LMC Bulletins 2009
Bulletin 40
15.12.09
Pandemic Flu - vaccinating under 5's, updated Q&A and vaccinating pregnant women
You will have received an email from the LMC last week with regards to the arrangement across Tees re the H1N! vaccination of under 5s. The LMC Executive agreed to support the PCTs offer of direct financial of £5.25 per immunisation for the under 5s. In supporting this direct financial payment and in recognising the concerns about the impact of this campaign all parties are fully committed to local discussions about the actual impact on workload and delivery of practice activity. We urge you to continue and complete the immunisation of the at risk and under 5s groups and will be in touch about the work we are doing on impact and practice activity. You should have seen copies of these letters from the GPC and the DH with regard to local agreements being required.
A reminder that, currently, the antiviral collection point for Tees is at the Primecare Centre, Massey Road, Teesdale, Stockton on Tees and due to a decrease in demand it is now only open between 10am and 12 noon seven days a week.
The RCGP, Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) have issued this joint statement to nurses and midwives highlighting the importance of H1N1 vaccination for pregnant women and to allay fears that the vaccine is in any way ‘dangerous’ for this priority group or their babies. An updated version of the BMA Pandemic Flu Q&A is also available here.
Guidance on Correct Use of Choose & Book
A new document outlining responsibilities and operational requirements for the correct use of Choose and Book was published on 8th December 2009. The document is also on the BMA website here. You will note that in Section 6 : Page 14 it states that where providers offer named referrals on paper-based referrals they should do so on electronic-based referrals. This has been raised with the Tees PCTs and the LMC will be pursuing this where it is not available.
In January 2009, the BMA published ’Choose and Book - Learning Lessons from Local Experience’. The research found that implementation of Choose and Book goes far beyond installing systems and problems are often not due to the functionality of the system but due to broader issues such as national and local policies, processes in place and capacity issues. The BMA discussed these findings with the Department of Health and the outcome of the discussions is the ’Responsibilities and operational requirements for the correct use of Choose and Book’ document, which has been co-signed by the BMA. The document is intended to help organisations understand the importance of using Choose and Book correctly. Requirements include promoting rather than mandating the use of Choose and Book, allowing electronic referrals to named clinicians if paper based referrals to named clinicians are accepted and encouraging clinicians to initiate and review referrals themselves online. It is hoped that this document will ensure that all Trusts and PCTs deliver an appropriate level of support.
Requirements for Death Certificate
Some Registrars of Death have been requesting unnecessary information from GP practices because of a misunderstanding about the implications of the new GMC license to practice - for example, practices were asked to supply the names of GPs who were licensed to sign death certificates, together with their GMC registration, their GMC licensing number and details of their qualifications allowing them to sign the forms. GPC can confirm that there will be no GMC license number and there will be no further qualifications required of a GP to sign a death certificate. With the introduction of the license to practise in November 2009, Registrars just need to check that the doctor signing a death certificate is licensed with the GMC at the time of signing the form. There should not be a need to supply information to the Registrar prior to completing the form (particularly as the information could be out of date if supplied in advance). However, it would be helpful to Registrars if GPs could include their GMC number on death certificates so that it is easier for the Registrars to do the necessary checks.
Vetting and Barring Guidance
This guidance explains the steps that GPs need to take individually and as employers to ensure that they comply with the Safeguarding Vulnerable Groups Act 2006. This guidance is also available on the BMA website here.
Bulletin 39
08.12.09
Pandemic Flu - Sharing batches of H1N1 vaccines between practices and various updated guidance
MHRA have agreed have agreed that in order to immunise patients in the priority groups, vials of swine flu vaccine can be transferred between GP practices. Such transfers between GPs are not normally accepted practice. However, during the early phase of the swine flu vaccination programme, should it prove necessary for inter-practice transfers to take place, the health professionals involved should ensure, when dispatching and receiving vaccines, the maintenance of the cold chain, traceability, and provision of current patient information leaflets and summaries of product characteristics - latest versions available from here.
Quality Control North West has produced 'Safe Handling Standard Operating Procedure for the Repackaging of Bulk Packs of H1N1 Influenza Vaccines under the Supervision of a Pharmacist' on behalf of the NHS Pharmaceutical Quality Assurance. The Chief Pharmaceutical Officer has also published a this letter which includes information about repackaging boxes of H1N1 vaccine for onward distribution .
We will forward information on the vaccination of children under 5 as soon as we have it. In the mean time there have been a number of updated/new documents all of which can be accessed by following the links below:
Second edition of ‘Preparing for pandemic influenza - guidance for GP practices’
- this will be available shortly and reflects the current situation rather than the severe and aggressive pandemic originally prepared for.
DH Delivery and distribution of H1N1 vaccines FAQ
Updated BMJ H1N1 patient information leaflet
DH Flowchart for triage: swine flu patients
- for GP practice managers and receptionists.
DH Swine flu and rough sleepers
- for organisations working with rough sleepers in England.
Med1web/Novachannel, developments on being removed from their directory
We have written many times with warnings about Med1web otherwise known as NovaChannel but this time we hopefully bring a ray of hope for those registered with them! The organisation has now ceased trading from Switzerland but GPC believe payment for the Med1web forms is now being pursued by United Lda (a Portugese company). However we are aware of one doctor who has recently received a letter from United Lda notifying him that they had reviewed his file and that, because he is not an independent doctor, they have deleted his particulars from the directory and that the contract is null and void. We therefore advise all NHS GPs who unwittingly signed up to the Med1web form to contact United Lda asking for their details to the removed from its directory and for any contract to be terminated. United Lda's address is: PO Box 1571, 1056-001 Lisbon, Portugal or email: info@med1web.com.
Bulletin 38
01.12.09
Pandemic Flu
Do not start to vaccinate under 5's not at risk until negotiations are concluded.
Last week, the DH announced that private primary care providers are now able to obtain the H1N1 flu vaccine from PCTs in order to vaccinate private patients in the priority groups, as well as frontline healthcare staff providing direct patient care.Further information is available in the statement from the BMA’s private practice committee here.
The DH has also published this guidance on mental health services to support mental health trusts and other specialist mental health service providers implenting their plans for responding to the pandemic.
This is a national summary providing an overview of ten regional exercises which documents the high-level areas for further action. The exercise confirmed the extent and depth of planning that have already taken place in the NHS in preparing for an influenza pandemic.
Child Protection , requests for information
This is a joint GPC/RCGP letter to the profession on the issue of child protection. Please note that this will also be available on the BMA website. The RCGP may also distribute it to its members and the English DH is writing to PCTs with a copy.
Training Courses on GP Employment Law 2010
Please note that the programme of one day training courses for GP Partners and practice managers has been confirmed for 2010, including 'Managing Change', 'Managing Performance' and 'Managing Staff'. Full details of the courses including registration fees are included on the webpage here.
Bulletin 37
24.11.09
Pandemic Flu - 2nd Phase Vaccinations inc. letter from Ian Dalton
Last week it was announced that healthy children aged from 6 months up to 5 years (around 2.7 million) are to be included in the second phase of H1N1 vaccinations. This is due to an increase in GP consultation rates amongst school-aged children after half term, and a substantial increase in the number of under 5s in hospital, including in critical care. The CMO also announced that carers (1.5 to 5 million) are to be added to the group of front line health and social care workers to be prioritised for vaccination in the second phase.
Details of this announcement can be viewed in this letter from Ian Dalton.
The NHSE has indicated that it wishes to discuss the vaccination arrangements for the under 5s with the GPC. However, formal negotiations have not begun and there are not yet any arrangements in place for how the work will be organised or recognised. There have been suggestions that phase one is expected to be concluded by mid December, but the GPC has stressed to the DH that it is more likely that the first phase will conclude in mid January, after which time the second phase can commence. Until the first phase is finished, vaccination of the healthy under 5s should not begin.
Child Protection , requests for information
The LMC is concerned to learn that practices are not responding to all requests for information in relation to child protection in a timely and appropriate fashion. Please view and act on the details in this document from the Secretary. This is extremely important and must be rectified.
NHS Choices Practice Feedback
Since patients have been able to post comments and rate practices there have been 3060 live comments posted but only a small number of practices have taken time to respond to comments made on their services/practice (131 practice replies). Those practices with comments are advised to read and consider responding; NHS Choices automatically notifies practices when comments have been posted.
It is important to remember that the website is a public one and any comments which are, for example, factually incorrect will leave a false impression if there is no response from the practice concerned. We also advise that practices regularly check their profiles regarding the accuracy of information about opening hours, staff details and services available to patients. Practices that do not currently edit their own data on NHS Choices can do so by obtaining a login/password from the dedicated GP help desk on 0845 402 3089.
Locum GP Pension Contributions
In order for locum GPs' pension contributions to count towards the NHS pension, they should be paid within 10 weeks of the corresponding work being completed. Some practices may not have been paying locum GPs within this 10 week period for work carried out in their practice, leading to locum GPs missing the contribution deadline. Although some PCOs are more strict on this than others, a PCO certainly can decide not to pension contributions sent outside of the 10 week limit. Although it is our view that locum GPs would not be forced to opt out of the NHS pension scheme as a whole in this circumstance, they would lose out on pension benefits for that specific piece of work. It is therefore important that practices pay locum GPs within this timeframe, and preferably much earlier than this.
Interim Seniority Figures
Interim seniority factors for 2009/10 for England and Wales have been published today and figures and details of the methodology may be viewed on the NHS Information Centre website at
www.ic.nhs.uk/tsc. The figures are: £94,743 for England and £84,667 for Wales.
Bulletin 36
17.11.09
Pandemic Flu - Pregnancy Leaflet
This week the DH has published a leaflet ‘Swine flu and Pregnancy: How to protect yourself and your baby’ (click here to view), which gives information about the swine flu vaccination, precautions to reduce risk of infection and available treatments.
Bulletin 35
10.11.09
Pandemic Flu - national guidance inc. Vaccinating locums, updated Green Book
BMA guidance
The latest news and guidance is available in the newly spruced up GP flu pages on the BMA website here.
There have been some additional questions about the nature of the DES agreement as below:
Q: Will the income from the vaccinations deal harm the prospects of a GP pay rise for next year?
A: The health departments have recognised that the vaccinations are being delivered at cost and that no profit will be made. However, the current financial climate does make it unlikely that there will be a significant pay rise regardless of the vaccinations deal.
Q: Has a dangerous precedent been set by agreeing to a financial reward below that of other vaccinations?
A: This had been one of our biggest concerns and fundamental to our negotiating position, since this could potentially have devalued all vaccine payments in the future. Given that the Government were unwilling to negotiate payment at the seasonal flu rate, we negotiated the “basket” of concessions to equate to the value of an item of service and ensured that the payments will be made via a Directed Enhanced Service (DES). The swine flu vaccinations deal is NOT an item of service. We have a clear written assurance from the Government that this deal will not set a precedent.
H1N1 Vaccination for Locum GPs
This is a reminder for GP practices to include any registered locum GP patients in your list of patients to be vaccinated, if they request this. You may also wish to vaccinate locum GPs who are working in your practice. The practice will not receive a fee for vaccinating the locum GP (or any frontline staff), and no charge should be made to them for the service. There will only be a payment for patients/healthcare professionals that fall within the JCVI risk groups. The advice in the joint DES guidance is as follows:
3.1 Will there be any payment for the vaccination of practice staff and doctors?
No. Practices can freely use the vaccine for these groups but payment is only in relation to the JCVI at-risk groups. If a member of staff or a doctor falls within one of the at-risk groups, the expectation is, subject to patient preference, that they will be vaccinated by their registered practice. |
Delivery of H1N1 vaccines
The CMO hopes that by the end of next week, most GPs will have received their first delivery of swine flu vaccination. Ian Dalton, National Director of Flu Resilience, has also written this letter to all PCOs to update on the vaccination programme and about the delivery and re-supply of the H1N1 vaccine.
Updated Good Medical Practice: Responsibilities of doctors in a national pandemic guidance
The GMC has updated their guidance to take into account the fact that a pandemic can break out regionally, so while some doctors may be working normally, others may be struggling to cope with the additional workload. The guidance allows those most affected to work flexibly.
Practical guide for preparing and administering H1N1 vaccine
The DH has published this practical guide on how best to administer the H1N1 vaccine, which answers questions about the vials and syringes, infection control and whether swine flu vaccine can be administered at the same time as other vaccines.
Vaccination of Pregnant women
Professor Salisbury has written this letter to GPs providing information to support the vaccination of pregnant women.
Green book updates:
Chapter 19 Influenza - Immunisation against Infectious disease (revised chapter)
Chapter 19 Influenza - Immunisation against Infectious disease (list of updates)
Chapter 23a Pandemic influenza A(H1N1)v 2009 (swine flu) (revised chapter)
DH patient leaflets
Patient leaflets for recipients of the new vaccine that could be included with any invitation letters sent out, posters that can be used to advertise local clinics and raise awareness and vaccination appointment/record cards – can be ordered through www.orderline.dh.gov.uk quoting:
- Swine flu vaccination leaflet 297563
- Swine flu vaccination information poster 299247
- Swine flu vaccination empty belly poster 299248
- Swine flu vaccination appointment cards 299249
Med1Web/Novachannel
DO NOT SIGN ANYTHING. Once again this scam is operating in our area. We are aware of a number of GPs who have personally received letters. Running under a number of guises (European Medical Directory or Novachannel are other names) they are trying to get their hands on your money. This time they are targeting individual GPs by sending out directly addressed letters.
2008/09 (main) Certificate of GP (& non-GP) Provider NHS Pensionable Income
The pensions department have circulated this attached email - there is a lot of information contained in the links.
This is the main 2008/09 Certificate and guidance notes. It is similar to the 07/08 Cert except that we now have to take account of tiered contributions and the new Additional Pension. Here you can view FAQs and further information on overlaps.
Please remember that a GP Provider must a complete a Certificate for each GMS, PMS, APMS contract that they are a party to even if the contracts are all with the same PCT/LHB. This means that you may have several Certs to complete. Non-GP Providers however can only be pensionable in one of their posts by virtue that they are afforded WT Officer Scheme status; not Practitioner.
At the end of year 2009/10 (and in future years) salaried GPs/long term fee based GPs will have to complete a Certificate in order to reconcile their tiered contributions...so watch this space.
The same broadly applies to GP Locums however they have tweaked forms A & B so that they do not need to complete yet another form in 2008/09. If a GP Provider is also a GP Locum any arrears (or overpayments) of their GP Locum employee contributions in 2008/09 must be reconciled with the relevant PCT/LHB via the forms A & B and not via the Cert.
The 2008/09 Ltd Company Certificate plus guidance notes and a FAQ are also available by following the respective links.
Bulletin 33
27.10.09
Pandemic Flu - DH Support materials practices and patients
For practices - DH swine flu information materials, including template consent forms and invitation letters have now been published on the DH website and can be viewed here. Note that FAQs on the vaccination deal will be published shortly as well as an update of the flu Q&A already available on the GP flu pages of the BMA website here.
For patients - The DH has published a swine flu patient leaflet available here. There is also advice for pregnant patients here.
Pandemic Flu - guidance for pregnant health care workers
DH H1N1 guidance for pregnant health workers is available here. It will be published on the DH and BMA website shortly.
BMA Employer Advisory Service (EAS)
Many of you are aware that the BMA launched this service in England in January. This service specialises in providing advice, guidance and support to members who have employer related queries.
This service is available to any member who is an employer of staff. It is supported by a dedicated team of advisors who only deal with employer related queries. This team operates independent of the service that supports employed staff.
The advisers work with you and your Practice Manager, as appropriate, on a day to day basis to guide you through the relevant internal processes and procedures that you are required to follow.
They are also looking to develop strong links with LMCs and Practice Manager groups and are to provide seminars on Employment Law. This is in addition to the national programme of training available to GPs (Managing Change, Managing Performance and a new programme called Managing Staff which is to begin next year)
In addition to being well versed in employment law and current good HR practice our advisers have specialist knowledge of the medical profession and our familiar with the issues facing general practice. They also have established links with SHAs, PCTs and LMCs.
Typical work that advisers deal with on a regular basis is guidance and support related to:
- Recruitment and selection
- Contracts of employment and varying terms
- general partnership advice (excluding drafting)
- grievance and disciplinary
- performance management/appraisal
- absence management
- reorganisation/restructuring
- dismissal
- redundancy
- to avoid discrimination
- best practice HR guidance in terms of the development of procedures and policies
An Employment Handbook is also being developed by this team,due for issue in early 2010. This service is available as part of your BMA membership.
Bulletin 32
20.10.09
Pandemic Flu - North East SHA; vaccination of independent
domiciliary and residential care sector staff.
There has been some discussion between the North East SHA
and the LMCs with regards to vaccinating independent social
care staff. It was agreed that this would be best carried
out by GP practices. A letter from the SHA outlining the
proposal
can be viewed here.
Pandemic Flu - vaccination programme update
We are awaiting details of the Swine flu DES agreed between
the DH and BMA but in the meantime please find a summary of
the current situation below:
Practices will be paid only for the vaccination of patients
in at risk groups.
Payment will be made for every dose of vaccination given at
a rate of £5.25 per dose.
All housebound patients will be vaccinated by the District
Nursing service. (DNs) This means all patients identified by
the practice as housebound. Details of any criteria that can
be used in defining the housebound will be within the DES
Practices will be paid £5.25 per dose for all vaccinations
given by DNs. There will be no charge to practices for the
work undertaken by DNs. This is the responsibility of the
PCT
Practices are advised to offer vaccination to all of their
own front line staff. It is for practices to define who
comes within this definition. Medical defence organisations
have confirmed cover for vaccinating those staff members who
are not patients of the practice
Proper records of staff vaccinations, and refusals, must be
kept and the GP of the staff member must be informed.
Information to be recorded and sent to the GP should
include: Name, DOB, reason for vaccination, date of
vaccination, manufacturer and batch number. If the staff
member is in an at risk group then their GP will receive
payment
Any locum GP requesting vaccination from a practice in which
they are working should be offered vaccination at the
earliest mutually convenient time. This should be within the
vaccination programme of front line staff and so there is no
payment to the practice, nor should the locum GP be asked
for any payment
Vaccination is voluntary and any citizen has the right to
make an informed decision to refuse this treatment
It is our current understanding that Hajj pilgrims will not
be asked for a certificate of vaccination against swine flu
(H1N1) to acquire a Visa as it is not yet 'universally
available' due to only the at-risk groups being vaccinated
Further detail on the vaccination programme outlines above
are contained in the latest edition of the GPC news which
can be viewed here.
Pandemic Flu
- sick certificates
The DH has published guidance on sick certification in a
swine flu pandemic
which can be viewed here.
Pandemic
Flu - guidance on prophylaxis
DH guidance is
available here.
Replacement for QMAS (Quality Management Analysis System)
The Department of Health and NHS Connecting for Health are
currently considering replacing the Quality Management
Analysis System (QMAS) with a more flexible calculating and
reporting system. DH and CfH are looking to extend the
payments supported beyond QOF to the following:
the Quality and Outcomes Framework (the national QOF)
• quality indicators recommended by NICE that are not
negotiated into the national QOF
• most directed enhanced services (DES)
• local enhanced services (LES) that work in the same way as
the other payments that are supported by the new system.
DH and CfH are asking for the views of frontline staff, such
as practising GPs, practice managers and PCT staff. The
results of the consultation will be reviewed by
representative groups such as the GPC and the RCGP. To
participate in the survey, which is running during October,
go to the Connecting for Health website.
Vetting and Barring Scheme
The GPC will shortly be issuing guidance for all GPs
(including what a GP employer should do) on the new vetting
and barring scheme. This scheme comes into play 12 October
2009, and is being introduced in stages. From the 12
October, the following applies:
1. It will be a criminal offence for a person who is
on a barred list (e.g. the PoCA, POVA and/or List 99) to
seek or undertake 'regulated activity'. Regulated
activity includes working as a GP, as a practice nurse
and may also include working as a healthcare assistant.
It applies to those who are already in post or are
seeking a new post
2. It will be a criminal offence for a practice
knowingly to appoint a barred person to a 'regulated
activity' post. Also practices should require an
enhanced CRB check of all new recruits and of those
changing jobs who will be undertaking 'regulated
activity'. Please note that the PoCA, PoVA and List 99
are being replaced by two new barred lists managed by
the Independent Safeguarding Authority (ISA -
www.isa-gov.org ) - one for barred from working with
children, and one for barred from working with
vulnerable adults. The enhanced CRB check will now
provide information held on these two ISA barred lists
3. Employers have a duty to inform the ISA if they have
reason to believe that an individual has caused harm, or
posed a risk of harm, to children or patients that they
work with.
Please be aware that no central funding available to
practices for CRB checks. Therefore the question of who
pays for the check will be one for the employer and the
applicant.
Sickness Certification on discharge from Secondary Care
The LMC have received examples of a number of instances when
secondary care (inc. community services and hospitals) are
not certifying when appropriate. Whilst you may feel it is
in your patients interests to provide a sick note please be
aware that this simply perpetuates the problem and it may be
more appropriate to refer the patient back to the doctor
responsible - GPs not treating the patient should NOT issue
a sick note.
Bulletin 31
13.10.09
Pandemic Flu - new version of guidance
The Department of Health are preparing a range of materials for GPs including a new Immunisation Green Book chapter, fact sheet, Q&A, consent template, Patient Group Directive (PGD) template and patient vaccine invitation letters. Training materials to support NHS staff are also being developed. A new version of the joint GPC/RCGP/DH flu guidance Pandemic influenza – Guidance for GP practices is available here.
Pandemic Flu - H1N1 vaccination staff training video
The Department of Health has published a training video to show Health Care Professionals how to prepare the H1N1 vaccines for adults prior to administration. The video provides information about the two different brands of H1N1 swine flu vaccine (by GSK and Baxter) and shows how to draw up each vaccine, with some important differences between the two products:
- One vaccine requires mixing; the other does not.
- The DH still awaits conformation whether one or two doses of each product are needed.
- The two vaccines are not interchangeable so everyone must receive the same product for each dose.
- Use the dose-sparing syringes with fixed needles provided by the DH.
The video can be accessed here.
Pandemic Flu - Swine Flu clinical packages
The swine flu clinical package, which is a set of tools for use by frontline healthcare professionals during a pandemic is now available here. This has been updated to reflect changes in the guidance on the use of antibiotics and on oseltamivir prescribing in young.
Pandemic Flu - Additional guidance to meet workforce supplies during a pandemic flu.
The Department of Health has also published the document Pandemic influenza: additional measures to meet workforce supply . It is available here.
GMC Introducing the Licence to Practise - 16 November 2009
You will all be aware that with effect from 16th November 2009 doctors will need to be licensed to continue to perform Primary Medical Services or other clinical work both within the NHS and in a private capacity. This will mean that any doctor who is not licensed on 16th November cannot see patents and to do so will be a criminal offence, and breach of the Practice’s NHS contract. Practice Managers/contract holders are asked to confirm to the NEFHSA that all GPs in their practice have provided evidence to demonstrate that they have obtained a Licence to Practice from the GMC. NEFHSA can be contacted on 0191 333 3275.
An essential information pack for organisations that employ doctors produced by the GMC is available for download by practices here. The information pack aims to help employers prepare for the introduction of the licence to practise, which is the first step towards revalidation, the biggest change to medical regulation in 150 years. The pack explains how organisations can go online to check the GMC status of their doctors and provides information about important changes the GMC is making to the certificates it issues to doctors.
Bulletin 30
05.10.09
Pandemic Flu - DH letter sent to SHA
Professor Salisbury, Director of Immunisation, has written to all SHAs and PCTs in England, to assist immunisation leads, pandemic influenza leads and flu co-ordinators in further planning for the swine flu (influenza A (H1N1v) 2009) vaccination programme. The letter includes information about the vaccination deal, the licensing and delivery plans of the vaccines, as well as information about issues such as the Guillain-Barré Syndrome and the use of thiomersal in some vaccines. The letter can be accessed here.
Pandemic Flu - Indemnity for GPs vaccinating own staff
The GPC have had confirmation from the MDOs that GPs who vaccinate their own staff, who are not registered as patients at the practice where they work, would be indemnified as it would be part of their provision of professional services. The DH has deemed it appropriate for GPs to use NHS vaccines on practice staff who are not registered with them. There is more work to be done locally on the logistical issues for GPs vaccinating their own staff.
Pandemic Flu - Sickness Certification
DH will shortly be sending information about certification in the event of a pandemic. You can view some of the key messages it will contain here.
QOF Results 08/09 and business rules
As you will be aware, the QOF results for 2008/09 have been published. They've gone down slightly overall as a result of a drop in the Patient Experience domain, which itself was caused by the Patient Experience Survey being incorporated into the QOF.
Commenting on the publication of the QOF results for 08/09 by the NHS Information Centre, Dr Laurence Buckman, Chairman of the BMA’s GPs committee, said: "The continuation of high scores in the clinical domain shows that patients are still getting extremely good care from their GP practice. Much of this work is preventative, meaning patients are benefiting from early diagnosis and treatment. The dip in the Patient Experience QOF scores is a direct result of changes to the funding of the Patient Experience Survey and not because quality in this area has dropped. Practices got very similar, high patient satisfaction results to last year’s Patient Experience Survey, yet this year they have lost points and resources. It means that if patients look at their practice’s QOF results they could end up with the impression that the quality of the practice, and patients' satisfaction with it, has declined, when this isn’t likely to be the case. So as well as unfairly reducing resources for patient services the results are inevitably likely to be misinterpreted, and this is why GPs have so little faith in this survey."
You can view the full results here.
Version 15 of the business rules have now been published. They are available to view on the NHS PCC website here.
LMC useful reminders list
Occupational health services available to GPs and Practice Managers: GP Health (www.gp-health.org.uk) offer free occupational health services for GPs and their spouses/partners, and Practice Managers and their spouses/partners in the Tees Valley and Hartlepool area (includes sessional GPs and registrars). Identities of those seeking assistance are kept anonymous and not notified to any PCTs. If you would prefer to talk to someone about the different fields of assistance available, please contact: Dr Leslie Dobson (01287 610901) or Dr Ed Selby (07712 531 932).
The LMC sponsor two charities that offer help and support for GPs and their families:
· The Cameron Fund is the only medical charity which provides help and support solely to general practitioners and their dependants. It aims to meet needs that vary considerably from the elderly in nursing homes to young, chronically sick doctors and their families and those suffering from unexpected and unpredictable problems such as relationship breakdown or financial difficulties following the actions of professional regulatory bodies. Anyone who knows of someone experiencing difficulties, hardship or distress is urged to draw attention to the Cameron Fund’s existence or alternatively to contact Jane Cope, the Services Manager. E-mail:
janecope@cameronfund.org.uk / Phone: 0207 388 0796. Address: The Cameron Fund, Tavistock House North, Tavistock Square, London WC1H 9HR.
· The Royal Medical Benevolent Fund provides help and support for all doctors and their dependants in serious difficulty. Amongst the help they give are: back to work support packages, specialist debt management advice, regular financial support where there is long-term need due to accident or illness and one-off grants to help adapt homes or vehicles for independent living despite disability. To find out more about eligibility for assistance please see the link ‘How we can help you’ on their website
www.rmbf.org. RMBF also host information and advice websites:
www.support4doctors.org for those beginning their medical careers and
www.money4medstudents.org
is a resource for medical students to help them manage their finances. Contact address and phone number are: Royal Medical Benevolent Fund, 24 King’s Road, Wimbledon, London SW19 8QN : 0208 540 9194.
Movement of GPs: Practice Managers should contact FHSA Contractor Services on 0191 333 3275 whenever a GP is commencing or leaving the practice. The LMC is then provided with this information which enables us to keep a list of GPs in the area.
Email addresses: Practice Managers should contact the PCT IT Help Desk (0845 234 0233) with the names and email addresses of GPs or members of staff joining/leaving the practice so that email addresses used by the PCT and LMC can be kept up to date. Specify that the GPs and Practice Managers names/email addresses be inserted into:
· the “Global Address List”; and
· the “All Groups” section under the specific PCT GPs or PCT Practice Managers entries
Practice letterheads: Should show the names of all partners. If letterheads include non-partners such as salaried GPs, locums, nurses, Practice Manager or Business Partners, their role should be made clear otherwise there are circumstances in which they could be assumed to be partners thus exposing the partnership to financial and other risks.
Requests for short term sicknotes: employers / students: The LMC has produced this standard letter for practices to use for patients seeking short term sicknotes (less than 7 days including a weekend). Practices should hand this letter to patients for employers OR this letter to students for schools/universities.
Requests for Hep B in connection with employment/university: Here is a standard letter to be handed out by practices to patients seeking Hep B in connection with employment / university. To assist patients requesting Hep B for employment / university related purposes, you should be aware of Hep B arrangements at neighbouring practices/alternative providers, who can charge a fee for the vaccination and blood test, but you must not discuss charging arrangements. Any such arrangement must be for the convenience of the patient and no discussion or agreement over charges must take place with those practices as this may breach Competition Law with serious financial and criminal consequences. Here is an additional letter for GPs/Practice Managers from the LMC outlining this guidance.
Clinical waste (GMS/PMS practices in non-Trust owned properties): The latest version of clinical waste letters can be found by following the links below. All practices who produce 500 kg of hazardous waste annually (clinical waste comes under this category) must be registered annually with the Environment Agency for the production of hazardous waste. If you have any queries please contact Christine Knifton at the LMC office on 01642 737744 or email:
christine.knifton@middlesbroughpct.nhs.uk.
Letters to Practice Managers on different aspects of clinical waste:
· Clinical waste
· Collection and labelling of all clinical waste
· Collection and labelling of 1L diabetic sharps boxes from patients
· Collection and labelling of cytotoxic waste
· Collection and labelling of toxic waste
· Waste disposal easy reference
Bulletin 29
29.09.09
Pandemic Flu - Vaccination Arrangements
The National Director of NHS Flu Resilience, Ian Dalton, has clarified that in England, GP practices will not be charged for the time of District Nurses (DNs) engaged in the vaccination of housebound patients in the priority groups for H1N1 vaccination. PCTs have been asked to plan their vaccination programmes on this basis.
GPs, as employers, should be making arrangements to secure the appropriate vaccination of themselves and their staff. It is the responsibility of GPs to organise the vaccination of eligible front line staff, either via existing occupational health schemes or by putting in place other local arrangements to vaccinate practice staff. The Swine Flu vaccination agreement was specifically about payments to practices in respect of the 9.5 million people in the Joint Committee on Vaccinations and Immunisations recommended priority groups. View the letter from Ian Dalton here.
The dosage of Tamiflu for babies aged 6 months to 1 year has been changed by the European Commission. Full details can be found by following this link to the DH website.
Please see the Pandemic Flu Q&A (updated 14 Sept) here.
Audit of 'E' Discharge Letters
The PCTs carrying out an audit on discharge letters from each clinical directorate following the highlighting of some problems with the 'e' letter - misdiagnosis, lack of information regarding procedures, incorrect admission and discharge dates etc. The simple audit will require GPs to take a couple of minutes to complete a short audit form which will be sent with the discharge letters which were being audited by the Clinical Directors. We hope all practices will assist with this audit as it will enable the system to be more effective.
QOF Topic Suggestion Facility
As part of the new QOF process, NICE wants to ensure that all stakeholders from all participating countries have the opportunity to contribute to the development of future indicators for the QOF. NICE have launched two new online facilities to enable people to suggest topic areas for the development of new QOF indicators and also comment on existing indicators. The facilities can be accessed from 15 September – 13 October.
The GPC will not be involved in the suggestion of clinical areas for the QOF as it negotiates the final framework. However, individual GPs are encouraged to submit their personal views and experiences as part of this programme.
Suggesting a Topic
The online topic suggestion facility provides a list of evidence-based recommendations drawn from NICE clinical and public health guidance that could provide potential new QOF indicators. Over time this facility will be expanded to provide the opportunity to suggest a wider range of evidence-based sources, accredited through NHS Evidence. Each suggestion will be reviewed against the criterion presented in the submission form and suitable suggestions for the QOF will be presented to the independent Primary Care QOF Indicator Advisory Committee for consideration.
Suggestions can be made here.
Comment on Existing Indicators
The online facility to comment on QOF indicators enables people to input into the review of existing indicators. Comments will be used to review existing QOF indicators against criteria including, evidence of unintended consequences, significant changes to the evidence base or changes in current practice. Comments will be fed into a rolling programme of reviews and considered by the independent Primary Care QOF Indicator Advisory Committee. All contributions will be reviewed following the process laid out in the QOF process guide and only those suggestions and comments that fulfil the criteria for consideration will be presented to the Advisory Committee.
The online facility for commenting on existing QOF indicators can be accessed here.
Referrals to Complementary Therapists Regulated by Statute
Guidance has been produced in response to evidence of continuing interest amongst patients in the use of treatment modalities which are currently outside NHS healthcare provision but which are delivered by professionals who have statutory regulation in place. This guidance was first issued in September 2006 and has now been updated. It is available on the BMA website.
LMC Meeting Minutes
Are available on the LMC meeting pages
or by clicking here.
Bulletin 28
15.09.09
Local Involvement Networks (LINks)
The BMA has produced these
FAQs to provide information to practices on the introduction of Local Involvement Networks (LINks) and how this will affect GPs and practices in England. The information is also available on the BMA website.
European Medical Directory
Scam alert! Yet again the physician therapist guide has reincarnated itself and is trying to get your cash. We refer you to the original GPC warning (see bulletin 16 further down this page) re the organisation behind it known as Novachannel and/or Med1web but the short and simple advice - don't sign unless you have checked out the company and crossed your t's and dotted your i's.
GP Access & Responsiveness Workshops
A series of workshops, supported by the RCGP and BMA, are being planned to support practices with access and responsiveness. Please help to shape them by
clicking
here and completing the short survey. All the data is anonymous and results are automatically captured electronically. The same set of questions will be used in a survey via Management in Practice, to capture practice manager views.
Bulletin 27
08.09.09
PE7 & PE8, Patient Survey
The LMC is collating information as to how practices have faired with the patient survey and in particular PE7 & PE8. Please can you drop us a quick email (to
janice.foster@middlesbroughpct.nhs.uk) to let us know:
a) how did you fair with your scoring on PE7 e.g. was it higher, lower or as expected?
b) how did you fair with your scoring on PE8 e.g. was it higher, lower or as expected?
c) did you appeal your results and if yes what was your evidence and what has been the outcome?
Please do try and provide as much information as possible to enable the LMC to build up a true picture to, if required and appropriate, decide on next steps.
Continuation of Treatment for Terminally Ill Patients
Practices may already have read the July LMC Minutes (Min. Ref. 09/07/22), which refer to the case of a terminally ill patient whose own practice felt unable to continue the care in the terminal period because the patient was outside of the practice area. There are a number of issues which are raised in situations such as this. Principally, how patients are admitted to nursing homes and, from the practice point of view, whether or not GPs feel that they are able or willing to provide services in exceptional circumstances outside of their normal practice area; more widely there is a need to consider how GPs are seen by the public.
The LMC is pursuing the question of admissions to nursing homes and hospices separately but would like to take the opportunity of reminding practices that there is nothing which prohibits them from providing care to patients outside their normal area or even outside their own PCT, so long as it is clear that this is being done on the basis of a definite practice decision which has been based on grounds which in no way discriminates unfairly against categories or types of patients.
If a decision is made to provide care in such circumstances, it is important that the whole of the practice team is aware of this so that there is no confusion about whether or not care is being provided by the practice.
Information Commissioners Office (ICO), Registration Costs
The LMC has been made aware of a bogus organisation that is targeting practices requesting they make a payment to renew their Data Protection Act registration. There is a tick box on the form which asks if the respondent is a public body (the Data Protection Act website clearly states that this applies to practices) and if this box is ticked the registration fee jumps up from the current £35 to (up to) £500.
The ICO are aware of this and have issued a warning to be extra vigilant. They have clarified that GPs are defined as Public Authorities wit regard to the Freedom of Information Act as they provide NHS services but they still only pay £35 when it comes to paying the fee for registration under the Data Protection Act - not the £500 as suggested.This agency is fraudulently asking you to make payment to them in order to complete your registration.
In short, if any agency requests you make a payment of more than £35 to complete you Data Protection Registration then avoid these services altogether and contact your Local Trading Standards Office and inform them of the situation.
BMA Employer Advisory Service Flyer
In past bulletins we have included information regarding the BMA Employer Advisory Service. The service has been set up specifically to provide advice and support to BMA members who employ staff to assist them in dealing with a variety of employment relation and employment law matters.
Click here to view their flyer with further information.
Bulletin 26
02.09.09
Pandemic Flu Update
There has now been national agreement (England only)
regarding flu vouchers versus scripts. It has been agreed
that GPs will use flu vouchers for the under 13s and when
visiting patients at home and that GPs will use the blank
side of computer scrip stationery when in the surgery, with
a simple three-letter endorsement 'AVC' . Furthermore, GPs
will not have to fill in anything on the vouchers apart from
using a normal surgery address stamp and date stamp and
signing it. A letter has been sent to all PCTs, via the SHA,
to confirm this. You can view that letter
here. PCTs in Tees will be providing further information
about this process to all practices shortly but will
currently continue to accept any vouchers issued.
BMJ Best Health have published a 'Patient Information
Leaflet' on swine flu which can be printed out by practices
to give to patients. You can download the document
here. Please note that this document is BMJ Group
Copyright so should not be amended in any way but may be
updated by the BMJ in the future.
DH have recently produced a guidance document for PCTs on
planning for and responding to pandemic flu, titled
'Pandemic Flu: Planning & Responding to Primary Care
Capacity Challenge'.This document mentions the payment rate
for locums agreed between NHSE and other issues, including
accessing retired medical practitioners. You can view the
guidance
here. It is also available on the DH website by
following this link
www.dh.gov.uk/en/Publicationsandstatistics
LMC Guidance - Dealing With Complaints or Investigations
The LMC has produced a 'guidelines' letter which hopes to
provide support to practices when dealing with complaints or
investigations. The LMC has requested the PCTs forward this
letter to practices when they contact practices about
complaints. You can view the guidelines
here.
Bulletin 25
25.08.09
Pandemic Flu
Update
Tees PCTs have forwarded an important 'special edition'
briefing containing important information about the closure
of the North Ormesby the Anti-viral Collection Point. For
your ease, if you haven't seen it yet, you can view it
here.
DVLA - Consent for the Release of Relevant Medical
Information for Patients
From Monday17th August, new rules called Consent by
Assurance were implemented by the DVLA relating to the
release of relevant medical information for patients
applying for driving licences.
The BMA has given agreement that DVLA no longer need to
provide the patients written consent from the patient for
access to the relevant parts of their records for the
purposes of being granted a driving licence. The new rules
to GPs and to driving licence applicants are explained
here.
The BMA are aware that this agreement might generate
concerns amongst GPs about patient confidentiality. The GMC
web site has a frequently asked questions supplement to
their confidentiality guidance –
www.gmc-uk.org/guidance/current/library and one query
advises that doctors should:- “Obtain, or have seen, written
consent to the disclosure from the patient or a person
properly authorised to act on the patient’s behalf. You may,
however, accept written assurances from an officer of a
government department that the patient’s written consent has
been given.”
The BMA has taken legal advice about a system of accepting
such assurances from a government department, and received
written assurances from the DVLA, in the form of a written
legal indemnity.
NHS Complaints
Procedure
A guidance document has been produced to provide practices
and GPs with guidance on the requirements of the NHS
complaints system, including advice on how to deal with
complaints that come into the practice. This guidance also
addresses some of the concerns GPs and practices may have
about the way the complaints system operates and offers
advice on ensuring that the system works for GPs and
practices as well as patients. This document covers England
only. You can view the document
here. The guidance can also be found on the BMA website
here
www.bma.org.uk/employmentandcontracts
This guidance is supplemented by the 'New Complaints Process
FAQs' which can be found here
www.bma.org.uk/employmentandcontracts/independent_contractors
Look
After Our NHS Campaign Posters
A recent edition of BMA News (15/8) features a campaign
poster- 'Worried about the commercialisation of the NHS?' -
as a centrefold to display in GP practices, hospitals,
community settings, etc. This and another poster which uses
the ARM photo are now available to order. View the posters
here -
poster a and
poster b. Each poster is available in two sizes: A4
(ideal for noticeboards) and A2 (420mm x 594mm). To order
your FREE copies, please email
info.lookafterournhs@bma.org.uk stating which poster(s)
you want, size and quantity, and delivery address. You can
also download pdfs. All details are also on the campaign
website -
www.lookafterournhs.org.uk
Bulletin 24
18.08.09
Tees PCTs have issued a second ‘special edition’ briefing
containing important information about opening times of the
Antiviral Collection Points at North Ormesby Health Village
and Primecare Centre. For your ease, if you have not seen it
yet, you can view it
here.
Bulletin 23
11.08.09
Tees PCTs have forwarded an important 'special edition'
briefing containing important information about opening
times of the Anti-viral Collection Points. For your ease, if
you haven't seen it yet, you can view it
here.
Locum GP Death In Service Payments (Flu) Guidance
This
guidance supersedes
the BMA's previous interim advice to locum GPs on death
benefits during the flu pandemic. For many months the BMA
has been working with NHSE officials to ensure that the
dependants of locum GPs would be fully protected should the
locum GP die while working for the NHS. The English
Department of Health has now issued a letter to primary care
trusts (PCTs) setting out how it considers the matter should
be dealt with, and this guidance relates to that. The
guidance can also be accessed here
www.bma.org.uk/health_promotion_ethics/
Administration of Medicines in Nurseries Framework
Some nurseries are still referring to out-of-date guidance
from the Department for Children, Schools and Families and
refusing to administer over-the-counter medicines to
children without a doctor’s prescription. The guidance on
the provision of medicines to children in nurseries was
amended in May 2008. ‘The Statutory Framework for the Early
Years Foundation Stage’ permits the provision of both
prescription only and of over the counter medication to
children, with a guardian’s written permission (see page
25). The framework is available to download here
http://nationalstrategies.standards.dcsf.gov.uk
Learning
Disabilities DES
The DH policy team working on Learning Disabilities will
take into account all the issues the GPC have been telling
them about when they review the DES internally. If anyone
has problems with this DES, please could you contact
Cleveland LMC.
NICE
Guidance Development Group Recruiting GPs
NICE guidance on improving outcomes for people with skin
cancer including melanoma - NICE are reviewing their
guidance and are asking for GPs who are either minor
surgeons or dermatologists or both to support their
deliberations.
The National Collaborating Centre for Cancer (NCC-C) has
been commissioned by NICE to update its guidance on
Improving Outcomes for People with Skin Tumours including
Melanoma (2003)
http://guidance.nice.org.uk/CSGSTIM relating to the
management of low risk basal cell carcinomas (BCCs) in the
community. The NCC-C is now looking to recruit members to an
expert Guidance Development Group (GDG) to formally review
the original recommendations which relate to management of
low risk BCCs in the community.
Dr Julia Verne, Deputy Regional Director of Public Health
(South West Region) and Director of the South West Public
Health Observatory, who chaired the original Guidance
Development Group has agreed to Chair the new group to look
specifically at this issue.
It is vital that the voice of genuine GPs is heard and that
those who apply to do this are not intimidated by the volume
of work or the volume of invective from hospital colleagues.
If you are suitable, or know someone who you trust who is,
please apply. GPs need to be involved with this . Further
details of role and commitments required can be found
here.
Bulletin 22
04.08.09
Pandemic Flu Update
On Friday (31/7) the PCT sent an important update to all
practices. If you haven't had the opportunity to look at
it,for your ease we have updated a link and you can do so
here.
Assessing Children with Swine Flu
The GPC, RCGP and RCPCH have published a joint statement for
assessing children with suspected swine flu (H1N1). Children
under 1 with flu-like symptoms should be seen and assessed
by GPs to exclude other serious treatable diseases, to
establish the severity of illness and assess whether
additional treatment is required (e.g. oral antibiotics).
Some older children may need face-to-face assessment.
regarding guidance for assessing children with a possible
diagnosis of swine flu. Read the full statement here
www.bma.org.uk/health_promotion_ethics
Reporting Adverse Side-effects for Antivirals
You may already be aware of this, but the MHRA has a
dedicated page on their website where patients and
Healthcare professionals can report adverse side effects for
the antivirals Tamiflu and Relenza:
swineflu.mhra.gov.uk
Child Death
Review Process
The Department for Children Schools and Families document,
'Working Together to Safeguard Children’, 2006 sets out
guidance intended to protect and promote the welfare of
children. The document outlines the responsibilities of
Local Safeguarding Children Boards (LSCBs) to ensure
effective co-ordination between individuals and
organisations throughout local authority areas and sets out
the review process following a child’s death. As part of the
Children Act 2004, LSCBs became mandatory in April 2008 and
as a result, the procedures set out regarding the Child
Death Review Process became statutory. You can view the
document
here. It is also available on the BMA website
www.bma.org.uk/employmentandcontracts
Final Seniority Figures for 04/05 & 05/06
The NHS Information Centre has published the Final Seniority
Figures for 2004/05 and 2005/06 for GMS in England and
Wales. The figures for England are: £81,123 and £91,123
respectively and for Wales £71,535 and £81,413. The figures
for the other nations are being published separately. After
taking legal advice, the Department of Health has decided
that the NHS Information Centre should not work out a Final
Seniority Figure for PMS because PMS contracts are local
contracts. The GPC therefore advises PMS practices and LMCs
that they should also use the GMS figure. Further details
about how the Final Seniority Figures have been calculated
are available on the NHS Information Centre's website at
www.ic.nhs.uk
LMC
GP Conference - Date for your diary
Early notification - Cleveland LMC is organising a
conference for all GPs across Tees at Middlesbrough Football
Club on 24 November. Agenda items will cover Partnership &
Partnership Agreements and Revalidation. It is hoped that Dr
Laurence Buckman, Chairman of the GPC will top the bill as
the guest speaker. Further information will be circulated
shortly but in the meantime ensure you put the date in your
diary.
Bulletin 21
28.07.09
Pandemic Flu Update
We are aware that patient requests for sick notes are posing
some questions/issues for practices in the area,
particularly where patients have been diagnosed by someone
other than the practice and have self certified for 7 days
but are now approaching the practices for a note as they
require additional time off work. We have raised this
nationally and will update you as soon as we get an official
response. As you will be aware, government is considering
increasing self certification to 14 days for swine flu cases
but until this decision is made there is no easy solution
practices will need to continue to manage this situation as
best they can. The pandemic flu Q&A has been updated and you
can view the latest version here
www.bma.org.uk/health_promotion_ethics
National
pandemic Flu line
The national English pandemic flu service has been now been
launched by the DH. There is a dedicated website where
people can get their queries answered on-line, or via the
flu line
0800 1 513 100, where
trained staff will be able to assess patients over the
phone. Following an assessment, they will be given an
authorisation number to give to the nominated person to
collect antivirals from their local antiviral collection
point.
It is hoped that this will allow GPs to focus on more
serious/at risk groups and all the patients they have who
are ill with things other than swine flu, as the patients
who are currently ringing surgeries worried about swine flu
will now ring the flu line for advice instead.
Fitness to fly notes
In the light of the confusing press coverage over fitness to
fly notes, after discussion with the airlines, we can
confirm that GPs will not have to give out fitness to fly
notes.
Airlines have made their staff aware of the swine flu
situation and have given them broad instructions on how to
spot possible symptoms. This is standard practice - they
issued similar guidance during the SARs incident. If their
staff have concerns, they can refer the passenger to their
onsite medical service - Medlink - who will then assess, in
cooperation with the patient, their fitness to fly. If they
are not regarded as fit, they won’t be allowed to fly and
will be asked to ring the NHS flu line or go online to the
symptom checker and then follow the normal advice for people
who suspect they have swine flu.
Holiday insurance cancellation certificates
The Association of British Insurers have stated that they
will accept the submission of the antiviral authorisation
number and the label from the Tamiflu packet as evidence of
a patient having had flu.
Guidance for Assessing Children in Primary Care with
Possible Swine Flu
Please find attached a joint statement from GPC, RCGP and
RCPCH regarding guidance for assessing children with a
possible diagnosis of swine flu
here.
Improving GP Services
The management of GP contracts in England is set to change
following the publication in January 2009 of the document
’Primary and Community Services: Improving GP services’ by
the Department of Health (DH). This document
www.dh.gov.uk/en/Publicationsandstatistics follows on
from the NHS Next Stage Review, and is part of the World
Class Commissioning (WCC) initiative. Where many GPs
previously considered WCC to involve the commissioning of
services in secondary and community care, this document
seeks to manage the quality of primary care services
commissioned by primary care trusts (PCTs) from all GP
practices, and provides practical advice on how PCTs can do
this. Throughout 2009/10, PCTs will look to begin a process
of monitoring practice performance in a number of areas and
managing practice contracts with these new data.
This represents a significant shift in the relationship
between practices and PCTs. It is essential that practices
familiarise themselves with this document. This DH guidance
will become a central part of the function of PCTs; ‘Get the
commissioning of GP services right and the benefits will
extend to the commissioning of wider NHS services, including
hospital care’ (p13).
Th e BMA have produced a ‘Focus on…’ that intends to
explore: how PCTs will assess practice performance and how
GPs/LMCs can influence this process; how PCTs have been
advised to manage all primary care contracts; and the
opportunities that this DH guidance presents for GPs. You
can view the document by following this
link. The guidance is also available on the BMA website.
www.bma.org.uk/employmentandcontracts
NE Wide
Work On Improving Communications
Following the Accelerated Learning primary care event led by
Chris Willis, there is a group with representation from all
‘clusters’ developing a NE wide framework which will inform
and support the development of local primary care
strategies. One of the key issues identified is around
improving communication.
The NE group have been developing a short questionnaire that
will provide you with an opportunity to influence how
practices are provided with different forms of information
and how the practices would like to develop a more two way
form of communication. We would encourage you to look out
for this questionnaire and endeavour to complete and return
it .
We appreciate that questionnaires are not always popular but
it was felt that this base line information would be really
important to find out what works and what doesn’t so that
mistakes from the past aren't replicated.
Guidance on Sealing Electronic Patient Records
Some GP clinical systems include functionality that allows a
GP to restrict access to elements of patients’ electronic
health records to different levels of user within the
practice. This functionality is not consistent across
systems and any data that is hidden is likely to be revealed
when the patient record is transferred to another GP
clinical system. This can happen when a patient’s record is
transferred to another practice via traditional paper record
transfer or GP2GP or following a data migration to another
GP clinical system in the practice.
GPs are therefore advised to inform patients, who want
elements of their electronic health record to be kept
confidential, that the information is not likely to remain
hidden when the record is transferred to another system,
either electronically or via paper transfer.
Look After Our NHS - a further letter from Hamish Meldrum
Dear colleague,
Have you signed up to the BMA's eight key Principles for the
NHS yet?
If you haven't yet visited
www.lookafterournhs.org.uk and registered your support
for an NHS which is publicly funded, publicly provided and
publicly accountable, now is the time to do so. Every vote
counts so please visit the website today, and register your
support. But whatever your views, we’d like to hear them.
Local examples of NHS market reforms
We’d particularly like to hear how NHS market reforms are
affecting you, your patients and your working lives, as well
as how they’re affecting existing NHS services and public
finances. Again, you can do this at
www.lookafterournhs.org.uk – it’s in complete confidence
and we won’t share the information further unless you’d like
us to.
Pass this email on to at least 5 colleagues – or even more!
Since the campaign was launched, hundreds of doctors have
been spreading the word about the campaign by email. This is
making a real difference to the number of people visiting
the website and pledging their support. You can too. Please
forward this email to your colleagues - the more the merrier
- and encourage them to visit the website and get involved.
The more people we can galvanise to cascade emails and the
website link to colleagues, the more effective the campaign
will be. By working together we can ensure our message is
spread far and wide - and acted upon.
Thank you.
Hamish Meldrum, Chairman of Council, BMA
GP
Trainees Subcommittee Elections
GP Trainers - Please pass this on to your GP trainees
The GP Trainees subcommittee recently invited nominations
for representatives for each of their 19 regional
constituencies. The nomination process has now ended. We
received more than one nomination for each of the
constituencies below, and will therefore be holding
elections in these constituencies. The boundaries for these
constituencies are organised along deanery lines.
• East Midlands
• Eastern
• Northern
• Oxford
• Scotland (West)
• West Midlands
• Yorkshire
Ballot forms will be sent out on 27th July, and the closing
date for the return of ballot papers is 17th August.
Bulletin 20
21.07.09
Pandemic Flu Update
Liquid Tamiflu/Oseltamivir Solution - This solution
must be limited for use in children under 1
There are reports from all across the country that GPs are
authorising the use of oseltamivir solution for adults and
children who are not able to swallow capsules. This is
causing an unprecedented demand for the solution and if GPs
continue to use this strategy, we will run out of solution
for babies under 1. GPs should be advising the emptying of
the appropriate strength capsules onto something palatable
and NOT prescribing the solution. PCTs have been provided
with templates for labels and these clearly state that the
contents of the capsules can be emptied into a sweet, sugary
solution.
GANFYD/Doctors Notes - We do not provide 'Fit Notes' in
relation to swine flu
GPs are getting a number of requests from patients
requesting 'fit notes' to say they are free from infection
and fit for work. Added to this 2 of the major airlines
(Virgin and BA) are now requesting GANFYDs to the effect
that patients are fit to fly . GPs should refuse to provide
these notes - they are worthless, a precious waste of time
and detract from GPs real work. The GPC is tackling this
nationally (with the airlines). Follow the link
here for a template letter that you may like to provide
to your patients to pass on to employers who make a request
for a 'free from swine flu' note.
Please keep the LMC updated of any problems/issues you are
encountering.
Hep C
The LMC have been asked for comments about whether or not
practices should be involved in testing for Hep C. Whilst
there is no clear answer, I suggest that if a person attends
and has a reason to be tested, including an appropriate
contact with a Hep C person, then testing would be part of
the Essential Services. My advice to the PCT which raised
this question, is that screening is not part of Essential
Services and would normally only be carried out as part of
an Enhanced Service. If you have any questions or queries,
please ask for advice.
John Canning,Secretary, Cleveland LMC
Improving Access to Psychological Therapies (IAPT)
The GPC has provided the LMC with a number of CD-ROMs
regarding Practice Based Commissioning and the Improving
Access to Psychological Therapies programme. The Department
of Health has provided this CD-ROM, which contains a number
of documents about how the IAPT programme works, as well as
a business case for those interested in commissioning the
service. The disk contains useful information about how to
use practice based commissioning to maximise the potential
benefit of the IAPT programme and strong evidence of the
effectiveness of the service in treating people with long
term conditions and medically unexplained symptoms, as well
as in treating the common mental health conditions of
depression and anxiety disorders. The involvement of general
practitioners is central to the development of the new
services.
The GPC, together with other primary care organisations
including the RCGP, signed a consensus statement supporting
the drive to improve access to psychological therapies for
our patients. This statement reflected the findings of the
Joint Scoping Document from the Royal College of General
Practitioners and the Royal College of Psychiatry on
psychological therapies. Previously access to such
psychological therapies has been limited, and characterised
by very long waiting times. In 2007, the Department of
Health announced new funding rising to £170m by 2011 to
train 3,600 new therapists to provide an improved service.
If you would like to receive a copy of this CD-Rom please
contact the LMC office (please note there is not enough for
every practice so first come basis!). For further
information please visit the IAPT website
www.iapt.nhs.uk
Somebody Else's Child, Everybody's Responsibility
The British Association for Adoption & Fostering (BAAF) has
launched a new campaign which is aimed at health care
professionals. The campaign is called Somebody Else’s Child
and is concerned with private fostering. This is an
arrangement for 28 day or more, which is when children are
cared for by someone other than a close relative. By law,
parents and carers must notify their local authority before
entering into these arrangements. But sadly many don’t.
There are an estimated 10,000 children living in private
fostering arrangements in England and Wales, but last year
only just over 1,500 notifications made with local
authorities. While most of these children will be safe,
others may be at risk of abuse and neglect at the hands of
their private foster carers. Without social services
intervention, this could go on for years.
Although the legal responsibility lies with the parent and
the carer, the campaign is urging anyone who works with
children to play their part. If you know of a child living
with someone who isn’t a direct relative, for 28 days or
more then, please don’t ignore it. You should either speak
to the child’s carer, if appropriate, or inform your local
social services. Keeping children safe is the responsibility
of the whole community.
For more information visit the campaign website
http://www.privatefostering.org.uk
BMA Employer
Advisory Service
The BMA Employer Advisory Service provides practices with
free comprehensive, impartial and authoritative advice on a
huge range of employer-related matters.
The team of specially trained and experienced advisers is
ready and able to deal with queries on issues such as
recruiting and employing staff, contracts and terms and
conditions of service, appraisals and performance
management, disciplinary procedures and dismissals. They are
also well versed in current employment legislation,
discrimination, the development of appropriate HR policies,
and how to implement best practice.
The advisers are not only experts in their field but
understand general practice and employer matters relating to
doctors:
-
employment law
-
grievance and
disciplinary issues
-
managing absence
-
recruitment
-
appraisal
-
discrimination
-
HR policies
-
best HR practice
They also have excellent
knowledge of local issues and well-established contacts with
local and strategic health authorities and primary care
trusts.
For free comprehensive, impartial, authoritative advice you
can trust call the BMA Employer Advisory Service on
0300 123 123 3 anytime
between 8.30am and 6pm (Monday to Friday, except UK-wide
bank holidays) and you'll be connected directly to one of
our expert advisers. Or you can email your query to
support@bma.org.uk.
To access the service at least one partner needs to be a BMA
member although we would recommend all doctors are members
of the BMA.
Bulletin 19
14.07.09
Pandemic Flu Update
As you will be aware, last week the H1N1v flu pandemic in
the UK moved from the containment phase to that of outbreak
management. This prompted a number of letters from the GPC
and DH to update GPs on the current arrangements all of
which you will find by following the links below:
Letter from Laurence Buckman to all GPs
Letter from English CMO, Sir Liam Donaldson, to all GPs
Letter from National Director of NHS Flu Resilience (DH),
Ian Dalton, to
PCTs and SHAs plus guidance issued re the move to the
treatment phase
The GPC has also updated the pandemic flu Question & Answers
document to take these changes into account . You can find
the updated Q&A by following this link www.bma.org.uk/health_promotion_ethics.
The GPC continues to work with the DH (England) to produce a
new Pandemic Flu SFE that will be a national framework that
would temporarily the GPC would urge affected practices to
keep details and reasoning of actual expenses as practices
may need to use these in evidence to their PCO in any
subsequent claim for exceptional reimbursement.
As you will be aware, in Tees the current operation
Antiviral Collection Centre (ACP) is located at the
PrimeCare Centre in Thornaby. You may have seen this message
in the latest edition of the Contractors Chronicle but for
those who haven't - 'The Tees PCTs have procured Personal
Protective Equipment (PPE) for GP practices. Supplies will
be couriered out on Monday 13 and Tuesday 14 July to all GP
practices across Tees. Practices should, However, ensure
that they have sufficient PPE available at this stage
without using the top up supplies.'
We will keep you updated on developments.
Introducing the Licence to Practise in 2009
The General Medical Council have written to the LMC
confirming that they will introduce the licence to practise
on 16 November 2009. From this date any doctor wishing to
practise medicine in the UK will, by law, need to hold both
registration and a licence to practise.
Earlier this year the GMC launched their campaign –
Licensing: it’s time to decide – and since then more than
half of all doctors have told the GMC their licensing
decision. Over the next few weeks the GMC will be writing to
those doctors who have not yet responded, asking them to
tell the GMC before 14 August 2009, whether they will
require a licence.
To help doctors make their decision, the GMC have launched
their Licensing help website at
www.gmc-uk.org/licensinghelp. More information about
licensing is available on their website at
www.gmc-uk.org/licensing and if you have any questions
about licensing, please email
licensing@gmc-uk.org.
Hep C
The LMC have been asked for comments about whether or not
practices should be involved in testing for Hep C. Whilst
there is no clear answer, I suggest that if a person attends
and has a reason to be tested, including an appropriate
contact with a Hep C person, then testing would be part of
the Essential Services. My advice to the PCT which raised
this question, is that screening is not part of Essential
Services and would normally only be carried out as part of
an Enhanced Service. If you have any questions or queries,
please ask for advice.
John Canning,Secretary, Cleveland LMC
PE7 & PE8
The LMC has undertaken initial discussions with the PCT with
regard to PE7 and PE8 (Patient Survey) and can inform that
the PCT is actively looking into this and the PCT should be
able to get back to practices w/c 20 July.
Primary Care and Community Services - Improving GP Access
and Responsiveness
DH have released their latest guide from the world class
commissioning suite. This document is a practical guide for
PCTs to improve the accessibility and responsiveness of
local GP services. The GPC realise GPs will dislike this
simplistic document and the encouragement it will give to
PCTs to damage practices, but simply cannot stop them
producing this kind of stuff. GPC thoughts on world class
commissioning have been made numerous times before, however
it is clear that DH are going ahead with their plans. GPC
need to focus on how best to take advantage of the good
parts and how best to ameliorate the bad parts.
The document can be accessed by following this link
www.dh.gov.uk/en/Publicationsandstatistics
Carson Paper on
Urgent Care
On 25 June the Carson paper on urgent care was launched.
This attempts to give practices ideas about how to improve
urgent access without wrecking the practice. At the launch
David Carson spent considerable energy telling the PCO
people there why he thought target setting was damaging, The
paper is useful, hence the GPC letter of support within it,
and you may like to look at it as it might make practice
pressures that bit less. You can view the paper by following
the link
here.
Important Note from Hamish Meldrum, 'Look After Our NHS'
Since 'Look after our NHS' was launched on 1st June the BMA
have received a constant stream of emails supporting our
Principles for an NHS which is publicly funded, publicly
provided and publicly accountable, as well as examples of
how NHS market reforms are affecting doctors.
The BMA need to ensure that the campaign's message and calls
to action are reaching all doctors, and encourage GPs to
support the campaign. GPs can do this is by providing local
case studies of how market reforms are affecting them. For
example, the BMA would be interested to hear GP views on:
The BMA would therefore
formally ask that you:
-
Ensure that the campaign
is put on the agenda of all your forthcoming meetings
-
Visit the campaign
website at www.lookafterournhs.org.uk and provide
examples of how NHS market reforms are affecting you
-
Register your support for
the 8 Key Principles at www.lookafterournhs.org.uk
If you need any information packs for your meetings,
please contact Helen Wright on 0207 383 6317, or email
h.wright@bma.org.uk
Bulletin
18
07.07.09
Physicians Therapists
Guide
Whilst we have not yet had
any reports in Tees we wanted to alert you to the fact that
individually named GPs in other areas of the country are
receiving literature and sign-up form (for 957 Euros per
year) to be included in the Physicians Therapists Guide.
Whilst there is now no mention of Nova Channel within the
blurb this could be related as SAE is included to a
registered office in Portugal. Please be extra vigilant when
considering proposals of this nature and ensure you study
the small print.
Bulletin 17
30.06.09
Pandemic Flu Clinical Assessment Tools
A pandemic flu page with information specifically aimed at
GPs has now been set up on the BMA web site (accessible to
members and non-members) you can view it by following this
link
www.bma.org.uk/health_promotion_ethics/.You
can also view the latest version of the pan flu Q&A
here.
Entitlement to (Free) NHS Treatment
A recent incident reported to us about a patient required to
pay a large sum for urgent cardiology treatment is an
opportunity to remind practices that GPs referring patients
to hospital may wish to point out that not all treatment to
patients registered with a GP will be free.
Practices will also want to note that reciprocal
arrangements with the Channel Islands were discontinued
earlier this year; there is still an obligation to provide
emergency and immediately necessary treatment, but you may
treat any other problems on a private basis. Don’t forget
that means the patient pays for practice time and all
medication which should be issued on a private prescription.
Private prescriptions for CDs must be issued on the
appropriate form available from the PCT, all other private
items must have the prescribers and patients details clearly
shown.
Full details of eligibility for secondary services is to be
found here
www.dh.gov.uk/en/Healthcare/Entitlementsandcharges/ but
in summary:
Nationality or past or present payments of UK taxes and
National Insurance contributions are not taken into
consideration when establishing residence. The only thing
relevant is being ordinarily resident in the UK
“Ordinarily resident” is a common law concept usually taken
to mean resident in the UK for more than 6 months and for
settled purposes as part of the regular order of their life
for the time being, with an identifiable purpose for their
residence here which has a sufficient degree of continuity
to be properly described as settled
anyone who spends more than 3 months living outside the UK
is no longer automatically entitled to free NHS hospital
treatment in England
people in receipt of UK state retirement pensions who have
lived in the UK for at least 10 continuous years at some
point in the past remain entitled for certain levels of
coverage. The extent of coverage depends on where outside
the UK you live, and how long you live there. See
www.dh.gov.uk/en/Healthcare/
If you go anywhere abroad for more than three months, either
for a one-off extended holiday for a few months or to live
permanently for several years, but then return to the UK to
take up permanent residence here again, then you will be
entitled to receive free NHS hospital treatment from the day
you return. So will your spouse/civil partner and children
(under the age of 16, or 19 if in further education) if they
are also living with you permanently in the UK again. A
hospital may require to see evidence that you have returned
to the UK on a permanent basis.
FAQs
Please follow this link
to view a number of FAQs that are raised to the LMC. Many
are a reminder of those previously posted in Bulletin 6 but
please take time to refresh yourself as this is important
information.
Bulletin 16
23.06.09
Pandemic
Flu Clinical Assessment Tools
You will have doubtless dusted down your cluster plans and
talked to your “buddies”. So far, the impact locally has
been minimal but things are moving. At the time of writing
(Monday morning) we hear that the situation in Birmingham
and West of Scotland is quite serious and that things are
taking off in London. It surely won’t be long before things
reach us in a bigger way.
The LMC will continue to liaise with the PCTs and especially
the Public Health Department. You may wish to re-visit the
various guidance documents issued on flu by following these
links -
www.hpa.org.uk and
www.bma.org.uk/health_promotion_ethics/influenza/
The clinical assessment tools that can be used during the
phase of a pandemic when there is an increased demand for
clinical care are now available on the DH website. This
includes community assessment tool for adults, paediatric
community assessment tool and adult hospital pathways.
Please follow this link to view the tools.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/
If you have any questions or concerns, please do not
hesitate to contact us at the LMC office.
Child Protection
The GPC have received numerous queries concerning what a GP
is expected to do in order to comply with child protection
procedures. This is due, to a large extent, to the recently
published government’s response to Lord Laming’s report,
entitled ‘The protection of children in England: action
plan’.
In this action plan, there are two recommendations from Lord
Laming (ref 34, 35) that outline more involvement of GPs and
more training for GPs. The government’s response is broadly
supportive of these recommendations, and it appears that
many PCTs have gone ahead and begun to implement these
recommendations without waiting for further guidance from
the Department of Health.
The GPC will be discussing
these recommendations with DH later in the summer and we
expect to be formally consulted before any action plans are
implemented. We fully support improving child protection,
however we know that the GPs unique position means that a
carefully thought out and well constructed action plan is
necessary to ensure that GPs can participate, and be
involved, without significant detriment to their practice
and patients.
In the interim, if your PCT has written to you regarding new
child protection procedures that they are implementing,
please remember the following:
1) A PCT cannot make changes to the national contract
2) GPs do have a duty to be involved in child protection
3) PCTs have a duty to remunerate GPs for their involvement
in any child protection procedure
During this interim period, it would be helpful GPs to
inform us of their experiences with their PCT attempting to
implement new child protection procedures. Please send them
to Genevieve Casey at
gcasey@bma.org.uk
Confirmation and Certification of Death
Please see the updated Confirmation and Certification of
Death guidance note. Please note that this is for England
and Wales only. View guidance
here or follow this link
www.bma.org.uk/ethics/end_life_issues/
Novachannel AG/Med1web Medical Directory
We have raised this issue in the past but have heard that
the above company is re-invoicing some practices for a
second year. In light of this we are issuing the original
guidance provided by the GPC.
The GPC have received a number of reports from GPs who have
signed up to be included on a medical directory operated by
Novachannel, also known as Med1web, only to later receive a
bill for 983 Euros a year. Notification of this charge is
hidden within the small print but there is no other clear
indication that there will be a charge. The GPC are advising
members that, whilst they have had soundings that this
company is operating in bad faith, they have no concrete
evidence to this effect, upon which to base our advice.
Therefore, whilst it is always an option for a practice to
ignore the requests for payment by the company, there is a
risk that the practice will be obligated in law to render
the amounts claimed in full plus interest.
The Swiss Embassy has advised the GPC that if someone has
been deceived into signing a contract, he or she can
challenge the contract by writing to the counterpart within
one year of discovering the error, stating that they have
been deceived and therefore consider the contract to be
invalid. The Embassy has stated that the contract is then
considered to be annulled, and that if a debt collection
company or other representative of the counterpart insist
that the money be paid, the debt collection company or
representative should be informed that the contract has been
annulled. The Embassy has advised that only a judge has the
power to definitely state whether the contract is really
invalid, providing that the party insisting on the validity
of the contract initiates civil proceedings. The GPC would
like to emphasise that the Swiss Embassy advice is given on
the basis of a person being deceived into signing a
contract. The affected person would have to be able to prove
they have been deceived in order to rely legally on the
advice.
Developing General Practice: Listening to Patients
The GPC have produced the above guidance document. You can
view it by following this link
www.bma.org.uk/employmentandcontracts/
GP
Trainees Subcommittee Newsletter
Follow this link to view the latest, spring/summer, GP
Trainees
newsletter. It is also available via the BMA website via
this link
www.bma.org.uk/news/branch_newsletters/
GP
Trainees Subcommittee Regional Elections
The GP Trainees subcommittee will be holding elections in
all of its 19 regional seats this summer.
All doctors who are/will be on a GP Training programme at
any point during the period 2 July 2009 to 30 June 2010 are
eligible to stand in this election, regardless of whether or
not they are a BMA member. For the avoidance of doubt, GP
Trainees in hospital placements or GP practice placements
are able to stand for election, as are Foundation Year
doctors who will begin a GP Training programme during the
above period.
Full details of the election, including nomination forms,
and introduction to the work of the subcommittee and a full
list of regional constituencies, can be found on the BMA
website:
www.bma.org.uk/gptraineeselections
Completed nomination forms must be received in the GPC
office by 5pm on Friday 3 July 2009.
In regions where there is a contested election, we can only
send ballot papers to those trainees for whom the BMA has up
to date contact details. However many GP trainees have not
recently updated their contact details on the BMA website.
It is important that each GP Trainee check and update their
details so that, if there is a contested election in their
region, we can make sure they receive a ballot paper.
For more information on how to update their contact details,
GP Trainees should visit the BMA website:
www.bma.org.uk/gptraineeselections
If you have any questions about this election that are not
covered on our website, please contact Andrew Young in the
GPC secretariat:
ayoung@bma.org.uk
Bulletin 15
15.06.09
Pandemic Flu Q&A
The 'Pandemic Flu Questions and Answers' has now been
published on the BMA website via the following link:
www.bma.org.uk/health_promotion_ethics/influenza/
This web page will be updated regularly as each query or
problem is resolved. Thank you to those who have already
brought our attention to the problems that you are
experiencing locally with the implementation of the pandemic
flu plan. Please continue to share information in this way.
You may also contact Marianne Simmonds
(msimmonds@bma.org.uk
) in order to describe problems that you are experiencing,
or to share examples of good practice/solutions implemented
locally.
IT
Support
Three practices have contacted the LMC in the last week
concerned about IT support. We are not sure whether this is
a blip or something more serious and would be interested in
your views. Please respond to
christine.knifton@middlesbroughpct.nhs.uk in the
first instance
Pharmacy
Names on repeat Prescriptions
The Local Pharmaceutical Committee has expressed concern
that practices are naming specific chemists on repeat
prescription request forms and the LMC has considered this
matter and is also concerned. The LMC believes that
practices are exposing themselves to accusations of bias and
financial or other interests if they do this, and the LMC
would counsel practices against the practise.
Any practice which wishes to make arrangements with
pharmacists should ensure that they are able to do this with
all local pharmacy contractors and not just one or two
specific organisations
Message from Hamish Meldrum - 'Look after our NHS'
Since Look after our NHS was launched on 1st June we’ve
received a steady stream of support for the BMA’s 8
Principles, and examples of how NHS market reforms are
affecting doctors – whether it’s affecting their patients or
their own working lives.
We need to keep these examples coming in! We need your
support to spread the word – and the web link – to your
colleagues. Put the web address on all emails and pass it
on. Use every opportunity talk to doctors about these issues
and encourage them to visit the website. The more we can
spread the message and the web address, the more we can
encourage doctors to pledge their support for our
Principles.
So please put the following on your emails as part of your
‘signature’ and ask colleagues to do the same:
Have your say about NHS market reforms
Visit
www.lookafterournhs.org.uk
And if you haven’t already, I urge you to visit the website,
get involved and encourage your colleagues to get involved
too. Together, we can look after an NHS led by professionals
who put quality before the delivery of crude financial
targets.
Thank you.
Hamish Meldrum, Chairman of Council, BMA
Bulletin 14
09.06.09
Patient Survey
The GPC has produced further guidance.
You can view this by following this link.
A number of practices have raised concerns with the LMC
regarding the Patient Survey; in particular around the
results of PE7 and PE8 and the consequential financial
impact they will have on practice income.
The LMC strongly recommend that any practice which is
concerned lodges a right to appeal with the PCT using the
GPC produced template letter. You will find the template
letter by
following this link Please be aware, you can sign
off your QoF whilst simultaneously lodging a right to appeal
so as not to delay other financial settlements.
One particular area of concern voiced by practices is around
the adequacy of samples used and the unexpected results
produced. You can request your confidence intervals from the
PCT. Your confidence interval should be 7% or less to get a
'true' result to PE7 and PE8. We strongly recommend that you
request your full information from the PCT if you have not
received this already.
The concerns across Tees echo those voiced throughout the
country and the GPC are exploring this at a national level.
We will issue further advice and information as it becomes
available.
The DH has published some guidance for PCTs. Whilst the GPC
still has serious concerns with this document you may find
it interesting reading. You can view the document by
following this link.
If you have any further questions or would like to voice
your concerns to the LMC please do so via
janice.foster@middlesbroughpct.nhs.uk in the first
instance.
BMA Employer
Advisory Service
The BMA now has a BMA Employer Advisory service which is
available to support and advise GP employers as opposed to
GPs, who are now often salaried as well. Practices can
access the service by contacting, in the first instance,
David Carter the regional BMA Industrial Relations Officer.
David is happy to visit practices (as long as one GP is a
BMA member) to make a presentation in relation to protocols
for employing staff. Practices should contact David directly
to book an appointment.
BMA Launches
'Look after our NHS'
The aim of this campaign is to raise awareness of the impact
that market-driven reforms are having on the NHS. The BMA
have long argued that Government policy to allow
commercially-run firms to provide NHS services are not
delivering as promised. If these reforms continue, the BMA
believe the impact on patient care, doctors' working lives
and the local health environment will be damaging.
The BMA has drawn up a list of 8 key Principles for its
vision of the NHS which we are urging all doctors to
support.
A new website -
www.lookafterournhs.org.uk - is the hub of the
BMA's calls to action.
These are:
• Support the BMA's key
Principles
• Provide examples of how NHS market reforms are
affecting doctors and their patients
• Share views and experiences
Bulletin 12
26.05.09
Patient
Survey
The GP patient survey was established in England in 2006/07
to support PCT assessment of general practices’ achievements
against national standards set out in DES agreements. These
agreements linked results from the administered surveys with
the rewards made to GP practices. The arrangements for this
year's survey have been different from the past two years as
the government decided to replace the previous arrangement
with a national postal survey, payment for which is now
through the QOF.
SGPC has already been dealing with some serious problems
with the Scottish results, of which practices were notified
a few weeks ago, in particular because they seemed to be
based on small response rates. Practices in England are now
receiving their own results, though the national-level data
will not be published until late June. The GPC debated this
yesterday, and is very concerned that problems similar to
those in Scotland may be reported in England and in the
other nations. If this does happen, some practices may have
their results and therefore some QOF points and a
significant amount of funding determined by a very small
proportion of their total practice population. It is quite
possible that practices will receive a good response rate to
the survey as a whole, but low levels of response to one or
both of the key access questions. It seems that this may be
a particular problem with the PE8 questions on advanced
booking.
If a practice feels that their results do not reflect the
reality of what they offer patients then they should put in
a QOF appeal to their PCT. The LMC will shortly provide a
template letter so that you can be reassured that the
wording you use is legally watertight. The latter and any
further information will follow as soon as we have it.
Follow this link for interim information from the GPC.
GPC Chairman, Dr Laurence
Buckman, has addressed a letter to all GPs which you can
view by
clicking here.
NHS
Branding
Practices may use NHS branding - should they wish - as long
as they follow the national guidance. Some practices may
find this useful in letting the public know they provide NHS
services, particularly in response to the broadening of
healthcare provision in the area.
Follow this link to view the brand guidelines.
Bulletin 11
12.05.09
Swine Flu
The situation with swine flu i continues to change and we
urge you to view the HPA website,
http://www.hpa.org.uk , for the latest information
We STRONGLY advise all GPs to follow the HPA guidance .
Across Tees there has not been any notable developments over
the last week. However, PLEASE NOTE that there is a meeting
to be held Thursday 14 May, 6.30 - 7.30 pm at Eaglescliffe
Medical Centre as a briefing on the current situation and to
review the GP cluster planning arrangements. Each cluster
has been invited to send a representative - please ensure
you are represented. You can follow this link to view the
local
(Tees) updated protocol for the collection of viral and
anti-viral swabs .
Sessional GP Newsletter
The GPC have produced a newsletter for sessional GPs. The
aim of this newsletter is to keep salaried and locum GPs
(known collectively as sessional GPs) up to date with the
wide range of new and ongoing issues affecting them, as well
as the hard work that the GPC’s Sessional GPs Subcommittee
undertakes behind the scenes on their behalf. To see the
newsletter, please
click on this link.
MMR
Vaccinations for Health Professionals
You will have received information re the recent outbreak of
measles on Teesside from Health Protection which stressed
the importance of health care workers being immunised and as
a consequence may find you receive an increase from patients
who are health care workers requesting to be immunised . It
is worth noting that there is an obligation under the
contract to do vaccinations at the request of the DPH in
case of an outbreak.
Bulletin 10
05.05.09
Swine Flu
The situation with swine flu is changing rapidly. The BMA's
website has the latest guidance plus links to other key
websites, including the Health Protection Agency at
http://www.hpa.org.uk . We STRONGLY advise all GPs to
follow the HPA guidance and specifically not to prescribe
Tamiflu to anyone unless advised by the HPA as per their
algorithms. Also only to take swabs after discussion with
the HPA as well. GPs are also advised to keep abreast of
developments on a daily basis. The Teeswide Flu Pandemic
Steering Committee held a meeting on Friday 1 May and you
can
click here to view the main bullet points.
Introducing the License to Practise in 2009
The GMS will introduce licensing in Autumn 2009 and this
will be the 1st step towards the introduction of
revalidation. In order to practise medicine in the UK after
licensing is introduced you will, by law, need to be both
registered (as is currently required) AND hold a license.
This applies whatever the basis on which you practise. All
registered doctors are entitled to a license if they want
one and you need to decide if you will need and want to hold
a license for the activities you undertake. You have 3
options and you now need to decide which best suits your
needs and requirements.
a) registration with
license to practise;
b) registration without license to practise;
c) no longer registered.
You can find more information
about the introduction of licensing
click here and there are some useful FAQs
click here.
Bulletin 9
28.04.09
New Complaints
Procedure FAQs
These FAQs have been produced to provide information on the
new complaints procedure and how it could affect GPs and
practices. The new procedure was introduced on 1 April 2009.
More detailed guidance on the new complaints procedure will
follow. You can view the FAQs through this link
click here, as well as via the BMA website
click here.
Letter
from GPC Regarding Revalidation
This is from Hamish Meldrum, Chairman of Council for the
information of all GPs and LMCs.
Click here.
Guidance on Preventing Child Accidents in the Home
The Child Accident Prevention Trust (CAPT) have produced
some publications to help parents of young children and the
practitioners who work with them keep children safe from
accidents at home:
- Accidents and Child Development. An easy-to-use guidance
booklet for any practitioners involved with the safety, or
care of children. reference DCSF-00255-2009BKT-EN
- How Safe is Your Child at Home? A short leaflet for
parents and carers, covering common risks to children in the
home and how they can be reduced. reference
DCSF-00254-2009LEF-EN
You can download or order hardcopies of both publications
(quoting the references above) free from the ECM Online
Publications page or from the ECM Resources and Practice
Page or write to: DCSF Publications, PO Box 5050, Sherwood
Park, Annesley, Nottingham, NG15 0DJ.Tel: 0845 60 222 60.
Fax: 0845 60 333 60. Textphone: 0845 60 555 60
Bulletin 8
21.04.09
Improving Pharmaceutical Services guidance - World Class
Commissioning
The DH has produced guidance for the NHS on how to
commission Pharmaceutical Services on the back of last
year's Pharmacy White Paper. GPC and the Dispensing Doctors'
Association were consulted on the sections relating to
dispensing doctors. The Guidance, and letter to CEOs from
the Minister, Phil Hope MP, can be accessed through the
following links.
Freedom of Information Act - GPC updated FAQs
Following the information provided in bulletin 5, by CLMC,
in relation to the new publication scheme, please note that
the GPC have updated their Freedom of Information Act 2000
frequently asked questions and these are available through
this link as well as via the
BMA website.
Video Clips on Pay Award and Q&A with GPC Chairman
The GPC have produced two online video clips with Laurence
Buckman that are on BMAtv. The first deals with the 2009 pay
award and the second is a Q&A with Laurence answering
questions from GP members, including those on MPIG and
salaried GPs. They are available through these links.
Bulletin 7
07.04 .09
Full
DDRB Report
Last week we published guidance as to what the DDRB's
recommendations meant for you practice. The report of the
Doctors' and Dentists' Review Body (DDRB) has now been
published.
You can view the full report by following this link.
Stamp Duty
Land Tax (SDLT) guidance
The GPC has published general guidance on Stamp Duty Land
Tax (SDLT) as it applies to GPs. SDLT is payable on
transactions relating to UK land and buildings and although
not all transactions involving GPs will be liable for SDLT,
it is likely to affect an increasing number of practices in
the future, due to the increasing number of practices
occupying leasehold premises and the varying nature of the
property market. Note that this guidance is not a substitute
for individually tailored professional accountancy and tax
advice and that GPs should always seek such professional
advice when considering a transaction that may be subject to
SDLT.
You can view the guidance here.
National Complaints
Procedure
As you will be aware, the new national complaints procedure
came into being 1 April 09. On the same date the Care
Quality Commission also came into being. People wishing to
complain may choose to make their complaint orally, in
writing or electronically to the PCT rather than the
practice and there will now only be 2 stages to resolving
complaints; local resolution at practice/PCT level and
referral to the Ombudsman. Guidance on the new complaints
procedure is available in a document titled ‘Listening,
Responding, Improving: a guide to better customer care’.
You can view the document and supporting literature by
following this link.
Bulletin 6
31.03.09
QoF Guidance 09/10
The QOF guidance for 09/10 has now been published. This is
the third revision of the Quality and Outcomes Framework
(QOF), which was introduced as part of the new GMS contract
in 2004. Revisions to the QOF were made in 2006 and 2008
and, following a review of the evidence by the QOF expert
panel, a further revision has taken place to commence from 1
April 2009. This includes a re-allocation of points to heart
failure, chronic kidney disease, sexual health, anxiety &
depression, chronic obstructive pulmonary disease,
hypertension and diabetes. The guidance provides the detail
to the initial agreement reached between the GPC and NHS
Employers announced in October 2008.
View guidance here. This is also available on the
BMA website here
These changes are independent from the changes to prevalence
which are to be introduced from April 2009. More detail on
the prevalence changes is available on the
BMA website here
What will this year's DDRB report mean for your practice?
Publication of this year's Doctors and Dentists Review Body
(DDRB) report is expected very soon. This year's
arrangements for translating any uplift recommended by the
DDRB into practice resources are more complicated than in
previous years. So, what will the DDRB's recommendations
mean for your practice?
View guidance here.
Cleveland LMC
FAQs/GP Reminders
We have had a number of questions on similar/related topics
so have collated these into a simple 'reminders' list.
Please take time to look over these to refresh yourself as
the topics are very important.
Review reminders
here.
Managing disputes with
PCO's
Updated guidance is available to all BMA members by
following this link.
Bulletin 5
24.03.09
Clinical DES for GMS contract 2008/09: guidance and audit
requirements.
NHS employers and the GPC have agreed five new clinical DESs
as part of the 2008/09 contract negotiations. These DESs
focus on health and service priorities of the Department of
Health that will benefit patients.
Focus on 2009-10
GMS Contract
The GPC reached agreement with NHS Employers (NHSE) in
October 2008 to apply several changes to the GMS contract in
2009-10. This Focus On guide outlines each of these changes
with particular emphasis on this year’s arrangements for
contractual uplift.
View the guidance here. This is will shortly be
available on the BMA website
Freedom of Information Act (FOIA): Practice Publication
Schemes
The Information Commissioner’s Office (ICO) started
monitoring the new model FOIA publication scheme March 09.
The LMC has not yet received guidance from the GPC or ICO.
In the absence of this we have pulled together a few FAQs
which we hope will be helpful.
View the guidance here.
Bulletin 4
10.03.09
Patient Registration FAQs
Patient Registration FAQs have been produced to replace the
'Focus on Patient Registration' and update the previous
FAQs. The document covers a range of issues including
eligibility, ID provision, allocated patients and removal of
patients.
View the document here.
Bulletin 3
03.03.09
Focus on Salaried GPs
The Focus on Salaried GPs guidance has been revised, and
incorporates guidance for salaried GPs on negotiating their
salary and handling requests to change hours of work.
View the guidance here. This is also now available on
the
BMA website
Bulletin 2
24.02.09
LMC Board Meeting Minutes
Minutes from the latest LMC Board Meeting held on Tuesday 17
February 2009 can be found by following this link.
Click
here.
GP Health
Information on GP Health which is available to all GPs and
their partners/spouses, and all Practice Managers and their
partners/spouses can be found by following this link.
Click here.
Further details are available via their website
www.gp-health.org.uk
Bulletin 1,
09.02.09
Statement of Financial
Entitlements (Amendment) Directions 09
The Statement of Financial Entitlements (Amendment)
Directions 2009 are now available on the DH website:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_094166
Their primary purpose is to introduce payment mechanisms
relating to the five new clinical DESs relating to alcohol
(new section 7H), ethnicity and first language recording
(new section 7I), learning difficulties (new section 7J),
heart failure (new section 7K) and osteoporosis (new section
7L).
There are also minor changes to some definitions in Annex A
of the Statement of Financial Entitlements.
The GPC negotiators are discussing with the NHSE the
problems associated with the delay in the publication of
these Directions and we will keep you informed of any
developments.
Appointment of Development Manager
Janice Foster joined the team at Cleveland LMC as
Development Manager on Monday 12 January.
Janice has moved to the organisation from Sport England and
has a vast background in business development, media,
marketing, communications and customer relationship
management.
Janice’s primary role is to build relationships and in time
she will become a pivotal point for information in and out
of the LMC with the overarching aim of improving service.
Over the next few months she will take time to absorb the
vast amount of information that is out there and will
endeavour to meet as many people as possible to help to
develop the role in the way that will best meet your needs.
We value you views and are sure that this role will prove to
be an invaluable addition to our services.
You can contact Janice on 01642 737627 or
janice.foster@middlesbroughpct.nhs.uk
Pandemic Influenza
You will have seen publicity about pandemic influenza and
the recently published guide for practices. We are pleased
to say that in Teesside is significantly “ahead of the game”
on this. Indeed, much of the guidance in the document has
already been implemented in Teesside based on the “buddying”
arrangements. Nevertheless, practices will wish to review
the guidance which is available at:
http://www.bma.org.uk/health_promotion_ethics/influenza/panfluguiddec08.jsp
This guidance is not written in the normal health service
speak and is immensely practical and we commend it to you.
This section cannot be concluded without paying tribute to a
local Eaglescliffe GP, Simon Stockley, who has been
intimately involved in the provision of the guidance.
LMC Elections
The LMC elections are taking place later this year and this
will provide an opportunity for new people to get involved,
as well as existing members to continue their
contribution. Anybody who is uncertain as to what the
commitments and requirements are may wish to discuss this
with their local representative. If anyone feels this would
be inappropriate as they may be challenging their local
representative, John Canning (John.canning@middlesbroughpct.nhs.uk)
would be more than happy to provide the information.
New
Practices
The PCTs have announced that the new practices will be run
by:
Scheme No |
PCT |
Practice/Health Centre |
Provider |
1 |
Hartlepool |
GP led Health Centre |
Assura Hartlepool LLP |
3 |
Hartlepool |
GP Practice |
Intrahealth |
4 |
Stockton
on Tees Teaching |
GP led Health Centre |
Assura Stockton LLP |
5 |
Middlesbrough |
GP led Health Centre |
Care Integration Partnership |
7 |
Redcar and Cleveland |
GP led Health Centre |
Teesside Primary Care Community Interest Company |
The
LMC will continue to work with all practices to ensure that
GPs and general practice receive the recognition and support
they require as the providers of the vast majority of
medical care in the NHS.
Extracts from GPC - Sept 2008