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Scotland GPs concerned over provision for pharmacotherapy and CTAC services

Scotland GPs concerned over provision for pharmacotherapy and CTAC services

GP leaders in Scotland have raised concerns over provision for pharmacotherapy and community treatment and care services, after the Government decided to discontinue their funding.

Health boards are contractually responsible for providing pharmacotherapy and community treatment and care services (CTACs) in Scotland but GP practices had been funded via transitionary services to fill the gaps in health board provision until 1 April this year.

The Scottish Government allocated £15m as a ‘sustainability payment’ for the services in 2021/22 followed by a further payment of £15m in 2022/23.

However, it decided to discontinue the funding after 1 April, with the BMA saying it did so ‘without issuing directions to health boards setting out the extent and manner of the pharmacotherapy and CTAC services they must commit to provide in individual practice contracts’.

Glasgow LMC said this caused ‘significant concern about continued workload shift from secondary care’.

In an update to practices, the LMC said: ‘We are aware that practices are working under significant pressures at the moment and this may be causing some in extremis to be considering the future of their contracts.

‘From the many contacts that we receive from practices, it is clear that there are significant concerns about continued workload shift from secondary to primary care.’

The BMA has issued guidance to help practices dealing with workload from these services and advised practices that they are ‘not required’ to book patients for routine pharmacotherapy or community treatment and care services.

The guidance said: ‘The 2018 GMS contract does not include specific requirements for practices to provide pharmacotherapy and CTAC services. However, practices have broader responsibilities to provide services to patients as part of “essential services”.

‘GP practices are under no obligation to provide any aspect of pharmacotherapy or CTAC services beyond what they were providing to patients before the new contract in 2018.

‘As with other health services provided by health boards, the adequacy or available capacity in these services does not create an obligation for practices to step in to fill any gaps without a contractual agreement to do so unless your individual contract with the Health Board has been varied to provide otherwise.

‘GP practices are not required to book patients into the practice for routine pharmacotherapy or CTAC services as would have been expected of health boards under the directions. Practices should direct patients to health board services as far as possible.’

The BMA also said that they ‘fully expect’ that this guidance will go ‘too far for some practices to feel comfortable implementing and not far enough for many others’.

‘Each practice will need to consider that guidance in the context of their own individual circumstances when looking at how to apply it.’

Dr Patricia Moultrie, medical director at Glasgow LMC and deputy chair of BMA Scotland’s GP committee, told Pulse: ‘The agreement was that these services were going to be provided by the health boards, what wasn’t agreed was that the health boards would do what they could with a certain amount of money from the Government.

‘One of the difficulties at the moment is that the provision of these services is very patchy, so effectively some practices have considerably more than others, and that has always been difficult, and practices have been very patient and tolerant about the situation.’

Last week, health secretary Steve Barclay suggested patients waiting a long time for treatment in Scotland and Wales may be able to transfer their care over to an English NHS or independent provider.