Newsletter
Index
Newsletter August 2001Reorganisation
of Health Authorities Salaried
GPs: Contractual Arrangements. Branch
Surgeries: Connection to the NHSnet Coal
Miners’ Compensation-Courier Service for Ex-Miners Medical Records EditorialRecent months have seen a change in attitude by the leaders of the GPC. They now appear to be in a more militant mood and ready to tackle Government over the problems facing general practice. This change in attitude is to be welcomed and they must be given the support they require from all of us. Whether their new strategy will be successful remains to be seen. The Government remains firm in its commitment to reorganise, at an immense pace, the management structure of the Health Service. Health Authorities will disappear on 1 April 2002 to be replaced by Strategic Health Authorities. Much of the work of the current authorities will be passed to Primary Care Trusts. There is great concern that these fledgling organisations, which have, to date, been starved of resource, will be able to cope. If they remain so resource and expertise depleted it does not bode well for the future of the service. The real problem lies in lack of NHS funding not necessarily in the structures which serve it.
Crisis in General Practice
The Committee held a meeting with GPs who are involved in Primary Care Organisations to discuss the current crisis. Various areas were identified for further consideration and colleagues will be circulated shortly with a list of these areas for prioritisation of effort.
Wheelchair Services
The committee has expressed concern at the number of referral forms, which have been returned to GPs for trivial reasons. I have written to Alison Morris, Wheelchair Service Manager concerning this and she has replied that the main reason forms are returned is the absence of the following: 1. Diagnosis 2. Height and Weight 3. Information on pages 2 & 3 of the assessment form 4. Doctor’s signature 5. Signed “Condition of Supply” The committee does not feel that obtaining a signed “Condition of Supply” form is part of the GPs duty and feels that this should be obtained on delivery of the chair by the wheelchair service. This is another example of a small but significant extra workload being passed onto general practice and the committee advise that GPs should not comply with the completion of this section of the form.
Psychiatric Services
The committee is concerned that one of the consultants in Child & Adolescent Psychiatry will only accept referrals on a form produced by his department, regardless of adequate referral details being given in a practice produced referral letter. Despite discussion with the Clinical Director, this situation is continuing. The Medical Defence Organisations have taken the view that GPs do not have to complete a hospital produced proforma in order to fulfil their duty of referral. The Committee has, therefore, reluctantly taken the view that any refusal by a secondary care professional to see a patient because of non-compliance with proforma completion, might form the basis of an official complaint about the professional concerned. On a positive note, two Child and Adolescent Mental Health Consultants have been recently appointed so that hopefully by the autumn there will be three staffed community CAMHS Teams headed up by consultants alongside the specialist in-patient service at Wall Lane House. Dr Katwala will cover North Stoke and Moorlands, and Dr Lovett will provide a service for Newcastle. Both will work from Abbey Hulton Clinic. Dr Dover’s service will continue as at present. MTRAC
A vacancy exists for a GP on the Midlands Therapeutic Review and Advisory Committee. Its remit is to provide a review system to identify the clinical value, safety and suitability for use of pharmaceutical products in primary care, to enable and encourage their optimum introduction in the West Midlands Region, including proposed transfers and requests from secondary care. MTRAC Committee meetings are held on the fourth Thursday of every month except for the months of August and December. Meetings commence at 1.00 pm with a working lunch and aim to finish by 3.30 pm. The April and October meetings commence at 12 noon and are open to all MTRAC committee members and their deputies. Key presentations on relevant issues precede the committee’s business meeting. 2-3 products are normally discussed at each meeting. The literature evaluations for products to be considered at each meeting are circulated in draft form two weeks before the planned meetings. At this stage all members are encouraged to comment on the evaluations and identify any additional information required. GP members are entitled to remuneration on an hourly basis for locum fees and additional travel expenses.
Pathology Links
There have been some problems recently with the links system and some confusion over who to contact to sort out problems. I have been informed that in the first instance practices should contact Sue Lane at Pathology. It is also important that she is informed of any changes to GP systems, eg replacement of servers. Diane Jackson, Assistant Director of Information at the Trust is leading on the Pathology links to GPs project and will be looking at future requirements. A & E Discharge Letters
The Committee has been concerned for some time over the poor quality of information contained in the letters generated in the A & E Department. This has been a problem for many years and has been the subject of much discussion and correspondence over the years. Despite this, any improvement is temporary. Because of its frustration over the issue, the LMC has recently written to the Regional Health Authority with our concerns. Surprisingly, the situation has still not improved. A large proportion of discharge summaries from the Unit still do not contain adequate information. The Committee is continuing to push for an improvement in this unsatisfactory situation.
Red Book Updates
Concern has been expressed that there have not been any recent issues of updates to the “Red Book”. The BMA have informed me that the latest version is available on the Internet at www.nhs.uk/redbook/2.htm. They understand that Health Authorities will be sent a copy of Amendment 23 to the SFA shortly and will be asked to distribute this to GPs.
Cancer Referrals
Alwyn Ralphs is currently working with the Two Week Cancer Bureau at the North Staffs Hospital Trust. Not all colleagues are using the proformas produced by the Trust for these cases. Whether we like the forms or not, it does help the office to process patients in the most efficient and speedy way and should ideally be used. I am aware that some of our consultant colleagues are refusing to accept referral on the two-week wait proforma. This has been taken up with the Trust and will hopefully be resolved.
Student Midwives
Students who are to undergo midwifery training at Keele University have been asked to contact their GP to have their Rubella antibody levels checked. This is the responsibility of the University rather than the student’s GP.
Undergraduate Nurse Training
The School of Nursing is seeking to place student nurses with GP practices in North Staffordshire. However, there is no funding available for this. Recognition has to be made that practice nurses will consult at a slower rate if teaching is taking place. Whilst recognising that increasing numbers of nurses are going to be recognised in the student nurse curriculum, the view of the LMC and the GPC is that we should not promote teaching without adequate remuneration.
Flu Vaccination
The Chief Medical Officer has recently circulated a document concerning this year’s flu vaccination programme with updated targets. Last year GPs were paid an Item of Service fee for immunisation of the over 65s. This was a one-off agreement. Negotiations are still continuing with the Department of Health concerning the current year.
Access to Medical Records
The GPC is still in negotiation over the reduction of fees which GPs are allowed to charge for access to medical records from October this year. I have contacted the GPC again recently over this and I am afraid there is still no news.
Reorganisation of Health Authorities
On 1 April next year, 30 Strategic Health Authorities will replace the existing 95 Health Authorities. They will step back from service planning and commissioning to lead the strategic development of the local health service and performance manage PCTs and NHS Trusts. PCTs will become the lead NHS organisations in assessing need, planning and securing all health services and improving health. The Regional Health Authorities will be abolished and four new Regional Directors of Health and Social Care will oversee the development of the NHS and provide the link between NHS organisations and the Central Department. It is planned that North Staffordshire will combined with South Staffordshire and Shropshire to form the local SHA. This has implications for the Local Medical Committee in that its boundaries are by statute aligned with the current health authorities. New legislation is required for the changes and it remains to be seen what the position will be regarding LMCs. They may have common boundaries with the SHA, with PCTs, or possibly their statutory role will be abolished. Either way this has implications for the LMC and it is hoped that there will be flexibility to allow them to organise in the most appropriate way for the GPs they represent.
Walk-In Centre
The reports issued by the Walk-in Centre have recently changed. These are now at least two sides of A4 and most of the information is unnecessary. I have asked whether the reports can be made more GP friendly. Unfortunately, the Walk-in Centre computer software has been changed to match that used by NHS Direct sites. The only alternative report which the system will generate is a summary report which only contains the patient’s name, time and reason for attendance and gives no address, GP name or nursing comments. Karen Dawson, the Centre Manager is feeding back comments to the supplier in the hope that some changes can be made. Items from GPC News:Salaried GPs: Contractual Arrangements.A guidance note has been produced by the joint GPC/RCGP Workforce Committee about the types of provisions which ideally should be included in contracts of employment for salaried GPs. This is now available from the GPC office. It will also shortly be accessible under the general guidance section on the GPC Website (www.bma.org.uk/gpc.nsf). Branch Surgeries: Connection to the NHSnetThe NHS Information Authority issued guidance to Health Authorities in England, at the beginning of July on connection of branch surgeries to the NHSnet following successful negotiations with the GPC. The guidance can be accessed via: http://www.gpnet.nhsia.nhs.uk/gpnetconnect/planning.asp#branch. Funding equivalent to a non-recurring payment of £2,000 per branch surgery has been made available to Health Authorities for branches that satisfy the following requirements: The branch surgery is open for more than 19 hours a week, even if a connection to the main surgery is already in place. The branch is open for less than 20 hours per week, and already has a Kilostream, or ISDN link, to the main surgery, or a NHSnet connection. This means that, where a satisfactory branch/main connection already exists, the practice can use the £2,000 to improve any aspect of the nominated branch surgery infrastructure.
Coal Miners’ Compensation-Courier Service
for Ex-Miners Medical Records
Over the next two to three years, the Department of Trade and Industry will be seeking access to the medical records of some 140,000 miners, and ex-miners, who are seeking compensation for chronic obstructive pulmonary disease (COPD) as a consequence of working in mines operated by the British Coal Corporation. An important part of the compensation process is the medical assessment of the claimant by a respiratory specialist. Healthcall and managers and processors of claims (MPC) are acting as agents for the DTI in carrying out this medical assessment of the claimant and need to have sight of his medical records. MPC is authorised to collect and scan the claimants’ medical records without which a claimant cannot be put forward for assessment by the respiratory specialist. To improve efficiency, and alleviate the difficulties accommodating scanning teams on site, MPC has set up a central scanning office in Newcastle and will shortly be establishing new offices in other areas. This means that, rather than accommodating a team on GP premises, MPC can collect records from the surgery, scan them at their Regional Office and return them to the practice usually in 3-7 days. GPs can be assured of security of the records as MPC are using an internal courier service to collect and return these. This means that no third party is involved. Should practices require the medical records in an emergency, there is a help line contact number for records to be returned. For every record being collected, MPC will provide a signed mandate form of authority from the claimant (or widow or estate). The mandates confirm that the claimants consent to release the records. MPC wish to encourage GPs to use this service as speedier collection of the medical records is clearly in the claimants’ best interest. The GPC, having consulted the GMC, is satisfied with the proposed scheme, and would encourage practices to participate. There are large numbers of records to be scanned, which involves medical record holders allocating resources to retrieve these records, including generating computer records. In recognition of the effort involved in providing medical records a fee of £62.50 per visit will be paid to surgeries. DR PAUL GOLIK Secretary |