Newsletter July 2010
White_Paper_-_Liberating_the_NHS
Goodwill_and_Dispensing_Briefing
Focus_on_the_DHs_Improving_GP_services
Learning_disabilities_DES_guidance
Department_of_Health_GP_bulletin
Dispensing_doctors_in_England_Cost_of_Service_Inquiry
Sessional_GPs_Representation_Working_Group
Notification_of_infectious_diseases
Services_for_GPs_from_the_BMA_library
Editorial
We now have a clearer idea of the government's plans for the future of General Practice and the Health Service. The recent white paper makes it clear that GPs will be in charge of commissioning care and of course maintaining the inevitable budgetary restraints. Whilst this brings exciting times for some, it must be taken into account that the vast majority, if not all of us came into medicine to provide medical care for patients rather than administer the system. We all have medical degrees and are not accountants and business entrepreneurs. There are, of course, a number of GPs who are enthusiastic about the changes and look forward to the challenge. We must give them our support, but at the same time they must recognise that probably the majority of GPs feel their main task is to treat and prevent illness in the community. We would like to hear from our "jobbing GP" colleagues what their thoughts are on the future changes, otherwise we risk being carried along on the wave of enthusiasm of the zealots. I do have concerns about the capacity of General Practice to take on these added responsibilities. No doubt we will try and hopefully we will succeed.
It is interesting to note that in the early 1980's there were approximately 235 GP practitioners in North Staffordshire. Now there are around 285 GPs on the performers list of North Staffordshire and Stoke PCT who are listed as being either principals or salaried GPs. It is very tempting to compare this with the increase in the number of consultant posts at UHNS, for instance in the early 1980's there were 3 paediatricians, 4 obstetricians, 6 general surgeons, 3 cardiologists, 3 ophthalmologists. The only speciality with no increase in consultant numbers is dermatology. This is despite evidence that the real gains in Health Care are made by increasing the number of General Practitioners per head of population. If we had achieved as much an increase in numbers as some of the consultant specialities I have no doubt that we would have the capacity to take on all that is expected of us in the white paper, all the secondary care work being transferred out and give an even better service to our patients.
White Paper - "Liberating the NHS"
Now that the government has published its white paper "Liberating the NHS", we have better but not necessarily clearer idea of their plans for the future. It is obvious to all that in the current economic climate resources are going to be limited. GPs will be expected to play their part in ensuring that the care they provide and refer patients on for is as cost effective as possible. In the coming months we will no doubt see all sorts of pressures brought to bear on us to ensure this outcome.
The white paper offers more freedom to all! GPs will be commissioners of care, patients will be given more choice and secondary providers will have to become NHS trusts which in turn will give them more freedom. PCTs and SHAs are going to be abolished. There will be a greater role for local authorities as the public health functions are moved back to them, where they were up to the 1970's. They will have the function of providing more co-ordination between health and social needs.
A "NHS Commissioning Board" will be set up to allocate and account for NHS resources. This board will hold our contracts and will be responsible also for dental, pharmacy and ophthalmic services. Among other responsibilities they will lead on quality and commission services which cannot be commissioned by GP consortia. There will be an economic regulator "Monitor", which will take on the responsibility of regulating all providers of NHS care.
At the same time budgets are going to be strictly limited and it is acknowledged that the NHS will only be able to increase quality through implementing best practice and increasing productivity. How this can be achieved, if at all by giving greater freedom to everyone will be interesting to see.
Mental Health Act
There has been some discussion among LMCs recently about the responsibilities of GPs in relation to the Mental Health Act. Any GP assessing a patient for detention under the Mental Health Act must, in law, have prior knowledge of the patient or be registered under Section 12 of the Mental Health Act. Having the patient's notes is not enough. We should not be receiving urgent requests. Sections 5(2) & 5(4) are available as 72 hour holding sections, or a section 136 is available to the police to detain someone from a public space. They also have section 135 which allows them to enter a property to detain someone believed to be a risk to themselves or others.
The GP might be called upon to help with the subsequent section 2 (28 days assessment section), but there should be plenty of notice of that (i.e. 72 hours as it should be triggered when a section 5 is applied) and if a GP with prior knowledge is not available then a section 12 approved doctor must be sought.
Focus on new Tax Brackets
This document which was first published in March and then withdrawn has now been republished. A spreadsheet added which illustrates the financial implications of taking on a salaried GP. Please also note the addition of the Mazars LLP letter report and the General Practitioners Defence Fund Limited (GPDF) disclaimer, both of which are integral to a proper understanding of this guidance and of its accompanying schedules, which are presented for illustrative purposes only.
This guidance is being revised after the emergency budget on 22 June.
A copy of the document can be found here with Schedule A and Schedules B - E
Vetting and Barring Scheme
The Vetting and Barring Scheme which was due to begin on 26th July has been suspended, until the scheme has been reviewed and remodelled. Thus the requirement for new GPs to be ISA registered has been suspended.
Goodwill and Dispensing Briefing
The BMA has produced a briefing on Sale of Goodwill and dispensing, which was drafted to clarify whether GPs can sell goodwill in terms of the dispensing element of their contracts or not. It is imperative that practices do not fall foul of the Goodwill rules because by doing so, a breach in the regulations could result in a criminal offence. A copy can be found here.
Focus on the DH's Improving GP services
Following the publication in January 2009 of the document ’Primary and Community Services: Improving GP services’ by the Department of Health (DH), the management of GP contracts in England has changed, with a new role for PCTs. This ’focus on…’ document looks at the way that PCTs are being encouraged to assess practice performance and how GPs/LMCs can influence this process, the use of balanced scorecards, how PCTs have been advised to manage all primary care contracts, as well as the opportunities that the changes present for GPs. A copy can be found here.
Items from GPC News May 2010
DDRB uplift
We expect a public announcement about the way this year’s award will be distributed within the next few weeks. The government’s decision to override the Review Body’s recommendation and impose a 0.8% gross uplift, means that GP contractors will not have the full increase in their expenses met in 2010/11.
Pandemic flu
The joint GPC / NHSE document, Question and answers – the swine flu (H1N1) vaccination agreement, has now been updated, and includes guidance on calculating the vaccinations uptake for the purpose of receiving patient survey threshold easements.
The document is available on the BMA website.
Learning disabilities DES guidance
The Department of Health (DH) has published guidance on the learning disabilities (LD) DES which is available online. A copy of the FAQs can be found here.
Following the introduction of the LD DES, the GPC requested that NHSE and the DH provide further guidance on the DES to assist with implementation. Unfortunately, although the guidance answers some of our concerns, many outstanding issues remain. The DH guidance has failed to address our concerns about the ambiguity in interpretation of the DES, the scope for room for unacceptable local variations in its implementation and the resulting potential for disagreements between GPs and PCTs to arise. A letter has been sent to Anne Williams, National Director for Learning Difficulties at the DH to raise these issues.
The Department of Health GP bulletin
The format of the Department of Health's monthly GP and practice manager bulletin is changing. From April onwards, hard copies of the bulletin will no longer be posted out, so the DH is encouraging postal subscribers, or current non-subscribers, to sign up to the email version of the bulletin. If you would like to do this, please send your name, practice address and email addresses to dh_gp_subscription@etdsolutions.com
Dispensing doctors in England Cost of Service Inquiry (COSI)
The Department of Health, with the full support and co-operation of the GPC and the Dispensing Doctors' Association, has commissioned PriceWaterhouseCoopers (PwC) to undertake detailed survey work on a number of practices to inform negotiations on the dispensing doctors' fee scale in the next few years. If you receive enquiries from constituent practices about this, we would be grateful if you would encourage their full co-operation.
Summary Care Record – Joint Statement from BMA/GPC and NHS Employers 4 May 2010
The BMA/GPC has agreed a joint statement with NHS Employers, on behalf of the Department of Health and Connecting for Health (CfH), regarding the suspension of uploads to the SCR. This statement, below, is being sent to all SHAs by the Department of Health.
GPs and LMCs should note that uploads to the SCR should only take place where there has been agreement between PCTs and practices that patients have been adequately informed, and that practices have also been fully supported.
This agreement applies to areas working to implement the SCR prior to the "accelerated roll out" but have yet to upload patient data, as well as those deemed to be "accelerated".
CfH has agreed to work with the BMA to define an appropriate public awareness campaign, in addition to improving examples and templates for PCTs and practices to support public awareness and practice and professional involvement; further details will be available shortly.
DH will be writing to SHAs with a copy of the statement, these will be shared with the BMA/GPC and be circulated once we have received them.
BMA/NHSE joint statement on SCR Roll Out
4 May 2010
CfH and BMA have agreed that the upload of information to the Summary Care Record should only take place in any practice once the practice and the PCT agree that patients have been adequately informed about the process and properly enabled to opt out should they wish. Practices must be fully supported and informed to upload data. Practices and PCTs must be satisfied that data are of an appropriate quality for sharing.
This will apply both to areas which were working to implement the SCR prior to the ‘accelerated roll out’ but have yet to upload patient data, as well as those practices in areas deemed to be “accelerated” and this status should not preclude uploads where agreement about adequate information has been reached.
CfH have agreed that they will continue to work with stakeholders including the BMA to improve the nationally available examples and templates for PCTs and practices to support public awareness, and practice and professional involvement. They have also agreed that the BMA and CfH will work jointly on what, within the constraints of current policy, constitutes an appropriate local campaign of public and professional awareness and practice support, in order to assist practices and PCTs in making decisions on whether local arrangements for public and professional information is sufficient.
SHAs are expected to ensure that their PCTs understand and implement appropriate communications arrangements.
Sessional GPs Representation Working Group
The Sessional GPs Representation Working Group, which was set up to review the representation of sessional GPs at a national and local level, continues to make good progress. In order to support its work, it commissioned the BMA's Health Policy and Research Unit to carry out an extensive research project, taking in the views of sessional GPs, LMCs and external organisations. It expects to publish both its report on the representation of sessional GPs, and the findings from this research, shortly.
Notification of infectious diseases
Under the Public Health (Control of Diseases) Act 1984 (as amended), GPs
are required to notify the proper officer of the local authority when
they have reasonable grounds for suspecting that a patient:
- has a notifiable disease as listed in Schedule 1 of the Act;
- has an infection (not listed in Schedule 1) which, in the view of the GP presents, or could present, a significant harm to human health; or
- is contaminated in a manner which, in the view of the GP, presents or could present significant harm to human health.
Guidance on the amended Act is available online and includes a list of notifiable diseases at table 1. A copy is available here.
There was previously a nominal fee set out in the Act for such notification, however this fee has now been removed by recent regulations. Nevertheless, GPs must still continue to notify.
The BMA was consulted on the removal of the fee and objected to it. However, the legislative change was made.
Services for GPs from the BMA library
The BMA library provides expert medical information services to members and staff and specialises in current clinical practice, medical ethics and education.
The library’s extensive collections of books and journals are supplemented by audio visual materials and a growing collection of e-books and e-journals.
The library offers a postal loans service, rapid document delivery, online search services and courses on finding medical information online.
The library can also help with the following:
- Over 400 e-books and 50 e-journals online
- Articles delivered to your desktop
- Free Medline searches
- Library courses to support your development
- Core clinical texts and DVDs
- New career and professional issues book collection
- Expert support from the library team.
Email the library with any enquiries on bma-library@bma.org.uk, call 020 7383 6625 or visit our website.
The Claire Wand Fund
The Claire Wand Fund is a trust working to provide grants for research and the further education of doctors working in general practice. Grants can be given towards the cost of administrative assistance, for stationery costs, conference fees, dissemination of information and travel costs if the project cannot be undertaken in the UK.
Awards are generally granted for sums up to £2,000 and trustees meet in May and December to consider applications.
To apply please contact the Secretary, Mrs Jane Cope, Claire Wand Fund, BMA House, Tavistock Square, London WC1H 9JP. Email: Clairewandfund@bma.org.uk.