Bulletin 166
18.12.12
QMAS is closing in
July 2013 – what you need to know
The Calculating Quality Reporting Service (CQRS) is
replacing the Quality Management and Analysis System (QMAS),
the system currently used to calculate payments to GPs under
the Quality & Outcomes Framework (QOF). While QMAS will be
used to calculate QOF achievement for 2012/13, CQRS will be
the new system for calculating and reporting on QOF for GP
practices across England for the 2013/14 financial year.
Registration for training on CQRS is scheduled to open in
early January 2013. This
letter
provides
more
information on what practices need to do in preparation for
QMAS closing down, and CQRS going live. All practices should
have received an email from NEPCSA with regard to this but I
will reissue as a reminder in eth New Year as it is very
important that you register for the local events to
understand how this will work.
Bulletin 165
11.12.12
Warning, Scam Alert
It seems to be a while ago since this company were last on
the scene but the scam is back. The name has changed yet
again but the message is still the same – DO NOT SIGN AND/OR
RETURN ANYTHING! TEMDI.com (the new ‘old’ name – The
European Medical Directory) are trying to get money from you
by suggesting you are already in a contract with them but
you can cancel this for a number (hundreds) of Euros! You
will know this scam as either European Medical Directory,
Med1web or Novachannel.
NHS
Pension 11/12 Certificate Guidance
NHS Pensions have revised their
certificate guidance. This
applies to Box 38b, outlined in red in the attachment for
ease of reference.
Reimbursement and Claim Forms of High Volume Personally
Administered Vaccines
NHS Prescription Services has published a
letter
reminding
practices that certain high-volume personally administered
vaccines must be claimed by using the FP34 appendix claim
form. Dispensing doctors should use the FP34D appendix form
(pink), and any other GPs should use the FP34PD appendix
form (salmon). As from January 2013, if practices
erroneously submit such payment claims on FP10
prescriptions, the incorrect forms will be returned, and
resubmission of the FP34 will be accepted.
Bulletin 164
04.12.12
QOF Business Rules V24
Version 24 of the business rules, which supports QOF 2012-13, has been published (this will include the October code release).
European Study on eHealth Usage Among GPs
The European Commission has sponsored a study on the use of information and communication technologies among General Practitioners in all European countries. The aim of the study is to improve understanding of the use of technology by GPs in their daily activities and how this may vary. The study is supported by the GPC and 4,000 GPs (principals and sessionals) selected at random from the BMA database have been invited to complete an online questionnaire. Contact details have been disclosed on a secure and confidential basis with an appropriate confidentiality agreement in place. All information provided in the survey will also remain strictly confidential. Please note that participation is by invitation only to ensure a randomised sample. GPs who receive an invitation are encouraged to complete the online questionnaire, which should take no longer than 15-20 minutes - your participation will ultimately benefit both healthcare professionals and patients.
Bulletin 163
27.11.12
Rotavirus
Vaccination Programme
Following the
announcement by the Department of Health
about the introduction of the Rotavirus vaccination
programme from autumn 2013, they have provided this
Q&A.
The Rotarix® vaccine is for two doses of an oral vaccine to
be given to children under 24 weeks, which would fit within
the current childhood programme. All infants aged 6 weeks to
3 months at the start of the programme should be offered
vaccination and there must be a four week gap between the
doses. The vaccine supply will be centrally procured and
therefore not liable to PA fees.
CMO Annual Report
The Chief Medical Officer for England, Dame Sally Davies,
has published the first volume of
her
annual report.
This volume focuses on epidemiology and public health and
contains information that may be useful to CCGs and GP
practices. The report notes an increase in liver disease,
and also looks at old age surveillance, access to
healthcare, heart disease, obesity and cancer. It looks
like it will be a mine of information about our populations.
CQC
Registration
The CQC has published a
report on its pilots of inspection methods for primary
medical services providers. It includes recommendations
about how the CQC will check that providers meet the
essential standards once they are registered. These
recommendations include that providers should be given a
48-hour notice period for scheduled inspections and that
these inspections should take place every two years.
Patients with Dental
Problems
Doctors do not treat dental problems - however,
treatment can be given for the pain. Should a patient attend
your surgery, apparently unable to find a dentist to treat
them, please give them the contact number shown below:
To find the nearest dental practice taking on NHS patients
in the Tees area, visit
www.tees.nhs.uk or call the dental helpline on 0345 045
0620, or Text: 07700 380000.
If you need a dentist in an emergency, call 0845 603 3131.
You will be given the next available emergency appointment
at a dentist somewhere in Teesside.
You may wish to use this
poster.
Financial Element in Recovery Plans
Given all the changes currently taking place in the NHS we
recommend that all practices ensure that a financial element
is built into their disaster recover plans – considering
financial contingency plans and/or surplus finances in the
event on any payment delays as the PCT switch to the new
world of the NHS.
Updated Clinical
Waste Letters
Please observe these updated letters for GMS/PMS practice in
non-Trust owned properties whose waste is collected by SRCL.
Bulletin 162
20.11.12
General
Practice IT Services from 2013
From April, the NHS Commissioning Board (NHSCB) will become
accountable for the delivery of primary care IT, with the
services PCTs currently provide (i.e. funding and
responsibility for hardware, practice networks and support
services, including training) being delegated to CCGs.
We
urge practices to keep an inventory of the IT systems,
software and services currently used and which are being
funded and provided by the PCT in order to keep track of
this information and lose nothing in the handover.
Although reassurances have been given by the NHSCB that PCTs will accurately identify the IT services they provide to practices, and that there will be a safe transfer of these services, keeping an inventory of the IT provisions currently provided by their PCT will help ensure this happens.
Although decisions on the funding to be devolved to CCGs in 2013-14 are yet to be finalised, the NHSCB has, at the GPC IT Subcommittee’s suggestion, indicated its intention to recommend that current actual spends on general practice IT provision are maintained for at least two years to ensure continuity of service.
Whooping Cough (Pertussis) NES
for Pregnant Women
Update
Further to the GPC discussion with NHS Employers regarding
the additional monitoring requirements for this NE, NHS
Employers has stated that it is a local matter as to whether
the PCT varies the NES and\or secure additional information
from GP practices. As you will be aware, we have raised this
with the PCT who have decided to issue the NES with the
additional monitoring requirements. It is now practice
choice as to whether or not they sign up to the NES. It
should be noted that the NES did include some requirements
in relation to data capture and sharing by GP practices.
This is in relation to the information required by paragraph
9 of the NES but more specifically 9(ii): "Producing and
maintaining a satisfactory register of all eligible pregnant
women on the contractors registered list during each
financial year of the programme. Simple registers of
pregnant women are all that is required although these will
need to be updated regularly to capture the target
population and record EDD so it is known when they are
eligible for vaccination."
Patient On-line Access to GP Records and Transactional
Services
The government has committed to provide all NHS patients
with secure online access to their personal GP record and
transactional services (electronic booking and cancelling of
appointments, ordering of repeat prescriptions and
communication with the practice) by 2015. The NHS Mandate
from the government to the NHS Commissioning Board,
published 13 November 2012, reiterates this commitment and
goes a step further by saying that e-consultations should
become more widely available by 2015, and that people with
long-term conditions should be able to benefit from
telehealth and telecare by 2017. The RCGP was asked by the
government to work in partnership with patient groups and
other professional organisations to lead on the development
of a plan, policy and procedures to support patient access
and engagement with their GP records. GPC representatives
have attended meetings of this project. While the GPC is
supportive of the principle of patients having easier access
to their record, and also support some of the transactional
services being proposed as long as they are adequately
resourced and straightforward to deliver (such as electronic
ordering of repeat prescriptions), there are a number of
outstanding concerns with the proposals. These include third
party information held in the record, patient understanding
of the record, workload implications for practices, security
and confidentiality and patient consent to sharing, among
other issues.
Care Home Patient
Reviews
We have been made aware that some care homes are contacting
practices to arrange an agreement to put in place
additional/regular patient reviews. Practice should provide
patient reviews (not always face to face) as per their
contract and according to individual patient needs. Any
additional arrangements would require an additional contract
with the care home.
Reminder, Registration of GPs as Patients
We strongly recommend GPs – salaried or partner - should not
be registered as a patient within the practice where they
work. This recommendation extends to other staff working
within the practice as managing consent, confidentiality and
disagreements can become very complex when the
patient/doctor dimension is added within the workplace.
Reminder, Practice
Agreements
Due to changes in the NHS and General Practice many
practices are dusting off their practice agreements. If you
have not done this already we strongly recommend you review
your agreement to ensure it is up to date, relevant and
signed. This
Partnership Agreement Checklist
may assist your review and also incorporates
previously circulated guidance on wording for minutes to
ensure CQC/CCG decision making is correctly documented.
Bulletin 161
06.11.12
Sharing Electronic Records for Direct Patient Care
This
set of principles has been developed to support GP
practices that are considering implementing shared record
systems. Until relatively recently, data recorded in GP
systems have not been directly accessible by other
organisations. Data have previously been shared via specific
clinical communications, such as referral letters. A number
of GP clinical system suppliers have developed systems which
allow healthcare professionals across different
organisations to access directly the detailed information
recorded during patient consultations. These are high level
principles, which the BMA believes represent best practice
in terms of allowing records to be shared in order to
facilitate patient care, whilst maintaining high standards
of confidentiality. All system suppliers should aspire to
meet these standards.
Whooping Cough (Pertussis) NES for Pregnant Women
It has come to our attention that the data that all PCTs
have been instructed to request from practices varies from
that which was previously agreed between the DoH and the GPC
(see a bulletin 157 below for a copy of the agreed NES). The
agreed NES only requires practices to provide the following
information for monitoring purposes:
Number of Pregnant patients (28 weeks and over)
Number of women in the above group who have been vaccinated with Repevax
The DH has given guidance to PCTs which supersedes this and additionally asks practices to provide:
Number of pregnant women with an estimated date of delivery (EDD) in the survey month
Number of pregnant women with an EDD in the survey month that received a dose of Repevax
Both the GPC and the LMC are concerned about the additional workload this is creating without any additional funding and find it unacceptable that additional reporting requirements have been added to the NES after the agreement was made. The GPC have written to NHS Employers asking for urgent clarification on this issue. The PCT have forwarded us a copy of a revised NES which reflects the new data collection – we have advised we are awaiting further national guidance before we can comment on such changes.
Focus on
Travel Immunisations Updated
The
Focus on Travel Immunisations
has been amended to add a note about the reimbursement of
oral typhoid vaccine, and to clarify which travel
immunisations are not reimbursable on the NHS.
CQC Consultations
The CQC has recently published two consultations, on fees
and their strategic direction. The consultations are
available at
http://www.cqc.org.uk/feesconsultation and
http://www.cqc.org.uk/thenextphase.
The BMA will be responding to both consultations, but GPs
are also encouraged to respond. The more who respond, the
better CQC will understand our unhappiness with being
charged to be inspected.
Area Health Guides
You may be approached by a company producing something
called the Area Health Guide. Please be advised that they do
not, currently, have PCT authorisation to sell
advertisements on the PCTs behalf. If you are approached
please contact
alison.hyde@tees.nhs.uk.
QOF
Achievement & Prevalence Data
The
2011/12 QOF achievement and prevalence data has been
published by the NHS Information Centre, including a
statistical bulletin, an online database and a set of
detailed data tables.
Bulletin 160
30.10.12
Oral Typhoid Vaccine
Following reports of the injected single typhoid vaccine being unavailable, GPC were asked whether the oral single typhoid vaccine could be given instead and whether the vaccine cost could be reimbursed on an FP34 when it is in fact a self-administered tablet. The NHS prescription Services has confirmed that the situation with the oral typhoid vaccine is somewhat unusual in terms of what is allowed. It is classed as personally administered and although it is not a vaccine in the conventional sense, it is listed as an Oral Vaccine and is a High Volume Vaccine on their system, and can therefore be claimed on the FP34 appendix. They will also accept it if practices were to print it on an FP10 and submit it with the end of month submissions. GPC have also had reports of shortages of the Oral Typhoid vaccine Typhim Vi, and in the September Vaccine update it is suggested that practices contact Crucell as they reportedly have stock of the Vivotif vaccine which can be used instead.
BMA 2013 Research Grants
The BMA was among the first of the professional bodies to award grants and prizes to encourage and further medical research. Today, around ten research grants are administered under the auspices of the Board of Science, all funded by legacies left to the BMA. Grants totalling approximately £500,000 are awarded annually. Applications are invited from medical practitioners and/or research scientists and are for either research in progress or prospective research this year - open from 11 December 2012. Further information on the grants and details of how to apply are available here - subject specifications for each grant vary so please check the information first (e.g. in 2013, research areas range from rheumatism and arthritis, cardiovascular disease and cancer to neurological disorders and terminal care). The application deadline is 15 March 2013 at 5pm. If you have any questions about the BMA research grants, or would like to receive alerts about them, please contact Chris Wood at
info.sciencegrants@bma.org.uk or telephone 020 7383 6755.
GP Trainees Subcommittee Newsletter
This is the October edition of the GP Trainees Subcommittee newsletter.
Bulletin 159
22.10.12
Primary Care Incentive Schemes
A number of primary care incentive schemes that reward arbitrary reductions in clinical activity without evidence that this is in the best clinical interests of individual patients are being developed throughout the country. There are also schemes with little or no restriction on the reward given to practices, for example, the stipulation that the money should be reinvested in patient services. The GPC and the BMA Ethics Department have significant concerns about the professional and ethical implications of these schemes. In particular, the schemes may breach paragraph 74 of Good Medical Practice (GMP):
"You must act in your patients' best interests when making
referrals and when providing or arranging treatment or care.
You must not ask for or accept any inducement, gift or
hospitality which may affect or be seen to affect the way
you prescribe for, treat or refer patients. You must not
offer such inducements to colleagues."
The BMA asked the GMC for its view of these incentive schemes. The GMC is clear that, in general, incentive schemes should specify that payments arising from the scheme should be used for improving patient services and not for the financial benefit of individual doctors. The BMA urges any doctor making decisions about commissioning or participating in an incentive scheme to consider the schemes carefully. Any GP with concerns about a proposed incentive scheme should seek advice from their LMC. Doctors should, where possible, review the evidence base for the schemes and satisfy themselves that, in participating, they will not be compromising patient care.
Crucell Flu Vaccines Update
Crucell has now sent this
letter to its customers confirming that they are withholding all their deliveries of the Viroflu/ Inflexal flu vaccine.
Zostavax Vaccine Update
The Department of Health has confirmed that if a GP makes a judgment that vaccination against shingles would be clinically indicated and beneficial for an individual patient, Zostavax can be prescribed on the NHS. The DH is also planning to make a statement about the possible introduction of a shingles vaccination programme for those people aged 70-79 years, as recommended by the JCVI. Their position on this issue has also been published in this edition of 'Vaccine update'.
Stamp Duty Land Tax
The GPC is currently seeking specialist advice on the subject of Stamp Duty Land Tax (SDLT), a tax on land transactions that, in the context of general practice, is liable on any lease of a GP practice or acquisition of freehold. The issue is complicated and further advice will be forthcoming once representatives of GPC have met with the Department for Health and received legal advice. In the meantime, GPs who are about to acquire land for a new practice, enter a new lease, or whose leases are up for renewal, are urged to seek advice from a specialist property lawyer. Please note that if your practice has a Licence to Occupy then there is no SDLT liability.
Door Entry Codes & the Patient Demographic Service
Practices are reminded that confidential door entry codes must be recorded correctly in patient electronic records. Practices are sometimes provided with four-digit codes by their patients to allow them access to a door entry system, or to a box containing a key for the patient’s front door. Last year, Connecting for Health wrote to practices to alert them that door code details were being stored incorrectly in the address, telephone number or name fields of patient records, which were subsequently uploaded to the Patient Demographic Service. This creates a serious security risk with, for example, the codes being included as part of the address on letters sent to patients. Practices should instead add the information to the patient record using Read Code 915L ‘Patient door access via key code’, and then record the code using free text.
GP IT
From April 2013, the NHS Commissioning Board (NHSCB) will be accountable for the delivery of primary care IT, with funding and responsibility for hardware, practice networks and support services (including training) being delegated to CCGs (i.e. the services PCTs currently provide). CCGs as commissioners will need to own a locality informatics strategy. The Local Service Provider contract and GP Systems of Choice programme will continue to be managed and funded at a national level.
Work is underway with PCTs to determine the current level of spending on GP IT before decisions on the funding to be devolved to CCGs in 2013-14 are finalised.
The NHS CB has provided the following update on arrangements for GP IT systems:
The following information is in support of the information released in issue 20 of the CCG bulletin. Primary care trusts (PCTs) have led on the provision and support of GP IT systems and therefore the safe transfer into the new commissioning system is highly important to ensure that GPs continue to have a choice of quality solutions which meet local needs. The future operating arrangements for GP IT, to apply from 1 April 2013, are due to be published in the autumn. GP IT services comprise of IT support services for GP practices as set out in GMS and PMS contracts (plus APMS contracts that specifically include these IT services) plus implementation and support for all appropriate nationally mandated systems. They also include discretionary, locally determined IT support services. The NHS Commissioning Board (NHS CB) will be accountable for these services. The NHS CB will continue to set overall direction, standards, strategy and budgets, such as the GPSoC contract and maintaining national infrastructure. Clinical commissioning groups (CCGs) are best placed to plan the use of IT systems to support service delivery and service change to enable better patient care across local health communities. The NHS CB will therefore discharge its operational responsibilities for GP IT services by arranging for CCGs to provide these services locally on its behalf and by devolving associated funding to CCGs. IT support for other primary care contractors will be incorporated into the NHS CB’s operating arrangements. The proposal is that the NHS CB, through its local area teams, will be the registration authority for all primary care contractors (administration of access to clinical and business systems) and will be responsible for clinical safety and assurance (adherence to dataset change notices). We anticipate that local area teams will arrange for commissioning support units or other IT providers to provide these services.
If you have any questions about these future arrangements please contact ccgdevelopment@nhs.net.
Bulletin 158
09.10.12
Seasonal Flu – Correct Coding and a SystmOne Issue
We have
been made aware that some practices are still using old
coding details for flu vaccination reporting. Please check
that you are using the new codes as per QOF 12/13 or you may
hit payment problems. Additionally, there are
concerns about the reports provided by TPP intended to
identify the ‘at-risk’ patients eligible for flu
vaccination. It appears that TPP have included a larger
range of codes than necessary and this is resulting in
inappropriate patients being identified. TPP have confirmed
that there is a separate set of reports used for upload into
ImmForm but there is no access to these reports so the PCT
cannot check whether there will be a negative impact on
reported achievement. Please ensure that you double check
that you are calling and vaccinating the correct cohort
bearing in mind this issue.
Overseas Patients
The aftermath of the Panorama programme has led to increased
interest in this. Please do not hesitate to contact the LMC
for advice pertaining to individual request. The latest DH
statement is as follows:
Treatment provided by a GP is free of charge, whether registering as a temporary patient (when you are in the area for more than 24 hours and less than three months) or registering as an NHS patient. There are certain types of service in the NHS that are currently free of charge irrespective of country of normal residence. These are outlined in the National Health Service (Charges to Overseas Visitors) Regulations 2011 as:
Emergency treatment at any Accident & Emergency (A&E) department, walk in centre or elsewhere (but not further emergency treatment (e.g. operations) away from these locations, or subsequent outpatient appointments)
Family planning services
Treatment for communicable diseases (see regulations for exact list)
Treatment for sexually transmitted infections (including HIV)
Diagnosis, counselling and treatment in relation to HIV
Those detained in hospital under the Mental Health Act 1983 or treatment given for mental health problems as part of a court probation order
Procurement Guidance
The GPC has published this
guidance explaining the basics of procurement law and
policy.
Bulletin 157
02.10.12
Pertussis (Whooping Cough
Vaccination Programme for Pregnant Women
Following on from advice from the JCVI, the CMO (England)
have asked that commissioners urgently put in place a
pertussis (whooping cough) vaccination programme for
pregnant women to respond to the outbreak of infection. The
GPC and the Department of Health have agreed this National
Enhanced Service
(NES) specification
for practices to undertake the vaccination of pregnant women
from 1 October 2012.
A summary of the NES agreement is below:
Vaccination of pregnant women in the third trimester (recommended between 28 and 38 weeks of pregnancy) with dTaP/IPV (Repevax®)
Practices will receive £7.67 per dose of vaccine given and will be responsible for determining how best to contact pregnant women to offer vaccination
Practices will already be holding stocks of Repevax® for the routine childhood programme and so can use this immediately to commence vaccination
Further stocks can be ordered through Immsform. As central supply applies no claim for reimbursement of vaccines costs (personal administration fee) apply.
This temporary programme commenced on 1 October 2012 and will be funded centrally. The LMC have had discussions with the PCT who confirm that this DH letter is a letter of authority/guarantee and the NES will be issued to practices ASAP. If practices are approached by patients prior to the NES being issued, they should progress with vaccination and reporting for payment is likely to follow that used for flu vaccinations.
If you have any questions please contact Toks Sangowawa (toks.sangowawa@nhs.net) or Jane Lawson (janelawson@nhs.net) at the PCT for further information.
The LMC and PCT will have further discussions as to how midwives can contribute to this vaccination programme – until this is finalised midwives will be asked to refer patients who have not yet been vaccinated to their GP practice.
Please note that although Infanrix is licensed for Pertussis vaccination, it does not provide the same protection as provided by Repevax. As such, JCVI has only recommended Repevax for this programme, which practices can order via ImmForm./font>
Bulletin 156
25.09.12
Pensions
The Government published the Public Service Pensions Bill on
13 September. It claims that changes to public sector
pensions are needed for sustainability. However, the BMA
strongly believes that the scope of these changes is unfair,
unnecessary and will adversely impact staff in the NHS
Pension Scheme:
Demanding the same savings of all public sector schemes across the board is unfair – the NHS Pensions Scheme underwent major reform only 4 years ago, and continues to deliver a positive cashflow to the Treasury.
Some healthcare workers will pay 66% of the cost of their pension benefits by 2014-2015 but the highest earning civil servants will pay a maximum 26% of theirs.
The Government wants to link the Normal Pension Age for NHS staff to the State Pension Age, but work in the NHS is often physically, mentally and emotionally demanding, and some staff will not feel able to work effectively beyond the age of 65.
The BMA will be proposing affordable ways in which the changes can be made fairer, both now and in the longer term. The BMA’s activity on these plans involves a number of strands. First, the BMA is playing an active part in the Working Longer Review, involving the Department of Health, NHS Employers and health unions examining the impact of NHS staff working longer. Additionally, together with other health unions, the BMA is building a campaign against the planned increase to the NHS retirement age. Also, the BMA are using the publication of the Bill to lobby Parliamentarians, to make them aware of doctors’ concerns about the changes to NHS pensions and to offer alternative solutions. The BMA is among the unions currently in talks with the government about the detail of the changes to the NHS pensions scheme.
Revalidation
The UK
Revalidation Programme Board considered preparedness for the
roll out of revalidation. The BMA believes that while there
is significantly more work to be done to get revalidation
into proper shape, its seven principles for implementation
have been broadly recognised and sufficiently addressed to
enable the General Medical Council to proceed with its
timetable. This is partly due to a commitment given that the
NHS Commissioning Board (NHSCB) will establish funding to
support GPs who need remediation away from their place of
work, and confirmation that the responsibility for funding
remedial placements and assessments for GPs will rest with
commissioners. Fair and reasonable access to funding will be
determined through a set of criteria determined by the NHSCB
working with the BMA. The GPC will continue to work to
ensure that the ongoing issues that require further work are
addressed, and that revalidation is reviewed regularly to
assess whether it is proportionate and appropriate, and
benefits patients.
Flu
Vaccinations for Healthcare Workers
Due to the continued low uptake of the flu vaccine in
healthcare workers (45% for 2011/12), the Chief Medical
Officer for England, Professor Dame Sally Davies, and the
BMA’s Chair of Council, Dr Mark Porter, have written this
letter to doctors to
ensure that as many frontline staff as possible get
vaccinated.
Pharmaceutical Service Regulations Amends
The Department of Health has made the following amendments
to the NHS (Pharmaceutical Services) Regulations 2012, which
will come into force on 1 November:
restore rights of appeals included in the NHS (Pharmaceutical Services) Regulations 2005 but not included in the 2012 regulations;
make it clear that members of limited liability partnerships are to be treated, for information providing purposes, in the same way as directors of corporate bodies;
correct the list of conditions that have to be met if a dispensing doctor is to dispense a repeatable prescription in Schedule 6 to the 2012 Regulations (terms of service for dispensing doctors).
Bulletin 155
18.09.12
GP
Practice Staff Census
This week, practices will receive a request, from NEPCSA, to
provide data with regard to GP practice staff numbers. This
is part of an annual national census. We support this
process and urge practices to provide the data as it feeds
into necessary workforce planning.
Medicines Use
Review Feedback Forms
On 1 September a new
Medicines Use Review (MUR) feedback form was
introduced, so practices may soon start receiving such
forms. This form is for pharmacists to advise GPs of any
issues that had been uncovered during an MUR consultation
that the GP may wish to be aware of.
GPC Message re
CCG Constitutions
The GPC are receiving reports of CCGs placing increasing
pressure on practices to ‘sign up’ to constitutions by a
certain deadline in order for the CCG to meet the timescales
of authorisation. The NHSCB have been clear in meetings with
the GPC that CCGs will only be authorised if they can
demonstrate adequate engagement with practices. CCGs that
rush or skip this engagement may find that in their rush to
be authorised, they jeopardise their chances of progressing
successfully to authorisation. It is vital that time is
taken to ensure that the early development of CCG is well
thought through and involves all the member practices. If
you are concerned about the development of your CCG please
email the GPC at
info.commissioning@bma.org.uk.
Bulletin 154
04.09.12
Red/Amber Drugs
We have been made aware that practices are increasingly
being asked to prescribe red/amber drugs, under shared care
arrangements, for which no local agreements exist. The LMC
advice remains that you should only prescribe medication for
which you feel competent to prescribe/monitor. Once you
issue a prescription, you become clinically responsible for
that patient not the consultant who may be overseeing the
patient. Additionally, please remember that red/amber drugs
should only be transferred by agreement with funding in
place for monitoring.
Cleveland
LMC Organisational Change
Cleveland Local Medical Committee has established a Limited
Company which runs in parallel with the Committee. This
protects Officers, Members and Constituents of the Committee
as it limits their liability. All advice is now provided by
Cleveland LMC Limited; the LMC is responsible for formal
representative activities including elections and levy
collection. In practise this will make no difference to the
service that GPs receive and has been undertaken following
extensive legal advice. If you have any questions or wish to
have further details, please contact the LMC office.
Bulletin
153
14.08.12
Sessional GP Newsletter
This summer edition of the
Sessional GP Newsletter includes key articles on issues
relevant to salaried and locum GPs, including items on
pensions, taxable expenses and insurance cover. A feature
article on sessional GP involvement with LMCs is also
included in this issue.
GP Trainees
Subcommittee Elections
As of August 3rd, ballot papers will be sent out for
elections to the GP Trainees Subcommittee in the Northern
Deanery. The deadline for votes to be received by the
Electoral Reform Society is 5pm on Friday 24th August, so if
you have not yet received a ballot paper (by August 10th)
and you feel that you should have, please get in touch with
Christopher Scott via
cscott@bma.org.uk
who will make
sure that ERS send out ballot papers to all eligible voters.
Bulletin 152
06.08.12
Updated Focus on Travel Immunisations
This Focus on Travel Immunisations, has now been updated taking in to account the recent amendments to the Statement of Financial Entitlements as set out in Annex BA ‘Vaccines and immunisations’.
Bulletin 151
31.07.12
Seasonal Flu Call & Recall Arrangements
The DH provided the following clarification of assurance on
flu vaccination planning:
Following the publication of the CMO’s letter of 3 May,
there has been some concern raised by GP practices about the
GP checklist for assurance on flu planning, specifically the
entry:
Robust call and recall arrangements
1. Patients recommended to receive the flu vaccine will be
sent a letter, inviting them to a flu vaccination clinic or
to make an appointment.
The flu DES requires practices to adopt robust call and
reminder systems to contact patients in order to maximise
uptake. It is not explicit about the system adopted.
Research shows sending a letter to be effective and is
therefore included in the checklist as one of the ways PCTs
can be assured of GP practice plans. GPs are expected to use
their judgment on the best way to reach patients in order to
meet the DES requirement and so this should be taken into
account when seeking assurance of local plans.
Guide to a Session for GP
Trainees & Trainers
The GP Trainees Subcommittee has published this "Guide
to a session for GP trainees and trainers" in
conjunction with COGPED that has been drafted to replace the
previous 'Guide to a session' (January 2009).
GP Trainees
Subcommittee Newsletter
This
newsletter covers
matters of interest to doctors in GP training including
information on education, training, contracts, terms &
conditions of service and the NHS reforms in England, as
well as information on getting involved with the
subcommittee.
Locum GP Forum
The online community for doctors, doc2doc, has recently
launched a dedicated forum for GP locums. This
forum provides an arena where locum GPs can get involved
and network with fellow locum GP colleagues - discussing
experiences with colleagues from across the UK and gaining
insight from others in similar situations. Registering
online to create an account is quick and straightforward.
Bulletin 150
24.07.12
Focus on Hep B
Immunisations
This
Focus on Hepatitis B Immunisations
aims to clarify the circumstances where charges can
be made and where active attempts to encourage hepatitis B
immunisation ought to be made. Note that the occupational
health section replaces and updates the former guidance
Hepatitis B vaccination for employees at risk.
General Practice Extraction Services (GPES)
GPES is a new
service, delivered by the Health and Social Care Information
Centre (HSCIC). From April 2013, GPES will make data
available from GP clinical systems with the intention of
improving the health and wellbeing of patients in England
and the first request will be the data required for QOF
2013/14. It is important that you are aware of GPES because
each GP practice will be asked to consider whether to
participate in the service.
From January 2013, HSCIC will be asking all GP practices about their preferences for participation in GPES data requests. For effectively anonymised data requests, you can either choose to automatically opt in to all requests, or alternatively make a decision on a case by case basis upon receiving details of each request. For identifiable data requests, you will NOT be able to make a general choice to opt in to all requests but will be asked to opt in to each individual request. The GPES software is being designed to minimise the workload for GP practice staff. Extractions of data will be undertaken by your GP system supplier and sent on to HSCIC. The data will be held in a secure environment and then sent to the customer in the required format. The data held in the HSCIC secure environment will then be destroyed.
GPs are rightly cautious about the information they hold on behalf of their patients – the BMA believe GPES strikes the right balance between patients individual rights to privacy and the need to share for the greater good.
The BMA has been involved in advising on GPES from the outset, particularly in relation to information governance and ensuring that the confidentiality of patient data is protected. This included agreeing GPES information governance (IG) principles which recognise the role of GPs as data controllers. One fundamental IG principle is that general practices, as data controllers, decide whether data should be extracted. Another is that anonymised data will be extracted wherever possible. Identifiable data can only be extracted if there is a legal basis, for example with explicit patient consent or approval by the Ethics and Confidentiality Committee (ECC) of the National Information Governance Board. New Read codes have been developed to allow patients to opt out of appropriate identifiable data extracts. Customers of GPES must be approved by the DH and/or the NHS Commissioning Board. The GPES Independent Advisory Group (GPES IAG), which includes BMA representation, considers each data extract request ensuring GPES IG principles are met and there are sufficient benefits for patients.
Further information on GPES will be provided shortly, but you may wish to access the current GPES information, including the GPES IG principles agreed with the GPC, on the HSCIC website.
Flu Immunisation Programme – Patient Leaflets
The DH has clarified that they do not intend to fund any distribution of communication media for the flu immunisation programme and that the patient leaflet that is available on the DH website is for practices to use should they wish to. Given the view that we do not believe GPs should be expected to print such leaflets at their own expense we would advise GPs not print such leaflets as there is no funding available for doing so.
Management of Adult Diabetes Service in NHS
At the end of May, the National Audit Office (NAO) published
this
report
on the
management of adult diabetes services which highlighted the
differences in reported achievement between QOF and the
National Diabetes Audit (NDA). NICE has subsequently been
asked by the Department of Health to consider the issues
raised in the report and have initiated a review of DM13
which is the QOF indicator for micro-albuminuria. The GPC
had several concerns with the recommendations set out in the
report, in particular Recommendation b.
Recommendation b.
Payment mechanisms currently available to GPs are failing to ensure sustained improvements in outcomes for people with diabetes. The current system of incentives needs to be reviewed and renegotiated to improve outcomes for people with diabetes in accordance with clinical practice recommended by the Framework and, more recently, by NICE. GPs should only be paid for diabetes care if they ensure all nine care processes are delivered to people with diabetes. The threshold at which GPs are remunerated for achievement of treatment standards should also be reviewed and increased at regular intervals.
The GPC disagrees with both parts of this recommendation. The suggestion that GPs should only be paid for diabetes care if they ensure all nine processes are delivered would have unintended consequences where patients did not wish to engage in some checks or continue to attend. They also believe that payment thresholds are outside NICE’s remit and have, therefore, written to Professor Sir Bruce Keogh, NHS Medical Director, to highlight their concerns over this report.
Vaccine Update June 2012
The Department of Health published this
vaccine update for June, which contains useful
information on: HPV immunisation programme - change of
supply from Cervarix to Gardasil from 1 September 2012; Flu
vaccination uptake reports for Winter 2011/12;
Deliveries of vaccines during Olympic and Paralympic games;
and Process of ordering of vaccines through ImmForm.
Reimbursement of GP Trainee Travel Expenses
GP trainees who use their cars to conduct home visits during
their placements are entitled to claim mileage expenses. The
journey to and from work (up to 10 miles in each direction)
can also be claimed, but only if a home visit is made that
day. Travel expenses can be reimbursed for deanery-organised
educational events or programmed teaching, but this does not
seem to apply to all deanery areas. Training practices and
trainees are advised to check this with their deanery.
Trainees are either able to claim this allowance through the training practice, which in turn claims reimbursement from the regional Deanery, or directly though the PCT. The training practice is expected to signpost the trainee to the correct person at the PCT if necessary.
The rates at which trainees can claim are set nationally by the Directions to Strategic Health Authorities Concerning GP Registrars and the amounts they can claim vary according to the cc of their car - up to a rate of 58.3p per mile for certain cars. This is over the rate permitted for the purposes of tax (45p per mile) and so any amount above the 45p per mile rate is seen as a benefit and should be taxed as such.
This means that the employer (practice) should then either complete a P11D form for the Inland Revenue detailing any of this and any tax owing will be taken out of the trainees National Insurance contributions the following year; or, some practices may have pay roll software that can do the tax calculations for them as they go along. Trainees and practices should ensure that they keep a record of any mileage claims for up to six years for tax purposes. The BMA is working with NHS Employers to see if the GP Registrar directions can be changed to come in line to reflect taxable allowances.
Locum GP
Handbook (BMA members only)
The
BMA GP locum handbook has now been published for the
benefit for BMA members and provides useful advice on a
range of issues to consider when working as a locum GP. The
handbook includes specific sections on starting out as a
locum GP, as well as others sections on setting up a
business and agreeing contracts for services with different
employers. It will also be a useful guide for practices that
engage locums. The official launch of the handbook will
take place at Sessional GPs: Redefining Success, a
one day conference to be held at BMA House on Thursday 11
October 2012. Attendees will be the first to receive hard
copies of the handbook.
Bulletin 149
10.07.12
CCGs
As you will be aware, the CCGs are currently working on
their Constitution in preparation for Authorisation. The
CCGs have been working with the LMC and the Constitutions
will be considered at the LMC Board meeting on Tuesday 10
July. Once we are in a position to share our views on the
documents with all practices we will do so prior to any
practice signatures being requested. The GPC has provided
this
information
on a number
of CCG related topics.
CQC
The CQC are sending out this
letter to practices registering with them by April 2013,
inviting you to set up an online account on their website.
As part of this process, you will be asked to pick a 28 day
window between September and December 2012 for submitting
the application form. If you have not received a letter by
the end of July, and you think you should register, you
should contact the CQC at
2012registration@cqc.org.uk.
This
LMC PowerPoint presentation
(from the
LMC event of 5 July) together with this
GPC guidance about
the registration process and accompanying
appendix
has been designed
to assist you but if you have any questions at all please do
not hesitate to contact the LMC or CQC.
Sharing Patient Information
Practices are increasingly receiving requests on sharing
patient information, particularly with regard to risk
stratification. Risk stratification is considered as a
secondary use of data and, therefore, any release of patient
identifiable information must be subject to existing legal
and ethical principles. Patient identifiable information
should remain within the practice unless explicit patient
consent is obtained or there is another legal basis for the
disclosure such as approval under section 251 of the NHS Act
2006. Identifiable patient information should not be
accessible to other staff, including clinicians, unless they
are providing direct care for that particular patient. The
BMA has produced this
guidance to assist in dealing with requests for data for
secondary purposes.
Agency Workers
Regulations Guidance
This guidance on the
Agency Workers Regulations
will be
useful for all locums who are engaged by agencies, as well
as practices who hire them.
GMC Continuing Professional
Development Guidance
This GMC
Continuing Professional Development guidance for all
doctors has been developed in co-operation with doctors,
medical Royal Colleges, employers, patients and the public,
and follows widespread public consultation earlier this
year. It is hoped doctors will use it to reflect on how
their learning and development improves the quality of care
they provide to patients and for the service in which they
work. The guidance describes:
Vaccine Update June 2012
The Department of Health published their
vaccine update for June,
which contains useful information on: HPV immunisation
programme - change of supply from Cervarix to Gardasil from
1 September 2012; Flu vaccination uptake reports for Winter
2011/12; Deliveries of vaccines during Olympic and
Paralympic games; and Process of ordering of vaccines
through ImmForm.
Services That Should Not Be Provided By GPs Guidance
GPs are increasingly being asked to provide services to
patients residing in institutions or homes where the types
of services expected do not fall under the responsibility of
primary care. This revised
GPC guidance
has
been developed to help GPs decide whether or not the
treatment they are providing in institutions and residential
homes falls within the remit of standard primary medical
services contracts.
Control of
Asbestos Regulations
Given the number of queries raised on Asbestos Inspections
following the Annual Returns earlier this year we thought it
may be helpful to share the link to this short
guidance note
on
the implications of the Health and Safety Executive’s
revision of the Control of Asbestos Regulations.
Bulletin 148
26.06.12
PIP Silicone Breast
Implants
The expert group on PIP implants chaired by Sir Bruce Keogh
published its report earlier this week. A summary of the
findings and recommendations of this expert group is
included in these letters to
MDs and
GPs.
The criteria for referral remains as outlined in the expert
group interim report published in January, and is also
included in the letters.
QOF FAQs
Joint BMA and NHS Employers guidance on QOF frequently asked
questions for 2012/13 has been published
here. These FAQs apply are for primary care
organisations and general practices covering a number of
historical issues and commonly asked questions.
NHS 111 Services
The Secretary of State for Health announced last week that
he recognises that an extension of up to six months is
required before local NHS 111 Services can be implemented in
certain regions of England including the North East. The DH
is keen to get as much clinical input as possible and
Berenice Groves (berenice.groves@nhs.net)
is the person in the North East responsible for coordinating
the work and engagement with local CCGs in order to get
local 111 services in place.
Bulletin 147
12.06.12
Changes to Group 1 & 2 Driving Licensing Standards for Vision
The DVLA driver licensing standards for vision have now changed. In summary:
Group 1 (cars and motorcycles): applicants and licence holders will need to have a visual acuity of 6/12 (0.5 decimal) as well as being able to read the number plate from the prescribed distance.
Visual field: the present standard of a total field width of 120 degrees remains but in addition, there will need to be a field of at least 50 degrees on each side.
Group 2 (buses and lorries): applicants and licence holders must have a visual acuity, using corrective lenses if necessary, of at least 6/7.5 (0.8 decimal) in the better eye and at least 6/12 (0.5 decimal) in the other eye. If corrective lenses are worn, an uncorrected acuity in each eye of at least 3/60 (0.05 decimal) is needed. All Group 2 drivers must also meet all the Group 1 visual acuity standards as outlined above. Where glasses are worn to meet the minimum standard for driving, they should have a corrective power of no more than plus eight (+8) dioptres.
The full standards are available on the DVLA website.
Diabetes UK also has information about the recent changes.
RCN Indemnity Guidance
The GPC has updated this guidance following MPS clarification on its advice to its members.
Updated Focus on Vaccines & Immunisations
The Focus on Vaccines and Immunisations guidance, which was originally published in 2004, has now been updated following the publication of the amendments to the Additional Services section of the NHS Regulations 2004 (Annex BA of the Statement of Financial Entitlements) on 30 April 2012.
In 2004, everything in the Red Book was transferred unchanged and carried into the new GMS contract as an additional service. These regulations became out of date because of changes in the vaccines themselves and continued to contain inappropriate references, such as smallpox. This did not prevent their being carried over into the new contract. The amendments to the SFE now reflect current practice and attempts to clarify the previous regulations to make them fully up to date, and are not intended to introduce any new work.
ePACT Data for Quality and Productivity Prescribing Indicator Achievement Practice signs off QOF achievement (approves and declares achievement) for QOF 2011/12 on QMAS minus the QP3,4 and 5 results which only PCTs can input. This enables PCTs to carry out pre-payment verification checks. In order to make sure that QOF payments are made by end June, PCTs may need to generate advance payments for QOF achievement on Exeter (not through QMAS) based on rest of QOF achievement plus an estimate of the QP3, 4 and 5. PCTs await the ePACT results, calculate the actual prescribing achievement using the ready reckoner and input final results in QMAS. QMAS calculates the final achievement payment and this generates the correct payment through QMAS. If the PCTs made an advance payment on Exeter, they need to recover the amount through an equivalent negative ad-hoc variance.
ePACT data to measure achievement was made available on 17 May 2012 and PCTs have been advised to use the ready reckoner (or formula on page 166 of the 2011/12 QOF guidance) to calculate the points achieved for each of their practices. Due to the additional time required by PCTs to calculate achievement for a number of practices,
practices should not delay signing off QMAS (approving and declaring achievement), as a PCT could withhold an achievement payment if QMAS has not been signed off. Early sign off will enable PCTs to complete pre-verification checks before payment is due. In particular practices do not have to wait until they receive their QP3 – QP5 results to sign off QMAS, as signing off QMAS does not prevent a practice from appealing their QP3 – QP5 results or raising a dispute.
Step by step process:
Changes to Community Pharmacy Medicines Use Review Scheme
From 1 July 2012 changes will be made to the community pharmacy Medicines Use Review (MUR) service. The main changes that will affect GPs are the introduction of a feedback form which will be used by pharmacists to inform GPs of any issues that arise during the MUR consultation and the removal of the requirement for pharmacists to inform GPs that an MUR has taken place when no recommendation has been made by the pharmacist to the GP. These new requirements are subject to a change of directions in due course.
Seasonal Flu Arrangements
The CMO wrote to practices on 3 May about the seasonal flu arrangements. Annex B (the GP check list) on page 9 says:
Robust call and recall arrangements
1. Patients recommended to receive the flu vaccine will be sent a letter, inviting them to a flu vaccination clinic or to make an appointment.
The GPC was concerned that the checklist does not reflect the requirements of the DES, and that it is up to practices to decide how they advertise to and follow up patients. We brought this issue up in a recent helpful meeting with the CMO, who noted that it was less specific in the DES. Our advice remains that the DES is followed and that the important point is that robust systems should be used to notify patients, although there may be local variations. It is up to the practice, not the PCT, to decide what these are.
LMC Conference Motions
These LMC Annual Conference Motions have now been published.
GP Trainee Elections
Nominations are now open for regional representatives on the GPC GP Trainees Subcommittee. Elections are being held for each of the 19 regional constituencies - nominations are open to all those on, or about the begin, a GP training programme - whether they are BMA members or not. Full details, including nominations forms, are available on the BMA website here. All nominations must be received by the GPC office
by 5pm on Friday 22 June 2012.
Bulletin 146
29.05.12
Outer Boundaries
You will shortly receive information from NEPCSA regards
outer boundaries (together with a contract
variation/Statutory Instrument). When considering outer
boundaries it is the practice decision as to what this
boundary will be and there is provision for outer and normal
boundaries to be the same where areas are extensive. If you
have any concerns/questions when agreeing outer boundaries
please do not hesitate to contact the LMC and we will be
happy to discuss this with you.
Jubilee Bank Holiday
As you are aware, next weekend is a ‘double bank holiday’
(Bank Holidays are 4th and 5th June) which will bring with
it the usual capacity and surge issues that we always see
over a 4 day weekend. The PCT are looking to do some
communications with patients around making the right choices
as to where to go for care and also to order repeat
prescriptions in plenty of time (similar to that which they
did for the Royal Wedding last year). We have also requested
they notify of which pharmacies are open to assist all
providers to appropriate direct patients. I am sure this is
all in hand but posters to patients and timely reminders to
ensure they have ordered their repeat prescriptions are
always helpful as, inevitably, someone will pitch up
expecting you to be open!
QMAS Underpayments
The Department of Health has informed PCTs that they are
required to correct payments to practices for the 2010/11
QOF achievement payments now that actual data is available.
This guidance highlights an error within the QMAS
and includes an action to make the necessary adjustments by
the end of June 2012.
Supplying Medicines within Healthcare Services
The MHRA have issued a statement in advance of the imminent
repeal of section 10 (7) of the Medicines Act 1968. This
change, part of wider consolidation to the Medicines Act,
removes the exemption for pharmacies required to hold a
Wholesale Dealer's licence for the supply of medicines other
than directly to patients or members of the public.
This
letter to organisations
clarifies how the MHRA plans to enforce this legislative
change. To summarise their position, the MHRA have taken the
view that "the supply of medicines by community and hospital
pharmacies to other healthcare providers in the UK who need
to hold stocks for treatment of, or onward supply to their
patients represents an important and appropriate part of the
professional practice of both community and hospital
pharmacy, and falls within the definition of provision of
healthcare services. In such circumstances the MHRA will not
deem such transactions as commercial dealing and pharmacies
will not be required to hold a Wholesale Dealer’s Licence".
GP Trainee Elections
Nominations are now open for regional representatives on the
GPC GP Trainees Subcommittee. Elections are being held for
each of the 19 regional constituencies - nominations are
open to all those on, or about the begin, a GP training
programme - whether they are BMA members or not. Full
details, including nominations forms, are available on the
BMA website here. All nominations must be received by
the GPC office by 5pm on Friday 22 June 2012.
Bulletin 145
15.05.12
CQC Registration
Guidance
The BMA have published revised
guidance on
CQC registration together with these
policies and protocols. The purpose of the guidance is
to provide a straightforward explanation of the registration
process, to help providers determine whether they are
compliant with the CQC’s essential standards, and to explain
what will happen once providers are registered. Cleveland
LMC will be holding a CQC event early July for all practices
in Tees to assist you with your registration questions. We
recommend all practices have 1 representative attend this
event and will publish full details on the website ASAP.
Smoking
Indicators in QOF Business Rules
Further to our bulletin on 1 May, where we explained that
the two code clusters PHARM_COD and REFERSSSA_COD would be
merged, it has now been decided that the business rules for
indicators Smoking 6 and Smoking 8 will look for a record of
support or treatment, i.e. a suitable code from either the
REFERSSA_COD OR the PHARM_COD clusters. The reason for this
is in order to get this changed for the April READ code
release, rather than having to wait until October. The
intent of the indicator is for patients to be offered
‘support and treatment’ whether this means a referral to a
smoking cessation service, drug treatment or follow up
appointments with the practice (GP/nurse etc.) and not for a
patient to accept ‘support and treatment’. If a patient
declines support and/or treatment, then suitable codes have
been included in the relevant clusters to accommodate this.
This query will be added to the QOF FAQs currently being
updated, due to be re-published this summer.
Bulletin 144
08.05.12
Patient
Registration, LMC Guidance
We
often receive questions with regard to the rules and
regulations around registering (or not) new patients. This
is increasingly becoming an issue in some areas where there
may be an influx of patients within practices. Please take
time to read this
LMC guidance
to ensure you are aware of the
current regulations - the guidance also includes the recent
changes to the legislation around patient registration and
closed lists.
Seasonal Flu Plan 2012
The
annual seasonal flu plan letter
from the
England
Chief Medical Officer, along with the
2012/13 flu plan have
been published on the Department of Health website.
As
in 2011, the plan for 2012 includes an ambition to
significantly increase uptake among under 65 patients with
an underlying clinical condition, as well as to push for a
higher uptake among pregnant women and health care workers.
Annexe B of the
letter
includes a 10 point good practice checklist
commissioned to help GP practices ensure high uptake of flu
vaccinations locally. For ordering flu vaccines, the system
remains the same as last year with GPs responsible for
ordering adequate stock for all eligible patients,
recognising the increase in size of the target population.
Bulletin 143
01.05.12
Nurses and Pharmacist Independent Prescribing of Controlled
Drugs
Government agreed changes to the Misuse of Drugs Regulations
2001 mean that nurses and pharmacists registered as
independent prescribers will be able to prescribe controlled
drugs where it is clinically appropriate and within their
professional competence. They will also be able to mix a
controlled drug with another medicine for patients who need
drugs intravenously, as well as supply or administer
morphine and diamorphine under Patient Group Directions (PGDs),
for urgent treatment of very sick or critically injured
groups of patients. Further details on the update to the
Misuse of Drugs Regulations 2001 relating to nurse and
pharmacist independent prescribing of controlled drugs
(Misuse of Drugs (Amendment No.2) (England, Wales and
Scotland) Regulations 2012 (Statutory Instrument 2012/973)),
which came into force on 23 April 2012 are available on the
DH website
Smoking Indicators in QOF Business Rules
There is an error in the current business rules (v22)
regarding the QOF indicators Smoking6 and Smoking8. The
business rules currently state that there has to be a
referral date AND a delivery of pharmacological agent date
for a patient to belong to the numerator (i.e. a code is
needed both from the REFERSSA codeset AND a code from the
PHARM dataset). NICE have confirmed that the intention of
the indicator is to get practices to offer support and
treatment (with the emphasis on ‘offer’ not the patient
‘accepting’ ) and have agreed to merge the two code clusters
for PHARM_COD and REFERSSSA_COD, which means only one code
will be required to cover both 'referral and treatment'.
This will be changed in the April READ code release.
RCN Guidance
Following the changes the RCN made to their members’
indemnity scheme, GPC has produced this
guidance for practices to ensure all staff are suitably
covered for the roles that they perform.
Direct Access to Diagnostic Tools for Cancer
The Department for Health has published Direct Access to
Diagnostic Tools for Cancer: Best Practice Referral Pathways
for GPs guidance
here.
Changes to Practice Boundaries
Permanent changes to practice boundary arrangements and the
relaxing of the closed list regulations come into place at
the end of April. We are awaiting the new Regulations but,
in the mean time, please take time to re-read the GPC
guidance linked to Bulletin 140 on this bulletin page.
Secondary guidance is available
here
European Funding
Opportunities
The BMA Brussels office have produced a
European funding guide which provides an overview of the
European funds that offer grants for health-related
projects.
Bulletin 142
23.04.12
Fair Commissioning Charter
The GPC carried a motion that stated that the GPC would encourage any clinical commissioning group (CCG) which wishes to sign a Fair Commissioning Charter that includes that the CCG will:
CCG Constitutions
As CCGs focus attention on authorisation, many are drawing up constitutions. The existing GPC constitution guidance outlines key elements of a constitution that GPs should check are included. It is vital that the CCG constitution has the support of member practices and that the constitution outlines how the CCG will engage with the LMC.
GPC / BMA Law have always advocated that any CCG constitution should be clear, robust and comprehensible. Although the NHS Constitution is helpful, it is not really a template constitution, it is more along the lines of detailed guidance. Huge sections of the Department of Health (DH) document are devoted to quotes and references to the Health and Social Care Act, which is confusing and unnecessarily burdensome in the context of a comprehensible template. This makes it unduly difficult to convert into a working practical document. Furthermore, the DH Constitution states that it has yet to be approved by lawyers. BMA Law has a template constitution in place which is being updated in line with both the Act and in respect of any agreed policy and guidance (whether current or future). This is accompanied by a detailed seminar which addresses all salient issues such as conflict of interest, procurement, engagement of consultants, internal governance, application for membership of the CCG etc. This includes advice on how to handle these issues in a practical way and how to keep good audit trails. If you would like more details please call Diane Smith on 020 7383 6019 or email at
info.bmalaw@bma.org.uk.
Enhanced GP Training
The RCGP's educational proposal for extending the GP training programme to four years was approved by the Medical Programme Board on April 18. This follows an agreement between the RCGP, COGPED, COPMED and GPC on a set of principles for the implementation of the enhanced programme. An agreement will be required between the aforementioned organisations as to how the implementation will work in practice, and the proposal remains subject to confirmation by Medical Education England on 26 June.
Supply of Non-Compliant Nutritional Products
The Department of Health Advisory Committee on Borderline Substances (ACBS), which is responsible for advising on the prescribing of certain foodstuffs and toiletries, has produced this guidance note on the supply of non-compliant nutritional products which highlights the problem of clinical errors created due to non-compliant stock entering the medical supply chain. Non-compliance can include instances where nutritional products have different formulations, are incorrectly labelled, or where there is incorrect information provision.
Cancer Awareness Campaign
This letter provides and overview of the national and local cancer awareness raising campaigns.
Bulletin 141
17.04.12
Anticipatory Prescribing for End of Life Care
The GPC Clinical and Prescribing subcommittee
has published this
guidance to clarify issues on anticipatory
prescribing for end of life care. It includes an example of
a drugs administration document used for 'Just in Case'
boxes.
Prescription Charges
As you will be aware, from 1 April 2012, the
prescription charges in England increased from £7.40 to
£7.65. The BMA has repeated the call for prescription
charges to be scrapped in England in line with the policy in
the devolved countries. PCTs were informed via this
letter from the Department of Health.
Business Continuity Plans
With an imminent fuel strike expected we
would like to remind all practice of the need to ensure they
have an up to date business continuity plan and give thought
to how a fuel strike could impact on daily work e.g. home
visits, difficulty for staff attending work. It may be worth
dusting off buddying arrangements that were put in place for
flu.
Change to Community Pharmacy New Medicine Service
Payment Structure
NHS Employers and the Pharmaceutical Services
Negotiating Committee (PSNC) have agreed changes to the
community pharmacy new medicine service payment structure
and have published this briefing
document to explain these changes. It is hoped that
the changes will fairly reward contractors and encourage
them to deliver the service to the greatest number of
patients. Further information is available here.
Interim Seniority
Factors
Interim Seniority Factors for 2012/13 have
been published as £96,646 for GMS GPs in England. Further
details and an explanation of the methodology are available
on the NHS Information Centre's
website.
What We Know So
Far - NHS Reforms
Follow this
series of new briefing papers and be informed on
'what we know so far' on a range of key topics related to
the Government's health reforms, and where questions remain
unanswered. The titles in the series are:
Numbers 1 and 2 are new, and the rest have been updated to reflect any changes made in the last stages of the Bill becoming an Act. Each briefing has an accompanying 2-side executive summary.
Bulletin 140
05.04.12
Changes to Practice Boundaries
Cervical Screening Training Update
sample takers need to be fully competent and appropriately trained in sample taking and cognisant of the latest developments;
the GMS contract places a responsibility on practices both as providers and employers to be satisfied this is the case;
the NHS Cervical Screening Programme supports practices both as a provider and employer through its training and update programme;
individual training needs will differ between practices and between health professionals and clinical governance systems should be in place to identify the training needs of all clinicians involved in the screening programme (nurses and GPs).
We would also recommend that practices familiarise themselves with the primary care guideline on unusual bleeding in young women.
BMA Guidance on Firearms Licensing
NICE Infection Control Guidelines
Reminder, Changes to HPV Vaccinations
GPC Message, CCG Constitutions
Bulletin 139
27.03.2012
Vitamin D Supplements for At-Risk Groups
UK Chief Medical Officers have provided this response/advice following concerned raised by the GPC with regard to the implications of advice issued on Vitamin D supplements .
Practice Leases and Service Charges
It is important that practices have a lease for the premises from which they operate rather than a licence to occupy. We understand the PCT is working through the lease arrangements and you can request a copy of your lease if you require it to check details. If you have any lease arrangement or abatement of service charges/facilities management issues please contact the LMC.
Ethnicity and First Language Recording Guidance Updated
The Ethnicity and first language recording guidance has been updated to include extended classifications to the list of NHS Data Dictionary codes for ethnic origin, which are based on a more comprehensive ONS 2001 census list, available within the Read Codes. Note that although practices may wish to continue to record their patients’ first language and ethnicity as a matter of routine in order to assess the needs of their population, this is a practice choice as there is no longer any contractual requirement to do so.
GPC Annual Report
This year's GPC Annual Report has now been published.
GP Trainees Subcommittee Newsletter
The March 2012 edition of the GP Trainees Subcommittee Newsletter is has now been published. The GP Trainees Subcommittee is a subcommittee of the BMA's General Practitioners Committee and provides national representation for all doctors in GP training, whether they are members of the BMA or not. The subcommittee meet four times a year and will be producing a quarterly newsletter covering matters of interest to doctors in GP training. The newsletter is intended as a useful resource covering education, training, contracts, terms & conditions of service and any other issues of importance to trainees, as well as information on getting involved with the subcommittee.
Bulletin 138
20.03.2012 Property / Lease / Landlord and Tenant Issues Dispute Resolution and Litigation matters including Defamation Family Law (Divorce, Co-habitation, Residency Applications and Pre-Nuptial Agreements) Corporate, Banking, Finance and Commercial matters in so far as they fall outside of BMA Law's remit These services can only be accessed via BMA Law
(info.bmalaw@bma.org.uk or 020 7383 6976) and Gateley will not accept instructions from members direct under this scheme.
BMA Message - BMA worried and saddened by the passing of the Health and Social Care Bill
You cannot have failed to notice that, despite last minute attempts to stall and derail the legislation, the Health and Social Care Bill completed its final debates in Parliament this week. Hamish Meldrum (Chairman of Council) wrote to all members outlining all the BMA’s key issues and next steps. We will continue working hard to minimise the risks of this dangerous legislation as we move in to the implementation phase. If you have any questions or concerns about the legislation or development of CCGs, please
info.commissioning@bma.org.uk.
Laurence Buckman
Chairman, General Practitioners Committee
BMA Law/Solicitors
BMA Law have an arrangement in place with Gateley's Solicitors to offer preferential rates to members for the following services:
Bulletin 137
13.03.2012
Pension Update
This brief summary will help ensure you are up to date on this important issue:
• Roadshow dates have been published, mass-emailed to members, and publicised on the front page of BMA News. Details are also on our Diary Dates page.
• The e-petition now has almost 28,000 signatories
• A timeline has been added to the BMA pensions web-pages to show the history and background of the changes and associated BMA activity
• A new "mythbuster" is being published on the BMA website shortly
• The government has published its 'Proposed Final Agreement' on the pension changes - a response has been prepared and is being published shortly on the BMA website
• Detailed planning for the next phase of activity is underway
QOF Guidance 12/13
This QOF guidance for 2012/13 has been produced jointly by GPC and NHS Employers and forms part of the GMS contract changes for 2012-13 as from 1 April 2012. Further information on QOF is available here.
Talking Health
In the run up to the UK Council elections, the BMA are launching a new microsite, Talking Health, aimed at encouraging doctors and medical students to get more involved in shaping the work of the BMA. Talking Health will enable members and non-members to give views on the key challenges facing them in their everyday working lives. It will also provide further information about the upcoming BMA UK Council elections including, from Monday 19 March, details of the candidates. Please feel free to leave comments in the areas that you are interested in, and to forward the site to your colleagues. If you are on twitter then use the #tlkhealth hashtag to join the debate.
CQC Reminder
We are aware that some private organisations are approaching practices and so we would, once again, like to draw your attention to this joint statement issued by CQC and the BMA: There is no need for practices to purchase expensive software or consultancy services in order to register with the CQC. Most practices delivering good quality care will already be meeting the majority, if not all, of the essential standards.
Final Seniority Payments 08/09
The Final Seniority Factors for GMS GPs in England and Wales for 2008/09 have been published by the NHS Information Centre. The figures are £92,955 for England.
GP Health
We would like to remind practices of the GP Health service that is available to all GPs, practice managers and practice staff in Tees. GP Health is a free and confidential health and wellbeing service, offering counselling, mentoring and psychiatric help to GPs, dentists, practice managers, nurses and practice staff in the Tees Valley Area. Further details are available here.
Bulletin 136
06.03.2012 All new Information and Communication Technology (ICT) contracts over the value of £10,000 to be published in full online from July 2010. All new tender documents for contracts over £10,000 to be published on a single website from September 2010, with this information to be made available to the public free of charge. New items of spending over £25,000 to be published online from November 2010. All new contracts to be published in full from January 2011. The Cabinet Office published this guidance on publication of new contracts, which applies to all NHS bodies. See section 2.16 on Contract Extensions (for renewal of contracts) and 2.17 on Re-tendering a contract (for new contracts). Advertisement of the requirement (e.g. Prior Indicative Notice, OJEU notice) Estimated procurement timescales Pre-Qualification Questionnaire (PQQ) Invitation to Tender (ITT) – includes requirement and Terms and conditions.
Continuity in a Changing World; 100 years of GP Representation
In the ever changing NHS landscape we often cite how the LMC is one of the few, if not the only, local organisation with a long memory. Faces have changed but the knowledge is passed on and continues to be available to assist local GPs in representing their interests in a local, regional and national forum. LMC, along with the BMA, have just celebrated their 100th birthday. Continuity in a Changing World; 100 Years of GP Representative Bodies reflects on the last century and GPC Chairman, Laurence Buckman recently wrote this letter to all GPs marking the celebrations with views on representation in the current NHS.
Commissioning Outcomes Framework
The BMA has submitted a response to the NICE consultation on the proposed Commissioning Outcomes Framework stressing the need to ensure that outcome measures are achievable and within the influence of CCGs, and that CCGs and practices are not overburdened with bureaucracy. It is proposed that the Commissioning Outcomes Framework (COF) will be used by the NHS Commissioning Board (NHSCB) to measure the performance of CCGs in relation to the NHS Outcomes Framework. Indicators will be developed from NICE quality standards, the NHS Outcomes Framework and existing indicator collections.
The BMA have also restated their opposition to proposals for a 'quality reward' for commissioning. It is vital that CCGs are fully resourced from the outset in order to commission effectively and any financial incentive for commissioning raises serious ethical concerns about the doctor-patient relationship and risks cultivating compliance with central direction, as opposed to promoting a locally-focussed and truly clinician-led commissioning system.
QOF Version 22 Business Rules and Quality & Productivity Guidance
The GPC and NHS Employers have published this joint supplementary guidance and FAQs for the 2012-2013 QOF quality and productivity (QP) indicators which is intended to assist practices and primary care organisations (PCOs) in understanding and working through the new QP indicators. Version 22 of the business rules, which supports QOF 2012-13, has also been published. The Average Contract Register Population (CRP) value has been updated on QMAS from 5891 to 6775 (in England). The 6775 figure was calculated using the list sizes from Exeter as at 1 January 2012. The updated figure will now be used going forwards in all additional services calculations. The change went in on 18 February 2012 and will result in an increase in achievement for all practices in the additional services domain.
CQC Guidance
The CQC has published its new Overview of Registration guidance, providing general information about how the registration process will work.
Website Cookies - Important Practice Information
If your practice website uses cookies you may need to be aware of recent changes to the law, outlined in guidance from the Information Commissioners Office. Cookies are small files of letters and numbers downloaded to a user’s computer when they access certain websites. They allow a website to recognise the user’s device. The previous rules on cookies said that websites had to inform users how they use cookies and that they could ‘opt out’ if they wished. Most websites did this through their privacy policies. In 2011 the laws on cookies were extended. Cookies can now only be placed on machines where the user or subscriber has given their consent, although this does not apply to cookies that are ‘strictly necessary’ for a service requested by a user. An example of a ‘strictly necessary’ cookie would be when a user chooses goods they wish to buy from a website, clicks ‘add to basket’ and then proceeds to the next page - the site ‘remembers’ what they chose on a previous page using a cookie. User consent would not be needed for this type of cookie.
The ICO does not produce a definitive list of ‘strictly necessary’ cookies. In the context of GP practice websites, cookies might be used to allow users to request a repeat prescription, or book appointments. If the cookie is strictly necessary for the service requested by the user, then explicit user consent is not required. Other cookies, such as those used to collect statistical information on usage of the site, are not strictly necessary and user consent is needed. Each organisation has to decide whether user consent is needed for each cookie they use. We recommend that practices read the ICO guidance, which includes practical advice on types of cookies and how to comply with the regulations.
Transparency Agenda
In May 2010 the Government made commitments as part of a ‘Transparency Agenda’ which came into force from November 2010 stating that all new contracts agreed by NHS bodies should be published. The BMA have received confirmation from DH Procurement, Investment and Commercial Division that this applies to private sector providers and will include all contracts for goods and services. If the contractor wishes to state that something is commercially sensitive that they do not want to publish as part of the contract this could be communicated to the authority in a separate letter. However, any commercially sensitive information is subject to the Freedom of Information Act as is the rest of the contract.
The Transparency Agenda additionally made the following commitments which are now reflected in the NHS procurement policy:
The guidance states that departments are recommended to publish, where relevant, the following, or the nearest equivalent, as a minimum:
Bulletin 135
28.02.2012
Clinical DES Guidance 2012/13
Cervical Cytology Good Practice
Important Reminder - Nurse Registration
This Clinical DES Guidance outlines the requirements for 12/13 including details on the alcohol and learning disabilities DESs which will continue until 31 March 2013 and the osteoporosis DES will no longer be available from 1 April 2012.
Commissioning - Key Questions for ALL GPs to Consider and Key Issues for CCGs
This summary briefly outlines the key issues for CCGs and all GPs to consider as clinical commissioning groups develop and seek authorisation. Additionally, to help empower GPs the GPC has produced these key questions and urges you to ask these questions of your CCG and LMC. GPC Chairman, Dr Laurence Buckman, has circulated this message:
Dear colleagues,
The Health and Social Care Bill purports to develop a commissioning structure that is clinician-led and locally focussed. This aspiration is looking ever more difficult to achieve due to the increasingly complex and confused legislation and the rushed implementation of the reforms.
If the Bill becomes an Act, GPs and practices will be the constituent bodies of clinical commissioning groups (CCGs), and will play an important role in holding them to account. The General Practitioners Committee (GPC) is concerned that due to the fast pace of developments, many GPs are not aware of the decisions being made on their behalf, or which will impact on them and their practice in the future.
To help empower GPs and practices we would urge you to ask these questions of your CCG and local medical committee (LMC).
Yours sincerely
Dr Laurence Buckman
Chairman, BMA General Practitioners Committee
Following the recent letter from Barbara Hakin regarding mandatory cervical cytology training, we would still advise practices to make sure that anyone conducting smears are cognisant of the latest guidance on good practice e.g. the need for the cervix to be visualised for a smear .
084 Telephone Numbers Compliance with Regulations
DH has published this further guidance on the use of 084 numbers in the NHS. For clarity, the DH position has not changed and the regulations remain the same. Consequently, the legal advice the GPC has obtained also remains the same. The issue revolves around the word 'reasonable' within the regulations. All the suggestions about termination or varying the terms of the contract are always going to be based on 'reasonable steps'. Any practice would have a very strong arguable case to say that, albeit all 'reasonable steps' had been taken to try and cancel the contract or vary it, to do so would mean the practice would be subject to a financial penalty. The regulations do not say the practice must cancel or vary the existing contract. If this were to be the case, 'reasonable steps' would be replaced with 'best endeavours'. Subsequently, it would not be possible to argue that the acceptance of a financial penalty is reasonable. If practices ensure they have correspondence from their telephony provider on record stating that they will be financially penalised if they vary or cancel the contract, this should be enough to satisfy that 'reasonable steps' had been taken. All practices will be expected to become fully compliant with regulations once their existing contracts are up for renewal or they wish to contract with a different provider. At this point, practices will be expected to ensure they contract with a provider who is compliant with regulations. Practices are advised to obtain a copy of the statement of compliance with NHS regulations from their telephony provider when entering into new or renewing contract arrangements.
CQC Registration - Joint GPC/CQC Statement
The GPC and CQC have agreed the following statement about CQC registration:
Under the Health and Social Care Act 2008, all providers of primary medical services will be required to be registered with the CQC by 1 April 2013. The process leading to registration will begin in July 2012. As part of registration, practices will have to tell the Care Quality Commission (CQC) whether they are meeting the essential standards of quality and safety, which are derived from regulations governing the CQC's work.
The essential standards are based on legislation and cannot be altered. However, the British Medical Association’s General Practitioners Committee (GPC) and CQC are currently discussing how the standards will apply to primary care providers. Work carried out by the CQC, during the delay to the registration of most providers of primary care, has focused on the need to be proportionate and appropriate, reducing bureaucracy to a minimum. The CQC and the GPC have been working together to achieve this and to ensure that the registration requirements are understood across the primary care sector.
To that end, the CQC is working with stakeholders to improve the logistics of its registration process. This is partly taking place through the CQC's Stakeholder Advisory Group, on which the GPC is represented.
Discussions are also taking place between the CQC and GPC about how compliance will be demonstrated and monitored following registration. The CQC is working to ensure that the compliance monitoring process is proportionate and appropriate. As part of this, the CQC will be carrying out a pilot in the summer, to test how its model of compliance monitoring will work in primary care.
There is no need for practices to purchase expensive software or consultancy services in order to register with the CQC. Most practices delivering good quality care will already be meeting the majority, if not all, of the essential standards.
The GPC and CQC will continue to issue updates in the coming months, including further detailed guidance on registration.
We would like to remind you of the importance of ensuring sure periodic checks of registrations take place as we have been made aware of a small number of cases where qualified nurses failed to keep up their registration. It is an offence to work as a nurse without the required registration in place and practices will have to deal with any consequences should this occur. The NMC website has 2 separate means of checking registration, a simple pin number check that is open to the public and an employers check. It is important that practices register as employers and undertake the enhanced employers check as this gives additional information including the employment history of the nurse.
Locum Payment Form Error
We have been made aware of an error in the letter to locums provided by NEFHSA with regard to payments. This error has been highlighted to NEFHSA to be rectified. The letter states "Each month you should send to me the completed forms and a cheque made out to the PCT of whom you are listed with on the Medical performers List. They should reach me no later than 7 days into the following month after the month the work relates to, i.e. forms for work done in April should reach me no later than 7th May". To avoid any confusion, the rules have not changed and the correct rules are that the money should reach the pensions dept no later than 7 days into the following month after the month in which the payment is received.
NHS 111
This document clarifies the GPC view, supportive but with implementation/procurement concerns, with regard to NHS 111. The GPC supports the principle of developing an easily accessible national telephone number for patients who have urgent health problems, as proposed by the new NHS 111 system which has recently been piloted but are extremely concerned that the new NHS 111 service is being rolled out without full, truly independent and thorough evaluation of pilots and without adequate input from local clinicians. A comprehensive NHS 111 service is currently expected from April 2013. The GPC has written to the Secretary of State for Health, calling on the Government to slow procurement of NHS 111 services to allow for proper evaluation of the pilots, and to adopt a flexible deadline for full implementation of the service to ensure that fledgling clinical commissioning groups can become fully established and ready to drive local procurement decisions at a pace that will ensure that the right decisions are reached.
Bulletin 134
21.02.2012
Revalidation
It is currently expected that, subject to an assessment in
the Summer, the revalidation legislation will be enabled in
December and doctors will start to undergo the revalidation
process from early 2013. PCTs should, therefore, not be
implementing new appraisal frameworks on this basis. We
will notify you once we are aware when new appraisal
processes may commence but, until this time, please notify
the LMC if you experience any changes to your appraisal
under the guise of the planned introduction of revalidation.
Guidance on
Commissioning Support
The GPC have produced this
Commissioning Support Guidance that you may find
helpful.
Bulletin 133
14.02.12
084 Telephone Numbers
The GPC understands that a nationally coordinated initiative has recently begun by PCTs to remind practices that they must take 'reasonable steps' when reviewing arrangements for the use of 084 telephone numbers, as defined by the Directions to NHS bodies concerning the cost of telephone calls 2009 in paragraph 2(3b), to ensure that the cost of calls made by patients is kept to a minimum.
There are now very few practices in Tees who have an 084 number and, we understand, all those who do have reviewed their arrangements and are operating within the Directions. However, we would like to remind you that GPC's legal advice on this matter is that practices should take 'reasonable steps', but this does not mean practices should break existing agreements with telephony service providers that will incur financial penalties. When the time comes for new agreements to be made with telephony service providers, all practices will be expected to adhere to the regulations in full. For those practices who remain in existing agreements, they should still take all 'reasonable steps' as far as is possible, but they are not expected to incur financial penalties as a consequence.
Practice Lease Arrangements
Following the implementation of the Department of health's Stocktake and Stabilise Project, an auditing initiative designed to ensure PCT documentation is in order prior to handing over responsibilities to the NCB and CCGs, it has come to the GPC's attention that, in many cases, practices do not have premises leases but licences to occupy. These licences carry fewer liabilities, but are weaker to defend legally and some PCTs will be asking practices to sign formal leases. Cleveland LMC has discussed this with Tees PCTs who are working through the process but do not currently envisage any problems for Tees practices as it seems that Tees leases have succession arrangements already so we only anticipate a change in landlord details. We will maintain dialogue with the PCT on this and if the picture changes we will keep you informed but if, in the meantime, you are approached with a new formal lease you are advised to contact the LMC in the first instance and not to sign leases until you have sought legal advice as they may make you responsible for any unnecessary liabilities.
Updated Medicines Section Patient Liaison Group Patient Resource
The BMA's Patient Liaison Group (PLG) has updated its ‘Working together for better health' patient resource to provide more detailed information on medicine waste. The resource features practical tips for patients on how to avoid wasting medicine, together with details of how to dispose of unwanted medicine safely.
Bulletin 132
31.01.12
Commissioning News
This week the Government published more information about the development of CCGs, including final guidance relating to the authorisation of CCGs and proposals for commissioning support. Although timescales are tight, it is important that GPs and CCGs do not make decisions about their structure or support until they are ready - these decisions need to be well thought through and have the support of local practices, GPs and LMCs. This BMA Guidance highlights key issues to consider as CCGs enter into the authorisation process, such as the role of LMCs and appointment and elections to CCGs.
Medicine Reconciliation
NHS Employers have produced a film about medicines reconciliation which may be of some interest to GP practices. This film aims to highlight the role each sector plays in medicines reconciliation, particularly hospital pharmacy and goes through the medicines pathway from a patient's point of view, demonstrating that both hospital and community pharmacists can work together to improve patients' understanding of their medicines. The film builds upon this guidance published by NHS Employers and the Pharmaceutical Services Negotiating Committee (PSNC) for hospital colleagues and community pharmacists to help the transfer of care between settings.
BMA Research Grant
The BMA was among the first of the professional bodies to award grants and prizes to encourage and further medical research. Today, around ten research grants are administered under the auspices of the Board of Science, all funded by legacies left to the BMA. Grants totalling approximately £500,000 are awarded annually. Applications are invited from medical practitioners and/or research scientists and are for either research in progress or prospective research. Information and application details for the 2012 research grants are now available here. The application deadline is 16 March 2012 at 5pm. Subject specifications for each grant vary. For example, in 2012, research areas range from rheumatism and arthritis, cardiovascular disease and cancer to the uptake of preventative measures and the use of information and communication technologies in medicine. If you have any questions about the BMA research grants, or would like to receive alerts about them, please contact Chris Wood at
info.sciencegrants@bma.org.uk or telephone 020 7383 6755.
Bulletin 131
24.01.12
Commissioning News
The GPC discussed recent developments affecting Clinical
Commissioning Groups (CCGs), in particular the need to CCGs
to develop clear and comprehensive constitutions. It was
strongly reiterated that local medical committee (LMC)
involvement and engagement would be imperative to the
success of successful clinical commissioning. The
authorisation process will require CCGs to demonstrate that
they have good relationships and engagement with member
practices and local GPs (principal and sessional). CCGs will
be accountable to member practices for the decisions that
the CCG takes on their behalf. LMCs, as statutory
representatives of the profession, should work with their
CCGs to ensure that the local profession is consulted in the
development of their CCG. The GPC has published this
guidance which highlights essential elements that should
be included in a CCG constitution. Further to the recent
messages, the GPC have been pleased to hear examples of GPs
feeling empowered to resist pressure locally for their CCG
to reach rapid and unacceptable agreement on commissioning
support or CCGs ‘clustering’. They hope other GPs will take
heart from this and feel similarly empowered to resist such
pressure.
Remediation/Revalidation
The DH steering group on remediation has published this
report
which sets out the
following recommendations:
performance problems, including clinical competence and capability issues, should normally be managed locally wherever possible;
local processes need to be strengthened to avoid performance problems whenever possible, and to reduce their severity at the point of identification;
the capacity of staff within organisations to deal with performance concerns needs to be increased with access to necessary external expertise as required;
a single organisation is required to advise and, when necessary, to co-ordinate the remediation process and case management so as to improve consistency across the service;
the medical royal colleges should produce guidance and also provide assessment and specialist input into remediation programmes;
postgraduate deaneries and all those involved in training and assessment need to assure their assessment processes so that any problems arising during training are fully addressed.
Although the issue of funding fell outwith the remit of the group, a range of options were developed on the assumption that there was unlikely to be any additional money in the system. The BMA’s view is that remediation must be fully funded to ensure equality across the different branches of practice, and they will continue to lobby the Department of Health for this to occur.
Extending GP Training
GP trainees and trainers may recently have seen a document
produced by the Committee of General Practice Education
Directors (COGPED) outlining proposals for extending GP
training to four years. The GPC is urgently seeking to
discuss this with the relevant parties to establish a
suitable way forward as the GPC does not believe that these
proposals are sufficiently focused on educational benefit
for GP trainees, nor do they outline a suitable
implementation process, particularly sufficient funding.
NHS 111
The GPC has concerns that the new NHS 111 service has not
been properly piloted or evaluated and shadow CCGs are
already being asked to make procurement decisions, despite
the fact they have not been properly established themselves.
Procurement decisions are also being driven at excessive
speed and influenced by the Stocktake, Stabilise and Shift
project that PCTs have been asked to undertake in
preparation for the handover to CCGs. It appears that the
exercise may be being used to bring forward reviews of or
renegotiate existing out of hours provider contracts. There
is a serious risk of a potentially costly, ill-conceived and
unalterable urgent, emergency and unscheduled care solution
being imposed upon / inherited by CCGs, with consequent
detriment to GPs and their practices. GPC representatives
are taking forward these concerns with those responsible for
the project.
Sessional GPs Newsletter
The Sessional GPs newsletter draws together information
about new and ongoing issues affecting sessional GPs and
this issue covers pensions reform, NHS reforms update,
guidance on setting up and developing sessional GP groups,
locum agreement guidance, devolved administration updates,
information cascades, revalidation, retainer and returned
schemes and sessional GP conferences. We encourage members
to forward this newsletter to any locum and salaried GP
colleagues.
Bulletin 130
17.01.12
Dealing with Complaints or Investigations Advice
Cleveland LMC represents and assists all GPs in Tees -
irrespective of employment status and contract type. We
always recommend that you contact us as soon as possible if
you have any questions or find yourself in circumstances
where support could be beneficial. The LMC can particularly
provide assistance with regard to any performance issues if
you are contacted by NEPCSA/PCT.
This letter was drafted to assist you at, what could be
a difficult time, and remind you of the support that is
available when you need it most. Please remember to contact
us as soon as possible for confidential support however
trivial the issue may appear.
Commissioning News
It is important that ALL GPs are aware of key
developments in GP Commissioning. GPC would like to
highlight that the NHS reforms in England are moving at
breakneck speed and in different directions depending on
where you live. The decisions being made now (about
democratic processes in CCGs, constitutions of CCGs,
appointments and plenty besides) are crucial for many
reasons, not least in determining whether in future, the
local profession will be able to hold their CCG to account.
If you feel concerned about any commissioning
developments in your area or need advice, then you should
get in touch with the LMC. The BMA have also published
this commissioning update which includes the latest on
the Health and Social Care Bill and how the reforms are
impacting on the ground. This issue focuses on the
Authorisation Process for Clinical Commissioning Groups.
Eric Gambrill
Travelling Fellowships
The Eric Gambrill Memorial Fund is seeking applications
for up to two Travelling Fellowships, to be awarded in
Spring 2012. The value of each Award is £3,000.Those
eligible for the Award will be fully trained and practising
UK general medical practitioners. In recognition of Dr. Eric
Gambrill’s interest in general practice, education and
travel, the successful applicants will be expected to
undertake a study or project as part of his/her professional
career development.
For more information, see the
Fund’s website.
Bulletin 129
10.01.12
How to Set Up
a Sessional GP Group
This guidance aims to share some of the models of good
practice, and successful ideas and raise awareness about
pitfalls of Sessional GPs groups which have been recognised
as providing invaluable peer support for sessional GPs.
Models differ but there are some common themes and
challenges with groups offering a range of services and
benefits, including educational and social meetings,
electronic mailings systems for vacancies and educational
events. Sessional GPs may experience professional isolation
and reduced access to education, clinical information and
career opportunities. Newly qualified GPs and GPs new to an
area are particularly vulnerable to this. Whilst newly
qualified GPs now have access to a range of 'First5'
initiatives, sessional GP groups have the advantage of
putting younger GPs in contact with more experienced GPs.
Cervical Cytology Training
Further to our update in our last bulletin we would like
to clarify that the principles (of there being no
contractual requirement for update cervical cytology
training) outlined in the letter extend not only to GPs but
to others employed by practices to carry out the services
including practice nurses.
Injury Benefits Review
The outcome of an NHS review of its injury benefits
scheme, which currently provides benefits to GPs who suffer
injuries and a resultant loss of earnings as part of their
employment , is that the current Injury Benefit Regulations
are to be replaced by contractual provision held within a
new section of the Agenda for Change (A4C) Terms and
Conditions Handbook. Future injury benefit provision would
be limited to the period of the employment contract only.
GPC's legal advice on this matter is that GPs should
consider getting their own injury benefits insurance.
Full details of what is covered as part of the benefits can
be found
here
Retainer Scheme
Despite a decrease in the number of participants in
recent years, the retainer scheme remains a good option for
those GPs who, for a variety of reasons, such as family
commitments, need to undertake a reduced number of hours. It
allows GPs to retain their skills and keep in touch with
general practice. GPs who are interested in the scheme
should contact their Deanery.
Blue Badge Scheme
Please be aware that under the new Blue Badge Scheme
payment for the completion of any factual evidence provided
by a GP to support an application should be paid by, and
requested by, the LA under a collaborative arrangement. If a
patient approaches you directly on LA advice you should
direct them back to the LA. Please contact the LMC if you
patients contact you directly.
Revised
Focus on Travel Immunisations
The BMA have published this revised
Focus on Travel Immunisations guidance following some
minor amendments to the document printed last year.
Business Insurance
Reminder
Practices are reminded to ensure that all staff who use
their own transport for business purposes (to travel to and
from branch surgeries, patient homes, care homes etc) are
covered for business use on their personal/private motor
insurance.