October 2011

The LMC has been very concerned about the amount of extra workload creeping into general practice, particularly that which is not directly connected with patient care. We were especially concerned about the work involved in the LES monitoring template which was produced by the PCTs. Harald Van Der Linden was involved in discussions with the PCTs about the amount of information which should be requested and it was agreed that this should be the minimum required to monitor the contracts. As a result an amended template was produced with much less information required.

Practices do have a contractual obligation under section 439 of the GMS regulations to provide any information which is reasonably required by the PCT for the purposes of or in connection with the Contract; and any other information which is reasonably required in connection with the PCT’s functions. The key word is "reasonably".

With ever increasing demands for information from practices by PCT, Commissioning Groups and others, we will endeavour to ensure that all requests are reasonable. Please bring any requests which you receive and feel to be unreasonable to our attention.

The amount of clinical work is also increasing particularly with new care pathways which envisage more work in primary care both before and after referral and usually with no extra resource forthcoming. We encourage GP colleagues to become involved with their locality commissioning groups and to make their opinion heard regarding the plans of commissioning groups.

LMC Membership

The leadership of the LMC will have received a complete change in April next year, when Harald Van Der Linden takes over as Medical Secretary. Paul Scott has taken over as Chairman and Jacky Aw as Vice Chairman. Elections will be held in the first quarter of next year for half of the LMC membership. Those members whose terms of office as members comes to a end in March 2012 are Dr P Golik, Dr C Kanneganti, Dr B N Kulkarni, Dr I D Leese, Dr S Y P C Rao, Dr P Shah Dr P Scott, Dr A Sonnathi Dr P N Unyolo and Dr H Van Der Linden

Following changes made two years ago, two places will be reserved for female members and one for a salaried GP

We need to encourage our female colleagues to stand for election. They make up a significant proportion of the GP workforce and are sadly under-represented on the committee. We are willing to provide any information or help anyone may require in making a decision to stand and anyone is welcome to attend a meeting of the LMC to obtain a flavour of the business we discuss. Please contact the office for further details

Oxford Scores

In the last newsletter I reported that the requirement to complete Oxford Scores for patients who are referred for hip and knee replacements had been abandoned. We were led to believe that this decision applied to both Stoke on Trent and North Staffordshire referrals. Unfortunately, this decision only applied to Stoke on Trent. We are continuing to press North Staffordshire Commissioning Group to abandon this requirement. It is against NICE guidelines and in our opinion an unnecessary workload for primary care.

Commissioning Group Configuration

During discussion prior to the formation of the current GP commissioning boards, the LMC was of the opinion that we should have a single GP Commissioning Consortium for the whole of North Staffordshire including both of the current PCT areas of NHS Stoke and NHS North Staffordshire. We are now being consulted on the "authorisation" of the current board structure. We would like to hear any views you have on whether the current two board structure should continue or whether we should continue to hold the view that a single structure across North Staffordshire is the preferred option.

Communications from UHNS

The committee has had a lot of discussion with the UHNS concerning problems with timely communication with GP practices. The UHNS is in the process of implementing an "edischarge" system which when fully implemented should improve the situation. However, the committee is concerned about the clinical risk. The committee has written to the Department of Health expressing our concerns over the situation and now look forward to an improvement in the situation in the coming months.

Care Quality Commission

The Care Quality Commission have issued a helpful short guide for general practices which includes a number of myth busting facts about the registration process. It is only nine pages and a copy can be found here.

QOF - Frequently asked questions

NHS Employers and the GPC have published joint QOF FAQs for use by Primary Care Organisations and general practice. These FAQs cover a number of historical issues and commonly asked questions. A copy of the FAQs can be found here.

Other documents relevant to this years QOF are:

QOF guidance 2011-2012

Summary of 2011-2012 QOF indicator changes, points and thresholds

Outline Agreement for the QOF indicators, May 2011

New Medicines Service

From 1st October 2011, pharmacies have been able to offer a "New Medicines Service" to patients.

It is well recognised that patients often do not take their medicines as intended by the prescriber: this is reflected in the ever increasing amounts of unused and unwanted prescribed medicines returned to the pharmacy for safe disposal. When patients do not take their medicines correctly they not only waste NHS resources through the amount of medicines wastage but by not taking their medicines as intended they do not achieve the intended good health outcomes and improved quality of life which in turn results in increased hospitalisation and mortality.

The News Medicine Service (NMS) is designed to provide early support for patients to maximise the benefits of their medication.
Research has shown that early intervention by a pharmacist can help improve patients' adherence and has demonstrated that patients experience fewer medicine problems and make less use of NHS services in the longer term.
It is a DH funded initiative – therefore no cost to commissioners at point of delivery
The service is available for patients who are prescribed drugs for asthma and COPD, type 2 diabetes, antiplatelet/anticoagulant therapy or hypertension.
The patient can consent to the service when the pharmacist first supplies the treatment.
7-14 days after the initial treatment supply, the pharmacist goes through an interview schedule with the patient about their treatment to assess adherence, identify any problems with taking the new medicine and offer information and support to encourage continued adherence with the regimen.
14-21 days after the initial interview the pharmacist conducts a follow-up interview to assess how the patient is managing in the longer term, to encourage continued medicine taking or to refer back to prescriber if medication is not being taken by the patient or having side effects that affect adherence.
Ideally GPs and hospital staff will refer patients to community pharmacists when they prescribe a new treatment to a patient
Pharmacists can offer the patients the service at the point of first supplying the treatment to the patient.
A standard NMS feedback form will be sent back to the prescribing GP with all relevant information when the patient receives the service.
Pharmacists are receiving training addressing the needs of the new service during September 2011
Pharmacists can start recruiting patients in October 2011

It has been suggested that GP can flag up potential patients to pharmacists by endorsing the FP with "NMS"

Guidance on Locum Agreements

The BMA has produced guidance for both locum GPs and the practices who engage them. It is aimed at locum GPs to help them put together written agreements with practices for which they work, and should also be of interest to practices who engage locums. It assumes that the arrangements made will reflect the locum's status as a self employed GP and that the agreement will be a contract for services, rather than a contract of service, which would apply to an employee.

This guidance is available on the BMA website, but access is restricted to BMA members.

Items from GPC News October 2011

NHS Reforms

The Second Reading of the Health and Social Care Bill took place over two days in the House of Lords on 11 and 12 October. There was a very large turn out from peers to participate in the debates, which raised interesting constitutional issues. Some peers were concerned about accountability and the constitutional issues the Bill raised, such as Government’s and Parliament’s constitutional responsibilities to the NHS and namely, the Secretary of State’s duties. Other peers also raised the constitutional role of the Lords itself in scrutinising legislation.

Two motions were debated; one from Labour peer and former GP, Lord Rea, calling for a halt to further progress of the Bill and another from Lord Owen, a former GP and Labour health minister, now a Crossbench peer, asking for parts of the Bill to be referred to a special select committee for further scrutiny. When it came to the votes on the two motions, Lord Rea's amendment for the reforms to be abandoned failed by 220 votes to 354. Lord Owen's amendment, which would have referred parts of the Bill to a special select committee, failed by 262 to 330.

The Bill will now start a normal Committee Stage (in the Lords, a ‘Committee of the Whole House’, with all peers able to contribute to detailed discussions on the Bill) on 25 October which is expected to conclude just before Christmas. After this stage is finished, it is expected the Bill will have its ‘Report Stage’ and ‘Third Reading’ early next year followed by ‘ping pong’ between the Lords and Commons before ‘Royal Assent’ – making the Bill law – in the spring.

Commissioning

The authorisation process

A government document outlining the authorisation process (the process by which CCGs are deemed ready and able to take on full budgetary responsibility) was published at the end of September. The document, “Developing Clinical Commissioning Groups: Towards Authorisation” specifies six domains that will indicate a competent CCG, including evidence of a strong clinical focus, the support of constituent practices, engagement with patients and the public, robust governance processes and clear commissioning plans.

The process will be overseen by the National Commissioning Board and will commence with a risk assessment of shadow CCGs to be undertaken by SHA clusters by the end of this year. This risk assessment will include consideration of the size of the CCG (CCGs need to be large enough to be able commission effectively for their population and secure sufficient commissioning support) as well as the boundaries of the CCG – these will need to be co-terminus with local authority boundaries unless there is very good reason.

The GPC is working to ensure that the authorisation process facilitates the development of robust and successful CCGs, which have engagement from their constituent practices and LMCs, and avoids placing unnecessary bureaucratic burdens on CCGs. We will be producing further guidance on authorisation process shortly.

Health and Wellbeing Boards

The GPC has released guidance relating to Health and Wellbeing Boards. The Boards will work to encourage collaboration between local authorities and health professionals, linking health care, public health and social care. They will also have potential to yield considerable sway over CCGs, as they will have a role in scrutinising commissioning strategy, although this in itself could be very useful for CCGs seeking assurance that a commissioning plan is free from perceived or actual vested interest. This guidance urges GPs and CCGs to involve themselves in the establishment of the Boards and foster good relationships.

Commissioning Update

At the end of September the GPC published the first edition of “Commissioning Update”, a newsletter focussing on commissioning news. This edition discusses the new structures in the NHS. Developments are moving quickly, so keep an eye out for the next issue at the beginning of November.

Position of LMCs

The GPC has sought clarification and assurances from the Secretary of State on the position of LMCs under the changed NHS structures detailed in the Health and Social Care Bill. A helpful response has been received from Andrew Lansley, the key paragraphs of which are as follows:

“I very much recognise the important role played by LMCs in relation to local provision of primary medical services. We want this to continue – and that is why the Health and Social Care Bill continues to provide a legal framework within which LMCs may operate. The proposed amendments to section 97 of the NHS Act, which are set out in Schedule 4 to the Health and Social Care Bill, fully preserve the existing primary legislative provisions, with references to Primary Care Trusts being replaced, as you note, by references to the NHS Commissioning Board. This is a straightforward consequence of the proposal for the NHS Commissioning Board to take on statutory responsibility for commissioning of primary medical services.

Under the proposals in the Bill, the NHS Commissioning Board will, as you say, be able to arrange for clinical commissioning groups (CCGS) to undertake some of the Board’s functions relating to primary medical services. Where these functions include a duty on the Board to take certain actions with regard to LMCs, the delegation of the function would not alter this duty – and the Board would need to make arrangements to ensure that LMCs were appropriately involved. For example, if the Board were to delegate the function of investigating excessive prescribing to a CCG, the Board would need to decide whether to involve the LMC itself (through one of its local offices) or whether to make delegated arrangements for the CCG to involve the LMC. The statutory duty would, however, remain in either case with the NHS Commissioning Board.

It is also worth bearing in mind that much of the valuable work done between LMCs and local NHS partners does not only arise because of the legislation permitting LMCs to be recognised, nor through the requirement for PCTs to seek their views in certain circumstances. A large part of this valuable work happens because both parties recognise the benefits of co-operation and dialogue for the effective provision of services for patients.

This sort of co-operation will, of course, continue to be very valuable in improving the quality and efficiency of local health services. As well as protecting the existing legislative framework, we would therefore very much wish to encourage both the NHS Commissioning Board and emerging CCGs to identify ways in which they can work with LMCs for the greater good. I understand that officials working on the setting up of the NHS Commissioning Board are already seeking help from the GPC in developing a set of proposals that will allow local relationships to develop and flourish.”

Patient participation DES - Third party ‘Starter DES sessions’

Following a query regarding the implementation of the Patient Participation DES, please note the extant GPC and NHS Employers guidance Patient participation directed enhanced service (DES) for GMS contract, which clearly sets out the key objectives of the DES for practices.

The guidance encourages practices to seek the support of voluntary organisations in engaging with marginalised or vulnerable groups. This should help ensure the Patient Reference Group (PRG) is representative of the practice profile, while the onus remains on practices taking the initiative in achieving each component of the DES.

However, it is unnecessary for practices to accept offers from third party organisations for ‘getting started’ DES packages in return for payment. This goes against the spirit of the DES and defeats the object of practices forging closer relationships with their patients, better understanding local need and improving outcomes.

Pensions Day of Action

The BMA issued guidance for doctors this week in the form of frequently asked questions (FAQs) regarding the forthcoming Pensions Day of Action on 30 November, including specific guidance for GP partners. The FAQs and other information can be accessed from the BMA website.

The BMA has decided against a ballot on industrial action at this stage. However, the BMA is supporting the Day of Action and needs the help of Local Medical Committees to assist GPs who wish to demonstrate their opposition to the reforms, and to provide them with advice on issues arising from industrial action by other unions.

LMCs are being asked to join the BMA in encouraging members to visibly show their support for the Day of Action. Campaign materials, carrying a simple message of support, will be mailed out to individual members with the BMJ ahead of the day.

A letter from Laurence Buckman giving an update on threats to NHS pensions has been sent to all GPs.

Pension Dynamising Factor for April 2012

The dynamising factor for April 2012 will be 6.7%. This is as a result of the Consumer Price Index (CPI) figures, released this week, of 5.2%. The Retail Price Index (RPI) for September 2011 was 5.6%.

Information cascades for sessional GPs

The GPC and its Sessional GPs Subcommittee has raised concerns about problems with information cascades to GPs. Further to this, the Department of Health National Managing Director of Commissioning Development, Dame Barbara Hakin, has written to PCT clusters recommending the use of personal contact details of salaried and local GPs held on the medical performers list to communicate important information. The letter advises that the DH ‘shares the BMA’s view that all GPs should have access to communications from PCTs’, and states that using the details from the medical performers lists is unlikely to be considered a breach of data protection rules due to the need to communicate important information to all GPs in an area.

The GPC welcomes this as progress in ensuring that sessional GPs receive important communications. PCTs have also been asked to discuss with CCGs how to develop the most efficient and effective ways of engaging sessional and locum practitioners in their area.

Practice nurse indemnity

The Royal College of Nursing have sent the attached letter (appendix 1) to their members regarding indemnity for work undertaken in practices. As a result of this, we advise practices to check their indemnity arrangements to ensure that the work carried out by their practice nurses is appropriately covered.

Prescribing specials guidance

The National Prescribing Centre (NPC) has published guidance for prescribing specials. The guidance explains what specials are and advises on when to prescribe a special. Appendix 2, Prescribing Specials: a quick checklist for prescribers, may be of particular use for GPs.

The guidance is available here.

Social determinants of health – what can doctors do?

A BMA report about health inequalities has now been published, giving some practical examples of what doctors can do to make a difference. This report follows on from the work led by the previous BMA President, Sir Michael Marmot, focusing on health inequalities as one of the many priority areas of work for the BMA. There have been a number of events raising awareness of this issue, and earlier this year the BMA asked for examples of good practice in the UK that tackle health inequalities and the wider determinants of health, some of which have been included in this report.

The report is available here.

NHS general practice workforce census

Practices and LMCs may be aware that the annual NHS general practice workforce census is about to take place. The GPC generally supports this as a means of getting accurate information for negotiators on both sides, to support negotiations in the coming year. This census (as at 30 September each year) is one of three which together deliver statistics on the total NHS workforce. The other two censuses relate to hospital and community health service staff in medical, and non-medical, roles.

General practice workforce statistics in England are compiled from data supplied by or on behalf of around 8,300 GP practices. The NHS Information Centre for health and social care liaises with these organisations and their agents to encourage complete data submission, and to minimise inaccuracies and the effect of missing and invalid data.

The general practice census aims to gather information on all practices and practice staff in England, including GPs. It delivers a detailed view of the workforce including staff type, headcount, full-time equivalence, age, gender, and country of qualification (in the case of GPs). It also delivers information on practice size (in terms of number of GPs, and list size). It has historically been published at the level of SHA and PCT. Recent census publications may be viewed online.

The collection of information is rigorously vetted and controlled by the Review of Central Returns process which demands ministerial approval for any collection and specifically seeks to reduce the burden imposed on the service.

The majority of the information for the census is obtained automatically from the Connecting for Health / NHAIS / 'Exeter' GP practice re-imbursement system, the aim being to reduce the burden imposed on practices. The census has a number of uses, including:

workforce planning
planning and development of education and training
evidence to Doctors’ and Dentists’ Review Body
policy development
monitoring changes in general practice provision (eg by contract type)
parliamentary accountability (eg in answering parliamentary questions)
public accountability under the Statistics and Registration Act.

The NHS Information Centre will be distributing templates to PCTs shortly and PCTs will then contact practices to ask for this information. We would encourage practices to participate, as it is important that accurate and complete information is available. LMCs are therefore asked to ensure practices are aware of the background to this census and the GPC's support for it.

Items from GPC News September 2011.

NHS Reforms.

MPs debated the Health and Social Care Bill at its Commons Report Stage and Third Reading on 6 and 7 September. The Government had tabled over 1000 amendments (approximately 700 of which replaced the word ‘consortia’ with ‘clinical commissioning group’), covering issues relating to competition, duties of the Secretary of State and the NHS Commissioning Board, amongst others. All the government amendments were passed and in a final vote on the Bill on 7 September, 316 MPs voted for the Bill, 251 against; with 4 Liberal Democrats out of a total of 57 voting against the Bill. The Bill will be debated in the Lords on 11 October, where it will have its Second Reading.

Despite achieving some amendments to the Bill, the BMA remains seriously concerned that the damaging aspects will undermine the potential benefits of more clinician involvement in commissioning. The BMA has been calling for the Bill to be withdrawn, or at the very least, significantly amended. The BMA has been lobbying MPs and Peers ahead of the parliamentary debates, including launching a lobbying toolkit to help members contact their local MP prior to the debates in the House of Commons. Social media is now a recognised and powerful tool for heightening awareness and activating engagement on an issue and the BMA held an online day of action on 5 September to maximise the profile of members’ concerns about the Bill and the direction of travel on NHS reform. More information about the BMA’s lobbying activity the NHS reforms can be found on the BMA NHS reform webpages.

The GPC discussed the draft Department of Health document ‘Developing clinical commissioning groups: towards authorisation’. Members expressed concerns that, although the document was ostensibly a ‘draft’, GPs on the ground were under pressure to begin implementing the recommendations. Concerns were also expressed that, contrary to the Secretary of State’s original vision, the reforms were resulting in increasing central control and additional bureaucratic layers that would stifle the ability of clinical commissioning groups (CCGs) and the clinicians involved to exert their influence over the commissioning process. Members emphasised the importance of LMC involvement in the development of CCGs and strongly urged LMCs to ensure that they were being consulted and engaged in the development of the new local structures.

Information provisions in the Health and Social Care Bill

The GPC received an update on progress on the information provisions in the Health and Social Care Bill. BMA Council had agreed that the BMA should accept the concessions offered by the Department of Health on the information provisions in the Bill. These included a restriction on the number of bodies that would be able to mandate the NHS Information Centre to collect data from providers and a limit on when these powers could be applied. Any release of data from the Information Centre would remain subject to existing legal protections. In addition, provision would be made for a statutory code of practice in order to implement effective information governance controls around extractions.

The BMA has made it clear that ongoing acceptance is dependent on the outcome of the work on the code of practice. The BMA has highlighted the need for an approval body, which will consider requests for data. In addition, the Association has emphasised that the public must be aware of the new arrangements and patients should have the opportunity to dissent from sharing identifiable information. The BMA has agreed two places on the code of practice working group with specific representation from the General Practitioners Committee.

The GPC emphasised the importance of maintaining the highest standards of confidentiality and was concerned by any attempt to undermine this principle. This was reflected in the following motion which was passed:

GPC insists that any “Code of practice” must, where relevant to GPs, incorporate the General Practice Extraction Service Information Governance Principles published in March 2010.

Guidance on requests for disclosure of data for secondary purposes

Doctors often receive requests for patient data for secondary uses. These requests may come from researchers, from NHS managers who require the data for health service planning or from private companies providing risk stratification services, for example.

This document provides guiding principles to assist LMCs and practices in considering how to respond to these types of requests. A copy can be found here.

NHS 111

The GPC discussed the views of a number of LMCs regarding the implementation of the NHS 111 service.

The principal areas of concern are:

the hasty implementation of NHS 111, without sufficient time to evaluate the results from the pilots;
the lack of new resources to assist with implementation;
the potential for the destabilisation of in and out-of-hours services because call triage will be undertaken by staff who are not medically trained;
the lack of consultation and communication by PCT clusters and urgent care providers with LMCs and local practices in some areas about the implementation of the service.

The GPC will discuss these matters with NHS 111 and the Department of Health.

CQC registration

The committee was updated on developments regarding CQC registration for primary medical services providers. Subject to parliamentary approval, the Department of Health has formally announced a delay to the CQC registration of GP practices, including NHS walk-in centres, until April 2013. Out-of-hours providers that are not GP practices looking after their own registered patients will still have to register in 2012. The CQC will shortly be sending out letters to both groups of providers with further details. We remain of the view that the compliance requirements on GP practices need to be radically reduced, and are continuing to lobby the CQC and other stakeholders to ensure that this occurs.

Firearm / shotgun licences

Following discussion between the BMA and the Association of Chief Police Officers (ACPO) in 2010, it was agreed that when an individual applies for a licence, or applies for a renewal of a licence for a firearm or shotgun, a letter will be sent from the police to his or her GP informing them of the fact. The purpose of the letter is to provide an opportunity for the GP to alert the police to any medical concerns that may have a bearing on the individual’s ability safely to possess a shotgun or firearm. If there are no concerns, the letter does not need to be replied to. Unless, in the GP's view, the patient presents an immediate risk of serious harm to themselves or another, consent for any disclosure will be required from the patient. If the GP does wish to disclose a concern, and the patient refuses consent to any disclosure, the refusal will have to be relayed to the police, thereby potentially jeopardising the application. Following advice from the Information Commissioner, copies of the original letter from the police should not be retained in the medical record. However, doctors are at liberty to make a note in the medical record, as they would with any other request for health information by a third party.

You can find full guidance on this subject, including on applicants who may pose a risk and the use of tags in the medical record, here.

GP educator seniority

We have heard reports of some PCOs not classifying GP educator work as NHS work for seniority purposes thus, according to PCO calculations, reducing their superannuable income and affecting their eligibility for seniority payments. It is our view, supported by the GPC's lawyers, that GP educator work should in fact be classified as NHS work for these purposes and that calculations of eligibility for seniority payments should be made on this basis.

Review of the procurement of the seasonal flu vaccine

The BMA has responded to the Department of Health consultation on the review of the procurement of the seasonal flu vaccine. In the response we highlighted our concerns about the proposals to move to central procurement of seasonal flu vaccines in England. We believe that GPs should retain the right to procure the seasonal flu vaccine, but that the system could be improved by allowing practices and PCTs to share vaccines, and for emergency stocks to be available to be called on if necessary. We were also concerned about the lack of evidence that central procurement would improve vaccination uptake in England.

Seasonal flu vaccination programme for 2011 / 12

The GPC has written to all GPs to remind them of the arrangements for the seasonal flu vaccine programme in 2011 / 12. Evidence show that patients in at-risk groups are much more likely to die from seasonal flu than healthy individuals, and given that the seasonal flu vaccine uptake in the at-risk groups in patients under 65 and pregnant women was much lower last year than that recommended by the WHO, we would encourage practices to ensure that those in the at-risk groups are given priority. We are also concerned about the low uptake in healthcare workers, so we would encourage practices to ensure that staff are better protected.

Dispensing doctors - Category M drug prices

The DH announced reductions in the prices of category M drugs in the Drug Tariff on 8 September. The Drug Tariff is part of the Community Pharmacists' contract, but is linked to the dispensing doctors fee scale via the SFE. We are currently in negotiations with NHS Employers regarding the dispensing doctors fee scale.

Doctors providing assistance at sporting events

The BMA’s Board of Science has published an updated version of its resource for doctors providing assistance at sporting events, which can be found here.

The aim of this resource is to provide information for doctors who are interested in providing medical care at sporting events in a professional (whether paid or unpaid) capacity. In particular, it emphasises the importance of a doctor contacting their medical defence organisation prior to assisting or providing care at a sporting event.

This resource was first published in 2001, with an updated version in 2009. This latest edition, published in August 2011, includes specific guidance for doctors providing medical care at the 2012 Olympic and Paralympic Games.

Primary HIV infection: knowledge amongst gay men

We have been asked to draw to your attention the National AIDS Trust’s (NAT’s) new report ‘Primary HIV Infection: knowledge amongst gay men’, outlining the results of a recent survey of over 8,000 gay men.

Early diagnosis of HIV is very important, both in terms of preventing onward transmission and in terms of maximising the long-term health of people once infected. However, 52% of people diagnosed with HIV last year were in fact diagnosed late, meaning greater risk both of onward transmission and harm to future health. Primary HIV infection is for many a key early opportunity to diagnose HIV infection before a long asymptomatic period. The survey revealed that over 60% of gay men incorrectly believe there are no symptoms of primary HIV infection. However, when experiencing the most common combination of symptoms: sore throat, fever and rash, the most popular choice of action for respondents would be to go to their GP. GPs present an excellent opportunity to diagnose more people early, so it is vital that GPs have sufficient knowledge to recognise the indicators of primary HIV infection and feel comfortable suggesting an HIV test.

The report can be accessed here.

BMA Law – services to members

BMA Law has launched a new service for GPs involved in CCGs. The package includes advice from BMA Law on six legal questions on any issue falling within the description of services set out in BMA Law’s Terms and Conditions and 15% off total fees on any one BMA Law service. Further information can be found on the BMA Law webpages (you will need to log in to the BMA website to view these pages).

NORTH STAFFORDSHIRE

LOCAL MEDICAL COMMITTEE

Newsletter October 2011