NEWSLETTER JULY 2004
Generic and Brand Name Prescribing
Lower cost Microsoft office programmes for NHS Staff
Reforms of the NHS Complaints Procedure
Partnership Agreement Guidance
Control of Asbestos Regulations
Reforming the Coroner and Death Certification Service
PMS Contracts
Lockharts Solicitors, (a firm who acted for the General Practitioners Committee during the implementation phase of the new GMS Contract and who have been familiar with PMS Arrangements since the introduction of the NHS (Primary Care) Act 1997.) have produced a model agreement for PMS practices. A copy of this agreement is available at the LMC office for inspection. We have obtained this from Lockharts by a licence agreement which allows us to have one copy for inspection by any LMC member or by practitioners who are interested.
It is also possible to supply interested practitioners with an electronic copy of the Model, but when this happens Lockharts must be supplied with a list of all the practices to whom the copy is sent and a covering letter must be sent to each practice stating that the copy is purely for inspection purposes and if it is used in any way or if any further copies are made or copies are sent to any other person the per copy licence fee of £225 plus VAT becomes payable immediately for each use and/or copy.
New Contract
The new contract is bedding in slowly and new problems are coming to light. LMC members meet regularly with the PCTs and continue to discuss enhanced services and other problems. I would be grateful it colleagues can let us know of any problems they have encountered with the new contract.
Generic and Brand Name Prescribing
The Prescribing Pricing Authority (PPA) treats prescriptions that include both the generic name and the brand name as prescriptions for the branded product. Up until now, if the branded product is a blacklisted item the PPA has made an exception and allowed the prescription and made payment based on the generic price.
The PPA has now decided to update their pricing procedures and no longer make an exception in this situation so that a prescription written using both the generic name and a blacklisted brand name will be interpreted as an order for a blacklisted produce and they will disallow the prescription.
Some GP computer systems may be set to order prescriptions using both names e.g. Co-proxamol (Distalgesic). From 1st December these prescriptions will be disallowed. The LPC have asked me to request that colleagues make any adjustments necessary to prevent disallowed prescriptions being returned.
Dental Problems
The following procedure has been agreed with the Local Dental Committee regarding patients who present with acute dental emergencies.
If a patient is currently registered (whether privately or NHS) with a dental practice, the practice should be contacted in the first instance with regard to:
- Daytime emergency arrangements
- Out of hours emergency arrangements
If a patient is not registered with a dental practice at the time of their presentation, they should be directed to contact the dental advice line which gives details of daytime and out of hours cover for non registered patients.
The dental advice line telephone number is 01782 425846
Lower cost Microsoft office programmes for NHS staff
NHS Staff are being offered licensed copies of select Microsoft Office programmes, for use at home, for as little as £17 compared to the usual cost of about £400. This includes Word, Access, Excel, Outlook, Powerpoint and FrontPage. Further information is available at: http://www.nhsia.nhs.uk/def/pages/inform/informish18/p6.asp#microsoft
GPC Representation
Dr Steven Edmunds is now the GPC representative for Staffordshire and Shropshire. His contact details are as follows: Dr S Edmunds, Pontesbury Medical Practice, Hinton Lane, Pontesbury, Shrewsbury SY5 0PS. Tel: 01743 790325 Fax: 01743 792851. Email: Steve.Edmunds@gp-M82030.nhs.uk
Female Genital Mutilation
Female genital mutilation (previously known as female circumcision) is a collective term for procedures which include the partial or total removal of the external female genital organs for cultural or other non-therapeutic reasons. It causes long term mental and physical suffering, difficulty in giving birth, infertility and may even cause death. Up until recently female genital mutilation has not really been a problem in this country but with the increased influx of refugees and asylum seekers, the problem has come to the notice of various workers. This practice is carried out mainly in people from the Horn of Africa such as Somalia, Sudan, Eritrea and Kenya.
Under the Female Genital Mutilation Act 2003, it is an offence for female genital mutilation to be undertaken in the United Kingdom and it is also an offence for UK nationals or residents to carry out FGM abroad or to aid, abet or counsel the carrying out of FGM abroad, even in countries where the practice is legal or accepted. There is a maximum penalty regarding these offences from 15 - 40 years imprisonment. Many General Practitioners, particularly in Stoke on Trent, are now coming across people from the Horn of Africa and I have been asked to raise awareness of this particular problem so that you may advise patients accordingly.
Resignation of Members
Drs Julie McGowan and Ken Parkinson have resigned from the Committee. Its is the committees responsibility to appoint replacements to these two casual vacancies. If anyone would like to serve on the committee for the remaining 20 months their term of office please let me know. We are particularly interested in appointing members from the Moorlands or North Stoke PCTs to try to ensure a balance of membership across the PCTs.
Dr S Fee OBE
Dr Sam Fee passed away on 24th July at the age of 96. Dr Fee was a long serving member of the Staffordshire Local Medical Committee and its sub-committees. A Memorial Service is to be held at the Clayton United Reform Church on 14th August at 11.00am.
Items from the GPC
Reforms of the NHS Complaints Procedure
The Department of Health has announced that there is to be a delay in implementing the reformed complaints procedure. This is because the fifth part of the Shipman inquiry will not report until late summer and is expected to deal in some detail with the NHS complaints procedure. Therefore a phased implementation of the new framework will take place. The first stage of the complaints procedure (local resolution) is expected to remain broadly the same, with complaints being resolved at local level wherever possible. The DoH remains committed to reform of the local resolution stage in 2005 but content and precise timing will be dependent upon the recommendations made by the Shipman, Neale and Ayling inquires.
If local resolution is unsuccessful, the the complainant will still have the right to request an independent review. However, from 1st July, independent review requests will be made to and administered by the Commission for Healthcare Audit and Inspection (CHAI).
NHS Improvement Plan
The GPC has considered the NHS Improvement Plan, published by the Department of Health in England on 24 June; its proposals pertain to the NHS in England only. A summary of the key proposals has been prepared by the secretariat and can be found in here. The full document can be downloaded from the Department’s website: www.dh.gov.uk/assetRoot/04/08/45/22/04084522.pdf
Being a White Paper, the NHS Improvement Plan is a statement of the government’s intentions should it be re-elected in the general election expected next year. However, some of the proposals are to be implemented prior to the election. Following a resolution at the ARM, the BMA will be holding a conference in November to discuss the implications of the document.
Practice level commissioning is to be introduced from April 2005 in GMS and PMS, but no further details are available at present. GPC members are concerned that another major change is being introduced in general practice so soon after the new GMS contract, and consequent changes to PMS, have been introduced. In addition, in PCTs where foundation trusts and the new Payment by Results finance system are operating, there is evidence that acute trusts are exerting considerable pressure on PCTs. There is concern about the implications for practice level commissioning.
Whilst the GPC acknowledges that the proposals in the White Paper are likely to be implemented, it is feared that the document heralds the fragmentation and contracting out of primary care services, with a move to the concept of “managed care” with implications for chronic disease management and clinical care pathways. The number of APMS contracts is set to increase and there is little guidance available at present on how to respond locally.
Many of the proposals appear to be heavily dependent on the development of complex IT systems, which will take far longer to implement than the Department might have anticipated. In addition, there appears to have been no consideration of the serious implications for the confidentiality and security of patient records and information.
Regulation of private GPs
The Healthcare Commission has taken over responsibility for registering private GPs from the National Care Standards Commission. Those who work solely as a private GP must be registered with the Healthcare Commission. GPs who undertake NHS work but do some private work from the same practice do not need to be registered with the Commission. However, if an NHS GP does private work at a different location from their NHS practice, they do need to be registered. To register, GPs should contact their local Healthcare Commission office. Any GP who is unsure about whether they need to be registered should contact the Healthcare Commission on 020 7448 9200.
It has been a requirement for private GPs to be registered since 1 April 2002.
NHS care record
By 2010 it is intended that every patient in England will be offered an electronic NHS care record. This will allow clinicians and healthcare professionals across the NHS to view elements of the patient record. Level of access will vary, so a receptionist would have a different view of the record to a GP or consultant. Patients will automatically be provided with an NHS care record and will need to opt out if they do not wish to have their data used in this way. Some reservations have been expressed about an opt out rather than an opt in model.
The GPC has had some concerns about the level of clinician and stakeholder engagement and lack of consultation on the development of the NHS care record. This has started to be addressed and the GPC now has representation on some of the working groups. The GPC wishes to continue to engage with the programme. There was a themed debate on this issue at the LMC conference.
Partnership Agreement Guidance
The BMA and the GPC have published guidance for GMS and PMS practices on partnership agreements. This is now available on the BMA website at www.bma.org.uk/ap.nsf/Content/PartnershipAgreements0504
The guidance has been prepared in consultation with the BMA's regional offices, the BMA legal advisors and the GPC's legal advisors. It is intended to help general practitioners to identify matters to be covered under a partnership agreement including income and expenses, accounting, partners' obligations to each other, and the effects of retirement.
The guidance highlights particular issues of importance, which include that:
- the GPC and the BMA strongly advise that all practices should enter into written partnership agreements.
- the guidance applies to practices in all four UK countries, and indicates where there are variations.
- the guidance is not a 'model' partnership agreement or 'model' clauses. Our lawyers advised us that to produce model clauses would be inappropriate and could be misleading, particularly given the varied nature of GP partnerships and the differing needs of each partnership. However, it does include a checklist of issues that should be covered in a partnership agreement, together with guidance notes on each of those issues.
- partnerships with an existing agreement may not need to draw up completely new agreements, but will need to consider their existing agreements and amend these where necessary. Practices should seek specialist legal, accountancy and tax advice in relation to new agreements or amendments to existing agreements.
- BMA members may also obtain partnership advice from their local BMA office.
Control of Asbestos Regulations
The Control of Asbestos at Work Regulations create certain duties with relation to practice premises of which both owner-occupiers and leaseholders should be aware. The duties are twofold. First, there is a general duty on “dutyholders”, as defined below, to ensure that a suitable and sufficient assessment is carried out as to whether asbestos is or is liable to be present in the premises. A “dutyholder” in this context is:
“every person who has, by virtue of a contract or tenancy, and obligation of any extent in relation to the maintenance or repair of non-domestic premises or any means of access thereto or egress there from or
in relation to any part of non-domestic premises where there is no such contract or tenancy, every person who has, to any extent, control of that part of those non-domestic premises or any means of access thereto or egress there from”.
If the assessment shows asbestos to be present, the regulations prescribe further measures, including a risk assessment and the drafting of a written plan identifying those parts of the premises that are affected.
The second broad duty falls on employers in respect of their employees. The regulations prohibit employers from carrying out any work on their premises that may expose its employees to asbestos unless it has made a full assessment of the risk of exposure to the health of employees, recorded the findings of that assessment and implemented a detailed range of further precautionary measures listed in the regulations.
This is a brief summary only and cannot be taken as a full exposition of the duties which the regulations impose. The full text can be found on the HMSO website (www.hmso.gov.uk). The full reference is Control of Asbestos at Work Regulations 2002, Statutory Instrument 2002 No 2675.
The GPC has contacted NHS Estates to ask whether any central funding will be made available to cover these costs.
Clinical Action Cards
The Health Protection Agency has distributed clinical action cards to all GPs in England. The cards provide information to GPs about possible illnesses they may come across which have been caused by chemical, biological, radiological and nuclear weapons. The cards should help GPs recognise the symptoms of these illnesses, as well as providing information about emerging diseases like West Nile Fever.
The cards were produced following consultation with GPs around the country, many of whom felt that they would like more information about these illnesses and diseases. The information reminds GPs that early identification of symptoms is important and that the local Health Protection Team can provide advice and support.
The BMA supports this initiative. They have said that they would like the cards to be sent to GPs throughout the UK, rather than limiting their circulation to England only, and that they should also be distributed to accident and emergency staff in hospitals.
Further information is available from the Health Protection Agency website at www.hpa.org.uk
GPC Chairman, Dr Chisholm said " We fully support the issue of information to GPs about unusual illnesses which they may detect in patients and which may have been caused by deliberate terrorist acts. We would like the cards to be sent to GPs throughout the UK and to accident and emergency staff in hospitals . Doctors and their colleagues are at the front line of detection and treatment and timely information will help them save many lives should the unthinkable happen. The BMA will do all it can to spread the information and hopes this is just the start of an extensive education and training programme for doctors to help them deal with a very real 21st century threat "
Reforming the Coroner and Death Certification Service
The Home Office has issued a position paper setting out proposed reforms of the coroner and death certification service. This document is not a consultation; it outlines reforms that will be implemented within the next few years. However, interested parties have been asked for their views and the BMA will be sending a response.
The key points are:
· verification of death will become a statutory requirement. The document raises the possibility of other groups of professionals being permitted to do this;
· after initial certification of the cause of death by the doctor who attended the deceased in the recent past (the "first certifier"), the forms and details will be passed for confirmation to a "second certifier" (a medical examiner employed by the reformed coroner service who would head a small team). The medical examiner's team would be able to seek further relevant information about the deceased, including from the deceased's family;
· improved IT will be provided;
· it is proposed that the reformed system will be financed from the existing financial envelope.
The GPC is particularly concerned at the likelihood that the new system will lead to more post-mortems and greater delays in releasing the body. The social duty to ensure that the cause of death is accurately recorded will have to be balanced against the sensitivities of religious and ethnic groups that need to dispose of their deceased swiftly.
It also believes that certifying doctors must be able to retain the ability to cite "old age" as a cause of death, as often it is not possible to offer any more detailed clinical explanation.
The GPC is very sceptical that such a radically reformed system and improved IT can be adequately financed with existing levels of resources.
On a more positive note, it welcomes the potential benefit to accident prevention, patient safety and public health that a more rigorous system of ascertaining and recording causes of death affords.
Dr P Golik
Secretary