Proposed new GP contract in Scotland will embed pharmacists in all practices as part of clinical team



PROPOSALS for a new GP General Medical Services (GMS) contract, jointly designed and agreed between the Scottish Government and the British Medical Association (BMA) have been announced.

The aim of the new contract is to allow GPs to use their skills as expert medical generalists to spend more time with the people who need them the most (undifferentiated presentations, complex care); focus on whole system quality improvement and leadership; and ensure that all patients get the support and most appropriate care they need from the extended community healthcare team, including nurses, physiotherapists, community mental health workers, paramedics, and pharmacists.

Funding will be reformed in a phased approach. In phase one, starting from April 2018, a new funding formula will be introduced that “better reflects practice workload”, and a new practice income guarantee which will operate to “ensure practice income stability”.

There will be an additional £23 million investment in GMS to improve services for patients where workload is highest, and a commitment to ensure that no GP partner earns less than £80,430 (including pension contributions) NHS income for a whole-time equivalent post from April 2019. The government also announced an additional £30 million over three years to help reduce the risks to GPs of leasing or owning premises, and to improve practice sustainability.

As part of the redesign, core and additional pharmacotherapy services (additional advanced, or additional specialist) will be developed over the next three years and provided by pharmacists and pharmacy technicians who will become “embedded members of the core practice clinical teams”. While they will not be employed directly by practices, the day-to-day work will be coordinated by practices and they will take responsibility for:

  • Core elements of the service, including: acute and repeat prescribing, medicines reconciliation, monitoring high risk medicines.
  • Additional elements of the service, including: medication and polypharmacy reviews and specialist clinics (e.g. chronic pain).

The aim is that by 2021, every practice will benefit from the pharmacotherapy service delivering the core elements. This will be supported by additional funding to increase the number of pharmacist training posts from 170 to 200 per year from 2018/19.

Health Secretary Shona Robison said: “GPs tell us they want to spend more time with patients with undiagnosed illness and less time on bureaucracy, while patients say they want better access to GPs when they really need them. We have listened and, I believe, we have achieved that balance.

“These changes will give patients the right care in the right place, and give those who need to see GPs the most the time they need. Patient safety is at the very heart of this agreement and is the central principle guiding how changes will be implemented.

“We are also investing in facilities which will offer more doctors the chance to enter the profession.

“We’ve worked closely in partnership with the British Medical Association on shaping the future of general practice and primary care and we are confident that this contract best supports Scotland’s healthcare needs while also making general practice an even more attractive career prospect for doctors.”

Scottish GP Chair of the BMA Alan McDevitt said: “I truly believe that we have negotiated a contract that will make general practice sustainable for the future.

“Our aim was to reduce workload pressures, reduce individual risk and stabilise practice income, and these are all addressed in this contract.

“This historic agreement will help make general practice an attractive career choice once more.”

A spokesperson from Community Pharmacy Scotland said: “We note with interest the conclusion of the discussions around the GP contract. It is encouraging that the direction of travel in Scotland is consistent – with recognition of the essential role of the wider healthcare team in the delivery of primary care in future.

“GPs are crucial partners in the delivery of the health and social care vision, but their skills and expertise must be best utilised along with the skills and professional expertise of others – such as community pharmacists.

“We will enter into discussions with partners and Scottish Government around the next steps to see how community pharmacy build on the new ways of working already happening including the Pharmacy First concept. We will also look to areas such as information sharing to understand how the community pharmacy network can be enabled to support patient care further.”

GPs will decide whether to accept the new contract in a poll that will run from December 7, 2017 to January 4, 2018. If accepted, the new contract will come into effect on April 1, 2018.

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