NEWSLETTER AUGUST 2005
Prescribing for intermediate care patients
Children's Community Nursing Team
Pneumococcal Vaccine Uptake Study
Hazardous Waste Regulations 2005.
GP2GP Transfer – Attached documents
The Clinical Development of the NHS Care Record Report
VAT allowance on dispensed drugs
New Contract
During the last month the GPC have issued further documents on phlebotomy as an enhanced service and Community Hospital GPs. These documents can be found on the BMA website and also on the LMC website at http://www.northstaffslmc.co.uk/new_contract.htm
Prescribing for intermediate care patients
The committee has received a number of complaints from colleagues about being requested to fill in medication charts/prescriptions for patients who are newly admitted from the community into intermediate care beds. It is not the responsibility of GPs to complete these forms or prescribe for any patient who is not under their clinical care. The doctor who is employed to provide intermediate care and has clinical responsibility for the patient must prescribe and complete the appropriate forms. I have written to the intermediate care team suggesting that this practice should stop immediately. GPs are strongly advised not to prescribe for any patient who is not under their clinical care, whether in intermediate or secondary care.
Children's Community Nursing Team
This team is a North Staffordshire wide specialist children's nursing service which provides domiciliary nursing care and support to children aged 0 to 16 years. The management of this team has decided that they will no longer accept referrals for minor problems and that these should be directed to either our practice nurses or the adult district nursing service. Contrary to the information circulated by them there has been no discussion with the LMC about the re-direction of workload. They are under the impression that post-operative care is within the remit of our contract. I have written to them pointing out their error. It will be up to the PCT's as commissioners of care to decide whether the CCN service is funded for this care and if not where they wish to commission the service in the future.
Pensions
Guidance has been prepared on behalf of the BMA’s Pensions Department and General Practitioners Committee by Kingston Smith Chartered Accountants in response to common queries received from GPs and their accountants on the new arrangements for assessing GP pensionable earnings. It is intended primarily for GPs’ accountants for them then to discuss the arrangements with their GP clients. The guidance follows the GPC’s guidance on the new arrangements “Focus on assessment of GPs’ pensionable earnings” issued earlier this year. The document can be found here
Pneumococcal Vaccine Uptake Study
Dr Giri Rajaratnam has asked Dr Musarrat Afza, Specialist Registrar Public Health to undertake a study to identify current state of the implementation of pneumococcal vaccination programme in practices in both North and South Stoke PCTs. As you are aware that the Polysaccharide Pneumococcal vaccine has been available to vaccinate patients in high risk groups (HRG) for over 10 years now.
However there has never been any formal assessment for uptake in this group. The recent roll out of the programme to all patients aged 65 and above provides an opportunity to review uptake in both groups of patients (i.e. HRG and over 65s).
As a part of this programme evaluation he intends to do a postal survey and send questionnaires to practice managers, care homes managers/matrons and patients. The study has been approved by the research governance lead for the two PCTs.
He would also like to visit a selection of practices to learn from their experience of implementing the programme and to see if he can gather data on number of patients on chronic disease registers who have already been vaccinated.
Hazardous Waste Regulations 2005.
The GPC have issued a guidance document concerning these regulations which came into force on 16th July and require practices to register with the Environment Agency. The document can be found here.
GPC News Items
GP2GP Transfer – Attached documents
The testing of GP2GP transfer has identified an issue which GPs can assist with prior to the system being implemented. Whilst the “core” record in most GP systems is very compact, attachments are generally much bigger by comparison. As more and more practices are utilising document management systems, the number of attachments is growing. Attached records will be transferred with GP2GP but they have the potential to swamp the system. The practice of one of the Joint Chairmen of the Joint GP IT Committee has 89,000 attached documents; practices need to ensure that attached documents are as compact as possible.
In particular, Microsoft Word processed documents have the potential to be very large, especially if they incorporate images in the header or background. Some embedded images can make the file size 100 times bigger than the text-only version and the implications are self-evident.
The GPC advise practices to consider removing any embedded images in any word processor generated letters they attach as their core clinical records. If at all possible, attached word processed documents should be text-only. This would not apply to word processed documents that were not attached or appended to the clinical system records.
The Clinical Development of the NHS Care Record Report
The GPC considered the recently published Connecting for Health document The Clinical Development of the NHS Care Record Report. It can be accessed at the following link :www.connectingforhealth.nhs.uk/crdb/docs/scrrdocument.doc
The Joint GP IT Committee has already submitted its response and this will be available on the GPC website in due course.
A key part of the consultation document is the NHS Care Record Guarantee. This will be an ‘evolving’ document, i.e. it will be continuously updated, following consultation with the profession.
The Committee remains concerned at the lack of public knowledge about NHS Care Record (NCRS), especially its implications for the confidentiality of information. However, the development of the NCRS will be incremental and the Joint GP IT Committee will be fully involved in future developments.
Modernising Medical Careers
The BMA is concerned that F2 junior doctors will be discouraged from undertaking a training period in general practice. This is because they may only receive their basic junior doctor salary, and not a supplement, during their time in general practice, which would mean a pay drop. The GPC will be liaising with the BMA’s junior doctors committee (JDC) on the need for these F2 doctors to receive a pay supplement during their GP training component to ensure that they do not suffer a pay detriment.
GP educators' pay
The GPC are pleased to report that the Department of Health has confirmed that the GP educator payscale in England will be uplifted by 3% with effect from 1 April 2005. They will continue to work to ensure that the pay level is appropriate for these doctors.
Partnership Agreements
The GPC has dealt with some difficult and acrimonious partnership split cases recently, mainly due to the fact that there was not a partnership agreement in place. Unless a partnership agreement is in place, a ‘partnership at will’ will operate and the partners will be governed by provisions of the Partnership Act 1890. This could result in:
· the loss of the practice NHS contract, with no obligation on the PCT to award a new contract to the remaining partners;
· the forced sale of partnership assets including the premises;
· significant legal costs;
· the inability to exclude one of the partners without a lengthy dispute resolution process or a court case.
The GPC urges practices to ensure that they have a written partnership agreement in place and to check that it is up to date and includes all partners. Further guidance on partnership agreements is available at: www.bma.org.uk/ap.nsf/Content/PartnershipAgreements0504
Jury Service
Representatives of the GPC, senior hospital doctors and junior doctors committees recently attended a meeting with the Department of Constitutional Affairs to discuss doctors’ concerns about the implications of jury service on service delivery and practice organisation. The meeting was constructive and, as a result, the BMA is to draft guidance for those doctors who would like deferment or excusal from jury service. We anticipate that the guidance will be available in the autumn. In the meantime, we advise that any application for excusal or deferment should be accompanied by detailed reasons, including the implications for service delivery of the absence of the doctor summoned; this explanation may be continued on a separate sheet of paper where there is insufficient space on the jury summons response form. Further advice may be sought from Rachel Merrett (rmerrett@bma.org.uk)
MMR
An issue has arisen about the supply of imported MMR vaccines from the US that are not licensed for use in the UK. Despite the Department of Health’s assurance that the vaccine is identical to the MMR-II routinely supplied by Sanofi Pastuer MSD, which is licensed in the UK, it has so far not agreed to the GPC’s request for general indemnity.
A letter from David Salisbury, Principal Medical Officer, says “in relation to the liability of individual GPs, the general position is that doctors prescribe or administer unlicensed specials to their patients on their own direct responsibility”. The GPC advises GPs and LMCs not to use this vaccine until the position is clarified satisfactorily. In the meantime, we have written again to the Department to reiterate our concerns and restate our position. We will keep LMCs informed of any progress.
Premises survey
The GPC is undertaking a comprehensive, one-off survey to gather information about the state of GP practice premises and the position of GP finances with relation to their premises. This is primarily to help build a case for increased revenue and capital funding for premises to enable GPs to provide a wider range of services under the new contract, to engage in practice-based commissioning and to help deliver funded shift of work from secondary to primary care. We will be seeking information not only on the physical condition of premises, but also views on what GPs would do with improved premises. It is requested that as many practices as possible complete the survey, which will be made available shortly.
VAT allowance on dispensed drugs
Following consultation with DDA representatives, the GPC has recently agreed to an amendment to paragraph 18.3 of the SFE relating to the VAT allowance paid on dispensed drugs. An error in the transcription of this provision from the SFA to the SFE led to the SFE stating that the allowance is calculated on the basic price before rather than after deduction of the discount. This meant that in 04/05 there was a considerable overpayment of the VAT allowance to dispensing doctors, which the Department of Health has agreed not to claw back. We are satisfied that this was a genuine transcription error and have agreed to an amendment to the SFE for 05/06 to correct it with immediate effect and to avoid further overpayment.