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At the heart of general practice since 1960

Why PMS practice is an attractive alternative to new GMS contract

Dr Gavin Brydone on his practice's successful PMS pilot in Scotland

s successful second-wave fundholders

the initial attraction of PMS in 1996 was the possibility of negotiating a local contract that would reward us for work done. We felt it would also correct the inequities felt by all Scottish practices inherent in the old GMS contract.

Our initial hopes were dashed by our early realisation there would be no extra funding (unlike England). However, in our initial interest statement we had stated that would institute a system of pro-active chronic disease management.

The health board asked us to work this up and particularly to demonstrate that we could reduce secondary sector work. In return, additional resources were found for the practice in the form of a salaried associate, management time, extra staff and pharmacist input.

We proposed time-protected chronic disease management clinics running separately from the usual practice activity managed by each of the six partners. Patients were identified from the disease registers we had at the time, opportunistically, and from prescribing searches. To track item of service, admissions, bed stay times and

clinical data from the chronic disease clinics necessitated setting up our own database and entry screens.

The initial business plan had suggested we would be able to save the secondary sector £300,000 over three years. Because of lack of hospital data we were never able to cost inpatient activity, but from outpatient activity and prescribing savings we were able to demonstrate a notional saving of £250,000 over three years.

The initial two years were very hard work, with a feeling of isolation. This was because political support was ambivalent. But we had unwavering support from the PCT and we found the evaluation process to be supportive and encouraging. After an excellent report from the ministerial review we felt we had achieved our objectives.

Since then we have had to amalgamate our original data system with the General Practice Administration for Scotland and the Scottish Programme for Improving Clinical Effectiveness to facilitate data extraction. We also provide minor surgery and musculoskeletal services to the local health care co-operative generating extra practice income.

For some time we had covered long-stay NHS beds in the local hospital, and because of the crisis in nursing home care and increasing numbers of delayed discharge patients we now cover 250 geriatric and psychogeriatric beds on four sites. In all we have been transformed from an average practice to a complex organisation covering a spectrum of care with a high degree of computer use.

The process has brought the whole team closer together and has given us a focus and sense of purpose.

All practice members are comfortable with data input and management and we feel well-placed to cope with current developments.

Our pilot had a clear clinical focus but subsequent development in Scotland has spread to inner-city homeless practices, local health care co-operatives and health boards in the Highlands and Islands to address rural practice problems.

In all instances the emphasis has been in flexibility and sensitivity to local circumstances.

Although there are now 100-plus PMS practices in Scotland, the limiting factor has largely been lack of development money.

The Scottish Executive is working hard to produce national guidelines for contracts, quality frameworks and financial frameworks which with access to the new funding streams opened up by the new GMS contract will make the PMS contract a very attractive alternative in the current climate.

We've been transformed into a complex organisation covering a spectrum

of care~

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