The 2018 Scottish GMS Contract embarked primary care in Scotland on a journey towards reducing unsustainable workload in general practice, through the expansion of multidisciplinary teams of health professionals.
The Memorandum of Understanding (MoU) agreed as part of the 2018 contract set out the responsibilities of all parties to deliver on the elements of the contract during the three year implementation period to 2021. However, it is now clear that most local areas will not be in a position to fully implement these services by 1 April 2021 as originally envisaged.
In response to the reality of this situation, the BMA’s Scottish GP Committee (SGPC) has negotiated further expression of elements to the contract. The principles underpinning our approach to these discussions were:
- to give contractual expression to the transfer of responsibility for services so that they can no longer default to GPs to deliver
- to create a mechanism where GPs will, where necessary, temporarily continue to provide MoU services so that there is no gap in provision
- to agree a payment mechanism to compensate GPs where it is necessary to temporarily continue to provide MoU services that should no longer be their job
- to prevent erosion of services once they are in place
- to restate both parties’ commitment to the direction of travel in the contract, including Earnings and Expenses Reform and increasing investment in general practice.
While the direction of travel of the 2018 contract remains the same, timetabled changes to regulations will see responsibility for providing vaccinations and immunisations; a core pharmacotherapy service and community treatment and care services transfer to health boards and no longer default to GPs to provide.
Transitionary Services will be negotiated and will commence when services are removed from the core contract to ensure continuity of provision to patients in those situations where responsibility has transferred, but the health board is still not yet able to deliver the service in full. This will see GPs compensated for temporarily delivering a service that should no longer be their responsibility and will help to encourage continued progress towards delivery.
The timescales that have been agreed upon for these changes varies by service and are set out below.
All vaccination and immunisation arrangements that are still part of the core contract are to be removed from the regulations by October 2021.
All historic income from vaccinations, including enhanced services, will transfer into the global sum from 1 April 2022.
Transitionary service arrangements begin in October with new payments for practices who continue to vaccinate beginning from 1 April 2022.
Change to regulations no later than 1 April 2022 will make clear that boards must provide a level one pharmacotherapy service to patients, as described in the contract framework.
Where a level one service is still not available to patients at a practice from 1 April 2022, practices will receive additional payment via a transitionary service until the service is delivered.
Level two and three services remain part of the contract and we will look to agree timescales for delivery which have not existed to date.
Changes will be made to regulations no later than 1 April 2022 to make clear that boards must provide patients with access to a community treatment and care service.
Where a CTAC service is not available to patients at a practice from 1 April 2022, practices will receive additional payment via a transitionary service until the service is delivered.
To date, what level of urgent care is required to be delivered by HSCPs has been for local determination.
A change to regulations will be made by 1 April 2023 to create a responsibility for boards to provide an urgent care service to practices, creating more certainty and consistency as to what should be provided than was set out in the 2018 GMS contract.
With the exception of the headcount requirement for links workers, the 2018 contract has until this point left levels of service for additional professional roles, such as mental health professionals and MSK physios, entirely to local determination.
By December 2021, we will work with HSCP leaders to produce a more clearly specified commitment of the level of mental health worker, physiotherapist and community link worker service that practices should expect will be developed, along with a timescale for delivery.
A new Memorandum of Understanding covering the period from April 2021 will also be agreed, again setting out the responsibilities of all parties to delivery of this contract.
Further details, such as the terms of the transitionary services, will be published in due course once agreement is reached between SGPC and the Scottish Government.
Remote and rural practices where it has been identified by a completed options appraisal process that MoU services cannot feasibly be delivered to their patients will be eligible for the same transitionary services as other practices until such time as alternative support provisions for such practices is put in place.