Newsletter July 2009
Confirmation and Certification of Death guidance
Circumcision on Religious Grounds
The commissioning of out-of-hours care
Safeguarding vulnerable adults
Representation of sessional GPs
Working in Partnership Programme Workload Analysis Tool
Pandemic Flu
We have all seen a great increase in the number of patients presenting with flu like illness in the last few weeks, as well as those who are worried about a possible contact with someone who may have the disease. The PCTs have spent a lot of time in the last few months planning for the flu epidemic. The main features of the plans locally are a budding up of practices to cope with the impact of illness amongst our GPs and staff and a plan for a visiting service for those patients with flu like illness who need to be assessed further at home. Inevitable some have found fault with these plans. However the issues have been discussed with the LMC and we ask that practices do not obstruct the plans being made by the PCTs. We are all working to provide the best model of care for the patients of North Staffordshire in the difficult circumstances which a flu pandemic will bring. It is not in the longer term interests of the profession for us to be seen to be obstructive to the flu pandemic plans.
The PCTs are planning to introduce a "flu line" to take calls from patients who feel they may be suffering from swine flu, however, these plans may be modified by the announcement by the CMO that a national flu line will be in place within the next week. It is important that we keep up to date with and read the emails sent out the respective Directors of Public Health of the two PCTs.
The BMA has published a list of "Pandemic Flu Questions and Answers". This can be found on their website at http://www.bma.org.uk/health_promotion_ethics/influenza/panflugp/index.jsp The web page will be updated regularly as each query or problem is resolved.
The GMC has amended it guide to Good Medical Practice to help doctors be clear about what the GMC will regard as good practice during a pandemic. In this version some of the usual requirements - such as participating in appraisal and performance review - have been lifted. They have recognised the pressures and restrictions that may accompany a pandemic by adding qualifying clauses to the guidance, recognising that constraints on time and other resources may limit doctors' ability to provide detailed information or help for patients. A copy of the document can be found here. The additions to "Good Medical Practice 2006" are shown in italics. This version of Good Medical Practice will be implemented when the UK reaches Level 3 of a pandemic. We are currently at level 2
QOF and Patient Survey 2009
It has become apparent that there are some serious problems with the results of this years patient survey in particular because they seemed to be based on small response rates. The GPC debated this and is very concerned that problems similar to those in Scotland have been reported in England and in the other nations. Some practices may have their results and therefore some QOF points and a significant amount of funding determined by a very small proportion of their total practice population. It is quite possible that practices will receive a good response rate to the survey as a whole, but low levels of response to one or both of the key access questions. It seems that this is a particular problem with the PE8 questions on advanced booking.
Following discussions between the GPC and the Department of Health and NHS Employers to seek to resolve this issue. The DoH has issued further guidance to PCTs regarding the QOF patient experience indicators. The important paragraph reads:
We have clarified in previous guidance that there remains provision for PCTs to make discretionary local payments where this is beneficial to the delivery of services and there is an absence of a survey result or where the result is very low for an individual practice and the PCT can reasonably be assured by other evidence that achieved survey results may be ‘unduly skewed’ from the limited response an individual practice received. In these circumstances, PCTs will need to be satisfied that
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The survey result is substantially lower and different than that of previous years, and
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The practice can provide clear evidence that they routinely provide arrangements that consistently offer 48 hour and advanced booking access, backed up by evidence from patient participation groups or local surveys. This evidence must be clear and auditable to demonstrate that decisions reached are fair and justified.
The practices concerned should by now have submitted an appeal to their PCTs who are convening panels to decide the outcome of these appeals.
Quality in General Practice
Earlier this year the GPC undertook a consultation asking GPs and stakeholder to share their experiences in the area of non-clinical services provided by general practices. As result a document "Developing General Practice: Listening to Patients" has been published. The intention is to share best practice among the profession. The GPC feels that it is important for practices to focus on "customer service" and patients who are made to feel welcome by their practice are more likely to remain loyal to their GP, reinforcing the doctor-patient relationship and continuity of care, which is so important in general practice. Practices that maintain such a focus will be ready for practice accreditation, whenever it comes, and the patient informed appraisal outlined in the revalidation proposals.
With increasing competition from the newer models of care being promoted by the government and increasing scrutiny by PCTs, this publication is important to us all. A copy can be found here.
Sugar Free Medication
Article submitted by Mary Doherty, Specialist Registrar in Dental Public Health
A big thank you to everyone who has worked with us over the last few months to try and increase the prescription of sugar-free medicines. As part of a wider preventive strategy, increasing the prescription of sugar-free medicines will contribute to decreasing levels of dental decay.
In 2006-2007 a baseline assessment of prescribing patterns for sugar-free medicines in general medical practices was carried out. Key indicator medicines were selected for analysis.
Following on from this initial assessment, work has been done to try and increase the prescribing of sugar-free medicines. With the help of the Medicines Management team, practice computer systems have been modified where possible to promote sugar-free options.
Data from August 2008 – October 2008 was then evaluated to assess the effect of the changes to the computer systems. Overall the proportion of sugar-free medicines prescribed had increased. Significant increases were seen for amoxicillin, ibuprofen and paracetamol but a significant decrease was noted for sodium valproate.
Proportions of medicines prescribed sugar-free, 2007 - 2008
| July - Dec 2007 | Aug - October 2008 | |
| Amoxicillin | 44.3% | 67.4% |
| Ibuprofen | 68.1% | 74.0% |
| Paracetamol | 38.9% | 49.3% |
| Sodium Valproate | 74.0% | 51.9% |
Source: EPACT database, Medicines Management Team, Stoke on Trent Primary Care Trust
Some practices had not yet had their computer systems changed when the second round of data was collected in late 2008 – this may mean that the effect of the changes has been under-estimated. To get a clearer picture of the proportions of sugar-free medicines now being prescribed it is important to carry out a repeat audit looking at data collected once all of the computers have been modified. This repeat audit is planned for later in the year.
We are delighted to have seen positive changes to sugar-free medicine prescribing patterns and would like to encourage everyone to consider sugar-free alternatives wherever possible. Thank you once again for your continued support for this project.
If anyone would like further information please contact Mary Doherty via email at mary.doherty@stoke.nhs.uk or via telephone on 01782 298142.
Confirmation and Certification of Death guidance
The BMA has issued updated guidance on the confirmation and certification of death. A copy of this guidance can be found here.
Circumcision on Religious Grounds
Colleagues are reminded that if they are undertaking circumcisions, they to ensure that they are complying with an accredited competency framework and that they are registered with the Care Quality Commission.
GPC News Items
A selection of items from the latest issue of GPC news.
Pandemic influenza update
The GPC continues to meet regularly with the NHSE and RCGP to discuss outstanding issues of the joint DH - BMA - RCGP guidance: Preparing for Pandemic Influenza - Guidance for GP practices, what to do now and in a pandemic, which can be found on the BMA website.
We will also be writing to GPs, LMCs and PCTs with an update on pandemic flu arrangements and the current progress of some of the issues that were raised in the joint pandemic flu guidance, in particular those relating to sessional GPs.
We would urge doctors regularly to check the latest guidance on the BMA website to keep updated of the latest developments; and this is particularly important for sessional GPs who may not routinely receive communications sent out to practices. The BMA's website also has links to other key websites, including the Health Protection Agency.
The commissioning of out-of-hours care
Following a resolution passed at the 2008 LMCs conference, the GPC was asked to consider whether GPs should resume responsibility for the commissioning of out-of-hours (OOH) services. After much deliberation, it was concluded that practice based commissioning already enabled those GPs that wished to commission out-of-hours services, to do so. However, it was agreed that to recommend any change to the statutory framework of OOH commissioning would be inappropriate while funding remained inadequate in many places and inequitable across the country. There was also a considerable risk that if GPs were to resume the commissioning of OOH services, this would be confused with a responsibility to provide these services. Lastly, it was noted that different political parties have different intentions regarding the involvement of GPs in the commissioning of OOH care, and thus any change in government would require a detailed review of these considerations.
Safeguarding vulnerable adults
In October 2008 the Department of Health (DH) launched the national consultation on the review of the No Secrets guidance. The Safeguarding Adults: A Consultation on the Review of the ‘No Secrets’ Guidance document can be viewed via the Department of Health website.
The Community Care Committee coordinated the BMA’s response with significant input from the GPC and the Patient Liaison Group (PLG). The response was sent in January 2009.
In conjunction with the formal consultation, in October 2008 the DH invited a representative from the BMA to attend the NHS ‘No Secrets’ Advisory Group meetings. The DH set up the steering group to provide a communication channel between the DH and the NHS to ensure full engagement is achieved to develop safeguarding in the NHS during the next phrase of the development and implementation of the No Secrets guidance in 2010.
On 6 May 2009 the chairman met with Anna Morgan, National Programme Manager No Secrets, Department of Health, to discuss the safeguarding of vulnerable adults and the DH’s draft practical guidance for GPs being developed.
From the consultation and these meetings, the GPC is anticipating that this initiative could have a significant effect on GP as employers in addition to GPs themselves. The GPC will be working closely with relevant stakeholders to produce guidance for GPs in the near future.
Workforce issues
The BMA’s Health Policy and Economic Research Unit is working with all branch of practice committees on a coherent BMA-wide medical workforce policy. The GPC proposed that any expansion or extension to GP training must be properly resourced, as well as support for career progression across the range of different contractual arrangements for GPs.
Alongside this work, the GPC has set up a workforce sub-group to examine GP-specific workforce issues. The sub-group is working on an agreed GPC workforce policy in the context of a number of issues, including the current lack of career choices and partnership opportunities for newly qualified and other GPs, the trend towards the recruitment of salaried GPs, the expansion of GP trainee numbers, and the increased demand for primary care services. The GPC supports the need for concrete action in this area, and the workforce sub-group will be meeting again to determine and prioritise its proposals for further action.
Representation of sessional GPs
Representatives of the Sessional GPs subcommittee and the Representation subcommittee will be meeting in the forthcoming session to consider the representation of sessional GPs on GPC and within the wider BMA. The group will consider the possibility of seeking views from the wider body of sessional GPs.
Working in Partnership Programme Workload Analysis Tool
The GPC received an announcement about the Workload Analysis Tool developed by the NHS Working in Partnership Programme to help general practice manage workload demands more effectively. The marketing rights and intellectual property rights to the Tool have been awarded to Informatica Systems Ltd. Further information is available online.