The DDA expects to play a key role in discussions with Scottish GP contract negotiators GPC over the review of dispensing arrangements in Scotland announced today. DDA Scottish spokesman Dr Hal Maxwell has said: “The DDA welcomes at least one of the UK governments paying close attention to dispensing matters.”
In the 2018 Scottish GP contract announcement, the Scottish Government has pledged to consider the current dispensing arrangements and look for “mutually beneficial improvements”.
The contract acknowledges that rural GP practices have, on average, higher expenses per patient than urban ones. In a statement, the Scottish Government says: “Partly, these can be explained by the diseconomies of scale of small GP practices and the costs of dispensing, or having one or more site/branch surgeries and we recognise that these differences will need to be addressed.”
There is also official recognition that rural GPs provide the broadest range of skills because of their remoteness. “They usually have smaller primary care teams… and locality services that may be available in areas with larger populations may not be available.”
In a two-phased approach to contract implementation, the Government will introduce a revised funding formula following a poll next month. During 2018-19, there will also be data collection to inform phase two of the contract negotiation – due for implementation from 2020-21. This phase introduces a guaranteed income range and direct re-imbursement of expenses. The 2020 proposals include:
- Introduce an income range that is comparable to that of consultants
- Directly reimburse practice expenses (staff and premises).
Expenses relating to drug purchases are not specifically listed in the contract announcement, although the Scottish government has agreed a number of key safeguards, including that proposals will “stabilise practice income… include arrangements for protection of GP income and GP practice expenses”.
According to the contract agreement, the aim of the new formula is “to define the GP input and an expenses ‘norm’ for a practice” to guide the allocation of primary care resources across the country. However, it will not be used to allocate money directly, the Government has said.
Instead, the formula will indicate the necessary resources of individual practices to meet patient demand. The contract document says: “The flexibilities that will be required under this proposal will be negotiated between the Scottish Government and the SGPC before implementation.”
The 2018 contract proposal also contains several provisions for rural practices:
- Vaccination transformation programme: delivery of vaccinations transfers from GPs to NHS Boards. Locally-agreed contract options may be put in place for small remote and rural practices to continue delivering these services “in rare circumstances”
- Community treatment and care services: small remote and rural GP practices may agree locally to deliver these services in some circumstances. Support will be provided in the form of staff expenses or the deployment of NHS Board employed staff
- Deprivation: Methodological improvements in the allocation formula are said to improve recognition for deprivation in urban areas and isolated pockets of rural deprivation.