Updated FAQs,
14/15 Contract
The GPC
FAQs have now been updated to include some questions in relation to funding.
PMS Letter
NHS England has sent this
letter
to its Area Teams, confirming arrangements for the uplift for PMS practices
relating to locum employer superannuation costs, which for those practices who
have not already received it will need to be backdated to April 2013. This
confirmation comes after a long period of lobbying from the GPC for this issue
to be resolved. If you have not received this uplift, now this letter has been
circulated, please email
Janice.foster@tees.nhs,uk. The letter also refers to announcing wider steps
on PMS in around a month's time, linked to applying equitable funding to PMS
practices. Again, the have been pushing for some time for a resolution to this
issue, in order to provide more certainty to practices about their funding in
the coming years. We will provide more information about this when it is
available.
Reconciling
GP Payments Guidance
NHS England has
been working closely with stakeholders, including GPC, to tackle the issue of
some GP practices experiencing difficulties receiving and reconciling payments.
To help practices on payments, NHS England has published a new NHAIS Statement &
NHS Shared Business Services Remittance Guide document, to highlight the
improvements made to practice statements generated by the National Health
Application and Infrastructure Services (NHAIS) system. The guidance is
available on Health and Social Care Information Centre (HSCIC)
website, but is only accessible to those on the NHS web.
Care.data,
Important Information
In January
2014, every household in England will receive a leaflet from NHS England which
will support practices with their public awareness raising activities. The
leaflet will describe how information in medical records is used for purposes
beyond the direct care of the patient, including the care.data programme. It is
important that GP practices continue to raise awareness proactively with their
patients about the ways in which patient information is used and shared beyond
direct care. The content of the leaflet being sent to households is very similar
to the leaflets provided to
practices in September 2013 and will include the telephone number of a dedicated
patient information line that will come into operation on 6 January. The BMA and
patient representatives have been involved in the wording of both leaflets.
GPs will receive an email communication shortly before the household leaflet
drop. This will include a link to the leaflet and updated GP and patient FAQs.
Once the leaflet has been delivered to households, patients will have a minimum
of four weeks to read the leaflet and register their objection at the GP
practice, if they wish to do so before the first extract begins. Extractions of
GP data for care.data will begin in Spring 2014. We will keep you informed of
developments. Background information and existing guidance are available
here.
CQRS, Latest
Bulletin
This latest
CQRS bulletin was sent out to subscribers this week. The bulletin provides
updates and information on the manual data entry for the Enhanced Services, QOF
2013/14 and preparation for year-end, reports available on CQRS and GPES
awareness sessions. Following the simple guidance I provided, if you are still
having problems with CQRS, be it the manual data entry or awaiting approval from
the Area Team, please do email
Janice.foster@tees.nhs.uk and I will do my best to assist.
NHS England
Audit of 084 Numbers
Area Teams were recently instructed to carry out audits of practice telephony
arrangements by NHS England. This is to determine the scale of continuing
non-compliance with
regulations.
As stated in the
GPC guidance
on the use of non-geographical numbers, practices that signed contracts with
telecommunications providers prior to 1 April 2011 should have taken all
'reasonable steps' (as referred to in the regulations), with the support of
their provider, to ensure practice telephony arrangements are compliant. It
would not, however, be reasonable for practices to re-negotiate, vary or
terminate these existing contracts (signed before 1 April 2011) if this meant a
significant financial penalty. In these cases, the vast majority of telecomms
providers are able to offer alternative solutions to ensure practice
arrangements are compliant. Practices should only sign new or renewed contracts
if the provider can assure them that the arrangements will comply with the
regulations.
Prime
Minister’s Challenge, Expressions of Interest Invited
On 1 October,
the Prime Minister announced that there would be a new £50 million Challenge
Fund to help extend access to general practice and stimulate innovative ways of
providing primary care services. The Government has asked NHS England to lead
the process of inviting expressions of interest and oversee the pilots. Details
on how to apply to become a pilot site, the application criteria and timescales
are all now available on NHS England’s
website.
Charges for
Occupational Health Vaccinations
Nationally, some GP trainees working in a general practice setting are being
asked to pay for occupational health vaccinations. Under no circumstances should
GP trainees or any other doctors in the NHS be required to pay for vaccinations
where they are involved in direct patient care. This is outlined in the
Department of Health ‘Green Book’ on immunisation against infectious disease
(pages 83-90), which states:
“Employers need
to be able to demonstrate that an effective employee immunisation programme is
in place, and they have an obligation to arrange and pay for this service.” The
Control of Substances Hazardous to Health (COSHH) Regulations also requires an
assessment to be made (by an employer) of a range of hazardous substances,
including “biological agents”, in order that suitable “control measures” can be
implemented to minimise the risk. Where a risk has been identified and where
effective vaccines are available these should be used as a method of control.
The employer is required to make provision of the vaccines to staff who are not
already immune. Section 9 of The Health & Safety at
Work Act 1974 requires that this be offered free of charge to staff. If you are
a GP trainee and have been charged for occupational health vaccinations please
contact Christopher Scott via
cscott@bma.org.uk.
GP Trainee
Subcommittee Newsletter
This GP Trainees Subcommittee's winter
newsletter
includes, top tips for the Applied Knowledge Test (AKT), important information
on charges for occupational health vaccinations, 'to do' list for
GP trainees
going on maternity leave and the details of the elected regional
representatives.
Bulletin 208
17.12.13
SCAM –
Temdi.com
It seems that we have a new name on the block doing the same old scam. A company
called TEMDI is writing to practices asking them to confirm details are correct
or send any changes so their directory can be amended if necessary. IF YOU
RETURN ANYTHING YOU WILL BE BILLED!! DO NOT SIGN AND/OR RETURN ANYTHING! You may
also know this scam as European Medical Directory, Med1web or Novachannel.
Updated GPC
Guidance for Christmas and New Year Opening
The GPC have
issued this further guidance on
Christmas and New Year opening times.
Winter
Pressures, GPC Posters for Practices
These posters have been mailed to practices and are also
available to download in a form that you can use on screens if you wish. This is part of a
wider initiative on winter pressures in the NHS, and other material, including a
briefing paper on winter pressures and information
about self-care, are also available on the
BMA website.
Bulletin 207
09.12.13
CQRS – Make
sure you get paid!
I sent an
important email to all practice managers on Monday 9 December outlining common
mistakes that are preventing practices from completing CQRS manual data entry.
The email covers 4 simple steps to take. I am chasing up the Area Team with
regard to practices who are still awaiting ‘approval’ after they have ‘accepted
the offer’. If you did not receive this email, please contact me directly. IF
YOU FAIL TO COMPLETE CQRS CORRECTLY BY 31 DECEMBER YOU WILL NOT RECEIVE PAY IN
JANUARY.
Urgent Care
Services, Sir Bruce Keogh’s Review
Professor Sir
Bruce Keogh's ‘Transforming Urgent and Emergency Care Services in England’
review
report refreshingly recognised that hospital pressures require a 'whole
system approach', with integration between the range of providers in urgent
care, rather than the non-evidence based portrayal that GP opening hours are
somehow the cause of hospital pressures. There is a strong focus on patient
self-care at the beginning of an urgent care pathway. The Government has also
announced £150 million to reduce A&E winter pressures. In the context of Sir
Bruce's review, it would be wholly logical to use this resource in a whole
system approach including investment in general practice and community services,
to enable more proactive management of patients in the community, aiming to
avoid hospital attendance.
Winter
Pressures, GPC Posters for Practices
Every GP
practice will soon receive two posters from GPC to display in their surgeries
advising patients about self-care this winter.
Bulletin 206
03.12.13
QOF Changes
14/15
The BMA have
published this full summary of all the QOF indicators that will be removed from 1 April
2014.
Safer Use of
Controlled Drugs: CQC Guidance
The CQC has
produced some information sheets on use of controlled drugs which may be useful for GPs.
Surgery
Thefts
We have made
aware of surgery thefts which are taking place elsewhere in eth country and
advise you and your staff to be extra vigilant. Their
MO is to dress smartly, wear false ID badges and gain access to non-clinical
areas. They steal purses from unattended bags and later phone in asking for the
victim by name (Taken from the stolen credit/debit cards). They purport to be
from the bank and illicit personal information, including the PIN from the
victim and then clean out their accounts. In the past, this has always been in
acute settings. However, it now looks like they are targeting health centres but
are keeping contact with targets to extend the length of time they can use cards
and get information.
Bulletin 205
26.11.13
FAQs GP
Contract 14/15
Following the
announcement of the greatest set of contract changes since 2004 the GPC has
produced a short
FAQ.
The GPC priority was to address the greatest concerns expressed by grassroots
GPs - the damaging impact of last year's sweeping imposed changes, exacerbating
bureaucracy and box ticking medicine to unmanageable levels – and, as with all
negotiations, there was some give and take by both parties.
Flu
Vaccinations for GP Locums
NHS England and GPC have agreed that locum GPs should attend the practice where
they are registered as patients to get their flu vaccination, and that practice
can then claim the payment via CQRS using the Read code 9OX4. which will be
acceptable by the Area Team. A statement to this effect have been added to the
BMA website. Vaccination of all other staff falls under the practice occupational
health responsibility and it is for individual practices to decide how they will
organise a provision for their staff to be vaccinated. A number of approaches
have been used across the NHS including buddy/reciprocal agreements with
neighbouring practices to vaccinate each others staff and a voucher scheme with
pharmacists.
Short Shelf
Life of Fluenz
We have been
asked to remind practices that Fluenz® has a shorter shelf life (18 weeks) than
other influenza vaccines and some of this will have passed by the time the
vaccine has been supplied to you. The expiry date on the nasal spray applicator
should always be checked before use. Vaccine has been ordered to cover the
period over which historically the flu vaccine has been used, extending from
September to mid-December. All the Fluenz® will have expired by 16th January
2014. In the light of this it will be important to ensure that efforts are made
to vaccinate children before the Christmas holidays.
GP Services
over Christmas and New Year
This GPC guidance
designed to
provide clarity around what is permitted with regard to Christmas and New Year
opening was shared with via email last week. The Area Team have also had sight
of this guidance and will be issuing a letter to practices this week to clarify
their position with regard to Christmas and New Year opening.
Issuing
Medical Certificates of Cause of Death or Cremation 4 (“Part 1”) Forms Outside
the Practice Area
We have been
contacted by practices concerned that funeral directors are increasingly
requesting GPs to travel outside their practice area following the deceased
being moved to a chapel of rest. With regard to “death certification” i.e.
issuing an MCCD - if you have been looking
after the patient in their last illness then
you are obliged to issue, free of charge, a medical certificate of the cause of
death. However, you do not always need to see the body to do so. With regard to
Cremation 4 (“Part 1”) forms – there is no obligation to carry out this work and
it does levy a fee. It goes without saying that GPs will do their utmost to
assist the family and normally do carry out this work. However, if it is proving
difficult/prohibitive owing to the deceased being moved outside your practice
area you can request the funeral director arrange for the deceased to be brought
to a suitable place to allow you to complete the work or you can request a
higher fee to cover mileage and time. You can decline to complete cremation
certification work but you may wish to try whatever possible to comply with the
request first – for example offer to meet at an alternative place or at a time
outside surgery hours. If you are unwilling or unable to undertake the work you
have a responsibility to inform the undertaker as soon as possible after the
request is made.
Bulletin 204
19.11.13
GP Contract
14/15
Negotiations on changes to the GP contract in England for 2014/15 have been
concluded and announced. The GPC believes that this package, as a whole, puts
general practice and all GPs in a better position to deliver improvements to
patient care. An email from Chaand Nagpaul, GPC Chairman, was sent to all GPs in England on
Friday to inform them of the position and outline the key points of the package.
Full details of the agreement are available on the
BMA website. Work will now being on the detailed arrangements for implementation.
An email was sent from CLMC to all practice managers on Friday. If you have any
questions or did not receive the emails on Friday please contact
Janice.foster@tees.nhs.uk.
Future of
General Practice: BMA Response to ‘Call to Action’ and BMA ‘Developing General
Practice’ Paper
The GPC has published its vision discussion paper, ‘Developing general practice:
Providing healthcare solutions for the future’,
setting out proposals and ideas on the future of general practice. Views are
being sought on the paper and it will be taken forward through a programme of
activity over the coming year. A BMA Health Policy and Research Unit paper
outlining the findings from some GP focus group work on views for the future was
issued to accompany the paper. Alongside the GPC vision paper was also published
the BMA’s response
to NHS England’s Improving General Practice Review – the Call to Action.
Legionella
Risk Assessments
We have been made aware of a company approaching practices with regard to
legionella risk assessments. This is not required by CQC or anyone else and you
do not need to waste money getting an outside organisation to do this. Under HSE
law you are required to consider the risks and take suitable precautions.
Considering the risks is straightforward and it is highly unusual for an
external agency to be required. If you have any questions, please do not
hesitate to contact
Janice.foster@tees,nhs.uk.
GP Practice
Premises Development
David Geddes, Head of Primary Care at NHS England, has confirmed to the GPC that
Area Teams do not currently have allocated funding to progress premises
developments that, though considered previously by PCTs, had not received final
approval and confirmation of funding by PCTs before 1 April 2013. Area Teams
will not be in a position to progress business cases which are still pending
approval, or to consider any new developments until April 2014 at the earliest.
NHS England has confirmed its intention to remove barriers to future premises
development from 2014/15. Following on from a recent review of capital
commitments by Area Teams, NHS England is now undertaking an audit of the
current backlog of business cases. David Geddes has asked Area Teams to
prioritise all outstanding business cases against set criteria which match the
NHS England business case approval guidance for capital investment.
New BMA QOF
Guidance
The BMA have updated their guidance Focus on QOF payments for 2013-14
and NHS Employers has also updated their QOF FAQs. You can view both documents
on the BMA webpage for
QOF guidance for 2013-14.
Pharmaceutical Regulations 2013
The guidance on
market entry and performance sanctions, within the Pharmaceutical Regulations
2013, has been
updated.
Sick Leave
Guidance for GP Trainees
The updated
version of the
sick leave guidance for GP trainees is
intended to clarify sick leave arrangements in line with the Framework Contract
agreed between GPC and COGPED.
GMC State of
Medical Education and Practice 2013 Report
The GMC have
published a report,
State of Medical Education and Practice 2013, which focuses on key trends
around complaints and identifies some of the challenges these reveal for doctors
and those working in healthcare.
Bulletin 203
12.11.13
Focus on Vaccinations and Immunisations Guidance Update
The Focus on Vaccines and Immunisations Guidance
has now been updated following the many recent changes to the vaccinations programme. This document explains the various
payment mechanisms available, and the new sections include information about shingles, pertussis, childhood flu, rotavirus
and meningitis C vaccinations.
HIV Testing Week
This letter provides detail on HIV testing week (22-29 November) led by the Terrence Higgins
Trust and funded by the Department of Health. This may result in your services receiving requests for an HIV test or
information about HIV. National HIV Testing week promotes the benefits of HIV testing to gay and bisexual men and African
communities. The British HIV Association and the British Association for Sexual Health and HIV are supporting this by
encouraging clinicians in both hospital and primary care to be alert to the need to offer and recommend an HIV test. This
may result in your services receiving requests for an HIV test or information about HIV.
Bulletin 202
05.11.13
QOF
Achievement Data
The 2012/13 QOF achievement and prevalence data have been published by the
HSCIC,
including a statistical bulletin, an online database and a set of detailed data
tables. The average achievement decreased from 96.9% in 11/12 by 0.8 % to 96.1
%.
QOF Business
Rules v27
Version 27 of
the QOF Business Rules have now been published on the
PCC website.
Improving
General Practice: A Call to Action
The NHS England review of general practice is ongoing. The consultation aims to
gather views on how general practice can best meet the challenges of an ageing
population, increased patient demand and growing recruitment and retention
problems. NHS England has also said it wishes to address inequality of and
patient dissatisfaction with access to GP services. Both the GPC at a national
level and the LMC at a local level are coordinating a response to the
consultation, but individual GPs can also provide a response. You can fill in
the online survey form on the
NHS
England website.
CCG
Constitutions and Conflicts of Interest
The GPC has
issued these
FAQs and
updated guidance on CCG constitutions (focusing on what to do if you are unhappy
with something in your CCG constitution and the process for requesting changes)
and conflicts of interest (providing advice for GPs as commissioners, covering
issues such as the GMC guidance for doctors in management or commissioning roles
and how to manage conflicts of interests when commissioning services from member
GP practices).
Read Code
for Dementia DES
The Read codes
for the Dementia DES are available in the version 2 enhanced services
guidance.
NHS Employers have advised that although the guidance refers to the October Read
code release, which is not yet available, practices should be able to use these
on their systems already. However, the codes may not yet be picked up as part of
reporting until system suppliers have put the necessary templates in place. The
Read codes in italics in the guidance should be the correct codes, as there have
been no changes since the publication of the enhanced services guidance, but
they had to include a line around the possibility of change in case they did.
Local
Enhanced Services
During 2012-13,
NHS England guidance stated that all existing local enhanced service contracts
should be extended into 2013-14, in order to provide stability during the
transition period as PCTs transferred commissioning responsibility to CCGs. The
guidance recommended that the contracts be extended with a six month review
clause, so that CCGs, if they wished, could choose to change or decommission
services during the current commissioning cycle. In addition, all local enhanced
services (now referred to as community-based services) commissioned by CCGs
would need to be contracted using the NHS Standard contract from April 2014. As
such, our CCGs are reviewing current LES contracts and making decisions about
services to be commissioned for 2014-15, using the NHS Standard Contract. We
would urge you to read the
GPC FAQs on the NHS Standard Contract. NHS England has this further details
guidance on how to contract using the standard contract.
Firearms
Policy
The GPC has
published this updated interim version of the
firearms policy.
BMA 2014
Research Grants
The BMA was
among the first of the professional bodies to award grants and prizes to
encourage and further medical research. Today, 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,
for research in progress or prospective research. The 2014 research grants will
be available to apply for online from 10 December this year. The application
deadline is 14 March 2014 at 5pm. Subject specifications for each grant
vary. For example, in 2014, research areas range from rheumatism and arthritis,
cardiovascular disease and cancer to neurological disorders and clinical outcome
measures. For more information on the grants on offer in 2014 and details of how
to apply follow this link. Please disseminate this
information as widely as possible, in particular to any potential applicants.
If you have any questions about the BMA research grants, or would like to
receive alerts about them, please contact Hugh Garnett at
info.sciencegrants@bma.org.uk or telephone 020 7383 6755.
Bulletin 201
29.10.13
Care.data Information from the Area Team Communications
The Communications Team who support the Area Team have provided this Q&A document which they hope you will find useful. A leaflet drop, taking place throughout January to all 30 million households in England, is the next stage of NHS England’s public awareness plan and follows wide consultation with a range of stakeholders including GPs and patient groups.
Bulletin 200
21.10.13
Care.data
Fair Processing, Additional Guidance
Further to the
announcement by NHS England with regard to their national awareness raising
plans for care.data, this fair processing
guidance has been produced for practices by NHS
England and the HSCIC, with ICO, GPC and RCGP input, and sets out the
responsibilities of practices in meeting their fair processing obligations under
the DPA.
GPC Guidance
on Alliances, Federations and Sharing Staff
The GPC has produced guidance
for practices considering forming alliances or federations and sharing staff.
The guidance gives advice on what practices should explore before taking
decisions, possible structural and legal models and provides case studies on the
different organisations some GPs have already created. The related advice on
sharing staff includes secondments, joint employment, VAT considerations,
alternative arrangements and managing change.
Vaccines &
Gelatine
Following
reports in the media about the use of gelatine in Fluenz, the vaccine
recommended for use for children, Public Health England has published a
statement
on this issue. More in depth guidance has also been published in a recent
Vaccine Update.
Vaccine
Supply – Zostavax Temporarily Unavailable
National distribution of Zostavax® vaccine began on 1 August 2013. However, due
to an ongoing delay in the supply of the vaccine into the UK, PHE has
temporarily removed Zostavax® from the ImmForm website, and it is not currently
available to order. PHE expect further limited deliveries during October, at
which point ordering will be resumed, with more substantial volumes due in
November and December. It is likely that the order level cap for England will
remain in place during this period. PHE apologise for the inconvenience caused.
Multiple ordering to circumvent the cap has presented a number of challenges
both for the distributor in distributing those orders, and for PHE in managing
the remaining stock. Further orders will be monitored. When ordering resumes,
Zostavax® must only be ordered for the 70 year old and 79 year old cohorts
this year. PHE have asked GP practices not to stockpile the vaccine as the
vaccine is expensive and it is important to minimise wastage. Please note that
the vaccine can be administered to the two eligible cohorts at any time between
1 September 2013 and 31 August 2014.
2013/14
Enhanced Service Guidance and Audit Requirements Update
NHS Employers, NHS England and the Health and Social Care Information Centre (HSCIC)
have updated their guidance
and audit requirements for the 2013/14 enhanced services and the vaccination
programmes supported by automated extractions. This guidance is intended to
support area teams and practices in delivering these services, and includes the
new read codes and business rules, including for childhood influenza. Note that
guidelines and a template for all the flu vaccines (including childhood nasal
spray) are available for Vision practices. The
business rules have also been
published.
Bulletin 199
15.10.13
Data Entry
for Quality Services with CQRS
CQRS has sent out a communication providing GP practices with information on
manually entering data for Enhanced Services. GP practices will need to manually
enter data on CQRS for supported Enhanced Services in order for payments to be
calculated via CQRS for the remainder of the 2013/14 financial year. This
decision has been made to provide more time to successfully deliver the QOF
2013/14 extractions. The full CQRS message can be read
here.
Prescription
Direction
The GPC has published a
joint statement
with
the PSNC and Pharmacy Voice on prescription direction which reminds practices
and pharmacies that proper prescription practices should be followed and
highlights activities to avoid in order to maintain good practice. A related
online article has also been published by BMA
News.
NHSmail User
Survey 2013
The NHSmail user survey 2013 is now open. The NHSmail team at the Health and
Social Care Information Centre are currently planning for NHSmail 2 which will
replace the current service – they are keen to hear your views and understand
how you use your account. Every NHSmail account will have received an email
inviting them to complete the survey, but if you can’t find it please email
feedback@nhs.net. We recommend that users take
part - it should only take a few minutes of your time and the survey is open
until 28 October. The full results of the survey will be published in the
NHSmail newsletter.
Bulletin 198
08.10.13
Vaccine Update
Public Health England has sent out this special issue of
Vaccine update, which deals
with the temporary suspension of the acceptance of orders for Zostavax®
following the recent capping of orders.
Bulletin 197
24.09.13
Care.data
As you will be aware, there has been a lot of discussion about this – locally,
regionally and nationally. I sent an email to all GPs and practice managers on
Friday (20.09.13) outlining our position to date. If you have not received this
please get in touch I will resend. The BMA has received a number of concerns
from practices and LMCs about the level of patient awareness, and whether an
eight week period of activity undertaken by the practice will be sufficient in
informing all patients of the extract. Some practice shave suggested applying
the objection code to all their patients’ records and removing the code once
patients have provided explicit consent.
The BMA strongly advise practices against doing this because the HSCA creates a statutory obligation for GP practices to disclose data to the HSCIC. In addition, it is a patient’s right to object, not that of the practice. As the law creates a legal obligation to disclose data, consent is not required. GP practices must meet their legal obligations under the HSCA, as well as their obligations under the DPA to undertake fair processing. The BMA has been in regular contact with NHS England and have been advised that they will be providing further information about awareness raising activities. Practices should, therefore, be reassured that they will not be solely responsible for making patients aware of care.data and they will be informed before any extractions take place. NHS England has been working with the ICO so that there is clarity about what GPs have to do in order to meet the fair processing component of the DPA. I have suggested something in writing from the ICO for practices to use in recording the sharing would be helpful but we do not know if anything will be produced. It has also bee confirmed that data will not be extracted until the awareness raising activities have taken place.
Collaborative Arrangements/FeesThere is a contractual obligation to provide the information requested in the annual practice declaration. There is a section in both the GMS and PMS regulations stating that contractors shall submit an annual return to the Board (NHS England). There is not a specific contractual obligation to submit this information in electronic format, but practices may find it is more convenient to do so.
The letters sent out by NHS England to practices about the framework state that practices will be required to submit their catchment area electronically. There is no specific contractual requirement to submit this information in electronic format, but practices, again, may find it more convenient to do so. The BMA has written to NHS England and advised hat practices which have problems submitting this information electronically, or choose not to do so, will be able to submit the information in a different format.
The web interface that is being shared with practices also includes data about practices based on NHS England’s high level indicators and outcome standards. The information on the interface relates to every practice in England, with the intention being to allow comparisons with local practices within the CCG or Area Team and also to practices with similar demographics. Even though the process has been improved through discussions, the BMA does still have some concerns about this process and the validity of some of the data, including how this data might be used in the future. Both the BMA (nationally) and CLMC locally (through discussions with the DDT Area Team) are continuing to try and minimise the risk through continued engagement.
Migrant Access to Healthcare97% of GPs said that bureaucracy and box ticking had increased in the past year while 94% said their workload has increased
82% felt that some of the new targets were actually reducing the number of appointments available to the majority of patients
76% believed they had reduced the time spent on patients’ other clinical needs as the result of the latest QOF changes
86% of GPs reported a reduction in their morale in the past year
90% of GPs said their practice’s resources are likely to fall in the next year
45% of GPs said they are less engaged with new CCGs because of increased workload.
Broadening your Horizons – International Guidance for Doctors & Medical Students
Bulletin 196
17.09.13
Enhanced Services FAQs
FAQs on the
four new enhanced services are now available on
NHS Employers’ website.
Additional MMR, Childhood Flu & Shingles FAQ re Read Codes
The following FAQ has been added to those previously published:
Q) Where a practice has been using Read codes not included in the service specification, guidance and audit requirements or Business Rules for enhanced services and vaccination programmes, are practices expected to re-code patients?
A) Yes, all services being supported by CQRS, require that practices who intend to participate in these services record their achievement in the clinical systems using the appropriate Read codes. This should be recorded using the relevant Read codes in the service specification, guidance and audit requirements or Business Rules from the date those services commence. As such, practices would need to re-code using the relevant codes.
NHSmail for Sessional GPs
As you will be aware, there was recently an overhaul of all NHSnet accounts
where email addresses previously linked to PCTs were reallocated to CCG as the
new host organisation. The same work is happening for sessional GPs previously
linked to their previous PCT. The NHSmail team have issued the following advice:
If you are a sessional/locum/salaried GP and require an NHSmail account for securely exchanging data, please contact the GP practice NHSmail Administrator for which you carry out most work. The Administrator will need to liaise with the CCG Local Organisation Administrator (LOA) to request an account is hosted and administered via the GP Practice on your behalf. If you work across several GP practices on a regular basis, it may be more appropriate to have your account hosted and administered by the CCG. If this is the case, please contact the Local Organisation Administrator (LOA) in your local CCG, who can normally be found via the IT department. If you have any issues registering an NHSmail account please email feedback@nhs.net.
Vaccine Update
re Current Shortages of Shingles Vaccine
Public Health England has sent out this special edition of their 'Vaccine
update' about current shortages of the shingles vaccine.
Bulletin 195
10.09.13
Advice for Overseas Doctors Thinking About Working in the UK
As a part of the BMA's commitment to supporting BME doctors
in their career progression, as well as implementing
positive solutions to overcome the barriers they face, the
BMJ has published an online e-learning module, authored by
the BMA, which provides overseas doctors with advice on
coming to work in the UK.
The module is free
to access for BMA members and aims to provide doctors with the following skills:
Bulletin 194
03.09.13
Care.data Information
for Practices
Further to our update in the last bulletin (see below) we
can now advise that in the next couple of weeks you will
receive an email containing links to various resources and
guidance, together with a communications pack with patient
information materials. You can view some of the information
here.
The
documents include:
Once received, you should display the poster and make leaflets available in the practice without delay as extractions will be begin approximately 8 weeks after you receive the materials. FAQ 6 provides some further guidance on what practices should do to raise awareness. The guidance also explains how to manage patient objections to the disclosure of their personal confidential data. Additional supporting activity to help raise awareness is being planned by NHS England at a regional and national level and we will provide further details of this as soon as possible.
The Health and Social Care Information Centre (HSCIC) are providing a helpline for GPs with queries and can be contacted on 0845 300 6016 or by emailing enquiries@hscic.gov.uk, quoting 'care.data - GP' in the subject line. The helpline can also be used where practices need further guidance in responding to queries from patients that are not answered by the patient FAQs.
NHS Community Pharmacy Advanced Services Briefing
This
Briefing has been developed jointly by NHS Employers,
the Pharmaceutical Services Negotiating Committee (PSNC) and
the General Practitioners Committee (GPC) to provide
information for GP practices about advanced services
provided by community pharmacies in England under the new
NHS structures implemented in April 2013.It covers both
Medicines Use Reviews (MURs) and the New Medicine Service
(NMS).
Childhood Influenza Vaccination Programme FAQs
The GPC have published joint
FAQs together with NHS Employers and NHS England, to
help answer questions about the childhood influenza
vaccination programme.
Bulletin 193
19.08.13
Possible
Scam Under Land Registry Heading
We have been made aware of a possible scam whereby practices receive an email detailing direct debit payments. The email has an attachment. We believe this could be a scam and you should NOT open any attachments until you have verified this with the Land Registry directly (tel: 0844 892 1111). The Registry advise the following action if you receive phishing emails, which we believe this to be:
Unsolicited emails Land Registry will never ask you to disclose personal or payment information by email. If you have any doubt that an email
you receive from Land Registry is genuine, please do not follow any links or open any attachments, disclose any personal
details, or respond to it. Please forward it to Land Registry at
phishing@landregistry.gsi.gov.uk then delete it. Land Registry is unable to investigate paper copies of phishing emails/websites. In order for us to take any action, you
will need to forward the original phishing email to
phishing@landregistry.gsi.gov.uk . Land Registry will review all e-mails received but will not respond to them individually.
CQRS
Rotavirus
Care.data Information for Practices
The BMA supports the use of data for secondary uses but also recognises the importance of confidentiality and have negotiated the right for patients to object to the use of confidential data for these secondary uses. The BMA have also considered the GP dataset to be extracted which appears to be appropriate for commissioning purposes and have jointly badged the GP guidance with the RCGP, NHS England and the HSCIC as it is important that GP practices understand their obligations under both the Health and Social Care Act and the Data Protection Act. The HSCA removes the duty of GPs to seek consent prior to extractions but it does not remove the duty to raise patient
awareness about the extractions. Materials have been tested in a small number of practices and their feedback has been incorporated into a revised set of materials and resources. From mid August, over a 4 week period, practices will begin to receive an email containing information about the implementation of care.data. The email will include links to a number of resources and materials. Practices will also receive a separate communications pack containing patient information and materials. It is important that you are prepared for this information. The ICO has been involved in these discussions and has made it clear that GPs
as data controllers are responsible for patient awareness raising. It is important that when you receive this information
you display the poster and make leaflets available in your practice without delay as extractions will begin approximately 8 weeks after you receive the materials. Other resources will also be included in the email communication to practices. As soon as we receive any further guidance we will forward this to you. Bulletin 192
Possible
Scam Targeting Elderly Patients
CQRS
Bulletin
Childhood (2
– 3 yr old) Influenza Vaccination Programme
a
proactive call basis, if not considered at-risk, or
a
proactive call and recall basis, if considered at-risk
Fluenza is the
recommended vaccine which is administered as a nasal spray and an item of
service fee of £7.64 will be paid for each eligible patient.
MMR Guidance
and Audit
Bulletin 191
Remote Care Monitoring (Preparation) Scheme Year End Reporting Template
Be suspicious of unsolicited emails, even if they look like they're from a trusted source.
You should have received a message
from the Health and Social Care Information Centre advising you are now able to manually enter data for July if you are
participating in the Rotavirus Enhanced Service. It is important that you enter data by 31 August in order to receive
payment by the end of September – declaring achievement after the 31 August is possible but may result in a delay in payment.
Guidance on how to manually enter data is available on the
CQRS webpage and this
guidance provides further
details including read codes, calculations and payment details on Rotavirus and other new or amended services.
The new care.data service commissioned by NHS England is the first use of the new powers under the Health and Social Care Act 2012 to extract confidential data from providers into the Health and Social Care Information Centre (HSCIC). The intention is to make increased use of clinical information with the aim of improving healthcare, for example by ensuring that data are made available to NHS Commissioners so that they can better design integrated services for patients.
06.05.13
We have been
made aware of a possible scam whereby market researchers target elderly
patients. Elderly patients in the Middlesbrough area have received telephone
calls from market researchers who have a lot of the patient’s personal details,
including medical conditions, and seek to make an appointment with the patient
in their own home. This could be a genuine organisation but it did cause alarm
to the patients and prompted them to contact their GP practice to ask if the
practice had provided personal/medical details to this organisation. This has
been reported to the police. If any other practices are alerted to this activity
please advise your patients to double check the organisation before making an
appointment and alert the police if they are concerned or, with patient consent,
you can alert the police on behalf of the patient if you consider it appropriate
to do so.
HSCIC has published a
CQRS bulletin
which practices may find useful. For any queries regarding CQRS, please email
cqrsfeedback@hscic.gov.uk
or
cqrsservicedesk@gdit.com.
The Department of Health, Public Health England and NHS England have published
this letter and
service specification.
explaining the extension of the 2013/14 flu immunisation programme to healthy
children (two and three year olds). From 1 September, practices should vaccinate
children who attain the age of two and three years, but not yet four, on 1
September 2013 on either:
NHS Employers has published further guidance about the
MMR catch-up campaign and
the audit requirements
for this. This is in addition to the already existing service specification
which was introduced on 25 April 2013.
30.07.13
NHS Employers have now published the final template in
word and
excel for practices to use when reporting
progress on the remote care monitoring directed enhanced service. GPC continue
to believe the scheme is simply too bureaucratic and that practices need
carefully consider how worthwhile it is for them and their patients before they
participate.
This useful
guidance document provides advice on how to make an application for dispute resolution to
the NHSLA. Practices should escalate contractual disputes to the NHSLA’s Family
Health Services Appeals Unit (FHSAU) if all local dispute resolution procedures
have been exhausted and no satisfactory outcome can be agreed by all parties.
Primary Medical Services Assurance Management Framework
As part of this process, practices will be asked to submit an annual self-declaration using the web interface. The declaration will commence in September, and practices will be notified when the submission is open for completion. The policies, web interface and practice declaration have been discussed with GPC representatives and a group of LMC secretaries and some of their content has been changed as a result of these discussions. Concerns still remain about this process, including how the information on the web interface might be used in the future and the GPC are continuing to try and minimise that risk through their engagement.
Multi-Compartment Compliance Aids (MCA) (also known as Monitored Dosage Systems
RPS has considered the evidence base, which indicates that MCAs are not a panacea for medicines use, and that they should not automatically be the intervention of choice for all patients. Not all medicines are suitable for inclusion in MCAs and health and social care professionals should recognise that re-packaging medication from the manufacturer’s original packaging may often be unlicensed and involves risks and responsibility for the decisions made.
Reminder, Stamp Duty Land Tax
Bulletin 190
22.07.13
GPC Election Results
Permanent residents, who have a right to free NHS care. The consultations propose that the definition of ordinary residence, which entitles patients to free NHS care, should be changed so that non-European Economic Area migrants must have indefinite leave to remain (ILR) in the UK before they can attain this status.
Temporary migrants - non-EEA migrants who are subject to immigration control and do not have ILR. It is proposed that this group will in future have to contribute separately to their healthcare costs through a new levy on their visa of at least £200 per year. There would be an initial NHS registration process which would assess the need to pay this levy, be run externally to GP practices and be separate to practice registration.
Short term visitors from outside the EEA and illegal migrants, who would be charged directly at the point of use for treatment, both by hospitals and by GP practices.
Expatriates and former legal residents of the UK not subject to immigration control. It is proposed that this group would have a right to free NHS care if they have paid National Insurance contributions for a significant period.
Other issues considered in the consultations are:
Whether non-EEA visitors and other chargeable migrants should be charged for access to emergency treatment in A&E or emergency GP settings.
Whether the levy for temporary migrants should be at a fixed level or vary, for example, according to the age of the applicant.
How to improve current hospital processes for collecting income from chargeable patients.
How to improve the effectiveness of cost recovery from other member states for EEA citizens who receive NHS treatment.
The GPC has a number of concerns, including that the NHS access status of all patients would need to be checked by GP practices on registration, placing a further administrative burden on practices and risking damage to the doctor-patient relationship. The GPC believes there is currently no regulatory basis for NHS England Area Teams not to accept the registration of patients whose immigration status has not been checked. If you respond to the consultation please make the LMC office aware of your response.
Monitor Call for Evidence on General Practice, Consultation
To determine the extent to which commissioning and provision of general practice services is operating in the best interests of patients.
To gain a better understanding the challenges faced by an important part of the health sector at a time when it is operating under increased pressure.
The BMA will be responding with the following points, amongst others: the high levels of patient satisfaction with current GP services, the fact that patients rarely encounter issues with changing their GP practice, that greater investment in funding for current practices is required in order to allow expansion of services and that Monitor should be encouraging integration of services rather than further competition. Once again, if you respond to the consultation please make the LMC office aware of your response.
Criminal Injuries Compensation Authority
The Criminal Injuries Compensation Authority (CICA) is a
government body which provides compensation to blameless
victims of violent crime and relies on evidence from the
medical authorities to help its work. As a result of the
Government consultation “Getting it right for Victims and
Witness”, the
Criminal Injuries Compensation Scheme
was revised on 27 November 2012.
Under the new provisions of the 2012 Scheme the applicant must now obtain and pay for the initial medical evidence to up to a maximum value of £50.
To ensure suitable information is requested, the CICA will send the applicant a blank medical report to take to their GP to complete (TCX1). The applicant is expected to pay the GP/Practice for the completion of the report up to a maximum value of £50. The completed report should be returned direct from the GP to the CICA. Where an applicant cannot afford to meet the cost of the initial medical report, the CICA will send the applicant a blank medical report to take to their GP to complete (TCX2) or where an applicant cannot obtain the report due to a medical condition which prohibits them from attending their GP, the CICA will issue the TCX2 direct to the GP. The completed report including the payment voucher should be returned direct from the GP to CICA. On receipt the CICA will ensure payment is made for the report. Where the CICA is required to pay for the initial medical evidence, the value of the initial report will be deducted from any award of compensation given. Any follow up reports requested will be done so direct by the CICA and will continue to be processed in the normal manner. If you have any questions about the new provision, please contact the CICA on 0141 331 5495 or alternatively email their relationship managers; relationship.managers@cica.gsi.gov.uk.
Community
Pharmacy, a Guide for GPs and Practice Staff
An updated version of the community pharmacy - a
guide for GPs and practice
staff has been
published jointly by the BMA, PSNC (Pharmaceutical Services Negotiating
Committee) and NHS Employers. It provides support for GPs and community
pharmacists in developing more effective working relationships as well as
providing an insight for NHS commissioners, for improved working in primary
care.
GP Trainees Subcommittee
Newsletter
Please widely
circulate this latest
GP trainees subcommittee newsletter to any GP
trainees who may be interested.
Bulletin 189
16.07.13
Flu Vaccine for Children
Following some confusion about the process for ordering flu
vaccine for children, NHS England has confirmed that Fluenz
is the recommended vaccine for children and that this will
be centrally supplied. Practices will be able to request the
vaccine via IMMSFORM. Where two and three year olds are
contraindicated to Fluenz, contractors will be required to
make an alternative Inactivated Trivalent Influenza Vaccine
(TIV) available. Inactivated TIVs which have already been
ordered by GPs for two and three year olds in clinical risk
groups can be utilised for the contraindicated two and three
year olds. Practices will be reimbursed for this as per
children in clinical risk groups. If practices experience
difficulties in sourcing inactivated TIV for the
contraindicated 2 and 3 year olds please contact the
ImmForm helpdesk on 0844 376 0040 which will be able to
assist in ordering inactivated TIV. Further information will
be available in the tri-partite letter which will be issued
shortly.
Flu Advertising Campaign and Vaccine Shortage Notifications
Due to lack of evidence that advertising campaigns have any
positive effect on seasonal flu take-up rates, NHS England
has decided against having a national flu campaign this
year. Their research found that whilst seasonal flu
advertising did raise awareness of the vaccine it did not
motivate people to get vaccinated. It found the biggest
positive influence on seasonal flu vaccine uptake was a
recommendation from a health care practitioner, be that in
person, via letter or telephone. Additionally, there have
been no reports from suppliers of potential shortages this
year but Public Health England will inform of any problems
via the
vaccination newsletter for health professionals and
immunisation leads.
Shingles Vaccine FAQs and Supporting Information
NHS England, Public Health England and the Department of
Health have published this
letter and
FAQs explaining the introduction of a vaccine programme
for people aged 70 years (routine cohort) and 79 years
(catch-up cohort) to protect against shingles, available on
the DH website. Links to these documents will also be
available on the on the
BMA website vaccination page.
Major Drug Recall
by Wockhardt
The MHRA has issued a precautionary major drug recall of
products manufactured by Wockhardt. Pharmacies, dispensing
clinics and wholesalers have been asked to return 16
different prescription only medicines in a variety of
strengths, made by Wockhardt Ltd, following manufacturing
deficiencies identified by the MHRA at Wockhardt’s Waluj
site in India. Note: patients do not need to return
their medicines because there is no evidence that the
medicines affected by the precautionary recall in the UK are
defective, and patients should, therefore, continue to take
their medicines as prescribed.
The drugs affected and further information is available on
the
MHRA website.
Premises Development Previously Approved by PCTs
Issue 6 (5th July) of the NHS England primary care
commissioning newsletter contained this
article
regarding premises developments that were approved by PCTs
before 1 April 2013, stating that if an agreement for
premises development had been agreed in writing with the PCT
then NHS England are bound to honour this.
Action on Hearing Loss
One in six of the population has some form of hearing loss,
rising to over half of people over 60 years old. This is a
condition affecting a high proportion of patients, and yet
they can face issues when visiting their GP, from
communication problems to difficulties booking appointments,
as outlined in a recent report from Action on Hearing Loss
entitled Access All Areas. Action on Hearing Loss (formerly
RNID), have asked us to promote the
information they have for GPs
to assist in understanding how surgeries can be made more
accessible to people with hearing loss.
Bulletin 188
08.07.13
GP
Locums Employed Through Limited Companies
You may have seen an article in The Times on 28 June that
referred to dozens of NHS Trusts in England being under
investigation by HMRC over their alleged use of schemes to
avoid VAT when employing locum or part-time doctors. In
light of that, please be aware of the position of GP locums
employed through a Limited Company, often referred to as a
service company. The services they provide are subject to
VAT when the registration threshold for VAT has been
reached. The threshold level includes all charges made by
the company including but not limited to fees and the
recovery of expenses. The registration threshold is
currently £79,000. Doctors working as locums through an
agency should, if they have not already done so, take advice
on the application of VAT to their work and if registration
has not been effected on time how to mitigate any penalties
and interest charges accruing for late registration by
making voluntary disclosure. The GPDF, the LMC nor the BMA
can assist with VAT or other form of taxation, but do
encourage all doctors to seek appropriate professional
advice on taxation matters.
QOF
Business Rules v26
Version 26 of the QOF business rules have now been published
on the
PCC website.
Intending
Trainer’s Course 2014
Applications for the 2014 Intending Trainer’s Course are now
open. Further information about the course is available in
this
course information pack and this
frequently asked questions document. Closing date for
application is 17th January 2014 and applications made after
this date cannot be accepted. If you are interested please
complete this
application form and return it via email to
susan.convery@nhs.net.
Once
the application form has been received you will receive
further information about the pre-course tasks.
Bulletin 187
01.07.13
CQRS
CQRS has gone live and is now being rolled out across
England. The service will support QOF, Learning
Disabilities Health Check Scheme, Rotavirus (Routine
Childhood Immunisation) and Alcohol Risk Reduction Scheme
from go live with other services supported later in the
year. NHS England Area Teams have identified and set up
where possible, a CQRS User Administrator within each GP
practices to CQRS. To ensure users understand how the
service will work and what they need to do to
declare/approve achievement activities CQRS have developed
the following implementation guidance
for
GP Practices and
Area
Teams.
For further information on CQRS rollout, view the latest
newsletter.
For any concerns or queries related to CQRS, including
training, practices should email:
cqrsfeedback@hscic.gov.uk.
Business
Rules for Enhanced Services
The business rules for the alcohol, learning disabilities
and rotavirus enhanced services are now available to
download via the
PCC website.
Change in QOF Business Rules for MH002 (mental health care
plan)
The HSCIC has provided this
explanation about changed business rules for QOF
indicator MH002.
Updated v25.0
of QOF Business Rules
The HSCIC has made some changes to v25 of the QOF Business
Rules to the following rulesets:
cardiovascular disease primary prevention
hypertension
rheumatoid arthritis
secondary prevention of coronary heart disease.
These four documents have now been updated to v25.1 and have been added to the PCC website to replace their v25.0 versions.
Vaccinations and Immunisations Update inc. flu, shingles and
MMR
Recently, a number of changes have also been made to the
vaccination programmes. This
summary includes information on flu, shingles and MMR as
well as useful links to the BMA website for more detail.
AQP
Information Governance Toolkit Assessments
The Health and Social Care Information Centre (HSCIC)
confirmed this week that the requirement for an AQP IG
Toolkit assessment is placed on the legal entity that has
access to NHS patient information. Therefore:
If the legal entity offering AQP services is the GP practice then the current published assessment will suffice. A top-up assessment may also be necessary, but this will depend on the AQP service to be provided.
If a new legal entity has been created to deliver AQP work, e.g. limited liability companies or partnerships, then a separate AQP assessment is needed.
CQC Consultation
The CQC has published a
consultation on changes to the way it regulates,
inspects and monitors care and it is available on the CQC
website. Some parts of the consultation relate to hospital
inspection only, but there are sections that will have an
important impact on the regulation of primary medical
services.
In particular, Section 2 of the consultation applies to all providers that the CQC regulates and sets out the following:
The five questions they will be asking of every service they regulate: Is it safe, is it effective, is it caring, is it responsive to people's needs and is it well-led?
Three concepts to help the CQC judge the quality and safety of services: the "fundamentals of care", which are the basics of care below which standards of care should not fall, "expected standards of care", based on the five questions they will be asking of every service and "high quality care", which is intended to help the CQC make judgements about a provider's overall quality of care.
Their proposals to appoint expert inspection teams, led by expert Chief Inspectors.
A proposal to develop a ratings system for most providers of health and social care, including in primary medical services. The consultation does not provide details of how this will work in general practice; these will be developed in the next two years, led by their Chief Inspector of General Practice.
Section 4 of the consultation also applies to all providers registered with the CQC. It sets out proposals for changes to the CQC's regulations to introduce fundamentals of care, to introduce of a statutory duty of candour as one of the organisational requirements on all registered providers, and to strengthen the CQC's powers in holding providers to account. The Department of Health will publish draft regulations following the closing of the consultation. We encourage you to read and respond to the consultation, which closes on 12th August 2013.
GP
Subcommittee Regional Elections 13-15
The GP Trainees subcommittee are holding elections for 14 of
its regional constituencies (including the north east) this
summer. Nominations are open now until 5pm, Friday
19 July 2013. Nomination forms and further information
about the elections are available
here. Posts are held for two
years, unless the representative qualifies as a GP during
the first year, in which case they will only serve for one
year.
Anyone can stand who is either:
a) on a GP training programme that will not finish before 24
September 2013;
b) starting a training programme between 28 June 2013 and 29
June 2014.
Candidates do not have to be BMA members.
Please spread the word to any GP trainees you know who may
be interested. If you have any queries, please contact Karly
Jose (kjose@bma.org.uk)
or Christopher Scott (cscott@bma.org.uk).
Crisis Support for Victims of Domestic Abuse
Many victims of domestic abuse come in contact with their GP
long before seeking help elsewhere - on average, female
victims of domestic abuse are subjected to 37 beatings
before they involve the police. In addition to the
healthcare needs these victims may have, they commonly need
help in getting immediate protection from their abuser. A
non-molestation order, granted by a civil court, can provide
this protection by preventing the abuser from using or
threatening violence against the victim, or intimidating,
harassing or pestering them.
While it is possible for victims to apply for this injunction themselves, they are often unsure how to do so, and are commonly put off from seeking legal support because of the cost of seeking advice. The National Centre for Domestic Violence (NCDV) provides a free, fast emergency injunction service to victims of domestic abuse, regardless of their financial circumstances, race, gender or sexual orientation. They help anyone apply for an injunction within 24 hours of first contact (in most circumstances), and work closely with the police, local firms of solicitors and other support agencies to help obtain protection.
To help victims get this support, the NCDV provide a range of materials (posters, cards or other literature) about this service, which can be distributed directly to a patient, or in waiting areas. More about the NCDV, and how to order any materials can be found at www.ncdv.org.uk.
Bulletin 186
18.06.13
084 Numbers
Imminent Ofcom changes will mean that any bodies that use 08
revenue share phone numbers will be required to advertise
the part of the call charge they receive wherever that
number is published, so that consumers know what service
charge the bodies receive from each call. Ofcom cannot tell
any organisation which number to use, but are concerned that
individual surgeries may not be aware of their forthcoming
changes. The changes will come into effect in early 2015. As
soon as Ofcom publish their final statement in the summer,
the changes will occur exactly 18 months after that. We
would like to remind GPs of this
guidance on the use of 084
numbers. Practices should note that the regulations require
them to satisfy themselves as to the cost of calls.
DVLA Survey
The DVLA have asked us to send a short online survey to
practices on the questions about cognition which are
currently used on DVLA questionnaires. This survey is
entirely voluntary but if you would like to take part the
link for this survey
CLICK HERE. Please note: you need to read this
NEURO2 questionnaire before you start the survey. The
aim is to improve the DVLA questionnaires so that they best
capture the necessary information to enable a correct
licensing decision. This survey is being undertaken to
canvas the views of GPs about the ‘red flag’ questions which
are currently used on DVLA questionnaires, to determine what
you anticipate is the effect of your answer to these
questions on licensing decisions. The DVLA have asked for
suggestions from you for additional ‘red flag’ questions the
DVLA could ask which might help GPs to inform DVLA more
comprehensively about your patient’s likely fitness to
drive.
GPC Sessional
GP Election Results
The results of the election to GPC's Sessional GPs
Subcommittee for 2013-2016 have been announced
CLICK HERE. The North East Representative is
salaried GP Paula Wright.
Premises Cost Directions Guidance (provided by Capsticks)
Capsticks have drafted some
guidance with regard to the
changes in the Premises Costs Directions. Cleveland LMC
cannot recommend or promote the services of any one
company/solicitor but believed practices may find this
information useful. It looks at the reimbursement of GP
practice premises costs, now dealt with by NHS England, and
the Premises Costs Directions, which previously, under the
2004 Directions, dealt with reimbursement of premises costs
to GPs but have been replaced and include a number of subtle
but significant changes under the new 2013 Directions.
111 Repeat Callers
"MMR Outbreak Control and Catch up NES
Conflicts of Interest Guidance
AST002 Indicator – Coding in business rules to be reverted
Meningitis C Booster for Adolescents
PMS Equitable Funding Reviews
GPC Campaign – helping patients understand
NHS changes
The GPC has been working on a new initiative
to communicate with patients and public about the various
issues facing general practice and the wider NHS. The first
phase of their programme of communications - a new,
public-facing section of the BMA website at changingnhs.com
A patient's guide to the new NHS - is now live. It explains to patients and the public
what’s happening, while also communicating our concerns and
reassuring them that doctors will always put patients first.
You may wish to display this poster
'GPC Poster' in your practice. The pages on the site have been
designed to be print-friendly, so you may also want to run
off copies of some of the information for patients who do
not have internet access. The GPC will be raising awareness
of the site further through online advertising, contact with
other organisations, and media coverage. Please note that
all of this is only the first step in a longer term campaign
seeking to engage doctors and patients in a dialogue about
the future of general practice. Hopefully you find these
resources useful but do let the GPC know what you think by
sending any feedback or questions to
info.gpc@bma.org.uk.
LMC Annual Conference 2013 Resolutions
These LMC
Annual Conference Motions and Resolutions
'General Practitioners Committee, Conference News' have now been published.
Bulletin 184
04.06.13
111
Repeat Callers
The national service specification for handling repeat callers (i.e. patients who call NHS 111 three times in four days) states that these patients should receive an assessment from a GP within one hour.
The GPC and NHS England reached an agreement that GPs are neither contractually obliged nor indemnified to make call backs and assess these patients within one hour and they have agreed the following joint statement:
NHS 111 commissioners and providers have a responsibility to ensure that repeat callers (those who have called the NHS 111 service 3 or more times in 4 days and, because of the potential risk, require a thorough senior clinical re-assessment by a GP within the hour) receive the service as specified.
There is no national mandate as to how this service should be provided or resourced, nor is there a contractual obligation for practices to do this work. However, it is the responsibility of CCGs as the local commissioners of NHS 111 to ensure an appropriate service is commissioned. If local GPs are not satisfied with the current local arrangements for dealing with repeat callers, then commissioners and providers should work to find another solution.
Cleveland LMC has been involved in lengthy discussions with the 111 team to try and find a local solution to this problem that is as safe as possible for patients and all GP practices. The simple fact is that it is not contractual for anyone to do this, including GPs, 111 or any other provider. This is an inherent problem of the system that has been created nationally then passed for local solution with no guidance other than nobody is contractually obliged to deal with this pathway but this pathway will still continue to exist! We are not happy that the ‘your GP will call you back within one hour’ element is to continue within 111 for repeat callers. However, we have compromised with a solution that will offer a safety net to practices and patients whereby, when a GP is not able to contact the patient within 1 hour (be it due to capacity, GP is unavailable, patient is unavailable, triage deems it inappropriate or you are simply not contractually obliged to do so) the patient is advised to return to 111 who will direct them to a walk-in centre to see a GP. Hopefully this safety net will catch any patients who GPs have not been able to contact in the hour and, to a degree, puts the onus back on the patient to notify 111. Below is the new system that is now in place for repeat caller:
As explained earlier, practices are not contractually obliged contact patients within 1 hour but responsibility will still be passed to practice by 111 and you need to triage appropriately – as you would any urgent call to the practice. It is anticipated that practices should on expect a couple of repeat callers per year. Everyone involved accepts that this solution is far from ideal but given the constraints of contracts, budgets and a nationally produced specification it is the safest and best practical solution that can be put in place within a tight timescale as, since 111 went live in April, there has been no safety net for patients or practices and potential for a serious untoward incident.
We will closely monitor the number of repeat callers and the outcome of this element of 111 and we will continue to work with 111/CCG to find a longer term solution to this ‘specification v contract’ issue. It is imperative that something is put in place so that there is a contracted/resourced solution with a provider for this element and we are urging CCGs to look closely at the contracts of providers in the new commissioning round to resolve this nationally created problem. If you have any question on this element of 111 please do not hesitate to contact
Janice.foster@tees.nhs.uk
Interim Seniority
Payments
The Health and Social Care Information Centre has published
the interim seniority factors 2013/14 for GMS GPs in
England, Wales and Northern Ireland today. The figures are:
England £96,183, Wales £84,479 and Northern Ireland £82,176.
Further information about the calculations and the
methodology may be seen on the primary care section of the
Health and
Social Care Information Centre website.
CQRS
Phase 2 Training
Please see attached information regarding phase two training
sessions for CQRS. We strongly recommend that ALL practices
ensure they attend the phase two
training sessions for CQRS as much of the practice
funding streams will rely on timely and accurate completion
of CQRS data by the practice. In summary:
CQRS will go live early June (replacing QMAS).
GP practices may find it useful to undertake phase two training to learn how CQRS works and what is required to ensure that practices continue to receive accurate payments throughout the financial year.
Phase two training sessions will run from the 29 May to the 26 June and are bookable via the CQRS Learning Management System (LMS).
To book onto phase two CQRS training GP practices will need to be registered onto the LMS and have access to an N3 connection. To register and book on the LMS, please read the details on the how to book onto a training session page.
QMAS will remain operational until the 31 July 2013 to allow for end-of-year activities for the QOF for 2012/13. On 2 July 2013, at 8pm, all submissions to QMAS from GP system suppliers and any manual updates or adjustments will be suspended. From this date QMAS will only be available in 'view only' mode for all users until 31 July 2013.
Existing data from QMAS will be migrated to CQRS, giving users on going access to their QOF reports from previous years.
GP Central
Data Base Patient Opt Out
The care.data service is a new project that
is designed to link information from general practice, with
information from hospitals and community health care
services. It
is not the same as the national spine and if patients wish
to opt out they have to do so again.
It is hoped the project will help the NHS
evaluate and improve the quality and safety of the NHS, and
enables patients to make more informed choices about the
treatments and services they use.
The relevant READ CODES are contained in the
information sheet
and the associated
FAQs, developed in partnership with the British Medical
Association and Royal College of General Practitioners.
Further information is available on the
NHS England website
and explains the process of how
data from general practice will be collected, anonymised and
used to improve patient care. The posters and leaflets are
not yet available and we understand that GP practices will
be contacted directly with further details and materials in
June.
Bulletin 183
21.05.13
Locum Appraisals
Contributions
NHS England have confirmed, in a letter to English
responsible officers, direct payment to locums undergoing
appraisal has now ceased. This is being challenged
nationally. In the same letter, NHS England have confirmed
they believe a fair level of remuneration for appraisers is
£500 per appraisal, with an additional amount of £70 for
employer on costs. They have asked responsible officers to
make efforts to move towards this standardised approach as
quickly as possible, and by no later than 1 April 2014.
GP
Health Services
Due to the national withdrawal of occupational health
funding, GP Health (the local service) will cease as of 31
May. The service is a great loss to local GPs but GP Health
have been running without funding since 1 April 2013 and are
no longer in a position to do so. The detrimental impact of
the lack of occupational health services and loss of funding
(which just appears to have been sucked into the system
somewhere and disappeared from all budgets) is being raised
at a national, regional and local level.
Sessional GP Newsletter
This Spring issue of the Sessional GP Subcommittee’s
Newsletter contains updates relating to pensions, injury
benefit, claims for unfair dismissal and revalidation &
appraisal. It also features articles from several
contributors detailing their experiences with support groups
for Sessional GPs, including advice on how to set up your
own.
Bulletin 182
13.05.13
Petussis Vaccination Programme Continuation
The Department of Health has announced the extension of the
extension of the Pertussis vaccination programme for
pregnant women for a further 6 months and sent this
letter to area teams and practices. We have contacted
the Area Team to confirm the extension of this arrangement
in practices from a contractual perspective.
Meningitis C Vaccination Programme Changes
The
Department of Health has also announced that, following
advice from the JCVI, there will be some changes to the
current vaccination schedule for Meningitis C in that the
second dose currently given at four months will be replaced
by a booster dose given in adolescence. The initial change
will be to cease giving the four month dose as from 1 June
2013, and from mid-August 2014, there will also be a
catch-up programme for first time university entrants under
the age of 25 years. We await further details on this
catch-up programme.
Bulletin 181
22.04.13
Commissioning & Conflicts of Interest
The new NHS England guidance on conflicts of interest for
CCGs, ‘Managing conflicts of interest:
Guidance for Clinical Commissioning Groups’ outlines the
statutory governance requirements of CCGs and provides
advice for CCGs on managing conflicts of interest. The
guidance provides details on the CCG’s register of conflicts
of interest such as how often CCGs should update the
register and the steps they should take to ensure that
patients and the public have access to the register. The
guidance clearly states that an individual with a ‘material
interest’ in an organisation which provides or ‘is likely to
provide substantial business’ to a CCG (and this encompasses
commissioning support services) should not be a member of
the governing body. The GPC’s guidance on conflicts of
interest is being updated in the light of the new edition of
the GMC’s Good Medical Practice, new GMC guidance on
conflicts of interest and the NHS England guidance on
conflicts of interest.
Fitness to Drive
Regulations
The DVLA has amended the epilepsy and vision elements of the
minimum medical standards for group two drivers (driving
lorries and buses) in the UK. They have updated the
form for doctors reporting on patients' fitness to
drive and their
information leaflet (with link to attached document)
about the requirements. Because the visual standards now
require a higher level of response from doctors, the GPC
advise GPs to refer patients requesting certification to
optometrists for the vision section of the assessment,
unless the patient has either 6/6 vision uncorrected or 6/6
vision corrected and with recent evidence of prescription
strength.
Taking a Career
Break Guidance
The GPC guidance for GPs considering taking a career break
gives information about Induction and Refresher (I&R)
schemes and lists the important factors to consider before
deciding whether to take a career break.
GP Trainees
Newsletter April 2013
The latest edition of the GP trainee
newsletter covers MRCGP pass rates and costs,
charges for occupational health vaccines for trainees,
useful documents for trainees, and why you should join the
subcommittee, amongst other issues.
DH Letter Confirming Continuation of Premises Payments
The Department of Health has circulated
this letter regarding the continuation of existing
premises related payments
Bulletin 180
16.04.13
GP Contract
Imposition Survival Guide
The GPC is developing survival guides for practices and GPs
to help guide them through the contract imposition. Parts
of this guidance are already available on the
BMA website.
Further guidance will be published over
the next few of weeks so keep an eye on the website. Current
survival guidance include:
Locum pension contributions – for both locums and employing practices
QOF – clinical changes, increase in upper thresholds, reduce time periods
Funding and finance
Enhanced services – risk profiling and care management, dementia, online access, remote monitoring
Vaccinations and Immunisations
Premises Guidance
This
guidance provides information on various elements of
premises information including stamp duty land tax, lease
arrangements and the new premises costs directions.
New Enhanced Services
Guide
NHS Employers and the NHS England have published this
guidance on Enhanced Services (ES) in 2013/14 that will
make use of the General Practice Extraction Service (GPES)
and Calculating Quality Reporting Service (CQRS). The
guidance includes the two extended Clinical Directed
Enhanced Services (DES) and other new/existing ESs including
the 4 new DESs and immunisations and provides primary care
organisations with information to help support the
continuation or introduction of these services.
111
Feedback forms
As you will be aware 111 has now gone live in Tees. We would
be interested to hear your comments as to how the service is
working – good and bad. It is also important that you ensure
that you raise any concerns with the providers and the CCG
using the healthcare professional
feedback form in order that these can be addressed to
ensure the service is a safe and effective as possible.
Please also send any issues that arise to the LMC so we are
aware as to what is being experienced on the ground.
Questions have been raised with regard to 111 repeat callers
and how these will be handled. This has been discussed
nationally with regard to patients taking responsibility for
contacting GP practices rather than the GP being responsible
for contacting the patient. This is certainly an approach we
have requested for the start and are encouraged that
national discussions have resulted in this. As soon as we
have a local update as whether the new national line will be
adopted we will forward this to you.
QOF Business Rules v25
The new QOF Business Rules v25 have been published
here.
Error
in Prescribing General Practice Guide
There is an error in the
Prescribing in General Practice guide
previously circulated
26.03.13 please use this
new guidance.
In the Q&A section, in response to the query 'Can my GP
supply me with drugs directly rather than going to a
pharmacist?' the guidance states: 'a dispensing doctor is
allowed to supply drugs to named patients who live more than
one mile by road from a pharmacy' where as it should say,
'one mile as the crow flies'.
Study Leave
Guidance for GP Trainees
Study leave enables trainees to direct their own learning,
meet their educational needs as set out in their personal
development plan, and cover the wide range of knowledge and
skills required by the RCGP curriculum. This
guidance note has been produced by the GP Trainees
Subcommittee to provide GP trainees with the information
they require for a broad understanding of their entitlements
to study leave and how the process works.
NICE QOF Advisory
Committee
NICE is currently recruiting for specialist membership of
the QOF Advisory Committee, and are seeking applications
from GPs (salaried and trainee), Practice Managers and
Practice nurses and a range of other groups. GPC urge
members and practice staff to apply and would suggest that
those that do so have not just a clinical interest but some
political understanding, bearing in mind how the group's
recommendations have been imposed this year. Further
information including how to apply is available on the
NICE website. The
deadline for applications is Wednesday 24 April. Note
that NICE changed its name to the National Institute for
Health and Care Excellence from Monday 1 April 2013.
Bulletin
179
02.04.13
CQC
Regulation Fees
Care Quality Commission (CQC) has published details of the
fees to be paid by providers, including newly registered NHS
primary medical services (GP practices) from 1 April 2013.
All services registered with the CQC are required under the
Health and Social Care Act 2008, to pay fees to cover the
cost of registration and inspection. Full details of the
fees, including a fee calculator so you can work out exactly
how much you will pay as a practice, are published
here.
QOF Guidance 2013/14
QOF Guidance
2013/14
has now been published.
Good Medical Practice 2013
The GMC have published an updated version of
Good Medical Practice together with explanatory notes.
The GMC publish a raft of
guidance
which practices may find helpful and,
also, host a website ‘Your
Health Matters’
which aims to support doctors with
health concerns.
Bulletin 178
26.03.13
Procurement, Choice & Competition Regulations
The Procurement, Choice and Competition Regulations have
been rewritten and laid under Section 75 of the Health and
Social Care Act. This
BMA briefing provides more information about the
regulations. The Government maintains that the Section 75
regulations are intended to 'ensure good procurement
practice'. However, the BMA is only one of a wide range of
organisations who have expressed serious concerns that the
regulations are unduly restrictive and will, in effect, mean
that CCGs and other commissioners will be required to use
competitive tendering when contracting for the vast majority
of services. The GPC was of the view that the rewritten
regulations offer little to assuage these concerns. In
particular, there is a worrying lack of clarity for
commissioners about the circumstances in which competition
does not have to be used. The committee therefore resolved
that it opposed and called for the withdrawal of statutory
instrument 2013/500. We will forward the GPC guidance on
procurement as soon as it has been updated in the light of
the new legislation.
Prescribing in General Practice Guidance
The GPC has updated its
Prescribing in General Practice Guidance, to include new
and updated guidance on medicine shortages, the transcribing
of medication directions, the use of multi-compartment
compliance aids (previously referred to as Medidose or
Dosette boxes) and supplementary and independent
prescribers. Please note that this guidance replaces the
Information and guidance for prescribing in general practice
from 2004.
Injury Benefit Scheme
Ensure you are aware of the changes to the
NHS Injury Benefit Scheme,
which currently provides
for the payment of either a Temporary Injury Allowance (TIA)
or a Permanent Injury Benefit (PIB) and is being removed on
31 March 2013.
Locum Employer’s Pension Contributions Guidance
This
guidance on the change in locum
superannuation/employer’s pension contributions offer
further advice for practices and locums.
Information Commissioners Office (ICO) Advisory Visits to GP
Practices
The ICO is the UK’s independent regulator of the Data
Protection Act and is offering ‘advisory visits’ to GP
practices. The purpose of these visits is to provide
practices with specific, tailored data protection advice. It
is a free service and practices are legally protected
against being penalised for anything discovered by the ICO
during the visit. These are one day visits to help
organisations develop good practice and identify areas of
potential improvement. They may also provide practical
recommendations and advice on data security and records
management. Practices will be provided with an informative
follow-up report to showing any next steps to take. Further
information, can be found on the
ICO’s website, including details on what the sessions
cover, what the follow-up reports can contain, and how you
can request a visit.
GPC Annual Report 2013
The
2013 GPC Annual Report - written before the publication
of the latest DDRB report and the details of the GP contract
for 2013/14 – is available.
Trevor Silver
Memorial Essay Prize
Are you interested in primary care musculoskeletal medicine?
If so, you may be interested in the
Trevor Silver Memorial Essay Prize.
It is open to all GPs and GP trainees registered in the UK.
Bulletin 177
19.03.13
DDRB Report and
Uplifts 2013
The
2013 report of the Doctors’ and Dentists’ Review Body (DDRB)
was published on Thursday 14 March and recommended an uplift
of 1% for all doctors. Regrettably, the government in
England has not accepted the DDRB’s recommendations in full
for GP contractors and has decided to reduce the uplift
recommended for this group. The Review Body recommended a
2.29% uplift to the overall value of GMS contract payments,
intended to deliver a 1% net uplift for GPs after allowing
for staff costs and non staff expenses. This recommendation
was based on a formula carefully constructed to recognise
rising costs in general practice. The government in England
has however imposed a reduction in the uplift recommended by
the DDRB. The GP contract will receive a 1.32% gross
uplift, which the government says is designed to deliver a
1% net increase to GP income by restricting increases in
practice staff pay, also to 1%. It has not yet confirmed
whether this uplift will be applied differentially across
the various funding streams. If this is the case, some GPs
will receive a lower uplift than others. We are bitterly
disappointed but not surprised that the government has
decided to interfere in the uplift deemed to be fair by the
review body. We believe that in view of rising expenses,
this level of gross uplift is likely to deliver little, if
any, net increase in income, even if the structure of the
contract were to remain unchanged. The impact of this 1.32%
gross uplift must be seen in the context of the imposition
of far reaching contract changes from April 2013; we expect
the detrimental impact of this year’s imposed contract
changes on the income of most GP contractors to offset any
uplift to contract prices. GPs will not forget this in a
hurry and will bear it in mind when asked to put themselves
out for the CCG. To expect GPs to happily participate in an
agenda that involves cutting NHS resources, privatising the
NHS, and then GPs getting the blame when it fails, shows
that someone somewhere isn’t thinking very clearly. GPs may
have to help them see through the fog of their own making.
We will provide a further update once we know how the 1.32%
uplift to GMS contract prices will be delivered. The
following uplifts have been recommended and accepted:
Salaried GPs - the Review Body has recommended that the minimum and maximum of the salary range be increased by 1% for 2013/14. As a result of the DDRB’s recommendation, salaried GPs on the model salaried GP contract should receive an uplift of at least 1% to their salaries.
Trainee GPs - the Review Body has recommended an increase of 1% to GP trainees’ basic pay. For 2013/14 the supplement for trainees will remain at the current rate of 45%.
GP Trainers - the Review Body has recommended a 1% uplift to the GP trainers’ grant for 2013/14. This is in addition to the £750 per annum continuing professional development supplement.
GP educators - the Review Body has recommended a 1% uplift to their pay scale for 2013/14.
Contraceptive Implants Enhanced Service
The Department of Health (DH) has confirmed that as from 1
April 2013, the IUCD NES will come within the remit of
Public Health England, and will, therefore, be for local
agreement. Locally, all sexual health services – including
IUCD – are provided through Assura with practice
subcontracting arrangements. The DH are planning a wider
review of contraceptive services, which would be likely to
be led by Public Heath England, and we will update you if
there are any changes that may impact on the Tees delivery
model e.g. the development of a DES. As it stands at the
moment, practices will see no changes.
Focus on Excessive Prescribing Guidance Update
The GPC has published this updated version of its Focus on
excessive prescribing guidance (to follow), which includes a
new section on shorter duration prescribing, highlighting
that shorter duration prescribing can be associated with
increased costs and decreased compliance.
Locum
Employers Pension Contributions
Practices and individual locum GPs are understandably
concerned about the proposed changes to locum employer’s
pension contributions, which are currently paid by PCTs and
are asking many questions on how the contribution payment
will be managed when, it is proposed, practices become
responsible for the payments on April 1st.
Although not confirmed, it is understood, from the Pensions
Agency, that it is very likely that this change will be
implemented from 1st April and that the process
for making the payments will be as below.
Locums themselves will physically make the payment to the Local Area Team. They will pay their employee’s contribution and the employer’s contribution at the same time.
'GP Locum Form A', which validates that a locum has worked for a practice, will still be used. The form will include a statement to say that the locum wishes to pension the income and will also detail the amount of employer’s contribution to be paid.
The same deadlines for payment will still apply – the locum will still be required to send the cheque and form by the 7th day of the month following the month in which the income was earned.
'GP Locum Form B' (a record of all locum work undertaken in that month) will also be retained.
For GMS practices, the additional costs will be reimbursed via global sum. Practices should, therefore, expect to pay the 14% employer’s pension contribution on top of any locum fees. The GPC are seeking urgent clarification from the Department of Health as to how the costs will be reimbursed for PMS practices. Once we have received confirmation of the process for making the payments, we will be sending out a template pro forma invoice for locums to use to set out their fees in detail, including the 14% employer’s pension contribution.
The Information
Governance Toolkit
Version 10 of the
Information Governance Toolkit
for General Practice went live in June 2012 and the
deadline for final submission is 31 March 2013. The
toolkit encompasses 13 requirements for general practice to
self assess against. Connecting for Health (CfH) state that
completion of the toolkit is necessary in order for
practices to ensure that their CfH (or, from 1 April 2013,
the Health and Social Care Information Centre) services
continue to be provided. One person from a practice will
have been nominated as the IT lead and they will register
for a user account and complete the online self-assessments
on behalf of the practice. We recommend that practices
submit their 2012/13 self assessments by the deadline. This
guidance on information governance for GPs clarifies
what is and is not mandatory. PCTs have traditionally
provided support to practices in regards to their
information governance arrangements. If practices require
assistance with completion of the online toolkit the
national information governance team can also be contacted
via the ‘help’ section of the toolkit.
Bulletin 176
12.03.13
Prescription Charges
This full list of NHS charges from 1 April 2013, includes the prescription charges increase, in England, from £7.65 to £7.85. The BMA continues to call for prescription charges to be scrapped in England in line with the policy in the devolved countries.
Vault Cytology
We would like to re-iterate our advice to practices, in that this work should never be delegated to GPs and that GPs should not to feel pressured to undertake the recall and continued surveillance for their patients, whose indication for ongoing vault smears will have been a malignant diagnosis. In 2011, the Advisory Committee for Cervical Screening and the British Society for Colposcopy and Cervical Pathology (BSCCP) confirmed that the responsibility for follow up care of women who require vault cytology lie with their gynaecologist, not their GP. There is still some flexibility so GPs who wish to continue this practice, can do so on a case by case basis in agreement with their local gynaecologist, but that there is no contractual requirement for GPs to do this. Subsequently, NHS Cancer Screening Programmes have reconfirmed that ‘gynaecologists are expected to take individual responsibility for a woman’s follow up and if they wish the woman’s GP to undertake cytological follow up, they would expect that to be organised between them and the GP on an individual basis’. We believe that this could still be interpreted as if gynaecologists have the discretion to delegate cytological follow-ups to GPs. This would be unsafe and clinically inappropriate, and, therefore, dangerous for patients.
Revalidation Guidance
This guidance on revalidation, provides clarification on how the GPC expect the process to work and deals specifically with some of the practical questions that are arising as revalidation is implemented.
GMS/PMS Regulations
Amendments to the GMS contract and PMS agreement regulations coming into force on 1st April 2013 have now been published.
DWP Fit Note Guidance
The DWP has published revised guidance on usage of the GP fit note. The guidance provides information on completing each section of the fit note, using case studies to illustrate different situations that may arise.
Display Energy Certificates
The DH has confirmed that practices should show Display Energy Certificates. The Department for Communities and Local Government has published this guidance which states 'a DEC and advisory report are required for buildings with a total useful floor area over 500m2 that are occupied in whole or part by public authorities and frequently visited by the public'. Further, general, details are available on this website.
Bulletin 175
05.03.13
Sharps Guidance
The Health and Safety Executive are introducing new Regulations in response to a new European directive on preventing sharps injuries in the healthcare sector (Council Directive 2010/32/EU). The HSE have not yet confirmed when the regulations will come into force, but the directive must be implemented by 11 May 2013. We advise all practices to make use of the outline of the requirements of the directive available on pages 8-9 of the Royal College of Nursing's Sharps Safety leaflet, and the employers' checklist on page 17.
NHS (Pharmaceutical & Local Pharmaceutical Services) Regulations 2013
The NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 were laid on 22 February and will come into force on 1 April 2013. Most PCT duties and functions will transfer to the NHS Commissioning Board, and Local Authority Health and Well Being Boards will take over responsibility for the development and publication of local pharmaceutical needs assessments from PCTs.
Error in 2012/13 QOF Guidance Indicator OST1
The GPC and NHS Employers and have been made aware of an error in the 2012/13 QOF guidance for indicator OST1. The sentence 'the DXA scan codes will only be those that indicate a positive result of osteoporosis, and T score codes will not be included' under the reporting and verification section is incorrect (see page 140 of the 12/13 guidance) and contradicts the business rules. It should read 'The DXA scan codes will only be those that indicate a positive result of osteoporosis'. This correction does not impact the supporting business rules that are correct. Note that a revised version of the 2012/13 guidance will not be issued, and the full guidance is available here.
Bulletin 174
26.02.13
Patient
Group Directives Post April 2013
The Department of Health (DH) is making changes to PGDs to
reflect the organisational structures that will be in place
from April 2013.
The NeLM
website
highlights planned
changes to medicines legislation to enable CCGs, local
authorities and the NHS Commissioning Board to authorise
PGDs. It also outlines the transitional arrangements that
the DH aims to put in place to support transition of
services to the organisations that will be responsible for
authorising PGDs from that date. These arrangements will
allow PGDs to remain legal after the authorising body has
been abolished, and until expiry or authorisation by the new
body responsible for the service in question. It will be
essential that organisations 'inheriting' PGDs (e.g. CCGs)
put in place arrangements and a timetable for review and
adoption/authorisation of all existing PGDs. The NHS PGD
website team is updating the current guidance, and the
existing
PGD guidance document
produced by the National
Prescribing Centre (now the Medicines and Prescribing Centre
at NICE), is also in the process of being updated, expected
to be published in June. As the principles and legal
requirements remain the same, organisations will still be
able to use the existing document to guide them through the
legal framework governing the use of PGDs, and as a
practical guide on their use.
N3 Next generation
Access
The N3 network is being upgraded under the GP Next
Generation Access programme, which will help ensure that
many GPs in England are equipped with faster broadband
technology to help improve access to clinical applications
and services. All practices under this scheme will have
access to broadband of at least 2mbps (megabits per second).
Funding has been made available for every practice in
England to be upgraded under the programme, but we
understand not all have been registered for the upgrade by
their PCT. Practices should now have heard from their local
IT service or the N3 service provider (BT) about their
upgrade, and indeed many will have already had a new router.
If you are not clear on this you should check with the PCT
to ensure that the order for an upgrade has been implemented
or requested prior to the end of March 2013. If you have any
problems please contact
Janice.foster@tees.nhs.uk.
PIP Breast Implants
Following the advice given last year in a letter by the CMO
(England) and in the report by Sir Bruce Keogh that NHS
patients who have decided against having an PIP breast
implant explanation should have an annual follow up by their
GP, the GPC has highlighted concerns in a number of meetings
and letters. Although the advice in the guidance from the
surgical associations remains unchanged, and still suggests
that GPs need to see all those women who have a PIP implant
annually, the GPC advice would be to refer any eligible
patients to a consultant breast surgeon for review. This
view is also shared by the Department of Health. Carrying
out PIP breast implant reviews are outwith a GP’s remit and
should a patient attend a practice and the GP feel
assessment of their implants is outwith their skills and
experience, they should be referred to secondary care.
Francis Report &
GPC Response
The GPC have had an initial discussion about the Francis
Report into the care provided by Mid-Staffordshire hospital
and its implications for general practice. The committee was
particularly concerned about the report’s conclusions on
target-driven cultures in light of the government-proposed
changes to the GP contract, as these proposals would
introduce an even greater focus on targets and box ticking
and damage patient care. Key points raised in the discussion
were:
Suggestions that a regulatory body was introduced for NHS managers.
The need to develop tools and systems to enable clinicians to draw together and report on concerns about patient care and the importance of a duty to listen to go alongside the duty to speak out.
The need for patient-centred holistic care was an important factor in the findings.
The Committee will discuss the report in more depth at March’s meeting. The BMA has posted this response and as a whole is also reflecting on and considering the findings of this report very carefully, pledging to work with others in developing a new NHS culture where doctors feel supported and protected to raise concerns.
Latest NHSCB
Guidance for CCGs
The latest commissioning guidance from the NHS Commissioning
Board (NHSCB). ‘Everyone
Counts’ outlines how the NHSCB will hold CCGs to
account, including the financial allocations CCGs will
receive in 2013-14 and the incentives and outcome measures
the NHSCB will use to measure commissioning performance. The
NHSCB will focus on five areas, which are drawn from the NHS
Outcome Framework:
•
Preventing premature mortality;
• Long term conditions;
• Reducing hospital readmissions;
• Improving patient feedback;
• Reducing the incidence of MRSA and C Difficile.
The GPC expressed fears that the proposals in this guidance will foster a target driven culture that would also be contrary to the aims and recommendations of the Francis Report. Whilst it is important that commissioning bodies are accountable for how they spend public money, the GPC was of the view that the outcome measures identified were too detailed and often without the remit of commissioning bodies.
Quality Premiums
Further proposals for the Quality Premium – the financial
incentive for CCGs to reward commissioning performance –
were also published by the NHSCB. The Quality Premium will
be based on four national measures and three local measures,
to be determined by CCGs and the NHSCB Area Teams. Award of
the Quality Premium will be dependent on CCGs achieving
financial balance. Some of the BMA’s initial concerns about
proposals for the Quality Premium have been taken on board
in these latest proposals, including the need for local
targets to prevent the Quality Premium to become a lever for
central control. However, GPC is strongly of the view that
an incentive based on financial performance has serious
potential to exacerbate health inequalities. The GPC will
continue to raise these concerns with the NHSCB and
government.
Bulletin 173
19.02.13
LESs & the
NHS Standard Contract
From April 2013 CCGs and local authorities will commission
Local Enhanced Services. Public health services will be
commissioned by local authorities and CCGs will commission
all other LESs. These services will be called
'community-based services' and will be commissioned using
the NHS Standard Contract. You can read more about the NHS
Standard Contract
here.
These FAQs
will be regularly updated so please send any questions you
would like answered to
Janice.foster@tees.nhs.uk.
Official Lease Documentation for Practices in PCT Owned
Premises
It is imperative that arrangements between GP tenants and
PCT landlords are officially documented and, as independent
contractors, GPs should always seek their own expert legal
advice before signing any type of commercial agreement such
as a lease. Some lease agreements
do attract stamp duty land tax (SDLT). The Department has
informed the GPC that this will be a one-off payment, but
may not apply in every case (consideration will be given on
a case-by-case basis. GPs should, however, still seek advice
from the practice accountant. SDLT can be very costly and
can cause cash flow problems if, for instance, it is not
given consideration before agreeing to move premises. SDLT
will continue to be reimbursable via the 2013 Premises Costs
Directions (up to 100%), but this will require PCT / Area
Team approval as they have discretion on all new
reimbursements provided for within the Directions.
GPC understands that, following
the transfer of premises ownership from PCTs, NHSPS plans to
negotiate better deals on service charges for its premises
estate. This could include utilities costs, cleaning,
maintenance of communal areas etc. Finally, the
Department of Health and the NHS Commissioning Board have
decided that it is impractical to obtain official
documentation for all PCT-owned premises before 1st
April 2013 (i.e. the deadline for the transfer of ownership
to NHS Property Services). The process will roll into the
new financial year, providing adequate time to negotiate
lease agreements or agree on suitable updates to existing
leases.
Bulletin 172
12.02.13
CQRS –
Training and Registration Issues
NEPCSA have made us aware that some practices are
experiencing difficulties in registering with CQRS and
booking training places. Please note the LMS is only
accessible via the N3 network. If you have experienced
any issues relating to booking a training slot and/or
logging onto the Learning Management System (LMS) in the
past week, please visit the
FAQs webpage
in the first instance and if you are
still experiencing difficulties please email
Janice.foster@tees.nhs.uk with details of the problem
and your practice and we will escalate this to the CQRS team
who will assist.
Booking for CQRS (the programme that replaces QMAS) training opened on 24th January for GP practices and CCGs. The first phase of training will begin on 25th February and will be conducted over a three week period. The sessions will be run via Adobe Connect, a web conference application. They will be hosted by a facilitator and users will be able to interact and ask questions. All the material from the training sessions, along with an audio recording, will be made available from 25th February 2013.Places are limited to one person per organisation. Further information is available here if you or a member of your GP practice or CCG would like to participate in this first phase of CQRS training.
Appraisal & Revalidation – GPC/RCGP Statements
The GPC and RCGP have agreed two statements on
Safeguarding Children and Young People and
Quality Improvement Activity,
written in conjunction with COGPED. The statements were
agreed following numerous reports of PCTs requiring all GPs
to attend training on child safeguarding and young people,
and to clarify the revalidation evidence requirements for
quality improvement activity.
Interim GPC
Response on QOF Proposals
The GPC has published this
interim response
(with link to attached document) to the clinical QOF
sections of the GP contract proposals. They are also in the
process of drafting a full response to the rest of the
proposals. Please help shape the GPC response by feeding in
your views by responding to the
BMA survey.
Bulletin 171
05.01.13
Measles and Management of Staff
There is some confusion as to what practices need to do for
staff with regard to the recent measles outbreak. Practices
should review the immunisation status of staff as
appropriate, particularly those whose work involved face to
face contact with patients. This means you should check
staff have 2 recorded doses of MMR or recorded confirmed
exposure (pre 1970 age group). If not then you may consider
testing immunity of staff or recommending MMR if appropriate
though there is no obligation to do either unless a
confirmed case has been recorded within your
practice/patients. If specific action is required by your
practice the HPA will usually contact you (usually following
a confirmed case within your locality or practice). Immunity
testing falls under occupational health obligations and, as
such, the cost sits with the practice. If your staff have
been exposed to measles (you have had confirmed cases within
your practice/patients), you should follow
this guidance on the management of healthcare workers.
If you are still unsure of the action you need to take
please contact Janice Foster 01642 745 813 or Julia Waller (HPA)
on 0844 2253550.
Chest Pain
Patients Checklist
We have been working with NEAS with regard to 12 lead ECG
recording and vital signs on chest pain patients referred to
the 999 ambulance service and have agreed
this checklist as good practice for all practices. NEAS
understand the concerns primary care clinicians will have
when they come across patients at the surgery who have a
history of chest pain and need prompt hospital
assessment/subsequent management. As treatment for MI is
time critical, it is standard practice for the surgery staff
to request a 999 ambulance. While awaiting the ambulance, a
patient with an infarct/severe ischaemia is at risk of
abrupt deterioration due to ventricular arrhythmias. For
this reason they should be observed in a suitable clinical
area until the paramedics arrive. Aspirin should be given as
soon as possible, in doing so, and whilst waiting for the
ambulance to arrive, the vital signs should be measured and
the ECG should be recorded, where possible.
Copies of
Medical Records Fees
To further clarify advice we have previously given and
questions we are receiving; the following fees apply to
copies of medical records. This guidance applies to the fees
only and does not cover consent. If you have specific
questions on consent or what information should be included
please contact Janice Foster – 01642 745 813.
Deceased Patient:
Request should be made under Access to Health Records Act (AHRA)
Fees:
For access only = £10 max
For copies = £10 + cost of copying and postage
For access or copies of records pre Nov 1991 = practice to set charge (possibly in line with collaborative arrangement fee if it is considered appropriate to disclose this information at all as there is no right of access)
To provide advice to the PCT = practice to set charge (possibly in line with collaborative arrangement fee where the PCT holds the records and, therefore, responsibility as the statutory provider and copier of the data)
Living Patient:
Request should be made under Data Protection Act (DPA)
Fee:
For electronic records (including access and/or copies) = £10 max including postage (very few, if any practices have ALL electronic records so check if you are unsure)
For paper or part paper (including access and/or copies) = £50 max including postage
We
appreciate the agreed fees under the DPA rarely cover the
cost of postage etc as they were set such a long time ago.
You can raise this with the person making the request and
ask that they cover the reasonable charges (e.g. additional
postage) involved as the guidance does state that the
charges should be proportionate and justifiable and reflect
the actual costs incurred. However, should the requestor
decline, unfortunately, you are still obliged to provide the
information at the agreed fee.
Bulletin 170
29.01.13
GP Trainees
Subcommittee Newsletter
You can view the latest newsletter from the GP Trainees
Subcommittee
here.
BMA Research Grants 2013
The 2013 research grants are now available to apply for
online on the
BMA website. The application
deadline is 15 March 2013 at 5pm. 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 totaling 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.
Subject specifications for each grant vary. For example, in
2013, research areas range from rheumatism and arthritis,
cardiovascular disease and cancer to neurological disorders
and terminal care.
For more information on the grants on offer in 2013 and details of how to apply, please see: www.bma.org.uk/researchgrants. If you have any questions about the BMA research grants, or would like to receive alerts about them, please contact Hugh Garnett at info.sciencegrants@bma.org.uk or telephone 020 7383 6755.
Eric Gambrill
Travelling Fellowship
Applications are invited for up to two Eric Gambrill
Travelling Fellowships, to be awarded in Spring 2013. The
value of each Award is £3,000 and the closing date for the
receipt of applications is 07 April 2013. 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. Application forms and further
information may be obtained via the
website, or from: The Honorary Secretary to the
Trustees, Eric Gambrill Memorial Fund, Altyre House, Church
Lane, GRAYSHOTT, Hindhead, Surrey GU26 6LY or via email:
vanessambmason@aol.com.
Bulletin 169
22.01.13
Medicines Supply Chain Guidance Update
The Department of Health has updated its guidance on ‘Trading Medicines for Human Use: Shortages and Supply Chain Obligations’ and ‘Best Practice for Ensuring the Efficient Supply and Distribution of Medicine to Patients’ to take account of the introduction of the Human Medicines Regulations Act 2012. Trading medicines has also removed mention of registered pharmacists exporting drugs and updated references to RPSGB to the General Pharmaceutical Council and their principles and standards.
Bulletin 168
15.01.13
GP Locum
Handbook
The BMA recently published the GP Locum Handbook, ’The
Essential Guide for Freelance GPs’ which provides advice on
setting up as a locum, starting a new business and
establishing a contract for services with a provider. It
also looks at different types of locum work and contains
information on professional issues such as appraisal and
networking. The Handbook is available for BMA members only
- please log in to the website to access it at
www.bma.org.uk/sessionalGPs.
GP Trainees Newsletter
The latest edition of the
newsletter for GP trainees, including advice on expenses
and information on the Junior Members Forum, is now
available.
Bulletin 167
08.01.13
Locum Superannuation
The government is proposing that from April 2013, GP
practices will pay locums’ employer pensions contributions,
which are currently paid by PCOs. The GPC understands that
the intention is that the funds would be moved into global
sum. This change would be introduced via amendments to the
NHS Pension Scheme Regulations, which are currently
being consulted on by the government. The GPC is very
concerned about the implications both for practices and for
GP locums and the BMA will be responding to the consultation
to express these concerns, as well as raising it via GPC
negotiations with the Department.
NHS Commissioning Board (NHSCB) ‘Everyone Counts’ Planning
Guidance
The NHSCB has published planning guidance for CCGs
‘Everyone Counts’ which outlines priorities set by the
NHSCB, financial allocations and contains details of the
Quality Premium. The GPC has opposed plans for the Quality
Premium – a financial incentive for commissioners – on the
grounds that it has potential to exacerbate health
inequalities, as CCGs commissioning for more challenging
populations may find it more difficult to achieve any award
available. Further details about how the Quality Premium
will be calculated are expected in January 2013, however,
the reward will be dependent on CCGs achieving:
High standards against four outcome measures drawn from the NHS Outcomes Framework, which for 2013/14 will be:
o potential years of life lost from causes considered amenable to healthcare
o avoidable emergency admissions
o patient feedback - the Friends and Family Test
o incidence of MRSA and C Difficile;
Three locally identified measures to be agreed between CCGs and the NHSCB in consultation with Health and Wellbeing Boards and patient representatives;
No ‘significant quality failures’ during the year;
No overspend on approved Resource Limit in 2013/14;
The NHS Constitution Rights and Pledges.
The GPC will continue to work to influence plans for the Quality Premium and will be lobbying on the calculations guidance and regulatory framework when they are published.
NHS111 FAQs
Further to the recent questions relating to the local
Directory of Service (Dos) the NHS 111 National Clinical
Advisors have provided this
FAQ document on behalf of the Department of Health.
King's Fund
– Time to Think Differently
The King’s Fund has recently launched their new
Time to Think Differently programme. A central aim of
Time to Think Differently is to stimulate debate about the
changes needed for the NHS and social care to meet the
challenges of the future. Firstly, the King’s Fund has
created some online content on the trends that will
influence the way health and social care is delivered in
future. Secondly, over the next few months the King’s Fund
will be looking at the challenges that lie ahead and
discussing potential solutions and providing the opportunity
for individuals and organisations to feed into this debate
through their website.