Financial incentives for primary care networks (PCN) to carry out structured medication reviews (SMRs) are to be scrapped, following NHS England’s changes to the GP contract for 2023/2024.
In a letter to GPs and PCN clinical directors, dated 6 March 2023, NHS England said the contract changes aim to improve “patient experience and satisfaction” with general practice.
The changes include a reduction in the number of funding incentives offered to PCNs through the Impact and Investment Fund (IIF), down from 36 incentives to 5 incentives.
The remaining five incentives include two related to flu vaccinations, one related to learning disability health checks, one related to early cancer diagnosis, and an additional two-week access incentive.
The other 31 incentives had included targets for PCNs to carry out more SMRs, to switch patients to environmentally friendly inhalers, and to prescribe more patients with the direct oral anticoagulant (DOAC) edoxaban.
In 2022/2023, PCNs could claim a total of £223m through the IIF, with the amount of funding available for individual incentives dependent on each PCN’s patient demographics.
The IIF for 2023/2024 had been expected to increase to at least £300m; however, NHS England’s letter said that £246m of the IIF funding for 2023/2024 will now be diverted to “improving patient experience of contacting their practice and receiving a response with an assessment and/or be seen within the appropriate period”.
PCNs started offering SMRs in October 2020 to patients diagnosed with frailty and/or living in care homes; and to patients with complex polypharmacy, multiple long-term conditions, and/or with high numbers of prescribed addictive pain management medication.
In June 2022, Tony Avery, the national clinical director for prescribing in England, said SMRs should last at least 30 minutes to maximise the scope for shared decision making, after pharmacists complained they were “struggling to convince” GPs to give them long enough appointments with patients.
Commenting on the changes to the IIF, Graham Stretch, president of the Primary Care Pharmacy Association, chief pharmacist at Argyle Health Group, and clinical director at Brentworth PCN, said: “A lot of the incentive payments, the levers and some of the Quality and Outcomes Framework (QOF) indicators that would incentivise clinical directors, GP partners, towards hiring and using their pharmacists and pharmacy technicians to deliver SMRs are gone from the new contract.”
However, he said that guidance published by NHS England on 2 March 2023 on supporting patients who are taking prescribed medicines associated with dependence or withdrawal has “put the ball into the integrated care board’s court to organise a system-wide response” for these patients.
“I suspect some of the incentives will, instead of coming from national contracts, start to come through in integrated care board incentive payments,” he added.
“I don’t think we should be too quick to imagine that SMRs are finished.”
Stretch also pointed out that SMRs are still a requirement under the Network Contract Directed
Enhanced Service, meaning it is still a requirement but no longer attracts any funding.
“I think the change in emphasis will leave quite a lot of pharmacists feeling vulnerable, particularly those who haven’t been able to develop the patient facing clinical examinations clinical reasoning skills that one would expect at that advanced level,” he added.
In October 2022, MPs called on NHS England to “abolish” the IIF and QOF after finding that they had become “tools of micromanagement”.