Newsletter December 2001Editorial December 2001 Written Complaints collecting Ethnic Data Capital for GP Premises Improvements Short-term sickness certification
Editorial
The end of the current year is fast approaching. Workload seems to be increasing yet again as the problems in the NHS deepen. We have recently seen yet another crisis in MAU, SAU and the Accident Unit with the Trust appealing yet again for our help. In the coming year we will be expected to take on even more - intermediate care, more NSFs, emergency care (recent document – emergency care – practical steps) to name but a few. These cannot be taken on without two basic necessities, resource and manpower. The chance of more manpower in the foreseeable future is practically nil. With the age profile of general practitioners, our numbers are more likely to decrease. Although more doctors are now being trained, this will take time and other specialties are also crying out for more. The alternative is a change in the skill base in primary care with more responsibility and care being passed to our nursing colleagues, although they too have their recruitment and retention problems. There will also need to be a patient education programme to lower their expectations of being able to see their GP for routine treatment. The crisis is not surprising when one considers that the UK spends only 6.9% of GDP on health care compared to 9.4% in France 36% more. To remove the backlog of problems and compensate for years of under funding we need to spend even more. When our patients complain of a poor service, this is the real reason why.
Website
I have produced a website for the LMC. This is deliberately low cost (free) and basic. A number of LMCs have websites which are maintained by commercial companies and include a number of high-tech features. However, I believe that the main use of an LMC website is a source of easily accessed information for local GPs. This must be relevant and up to date. By keeping the design simple and in-house I can hopefully post information quickly and easily. This can be found at: www.staffslmcs.freeserve.co.uk
E-mail
I recently sent an E-mail to all GPs in North Staffordshire via the NHS net. I asked for a reply to be sent to enable me to assess the use of this method of communication. I was surprised by the number of replies received (75 GP acknowledged receipt) and I intend to use E-mail in the future for any communication which is urgent. It is a lot easier than producing a newsletter and circulation is immediate. Newsletters take at least a week to reach all practices. I will also attempt to post anything sent by E-mail onto the website.
Crisis
in General Practice
The LMC and PCG/T board members held a meeting in November to discuss the issues raised from our earlier survey to GPs. From this we hope to produce a policy document which will give the LMC’s policy on various issues. We hope to publish this early in the New Year.
Future
of the LMC
The government have now published the NHS reform
bill which provides for the future configuration of LMCs. The Bill contains provision for establishing arrangements for local
representative committees for the contractor professions. It transfers
recognition from Health Authorities to Primary Care Trusts.
However, there
will be flexibility for practitioners to propose to PCTs that recognition
should be at other levels: i.e. a number of PCTs, an SHA or current
boundaries. The Bill proposes no restrictions on LRCs crossing SHA
borders, only that the minimum requirement should be that the LRC covers
at least one PCT. There is no obligation for different LRCs in the same
area to adopt the same recognition arrangements (e.g. LDCs and LMCs)
Practitioners will decide on the most appropriate recognition arrangements
and make proposals to the PCTs involved. This has been
discussed by the LMC and we feel that the best configuration for North
Staffordshire is a committee covering the four North Staffordshire Primary
care Trusts. We will need to
amend the constitution to take into account the change. One area in
which discussion is needed is the balance of membership of representation
across the four Primary Care Trusts.
The Committee does not currently have constituencies as such and
the distribution of membership is: North – 3 South – 8 Central – 1 Newcastle – 5 Moorlands – 3 It may be that we will need to form constituencies to ensure a more equitable distribution of members. Any views you have on this would be greatly appreciated.
Hepatitis
‘B’
There has recently been a change in policy of Staffordshire Police in the way they handle Hepatitis ‘B’ immunisation. They are asking potential recruits to attend their general practitioner with a view to obtaining Hepatitis ‘B’ immunisation prior to joining the force. The current legal advice obtained by the BMA is that there is no Terms of Service obligation for GPs to provide this immunisation, as GPs are not trained in Occupational Health risk management. The Department of Health has clearly stated that Hepatitis ‘B’ immunisation for Occupational Health reasons is the responsibility of the employer. The Green Book, also known as “1996 immunisation against infectious disease” states that the incidence of infection with Hepatitis ‘B’ is not apparently greater for the Police, Fire and Rescue Services than in the population as a whole. Nevertheless, there may be individuals within these occupations who are at higher risk and should be considered for immunisation. Such a selection is to be decided locally by the Occupational Health Service or as appropriate medical advice following necessary risk assessment. It is clearly the responsibility of Staffordshire Police to provide Hepatitis ‘B’ immunisation for these officers who they have assessed as being at increased risk. Both North and South Staffs LMCs, along with Dr Jonathan Howell, Consultant in Public Health Medicine and Medical Advisor to South Staffs Health Authority have been in communication with the Police Service concerning this and have so far been unsuccessful in altering their policy. I have also become aware of a similar practice in combined healthcare and have written to them in the same vein.
Practice
Nurse Pay
The committee has received a circular from the GPC
and Department of Health stating that both are committed to seeing that
practice nurse pay increases in line with the Nurse Pay Review Body. They
are keen to see that all GP practices should be adequately reimbursed for
the employment of practice staff and that practice nurses are paid on an
appropriate scale. I have written to all PCOs concerning this and stating the LMC view that although the 70% reimbursement level may be appropriate for some practice nursing levels, above average levels used for the implementation of NSFs and department of health initiatives should be reimbursed at 100%.
Varicose
Vein Protocol
There was a lot of confusion at the introduction of this policy and the Trust sent out a letter to GPs informing them that patients already on the waiting list would be asked to contact them for re-assessment. In the event this letter did not go from the hospital to patients it is understood that clinics have been arranged by the Trust to review these patients. The Secretary has received comments from GPs about the referral guidelines and the conflict this causes with their responsibility to refer. These are only guidelines and adhering to them should not be too much of a problem, however, if a GP feels referral is necessary, they should do so, the patient should be seen by the Trust and the guidelines can be implemented at that level.
Emergency
Pressures
Recently GPs were again written to concerning the bed situation at the Acute Trust. These crises have been appearing regularly for years and with increasing frequency, despite winter pressures measures etc. It has long been the opinion of the LMC that the only way to prevent such crises is to increase the number of beds to an adequate number, yet there are plans to decrease them even further. Whilst sympathising with their plight, GPs have a duty to refer patients when their condition requires it. Not to do so is against our Terms of Service. I would not advise any GP to put themselves in such a position. General Practice is also facing severe strain and is at breaking point. We cannot take on the responsibilities of the secondary care sector and deprive patients of the care they need by not referring them. Studies have always shown that the vast majority of acute referrals to the MAU are “appropriate”. There is no leeway in this. I suspect that if secondary care physicians were working in primary care, the referral rate to the MAU would increase. The local health service is clearly at breaking point and this should be flagged up to the public. An article in the last edition of GPs news published last week reads: “We have been asked to clarify whether a GP has fulfilled his/her Terms of Service obligations if a patient has been referred to secondary care, but the hospital has refused to accept the referral stating that the hospital is “closed” to GP referrals. This problem is arising when a patient presents at the surgery and the GP attempts to get a referral by telephoning the local hospital. In the event that a GP finds him/herself in this position, our legal advice is that they should send the patient to the local Accident and Emergency Department with a letter of referral. This discharges the duty of referral under paragraph 12(2)(d) of the Terms of Service.”
Child
Protection Procedures
I have been asked by the Health Authority to bring this to your attention. All disclosures of potential child abuse must be taken seriously and acted upon where the child concerned is under 18 years old. Action must be in line with the relevant ACPC Child Protection procedures, a copy of which all practices should have. Further information or copies of this guidance can be obtained from Hester Parsons.
Microsoft
Software
A software deal with Microsoft to save the NHS over £50m was announced on the Department’s information and IT website on 5 October. The Press Release includes the comment “NHS organisations are immediately covered for legal use of these and earlier versions of these products. The NHS are also able to request new software from contracted resellers and deploy on current NHS devices as required. New hardware can also be pre-loaded with software from the new arrangement. “I understand that practices can purchase new software from DoH approved suppliers – a list of these is given on their website. Anyone who is about to purchase new software should look at the new deal before purchasing. It could save you pounds. I have spoken to Sanderson’s (one of the 4 account resellers under the agreement) They tell me that we can use previously purchased software on other machines under the new agreement, as long as it is one of the products covered and the PC meets the relevant requirements – i.e.: · The hardware funded by “Vote 1” money – i.e. “NHS” money”? · The PC is configured and connected to NHSnet? · The PC on an NHS asset register? If you have a networked clinical system it is likely that all the PCs on the network can be configured to connect to the NHSnet. New software can be supplied from Sanderson. WindowsXP and Office XP come on CDs priced at £20 each. Sanderson website can be found at Contact telephone number is: 020-7731-9200. The Department of Health Press Release can be found at: http://www.pasa.doh.gov.uk/it_telecoms/microsoft_dh_pressrelease.doc and FAQs at: http:www.pasa.nhs.uk/itservices/shared/Microsoft_faq.doc (NOTE: NHSnet only)
Golden
Hellos
The guidance on the Government’s golden hellos
for GPs is now available on the web at the following address: http://www.doh.gov.uk/pricare/goldenhello An application form is available from this site in both Word and PDF formats. A qualifying GP is one who: Works under either GMS or PMS arrangements and either Takes up a first GMS or PMS post as an assistant or a salaried GP or as a principal (or the PMS equivalent) or Takes up an eligible post after leaving the GP retainer scheme, and in either case Commences or commenced the eligible post on or after 1 April 2001.
HA/PCO
Circulars
Practices are being inundated with documents from Primary Care Organisations. Some of these are helpful, relate to legislation and help us not to have to reinvent the wheel. Others are not legal requirements and relate to the Department of health policies for the health service. Not all are relevant to General Practice and can be safely filed appropriately. It is sometime difficult for GPs and managers to assess these circulars. In each case an assessment needs to be made as to the priority to give to these. It is impossible to implement them all. Two such documents are listed below. The LMC is available to give advice on such documents.
Fraud
Response Guidance
I have received documentation on this from the PCT. They expect every member of staff to read a 20+ page document, understand it and sign a document to that effect. This is clearly “pie in the sky”. I have spoken to the BMA about this. It is nonsense to expect all our staff to have the time to do this and to understand it. GPs have a responsibility to ensure against fraud in the practice and it may be appropriate for the senior partner and the practice manager to read this document. GPs do not have to comply with this request. I suggest that the document is filed at the bottom of the pending tray, along with a few others from the PCTs.
Written
Complaints collecting Ethnic Data
You may recently have received a request from your Health Authority/PCT to give them information on the ethnic classification of complainants to your practice. The General Practitioner Committee (GPC) of the BMA has commented as follows: “This is unethical, could cause offence to the complainant and doctors should refuse to have anything to do with it. The Terms of Service would be on the GPs side in that there is no obligation to collect this data. I can confirm that we were never consulted on this. Since it has been published we have raised our concerns with the NHSE and are awaiting a response. It will also be put on the Agenda for the next negotiating meeting with the Department”. You are advised, therefore, not to comply with such requests.
Capital
for GP Premises Improvements
The Government has announced funding of £55m for premises improvements. £30m is being allocated through the Deaneries to improve the premises of existing or new training practices in order to attract additional GP Registrars. £15m has been earmarked to help general practice – GMS practices and PMS providers to accommodate the expanding primary care workforce. This funding is being targeted on those Health Authorities which include PCOs with below average numbers of GPs per weighted population. The funds may be used by PCOs for GMS practices (through the GMS “Red Book” arrangements) or for PMS pilot providers (through contract variations). The funds are to be used to contribute towards the costs of premises improvements which will facilitate expansion of the primary care workforce. North Stoke PCT will be allocated £129,000 (43k in 2001/2 and £86k in 2002/3), Central Stoke £104,000 (£35k 2001/2 and £70k 2002/3), South Stoke £119,000 (£40k 2001/2 £79k 2002/3) and Newcastle £119,000 (£40k 2001/2 £79k 2002/3). The Moorlands PCT falls outside this scheme, presumably being relatively well doctored. The remaining £10m is being used to develop 6 LIFT projects. This is a public private partnership to build and refurbish primary care premises and then lease them on favourable terms to GPs.
Short-term
sickness certification
As a result of the recent review by the Cabinet Office’s Regulatory Impact Unit into reducing GP paperwork a campaign on managing sickness absenteeism is being launched by health professional representatives, government, employer organisations, employee representatives and patients groups. The objective is to remind and reinforce to employers that the management of short-term sickness absence is an employer’s issue and not a medical one. We aim to reduce the number of GP consultations taken up with patients attending for short-term sickness certification for periods of illness of 7 days or less. The aim is to encourage employers to review their sickness absence policies in light of the impact on costs for employers, employee’s health and pressure on NHS services. The communication of the campaign messages will be two-pronged. A supply of A5 leaflets will be available to GPs via the LMC which can be given to patients when they attend for sickness certification for 7 days or less. We will circulate these when they become available. The leaflets will state that GPs are not under an obligation to supply a certificate under statutory sick pay regulations and that using GP services to manage sickness absenteeism has cost implications for employers, GPs and employees. A feature of the leaflet will be a website with an explanation of statutory sick pay regulations, examples of good practice in sickness management, helpline numbers and websites for more information. The leaflet will be supported by an employer’s
communication highlighting the problems associated with GPs policing of
sickness absenteeism. This will be sent directly to employers via their
representative bodies including the Confederation of British Industry,
British Chamber of Commerce, Federation of Small Business and many others. DR PAUL GOLIK
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