GP contract victory
Rethink has had a great campaign victory – the new GP contract contains even more services for people with severe mental illness. There are some major changes in the contract - but more still needs to be done for people with severe mental illness to get the primary care services they deserve.
What is the GP contract?
GPs are now rewarded for giving people specific services. The contract tells GPs what ‘extra’ services they should provide and how many points they will gain for doing so. The more points a GP practice gets, the more money it gets – so there’s a clear incentive for GPs to provide as many services they can.
A review group looked at whether the right ‘extra’ services were included and if any new services should be added. The new contract came into force at the beginning of April 2006.
What was in the old contract for people with severe mental illness?
The contract in 2004 contained health checks for people with severe mental illness. These are very important as people with severe mental illness currently die 10 years younger on average than the rest of the population because of physical health problems. The health checks looked a physical health problems so that they could be detected early and people could be given treatment.
There was also a lithium monitoring service.
What’s in the new contract for people with severe mental illness?
The health checks now specify that GPs must give people information about diet, smoking and exercise. Up to 70% of people with severe mental illness smoke (much higher than average) and these people are far more likely than other smokers to die from respiratory diseases. Research had shown that GPs were unlikely to give people with mental illness health promotional information, so it is great news that the contract now specifically says that this is necessary. Rethink specifically recommended this in its submission to the review group – so this is a great victory for Rethink.
Rethink believed that there was a problem in the contract as people had to give their consent to be on a register before they were offered one of these healthchecks. People may be very frightened about the prospect of being on a register and hence miss out on a very useful healthcheck. Rethink raised this problem in the submission to the review group. The new contract will now ask GP staff to contact people who do not attend. This should help to ensure that people have more information about the healthcheck: another great step forward.
The contract also says that people should have a care plan stored in their records, which should be agreed with them and, if appropriate, their carer. It should specify how someone wants to be treated in a crisis, their medication preferences and what you believe to be ‘early warning signs’ of a crisis.
What more needs to be done?
Everyone who works in GP surgeries needs to understand mental illness better. Training should be given to everyone in GP surgeries: receptionists, practice nurses, practice managers and GPs.
GP staff also need to understand how the Disability Discrimination Act (DDA) applies to people with mental illness. The DDA says that GP practices must make ‘reasonable adjustment’ if a disabled person needs them to change their policies or procedures - this includes people with mental illness.
There is a lot that GPs can do to make an adjustment for people, for example, giving people longer appointments so that there’s time to explain symptoms. This is not just a matter of good practice – people have a right to this under the law.
GPs are now rewarded for giving people specific services. The contract tells GPs what ‘extra’ services they should provide and how many points they will gain for doing so. The more points a GP practice gets, the more money it gets – so there’s a clear incentive for GPs to provide as many services they can.
A review group looked at whether the right ‘extra’ services were included and if any new services should be added. The new contract came into force at the beginning of April 2006.
What was in the old contract for people with severe mental illness?
The contract in 2004 contained health checks for people with severe mental illness. These are very important as people with severe mental illness currently die 10 years younger on average than the rest of the population because of physical health problems. The health checks looked a physical health problems so that they could be detected early and people could be given treatment.
There was also a lithium monitoring service.
What’s in the new contract for people with severe mental illness?
The health checks now specify that GPs must give people information about diet, smoking and exercise. Up to 70% of people with severe mental illness smoke (much higher than average) and these people are far more likely than other smokers to die from respiratory diseases. Research had shown that GPs were unlikely to give people with mental illness health promotional information, so it is great news that the contract now specifically says that this is necessary. Rethink specifically recommended this in its submission to the review group – so this is a great victory for Rethink.
Rethink believed that there was a problem in the contract as people had to give their consent to be on a register before they were offered one of these healthchecks. People may be very frightened about the prospect of being on a register and hence miss out on a very useful healthcheck. Rethink raised this problem in the submission to the review group. The new contract will now ask GP staff to contact people who do not attend. This should help to ensure that people have more information about the healthcheck: another great step forward.
The contract also says that people should have a care plan stored in their records, which should be agreed with them and, if appropriate, their carer. It should specify how someone wants to be treated in a crisis, their medication preferences and what you believe to be ‘early warning signs’ of a crisis.
What more needs to be done?
Everyone who works in GP surgeries needs to understand mental illness better. Training should be given to everyone in GP surgeries: receptionists, practice nurses, practice managers and GPs.
GP staff also need to understand how the Disability Discrimination Act (DDA) applies to people with mental illness. The DDA says that GP practices must make ‘reasonable adjustment’ if a disabled person needs them to change their policies or procedures - this includes people with mental illness.
There is a lot that GPs can do to make an adjustment for people, for example, giving people longer appointments so that there’s time to explain symptoms. This is not just a matter of good practice – people have a right to this under the law.
