NEWSLETTER JULY 2003
Undergraduate Medical Education
New Contract
A majority of the profession has voted to accept the new GMS contract and as a result the way in which General Practice is funded will change radically from April next year. This will be a great challenge for both General Practices and the Primary Care Trusts. Detailed information about the implementation of the contract is still awaited; in the meanwhile there will inevitably be some confusion in some areas. One particular area is the funding of IT. With the implementation of the contract there should be 100% funding of IT, with the PCT s owning the equipment. Until details of this funding are clarified PCTs are reluctant to approve IT expenditure. Practices are advised to wait for PCT approval before purchasing, if they wish to be sure of reimbursement.
The PCTs and the LMC will be providing more information and some training events after the summer holidays and when more information is available. Perhaps the most important tasks for practices at present is to form an opinion as to which services they wish to provide and to ensure that information required for quality payments is recorded in appropriately coded way on the practice computer. Advice on the appropriate Read Codes is expected to be made available both by the PCTs and the computer suppliers in the near future.
The GPC are producing an action plan for the implementation process and this will be placed on the BMA website once it has been agreed with the NHS Confederation and the Departments of Health. The GPC also plans to produce guidance on key aspects of the new contract as soon as possible. In the meantime the GPC will provide help and advice to LMCs and individual GPs through the normal arrangements.
Child Protection
Doctor Gordon Carpenter, Moorlands Medical Centre, Leek has contributed the following article.
Lord Laming's findings of the Victoria Climbie enquiry have now been published and as a result, Lord Laming has made 108 recommendations. I get the impression that these recommendations are not just "good ideas" but are going to have to be acted upon. The majority of the recommendations relate to changes at national level, changes in Social Services activities, and health care recommendations probably mainly in the secondary care sector. There are however some recommendations which will impinge on our lives and some which are specifically targeted at General Practitioners and I summarise these below. For economics of space I have not named the recommendation number nor quoted them verbatim, I have just summarised the salient points: -
- Whenever a professional refers a case to Social Services concerning the well being of a child, that confirmation must be confirmed in writing within 48 hours.
- Whenever concerns about the deliberate harm of a child have been raised, Doctors must ensure comprehensive and contemporaneous notes are made of these concerns.
- In such situations records must be kept in the case notes of all discussions about the child including telephone conversations and if the child's case notes are not available, the record of discussions must be entered at the earliest opportunity.
- No child about whom there are concerns about deliberate harm should be discharged from Hospital without an identified GP.
- All Doctors involved in the care of a child about whom there are concerns about possible deliberate harm must provide Social Services with a written statement of the nature and extent of their concerns. Any misunderstandings of medical diagnosis must be corrected at the earliest opportunity in writing and it is the responsibility of the Doctor to ensure that the concerns are properly understood.
- The RCGP should explore the feasibility of extending the process of new child patient registration to include gathering information on wider social and developmental issues, for example living conditions and school attendance.
- The DOH should ensure that all GP's receive training in the recognition of deliberate harm to children and in the multi-disciplinary aspects of child protection as part of their initial vocational training and at regular intervals of no less than three years thereafter.
- The DOH should look at the feasibility of introducing training in recognition of deliberate harm to children as part of the professional education of all general practice staff and for all those working in primary health care who have contact with children as a regular feature of their work.
- All GP's must devise and maintain procedures to ensure that they and all members of their practice staff are aware of whom to contact in the local health agencies, Social Services and Police in the event of child protection concerns.
The phrases in italics are where I thought there may well be maximum effect on our working lives.
I think the major affect on us is the recommendation advocating a three yearly re-training programme in child protection procedures, and how that can be made compulsory for General Practitioners, I am sure that is something the PCT's will have to ponder upon.
Dr Gordon R. Carpenter
Freedom of Information Act
This act affects all General Practices. From 31 October 2003, every health sector public authority must make some information available as a matter of course through a publication scheme, with information included in the publication scheme being routinely made available to anyone who asks for it. A publication scheme is therefore both a commitment to make certain information available and a guide to how and where that information is available. All publication schemes have to be approved by the Information Commissioner. However for some groups (including general practice), if the model publication scheme is used, separate approval is not required. We will be legally required to adopt and maintain a publication scheme which has been approved by the Information Commissioner by 31st October 2003. The aim of this act is to promote greater openness and accountability across the public sector. Information about how to produce a scheme and model documentation can be found on the Commissioner's website at www.informationcommissioner.gov.uk. There is also information on the Freedom of Information website at www.foi.nhs.uk/redtape. The GPC is planning to produce guidance about this in the near future and Wessex LMC have produced some information on this which can be found on their website at www.lmclive.co.uk.
Miscarriage and Histology
In order to comply with the NHS Management Executive Guidelines on the "Disposal of Foetal Tissue" (HSG(91) 19), the Acute Trust has introduced documentation whereby the mother must sign a form to indicate whether she agrees to a histological examination of foetal/placental tissue, the disposal of the unprocessed tissue samples, the use of these materials for future medical research etc. In addition to this, the Trust is unable to arrange for disposal by cremation or burial at the local cemeteries and crematoria unless the mother has signed the appropriate forms. The Pathology department will not process any specimen containing products of conception without the mother's consent. We are informed that a significant number of GP colleagues send such material to the Pathology Department. In order to help the above process the patient should be referred to the Early Pregnancy Assessment Unit. The nursing staff on the unit will be able to guide the patient through the completion of the forms prior to the histological examination and disposal. The EPAU is open between 8.30 am and 4.30 pm Monday to Friday and can be contacted on 01782 552677.
Undergraduate Medical Education
Concerns have been raised at the committee about the apparent disparity between the funding available in the Secondary Care Sector compared to Primary Care. The two funding streams are organised differently and it is therefore difficult to make direct comparisons. In Primary Care, GPs receive a payment for the actual teaching done and there are also centrally funded sessions for co-ordinators and directors. Payments to Practices have been calculated on the basis of time-lost from clinical sessions and the equivalent locum cost. Also included are planning and feedback time, administrative and support time, tutor training time, teaching time by practice nurses and finally other miscellaneous costs. Recently an increase in year 5 student placement fees as been negotiated from £1600 to £2150, as well as a 3% increase in the payments for students on their core module attachments.
In the Secondary Care Sector, Consultants do not receive direct payment for teaching, they are recompensed in a different way. For example, for each of the four core modules there is a module leader. These jobs are four-session appointments. Typically one session will be for a group tutorial, two sessions for additional teaching and one for administration. The department then receives a ten session consultant backfill post, which equates to £88,000. Four sessions cover the loss of the module leaders time, of the remaining sessions, three sessions would be used to compensate a group of firms who are providing teaching on two full days per week, a further two sessions may be used for problem based learning tutor time and the remaining session would be for OSCE examining, interviews etc.
At the end of the day, it is for individuals to decide whether the recompense is worth the time and effort needed.
Personal Injury Claims
The LMC has been informed that a firm of personal injury specialist operating from a local office has circulated some GPs offering a commission payment for any information that results in a claim coming from a practice which is successful. Also a scheme offering inducements to private referrals has been reported in other parts of the country. Participation in such schemes is not encouraged and any doctor tempted to do so should bear in mind the advice given on finance and commercial dealings details in "Good Medical Practice for General Practitioners" and the GMC guide "Good Medical Practice" In particular it is unprofessional conduct to accept a fee for a referral without informing the patient and doctors must act in the patients best interests when making any referral. This type of scheme can easily compromise these principals.
Dr P Golik
Secretary