The Matrix – 50 Things You (and your customers) ought to know about the GP Contract – Part 5

CONTRACT FACTS 40-45!

40. Selling in Mental Health: There are only 41 points available for mental health as a therapeutic topic but interestingly another 4 points appear in medicines management chapter (identifying non attendees for those who receive regular neuropleptic injections). So pharma companies need to really see where products may be aligned to aid in achieving these. By far the largest weight goes to review of patients with long term mental health problems (23 out of the 41 points). These problems will need a value-added-service approach.

41. THINK POINT PF: I am a little perturbed at the vagueness of mental health in the GMS contract. Of the 41 points, 7 points for creating a register, 11 points for dealing with lithium and the rest on the ‘review’ of the patient. This review covers 3 areas: physical health of the patient, co-ordination with secondary care services and – review of prescribed medication. The maximum threshold is 90% so there is a lot of room to manoeuvre if practices want to take an interest in earning their points this way. But notoriously, dealing with mental health, sorting out medication, trying to improve patients lives is often just too lethargic for primary careto take initiative on. I think that pharma companies are going to really have to consider far more than just ‘product features and benefits’ here. Unless a company has created a serious attempt at ‘branding’ themselves as leaders in mental health with the offer and ability to gear themselves as main players at the primary/secondary care interface then there is a danger that the GMS contract changes nothing for patients in this section of our society. Worryingly, the absence of specifics (for example – why is depression not even mentioned once?) with lots of points created ‘vaguely’ may result in an apathy here (that already exists). Without pharma companies pushing the envelope in mental health I worry for the sanity of all of us! Don’t forget that secondary care is still leading on trends and referrals for new ideas. Primary Care is good at blocking new drugs and cutting budgets, but secondary care is still where leading therapies are tried, new advances advocated and KOLs will still want to do the best for this group of NHS ‘clients’.

42. Selling in Epilepsy: There are even fewer points in epilepsy management as there are in mental health! Of the 16 points available, the creation of a register of patients who are on anti-epileptics (2 points) is the easiest. The rest of the 14 points apply only to 16yr and above and cover 3 areas: seizure frequency and medication review (4 points each) needs to be done within the last 15 months. The % patients convulsion free within the last year is worth an extra 6 points.

43. THINK POINT PF: Come on epilepsy companies! What are you waiting for! Sure there are not many total points for epilepsy but with a little help from you and your company we can get this topic done and dusted. Think about your product – what’s the data like on seizure frequency? Do you have medical information versus another competitor or as an add on showing seizure free in patient groups? Then get this data in front of us! Companies who are not dealing with patient groups here are missing out – it’s the way forward and epilepsy is no exclusion here. One problem I have noticed is that primary care often just wants to ‘refer’ everything. Fair enough – let the specialist organise care plan and juggle treatment. But the patient needs babysitting’ in primary care and with out good review secondary care management becomes more akin to complicated interference. Pharma companies that can smooth out this process will be on to a winner. Tolerability of anti-epileptic medication is a key area for problems and data is often confusing and conflicting. I am yet to meet a company representative that can make this clear! I am as confused as the rest of them! Finally, care for the patient needs. Driving license problems, prejudice in public, weight problems and behavioural interactions are all peripheral to care but often central to the patient. Ask yourself – does my company take this seriously! If not – change their view – or change the company you work for.

44. Selling in Respiratory: Life is very heated here. Lots of strong products. Lots of very committed competitors. Significant and increasingly vocal patient voice and lots of points! Having recently presented at the annual British Lung Foundation patients & carers group I found the whole experience deeply moving. I had to tone down the humour as significant laughter caused respiratory distress. I had never really appreciated how significant that was.

45. THINK POINT PF: There is a total of 117 points in respiratory medicine split unequally between asthma (72 points) and COPD (45 points). This is such a competitive area to sell within. Some companies have significant ‘branding’ in respiratory medicine (Allen & Hanbury’s) which represent almost unparalleled commitment to airways disease. This has led to original and diversified strategies from other pharma companies (ie Altana’s patient initiatives) which are proving impressive. Companies torn between asthma and COPD would do well to see how the new GMS contrasts the 2 diseases. To produce a register of asthma patients is 7 points whereas COPD registers obtain 5 points. Confirming diagnosis with spirometry in asthma patients 8yr+ provides 15 points compared to COPD which provides 10 points if reversibility is also documented. Lesson – spirometers are desirable and so is the avoidance of so-called ‘doctor diagnosed asthma or COPD. It appears that objective measurements are wanted. Ongoing management of asthma provides the remaining 50 points though when examined in detail, the ‘asthma review; will give 20 points. The rest comes from recording smoking status, offering smoking cessation and jabbing with influenza vaccine. Strange in that whilst most of us do not deny the importance of smoking or flu jab, there appears nothing very specific tailored to asthma therapy as has been described. In fact, even if you hit all the above points, anyone treating or selling within the asthma disease area will know that this will not necessarily provide good control of the disease. Ongoing management of COPD provides 30 points (equally provided by 5 areas). Whilst smoking status, smoking cessation advice and flu jabs also feature, here we also see 6 points for recording a FEV1 and another 6 points for checking inhaler technique. I think companies may feel something more tangible to focus on here. Inhaler technique is an onerous task and one that pharma companies will begin to seek out as a service add-on. Just thinking back to my BLF presentation – what if every patient in that room had their inhaler technique checked before entering the room! Just a matter of time before this starts to happen in local areas and surgeries. What’s more – why was inhaler technique left off from asthma? Is it less important that they know how to use inhalers than those with COPD? Also of significance look at the maximum thresholds for achieving the asthma quality indicators versus achieving COPD indicators… surprised? I am.   

 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 ‘alipha@aol.com