Bulletin 248
23.12.14
Co-Commissioning,
GPC Guidance
You have received information from your CCG with regard to
co-commissioning – it is vital that you read this
information and take this opportunity to inform their
intentions. This is your opportunity to have your say –
every practice should make their voice heard.
GPC Chair, Chaand Nagpaul sent this
message to all GPs
and the
GPC recently published this
guidance designed to inform GP practices about
co-commissioning, including the commissioning and
performance management of general practice contracts. It is
important that all practices understand these changes and
their implications. This guidance follows the release of NHS
England’s plans for primary care co-commissioning, outlined
in the ‘Next steps towards primary care co-commissioning’
report, and the request from NHS England for all CCGs to
express their intentions for co-commissioning in January.
The Next Steps report provides information on the scope of
co-commissioning arrangements that CCGs can apply to take on
board from April 2015. This includes the option for CCGs
to maintain their current arrangements and not apply for any
of the co-commissioning models proposed.
The three models described in the report are:
(1) greater involvement in primary care commissioning,
(2) joint commissioning with area team (application deadline
is 30 January), and
(3) delegated commissioning (application deadline is 9
January).
Amongst the many changes outlined in the report, a number are of great concern to the GPC. These include the proposal to extend the following powers to CCGs who take on board delegated commissioning:
The GPC will be issuing further specific guidance covering conflicts of interest in early 2015. NHS England has released this Conflicts of Interest Guidance for CCGs.
CQC Intelligent
Monitoring Update
The GPC is considering whether any further action might be
possible on behalf of practices who were banded
inaccurately. They would like to hear from any practices
that were subsequently informed by the CQC that had been
placed into the wrong band. Please contact Greg Lewis,
glewis@bma.org.uk, in the GPC secretariat with details.
Following the CQC’s introduction
of intelligent monitoring, based on a narrow range of
indicators, the GPC wrote to Professor Steve Field to
express concern about the process and the way GP practices
had been publicly banded ahead of inspection - arguing that
the data used to band practices had been published without
proper context and was misleading patients. The information
did not take into account the differing circumstances in
which GP practices operate, including levels of deprivation
in the practice population, the level of support the
practice receives from community services or the state of
its facilities. These and other factors outside the
practice’s control had a major impact on how well it
performed against these indicators. It was predictable that
the publication of the indicators and in particular the
bandings for all GP practices in England would result in
hostile press coverage that did not reflect the reality of
good health care being delivered by the vast majority of
them. While the CQC stated on its website that “intelligent
monitoring” was not a judgement on GPs that is exactly what
it became, with some uninformed and inaccurate stories at
both a local and national level. The negative reporting in
local media was particularly damaging as GPs and their
practice staff, rooted as they are in local
communities, had their reputation undermined with practices
being subject to unfair criticism. Subsequently, on 5
December, the CQC announced that it was revising the
intelligent monitoring indicators, as a result of which a
number of practices were placed in different bandings. The
GPC reacted strongly to this announcement, urging for the
banding system to be withdrawn.
CQRS December QOF Reporting
There’s been an issue with the QOF reporting collection in
December that has prevented QOF data from coming into CQRS.
You won’t receive data back from this collection and you
don’t need to take any further action. The December
collection is part of the normal reporting collections cycle
for QOF. HSCIC will be running the next scheduled collection
in early January. In line with previous years, payments for
QOF 2014/15 will be based on final year-end achievement
which can be made from April 2015 onwards. No payments are
based on the data in the monthly reporting collections –
other than the final year-end collection in April.
Managing Injuries to immobile Children, CCG Guidance
The CCGs have requested we forward this
guidance and
protocol/flowchart
on managing injuries to immobile children following
publication of several SCR’s in neighbouring areas in
relation to significant injuries/death of immobile children.
It does not replace procedures however, the CCGs hope it
will support appropriate decision making and communication
to parents.
Sessional GP Newsletter
The second monthly
e-newsletter for sessional GPs focuses on the recent BMA
Conference for sessional GPs, initial findings from our
survey on sessional GP experiences of appraisal and
revalidation and working as a GP appraiser.
MEDFASH Educational Tools on HIV Testing in Primary Care
MEDFASH has developed HIV Testing in Practice (HIV
TIPs), an online educational tool, to help increase
rates of HIV diagnosis in primary care. Launched in National
HIV Testing Week, the interactive web tool will enable GPs,
practice nurses and their teams to raise their knowledge of
HIV and enhance their confidence in offering HIV testing.
This in turn will reduce the avoidable illness and deaths
that still occur because of late diagnosis. It provides
updates about HIV testing in primary care; includes patient
stories, quizzes, group exercises, downloadable teaching
materials and an HIV testing audit tool and will help GPs
and practice nurses to:
Developing Patient
Leaders
Practices may find this programme designed to develop
patient leaders of interest to their PPG members. This is a
free course and closing date for expressions of interest is
9 January 2015. Please find information attached regarding
our Developing Patient Leaders programme. You can find
further details and how to register in these supporting
documents.
Bulletin 247
09.12.14
Referral Letters
for Urgent Care
We have been made aware that there are sometimes delays in
secondary care receiving GP letters following a GP referring
patient for urgent admissions/AAU/ A&E. Please can you
ensure that all patients are provided with a letter when you
direct them to one of these services? If used consistently
it can assist practices in supporting evidence where a
patient may present at A&E/AAU stating a GP had sent them
when they had, indeed, not attended the GP practice; as well
as assisting the patient and the Trust.
Individual Funding Requests
We have been made aware of a change to the process for
Individual Funding Requests. Correspondence will be sent
from the CCGs but please be aware that this system is moving
to an entirely online system and paper referrals will no
longer be accepted as of 15 December. If you have not
already done so, we recommend your practice registers an
online account at
https://ifr.sotw.nhs.uk.
Seasonal Flu Correspondence
We have been made aware that some practices may be deleting
important public health messages with regard to seasonal flu
without having read the content. We appreciate that you are
inundated with messages from various sources but some of
these messages do require action on behalf of the practice
which is mandatory. Therefore, it is important you read
these messages then manage them appropriately otherwise, by
the time the urgent reminder arrives you are left with very
little time to respond/collate information in order to meet
deadlines.
Dementia
Diagnosis Enhanced Service
We were pleased to note that NHS England has listened to
concerns and will not be continuing the flawed dementia
(diagnosis) enhanced service from April 2015. The GPC have
always opposed the chasing of arbitrary targets in diagnosis
rates, and believe that what is needed is to look
holistically at the detection and management of patients
with dementia. It was never believed appropriate to link
payments to specific targets as this undermines the
relationship GPs have with patients, and the GPC and LMC
maintain that care should be based on clinical need rather
than financial imperatives.
BMA Message, Chairman’s Email
Every two weeks the BMA distributes an email newsletter from Chaand Nagpaul,
Chair of the General Practitioners Committee, to all GPs for whom we have email
addresses, irrespective of whether or not they are BMA members. If you aren’t
receiving Chaand’s newsletter direct from the BMA:
BMA members please check your email details through the BMA website bma.org.uk and update if necessary; if you haven’t already done so, you will need to register to set up a web account.
Non-members with web accounts can also update via the website. Other non-members should send their email details to membership@bma.org.uk quoting their GMC number.
If you are experiencing problems with updating your details, please email membership@bma.org.uk.
Bulletin 246
02.12.14
Change in Immunisation & Screening Enquiry Line
From Monday 1st Dec the contact details for the Durham,
Darlington and Tees (DDT) immunisation and Screening enquiry
line are:
Tel: 01138253017
Email: england.cane.screeningimms@nhs.net
The process of accessing guidance and reporting incidents will remain the same however, our screening and immunisation colleagues in the Cumbria, Newcastle, Tyne and Wear (CNTW) team will participate in offering guidance and advice alongside the DDT team.
CQC
Inspection Guidance
This GPC
guidance page on CQC inspections will be a living web
page and will include regular updates based on feedback and
future developments. Any comments are, therefore, very
welcome. In particular, GPC plan to include a link to a page
detailing the personal experiences of those practices that
have already been through the new inspection regime. Again,
if you would be willing to contribute, please get in touch
with
Janice.foster@tees.nhs.uk.
Friends & Family Test Data Submission Guidance
This joint BMA, NHS England,
NHS Employers guidance on data submission accompanies
the GPC’s more general
FFT guidance.
Bulletin 245
25.11.14
NHS Property Services Lease Guidance
GPC have collaborated with BMA Law to put together this
short
guidance note about the NHS Property Services lease that
is currently in circulation. It provides an outline of the
headline issues and key provisions arising from the lease
including:
We are still seeking clarification with NHSPS on the exact nature of this document and the scope of its intended use. To that end, we will be meeting the Chief Executive of NHSPS in early December, and intend to make it absolutely clear that the current document is inappropriate. GPC are meeting with the Chief Executive of NHSPS to raise concerns about the appropriateness of the current document and continue advise all practices in NHSPS properties is that they should under no circumstances sign any current standard lease or other document from NHSPS without receiving full legal advice in order to understand the consequences of signing the lease.
Extension of Enhanced Service for MenC
Freshers Vaccination programme
The enhanced service for the MenC Freshers
vaccination programme is extended until March 2015 due to
reported outbreaks. Area teams will be informing all
practices of the extension and issuing this new
specification shortly. Participating practices can
continue to vaccinate patients. Practices who have not
signed up must be offered the opportunity to do so.
Seasonal Flu Vaccinations for Patients with
Learning Disabilities
There are a number of queries requesting clarification
around the position on flu vaccinations for patients with a
learning disability. Although this cohort is included in the
service specification under the category for ‘neurological
conditions’, the line ‘using clinical judgement’ has been
causing some confusion. As such, NHS England intends to send
out a bulletin to clarify this. GP practices should be aware
of information material to support the drive to offer
vaccinations to people with learning disabilities. NHS
England SharePoint provides materials/information for
parents of children with learning disabilities, adults with
learning disabilities and Headteachers of Special Schools on
the reasons for being vaccinated against flu. Practices and
providers can use this information to encourage more people
with learning disabilities to be vaccinated.
Friends & Family Test, Brief GPC Guidance
GPC have produced this brief
guidance on the Friends & Family Test to accompany the
more extensive joint guidance that was highlighted in
bulletin 242.
GPSoC, Contracts Signed for Lot 2 Services
The Health and Social Care Information Centre (HSCIC) has
announced that
agreements have now been signed with 30 suppliers to enter
into the new GP Systems of Choice (GPSoC) framework, to
provide Additional GP IT Services (Lot 2). This will enable
practices and CCGs to procure additional software, hardware
and professional services, complementary to those available
under Lot 1. A summary of the products and services each
supplier intends to provide is available on the
HSCIC website. The HSCIC will now work with suppliers on
a Lot 2 online catalogue detailing their service offerings.
This will be published in December 2014 and will be
accompanied by 'how to buy' guidance to support local
organisations in ordering services. Services will be funded
by the local organisations and ordered through a Call Off
Agreement. This will allow ordering parties to negotiate
some of the contract terms relating to delivery of the Lot 2
services, such as service management and implementation
provisions.
Armed Forces
Covenant
We have been asked by NHS England to draw attention to the
commitments of the Armed Forces Covenant that came into
effect through the Armed Forces Act 2011 and NHS England has
passed on this
information.
Sessional GP Revalidation Survey
If you are a sessional GP, please take a moment to complete
this online
GPC revalidation survey to provide your views on your
experience of revalidation and appraisal.
Royal Medical Benevolent Fund Annual Appeal
2014
The Royal Medical Benevolent Fund seeks your support for
their
Annual Appeal.
Bulletin 244
18.11.14
CQC Intelligent Monitoring Data on GP Practices
These
FAQs provide details on the
CQC Intelligent Monitoring Data tool, which helps inspectors
prioritise when, where and what they will focus on when they
inspect. This tool draws on existing national data sources,
such as Quality and Outcomes Framework (QOF) and the GP
Patient Survey, and includes indicators covering a range of
GP practice activity and patient experience. Based on 39
indicators, each GP practice will be categorised into one of
six priority bands, with band 1 representing the highest
priority for inspection. CQC emphasise these bandings are
in no way ratings or judgements on the quality of care
being given by a GP practice – that only comes after a CQC
inspection. This is one tool of many, and one part of the
wider information we gather to help inform our inspections.
Practices can view their individual reports, including
priority banding, via the CQC website and the public also
have access via a
postcode search.
Out
of Area Registration
All practices have received the specification and guidance
for out of area registration via email from the Area Team.
If you have not received this please contact
Janice.foster@tees.nhs.uk. Deadline for sign up is
Friday 28 November and practices are advised to remind
themselves of the
GPC guidance on this issue. This agreement purely
pertains to the delivery of care for patients choosing to
register with a practice outside their area of residence. It
is for individual practices to decide as to whether they
wish to contract with the area team to provide care for
patients who live within their practice boundary, or beyond,
but are registered elsewhere bearing in mind the required
information flow, monitoring, payment and validation
requirements. Regulations are in place for practices to
register out of area patients and you do not need to sign
this agreement should you choose to do so. However,
practices are strongly advised that they should NOT
currently register any patients to whom they do not intend
to provide home visits until they have sought and obtained
assurances from the area team that arrangements are in place
for individual patients. It would neither be clinically
appropriate nor practical to register patients without home
visits whilst there is no assurance that arrangements for
their care outside of the practice area are in place.
Sessional GP Newsletter
This first monthly GPC
e-newsletter for sessional GPs focuses on the
implications of the 15/16 GP contract agreement for
sessional GPs, a survey on sessional GP experiences of
appraisal and revalidation and some guidance on the
relationship between sessional GPs and LMCs.
Cameron Fund Loans Scheme and Christmas Appeal 2014
May we draw your attention to this
Cameron Fund Guaranteed Loans scheme for GPs who are
undergoing retraining and experiencing financial difficulty?
Also, it is that time of year again when the Cameron Fund
seeks your support for their
Christmas Appeal - apologies for mentioning Christmas in
November! The Cameron Fund is the only medical benevolent
fund that solely supports GPs and their relatives at times
of need. The Christmas Appeal to colleagues has made a real
difference to the Cameron Fund in the past and the
continuing work they do to support your colleagues.
Bulletin 243
11.11.14
Seasonal Flu – Immform Reporting Issue and GP Worker Data
Public Health have made us aware
of a potential reporting issue for TPP practices. The
uploading of flu vaccination figures via Immform for TPP
practices is not currently accurate. IT are trying to
resolve the issue but Public Health are concerned that it
may cause some issues for practices from a claim
perspective. Please double check the uploaded data and if
you encounter a problem contact
Aline.marron@nhs.net.
Seasonal Flu, GP
Worker Data
All practices received an email from Aline on 7 November
with regard to practices manually uploading data with regard
to practice staff flu immunisation numbers. The first
deadline for data completion is Tuesday 11 November! Aline
has provided a table of subsequent deadlines to assist
practices. If you have not received this email or have any
problems completing the data please contact
Aline.marron@nhs.net.
NHS England 5 Year Forward View, GPC Recommendations of
Urgent, Short Terms Measures
NHS England has published its
Five Year Forward View. The strategy is far-reaching and
enters uncharted waters for the NHS, including proposals for
radical new models of care, which would have significant
implications for GPs and practices. The BMA GPs committee is
giving this report full consideration. Meanwhile, the GPC
has already given recommendations as to the urgent, short
term
measures the
government and NHS England need to put in place.
Bulletin 242
04.11.14
Christmas and
New Year Opening 2014
As the holiday season fast
approaches it is only a matter of time before practices
receive a message from NHS England with regard to opening
hours. Please note that the Area Team is mandated by NHS
England to collect information with regard to practice
opening. Practices wishing to close early on Christmas Eve
and New Year’s Eve should act in accordance with the BMA
guidance which details contractual requirements
and suggests actions practices might consider to ensure
patient’s reasonable needs are met.
Summary Table of QOF Changes 2015/16 and QOF Business Rules
v30.0
This full summary
table outlines the agreed QOF changes for 15-16.
Additionally, v30.0 of the QOF Business Rules have now been
published on the HSCIC
website.
Deprivation of
Liberty Safeguards
The GPC has issued this
guidance covering Deprivation of Liberty Safeguards (DoLS).
It should be noted that there is no statutory requirement
for the Registrar of Births and Deaths to refer the deaths
of those who are subject to DoLs authorisation to the
coroner. However, there is a common law duty which applies
to everyone, to refer deaths to the coroner where there is
reasonable cause to suspect that the person died a violent,
unnatural or sudden death, the cause of which is unknown, or
where a person has died in prison or policy custody. In the
event that a person in their care should die whilst subject
to a DoLs authorisation, care homes and hospitals who are
managing authorities need to know how to contact the
relevant coroner’s office. If in doubt, it is always
preferable to report the death. The action taken by the
coroner will vary and could include the commissioning of a
post-mortem examination or the opening of an inquest (with
or without a jury). Equally the coroner could decide that no
further action is necessary. Until the coroner has made a
decision on whether to undertake a further investigation, a
doctor should not issue a medical certificate of cause of
death.
Fluenz Tetra Read Code
The Read Code for Fluenx Tetra has now been added to the
seasonal influenza and pneumococcal vaccination programme
information.
Patient
Online Toolkit and Local Contacts
NHS England’s Patient Online Programme has developed an
interactive
Support and Resources Guide to help practices get
started with records access, identity verification, coercion
and proxy process. The aim of the materials is to help
practices fulfil the IT requirements of the 14/15 GP
contract by March 2015 i.e. online booking of appointments,
online ordering of repeat prescriptions and online access to
summary information held in patients’ records. The guide
includes materials developed by the
RCGP. For further information please contact
england.patient-online@nhs.net. Please note
that the toolkit is work in progress, with updates to the
guidance and more resources to be added through 2014/15,
therefore, the guidance and suggested actions for practices
are subject to change. Locally, Fiona McDonald, who is
working as a Digital Clinical Champion, and Kay Renwick, who
is the Implementation Lead, are working to offer clinical
support with this change. Additionally, throughout the
Northern Region there are two other Digital Clinical
Champions (Rose Curry and Taz Alawoud), and one other
Implementation Lead (Pam Jenkins) working on the programme.
Kay has extended the offer to attend Practice manager or CCG
meeting (individual practice meetings are not manageable at
this time) to discuss the work further and ensure practices
have the required support and information to meet
contractual requirements. If you feel that this support
would be helpful in order to implement the programme please
email your request via Kay Renwick (Kay.renwick@nhs.net),
who will make the necessary arrangements.
Friends and
Family Test Materials
NHS England has published a range of
materials relating to
the Friends and Family Test to assist practices in
publicising the scheme. The Friends and Family Test becomes
a contractual requirement fir practices from 1 December 2014
and this joint GPC, NHS England and NHS Employers
guidance may assist practices with implementation.
Care.data Pathfinder
Stage
The CCG areas for the care.data pathfinder have been
confirmed (no north east CCGs) to trial, test, evaluate and
refine the data collection process, including communications
to patients. The care.data Advisory group is inviting
participation in their third public discussion on the work
they are doing in relation to care.data. The session will
examine some of the proposed responses to issues raised by
staff, patients and public. The meeting is to be held on 26
November 2014 (6pm – 8pm) in central Manchester and those
interested can register
here.
Department of Transport Guidance for Healthcare
Professionals on Drug Driving
This
guidance provides an explanation of the new drug driving
offence including the statutory ‘medical defence’ available
to patients who have taken their medicine in accordance with
the advice of a healthcare professional and the information
contained on the leaflet accompanying the medicine. It also
reiterates existing advice that healthcare professional
would normally consider giving to patients about taking
medicines that could impair their driving.
Payment
of NHS Pension Scheme Contribution
During recent months a number of practices have not met the
deadline for payment of pension contributions for their
staff in the Scheme. From 1 April 2014, NHS Pension Scheme
regulations changed authorising NHS pensions to charge
interest at a rate of 4.7% APR and an administration charge
of £75 to employers who pay late. An amount is deemed late
where contributions do not reach the NHS pensions bank
account by the 19th of the month, following the
month in which the earnings were paid to the member. In
order to inadvertently avoid paying late when using the GPI
payment processing method, please note the following:
Ensure you submit the payment request with sufficient time for the payment to clear. The GP1 submission initiates a Direct Debit payment from your bank account that requires two to five working days (the excludes weekends and bank holidays). Payments submitted by the recommended processing date and time will ensure payment is received on time.
Ensure you press the ‘submit’ button on the GP1 at the bottom of the screen. A small number of employers have missed making a payment because they have printed the input screen when processing the GP1 without finalising the action. A screen message will confirm your payment has been submitted.
To assist employers in ensuring they meet the payment deadline, this GP1 payment processing schedule details the deadline dates for the remaining months of the 2014-15 financial year. If you have any questions please email nhsbsa.pensionsfinance@nhs.net. Further information regarding the introduction of the changes to the Scheme Regulations can be found in the March Employers Newsletter.
Maternity Pay for GP
Trainees
The GPC understand there may be some confusion for area
teams regarding the payment of maternity leave to GP
trainees. To clarify, each new post on a rotation that a GP
trainee undertakes does not constitute a break in service
and there has been no change in policy to the contrary.
Where practices have followed the provisions in the GP
trainees framework contract on maternity pay, which are
consistent with the
Directions to the Health Education England (GP Registrars)
2013 and the NHS Litigation Authority (GP Registrars) 2013,
the GP trainee is entitled to receive ordinary maternity pay
(OMP) and should be fully reimbursed in accordance with the
Directions.
Paragraph 15.3(b)(iii) of the SFE 2013 (page 58)
confirms that NHS England should reimburse maternity pay if
‘the performer on leave is entitled to that leave under…a
contract of employment’.
Doctors
in Training Contract Negotiations
Unreasonable demands from the Government have resulted in the year of
negotiations on a new contract for doctors in training coming to a halt with no
agreement. The BMA entered discussion to fight for positive changes covering a
range of complex issues including unsociable hours, leave and business and
travel costs. However, one sticking point appears to have been the training
supplement. Given the Government’s stated aim of increasing the number of GP
trainees it seems at odds that the supplement which was introduced for
recruitment and retention purposes and is of vital importance appears to be one
of the key sticking points in the negotiations. The DoH has now instructed the
DDRB to make recommendations on a number of points. Full details are available
here. The BMA has been given a deadline of 31 December 2014 and it is
anticipated the DDRB will report in July 2015.
BMA 2015 Research Grants
The 2015 BMA Research
Grants are available for application from 9 December 2015. The deadline is 9
March 2015 and applications are invited from medical practitioners and/or
research scientists for research in progress or retrospective research. Alerts
or further information can be requested via
info.sciencegrants@bma.org.uk or 0207 383 6755.
Bulletin 241
28.10.14
Bulletin 240
21.10.14
Additional/New Dementia Enhanced Service
It is for practices to decide whether to sign up for this new scheme, which is
designed to operate in addition to the existing dementia enhanced service, not
instead of it. Key points you may wish to consider in this decision making
process are:
The enhanced service pays for diagnosis only
No payment for participation in the scheme or for planning
Payment will be based on the net increase in the dementia register on 31 March 2015
No payment for newly diagnosed patients who subsequently die or leave the practice
No payment where patients are referred to specialist services before 31 March 2015 but diagnosed after this date
Avoiding Unplanned Admissions (AUA) and CQRS
Practices signed up to the AUA DES need to know their
practice list size figures. Whilst initial guidance stated
these figures will be provided via Exeter report, you will
in fact be able to view your list size via CQRS. HSCIC will
be advising practices of this in their information
accompanying the launch of CQRS which is due shortly.
Flu Patient
Information Leaflets
Patient leaflets on flu have now been published and will
soon be available to order in hard copy through the
order line or by phoning 0300 123 1002. As always, there
has been a central delay in releasing these. The CCGs are
also planning a flu communication campaign.
Practice Nursing
You may have received this
letter providing an overview of ongoing work between NHS
E, HENE and other organisations to support the training and
development of nurses working in general practice across
Durham, Darlington and Teesside. Cleveland LMC has met with
NHS E and HENE to discuss this important area work and we
are encouraged that the need to support and training in this
area has been recognised. This
document provides further information with regard to the
development of pre-registration placements in primary care
for student nurses.
Bulletin 239
14.10.14
2015/16 Contract FAQs
Practices may find these
FAQs for the 2015/16 contract agreement helpful.
Additional/New Dementia Enhanced Service – Dementia
Identification Scheme
You should have received/shortly receive details of a new 6
month national enhanced service (NES) –
Dementia Identification Scheme - from NHS England.
This NES sits outwith the15/16 contract negotiations and was
pulled together very quickly by NHS England as a result of
Prime Ministerial pressure to improve national
identification and recording rates of patients with
dementia. The enhanced service will pay practices £55 for
every new diagnosis of dementia made prior to March 2015. It
is highly likely that there will be a number of questions
raised as the detail of the specification is considered. We
will provide guidance as soon as it is available but if you
have any questions in the meantime please do not hesitate to
email
Janice.foster@tees.nhs.uk and we will try to provide
answers to specific questions.
QOF
Changes 15/16
Details of the
QOF changes for 2015-16 have now been released. We hope
practices will welcome GPC negotiating minimum changes for
the coming year affording practices a little stability in
one element of their work in these uncertain times and
assisting practices through being resourced to provide
clinically appropriate care, and with more appropriate
weighting of QOF points.
As per the contract agreement, the overall points value and
thresholds in QOF remain unchanged. However, 26 CKD
indicators will end (the register remaining), with most of
this transferring to the dementia domain, increasing the
value of carrying out dementia care plans, to reflect the
greater workload for GPs in this area. In addition, the CHD
indicator (CHD006) will also end, with the points
transferred to amended AF indicators to reflect the
increased workload associated with current clinical
management of AF with anticoagulation.
CPR Guidance
The BMA, Resus Council and RCN have updated their
joint guidance on the
cardiopulmonary resuscitation.
Bulletin 238
07.10.14
2015/16
Contract
Negotiations with NHS Employers for the
2015/16 GP contract have concluded and an agreement has
been reached. The changes provide some much-needed breathing
space for practices, through further reductions in
bureaucracy; with a decrease in workload in the Avoiding
Unplanned Admissions DES and the withdrawal of the Alcohol
and Patient Participation DESs. Improvements have been made
around cover for maternity/paternity/adoption leave and
there will also be a requirement for all patients to have a
named GP in future. I will pull together a 1 – 2 page
summary sheet for ease.
The changes to the contract will not in themselves solve the workforce crisis or address the exceptional strain affecting general practice. In order to tackle these wider issues, the GPC wrote to and met the Secretary of State of Health in July to propose a set of urgent measures designed to relieve the pressure on GP practices.
GP
Electronic Annual Practice Declaration
NHS England wrote to all practices (23 September email) to
inform them that the 2014/15 GP electronic Annual Practice
Declaration (eDec) will be open for submissions over a five
week period from Monday 6 October to Friday 7
November 2014. The letter included a set of FAQs. All GP
practices are required to submit their eDec electronically
through the
primary care website.
This year they have been able to pre-populate 76% of the
eDec with responses provided from last year’s eDec
submission – including the catchment area and any updates
which practices have since made to it when in the GPOS
module. The remainder are new questions which relate to
recent changes to the GP contract. You need to check
pre-populated responses, amending these where necessary, and
also respond to the new questions in order to submit your
eDEC. An updated GP practice eDEC user manual has been
published on the website. A link to this can be found on the
website’s introduction to eDEC web page. If you have any
questions about the declaration please contact the Area Team
or email
Janice.foster@tees.nhs.uk.
I will offer any assistance I can for completion of
these return but we hope that the process should be a little
more simple this year as the system is bedded in and the
difficulty associated with the area maps has been removed.
Safeguarding and 111
JCUH will commence forwarding a letter to GP practices
following an A&E DNA of a child following referral from 111.
This letter is for information only but it is hoped that it
will be useful if GPs are noticing the emergence of a
pattern of behaviour that could indicate safeguarding
concerns. There have been a number of discussions in the 111
Clinical Governance Group with regard to concerns stemming
from A&E DNAs and the potential that this could form part of
a wider pattern of behaviour pertinent to that patient and
indicate a potential safeguarding concern. 111 has no
process for identifying where a young/vulnerable patient has
been advised to attend A&E and DNAs. To try and mitigate
this risk JCUH has put an internal system in place where
they check a child DNA against their safeguarding register.
This is beyond their responsibilities but they are equally
concerned about potential risks to patients. Being aware
that this internal process does not capture those who have
not yet appeared on the register but a pattern of behaviour
may be emerging, they will now send a letter to GP
practices, for information only, to ensure that there is a
full picture of any DNA/safeguarding patterns. This is a
short term solution until a national/contractual solution is
developed. If you have any questions about this please
contact
Janice.foster@tees.nhs.uk.
Urgent Primary Medical Care Services for Out of Area
Patients when at Home
You are strongly advised that you should not currently
register any patients under the new regulation.
Further to the announcement that it would not be practical
to allow GP practices to proceed to register patients who
live out of area without home visiting duties until 5
January 2015 concerns remain about this scheme due to
the reference in the Regulations. NHS England takes the view
that as the regulations, at the point of registration,
require GP practices to determine whether it is clinically
appropriate or practical to accept an application for
inclusion in their list of patients without access to home
visits etc (as set out in 26B of the GMS Regs), there is no
basis on which to amend the regulations at this time. Until
services for patients that register out of area are in place
nationally, the criteria to set aside home visits cannot be
met. Although the Regulations remain in place, a practice
should only register patients without home visits knowing
that they have sought and obtained assurance themselves from
the Area Team that such arrangements were in place for
individual patients. The GPC and LMC view is that it would
neither be clinically appropriate nor practical to register
patients without home visits whilst there is no assurance
that arrangements for their care outside of the practice
area are in place, even though the regulations now
technically allow it. Practices are therefore strongly
advised that they should not currently register any patients
under the new regulation.
GPSoC/Choice of
GP Clinical System
There are instances of CCGs (elsewhere in the country)
exerting undue pressure on practices to choose a particular
clinical IT system. You are reminded that the GP Systems of
Choice (GPSoC) framework and GMS contractual arrangement
entitles you to a guaranteed choice of clinical system from
a range of accredited options. Also, CCGs are responsible
for providing you with equivalent levels of support
following the exercise of your choice.
If you have any questions about your rights under GPSoC please contact Janice.foster@tees.nhs.uk.
GP Clinical IT System, Deed Of Undertaking for Data
Processing
A
Deed of Undertaking for Data Processing has been signed
by each general practice system supplier and published by
the Health and Social Care Information Centre (HSCIC). It is
a generic agreement covering all data processing undertaken
by suppliers on behalf of practices and clarifies the
relationship between practices and system suppliers. General
practices as data controllers are responsible for the data
held within their GP clinical system, and for any decisions
relating to accessing or processing these data. System
suppliers have been commissioned to process data held on
practice systems on behalf of practices. The document has
been agreed in
principle by the Joint GP IT Committee of the BMA and RCGP (JGPITC),
as well as the Information Commissioner’s Office, with input
from the Medical Defence Organisations.
CQC Guidance,
Emergency Drugs
You may find it helpful to be aware of this CQC Guidance
covering
Emergency Drugs for GP Practices.
Roles & Responsibilities of GPs in Supporting Pupils at
School with Medical Conditions
The Department for Education has issued new statutory
guidance and non-statutory advice on the roles and
responsibilities of GPs in supporting pupils at school with
medical conditions, which replaces previous guidance on
managing medicines in schools and early years settings
published in March 2005. This
new guidance came into force 1 September 2014.
Its aim is to ensure that all children with medical conditions, in terms of both physical and mental health, are properly supported in school so that they can play a full and active role in school life, remain healthy and achieve their academic potential.
NICE
Guidelines, Publication of the ‘Manual’
The new
manual for developing NICE guidelines was published on 1
October 2014 and will be used in future to develop all NICE
guidelines, including clinical, medicines practice, safe
staffing, public health and social care topics. The manual
will be implemented from 1 January 2015 for all guidelines
that start from this date. Topics that are in the final
stages will continue to be developed to their current
processes and methods until completion. Other topics already
in development will undergo a planned transition to the new
manual, and NICE will be in contact with registered
stakeholders regarding the implementation schedule for these
topics.
Seasonal Flu, Communication with Practice Nurses and Fluenz
Tetra Cap Lifted
The latest edition of Vaccine Update explains that the
temporary cap on the orders for Fluenz Tetra, the nasal
spray vaccine for children aged two to under 18 years, has
been lifted as of Monday 6 October. Please ensure that all
Practice Nurses are signed up tot an read on a regular basis
the information that is circulated both nationally and
locally with regard to vaccine updates. If your nurse is not
registered for local updates please contact
susan.kirkham@nhs.net.
Bulletin 237
30.09.14
Business Rules for Unplanned Admissions Enhanced Service
Business rules for the
Avoiding Unplanned Admissions (AUA) Enhanced Service have
now been published.
Out of Area
Registration Scheme Paused
All practices will have received a letter from the Area Team
notifying them that the Out of Area Registration Scheme has
been delayed. If you have not received this letter please
email
Janice.foster@tees.nhs.uk and I will forward a copy to
you. It is now proposed to commence January 2015 rather than
1 October 2014. NHS England are still working through the
details as to how the scheme will work and as soon as we
have further information we will forward this to practices
to enable you to make an informed decision as to whether you
wish to participate.
Bulletin 236
23.09.14
CQC
Guidance Notes
Nigel Sparrow, CQC's Senior National GP Advisor, has drafted
a number of guidance notes aimed at tackling some of the
common myths about CQC inspections of GP and out-of-hours
services. The guidance notes covering
clinical audit,
curtains,
carpets and
hand washing may prove
helpful in preparing for the new round of CQC inspections.
Prescription
Direction Guidance
The GPC recently met with the Pharmaceutical Service
Negotiating Committee (PSNC) and Pharmacy Voice to discuss
issues in relation to prescription direction and would like
to remind practices about the joint
guidance. Prescription direction occurs where a patient
is being directed by their GP practice to a certain pharmacy
to have their prescription dispensed, or where practices
have preferential arrangements for certain pharmacies, these
would be seen as a breach of good practice.
Fluenz Tetra
Restricted Orders
Please note the temporary restriction for orders of Fluenz®
Tetra - at present orders are restricted to 50 doses (5
packs) per practice per week. Further details available
here.
Vaccine Update
Newsletter
We would like to remind practices that they can subscribe,
free of charge, to Public Health England's 'Vaccine Update'
newsletter. This is published monthly and contains useful
updates on the latest developments in vaccines, and
vaccination policies and procedures in England. The
September issue
- to subscribe just click on the link within the newsletter
itself.
Update from RCGP on Resources to Support Doctors in
Appraisal and Revalidation
The RCGP has recently developed a number of new revalidation
resources and updated some of its existing resources. These
include Version 9 of the RCGP Guide to the Revalidation of
General Practitioners (the ‘Guide’), a number of mini-guides
(‘toolkits’) designed to augment the Guide, an updated
version of The Principles of GP Appraisal for Revalidation -
originally published in 2008, and a revision to the
Revalidation e-learning module. Version 9 of the Guide
clarifies aspects of revalidation, including: variations in
process between the four countries of the UK, the function
of ‘suitable persons’ and the patient and colleague feedback
process. Additionally the Review of Practice section has
been significantly developed. The RCGP Revalidation Toolkits
look in greater detail at the following elements of
revalidation:
• Colleague and Patient Feedback
• Personal Development Plans
• Significant Event Analysis
• Complaints
• Quality Improvement
• Impact Credits.
The above resources are accessible via the RCGP’s Revalidation Guidance for GPs and CPD Credits and appraisal, and signposted from the newly launched Clarity & RCGP Appraisal Toolkit for GPs. The RCGP can answer revalidation queries at revalidation@rcgp.org.uk.
Prescribing
Unlicensed Medicines
The GMC has confirmed that under European law, it is
unlawful to prescribe an unlicensed or off-license
medication in preference to a licensed one on the grounds of
cost. Prescribers should ensure that when prescribing such a
medication they are content that there are clinical rather
than financial reasons for the prescribing decision. Where
unlicensed or off-license medicines appear in an agreed
patient pathway their position must be determined purely by
their clinical properties, and licensed medicines should on
no account be changed to unlicensed ones for financial
reasons.
GP Earning & Expenses Enquiry Report 12/13 and Investment in
general Practice 09/10 to 13/14
The Health and Social Care Information Group has published
the
GP Earnings and Expenses Enquiry Report 2012/13
along with
Investment in general practice 2009/10 to 2013/14.
This
commentary summarises some of the key information on the
EEQ and the Investment report.
The main figure used in the EEQ report is now that of the
average of combined GPs (contractor and salaried), rather
than that for contractor GPs which has been the case
formerly.
The mean income before tax for combined GPs (contractor and
salaried) in the UK in 2012/13 was £92,900 for those GPs
working in either a GMS or PMS (GPMS) practice (compared to
£94,200 in 2011/12, a decrease of 1.4% which is
statistically significant). The median income before tax for
combined GPs in the UK in 2012/13 was £89,300 compared to
£91,200 in 2011/12, a decrease of 2.0%.
Bulletin 235
08.09.14
CQC Myth
Busters
CQC's National GP Advisor, Nigel Sparrow, has been drafting
some 'mythbusters'
guidance for GP practices which you may find helpful in
preparing for the new round of CQC inspections.
Local
Dialling Codes
From 1 October 2014 it is important that patients add the
area dialling code (01642, 01287, 01429 – apologies if I
have missed any!) as appropriate before calling a local
number. The charge will remain the same but, if they forget
to do this they will get a free recorded message and will
need to hang up and dial again which may cause them
inconvenience and delay. Additionally, you may wish to alert
patients that they will also need to check other equipment
such as personal and home alarms – particularly if they rely
on telehealth services e.g. carelines or pendants. You may
also wish to check any numbers you have stored within your
systems have the appropriate dialling code stored.
Bulletin 234
02.09.14
Prescription of Drugs Regulations Amendments 2014
Schedule 2 of the Prescription of Drugs Regulations has been
amended as follows
2.
In Schedule 2 to the National Health Service (General
Medical Services Contracts) (Prescription of Drugs etc.)
Regulations 2004(b) (drugs, medicines and other
substances that may be ordered only in certain
circumstances), in column 1 of the table (drugs), in the
entry relating to drugs for the treatment of erectile
dysfunction —
(a) omit “Apomorphine Hydrochloride”, “Moxisylyte
Hydrochloride”, “Sildenafil” and “Thymoxamine
Hydrochloride”; and
(b) after—
(i) “Alprostadil” insert “Avanafil”, and
(ii) “Vardenafil” insert “Viagra”
GPC Guidance - Ebola Virus
A Cascade
alert was issued on 1 August via area teams concerning
patients presenting with a positive travel history to Ebola
Virus areas within the previous 21 days. There is a complex
viral hemorrhagic fever risk assessment
algorithm which suggests that practices should carry out
complex investigations. This is a simplified version of the
algorithm, explaining which steps practices would need
to follow in case of a potential Ebola case presenting at
the practice.
CQC
Guidance Significant Event Analysis
You may find it helpful to be aware of this
CQC guidance on
Significant Event Analysis.
Bulletin 233
12.08.14
CQC Guidance on Agreed Principles for Defibrillators, Oxygen
and Oximeters
You may find it helpful to be aware of this
guidance CQC has issued to its inspectors ahead of
inspections.
Pertussis Vaccine
Recommendation
The service specification for the pertussis vaccination
programme currently recommends the vaccine to be used as
Repevax. From 1 July 2014, practices should be using
Boostrix-IPV instead of Repevax. Practices have been made
aware of this via the Vaccine Update, on the ImmForm website
and also through pop ups on ImmForm. Practices have been
able to order the replacement vaccines via ImmForm since 1
June 2014. Any remaining stocks of Repevax should be used
for the pre-school booster programme as it is the same
vaccine.
Free Data
Protection Workshops from ICO
The Information Commissioner’s Office (ICO) is holding a
series of free data protection
workshops, designed to help small to medium sized
organisations from a range of sectors learn about their
obligations when handling personal information. The
workshops are aimed at staff who may have limited practical
experience, but are working for organisations that process
personal data. The sessions will provide a basic overview of
the Data Protection Act, data controller responsibilities
and practical advice from the ICO, using case studies and
interactive exercises. The workshops are run by experienced
ICO auditors and there is no charge for the event (except
for individual lunch and travel costs) and the ‘local’
workshop is held in York on 1 October 2014.
BMA Committee
Visitors Scheme
The BMA recently launched the Committee Visitors Scheme - an
initiative aimed at encouraging grassroots members of the
Association to participate in the Committee process,
particularly women. They have had an encouraging number of
participants to the scheme so far, and there are still a
number of seats available for the 2014-15 session. The Chair
of BMA Council Mark Porter published a
blog on the BMA website supporting the initiative for
its desire to break down barriers to medico-politics. You
will find more information on the
Committee Visitors Scheme.
Bulletin 232
04.08.14
PIP Codes
Chemist and Druggist (C&D) believe practices are using PIP
codes without a valid licence and have been sending final
demands insisting on payment. However, the GPC, the
Dispensing Doctors Association (DDA) and NHS England believe
that because practices order through a wholesaler, who in
many cases have an end user license, they should not be
charged again for this licence and all agree that practices
should not pay any invoices they receive from C&D demanding
payment for the PIP licence. NHS England is monitoring the
situation and if you encounter any problems, contact the GPC
on
info.gpc@bma.org.uk so they follow this up.
CQC Guidance on DBS
Checks
You may find it helpful to be aware of this
guidance CQC has issued to its inspectors ahead of
inspections.
Indemnity Arrangements
New legislation resulted in a change in indemnity
arrangement as if 16 July. Historically there was no
requirement for private practitioners to have indemnity but
this is now a requirement for all healthcare professionals.
At the same time the NMC has required all nurses to be
indemnified prior to obtaining or maintaining registration.
Please ensure your indemnity arrangements, and those of your
staff, are up to date.
The Health Care & Associated Professions (Indemnity
Arrangements) Order 2014 {SI 2014 No 1887}.
Dementia
Extract
This additional
information on the forthcoming dementia extract follows
on from an email that practices received from the HSCIC in
the week of 21 July.
Pharmaceutical
Needs Assessment
This survey is being distributed to help inform each Health
and Wellbeing Board in the Tees Valley as they prepare to
publish a new
Pharmaceutical Needs Assessment (PNA)
in the spring of 2015. Please provide your view via
www.surveymonkey.com/s/pharmacy_stakeholder_yourviews
before the closing date of 10 August 2014.
PNAs describe the
pharmaceutical services in a given area and how they meet
the needs of the local population. They should identify
current and possible future gaps in provision and what might
be required to fill those gaps. NHS England (Durham,
Darlington Tees Area Team) uses the PNA when making
decisions on the commissioning of pharmaceutical services in
our HWB areas, including applications to open new
pharmacies. The PNA also provides a resource and steer for
other local commissioners (e.g., CCGs and Local Authorities)
when planning or reviewing local pathways or processes that
involve, or impact, pharmaceutical services.
Bulletin 231
22.07.14
LMC Conference Report 2014
The
Report from the LMC Annual Conference 2014 is now
available.
Spine 2
Transition 22 – 25 August
An upgrade to the NHS Spine service is scheduled on 22-25
August. The majority of GP practices will not be impacted by
the transition, but weekend users of services such as Choose
& Book, the EPS, General Practice Extraction Service, GP2GP
and the SCR are advised to read the transition documents
available
here. The Spine 2
mailbox can also be contacted with any queries.
The NHS Spine provides the infrastructure that delivers access for GP practices to the Personal Demographics Service (PDS), and enables Smartcard logon and functionality. The Spine also controls the messaging between key applications, such as Electronic Prescription Service (EPS), Summary Care Record (SCR) and Demographics. The Health and Social Care Information Centre (HSCIC) will be moving Spine from BT to a new platform called Spine 2, which has been developed and will be managed by the HSCIC.
GMC
Guidance – Better Care for Older People
The GMC has launched a new online
resource to help doctors challenge the stereotypes
associated with older people and tackle the most common
concerns older people have about their care. Resources
include guidance, case studies, tips, tools and signposts
for discussion with colleagues and to share with patients.
To keep this content current and relevant and to respond to
any new issues that arise, these resources will be
continually updated and reviewed, with regular e-updates
about these, to doctors and other subscribers - subscribe to
updates
here.
Local
Health Profiles
Public Health England has published the 2014
local health profiles.The profiles present a picture of
health in each local area in a format that’s easy to use.
This valuable tool helps local government and health
services to understand their communities’ needs, so they can
improve people’s health and reduce health inequalities.
Bulletin 230
08.07.14
Technical
Guidance 2014/15 Contract
The guidance on the technical
requirements for the GMS contract for 2014-15, has been
updated to include sections on shingles and avoiding
unplanned admissions. One new Read code has also been added
to the dementia section following the HSCIC review of the
April Read code release.
Vaccinations and Immunisations Programme Guidance and Audit
Requirements
The final version of the of the supporting
guidance for the 2014-15, vaccination and immunisation
programmes includes the detail for the shingles routine and
catch-up vaccination programmes and the childhood seasonal
influenza and seasonal influenza and pneumococcal
vaccination programmes.
Focus on Vaccinations and Immunisations Update
The Focus on vaccines and immunisations
guidance has now been updated following the changes to
the regulations on 1 April 2014. This now includes
information and links to documents in the devolved nations,
and also changes to the new vaccination programmes hepatitis
B for newborn babies at risk and meningitis C for freshers.
Carers
and Annual Flu Vaccination Programme
The annual
Flu
Plan for 2014-15 has recently been published and as in
previous years, carers (defined as ‘people who are in
receipt of a carer’s allowance, or those who are the main
carer of an older or disabled person whose welfare may be at
risk if the carer falls ill’) are one of the groups of
people who can request a free flu vaccination. The Flu Plan
suggests that ‘consideration should also be given to the
vaccination of household contacts of immunocompromised
individuals, specifically individuals who expect to share
living accommodation on most days over the winter and
therefore for whom continuing close contact is unavoidable’
potentially broadening the scope of previous programmes
where only the ‘main carer’ would be eligible. However, as
this is not clearly defined, practices should use reasonable
clinical grounds and discretion about to whom to give it, in
order to be eligible for payment.
Pharmacy Direction
Schemes
Following reports in the press about a number of schemes
that appear to encourage or have the potential to be
associated with prescription direction, the GPC,
Pharmaceutical Services Negotiating Committee (PSNC) and
Pharmacy Voice have written to the Department of Health and
NHS England to highlight concerns. Such schemes could also
have an impact on rent abatement under the Premises Costs
Directions. We know that a number of practices have been
approached recently and we would like to remind them not to
tie themselves into any long-term and inappropriate
arrangements. We would suggest that practices report to GPC
(info.gpc@bma.org.uk)
any concerns about similar arrangements between practices
and pharmacies which incorporate an element of prescription
direction. We would also like to remind practices about the
joint guidance to practices and pharmacies on
prescription direction
which was published last autumn. A copy of the
aforementioned letter is also available on this page.
QOF Business Rules v29
The HSCIC has published v29.0 of the QOF business
rules.
Learning Disabilities, Rotavirus and Dementia Enhanced
Service Business Rules v4
The HSCIC has published v4.0 of the learning disabilities,
rotavirus and dementia enhanced service business
rules.
Bulletin 229
24.06.14
Unplanned
Admissions Enhanced Service
A revised version of the joint
guidance on the unplanned admissions enhanced service
has now been published, along with NHS England's service
specification. The guidance now makes it clear that:
There are now no minimum requirements in place for the content of care plans. While the guidance does provide some suggestions about what could be included in care plans and a care plan template, practices should use their clinical judgement to determine the content.
The deadline for setting up the bypass number for healthcare providers and same day telephone consultations for case management register patients with urgent queries is the end of July.
The request to provide "any information" on reasons for the use of the above telephone access as part of the reporting template does not mean that practices will be required to carry out an audit of telephone consultations or supply statistics. Practices should provide any information or learning points that they believe would be of value.
A GPC “step by step” guide, which is being updated to reflect the above changes, is intended to minimise the administrative processes involved with the enhanced service, provide practical examples about how practices can meet the requirements and provide optional templates for practices to use to minimise bureaucracy for reporting purposes.
HPV Vaccination Programme Schedule Changing from 3 to 2
doses
From September this year, the number of doses of HPV vaccine
that girls aged 12 to 13 years should receive, is being
reduced from three to two. The two doses should be given at
least six and not more than 24 months apart, but, for
planning purposes, Public Health England is recommending an
interval of twelve months between doses. Local needs,
however, should be taken into consideration when planning
the programme, so that any girls who may have missed out on
their vaccinations can be accommodated. Also girls who have
received two HPV vaccine doses under the 2013/14 programme
should still receive their third dose, to complete their
course. For full details of the change to the programme, see
this
letter from Public Health England, the Department of
Health and NHS England
Shingles
(catch-up) Service Specification
NHS England have published the enhanced service
specification for the Shingles (catch-up) vaccination
programme.
Interest on Late
Payments
The GPC has sought legal advice on whether practices can
charge interest on late payment from the Area Team and sue
through the small claims court (assuming it has not elected
to become an NHS body) for cases of non-payment. The advice
confirmed that this course of action is open to practices
and 'The Late Payment of Commercial Debts (Interest) Act
1998' should apply too (as the GMS Contract does not appear
to have contracted out of this). This allows for interest at
the rate of 8% above base rate, plus a fixed sum and
reasonable costs of recovering the debt.
Bulletin 228
17.06.14
CQRS Guide
for 14/15 Enhanced Services
CQRS has now been updated to support the following services
(14/15) as of 4 June 2014:
Rotavirus (Routine childhood vaccination)
Learning disability health check scheme
MMR aged 16 and over vaccination
Meningitis C (freshers) vaccination
Hepatitis B (newborn) vaccination
This now allows practices to participate and provide achievement data for the services via the CQRS system. For the monthly programmes that began in April 2014 (MMR, Meningitis C and Hepatitis B), practices will need to enter the first three months of data into CQRS. These services will be manual entry on CQRS for the duration of the financial year. Guides on these enhanced services on CQRS can be found here. For further information on CQRS, the service desk can be contacted via email: cqrsservicedesk@gdi.com.
Change to
the Misuse of Drugs Act 1971
The Home Office Circular 008/2014: A
change to the Misuse of Drugs Act 1971 – Control of
NBOMes, Benzofurans, Lisdexamphetamine, Tramadol, Zopiclone,
Zaleplon and Reclassification of Ketamine came into force on
Tuesday 10 June. Please see below for the changes to
the control of Tranadol and Zioiclone:
Tramadol
The Misuse of Drugs Act 1971 (Ketamine etc.) (Amendment)
Order 2014 inserts tramadol as a Class C drug in paragraph
1(a) under Part III of Schedule 2 to the 1971 Act. Tramadol
is inserted into Schedule 3 to the 2001 Regulations, with
the effect that it is subject to regulations 14
(documentation), 15 (prescription writing), 16 (supply on
prescription), 18 (marking of containers), 22, 23 and 24
(record-keeping and preservation of registers), 26
(furnishing of information) and 27 (destruction of the drugs
only in presence of an authorised person) of the 2001
Regulations. Tramadol is also being inserted into Schedule 1
to the Misuse of Drugs (Safe Custody) Regulations 1973,
which means it is exempted from the safe custody
requirements.
Zopiclone and Zaleplon
The Misuse of Drugs Act 1971 (Ketamine Etc.) (Amendment)
Order 2014 inserts zopiclone and zaleplon as Class C drugs
in paragraph 1(a) under Part III of Schedule 2 to the 1971
Act. Zopiclone and zaleplon are also inserted into Part 1 of
Schedule 4 to the 2001 Regulations, with the effect that
they are subject to regulations 22 and 23 (record-keeping
and preservation of registers), 26 (furnishing of
information) and 27 (destruction of the drugs only in
presence of an authorised person) of the 2001 Regulations.
New GPC Online Community for Practice Networks, Alliances
and Federations
The BMA recently launched a new online initiative, called
Networks-L, which will provide a digital space for GPs with
an interest in practice networks, federations or alliances
to share learning, best practice and insights about these
new working arrangements. The forum is one of GPC’s first
steps toward offering greater support for practices looking
at new models of working. The GPC has also produced this
guidance
about collaborative GP alliances and federations. Networks-L
is best suited to those GPs, especially group leaders, whose
practices are already federated or in a network or alliance,
or those whose practice is exploring new models of working.
Networks-L was developed following a GPC survey which
revealed that GP practices are looking for more support and
information about new models of collaborative working. To
join Networks-L email Karen Day at
kday@bma.org.uk.
Bulletin 227
10.06.14
LMC Annual Conference Resolutions (including
GPC Chair Opening Address)
The
resolutions of the LMC Annual Conference 2014 reflect
the challenges and pressures practices face whilst also
looking forward, with a renewed self-belief in our
fundamental role in keeping the NHS afloat and a spirit of
collective determination to fight for a secure future for
GPs and our patients. In his first
speech as GPC Chair, Chaand Nagpaul highlighted the
parlous state of general practice: how it is facing
workload, workforce and premises crises, with morale at an
all-time low. He warned that ministers ignore this at their
peril, since destabilising general practice will have
dramatic adverse repercussions on the wider NHS and put
forward to government a clear programme of action, arguing
that investing in general practice is the indisputable
solution to achieving a sustainable NHS.
Your GP Cares Campaign
Film
Your GP Cares was officially launched at the LMC Conference
and we encourage you to find out
more
and what you can do in your practice to support the
campaign.
Bulletin 226
03.06.14
GP Health, Occupational Health service
Available to GPs
Recognising that the occupational health service provided
through GP Health is a valuable service and particularly
vital at this time of increased pressure in which GPs find
themselves, Cleveland LMC GP Members voted unanimously to
make a donation to GP Health to enable them to continue to
provide support to GPs in Tees. This donation has been made
from the existing levy, which all practices pay, and will
incur no extra cost to practices or their GPs. Please be
aware that this service is only available GPs in Tees.
Please view the Useful
Links page for further details. This service has always
been well received and is designed for you. Please do not
hesitate to contact GP Health if you feel you need their
support - it is completely confidential, anonymous and free
of charge.
GP Trainees Work Pattern Data Collection
As part of the negotiations (scheduled to conclude October
2014) for a new contract for all doctors in training,
GP Trainees received, from their deanery, a data collection
spread sheet and a letter including instructions on how to
complete the spread sheet. The collection asks for trainees
to record the hours they have worked for a two week period
beginning on June 2nd as well as their OOH work for 12
months. It is essential that as many GP trainees as possible
take part in the collection to ensure that there is accurate
information for negotiations – please encourage your trainee
GPs to take part. GP trainees do not currently have a
formally negotiated national contract; rather, the terms and
conditions in the GP trainee framework contract have been
produced by the GPC in conjunction with COGPED, and are
designed to reflect NHS directions. It is proposed that a
new nationally agreed contract would include GP trainees.
An important aspect of the negotiation
process will be to model pay arrangements for the new
contract. In order to do this, the negotiating parties need
to improve understanding of the hours of work and working
patterns undertaken by all doctors in training.
Bulletin 225
20.5.14
Public Health Services Contract through Local
Authorities – sign up reminder
Public Health Shared Services would like to
thank all practices that have returned their signed Section
A of the Public Health contract. Once the contracts are
signed and authorised by the Local Authority, all practices
will receive a copy of the signed agreement. For all those
practices that are yet to return a contract, could you
please do so as soon as possible or notify Philip Ray that
you do not wish to provide the services. If you have any
queries please contact Philip Ray on 01642 745288 or email
Philip.ray@nhs.net.
2014/15 Seasonal Flu Tripartite Letter
The tripartite
seasonal flu letter and
flu
plan have been published.
Childhood Flu Service Specification 14/15
The updated
childhood flu vaccinations service specification for
14/15 commences 1 September 2014 and will be offered to
practices by NHS England no later than 20 June 2014.
BMA
‘Your GP Cares’ Campaign
Your active support of this campaign is absolutely vital to
its success. Can we please ask you to do the following
today:
join the campaign via the BMA website www.bma.org.uk/YourGPcares
help raise awareness of the campaign with
your colleagues and contacts
engage with the campaign on Twitter using #YourGPcares
and following the BMA @TheBMA if you are active on
social media
if you have case studies to illustrate the issues the campaign is highlighting please email them to YourGPcares@bma.org.uk
join in the conversation on BMA communities
This campaign will aim to increase awareness amongst the public, patients, government and policymakers of the intense pressure faced by general practice caused by escalating demand, and fuelled by demographic change of an older population with complex needs, coupled with the shift of care out of hospitals. It also highlights the impoverished infrastructure of general practice with regards to workforce and premises, and of a service where demand simply outstrips capacity. It will promote solutions, and fundamentally the long overdue need for sustained investment. The campaign will be a prolonged programme of activity, leading up to the next general election. It will also enable GP practices to publicise the campaign to and involve their patients, through materials to be used in GP surgeries, which will be made available in the near future - there are two posters that you can download from the website and start using straight away if you so wish.
Locum Cover Reimbursements for Working with
NICE
NICE has increased the reimbursement rate for GP locum cover
for those involved in work on behalf of NICE. These
reimbursements are available for principle and salaried GPs
working in a practice and are payable where a practice
incurs costs in order to release a GP to attend a NICE
committee meeting. Self-employed locums are also now able to
be reimbursed at eth same rates. Full details available on
the
NICE website.
This
guidance on
Non-Staff Travel Subsistence and General Expenses Policy and
Procedures
has been updated to include the above
changes.
EU
Healthy Aging Questionnaire
The EU has released 2 linked questionnaires relating to
healthy aging. The
survey for doctors aims to assess their awareness on
functional performance (capacity), decline and frailty
relating to ageing and possibilities to prevent/delay the
onset of these issues and/or mitigate their consequences.
The
survey for patients aims to assess the awareness,
opinion and attitude of the population aged over 60
regarding healthy and active ageing. If you are willing to
assist with this survey please contact Paul Laffin (BMA’s EU
Policy Manager) via email:
plaffin@bma.org.uk.
Bulletin 224
13.5.14
Avoiding Unplanned Admissions DES - GPC Guidance and
Readcodes
The GPC have published a
guide to implementing the unplanned admissions enhanced
service. This should minimise the administrative processes
involved, while supporting you to achieve the requirements
of the enhanced service by complementing your care for the
frail patients already likely to be under ongoing
management.
In addition, the practical examples for practices
document provides further guidance and examples of how
practices can meet these requirements. There are also
optional
templates for ongoing internal practice use, to minimise
bureaucracy for reporting purposes. The
read codes for this DES have also been published.
Hep B Read codes
The
Read codes for the hep B vaccination programme have
been published. The technical requirements document will be updated to reflect
the read codes; however, this may not be ready for re-publication for a couple
of weeks or so.
Bulletin 223
29.04.14
GP Trainers Urgently
Required
If General Practice is going to cope with everything that is
being asked of it, we urgently need to increase our training
capacity. Please take a moment to look at this
flyer and consider becoming a trainer (if you are not
one already) or host more trainees (if you already are!).
North East Sessional
GP Group
NESG -
North East sessional GP group is a non-profit support
group for sessional GPs which has been around for about 15
years. It currently has around 300 members. It aims to
provide peer support for sessional GPs and also to improve
access to information about educational and job
opportunities. It also offers the facility for practices
(and trusts) to advertise vacancies (locum/salaried and
partnership) for free. Practices can post their vacancy on
their
website. In the last 3 months, for example, 75 vacancies
have been posted on our website (250 in the last 8 months).
The group was originally created by and for locums but now has a wide range of sessional GPs including retainers, salaried doctors, GPs with academic or teaching interests etc. It has been recognised by both GMC in its case studies for revalidation and in the RCGP latest guide for Revalidation. Regular NESG members' meetings occur on the same evening (7pm), and preceding, the deanery sessional GP educational programme (8pm) - on the 1st Tuesday of each month (except for January) at the Freeman Hospital Newcastle. If you would like further details please contact NESG Chair Paula Wright.
Bulletin 222
22.04.14
QOF & CPI Issues – Response from NHS England
The QOF re-calculation highlighted last week is expected to
result in approximately a 1.95% increase in QOF 13/14
achievement on CQRS for most GP practices. Further
information about the re-calculation of QOF 2013/14
achievement and declaring achievement can be found in these
FAQs. NHS England has also responded to some of the
queries in relation to this as outlined below:
Why is the index list size taken as it stood on 01 January 2013, when the year in question is 1 April 2013 to 31 March 2014? Basing the actual national average practice list size on that at the start of the last quarter before the financial year in question ensures there is transparency going into the financial year.
On the whole, it appears that list sizes are increasing - why is the current list size not taken into account? Contractors current list size is reflected in the CPI calculation which is the sum of Contractors Registered Population (generally that at the start of the final quarter in the financial year) divided by the actual national average list size as above.
CPI allows QOF payments to reflect comparative list size.
Is the PMS QOF deduction also incorrectly based on the January 2014 CPI figure? The letter from NHS England to area teams sent on 4 April uses the average list size which is applicable for 2014/15, but the calculation is for the 2013/14 QOF. NHS England has provided the following briefing in response:
The QOF PMS Points Deduction was set in 2004 as £13,050 for average PMS practice – that was a practice with a list size of 5,891 (the average in 2004). £2.22 is the deduction calculated as the price per patient when you divide the above price by the then average list size (£13,050/5891).
The worked example in the letter has used an incorrect CPI figure, but it is just that a worked example, to demonstrate that the current CQRS calculation will undervalues the QOF PMS Points Deduction.
The national average practice list size for use in CPI to calculate 2013/14 QOF achievement is being corrected to 1st January 2013, which is 6911, which is in line with the SFE. So to run the worked example again, a practice of 6,200 patients should have its deduction calculated as 6200/5891 x 13050 = £13,735 but CQRS will calculate as 13050 x 6200/6911 = £11,707. So CQRS remains to undervalue the deduction that needs to be made and in this example by £2,028.
Another way of looking at is CQRS will calculate the deduction at £1.89 price per patient (£130505/6911) which is a difference of £0.33 price per patient (£2.22-£1.89). Using £0.33 might be a simpler basis to calculate the adjustment required.
14/15
QOF Point Value
During the QOF negotiations for 14/15, the GPC negotiating
team highlighted the issue that the QOF point value needed
to increase comparatively along with any increase in the
national practice list size to NHS England. Although there
was a 16% rise in the value of QOF points for 13/14, GPC
pointed out that this would be an ongoing problem every year
if QOF was not adjusted accordingly every year. It was
argued that due to the 16% increase in QOF point value, this
change was meant to be cost-neutral. It clearly has not
been, so GPC are continuing to put pressure on NHS England
to sort it out.
Technical Requirements Guidance for 14/15 Contract
This Guidance on the
technical requirements and this guidance and audit
requirements
document for the GMS contract for 2014/15, includes
information on clinical enhanced services, named GPs for
patients over 75, and vaccinations and immunisation.
Guidance on PMS Reviews & Equitable Funding for PMS
Practices
As part of the 2013-14 contract imposition, the government
in England planned far-reaching changes to practice funding.
From 1st April 2014, the wide variation in core funding per
patient between practices will begin to reduce. This may
have a profound effect on practice income. Practices with
above average levels of funding generally receive either
large correction factor payments (as a result of the Minimum
Practice Income Guarantee (MPIG) negotiated at the time of
the new general medical services (GMS) contract) or above
average personal medical services (PMS) funding. NHS
England’s guidance puts the amount of ‘premium’ expenditure,
(identified as the amount by which PMS expenditure exceeds
the equivalent items of GMS expenditure) at £325m, which
will reduce to £235m over the seven years to 2021-22 as GMS
correction factor funding is phased out and global sum
funding increases. The guidance states that Area Teams
should invest the premium funding according to the following
criteria:
reflect joint Area Team /CCG strategic plans for primary care
secure services or outcomes that go beyond what is expected of core general practice or improve primary care premises
help reduce health inequalities
give equality of opportunity to all GP practices
support fairer distribution of funding at a locality level
Area Teams will complete these reviews over a two year period starting in April 2014. NHS England has suggested that GP practices can expect LMCs to be engaged in the local review process. GPC guidance on PMS reviews and equitable funding for PMS practices is available along with NHS England’s letter to Area Teams and accompanying presentation.
CLMC has been contacted by a number of practices with a view to reinstating the PMS Group which represented practices during the PCT PMS review process. Once we have further details on how the Area Team will be progressing with the PMS Review locally we will contact practices to consider the best way to ensure PMS Practice views in Tees are represented.
Care.data Phased Roll Out
A six-month extension to the start of data collections from
GP systems under the care.data initiative was announced in
February. Representatives from the GPC and BMA have met
regularly with NHS England to discuss the actions to be
taken between now and the autumn.
The GPC is also represented on the recently established independent care.data advisory group. The purpose of the group is to make recommendations to the care.data programme board to help ensure the benefits of the programme are understood and articulated, as well as the risks, and that these risks are appropriately mitigated. NHS England has issued a letter to stakeholders, which confirms that care.data will now proceed in the autumn with a phased roll out of the GP data extraction process. This will involve a cohort of between 100 and 500 GP practices to trial, test, evaluate and refine the collection process ahead of a national roll out. Further information on how the phased roll out will be implemented will be available soon.
Steps are also being taken to make changes to the law that will further increase protections around confidentiality and ensure greater transparency around the release of data by the Health and Social Care Information Centre (HSCIC). The HSCIC will provide additional assurances over the safety of data collected, stored and shared, including the option of accessing data from a controlled environment, sometimes referred to as a ‘data-lab’ or ‘fume-cupboard’, for use by organisations requesting data. NHS England will be taking further action to ensure that patients have a clearer understanding of the care.data programme and will be working with stakeholders to produce additional supporting materials, such as a template letter for patients, as well as simplifying the opt-out process.
NHS England is keen to hear your views so that they can improve and build confidence in the programme. They will be engaging with GPs and patient groups through local and regional engagement events and they also welcome individual comments, which can be emailed to: england.cdo@nhs.net. We recommend you feedback your concerns and suggestions.
NHS Property Services Guide for Customers & Tenants
New
guidance for tenants has
been launched by NHSPS.
Bulletin 221
15.04.14
Unplanned Admissions DES, Updated Guidance
Revised guidance on the unplanned admissions enhanced
service clarifies that:
Care plans for patients initially added to the case management register have to be in place by the end of September 2014, not June 2014 as was originally specified. This recognises the difficulty with producing care plans for these patients for the end of June and ensures consistency with the payment structure in place for the enhanced service.
Patients initially added to the case management register have to be informed of their named accountable GP and care co-ordinator by the end of July 2014, not June 2014 as was originally specified. The July deadline for the named accountable GP applies only to patients added to the register who are under the age of 75, as patients aged 75 and over will have been informed of their named GP by the end of June (existing patients) or within 21 days of registration (new patients), as per the requirements of the GMS and PMS regulations for a named GP aged 75 and over.
The changes are made on pages 7 and 15 of the guidance.
Practices signing up to this voluntary service should read
the guidance and ensure that any requirements from their
CCGs beyond the enhanced service are met with additional
resources. The GPC have made it clear to government that
reducing unplanned admissions is not in the direct control
of GPs and requires the whole system to play its part, from
community services to urgent and social care. This enhanced
service is part of a wider programme of care for vulnerable
older people, and NHS England expects CCGs to give practices
an additional £5 per head to support them in managing such
patients, as specified in the Everyone Counts planning
guidance (paragraphs 36 and 37).
QOF Recalculation
of Achievement
This newsletter from HSCIC has been sent out to
practices in relation to the re-calculation of their QOF
achievement.
QOF
Business Rules v28
Version 28 of the QOF Business Rules have now been published
on the HSCIC website.
Vaccinations & Immunisations Guidance 14/15
Guidance on a number of changes to the vaccination and
immunisation programmes has now been published along with a
summary table. Note that guidance or service
specifications are still outstanding for some of the
vaccinations; these will be added as soon as they are
finalised. In short - the changes refer to:
New vaccination programmes commencing 1 April 2014
Hepatitis B for new born babies at risk (SFE) -
guidance published.
MenC vaccination booster for freshers (ES) - guidance
and service specification published.
Existing vaccination programmes continuing from 1 April
2014
MMR (SFE) - for patients over 16 who self present at
practices (this was an enhanced service in 2013, but has now
moved to the SFE, so no new service specification will be
published).
Pertussis for pregnant women (Temporary ES) - service
specification 2014 has been published.
Rotavirus (SFE) - guidance published.
Existing vaccination programmes continuing after August
2014
Seasonal influenza for at-risk patients (DES/ES) -
widened so that it mirrors the at-risk groups set out in the
Green Book to include pregnant women, but excluding 2-4 year
olds - guidance and service specification to be published in
June 2014.
Childhood seasonal influenza (ES) - this has been
extended to include children aged 4, so that the new cohort
is children aged 2-4 - guidance and service specification to
be published June 2014.
Pneumococcal (DES) - There is an addition to
programme to include the cohort as indicated within the
Green Book – i.e. those aged under 65 in the at-risk groups
- guidance and service specification to be published June
2014.
Shingles (routine cohort patients aged 70, SFE; Catch
up programme (patients aged 78-79, ES) - Guidance and
service spec to be published soon.
Men C for freshers (England)
Full details were included in the CLMC bulletin dated 010414
Increase
in Prescription Charges April 14
The Department of Health (England) has announced
that prescription charges in England will increase from
£7.85 to £8.05 for each medicine or appliance dispensed as
from 1 April 2014. The charge is also intended to increase
by 20p to £8.25 in the following year.
Controlled Drugs and Repeat Prescriptions
Though we have not heard any reports locally, some
CCGs in the country are telling GPs they cannot put
Controlled Drugs on repeat prescriptions, which is
incorrect. There appears to be some confusion generated by
only reading the first sentence of a paragraph in the NPC’s
Guide to the management of controlled drugs in primary care
(12/09) on page 53 it says:
It is clear under the current legislation that repeat
prescribing of CDs in Schedule 2 and 3 is not permitted.
However, management systems which allow the patient to
receive a prescription (hand signed by a practitioner)
without a consultation is not subject to legislation, but is
a clinical decision made on a case by case basis. It is good
practice that patients should be reviewed before prescribing
Schedule 2 and 3 CDs.
The repeat prescribing systems within practices are
not the definition to which the regulations refer - the CCGs
are confusing repeat prescribing within a clinical context
(i.e. as every GP would understand it) with a “repeatable
prescription” which is defined in the Pharmaceutical
Services Regulations. They are correct in so far as Schedule
2 or 3 drugs cannot be prescribed on such a form but there
is no restriction whatsoever on what may or may not be
contained within the patient’s practice based medication
repeat list.
Amendment to Generic Medicine Reimbursement Prices: April
2014
NHS England has reduced generic medicine
reimbursement prices (Category M) from April 2014 by £10
million per month, equivalent to £120 million in a full year
–
view NHS E letter here. The Drug Tariff will be amended
from April 2014 to reflect this change.
MRCGP Exam
Costs
You may have been contacted by the RCGP regarding
tax relief on AKT and CSA examination fees paid since 2009.
This will translate into a significant tax saving. Please
see the dedicated
RCGP web page for more information about this issue.
GP Retainer Scheme
North East
Health Education North East (previously the
Northern Deanery) would like to raise awareness locally
about the
GP Retainer Scheme they run. This is an
opportunity for practices (funded) as well as for GPs
wishing to retain a part-time clinical commitment.
CCGs 1 Year On, GPC Surveys
April marked the first anniversary of the Health
and Social Care Act and CCGs. The GPC are carrying out a
short survey to assess GPs' views and experiences
of CCGs, and are interested in the perspectives of all GPs,
from sessional doctors to partners, CCG clinical leads and
board members. It should only take a couple of minutes to
fill out and the results will help inform GPC policy. The
BMA has also marked this anniversary by launching a campaign
to repeal the act, highlighting the damaging effects of
imposed competition and tendering, and pressing the need for
policymakers to prioritise integration over competition. You
can read about the launch
event in Westminster and provide your views/experiences
of working under the Act via email to
info.gpc@bma.org.uk
or by posting on the
BMA forum.
Bulletin 220
01.04.14
Men C for Freshers
This
tripartite letter has been sent to practices regarding the new Men C for freshers. In short, this is a booster offered to freshers (aged 17-25) not previously vaccinated with Men C since reaching age 10, and who self-present to the practice (they will be notified via UCAS). It will commence 1 April 2014 and run until 31 October 2014. There are no call and recall requirements, the vaccine will be centrally supplied, and there will be a payment of £7.64 per dose The letter is available on the
PHE website. The GPC are drafting joint guidance and a service specification, both of which are in the process of being finalised and will be published on
their website shortly. Note that there are quite a few updates in relation to vaccinations and immunisations, so there will be several updates to the GPC vaccs & imms web pages in the coming weeks
Reminder, Contract Changes and Ready Reckoner for Financial Impact
The GPC has published
guidance on the contract changes coming into effect 1 April 2014 and a
ready reckoner to assist in calculating the financial impact of the changes. We strongly recommend you look at this, if you have not done so already, to fully understand the impact the changes will have on your practice. The GPC is also preparing a checklist for practices in England on actions they should take from April. This is awaiting some last-minute detail from NHS Employers and NHS England but we will share it as soon as possible. We are also still waiting the information/specification surrounding the new DES – again this is still awaiting information from NHS England (national team) before our Area Team can discuss this with us. We will share as soon as possible.
IMPORTANT, HMRC Scam
We have been made aware of an email scam targeting practices throughout the
country. The email purports to be from HMRC and advises you can reclaim overpaid
tax returns. I am sorry to say that there is no money waiting for you via this
email and advice from HMRC is that they would not usually send such. Just hit
delete!
The GP trainee framework contract has been updated by the GPC and COGPED to bring it in line with current legislation and terminology. The changes to the framework are not the result of a negotiation and are in no way connected to the ongoing negotiations for a new contract for all doctors in training. We recommend that the framework is used for all GP trainees.
Federated
Flexiplan No. 1 Pension Scheme
This industry-wide occupational pension scheme covers workers in the health and
education sectors and was set up in 1966. The scheme is currently being wound
up, having closed to future accrual on 1 February 2010, with a deficit of
approximately £20 million. The GPC would like to hear from any practices that
are members of the scheme that may have been affected by increasing cost
liabilities as a result of the deficit. Please contact
info.gpc@bma.org.uk to share your experiences.
Bulletin 218
18.03.14
IMPORTANT, Scam
Targeting Patients
We have been made aware of a particularly malicious scam
that is targeting patients throughout the country (we have
also had local reports). The scam involves sending emails to
patients advising them that following recent blood tests the
results show they may have cancer. The email mentions NICE
and has attachments and links for reports. As you can
imagine this is incredibly distressing for patients and, as
one colleague has phrased it, an all time low for scammers.
It is currently unknown as to how they have accessed email
addresses and it could be purely coincidental that some of
the patients have recently had blood tests BUT we recommend
you alert patients to this. NICE is aware of this issue and
have posted a note on their website to advise patients they
are investigating this issue and not to open emails. Further
updates will be posted on the NICE website and via twitter:
@NICEComms.
CQRS, GP Practice Checklist for QOF 13/14 Year End
HSCIC has released an email bulletin providing a
step-by-step detailed checklist advising practices what they
need to do and when for QOF 2013/14 year-end. We recommend
that practices view this
checklist on line as updates will be made on a weekly
basis. A step by step guide on entering achievement data
manually for the 17 indicators and how to declare QOF
achievement in CQRS will also be made available
here together with a number of FAQs. If you require any
more information please contact the HSCIC service desk via
email:
enquiries@hscic.gov.uk
Alcohol Related Risk Reduction Scheme 2013/14
Practices will need to manually enter data into CQRS for the Alcohol Related Risk Reduction Scheme 2013/14. HSCIC are aware that previous guidance stated that practices would not be required to manually enter data for this Enhanced Service and, to support practices, a guide on how to enter data for the Alcohol Related Risk Reduction Scheme 2013/14 has been made available.
QOF
Guidance 14/15
The
QOF guidance for 2014-15 has now been published and
includes a summary table at the end of the document which
highlights all the changes made.
DDRB Report
The
DDRB report has now been published and the main
GP-related recommendations are:
For independent contractor GPs, an uplift of 0.28 per cent to be applied to the overall value of GMS contract payments for 2014-15. This is intended to result in an increase of 1 per cent to GP contractor income after allowing for movement in expenses.
For salaried GPs, the minimum and maximum of the salary range to be increased by 1 per cent for 2014-15. 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 salary.
For the trainers’ grant, an increase of 1 per cent along the same lines as basic pay for other doctors.
Given ongoing doctors in training contract negotiations, no recommendation on any change to the GP specialty registrar supplement.
MPIG
Changes, Ready Reckoner for GMS Practice
One of the most common calls we are currently receiving in
eth LMC office is with regard to the MPIG changes and how
practices can calculate the impact on their finances. NHS
England has produced a
ready reckoner for practices to use as a rough guide to
estimate how their funding will change in 2014-2015, both as
a result of the phasing out of MPIG and the negotiated
changes to the GP contract for 2014/15. We strongly
recommend that practices also read the
GPC guidance. If, as a response to these changes, you
have concerns about your practice and your ability to
provide services, please contact the LMC office (Janice.foster@tees.nhs.uk).
Reminder, Music
Licensing
GPC has been contacted by PPL, which is a music licensing
company that works on behalf of performers and record
companies (most of them small businesses or sole traders) to
license, amongst other activities, the playing in public of
recorded music. PPL issues licences to many medical
practices and surgeries for the playing of background music
within their premises. PPL’s role stems from the legal
requirement that the permission of the copyright owner must
be obtained before a sound recording can lawfully be played
in public, by virtue of the Copyright, Designs and Patents
Act 1988.
You may wish to view their
website
for more information, including an explanation of the
difference between PPL and PRS for Music.
Bulletin 217
10.03.14
QOF
Framework 2013/14
The Health and Social Care Information Centre (HSCIC) sent
an
email bulletin to practices last week on the QOF for the
2013/14 financial year. A step-by-step guide for practices
will be issued in March by the HSCIC. We recommend that
practices read last week’s bulletin, which explains how the
General Practice Extraction Services (GPES) will operate for
the QOF extraction. The bulletin also explains how practices
should prepare for and participate in the QOF using the
Calculating Quality Reporting Service (CQRS).The GPC has
emphasised to NHS England and the HSCIC the need for the
necessary functionality and training to be in place so that
practices can effectively use the CQRS with minimised
disruption. In the event that data is not available via GPES
for all practices by the end of March, the HSCIC has
provided some detail on their contingency plan – this is
also set out in the bulletin with further information to
follow. Please also see the HSCIC's
FAQs.
DEP001, QOF Business Rules
Following a query regarding the QOF business rules of
DEP001, where a practice had found that their performance on
this indicator dropped following the upgrade by EMIS to
v27.1 of the business rules, the GPC have had the following
advice from the HSCIC:
‘Originally indicator DEP001 was developed to follow the guidance which requires that the diagnosis of depression and the bio-psychosocial assessment (BPA) codes are recorded on the same date to meet the requirements for this indicator and that a patient would only have one BPA recorded for each new episode of depression. The BPA code was a new code in April 2013, however it was found that some practices were recording the code again following diagnosis (as well as at diagnosis), which was a use that HSCIC hadn’t anticipated. It has since been brought to HSCIC's attention that a patient may have more than one BPA recorded in a given QOF year. This has been discussed with QOF stakeholders and as the numbers of patients affected was expected to be small any change to the indicator was to be implemented in 2014/15, however this indicator will now be retired on 1 April 2014.
HSCIC have considered whether a change can be made to the business rules at this stage, however this is not possible as there will be an impact on GPES as all the suppliers would need to go through re-certification.
If practices feel that they have been unfairly disadvantaged for 2013/14 QOF they are advised to negotiate with their area team. Where a patient newly diagnosed with depression in the current QOF year, has received more than one BPA in the current QOF year the area team would need evidence that at least one BPA had been recorded on the same day as the depression diagnosis.’
Alternatively, practices could delete the second offending code, and re-enter it as free text to preserve the integrity of their record.
Workplace
Pensions
Neither the GPDF nor GPC provides financial advice to
individual GPs; however they would like to draw to GPs’
attention to areas of change in legislation which may have
an impact on GPs and/or their practices. Workplace pensions
place responsibilities on employers including GPs, both as
practices and individuals (e.g. for nannies), to provide a
pension.
Workplace pensions, or 'Auto-Enrolment', began rolling out in October 2012.
Roll out will continue for several years through until April 2017 for the smallest businesses, and that extended timetable will deal with many practices.
The legislation requires all employers to enrol automatically some or all members of their workforce, depending upon age and wage level, into an employer organised pension scheme with certain minimum standards.
The NHS pension schemes may not be the solution for all GP employers as some workers may be ineligible to join the scheme.
An individual does not have to remain in the scheme and can opt out within one month of being enrolled.
Every employer will be allocated a date from when the duty to establish a scheme first applies and this is known as the staging date; for the GPDF this will be 1 April 2014.
There is a particularly important consequence of Auto-Enrolment. It may lead to loss of fixed or enhanced lifetime protection already obtained with the possibility of a 55% tax rate.
The GPDF and GPC urge you to begin by taking independent financial advice in so far as Auto-Enrolment is likely to impact you personally and/or your practice. Planning is the key.
The BMA, NHS Confederation and Pension Regulator all provide very helpful further information.
Final Seniority
Figures 2010/11
The Final Seniority Factors for England and Wales for
2010/11 have been published today by the Health and Social
Care Information Centre, following agreement by the
Technical Steering Committee. The figures are £94,080 for
England and £82,237 for Wales. Further details and the
report explaining the calculations may be viewed on the
HSCIC website.
Bulletin 216
04.03.14
£5 Per Head Funding for Practices to Improve Care for
Vulnerable Older Adults
NHS England's recent planning guidance, Everyone Counts,
recognises the need for practices to be given additional
resources to provide improved quality of care for patients
over the age of 75, over and above the avoiding unplanned
admissions enhanced service that will be coming into effect
in April. CCGs are expected to fund practices at around £5
pounds per head of practice population. For more information
see page 14 (Part 1, paragraphs 36 and 37) in this
NHS guidance. The LMC has contacted the CCGs to request
information on just how this funding will reach practices
locally.
Funding
Redistribution for GMS Practices
You will be aware that from April 1, there will be funding
changes for GMS practices as the phasing out of MPIG over a
seven-year period commences. There will be redistribution of
the correction factor across all
GMS practices, with each ending with an equivalent
weighted £ per head funding in seven years. This will mean
that about half of GMS practices will lose funding, while
the other half will gain. We are not aware of any Tees
practices that fall into the ’98 outlier’ category but we
are concerned about the impact on service provision and
practice viability for those who will lose significant sums
of money. If you feel you will be significantly adversely
affected please contact the LMC (Janice.foster@tees.nhs.uk)
so we can work with our Area Team to try and manage the
impact. We have a meeting with the Area Team on 21 March
where we will discuss this as well as discussing the local
approach they are looking to take with regard to the PMS
practice funding review.
NHSE Consultation: Framework for Managing Performer Concerns
NHS England has begun a formal consultation on its framework
for managing performer concerns. The documents have been
published and will be open for four weeks, closing
midnight on Thursday 20th March. The framework incorporates
the policy and high level procedures that together detail
NHS England’s responsibility for holding and maintaining
performers lists in respect of primary medical, dental and
ophthalmic performers as detailed in the
National Health Service (Performers Lists) (England)
Regulations 2013. The framework aims to support Area
Teams in managing their responsibility for performers
seeking to join the relevant list and to support the few
performers that may fall below expected standards once on
the list. NHSE expects to publish the framework, annexes and
a range of further guidance in April/May 2014. GPC will be
preparing a submission to the consultation on behalf of the
BMA, but if you would like to contribute as an individual
GP, you can do so by contacting Kate Rogers, Responding to
Concerns Project Manager, via
kate.rogers2@nhs.net.
Bulletin 215
25.02.14
Care.data Roll Out Delay
NHS England has this week announced a six month delay in the
roll-out of care.data following follows concerns,
particularly on the grounds that the public awareness
campaign has not worked, with many patients still unaware of
care.data and their right to object to the extraction of
data from their medical record. GPs will welcome that NHS
England has allowed more time to ensure that patients are
made fully aware of the implications of care.data, how their
information is stored and used, and their right to object.
The BMA continues to support the use of anonymised data to
improve and plan NHS services, but will be seeking further
assurances from NHS England around the scheme, working
closely with
them to ensure
that the public is properly informed and that safeguards are
in place before uploads begin in the autumn. GPs should
continue to enter the objection code(s) to patient records
where requested by their patients.
Named GP for Over
75s Guidance
The GPC have published
guidance on the requirement for a named GP for patients
aged 75 and over, which has been agreed as part of the GP
contract changes beginning from April 2014. The guidance
includes information on the responsibilities of the named GP
and how practices should decide on the identity of each
patient's named GP.
Changes to Pension Arrangements for GP Locum Appraisers and
Salaried GPs
The NHSPA (NHS Pensions Authority) has stated that all the
practice income of salaried GPs will now be pensionable.
Practice-based overtime is not currently pensionable for
salaried GPs - for example, if they work a Saturday morning
that income is not pensionable if it is outside their
contracted hours. Now all practice income can be pensioned,
even if it takes salaried GPs over their working time hours.
The NHSPA has also announced changes that mean freelance GPs
who carry out appraisals can now choose to pension that
income. Until now, only salaried and partner GPs appraising
other doctors could do so. This move comes after continued
lobbying of NHS England by the GPC sessional GPs
subcommittee. GP locum forms A&B will be updated by the
NHSPA in the coming weeks to reflect this change, which
comes into effect from 1 April 2014.
Updated
Enhanced Services Guidance 13/14
The enhanced services
guidance for 2013/14 has been updated following the
October 2013 read codes release.
Information Governances Toolkit – 31 March Deadline
Version 11 of the Information Governance Toolkit for general
practice went live in June 2013 and the deadline for final
submission is 31 March 2014. The toolkit encompasses
13 requirements against which general practice should self
assess. The Health and Social Care Information Centre (HSCIC)
states that completion of the toolkit is necessary in order
for practices to ensure that their HSCIC services, such as
the N3 connection, continue to be provided. This is because
every practice receiving these services needs to sign up
annually to an Information Governance Statement of
Compliance and the only way this can be signed or submitted
is through the IG Toolkit online assessment. 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. A link to the
toolkit is available
here.
We recommend that practices submit their 2013/14 self
assessments by the deadline.
Potential Scam, IT Systems
We have been made aware of a potential scam involving
someone claiming to work for a technical support department
on behalf of BT, Virgin media and other telephone and broad
band providers contacting practices via telephone. The
caller stated that they were being alerted by the central
server that the person answering the phone had a number of
viruses on their computer that could be effecting the speed
of their machine and that if they switched on their PC the
caller would talk them through how to clean these viruses
from it. When challenged and informed that there is a
central IT department or when informed that this was a GP
practice the caller hung up. The caller ID in one case was
1010101010. Some practices have had this call on every phone
line they have into the practice! This has been reported to
IT to create awareness but please be extra vigilant if you
receive such a call.
Kings Fund Report, Commissioning & Funding General Practice
The King's Fund has published a new report entitled ‘Commissioning
and Funding General Practice: Making the Case for Family
Care Networks’. The report argues for increased
collaborative working between GPs and increased funding for
practices to meet the demands on primary care, but within a
new contractual framework. Dr Chaand Nagpaul, GPC Chair, has
made this
response to the report.
Chronic Kidney Disease Care Audit
We are sharing this information on behalf of the BMJ:
National CKD Audit commissioned by HQIP, delivered by BMJ and partners.
Practices participating in the audit will be able to easily identify and manage
patients with CKD using free tools to optimise coding of patients, improve
quality of care, and comply with NICE guidelines; without adding to their
current workload. BMJ encourage all GP practices to participate. Read more: http://informatica.bmj.com/ckd
Bulletin 214
18.02.14
Value
Based Clinical Commissioning Policy
Public Health Shared Services have shared this revised
Value Based Clinical Commissioning Policy for the
Individual Funding Requests (IFR) in the North East and
Cumbria. This joint policy has been adopted by South Tees
CCG and Hartlepool and Stockton CCG and has been operational
since January 2014. The IFR process is led by NECS. Public
health has been supporting the review of the policy as part
of the public health core offer to CCGs.
BMA Collaborative
Working Survey
Nationally,
there has been significant interest recently in GP practices working as part of
formal or informal networks or federations to maximise productivity, cost
efficiencies and meet future challenges. At the same time, GPs have rightly
expressed that such collaborative models must retain the essential values of
general practice, as well as giving opportunities to all categories of GPs.
Models have already been established in some areas, discussions are emerging in
others, while many practices have not felt the need to consider collaborative
working yet. In light of this, the GPC would like all GPs to fill in this
survey so they can
establish the current landscape. The survey should take no more than two or
three minutes to complete and your responses will inform the GPC on how best to
support practices and GPs wishing to work in groups. The GPC have also produced
guidance on forming alliances for GPs and practices, which includes illustrative case studies and
details the practical considerations and first steps you will need to take. This
resource is intended for England, but its contents can be applied across the UK.
Further
guidance on sharing practice staff is also available.
Message from
GPC Sessional GP Chair
As we face one of the biggest periods of change to affect
general practice, national and local representation of
sessional GPs has never been more important - and the BMA's
sessional GPs subcommittee, which I chair, is actively
working on your behalf.
We have seen the formation of clinical commissioning groups,
and now practices are looking to form federations or work in
collaborative ways. If we want to take control of our
future, it is essential that sessional GPs engage with these
changes. Representation of sessional GPs at local medical
committee (LMC) level (across the country) remains limited,
yet involvement in your LMC is one of the most important
ways for sessional GPs to understand and influence what
happens at a local level. Now is the time to stake your
claim and secure your future in a general practice that
upholds the standards and principles that we value as GPs.
To stay up to date with these changes, which directly affect
you, I urge you to visit the sessional GPs subcommittee
webpage, which includes information about local
sessional GP groups and links to individual BMA sessional GP
support.
Best wishes,
Vicky Weeks
Chair, GPC Sessional GPs Subcommittee Chair
Bulletin 213
11.02.14
PMS Equitable Funding and Reviews
NHS England has published
guidance
and an accompanying presentation for its local area teams on equitable funding arrangements and
reviews for PMS practices. £325m of "premium" PMS expenditure has been
identified by NHS England as the amount by which PMS expenditure exceeds the
equivalent items of GMS expenditure. The premium will reduce to £235m over the
seven years to 2021/22 as GMS correction factor funding is phased out and global
sum funding increases. Area teams will have two years from April 2014 to review
their local PMS contracts, with the pace of change on the redeployment of
funding following the reviews being left to local judgement. They will invest
the premium funding in GP services according to criteria set by NHS England,
which are that the investment should:
secure services or outcomes that go beyond what is expected of core general practice or improve primary care premises
help reduce health inequalities
give equality of opportunity to all GP practices
support fairer distribution of funding at a locality level.
The guidance gives area teams discretion about how the funding should be invested within these criteria. The GPC’s position is that the premium expenditure should have been redistributed to core GP funding, providing greater certainty for practices and allowing them to invest for the future with greater confidence, for example by employing long-term staff and taking on new partners. In largely leaving decisions about the process and timescales to area teams, the guidance will create further uncertainty for practices and potentially create further inequity between practices in different areas. This position has been made clear to NHS England.
Partnership Changes (LLPs)
The government intends to make significant changes to the taxation of
partnerships and partners therein from 6 April 2014. The draft Finance Bill 2014
was published on 10 December 2013 and contained further detail on the proposals.
Under current legislation, all partners in an LLP (known as ‘members’) are
regarded as self-employed for tax and national insurance contribution (NIC)
purposes. The GPC has obtained this
advice from
a leading firm of tax experts.
Scam Warning
We have been made aware of a potential scam targeting patients in the area. A
patient received a call from someone, falsely, saying they were her surgery and
advising that they were now able to supply all medication direct without going
to the chemist or the surgery. They proceeded to ask what medication the patient
was taking in order to update records and then asking for bank details so the
patient could pay the delivery fee. This incident was reported to the police and
the call was traced to a mailbox number.
Bulletin 212
28.01.14
Care.data, NHS England Information about Leaflet Drop
NHS England have circulated this
information
(with link to attached
document titled NHSE message to all practices about leaflet drop 24.1.14) to all
practices. You may find you are unable to view the animation they are promoting
on the NHS England website, but you should be able to view the same
video on NHS Choices.
Bulletin 211
21.01.14
Care.data, Important Information
GP Workforce, Flu Vaccination Data Collection
Special Patient Notes (SPNs)
British National Formulary (BNF)
BMA 2014 Research Grant
Bulletin 210
07.01.14
Compliance
Aids and Change of Medication
For safety reasons it is important that practices issue complete new
prescriptions for all medication within compliance aids/blister packs/medipacks,
even if the original prescription is only partially changed e.g. only 1
medication in 10 is to be changed in order for a complete new compliance aid be
issued. We appreciate that this may result in a lot of wastage but, without a
complete new script, there is risk of human error in removing the correct
medication and the pharmacy will not be aware of the conditions under which the
medication has been stored so there would be safety concerns for the pharmacist
in accepting and reissuing medication that has already left the premises. This
guidance
was issued by the PSNC (with BMA input) and provides more information if
required.
Guidance for the Implementation of Repeat Dispensing
This joint guidance
for the implementation of repeat dispensing was produced by the BMA, PSNC and
NHS Employers and explains briefly but clearly what repeat dispensing is, how
suitable patients might be identified and the potential benefits.