be cost-effective
Pharmacists working as PCO pharmaceutical advisers will already be involved
with the implementation of the new GMS contract. They will need to look
beyond the obvious aspects such as the clinical areas outlined in the
Quality and Outcomes Framework (see next week’s article), and some
enhanced services, and delve into the detail of the wording in the documentation
and guidance. They should look for the gaps, the vague areas that need
to be tightened up, and consider how to develop their prescribing advice
messages to keep them relevant to GPs after the new GMS contract is in
place.
Pharmacists working as practice prescribing support pharmacists on a
sessional or full-time basis may need to re-evaluate the work they do,
depending on who is paying for their services. Those already being paid
for by the practice will be a valuable resource in assisting the practice
to meet its targets. Arguably, pharmacists paid for by the PCO may be
asked to concentrate their efforts on clinical and medicines management
areas not covered by the new contract, such as reducing waste, improving
cost-effectiveness, antibiotic usage, osteoporosis, etc.
Whatever their stage of involvement or field of practice, what pharmacists
must do next is become more familiar with the new GMS contract because
it will affect them directly or indirectly. They must be proactive, create
their own opportunities and prepare to be involved.
Next week’s article will look into the Quality and Outcomes
Framework.
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The Pharmaceutical Journal