Newsletter March 2010
Earnings_and_Expenses_2007/08_Final_Report
Items_from_GPC_News_March_2010
Extended_hours_access_scheme_DES_2010
Locum_GP_pension_contributions
Women_doctors_making_a_difference
Items_from_GPC_News_February_2010
Transforming_community_services
GP_IT_system_survey_in_England
GP2GP_-_Interim_guidance_on_erroneous_transfer
GP_trainees_subcommittee_e-bulletin,_February_2010
Elections to the Committee
The elections to the committee have now been completed and the following have been elected to the committee for a four year term of office.
- Dr J Aw
- Dr J Boyapati
- Dr A Green
- Dr D Hughes
- Dr V Maheepathi
- Dr G Morgans
- Dr U Pathak
- Dr A Pugsley
- Dr M Sullivan
- Dr H A Talpur
In order to achieve a membership which more fairly represents the make up of GPs in the area the committee had decided to reserve two places for female GPs and one for a non-principal. This objective was achieved in this election in a straight forward count of the ballot papers.
Congratulations to the successful GPs and the committee welcomes five new members, Dr J Aw, Dr J Boyapati, Dr V Maheepathi, Dr A Pugsley and Dr M Sullivan. The five members leaving the committee are Dr H P Borse, Dr J J Edwards, Dr L M Hussain, Dr K Samal and Dr M S Shaikh. Thanks to these members for their contributions during their terms of office.
The remaining ten members whose term of office will end in March 2012 are Dr P Golik, Dr C Kanneganti, Dr B N Kulkarni, Dr I D Leese, Dr J McCarthy Dr S Y P C Rao, Dr P Shah Dr P Scott, Dr P N Unyolo and Dr H Van Der Linden.
Summary Care Record
The Summary Care Record (SCR) is being rolled out across a number of strategic health authorities (SHAs) in England. It is important that you understand the implications of the SCR for both your practice and patients. The BMA has produced guidance which represents the GPC’s views and answers questions you might have about the SCR. The guidance also provides information about the BMA’s and GPC’s involvement and any action we are taking, as well as the background on the SCR and its development. A copy of the guidance can be found here.
Fitness for work
The current Med 5 "sick note" is to be replaced from 6th April with a new Statement of Fitness for Work" or "fit note". The new form will enable doctors to advise a patient whether they can return to work if supported by their employer. A sample version of the new form can be found here. Detailed guidance for doctors has been produced with the RCGP, BMA, CBI, and ACAS and other relevant organisation. A copy of this can be found here. This change is driven by evidence that work is therapeutic and helps promote recovery and rehabilitation, whilst unemployment is generally harmful to health and can lead to increased morbidity and poorer physical and mental health.
Focus on the New Tax Brackets
The Finance Bill 2008-09 introduced significant changes affecting those earning over £100,000, which will come into effect from 6 April 2010, including:
- a new higher rate of income tax of 50% on total income (including all income, not just wages, salaries and profits) over £150,000);
- the gradual withdrawal of the personal allowance for those whose adjusted net income exceeds £100,000. The personal allowance will be reduced by £1 for every £2 of income in excess of the £100,000 threshold.
This guidance has been produced by the General Practitioners Committee to highlight potential ways to mitigate the effects of the tax changes which will affect doctors earning over £100k, and other financial considerations arising as a result. It should be noted that this guidance is not comprehensive; members should consider their own case in the light of their personal circumstances and take advice where necessary from an accountant. This document has been withdrawn pending the correction of an error.
Practice Premises
The GPC has produced updated guidance on the current state and future of the various primary care premises development options available and describes the premises provisions of the GMS contract. It incorporates GPC guidance on the premises costs directions and on the impact of the Disability Discrimination Act. A copy of this guidance can be found here.
Earnings and Expenses 2007/08 Final Report
The GP Earnings and Expenses 2007/08 Final Report is being published and can be found on the NHS Information Centre's website at www.ic.nhs.uk
The Provisional Report for 2007/08 was published in September 2009. This Final Report for 2007/08 contains additional information on earnings and expenses by practice size, Strategic Health Authority and rurality.
What the 2007/08 GP Earnings and Expenses Enquiry shows:
Contractor GPs
The EEQ for 2007/08 states that for contractor GPs in the UK, average net profit was:
- £100,324 for GMS GPs (a decrease of 3.1% since 2006/07 and 5.6% since 2005/06
- £96,189 for GMS non-dispensing GPs (a decrease of 3.4% since 2006/07)
- £121,753 for GMS dispensing GPs (a decrease of 1.8% since 2006/07)
- £116,059 for PMS GPs (a decrease of 2.1% since 2006/07 and 3.5% since 2005/06)
- £113,517 for PMS non-dispensing GPs (a decrease of 1.8% since 2006/07)
- £132,222 for PMS dispensing GPs (a decrease of 2.5% since 2006/07)
- £106,072 for all GPMS GPs (a decrease of 1.5% since 2006/07 and 3.6% since 2005/06)
The GPMS expenses to earnings ratio (the proportion of an individual’s gross turnover that is consumed by business expenses) was 57.9% in 2007/08. This is an increase of a further 1.4 percentage points on the 2006/07 expenses to earnings ratio of 56.5% (2.8 total percentage points increase since 2005/06), reflecting that expenses have increased further while earnings have continued to decrease.
Average net profit for contractor GPs in 2007/08 by country was:
- £110,139 in England (a decrease of 1.3% since 2006/07)
- £91,056 in Northern Ireland (a decrease of 2.4% since 2006/07)
- £87,371 in Scotland (a decrease of 2.3% since 2006/07)
- £93,366 in Wales (a decrease of 4.5% since 2006/07)
Salaried GPs
For all UK GPMS GPs identified as being salaried in 2007/08 (having more employed income than self-employed income) average pre-tax earnings from all sources of income reported were £55,790, an increase on the 2006/07 figure of 3.4%. The GPC hopes that the increased figure reflects practices paying salaried GPs the DDRB recommended rate of increase. It is also worth noting that on average contractor GPs work more hours than salaried GPs. Contractor GPs have additional responsibilities, covering clinical, organisational, operational, financial and personal responsibility for provision of services not borne by salaried GPs.
Comparisons with the 2006/07 Earnings and Expenses Enquiry
GP income fell for a second year between 2006/07 and 2007/08.The expenses to earnings ratio also increased further. For 2007/08 the Doctors’ and Dentists’ Review Body’s recommendation for GPs was 0%.
Vault Smears
Within the national cervical screening programme, the responsibility for follow-up vault smears has been shifted from GPs to the gynaecologists who performed the hysterectomy. We want to ensure that GPs are aware of this change, as some women requiring vault smears may not be called for them.
There are two main reasons for this shift:
- it is essentially a post-operative follow-up issue, as if there has been incomplete excision of neoplastic changes, this will require further intervention by the gynaecologist;
- there has been considerable difficulty in performing vault smears (knowing which part of the vault to smear and ensuring that the 'corners' of the scar are adequately sampled); this is very difficult to do properly in the primary care setting, so national advice is now that it should be done by colposcopic viewing and sampling, thus ensuring a good valid sampling and greater safety for the patient.
Patients requiring vault smears should not be referred back to the GP for this at any stage; it is the responsibility of the gynaecologist to follow up his/her patient, whether this entails a single vault smear and discharge from screening, or smears every 6/12 months for 9 years or more. The only patients that vault smears are (possibly) required in will be those with vaginal intraepithelial neoplasia (VaIN), who should really be under colposcopic management since vaginal cytology is very unreliable. This move will probably uncover a number of women who have been having unnecessary vault smears, since the evidence relating to their effectiveness has evolved significantly over recent years.
GPs with patients already listed for post-hysterectomy follow-up should be transferring their care to colposcopy/gynae clinics via the referrals process.
Items from GPC News March 2010
DDRB report
The DDRB report was published last week. Its recommendation to award GP contractors a 1.34% gross uplift reflected a formal acknowledgement of GPs’ increasing expenses, though would have left nothing beyond that. The government’s decision to override the Review Body’s recommendation means that GP contractors will not have the full increase in their expenses met in 2010/11. This decision to override the DDRB recommendation has been mirrored in Scotland and Wales. We are still waiting to hear what will happen in Northern Ireland.
The 0.8% gross uplift imposed by the government has been designed to force practices to find ‘efficiency savings’ to cover rising expenses. The GPC negotiators have been at pains to secure the same treatment from the DDRB as for other doctors. The DDRB’s award would have delivered this; the government’s decision does not.
The next step will be for the GPC negotiators to meet NHS Employers next month to discuss how the 0.8% award will be distributed to practices. The DDRB had suggested that its recommended gross uplift be split with half being distributed to all practices across contractual funding streams and half being channelled into global sum, with any correction factor funding saved as a result being recycled into global sum. As the gross uplift is so small, very few practices would come off MPIG as a result of this approach. The Department of Health has indicated that this proposal is acceptable to them if no alternative arrangement is agreed in negotiation.
Other GP groups fared somewhat better and the government will honour the DDRB’s 1% award recommendation for salaried GPs, trainees and educators. The GP registrar supplement has not been reduced again but held at 45%.
2010/11 contract changes
New Directed Enhanced Services Directions for 2010/11 and the associated SFE amendment are now available on the Department of Health website. These come into effect on 1 April.
Extended hours access scheme DES 2010
The GPC and NHS Employers have agreed that the extended hours access scheme will continue for a further year from 1 April 2010. The main change from the existing arrangements will be that practices will be required to indicate by 30 June 2010 whether they are proposing to participate in the new extended hours access scheme (or equivalent local arrangements) in 2010/11, so that PCTs are clear early in the financial year which practices will be involved.
PCTs must, before 30 April 2010, offer all existing GMS and PMS contractors in their areas the opportunity to enter into arrangements for extended hours access under the DES Directions. Contractors that wish to participate in these arrangements must submit a written proposal to the PCT within 28 days of the PCT’s offer to enter into arrangements under the DES Directions.
Where possible, PCTs must enter into these arrangements with practices before 1 July 2010. PCTs will not normally be obligated to enter into extended hours access arrangements after 30 June 2010 (exceptions are set out in the Directions). However, PCTs retain the discretion to do this if they wish.
Any agreement made under these DES Directions will last until 31 March 2011.
Extended access to GP services remains a priority of the English government. The Department of Health has made it clear that PCTs should try to maximise the number of practices offering extended hours access and is keen that PCTs commission additional appointment times in line with patient preferences as expressed through the GP patient survey.
Once PCTs have established which practices will be involved in the scheme, they are expected to commission alternative arrangements for patients whose practices are not involved in the DES or equivalent local arrangements. PCTs will be advised to use the balance of the funding available for extended opening to commission these services from:
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other GP practices already participating in this initiative
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GP health centres
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out-of-hours providers.
There is obviously a risk in this policy of further fragmentation of routine patient care, especially as information sharing between practices is far from straightforward. The reality is that consultations taking place outside a patient’s normal practice may be limited for practical reasons to treatment of minor illness.
Summary Care Record
Following the concerns raised by LMCs, the GPC again debated the issue of the faster implementation of the Summary Care Record (SCR).
The following motion was passed nem con:
“That the GPC deplores the recent fast roll-out of the SCR in England. We seek the halting of this roll-out, and that the DH and CfH discuss these issues urgently with the profession.”
Appendix 1 contains the letter sent by Hamish Meldrum (Chairman of BMA Council), Laurence Buckman and Dame Deirdre Hine (Chair of the BMA’s Working Party on NHS IT) expressing the BMA’s serious concern and requesting:
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Improved information so that patients can make informed choices about the upload of their medical information
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Additional support for practices to ensure the quality of records uploaded to the SCR are of the appropriate standard
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Additional support for practices to deal with returned mail relating to patient consent and FP69 procedures
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That roll-out of the SCR, where Public Information Campaigns (PIPs) have yet to commence, is halted until the UCL evaluation report into the project has been published and considered.
Appendix 2 contains the guidance which was issued last week The Summary Care Record – Guidance from the GPC of the BMA.
We would particularly draw GPs’ attention to the section on page 3 entitled "Should the GP practice play a role in informing patients about the SCR". A continuing concern is the lack of easy access and availability to the opt-out form for patients. It is essential that patients who wish to opt-out have the opportunity to do so and we recommend that practices make opt-out forms available in their practices.
The opt-out form can be found online and a PDF of the form is attached at appendix 3.
The consent model for the early adopters was an implied consent model for both upload and access. The BMA and GPC campaigned for an explicit consent model and following the publication of the UCL evaluation, NHS Connecting for Health agreed to change the consent model so patient information should only be accessed with explicit patient consent. This was accepted by the BMA, following consultation with members of the GPC, subject to an evaluation of the Public Information Programme and limited piloting of the revised consent model.
The BMA and GPC do not support, and have not been consulted about, the recent accelerated roll out particularly prior to the publication of the independent evaluation. We feel that this could jeopardise and counteract the preceding gradual implementation.
In addition, the GPC believes that practices need to be content with their local PCT/SHA SCR Public Information Campaign (PIP), the level and quality of training and information provided by their PCT/SHA and ensure that their data is fit for sharing before making a decision to proceed to upload to the SCR.
Practice boundaries
The Department of Health has released a public consultation on its proposal to remove boundaries from general practice. Responses can be submitted online.
The GPC set out its views on practice boundaries in a position paper in January, which is available online. The GPC will submit a response based on the ideas contained within this paper.
National Quality Board
Lord Darzi's ‘High Quality Care for All’ report contained the commitment to create the National Quality Board (NQB) with the aim of providing strategic leadership and a framework to quality improvement to the NHS. The BMA has produced a summary of the National Quality Board's 2009 annual report as part of overall monitoring of the Darzi review and the quality agenda in England.
The summary is now available on the BMA website.
Revalidation
The committee discussed the GMC Consultation Revalidation: The Way Ahead, which was published on 1 March and is available online. The consultation sets out the GMC's view on how revalidation will work in practice. The BMA will be responding to this consultation in due course.
Locum GP pension contributions
We are aware of anecdotal evidence of PCOs increasingly enforcing the rule whereby locum GPs engaged by GP practices have a ‘10-week window’ in which to pension their income. Practices not paying locum GPs within this timeframe can lead to locum GPs missing this contribution deadline. This is a reminder of the importance of practices paying locum GPs for their work as quickly as possible, thus enabling them to pension their income.
Tax health plan
As previously reported, HMRC's campaign for the medical profession is currently in operation with a deadline for applications of 31 March, payment to be made by 30 June. Further details can be obtained from HMRC's website.
The Tax Health Plan is a time limited HMRC scheme offering an opportunity for health professionals with undisclosed tax liabilities to come forward and settle their affairs.
Overseas doctors
The GPC believes that doctors who have not completed their vocational training in the UK should be required to demonstrate that they meet are suitable to work as unsupervised GPs in the UK. Suitability includes being fluent in English and an understanding of NHS general practice.
At present, the GMC is required to register any doctor who meets the qualification requirements of being a GP; no further tests are used. We are working with the BMA's International Committee to ascertain whether the Medical Act can be amended to allow the GMC to require any further testing as may be required. PCOs, on the other hand, are able to require a doctor to demonstrate that they have the relevant skills to work as a GP before granting entry to their Performers List. As a result, many PCOs require overseas doctors to undertake language testing and/or a period of induction in order to have full list inclusion. However, at present there is no uniformity between PCOs, although this will hopefully be addressed through the current review of the Performers List Regulations that is currently underway.
In the meantime, we encourage all practices to ensure that the doctors they engage with are on a PCO Performers List, are on the GMC's GP Register, and that they are competent to undertake the work.
BMA Employer Advisory Service
The BMA Employer Advisory Service provides GP partners with free comprehensive, impartial and authoritative advice on a range of employer-related matters. The service was designed to facilitate the BMA in representing both sides in a dispute between salaried and partner GPs
Advisers will be able to deal with your queries on issues such as recruiting and employing staff, contracts and terms and conditions of service, appraisals and performance management, disciplinary procedures and dismissals. They are also well versed in current employment legislation, discrimination, the development of appropriate HR policies, and how to implement best practice. Advisers have excellent knowledge of local issues and well-established contacts with Local and Strategic Health Authorities, Primary Care Trusts and Local Medical Committees.
For free comprehensive, impartial, authoritative advice you can trust call the BMA Employer Advisory Service on 0300 123 123 3 anytime between 8.30am and 6pm (Monday to Friday, except UK-wide bank holidays) and you'll be connected directly to one of our expert advisers. Or you can email your query to support@bma.org.uk
To access the service at least one partner needs to be a BMA member, although we would recommend all doctors to be members of the BMA.
PMS guidance
The GPC has updated its guidance on PMS reviews which can be found on the BMA website.
Cleanliness guidance
The National Patient Safety Agency (NPSA) is drafting guidance on cleanliness in the NHS for primary care providers. The guidance is aimed at helping primary care providers to set up simple, easy-to-follow processes to ensure that their premises are clean and safe. The GPC's Practice Finance subcommittee has been consulted on this guidance, which is in its final draft but has not yet been published. Members and LMCs will be informed when the guidance has been published and is available on the NPSA website.
Please note that advice on the manner in which cleaning is undertaken already exists in the Revised Healthcare Cleaning Manual on the NPSA website.
Women doctors making a difference
In August 2008, the Chief Medical Officer (CMO) asked Baroness Deech to chair an independent National Working Group to look at the position of women in the medical profession. The Working Group published in October 2009 their Women Doctors: Making a Difference report that can be viewed on the Department of Health website. The report considered the situation for women doctors, reviewed the existing work and recommended a programme of action to improve opportunities for women in medicine. The recommendations of the report include improving access childcare in NHS trusts and encouraging women to leadership positions within the NHS.
A BMA cross branch of practice project group will be taking forward the recommendations in the report that require discussion or negotiation with employers and educational organisations. If you have any suggestions on possible actions or any queries then please email William Jones at wjones@bma.org.uk.
GP trainees conference
‘Get Ahead: The essential GP trainee skills day’ - Friday 16 April at BMA House.
This one-stop essential skills day aims to help you make the very most out of your training and preparation for life as a GP, from expert advice on presenting yourself to employers through your CV and interview to managing your finances in the early years of practice. There will be sessions on how to make the most out of your career choices and helping you to avoid the pitfalls of the journey ahead. This conference will equip you with vital know-how that you cannot afford to be without, and that you won’t find anywhere else.
You can find out more on the BMA website.
In-practice fellowships
Are you a GP with an academic interest? The National Institute for Health Research (NIHR) has recently launched in-practice fellowships which aim to offer academic training to fully qualified general practitioners and general dental practitioners who may have already spent some time in NHS practice and who have had little formal academic training at this point in their careers. For further information visit the NIHR website.
Items from GPC News February 2010
Pandemic influenza
Owing to the decreasing number of H1N1 cases, a decision has been taken to stand down the National Pandemic Flu Service (NPFS). Antivirals will now only be authorised via health care professionals. Antiviral collection points will continue to function until 31 March 2010.
Letters regarding the H1N1 vaccination programme were sent to the service from the Department of Health on Thursday 18 February. Practices have been advised to continue vaccinating at risk groups opportunistically beyond the end of March. For this they will continue to receive payment, though not the related DES concessions. The Department has however advised practices to stop vaccinating children under 5 who are not in at risk groups from the end of March. The Joint Committee on Vaccination and Immunisation has suggested that the vaccine can now be offered as a travel vaccine for those travelling to Southern Hemisphere countries during their flu season. The letters are available on the DH website.
Many PCOs are now looking to review their business continuity management plans and it would be beneficial for practices to get involved with this work.
Transforming community services
One of the central themes of the transforming community services (TCS) agenda has been to separate the commissioning arm of PCTs from the provider arm. This process has been ongoing for the last 18 months. It was originally expected that PCTs would find new organisations to host existing services, possible via community foundation trusts, social enterprises, community interest companies, vertical integration with secondary care or with social services. However, over the past few weeks, many organisations which were working towards community foundation trust status have been stopped from doing so, on the basis that the NHS does not want to create new organisations in the current financial climate that would inevitably lead to increased administration costs. Furthermore, PCTs have now been instructed that by the end of March 2010, they have to decide who will be the preferred organisation to host their provider arm. The choice is now largely between secondary care, social services or mental health trusts. This means that major discussions will be taking place in PCTs over the next couple of weeks, before sign-off by PCT boards towards the end of the month.
The GPC is very concerned at the speed with which these decisions are being made, and the lack of GP involvement. In particular, community hospitals, which are part of PCT provider arms, are at significant risk under this hasty reorganisation. LMCs should seek to engage and influence this local process where possible.
The GPC passed the following motion in response to this TCS agenda:
That the General Practitioners Committee (GPC) of the BMA notes the following with regard to the separating community health services from PCTs:
- community health services – care of the elderly, child protection, terminal care – are an integral part of supporting patients in their homes and in the delivery of general practice
- moving community health services to organisations outside the National Health Service risks fragmentation of services, shared goals no longer being shared and instability in vital services
- the government has recently stated that the NHS is the preferred provider
- social enterprise organisations may be ‘not for profit’ but are outside the NHS. They may not be able to compete with neighbouring NHS community health services to retain or recruit scarce staff due to inferior terms and conditions of service particularly in relation to the NHS pension scheme
- as a result, quality may suffer in organisations outside the NHS to the detriment of patients and the provision of general practice and primary care services
- GPC therefore supports the retention of community health services within NHS organisations.
Sessional GP survey
The Sessional GP Representation Working Group, set up by the GPC to review the representation of sessional GPs, recently sent out a survey to sessional GP BMA members. The survey will be vital in informing the work of the group and helping it make recommendations on how sessional GPs should be represented at a national and local level. The results of the survey will also be used as part of next year's evidence to the Doctors and Dentists Review Body (DDRB) on the remuneration and working patterns of sessional GPs.
The response rate so far has been good, but there is still time for sessional GPs who have not completed the survey to do so. We would very much encourage sessional GPs who have received the survey to take the time to do this. Sessional GPs who have questions about this process can contact the BMA’s research department at info.hperu@bma.org.uk. Further details can also be found on the BMA website.
GP IT system survey in England
NHS Connecting for Health is undertaking a survey of GPs and their staff to gain an insight into opinions on various parts of the GP IT service. It will be used where appropriate to inform discussions with suppliers and enable service improvements in the most valuable areas.
The survey does not take longer than 10 minutes to complete and there is space at the end to add additional information.
Please encourage your constituents to complete the survey, which will remain open until Friday 5 March. It can be accessed online.
GP2GP - Interim guidance on erroneous transfer
Guidance has been developed by the GP2GP project and the Joint GP IT Committee to advise practices how to reduce the risk of making an erroneous record transfer request and advising practices and PCTs how to manage such erroneous requests when they do occur. Erroneous record transfers usually occur when patients are incorrectly identified when registering with a new GP practice. This may result in a request being made for the wrong record via a GP2GP transfer and a patient being inappropriately deducted from their true registered general practice.
Registering new patients
Correctly identifying and registering new patients on the demographics database (PDS) is absolutely key in reducing the risk of erroneous GP2GP record requests being made. When completing the GMS1 registration form, practices should carefully check the accuracy of patient data and try to provide as much information as possible, preferably including the NHS number when it is available. The GMS1 should be checked in the presence of the patient to check its legibility, completeness and accuracy. If a patient cannot be positively identified, practices might consider asking registering patients to provide formal identification and proof of recent address to ensure that correct GP2GP record transfer occurs. If in doubt, registration should be deferred and advice sought from the PCT/Patient Services Agency (PSA)
Erroneous transfers and the sending practice
Most erroneous transfers come to light when the patient contacts their practice (the sending practice) for an appointment or prescription, to be told they are no longer registered. Sending practices should contact their system supplier helpdesk to report the erroneous transfer. The practice should also contact their PCT/PSA to request that the patient’s registration be reinstated and consider informing the patient what has happened.
Erroneous transfers and the receiving practice
The practice requesting the record (the receiving practice) may also identify that they have the wrong record, or be informed by their supplier helpdesk that they have registered the wrong patient. Practices should contact their PCT/PSA to advise them of the erroneous transfer and with the support of the PSA and supplier helpdesk, arrange to delete the erroneous NHS number and ‘roll back’ the clinical system so that the erroneous incoming GP2GP record is deleted and no patient details remain in the receiving practice. The receiving practice might consider whether an erroneous transfer should be considered as a practice critical incident, to reduce the risk of further such errors.
GP trainees subcommittee e-bulletin, February 2010
The e-bulletin is a brief round up of all the issues relevant to GP training and is designed to keep trainees and trainers up to date with the work of the GP trainees subcommittee. The February 2010 edition includes updates on extending training and the BMA's evidence to the Doctors and Dentists Review Body. This e-bulletin is available on the BMA website.