NEWSLETTER FEBRUARY 2003
Medical Information and Insurance
Data Protection Agency Services
Commission for patient and public involvement in health
New childminders forms and fee
Editorial
I received some criticism from PCTs for my comments in the last newsletter concerning GMS underspends. Some colleagues will have received a letter from the Chief Executive and Clinical Chair of South Stoke PCT refuting the figures. The figures quoted in the newsletter were actually supplied by the PCT chief executive. However, I do apologise if I drew incorrect conclusions over the reasons for these underspends.
During the last few weeks, colleagues will have become aware of media interest in the fact that a colleague removed some patients from his list and the speculation that this action was related to asylum seekers. The officers of the LMC have again received criticism from Stoke South PCT about their handling of this situation. This has cumulated in the Chief Executive and Clinical Chair of the PEC jointly sending a letter to “The Sentinel” which contained a personal attack on myself.
Whenever I have been asked by the media to comment on the situation regarding the initial story in the Sentinel I have stressed that the issue is not to do with asylum seekers but the fact that a few of our colleagues find their workload excessive and have as a last resort decided to remove some patients in order to regulate their workload. It is a fact that in North Staffordshire we have the lowest number of GPs per head of population in the West Midlands and the number of GPs in post has not risen in recent years. It is also a fact that quite a number of practices have closed their lists to new patients in an effort to regulate their workload. As a result of this PCTs have to allocate an increasing number of patients.
I have also in conversation with the media mentioned among other things, the efforts by PCTs to increase the number of GPs by the use of PMS schemes and the benefits that we hope the new medical school at Keele will bring to the area.
I have tried to steer the argument away from the asylum seeker issue to one of resource in the health service both locally and in general. In doing so my aim has been to divert criticism away from hard working colleagues and perhaps put pressure on the DoH to increase resources for North Staffordshire.
I do not have control over which parts of an interview are used by the media and their criticisms would have been better directed at them rather than myself.
It is unfortunate that South Stoke PCT took this action. However, it is important that a line is drawn under this episode and that the LMC and PCTs work together for the benefit for both colleagues and patients.
New Contract
This should now be published in February. The plan is for it to be presented to the GPC on 20th February and to a special meeting of LMCs the following day. It should be circulated to all GPs the following week. A series of “Roadshows” will be held between 3rd and 21st March to present the contract to the profession. The ballot will take place between 20th March and 11th April.
At the meeting with LMC representatives on 10th January the GPC negotiators appeared confident that a fully priced contract will be presented in February. The delays were put down to delays in obtaining practice level data on costs and reimbursements. No doubt you will have read a lot of the detail in the medical press. The most important message at present is that practices will need to have at hand up-to-date data on all NHS income so as to enable them to compare estimated income under the proposed new contract. Colleagues will need to consider whether the “New Contract” offers the best deal for them in the longer term.
The GPC Roadshow in Staffordshire will be held at the County Showground, Stafford on Tuesday 4th March.
Removal of Patients
Colleagues will be aware of the publicity surrounding the decision of one of our colleagues to remove a number of patients following a block of allocations to his list. The real issue here is not that of asylum seekers or elderly patients but the fact that GPs are struggling to cope with a large workload. There is a conflict between our desire to limit workload to manageable levels and the right of a patient to have a GP. Despite efforts of practices and PCTs to bring more GPs to the area, the fact remains that we have the lowest number of GPs per head of population in the West Midlands. The number of GPs in post has not increased in the last year.
The number of allocations in the area has increased steadily throughout the year and in the last three months of last year averaged 320 per month approximately half of these were asylum seekers. The PCT staff undertaking this process have a thankless task. They are doing their best to be as fair as possible in the process and although we may feel aggrieved by an allocation we should not take out our feelings of frustration on these staff. There is a system in place where GPs can appeal against an allocation if they feel it unfair. These appeals should be made to the Chief Executive of the PCT within seven days of the allocation.
Last year the committee asked the Medical Defence Organisation for their opinion on the removal of patients and I reported their comment in the October newsletter. For information I will repeat this.
“The MDU advises that there are some serious pitfalls that can await the GP who removes patients from his list. In particular, the requirements of the GMC are very important and must be followed. Attention is drawn to “Good Medical Practice” and in particular paragraphs 5, 24 and 25.
The effect of paragraph 5 is that GPs must be extremely careful about which individuals they choose to remove from the list. The temptation to remove high workload patients must be avoided. This would be unethical and lead to potential problems with the GMC. To avoid any allegation of unprofessional behaviour, there must be no discrimination, e.g. the use of “last in – first out”, or selection of a block of patients based on address. Each one needs a letter from the GP explaining the exact reason why they are being removed. Removal may, of course, produce a local outcry, and the letter of explanation needs to be carefully worded.
The MPS cautions against such action. They stated that GPs who remove patients without good reason may find themselves subject to complaint and even criticism by the Ombudsman. They say that the Royal College of General Practitioners does provide guidance on when it is reasonable to remove a patient from the GP’s list. Resourcing issues and workload do not fulfil criteria of reasonable cause”
The MPS went on to suggest that the LMC should write to the PCTs setting out our difficulties. This we did and copy was sent to all GPs. The MPS felt that in the event of an adverse incident occurring as a consequence of workload, our correspondence with the PCT would be of assistance in mitigation.
I attach to this newsletter the advice issued by the GPC on patient removals. This information can also be found on the website.
PCT/LMC liaison
The committee is keen to have good working relationships with PCTs. However, it is proving difficult to engage with them effectively. Attendance by representatives at LMC meetings is relatively poor and monthly PCT/LMC liaison meetings are also experiencing poor attendance from some PCTs. We are looking at ways to improve this. A good relationship is beneficial to all, but it must be recognised that the remit of the LMC is to look after the interests of General Practitioners and that this will at times conflict with the actions and interests of other NHS bodies.
Cataract Referrals
The direct referral scheme by optometrists has now been running for over 12 months and some problems have been identified. Most hinge around whether or not the GP needs to be involved in any way in the referral process. This has been discussed by the Ophthalmology Working Group and it has been agreed that the hospital is happy to receive a direct referral from accredited optometrists without any further information from the GP. Referrals which we receive from a non-accredited optometrist can be reassessed by an accredited practitioner who will establish the need or otherwise to process the referral. This amended system should be implemented shortly.
Homely Remedies
The Care Standards Act 2000 provided for the setting up of the National Care Standards Commission which became fully operational on 1st April 2002. The NCSC regulates care services and requires care homes to follow the guidance produced by the Royal Pharmaceutical Society on the administration and control of medicines in care homes. The guidance contains a section on homely remedies. This recognises the need to treat minor ailments such as indigestion, cough, diarrhoea etc. The remedies are over the counter medications which can be prescribed for the patient in the usual way but could also be bought by the home for administration to residents when required under the terms of a written policy.
The care home is required to produce a policy on the use of “homely remedies” and their limitations, that is agreed by the home, the GP and the pharmacist. The GP is asked to sign off the policy document and does not need to sign each time the home purchases the remedies.
There is a view that this is unnecessary involvement of the GP and I have written to the GPC concerning this.
Medical Information and Insurance
The BMA together with the Association of British Insurers have produced joint guidelines on information that should be released to companies that are processing health information. The guidelines deal with many of the most sensitive issues affecting the doctor-patient relationship and the underwriting of insurance. A copy of these guidelines can be found here and on both the BMA and ABI websites.
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GPC Items
Data Protection Agency Services
A company trading as Data Protection Agency Services is sending business requests for £95 registration fees with the Information Commissioner. This is a hoax and practices must ignore such requests. Thousands of small businesses have already been caught out. The only statutory fee payable for registration under the DPA is £35 annually. There is no connection between this outfit, or those with similar sounding names, and the Information Commissioner. The Office of Fair Trading has taken out an injunction against the company.
GPs' discussion forum
On Friday 10 January a GPs' discussion forum on the BMA website was launched to provide all GPs with the opportunity to participate in open debates about the contract and the delayed negotiating timetable, and to convey their views to the negotiating team.
All GPs will be able to access the forum. Although the forum will not be open to the public or the press, "guest users" including lay LMC secretaries, PCTs, practice managers and MPs will be able to access it. The situation about access will be made absolutely clear in the opening information on the forum.
Some lively and constructive debates in the forum are anticipated and it is hoped GPs will find it of value.
Commission for patient and public involvement in health
The GPC welcomed the English Health Department's announcement that it has established a new Commission for Patient and Public Involvement in Health. The purpose of the Commission will be to promote the involvement of the public in decisions affecting local NHS services. Further information can be obtained from the following sites:
www.doh.gov.uk/involvingpatients
www.doh.gov.uk/patientadviceandliaisonservices
New childminders' forms and fee
The BMA and OFSTED have recently agreed on a revised health declaration booklet for childminding applicants. The revised booklet makes it clear at the beginning that the applicant should pay any fee that his or her doctor requires for this service. The BMA's suggested fee for GPs completing this form is £60.00 (based on an average of 35 minutes to complete the form).
Paul Golik
Secretary