Newsletter May 2010
Consultant_to_Consultant_Referrals
Dispensing_on_Discharge_from_UHNS
GPC_Trainees_subcommittee_Spring/Summer_newsletter
Items_from_GPC_News_April_2010
Sessional_GPs_Representation_Working_Group
Making_the_most_of_being_a_salaried_GP
Editorial
Now that the election is over we can expect changes in the NHS. PCTs have been told to look for significant cuts in management budgets. It is likely that PCTs will be required to work very closely together and share resources and management, even if not formally merging. In Staffordshire this may mean the joining together of all three PCTs in the county. The LMC feels that it would be best for North Staffordshire if the two PCTs in North Staffordshire were merged, leaving out the South Staffordshire PCT. The problems facing the two halves of the county are significantly different. We have the "Fit for the Future" programme which is delivering a new hospital with significantly less capacity. This programme requires a change in working practices across the North Staffordshire Health economy and the added distraction of mergers with South Staffordshire PCT would risk derailing this important project. We have written to the Strategic Health Authority, PCTs and MPs expressing a view that a merger of the two North Staffordshire PCT would be beneficial and should proceed as soon as possible.
The next few years are going to be difficult for the NHS. Although the new government says that the NHS budget will not be cut, the service is gearing up for significant cuts and efficiencies. General Practice will not be spared and we will be expected to work more efficiently. Particularly areas where we will be monitored include prescribing costs and referral management. We must play our part in this efficiency drive and be ever mindful of the cost of our clinical decisions. PCTs are already discussing triage of all of our referrals, be left in no doubt that Big Brother is watching us and unless we play our part fully in providing a cost efficient health service, monitoring will become ever more heavy handed.
Consultant to Consultant Referrals
The PCTs are looking carefully at Consultant to Consultant referrals. These have increased considerably recently and are a huge cost to the health economy. Guidelines around these were issued in 2005 which allowed referral on for problems related to the original referral, however recently these guidelines have not been adhered to and examples of inappropriate consultant to consultant referrals are commonplace, e.g. referral by a gynaecologist to a dermatologist for a patch of eczema, along with instances of patients being seen by a consultant in one speciality but then being referred on to another in the same speciality because of increasing sub-specialisation. Patients should be seen by the appropriate consultant at the first appointment.
The PCT have agreed that all future consultant to consultant referrals should be passed via the PCT for approval. The guidelines issued in 2005 for consultant to consultant referral will be used as the basis for those decisions. Those felt to be justified will be approved and those felt unjustified will be rejected and referred back to the GP. However, whilst this should not cause GPs much extra work we are hearing that some consultants are taking this to the extreme and referring back to the GP any patient who requires referral to another consultant. This is not appropriate and any instance of inappropriate requests should be brought to the attention of the PCT. In the longer term it is hoped that the new system will result in appropriate patient pathways which will ease the workload of all.
Secondary Care Follow ups
In a bid to decrease unnecessary follow up appointments, the PCT are setting target for new to old ratios for out-patient clinics. This is not meant to stop appropriate follow up appointments. However, as with the consultant to consultant referral issue we are heard of cases of consultants stating that they cannot see a patient more than once in outpatients because of this policy. This is not the case as the target applies to the overall number of patients seen rather than individual cases. Again the PCT need to hear about any instances of patients being refused necessary follow up appointments.
Dispensing on Discharge from UHNS
The University Hospital of North Staffordshire has been implementing the roll-out of One Stop Dispensing (OSD) since September last year. They are currently on track to complete the roll-out to 26 adult CGH wards by the end of May 2010.
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 bring their prescribed medication with them into hospital.
Over the coming weeks, 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.
As soon as UHNS are confident that they have addressed the issues around POD storage in A&E they will circulate a poster to all GP practices and other key areas where they hope it will be clearly visible to public and patients. 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.
PMS Contracts
The GPC has produced guidance on the options available to personal medical services (PMS) practices when PCTs seek to review existing contractual arrangements. This is an update of the GPC guidance issued in April 2006 and March 2007. A copy can be found here. With both local PCTs in the process of reviewing their PMS contract this document is important to all PMS practices.
Extended Hours Access Scheme
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. 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.
A copy of the guidance can be found here.
Patient Survey
The GPC has produced an update which aims to explain the results process for the 2009/10 GP Patient Survey, directing local medical committees (LMCs) and practices to sources of information and helping to prepare for the release of final survey data for this year. A copy of the document can be found here.
The patient survey is now being undertaken on a quarterly basis rather than annually as has been the case before. In terms of payment, the quarterly results will be amalgamated and the latest information is that final results will be made public on or around 15 June 2010.
Last year the results were issued very close to the deadline for signing off QMAS. While there may be a little more time this year, this is a reminder of our advice from last year that all practices should sign off QMAS (or its equivalent) by the deadline regardless of whether any appeal or dispute is likely to be raised over the results of the patient survey. However, all practices should, in signing this off, clearly state that they reserve the right to raise a dispute regarding the accuracy of any of the sections. If a practice does not sign off QMAS, the PCO could withhold part or all of an achievement payment and it is possible that this might also affect aspiration payments next year.
Fit for the Future
The General Practitioners Committee has published a 50-point plan for the future of general practice in the UK. Fit for the Future: The Evolution of General Practice sets out the committee's current thinking on a number of policy areas, including out-of-hours care, quality and outcomes framework, workforce and IT. More details can be found on the BMA Website.
GPC Trainees subcommittee Spring/Summer newsletter
Please see the Spring / Summer 2010 edition of the GPC’s GP trainees subcommittee newsletter.
The newsletter covers the following topics:
- GP trainees subcommittee elections
- GP trainees conference: Get Ahead - The essential GP trainees skills day
- Doctors and Dentists Review Body and GP Trainee Pay
- Extending GP training
and is available on the BMA website.
Items from GPC News April 2010
Summary Care Record (SCR)
The GPC today received an assurance from the Department of Health that the upload of the Summary Care Record in PCTs subject to accelerated roll-out will be suspended. The Department of Health informed the GPC that records will not be uploaded in PCTs subject to accelerated roll-out until there is greater public and professional awareness.
The committee is very pleased that Connecting for Health has listened to its concerns and welcomes the decision to suspend uploads. We will be working with the Department of Health in future to ensure that GPC’s concerns about the Summary Care Record continue to be listened to and addressed.
Practice boundaries
Following the announcement by the Secretary of State last year that all boundaries would be removed from general practice, the Department of Health has now released a consultation on how this could be done. The GPC debated the proposals and passed a motion stating that:
‘GPC has carefully considered the current proposals for the removal of practice boundaries and has concluded that:
- they put the quality of patient care and patient safety at risk
- they will undermine continuity of care
- they will disrupt practice based commissioning
- they will increase NHS costs and introduce inefficient and ineffective demands on resources
GPC therefore rejects the proposals.’
This position will be incorporated into the GPC’s response to the consultation. We will also put forward solutions which we consider to be preferable as detailed in the position paper we published in January.
Sessional GPs Representation Working Group
The Sessional GPs Representation Working Group, set up by the GPC to review the representation of sessional GPs on a national and local level, continues to make good progress. It is currently considering the preliminary findings from a survey that was sent out to sessional GP BMA members regarding representative and contractual issues. The working group hopes to report on its recommendations by the end of the current session.
H1N1 vaccines for travel use
Professor Salisbury, Director of Immunisation at the Department of Health has sent a letter to all GPs informing of provision of the H1N1 swine flu vaccine for protection of travellers to Southern Hemisphere countries. Practices can use their existing stocks of H1N1 vaccine as a travel vaccine for members of the public intending to travel to the Southern Hemisphere during their influenza season. GPs are able to charge patients for administration of the vaccine and GPs can set their own rates for this service.
Note the paragraphs in the appendix which state that:
Whilst GPs can generally charge patients for administering an H1N1 vaccine in connection with travel abroad, if the contractor is participating in the Swine Flu directed enhanced service or any local enhanced service that provides for a payment in relation to an H1N1 vaccination, no charge can be made to:
- patients in the priority groups defined in the Swine Flu directed enhanced service; or
- patients who are in a group covered by any local scheme under which the contractor is paid for administering the H1N1 vaccine.
Patients in these groups should receive the vaccination free of charge in accordance with the directed enhanced service or in accordance with the local agreement even if their request is related to travel abroad.
The letter can be found on the DH website at this link
“Making the most of being a salaried GP” seminars
June – November 2010
The BMA is organising a series of seminars aimed specifically at
salaried GPs.
These events aim to:
- Advise on employment rights for names, PMS, APMS and PCO-employed GPs – including sickness, maternity and redundancy issues, as well as giving general guidance on contractual rights following maternity leave and at the end of FCS and Retainer Scheme funding.
- Outline in detail the benefits of the model/minimum salaried GP contract negotiated by the BMA, and how to ensure that at least these minimum are obtained.
- Provide helpful tips for successful negotiations on salary, terms and conditions, and contract changes for use with current and new employers, with practice sessions.
- Provide an interactive setting, with the opportunity for delegates to ask questions on the day.
Dates of seminars
Friday 4 June 2010 BMA House, London
Tuesday 7 September 2010 Bar Convent, York
Monday 20 September 2010 Birmingham Medical Institute, Birmingham
Monday 11 October 2010 Park Inn Hotel, Brighton
Monday 25 October 2010 Park Plaza Hotel, Nottingham
Tuesday 9 November 2010 Manchester Conference Centre, Manchester
Monday 15 November 2010 Southampton Solent University, Southampton
Registration Fees
The costs to attend these half day seminars are as follows:
£46.00 including VAT for BMA members
£80.50 including VAT for Non-members
A sandwich lunch and refreshments will be provided.
Please note that non-members are entitled to the BMA rate if they join the BMA when registering. For further information about this please call BMA Conferences on 020 7383 6605/6137.