The vote was a landslide. On 20 June 2003, nearly 80 per cent of all UK GPs had lined up in favour of the new General Medical Services (GMS) contract.
When the GMS contract is implemented in April 2004 it will encompass the biggest change in general practice for 50 years and represent a shift towards patient needs and quality service.
The greater flexibility enshrined in the new contract will enable GPs to exercise more control over their workload and pursue areas of clinical speciality.
A central part of the framework is a points system that will add an element of payment-by-results to the way GPs are remunerated. These financial incentives are intended to increase performance in both clinical care and practice organisation with the overall objective of improving the experience of patients.
Undoubtedly, the arrival of the GMS contract throws up many challenges and opportunities for healthcare PR practitioners, be they in-house at a pharmaceutical company or an agency. But this radical new contract is also extremely complicated. Many GPs are still far from clear as to its full implications for their working lives. The onus is on healthcare PR specialists to get to grips with the new realities of primary care, and develop communications plans that will explain it more fully and exploit the new environment.
'PR professionals who don't understand the GP contract will leave themselves exposed,' cautions Red Door Communications managing director Catherine Warne. 'We're therefore having a training session with one of the GPs who negotiated the contract to make sure we understand it.'
Munro & Forster Communications deputy managing director Sarah Hart agrees.
'Pharmaceutical companies have got to get under the skin of primary care and think how they can offer not just products, but also solutions that help them meet their performance targets,' she says.
The clinical standards dimension to the quality framework will be key. Ten disease areas have been set out within the contract (see table). Each of these has been allocated a maximum number of points, which will be awarded to practices for identifying patients that suffer from these illnesses, and achieving quality indicators relating to the kind of intervention taken, as well as the outcome of the treatment.
Chandler Chicco Agency managing director Jennie Talman defines the ten disease areas outlined in the contract as 'core' conditions. It will, she says, be more important than ever for pharma companies to demonstrate the efficacy of their medicines to GPs. In the new performance-focused environment, evidence of effectiveness will need to show how medicines will meet clinical quality standards in these core disease areas.
However, there are a number of disease areas that fall outside these core illnesses and are therefore not incorporated into the contract. Talman expects to see pharmaceutical companies that have products for these areas lobbying the Department of Health with a view to securing inclusion when the GMS contract is revised.
Finally, there is a set of less serious conditions - migraine, for example - that will never be an NHS priority. The communications challenge for pharma firms with treatments in this category is to ensure their disease area is not neglected in favour of point-accruing core conditions.
According to Warne, GPs are undoubtedly going to focus on areas for which they are going to get quality points. Talman agrees: 'We will need strategies to keep what we call "satellite" conditions in mind and make sure primary care still regards these as important.'
In addition to communication activity related to specific products, there are opportunities for pharmaceutical companies to build reputation and levels of recognition by helping practices with the organisational aspects of the new contract. For example, MSD Informatics, a subsidiary of drugs company Merck Sharp & Dohme, has launched a software product called Contract Manager, which is designed to help co-ordinate practice activities around the quality agenda of the new GMS contract.
There are also opportunities for pharmaceutical companies to work with Primary Care Organisations (PCOs) - predominantly Primary Care Trusts - the bodies responsible for planning and commissioning health services at a local level. Each PCO typically covers about 100,000 patients. Pfizer, for instance, has worked with NHS Alliance, the body that represents over 90 per cent of PCTs, to publish a guide called Designing People Centred Services that proposes ways to make the best use of available skills and resources.
NHS Alliance chief executive Michael Sobanja says: 'The part that interests me is those pharmaceutical companies that are considering how they might help PCTs handle the contract. For example, how do you get the data from your GP practices? How do you go about having annual discussions? Is there best practice from elsewhere? The industry can be a broker of best practice.'
It can be argued that the GMS contract is a reversal of the healthcare policies of the 1990s, which attempted to encourage lower prescribing wherever possible to protect the NHS's stretched coffers. The introduction of an incentive model for GPs looks certain to increase prescribing in some clinical areas, thereby offering real marketing opportunities.
Yet, even at this early stage it seems clear that focusing simply on persuading prescribers to spend more money is not going to prove a sensible way forward. The overriding aim should be helping the NHS meet its strategic objectives, says Sobanja.
Given that points will be awarded for the depth and quality of patient care, there may be opportunities for pharmaceutical companies to carry out research, perhaps even at an individual practice level, that helps build a case for the efficacy of a product.
Countrywide Porter Novelli healthcare director Carolyn Brown offers the example of chronic diseases, where patients may not have their symptoms alleviated by a treatment, but may see the quality of their day-to-day lives improved as a result of taking the medicine. 'Although you can't objectively prove their symptoms are better they may be able to do more in their lives,' she says.
Working hand-in-hand with GP practices to illustrate how the condition of patients being treated in a certain way is improving - or perhaps, stabilising - will surely figure following the introduction of the new contract. Patient surveys are likely to increase.
Community pharmacies also have an important role to play in primary care provision. The GMS contract touches on the necessity for PCOs to work with pharmacies in order to reduce general practice consultations for over-the-counter medicines. Consequently, new opportunities are likely to arise in both the public education and pharmacist relations spheres.
So, with just over six months until the new contract kicks in, it's not only primary care doctors who need to prepare themselves.
DISEASE AREAS IN GMS AND ALLOCATED POINTS
Disease Area Points
Coronary heart disease 121
Chronic obstructive pulmonary disease 45
Mental health 41
Source: British Medical Association