GPC News Items

GMS Contract negotiations update

Interim Guidance on Extended Opening Hours DES -– Department of Health Interim Guidance

The Department of Health has issued interim guidance on Extended Access arrangements which is intended to help PCTs implement arrangements for practices to extend their opening hours, and arrangements for monitoring progress. The Statement of Financial Entitlement (SFE) is in the process of being drafted and will be finalised in a series of lawyer-to-lawyer meetings. Until then, we do not expect any further guidance on the DES to be issued by the GPC or DH.  The guidance can be found at the following link -

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_084333

GPs should be doing one of the following:

·         a LES (which can begin immediately as a LES is not dependent on DES directions);

·         waiting to see what the DES looks like (it is not know when it will be available);

·         or not offering extended hours at all if they do not wish to.

Delays in changes to the SFE are not unprecedented and should not be of concern to those who require a flexible LES, as we have details of what the DES will include.

Aspiration Payments

The statement below was sent to PCTs by the Department of Health.  This is to clarify that aspiration payments will automatically be amended by QMAS once the revised SFE has been finalised and that PCTs should not increase these payments manually.  This means that practices will have to wait until this point to receive their full aspiration payments due.  We appreciate this is frustrating for practices and will do all we can to ensure the SFE is signed off as soon as possible.

"The negotiated agreement is that aspiration payments should be increased to 70% to deal with cash-flow issues arising from the extension to the deadline for achievement payments until the end of June. However the increased aspiration payments are not legally due unless and until the Statement of Financial Entitlements has been amended accordingly. When the SFE is amended QMAS will increase aspiration payments to 70% and will calculate arrears of aspiration payments for the period of the 08/09 financial year prior to the new SFE coming into force. PCTs should not make any local payments to bring aspiration payments up to 70% as there will be a one-off national catch-up which cannot take account of such payments."

Patient Experience Survey

The results of this year’s survey will be published on 16 July although the payment data will be sent to PCTs on 22 May.  The full data set will only be released to ministers and GPC 24 hours before publication to prevent any leaks.  Attempts were made to get the data out earlier as GPs will want to understand why they have been given a particular amount, but this has not been possible.  The next survey is currently being procured.

DDRB recommendations and clinical DESs

There remains uncertainty about the legality of the process for implementation of the DDRB recommendations on the uplift of global sum and reduction of the correction factor.  This has been raised with the Department of Health and further expert legal advice is being sought.  While this is ongoing, the implementation of the new clinical DESs continues to be in abeyance.  Payment for the DESs is, of course, meant to make up the shortfall between the national pay uplift and 1.5% which was an integral part of the extended hours option A package.

Despite the uncertainty about the implementation of the DESs, as part of a May Day holiday announcement about strengthening family doctor services, the Secretary of State formally announced an investment of £50 million in additional clinical services, which are the new DESs, plus a further £50 million in improving access.  Although the press notice indicated that there would need to be a consultation with the BMA on the legislative changes to implement the DDRB recommendations, it was not clear about the knock-on effects on the DESs.  The GPC's position remains that while the legal position continues to be so unclear, the DESs cannot be implemented.

However, to ensure that there could be swift implementation depending upon the outcome of these legal issues, the negotiators have continued to discuss the detail of the clinical DESs, and they are close to a final form, should a position be reached where they will be implemented.

In outline, the DESs will cover the following:

·         enhanced treatment of heart failure – improving both the quality and length of life and for patients with left ventricular dysfunction through appropriate use of betablockers

·         osteoporosis – identifying and treating appropriately women with osteoporosis and a history of fragility fracture

·         health checks for patients with severe learning disabilities – an annual health check to include physical examination and medication review

·         harmful drinking – aimed at newly registered patients aged 16 and over identified as having problem drinking and delivering an evidence based brief intervention to those identified as drinking at hazardous or harmful levels

·         more comprehensive ethnicity recording of patients over a two year period.

NHS Next Stage Review

On 8 May, Lord Darzi published two further reports as part of the NHS Next Stage Review. Leading Local Change set out five key pledges detailing how the NHS will handle changes to services in the future. The report, aimed at the public, patients and staff, set out a rigorous process requiring any change to be transparent, clinically evidenced, locally led and for the benefit of patients.

This document was accompanied by Changing for the Better, operational guidance that identified eight key steps to enable service change through the five pledges to be realised.

Both documents can be found at:

www.ournhs.nhs.uk/2008/05/08/leading-local-change-framing-document-launched/

Throughout May and June, strategic health authorities (SHA) are publishing their clinical ‘visions’, representing the culmination of the work of the eight clinical pathway groups set up in each SHA in October 2007. These will set out the priorities for improving health and healthcare in the region over the next decade. Following the publication of each ‘vision’, the BMA will be holding a regional council meeting to discuss the reports. Details of these meetings are below:

1.         East Midlands/Trent – 11 June 2008 (Lincoln)

2.         Eastern – 28 May 2008 (Cambridge - RCSC meeting open to regional council members)

3.         North East– 28 May 2008 (Newcastle)

4.         North West – 23 June 2008 (Bolton Postgraduate Education Centre)

5.         Southern (covers S Central & SE Coast) – TBC

6.         South West – 16 June 2008 (Taunton)

7.         West Midlands – 18 June 2008 (Birmingham)

8.         Yorkshire – 17 June 2008 (Leeds University)

BMA members whose email addresses are held centrally will receive a formal invitation to their regional council. All others are welcome to contact their regional centre for information about the meetings – you do not need to be a member of the regional council to attend.

Lord Darzi is due to publish the final report of the Next Stage Review at the beginning of July.

The GPC is to publish guidance on the procurement process for the new services that Lord Darzi recommended in his interim report. This will be available from the beginning of the week commencing 19 May. This document, and all new guidance, letters and information, can be found on the section of the BMA’s website dedicated to the Next Stage Review:  www.bma.org.uk/ap.nsf/Content/HubDarziReviews.

Representation

The committee considered a number of proposals from the representation subcommittee to address issues raised in relation to the under-representation of sessional GPs, and voted in favour for the co-option of two further members of the sessional GPs subcommittee to attend the GPC in addition to the subcommittee chairman and deputy chairman for the 2008-09 session. It was also agreed that all the co-opted members of the sessional GPs subcommittee be allowed to send deputies to the GPC meetings if they were unable to attend.

The committee supported proposals that Northern Ireland (NIGPC) send one observer to each committee meeting to allow a greater degree of succession planning in Northern Ireland for the limited seats available on GPC, and also asked the representation subcommittee to consider further the potential for observers to be invited from LMCs to attend each meeting. Work on this proposal would be taken forward pending the available capacity of the new Council chamber.

Elections – GPC negotiators

The committee agreed that elections for the negotiating team are to be run using single transferable voting (STV) as opposed to serial voting, to allow a greater degree of involvement from all voting members in electing the team of negotiators. This will be implemented for the July GPC negotiator elections with assistance from the Electoral Reform Services (ERS), with further work to be taken forward in the new session towards an in-house STV programme.

GPC subcommittees

The committee considered proposals to improve the efficiency of the committee, and agreed to look at different ways for working in the future, to include a piloted ‘split’ committee day in the new session between full committee meeting, and subcommittee meetings, which would further increase devolved working to the GPC subcommittees.

GPC regional elections 2008-2011

The regional elections for the GPC are now complete, we are pleased to confirm that the candidates as listed below have been elected to the GPC for the 2008-2011 sessions.

John Rawlinson                      Berkshire/North & East Hampshire

Pritpal Buttar                           Buckinghamshire/Oxfordshire

Neil Thomas                            Cheshire/Mid Mersey

Gruffydd Jones                                   Dyfed Powys/North Wales

Peter Fellows                          Gloucester/Avon

Alan McDevitt                         Greater Glasgow & Clyde

Stewart Drage                         Hillingdon/Brent/Harrow/Ealing/Hammersmith & Hounslow

Kamal Sood                            Leicestershire & Rutland/Northamptonshire

Stewart Kay                            Lewisham/Southwark & Lambeth/Bexley & Greenwich/Bromley

Roger Ford                              Northumberland/Newcastle & N Tyneside/Gateshead &    S Tyneside/Sunderland

Mary McCarthy                      North Staffordshire/South Staffordshire/Shropshire

Douglas Moederle-Lumb        North Yorkshire/Bradford

Satya Sharma                         Sandwell/Walsall/Wolverhampton/Dudley

Helena McKeown                   Wiltshire/Dorset

There is a vacancy left for the Barnsley/Doncaster/Rotherham/Sheffield constituency, and nominations for this will be re-opened in due course.

Options for enhancing the career opportunities for GPs

The GPC recognises that there needs to be improved partnership and employment opportunities available for GPs, as well as the need for career pathways for all GPs.  Unfortunately at present there appears to be only a small number of partnership vacancies, and even fewer that are openly advertised.  There is also concern that many salaried GPs are not being offered appropriate terms and conditions and/or are not being adequately remunerated for the work they do. 

A working group was set up last month - which consists of representatives from the GPC's sessional GPs subcommittee, GP trainees subcommittee and the education, training and workforce subcommittee - to consider these important issues and to produce a scoping paper for the GPC to consider.  The working group's paper was presented to the May GPC meeting, and the suggestions arising from this will now be discussed in further detail with a view to early action being pursued.   We will keep LMCs informed of the work of this group.

Cremation forms and the review of death certification

As you may be aware, there is an ongoing review of death certification, cremation, and the Coronership since the publication of the Shipman Inquiry's third report and the Home Office review of these matters.  Progress has been very slow, but you will recall that some changes have already been made, for instance the very strong guidance that cremation should be refused unless the doctor signing Form C confirms that s/he has spoken to a relative or carer of the deceased or to some other person who can confirm what the doctor signing Form B has said.

It has been noticed that there may have been instances around the country where doctors have signed Form B or C without having seen and examined the body of the deceased after death.  We have been asked to remind you that this is a criminal offence under the Cremation Act 1902, with a possible punishment of up to two years' imprisonment.  We believe that police forces and the Crown Prosecution Service would take seriously and investigate any allegation of such behaviour.  It is also worth remembering that the GMC would be likely to view as serious misconduct the completion of the Form B or C with a statement that the body had been seen when in fact this was not the case.

Pensions

As reported last month, the Secretary of State decided not to appeal against the Judicial Review decision on pensions dynamisation, and has subsequently confirmed this in writing. Further exchanges of letters between the chairman of Council, and the Secretary of State have clarified that the rates for the dynamising factor for the years 2004-05 and 2005-06 are now to be calculated by the Technical Steering Committee and GPs will be advised as soon as this has been determined.

Additionally, under the judgement, the Secretary of State is free to re-determine the calculation of dynamising factors for the two years 2006/08.  We understand that the Secretary of State intends to replace the previous determination made for 2006/07 and 2007/08, which will be likely to result in a DF for both years of 1. We expect confirmation of the details of this method and its implications will be clarified during any consultation process.

NHS pension advice

Dr Andrew Dearden, Chairman of the BMA`s Pension Committee, discusses the upcoming changes to the NHS pension scheme in a short online video clip that is available to all members and non-members.

The clip can be viewed on BMAtv, the BMA’s YouTube channel, at:

www.youtube.com/watch?v=VsaUds4QbLE

To stay up to date with the latest online new from the BMA, subscribe to BMAtv via the left hand toolbar.

If you are not able to access YouTube, the clip can also be viewed on the BMA’s webcast channel (9 April entry):  www.bma.public-i.tv/site/webcasts

Premises survey

The GPC recently undertook a survey to establish how many formal applications for primary care premises funding were being approved by primary care organisations across the UK. 

A total of 146 PCOs provided data for the survey which showed that, since April 2004, 938 applications for funding for new practice premises had been made to PCOs.  Of these,

·         56.1% had been accepted

·         8.8% had been considered and rejected

·         28.8% were still under consideration

·         6.3% had not yet been considered.

It was stressed that the survey only covered formal applications for premises funding.  Informal applications and discussions about premises developments had not been considered, and it was recognised that many projects were abandoned at this early stage. 

The results of the survey will be published shortly. 

Consultation: the future regulation of health and adult social care in England

Subject to Parliamentary approval, the Health and Social Care Bill will establish the Care Quality Commission.  From April 2009, the new Commission will take over the functions of the Healthcare Commission, the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission (MHAC). The BMA has been consulted on the proposals and GPC representatives have attended two consultation events organised by the Department of Health. 

 

It is proposed that eventually, it will be essential for all providers of general practice to register with the Care Quality Commission. In order to register, particular levels of safety and quality will have to be demonstrated. The intention is for the registration system to come progressively into force from April 2010.

 

It is possible to view and respond to the consultation via the following link to Department of Health website www.dh.gov.uk/en/Consultations/Liveconsultations/DH_083625.  The closing date for responses is 17 June 2008.

Launch of Easyhealth website

We have been asked to draw your attention to this website.  Easyhealth.org.uk pulls together 'accessible' health information from across the UK onto one website.  At present the website contains information from over 50 organisations across the country.  

Easyhealth.org.uk has been built to make it easier for people to find health information they can understand. About 97% of the information is free so that people can download this information immediately.

Easyhealth has tried to make the website as easy to use as possible for all patients, but in particular for those patients with lower reading skills/levels.   The most important aspect for GPs would be the blue health leaflets section.