The Matrix – 50 Things You (and your customers) ought to know about the GP Contract – Part 3

21. Enhanced Services: The GPs should have got copies of their enhanced services, particularly DES & NES. These are vital (cost £5 per copy) and are available on the internet. These are important for GPs when deciding which activities will get them payments and which ones won’t.

22. Directed Enhanced Services (DES): The DES represent national benchmark for services that are essential for PCOs to commission. THINK POINT PF: The DES are literally ‘directed’ by the government. Hence there is no question of choosing whether or not to deliver these. They are a national requirement for all PCOs and a national pricing structure for payments will exist. They include services to the populations, improved access, dealing with violent patients, quality information, childhood vaccines and advanced minor surgery. If for example you represent a pharma company selling vaccines for children, these are essential pharmaceutical goods. To a certain extent, they always have been. Consider your self lucky… many representatives are selling good, cost-effective drugs for diseases that are just not high priority at the moment.

23. Enhanced Services: There are 2 types of enhanced services that fall under DES. There are the ‘essential / additional’ services which are at higher standards (ie extended minor surgery and then are the services not provided under the essential services. They will be specialised services delivered by staff who have been trained in that remit. THINK POINT PF: The specialised services will be of significant interest to pharma companies. Why ? Because here lies the remit behind all of that you tout. Working at the interface, treating specialised patients and meeting their needs and of course training of staff to empower them in their newly found speciality. Furthermore, we will find new pilots of interface clinics and specialised services started under this remit. One important point – funding follows the patient, or the service – not the drug- an important distinction.

24. Essential Services: Also under national direction with regards to payment benchmarks, the essential services cover three main areas. Patients who are ill/believe themselves to be ill whereby recovery from condition is expected, patients who are terminally ill and finally patients who have chronic diseases whereby the practices may plan how exactly they will be managed.

25. Additional Services: Covered in last issue : the 6 areas of cervical screening, child health surveillance, contraceptives, vaccinations and minor surgery. THINK POINT PF: The global sum (2/3 of salary) is aimed to deliver the essential and additional services as well as provide some staff costs and locum fees. The remaining 1/3 is the points, prizes, etcetera. So thinking from a GPs workload perspective there is much that can go wrong here. The global sum is ‘calculated’ (using the Carr-Hill Formula) which is then applied to the ‘practice register lists’, So what happens if you have more patients than are officially ‘on your lists’ ? Or what happens if the workload is far greater than the Carr-Hill has calculated in your favour ? Well what happens is the GP receives a fee which doesn’t reflect the workload he/she is doing. In fact, this is exactly what is happening all over the country.

26. Nationally Enhanced Services (NES): Although they have national benchmark pricing schemes they are not ‘directed’. These would include anticoagulant monitoring, IUD fitting, specialisation in depression/sexual health, minor injuries and others. THINK POINT PF: This is very important. Whilst the NES are critical services to patients, the fact they are not directed means that not all GPs will be doing them. In fact they will local contracts to provide these services. This will lead to the development of Local Enhanced Services (LES) which will be locally negotiated and involve some of the opting in/opting out scenarios, described in previous issues..

27. Minor Surgery: These are sub-divided into 2 parts. Almost every practice is doing some sort of minor surgery at the moment. These practices have preferred provider status, hence the PCT has to offer work at least to the volume of current work load It’s is not always easy for practices to evaluate just exactly what services they want to offer and continue with. THINK POINT PF: It’s going to be tricky to get agreement on this all the time. What about services offered by a GP who is off sick – or away ? Does the service just stop for a while ? Or does a partner from the practice provide back up ? What if he/she is not interested in this new service or is not trained up ? Interesting…

28. Paperless Practices: Some practices are already ahead of the game. In fact not only are they going near-paperless, they result halved receptionist times. Hence, receptionists are being trained and used as a nurse assistants. For example – does it take a nurse to ask a patient with COPD if they smoke, if so how many, and whether or not they would like some help stopping. THINK POINT PF: I would be surprised if you are not already seeing receptionists trained up to do blood pressures, simple screening and other tasks. Remember previous issue and points on how staffing will be reimbursed. There is mixed feelings from nursing staff – ask them about it. This new contract is affecting everyone like no other has ever done.

29. Read Codes: GPs need not waste time re-integrating new codes. It will be a waste of time. Systems will now have templates for disease areas related to quality frameworks. These templates allow simple tick boxes for framework and hence allow for simpler management. THINK POINT PF: Many of the GPs seems genuinely confused over this. Re-typing codes, re-stratifying indices. None is required. New system should allow the computer to do the all the work. There are over 150 read codes and to try and refit them all in to the new contract is hefty. However errors are already emerging and some paranoia around the ability of these systems to extract the correct coding (which will eventually lead to subsequent payments) is probably not a bad thing.

30. What about the consultants contract? Interestingly I have received significant requests relating to this. In particular, what are the differences and how do they relate to the GP contract. So frequent this has been that I have decided to cover some elements of this in the next issue of THE MATRIX.

OMAR ALI is the Formulary Development Pharmacist for Surrey and Sussex Healthcare NHS Trust and is a PCT Formulary Adviser to 2 PCTs. He is a lecturer on the MSc on Pharmacy Practice at Portsmouth University and is also an adviser to three Drugs and Therapeutics Committees in the South of England. Omar is a National Speaker in the UK (cardiovascular, diabetes, mental health) and is an Executive Board Member for the National Obesity Forum. He can be reached directly on ‘