This item was published during the term of a previous administration that ended in April 2007
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Changes to primary care services
29/10/2003
Fundamental changes to the way NHS primary care services
are provided in Scotland were outlined today.
The Primary Medical Services (Scotland) Bill replaces
the GP contract with a practice-based contract and
delegates the contract management from the Executive to NHS
Boards.
Regulations under the Bill will set out the different
services that will be provided under the new contract
defined as essential, additional or enhanced.
The practice based contract will ensure the
multi-disciplinary approach to primary care services - the
work of GPs, nurses, allied health professionals and
pharmacists - is recognised and developed for the benefit
of patients.
The delegation of contract management to NHS Boards is
aimed at ensuring a better strategic approach to the
delivery of services across a particular Board area.
Health Minister Malcolm Chisholm said:
"I believe that the new contract is very good news for
patients. It will mean more services, better services and a
team based approach to care. We want patients to able to
see a primary care professional within 48 hours by April
next year. I believe that this new contract, along with the
work of the Primary Care Collaborative, will ensure that we
meet that target on an ongoing basis.
"This new contract offers the opportunity to introduce
the most fundamental and far-reaching changes to how
primary care services are provided since 1948 when the NHS
was established.
"Through the introduction of the quality framework,
practices will be encouraged and incentivised to provide a
first class NHS primary care service.
"The new approach puts in place national standards and
expectations for patient care and, at the same time, allows
NHS Boards and local practices to agree on the best way to
provide care in response to local circumstances.
"I am very pleased that patient views will be
strengthened through measuring patient satisfaction as part
of the quality and outcomes framework. Patients will have
the opportunity to express their views about the services
provided by the practice."
The Minister set out eight reasons why the new contract
was good for Scotland:
- The Patient Service Guarantee will ensure that no
service will be cut. A
new duty will be placed on NHS Boards to provide
or secure the provision of services with some services
offered by different services, or other providers - an extra £142 million for primary care services
over three years
- a funding formula based on the needs of patients,
not the number - a high level of patient needs will
attract higher levels of funding
- extra funding for GPs to expand the range of
services available to patients in their local area
- the practice based contract will help develop the
multi-disciplinary approach. GPs, nurses, pharmacist,
health visitors and a range of allied health
professionals will pool their skills to provide better
services in their local communities
- enhanced services will shift work and resources
from the acute sector to primary care meaning patients
will be able to access more specialised services in
their own area rather than, perhaps, having to go to
hospital
- patients will have a say on their own practice
through the quality framework. Practices that listen to
patients will earn more funding than those who
don't
- the quality framework will also reward high
achievement with practices receiving financial rewards
for providing high standards of care
The Minister addressed concerns that have been expressed
about the provision of out of hours services.
He said:
"This is not about cutting services, it is about
providing services in a different way. Anyone who needs
access to primary care services out of hours will get them.
That is guaranteed.
"Practices will be able to transfer the responsibility
of providing services out of hours at night and weekends to
NHS Boards. Work is already underway to support this
change.
"A national working group has been established to
provide support to boards by sharing best practice and
undertaking modelling work on possible options. This is
being supported by the Out of Hours Development Fund which
will reach £10 million in two years' time."
The Minister went on to define the services and how they
will be provided:
Essential services must be provided by all practices.
This is the routine day to day work of the primary care
sector which covers:
- the management of patients who are ill or believe
themselves to be ill with conditions from which
recovery is generally expected. This means that
patients will continue to go to their own practice for
their routine health needs
- the general management of patients who are
terminally ill
- the management of chronic diseases
Additional services encompass cervical screening;
contraceptive services; vaccinations and immunisations;
child health surveillance; maternity services (excluding
delivery) and some minor surgery. 90 per cent of practices
provide all these services at present and the new contract
is not excepted to change that. If a practice is unable to
provide these additional services there is a planned
process to transfer responsibility to the NHS Board who
will arrange an alternative provider. Patients will
continue to be able to access services.
Enhanced services will be commissioned by the NHS Boards
and have the scope to develop primary care and transfer
work previously confined to the acute sector.
There are three main types:
- Directed Enhanced Services must be provided by
Boards including, for
example, flu vaccinations - National Enhanced Services which Boards may decide
to commission. If they
do then the service must be provided to national
minimum specifications. For example, a board may want
to provide a more specialised service to patients with
multiple sclerosis in the primary care setting - Local Enhanced Services allow Boards and practices
to develop and agree a service to meet the specific
needs of the local population. For example this could
be a GP providing medical cover for the hyperbaric
chamber in Orkney