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Substance misuse contract with CRI

You will have received, or shortly will receive, the email below from CRI, together with a revised contract and service specification for providing the substance misuse service. I can confirm that the LMC has indeed been consulted on the contract and have made suggestions which, as detailed below, have been incorporated into the revised contract. I gather that all substance abuse GPwSIs have also been consulted and are happy with the revised contract and service specification.

I would advise however that the input of the LMC has concerned itself with the contract rather than the service specification , in order to ensure that it is fit for purpose and a fair and reasonable document for practices to sign, but LMC’s is not a legal opinion of course , and it goes without saying that all practices/partnerships must consider whether to obtain their own independent legal advice on the document in order to provide further comfort and allay any residual concerns. I would further add that the LMC is not really in a position to advise on the content of the service specification; that is clearly something which practices need to be content is deliverable for the funding on offer, and something I expect they would wish to discuss with the GPWSIs , who again, as far as I’m aware , have not raised concern.

There are some further points worth making.

Firstly my understanding is that the new contract and specification places considerable additional burdens on practices, in respect of audit requirements and performance management, than does the previous contract, yet this is to be delivered with no increase in funding. And to add context for this, I believe that similar contracts to provide this service in other parts of the country are generally priced far higher than in Birmingham, in some cases over 25% higher. And many of these higher –priced contracts reflect areas where the demands on practices of providing the service are not as high as they are locally.

Secondly there is no guarantee that the service requirements will not escalate further in the future, once this new contract’s term has expired. Nor is there any guarantee that the current level of funding will not be reduced going forward. My understanding is that CRI’s contract with Birmingham City Council is for a total of five years, potentially extendable for a further two years. However total funding to CRI for all the services it is contracted to provide is to fall from £18m to £14m as a result of local authority cuts. Under these circumstances it would be a very pleasant surprise indeed if there were not attempts in future to cut practice ’ contract values to provide substance misuse services, as well as to increase the service demands it places on practices.

Dear colleague,

Further to our recent communication and circulation of the Primary Health Care contract please find attached a revised version following recommendations from the Local Medical Committee. I have highlighted these changes for ease of reference below.

B3.1e - the word ‘comply’ changed to ‘have due regard’
B7.3 - clarified that these services are exempt from VAT
B7.4a - 5 working days changed to 20
B14.1 – added ‘lawful’
B14.2 – Authorised person explained in definitions
B14.3 – extended to 20 days
B14.5c – added ‘reasonable’
B26.3 – deleted reference to The Authority
Appendix c: Dispute Resolution – removed specified roles to reflect practice staffing structures

I’d also like to take this opportunity to clarify processes for patients requiring alcohol support. Any patient assessed as needing support can be referred directly to the Recovery Co-ordinator based at surgery. A comprehensive assessment will be undertaken and patients scoring 20+ on the alcohol audit (attached for reference) will be offered treatment within CRIs specialist services. Those scoring less than 20 and requiring psycho-social interventions only, can be offered support at the surgery by your allocated Recovery Co-ordinator.

CRI have a single point of contact for all referrals and queries. In the absence of your worker, referrals can be taken over the phone by phoning 0121 227 5890. Guidance and support relating to Opiate Substitution Treatment can be sought directly via your GPwSI Mentor.

If you have any queries relating to the contract or information provided above please do not hesitate to contract me.


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