Newsletter December 2011
Items from GPC News December 2011
The National Dementia and Antipsychotic Prescribing Audit
Changes to the RCGP curriculum
Elections to the Committee
Elections for half the LMC posts will be held in the first quarter of next year. Nomination forms will be circulated in January followed by elections with the new committee meeting from April 2012. As in the previous election, two posts will be reserved for female members and one for a non-principal GP. The committee meets usually on the first Thursday of every month except where holidays dictate otherwise. We are will to provide any information or help anyone requires in making a decision to stand, we particularly encourage our female colleagues to stand. Interestingly in the last election the successful female colleagues won their places on a straight forward count of the ballot papers without having to evoke the reserved places rule.
Workload
The committee is in discussions with the Clinical Commissioning Groups about the seemingly ever increasing workload being shifted from secondary care. Some of this work is the responsibility of secondary care and should not be passed on, some occurs though poor working practices in secondary care who find passing a problem on to the GP an easy way of abrogating their responsibilities and some is the result of new pathways. An new work arising as a result of new pathways must be adequately resourced and if not GPs should refuse to take it on. Primary care, as always appears to be the focus of cost cutting and squeeze, whilst consuming a small percentage share of the NHS budget and being the most cost-efficient sector of the health service. There should be more investment in General Practice to deliver a cost-efficent health service and this investment should be sustainable and not just via short term fixes.
Travel Immunisations
The GPC has published "Focus on Travel Immunisations" which explains which travel immunisations are available on the NHS. The rules around this are based on the old "Red Book" regulations which were transferred unchanged into the New Contract and payments for some immunisations were included in the global sum. The change in availability of immunisations and the nature of foreign travel has made these regulations difficult to interpret. This document reflects the present situation and is intended to help practices by clarifying the existing regulations as they currently stand.
A copy of the guidance can be found here.
Firearms Licensing
The BMA has issued this interim guidance for GPs on firearms licensing:
The BMA has agreed in principle that where an individual has been granted a firearms licence, or an existing licence has been renewed, the police will subsequently contact his or her GP to enquire whether there is any medical information that might have a bearing on the individual's suitability to hold a firearm.
Although aspects of this agreement were discussed and agreed in principle in November 2010, the BMA was expecting confirmation and further discussion with ACPO on when implementation of the new procedure would occur to ensure GPs were informed and suitably advised prior to the letters being sent out.
Unfortunately this has not happened and police forces have already begun to issue letters to GPs (without the BMA’s prior knowledge) which do not provide sufficient instructions or advice. They are currently seeking further discussions with ACPO to try to resolve these issues.
Where doctors wish to respond to these letters and provide relevant medical information, consent to the disclosure of that information should ordinarily be sought as the letter does not currently indicate that consent has been given. If the patient does not consent to disclosure, this should ordinarily be respected, although the police must be informed to that effect. If, however, the doctor believes that the patient presents an immediate risk of serious harm to themselves or others, information should be disclosed even in the face of an explicit refusal.
Doctors are under no obligation to respond to these letters, but should they decide not to, doctors should inform the police as it will otherwise be assumed that there is nothing relevant on the medical record.
Although the letter from the police states that it does not have to be retained, in the BMA’s view doctors should record the request for information in the medical record and indicate what action, if any, they have undertaken. The BMA will be updating its guidance as soon as this matter has been resolved.
HPV vaccinations update
The Department of Health (DH) has announced that from September 2012 Gardasil, rather than Cervarix, will be used in the HPV vaccination programme. The BMA [co-signed by Central Consultants Dermatology & Venereology subcommittee and Public Health Medicine Committee] wrote to the DH earlier this year calling for them to consider the latest evidence and cost-effectiveness of Gardasil, which protects against the two types of HPV virus that cause cervical cancer and genital warts.
The programme was introduced in 2008 after the Joint Committee on Vaccination and Immunisation (JCVI) recommended that the HPV vaccine should be offered routinely to girls aged 12 to 13 years, as well as a catch-up programme for girls up to 18 years of age.
The press release is available on the Department of Health website.
Items from GPC News December 2011
Health and Social Care Bill
As you will be aware, in November BMA Council took the decision to oppose the Health and Social Care Bill in its entirety. This decision was taken in the light of the proposals for commissioning support in the Department of Health document ‘Developing Commissioning Support: Towards Service Excellence’. Hamish Meldrum and Laurence Buckman wrote to Andrew Lansley, expressing the BMA’s grave concerns about the document. As a result of this letter, a meeting with the Secretary of State took place this week. Discussion centred around the fact that, contrary to the aim of the Health and Social Care Bill, the risks inherent in the Bill (such as the promotion of the private sector in commissioning support) threatened to undermine the benefits of giving more decision-making power to clinicians. You can read about lobbying activity on the BMA website.
Laurence Buckman wrote to all GPs in England last week detailing concerns about the Bill as well as setting out a number of key conditions the GPC considers vital to the positive development of CCGs. The letter is available on the BMA website.
Commissioning Update
The GPC debated the development of CCGs, including concerns from some areas that PCT clusters were dictating how fledgling CCGs should develop. It was agreed that CCG leads should ensure that they were not bounced into importance decisions about policy and process. Good engagement with constituent practices would best enable CCG leads to set the commissioning agenda and form good relationships with the bodies they need to work and to which they are accountable.
The GPC has published guidance on the authorisation process, flagging the GPC’s top issues for LMCs and GPs to consider as CCGs seek to become established. This guidance can be found on the NHS reforms webpages.
Pensions
The BMA has launched Your pension, Your future, Your say a drive to ensure as many doctors as possible are aware of, and understand the proposed current changes to the NHS pension scheme, and what it means for them as individuals. Ministers are keen to reach an agreement on public sector pensions by the end of the year.
The BMA will then be seeking members’ views on whether they think the final offer is acceptable and, if not, what action they would be prepared to take. If the proposals are rejected a ballot on industrial action could follow. The BMA website includes a simple online tool for BMA members to update their workplace details – vital information for a successful ballot. Please encourage all GPs to login to check and update their place of work details at the earliest opportunity.
Cervical cytology training
Earlier this year, we were made aware of a number of PCTs insisting that all GPs working in their areas undertake either a half day or a full day's update training in taking cervical smears. Many had been told that this was a contractual requirement and therefore mandatory.
We believe that this was an unreasonable requirement, given that the training for undertaking cervical smears is already included in the GP curriculum covered during the period of vocational training for general practice.
We therefore wrote a joint letter with the Royal College of General Practitioners and the Department of Health. As a result of this and subsequent meetings, the DH has now written to all PCTs confirming that there is no contractual requirement for GPs to have cervical cytology update training.
A copy of the letter can be found here..
The National Dementia and Antipsychotic Prescribing Audit
The GPC position is that GP practices should opt in to the extraction of identifiable data for secondary purposes in accordance with agreed GPES principles. Unfortunately the circumstances and timing of the dementia audit do not allow for this, but we are very supportive of what the dementia audit is trying to achieve and, in view of the very limited dataset which will be extracted, we see no reason why practices should not take part. Practices will receive a letter from the NHS Information Centre very soon with further information about the audit, including details on opting out for those practices that do not wish to take part.
Changes to the RCGP curriculum
The RCGP recently announced changes to the GP curriculum, which are due to be implemented from August 2012. The changes are being made in response to feedback gathered from users, and are largely focussed on making the curriculum more user-friendly with a clearer and more consistent structure. There will also be some updates to the content. More details can be found on the RCGP website.