April 2011

Dr David Hughes has decided to step down from the Committee following his appointment as Chair of the North Staffordshire Shadow Commissioning Board. Dr Martin Sullivan has moved to a new practice in Shropshire and Dr James McCarthy has also decided to step down from the Committee.

This leaves three casual vacancies on the committee for the remaining term of office of these doctors. The committee has decided that there should be a by-election to fill these posts. Nomination papers will be circulated shortly and an election will then be held using the STV system for two posts until March 2014 and one until March 2012.

New Contractual Changes

The guidance relating to the new contractual changes has now been posted on the BMA website. The documents have had extensive GPC input. Copies can be found via the links below:

Also recently published have been the DES directions and SFE amendments

Fit Notes and the "Fit for Work Service"

The LMC held a meeting recently with Howard Paskin from ACAS and Margaret Brett from the North Staffordshire Fit for Work Service who described the reasons for change from the "sick note" to the "fit note" and the use of the "Fit for Work Service" available to residents in North Staffordshire.

The meeting sought to dispel some of the myths around sickness certification and fitness for work. Howard gave a presentation on the employer's perspective and how we can help patients return to work, whilst Margaret described the use of the "Fit for Work Service" which is a pilot service the government are funding to help patients return to work. They are in the unique position of being able to liaise with the patient, employer and occupational health services. They also have access to Musculo-skeletal Assessment, IAPTs, Self Management Group Intervention and Enhanced Employment Support Services. Patients who have been off work more than a few weeks should be considered for referral into the service. Surgeries should have already received information about the service and the methods of referral. Further details of the service can be obtained from Margaret Brett whose email address is margaret.brett@nhs.net.

A copy Howard's presentation can be found here.

A copy of Margaret's presentation can be found here.

Bowel Cleansing Preparations

As previously reported the National Patient Safety Agency has raised an alert concerning death and harm from electrolyte abnormalities, dehydration and serious gastro-intestinal problems that have been reported following the inappropriate use of oral bowel cleansing solutions, Picolax etc. The alert stated that a clinical assessment is to be undertaken by the clinician authorising the surgery or investigation (including GPs using the direct access route) to ensure that there is no contraindication (e.g. diverticulitis) or risks (concurrent medication such as diuretics) from the use of a bowel cleansing solution.

As a result of this neither GPs or our consultant colleagues have been happy about prescribing Picolax for patients who are to undergo a bowel examination. GPs don't wish to take prescribing responsibility for a drug they are not familiar with and secondary care colleagues don't know whether the patient has any risk factors prior to prescribing. This is causing problems particularly with 2 week wait referrals. A solution has been discussed both at the LMC and at the Area Prescribing Committee which will involve the 2 week wait referral form for suspected lower GI cancers being amended to include questions about possible contra-indications or risks associated with the prescribing of picolax. More details will be circulated to GPs in due course.

Dispensing on Discharge from UHNS

As reported last May, the University Hospital of North Staffordshire has been implementing the roll-out of One Stop Dispensing (OSD) since September 2009.

A key goal of One Stop Dispensing (or Dispensing for Discharge as some Trusts describe it) is to identify as soon as possible on admission whether the patient’s own drugs (POD’s) which have been brought in from home are suitable for use during the in-patient stay.

The West Mids Ambulance Trust has agreed to carry at least 8 green POD bags per vehicle. Patients who are admitted to UHNS will be encouraged to take their prescribed medication with them into hospital.

Ward-based clinical Pharmacy teams will be using wireless Computers on Wheels (COW’s) on wards. This will facilitate medicines reconciliation at the bedside as well as enabling remote dispensing from ward stock which in turn will help speed-up the discharge process. As a result of these changes patients may be discharged with less than 28 days supply of medication but should have at least 14 days supply.

The UHNS have now addressed the issues around POD storage in A&E. They will be circulating a poster to all GP practices and other key areas where they hope it will be displayed. They also plan to widen the existing in-house communication to include local media and to supply local pharmacies with a stock of the green POD bags to help patients to transfer their medicines to hospital safely.

GP Commission Consortia Leadership

The GPC has produced new guidance on leadship in consortia. A copy can be found here.

Clinical Waste Pre-acceptance Audit

The Environment Agency has now re-published its sector guidance 5.07 for operators of waste disposal facilities. The guidance requires all producers of healthcare waste, including GP practices, to complete an audit of their clinical waste. The deadline for this was originally set for October 2010 but was extended due to the need for further consultation with the waste management industry. GP practices must now provide the relevant information to their waste contractor by 1 July 2011.

Practices can either collect the data themselves or employ a third party to do so. Alternatively, the practice’s waste contractor may offer to complete the audit but may charge for this service. The GPC has produced a self audit tool and a ‘Focus on clinical waste’ to help practices provide the information themselves if they wish to do so.

Focus on Clinical Waste can be found here.

The self audit tool here (pdf) and here in word format.

Requests from Schools for sickness certification

GMS GPs are not contractually obliged to provide a sick note for pupils who are off sick from school. They are also not obliged to provide sickness certification for students that miss an exam or believe their performance was affected due to illness. The same is likely to apply to other NHS GPs. Unfortunately, many GPs still receive requests for the latter.

The BMA's General Practitioners Committee (GPC) therefore wrote to the Office of the Qualifications and Examinations Regulator (Ofqual) about this, last year and received a response which highlights that medical proof should not be required.

The Joint Council for Qualifications also states in their FAQ section

No: only for part absence and for circumstances you cannot verify. If a medical note is not forthcoming, is there a label from the prescription which can be used or part of a computer prescription sheet? It needs the candidate’s name and the date.

Please also see the self-certification form and notes for its use (Form 14 on the JCQ website). If a candidate misses a unit which can be taken at a later date, please do not ask for a medical note and submit an application. Simply re-enter the candidate at the next available opportunity. Remember to check that the correct preparation has been given for the next series’ unit.

Focus on QOF Payments

The GPC has produce a document which gives a full breakdown on the methods used to calculate and make payments earned through the Quality and Outcomes Framework. A copy of the document can be found here.

Focus on Taking on New Partners

The GPC has produced guidance on taking on new partners. This document looks at:

The cost of employing a salaried GP, including National Insurance contributions and employer's superannuation
The impact of the tax burden for existing partners earning over £100,000
The benefits of taking on a new partner.

A copy of the document can be found here.

Good Practice Guidelines v4

The Good Practice Guidelines v4 have now been published. This latest version of the GPG for GP electronic patient records supercedes version 3.1 and will act as a reference and source of information for all those involved in developing, deploying and using general practice IT systems.

A copy of the full guidelines can be found here.

A shorter quick reference guide can be found here.

Election of GPC Regional Representatives 2011 - 2014

A election will be held shortly for regional representative to the General Practitioners Committee of the BMA. GPs who contribute to the LMC voluntary levy are eligible to vote in this election and will receive postal ballot papers. The candidates for the Staffordshire/Shropshire constituency are:

Dr Uday Kumar Katkar
Dr Mary McCarthy
Dr Gulshan Kaul
Dr Chandra Kanneganti

Items from GPC News March 2011

Health and Social Care Bill update

BMA lobbying toolkit

The BMA is working incredibly hard to achieve amendments to the Health and Social Care Bill. This process is difficult, but every GP can help with this by lobbying their MP and the GPC urges GPs and LMCs to do this. The BMA has set up a specific lobbying toolkit to help. This includes a template letter that can be sent to your MP with a couple of clicks, and detailed guidance on the best way to write to your MP if you prefer the individual approach. Putting pressure on MPs is crucial if our concerns regarding the Health Bill are to be addressed – please use this toolkit and write to your parliamentarians.

The functions of GP commissioning consortia

The Department of Health has published a document outlining the expected functions of a GP consortium. This is described as a 'working document' in order to acknowledge that the proposals within the Health Bill have not been passed into law. This document is not binding on shadow or pathfinder consortia, and they should not consider it as such. The GPC had some concerns about the document and decided it would not be appropriate to be party to it. A GPC critique of the document will be produced shortly.

PCT consortia development fund

The NHS Operating Framework 2011/12 sets out a development fund of £2 per head that will be provided by PCT Clusters to emerging consortia. This is designed specifically to support consortia development. This does not mean it is to be used to begin the process of commissioning or maintain existing Local Enhanced Services, for example. The Operating Framework is very clear that this money

“should be in addition to, and used alongside, existing PBC (practice-based commissioning) funding and can be used flexibly to fund, for example, clinical backfill, training and organisational development”.

PCT Clusters have been instructed to raise this money from the management costs savings realised as part of the mutually agreed resignation scheme (MARS). This money should not be made available at the expense of funding provided to GPs or practices elsewhere.

Commissioning consortia transitional arrangements

The GPC believes that commissioning consortia will not be able to reach their full potential unless they have the support of the entire profession locally.

Because of this, LMCs and those involved in the development of consortia should make every effort to ensure that all consortia (and shadow consortia) electoral processes are open to all GPs in the consortia’s proposed locality, regardless of their contractual status. Any consortia (or shadow consortia) elections should be run on the basis of one GP, one vote.

If the Health and Social Care Bill is passed in its current form, some decisions will need to be made on a practice level. In cases such as this, we still believe that all GPs should be involved in the decision making process, and therefore believe that each practice must have in place a mechanism to ensure that all GPs working in the practice are appropriately involved in the decision making process.

To reflect this, GPC passed the following motion:

That, in order to maintain local professional confidence, all transitional arrangements towards Commissioning Consortia must,

where creating a clinical leadership team, include a democratic electoral process, that is inclusive and open to all GPs working in the proposed locality whatever their contractual status, and with one GP one vote
where a practice level decision is required, for example regarding the practice choice of proposed consortium, every practice must have in place a mechanism which ensures that all GPs working in the practice are appropriately involved in the decision-making process.

The GPC’s guidance (Shadow Consortia: Developing and Electing a Transitional Leadership) will shortly be updated and re-issued to include this motion and to re-emphasise the importance of involving all GPs in the work of consortia. The GPC particularly encourages sessional GPs to put themselves forward for leadership positions within consortia. The guidance "Sessional GPs: GP Commissioning and The Impact of the White Paper", available on the BMA website, provides more information.

Consultant involvement in commissioning The Central Consultants and Specialists Committee (CCSC) and GPC have produced joint guidance highlighting the implications of the Health and Social Care Bill and the importance of involving secondary and tertiary care clinicians in the commissioning process and enabling consultant involvement. This is available on the BMA website.

Special Representatives Meeting

The BMA’s Special Representative Meeting to debate the Health and Social Care Bill was held on 15 March. A list of the resolutions of the SRM is available on the BMA website.

In its meeting the following day, BMA Council confirmed its intention to step up its opposition to and continue to publicise the most damaging parts of the Bill. Council also considered a variety of options that would be necessary to achieve these aims. The role that competition, and in particular Monitor - as the economic regulator - will play in planning and running health care, is a key concern.

In a press statement issued after the Council meeting, Hamish Meldrum, Chairman of Council, said:

“Ministers can no longer continue to cite the often reluctant and pragmatic decision by GPs to get involved in commissioning groups as endorsement of their NHS reforms. Following yesterday’s SRM, the government should not be left in any doubt about the strength of feeling among the medical profession; many doctors recognise the need to change how the NHS is run but have serious concerns about scale and nature of the planned reforms which are hugely risky and, potentially, highly damaging.”

The GPC discussed the areas of concern in the Bill on which it will be focusing in the coming months. These will include: highlighting the considerable unacceptable restrictions the legislation would place on commissioning consortia; the damaging implications of the quality premium; and competition and the role of Monitor.

Vetting and barring scheme

The government has announced provisions to revise its vetting and barring arrangements. Information about the reforms, and the scheme remodelling review report, can be viewed online.

Care Quality Commission - hoax calls

We have been made aware that the CQC has received reports from care homes and nursing homes that have been targeted by bogus callers requesting the names and PINs of nurses employed there, claiming to be from the Nursing and Midwifery Council or the Care Quality Commission. Phone calls requesting personal data are not the policy of the CQC or the Nursing and Midwifery Council, and GPs and their practice staff should not volunteer any information to these scam callers. Please take as many details from the caller as you can and send the details to the GPC secretariat or take the matter to the local police.

Clinical Skills Assessment

A small number of GP trainees were affected by the confusion surrounding the recent changes to the CSA. The GPC is pleased that the RCGP has listened to the GPC’s concerns about this, and has written to each of the affected trainees to offer them either a refund of the cost of their CSA sitting, or a free re-sit at a future date.

PMS practices - salaried GPs and nurses employed by PCTs

A number of PMS practices have contacted the BMA's Employment Advisory Service (EAS) regarding the contractual status of salaried GPs and nurses working in their surgeries. Some PCTs employing salaried GPs and nurses working in PMS practices have unilaterally decided to transfer the responsibility for, and costs associated with, employing salaried GPs and nurses directly to the practices concerned under the TUPE regulations. If any PMS practices have been affected, and have not already sought the advice from the BMA's EAS, we would encourage them to do so. - 6 - Call 0300 123 123 3 or email support@bma.org.uk for free advice you can trust.

Seasonal flu vaccination programme for 2011/12

The Chief Medical Officer (England) has sent a letter to PCTs and GPs confirming that the arrangements for procurement of vaccines for 2011/12 will remain the same as last year, and urging practices to start ordering their vaccines now, if they have not already done so. This letter follows an announcement made earlier this year by Professor David Salisbury, DH Director of Immunisation, of their intention to carry out a review of current procedures, and the GPC asking the DH to confirm the arrangements for this year so that practices would know what they needed to do in preparation.

The GPC would like to congratulate practices on their hard work in relation to seasonal flu vaccinations for 10/11, despite all the potential problems practices faced over the winter.

The letter is available on the Department of Health website.

ImmForm

The ImmForm website is the system used by the DH, the NHS and the HPA to record data in relation to uptake against immunisation programmes, incidence of flu-like illness and to provide vaccine ordering facilities for the NHS. The GPC has been made aware that some PCTs have been using ImmForm data to ascertain flu vaccination payments for GPs.

The GPC has raised this with NHS Employers who have responded to confirm that PCTs should not be using ImmForm data to calculate payments for practices. PCTs can, however, choose to review the ImmForm data to compare numbers but should be aware that there will be differences as a result of patients who have come off the practice list.

NORTH STAFFORDSHIRE

LOCAL MEDICAL COMMITTEE

Newsletter April 2011

By-election to LMC