NEWSLETTER JULY 2007
Medical Examinations for prospective foster carers
Fees for prescribing pharmaceutical products – interim statement
Mental Capacity Act 2005 - Guidance for health Professionals
Medical Certification of the Cause of Death
Elections at GPC for a new chairman and negotiator
Department of Health survey on practice based commissioning
A rational way forward for the NHS in England: BMA discussion document
NHS Choices website practice entries and possible errors
National Survey of GP Opinion 2007
Access and Choice DES Directions
Medical Examinations for prospective foster carers
In December 2006, a report was submitted to the Stoke-on-Trent Looked after Children (LAC) strategy group following concerns around delays and or refusal of some GPs to carry out medicals for prospective foster carers. The report highlighted the need to expedite the process of both prospective carers having a medical in a timely manner to allow a complete report to be submitted to Fostering and Adoption panel to recommend their approval as foster carers, alongside the need for both the PCT and the City Council to improve the process for GPs being paid for the service. Historically, there have been occasions whereby GP payments for the service have been significantly delayed. This has been given as a major reason by GPs for not providing the service. As a result a more streamlined method of payment has been proposed which should result in payment being made within 8 weeks of the claim being presented. i.e. claims made before 26th of the month will be paid at the end of the following month.
There is no longer a recommended fee for these examinations, they fall under collaborative arrangements and these fees are no longer set by the DDRB. Doctors will therefore have to set their own fees for these examinations. The BMA and LMCs are prevented by law from suggesting fee levels.
Doctors will need to strike a balance in setting their own fee making sure their remuneration levels and overheads are charged on a time basis. Fee levels must be reasonable, transparent and be subject to scrutiny where necessary. The BMA strongly advises that fees should be set out in writing and agreed in advance of the work being undertaken. Due to the PCTs Standing Financial Instructions, they cannot make payments in advance of the work being undertaken.Health Visitors
Stoke-on-Trent PCT has undertaken a review of the services provided by its health visitors and concluded that in future they will no longer undertake routine childhood immunisations. This has implications for GP practices where health visitors currently perform this service. The PCT feel that they are "double" paying for this service and that they could make better use of the time involved in other areas. The funding for childhood immunisations in general practice is a little complicated. There is a directed enhanced service where payments are based on the previous target payments, this rewards the average practice with a list size of 5000 about £8000 for meeting the higher target and £2500 for the higher target of pre-school boosters. Childhood vaccination and immunisation schemes are also additional services, and the infrastructure costs of delivering these have been built into the global sum. Practices who have been providing the service in house will also have had their global sum and MPIG values uplifted to take account of the extra staffing they were using to provide the service.
The LMC have advised the PCT of the disadvantages of withdrawing this scheme including the disruption of the "primary care team", the invaluable liaison this provides with health visitors, the potential adverse effect it will have on uptake rates and the possible consequences of GP deciding not to take on this work. If the withdrawal of this service goes ahead, the practices affected will have to consider whether they wish to provide the service in house. If they do not, they will need to give notice to the PCT, with reasons, that they wish to withdraw from providing the vaccination and immunisation additional service and will forfeit a proportion of the global sum (2%). They will also find themselves ineligible for payment under the directed enhanced service.
Fees for prescribing pharmaceutical products – interim statement
The GPC recently issued guidance on fees for prescribing pharmaceutical products (see here).
Since it was distributed we have had a number of queries regarding the use of agencies for particular products that both dispensing doctors and pharmacies call upon. These agencies have expert knowledge on a range of products such as stoma bags, and GPs or pharmacists provide them directly with a prescription for which they get some of the fee that the agency gets when seeking reimbursement for it through the PPA. This fee goes to the GP or pharmacist for providing time and advising the patient on how exactly to use the products and ensuring it meets their needs.
The GPC strongly supports the principle that doctors must be properly rewarded for their professional time and professional activity. Where a GP or practice carries out work in connection with the provision of drugs or appliances and that work is shared with another person or organisation we accept that it is appropriate for the fees to be shared to reflect the division of work.
The GPC is working on and hopes to produce in the next year extended guidance on issues around conflicts of interest.
Mental Capacity Act 2005 - Guidance for health Professionals
This new act comes into force on October 1st. The Act applies to all decisions taken on behalf of people who permanently or temporarily lack capacity, including decisions relating to medical treatment. All doctors working with adults who lack, or who may lack, capacity will need to be familiar with both its underlying principles and its basic provisions. There is a good article on this can be found on the BMA website at http://www.bma.org.uk/ap.nsf/Content/mencapact05?OpenDocument&Highlight=2,mental,capacity .
CPD payment to GP trainers
Following pressure from
the GPC, the Department of Health has confirmed the SHA is responsible
for funding the £750 CPD payment for GP trainers for 2006/07. The
Department has promised to write to SHAs to remind them of this
commitment and it is hoped that by the end of July (at the very latest)
all SHAs will have paid the money to GP trainers.
Please note that the
CPD payment is not available for 2007/08.
Medical Certification of the Cause of Death
Following our recent meeting on "Death and Dying", the coroner has forwarded a document from the Office of National Statistics' Death Certification Advisory Group which give guidance for the completion of death certificates. It would be useful for us all the read this document as a reminder of the requirements and current legislation. A copy can be found here.
FAQs in CKD
The GPC has produced a document entitled "Frequently asked Questions in CKD", which gives guidance on the identification and treatment of patients with Chronic Kidney Disease. A copy can be found here.
ITEMS FROM GPC NEWS
Elections at GPC for a new chairman and negotiator
The GPC voted for a new chairman at the start of the meeting. Six candidates were standing for election and Dr Laurence Buckman was elected chairman of the GPC from 2007-2010.
Laurence Buckman's election to the post of chairman of the GPC left a position open for a new negotiator. Five members of the committee stood for the position and Dr Chaand Nagpaul was elected.
Laurence Buckman named his deputy chairman as Dr Richard Vautrey.
The current negotiating team is now:
Laurence Buckman (Chairman)
Richard Vautrey (Deputy Chairman)
Stewart Drage
Peter Holden
Chaand Nagpaul
Dean Marshall (Chair of GPC Scotland)
Brian Dunn (Chair of Northern Ireland GPC)
David Bailey (Acting Chair of GPC Wales)
Dr Andrew Dearden has stood down as Chairman of GPC Wales.
As is permitted under GPC standing orders, the seat that the chairman occupied on the committee is released for another member from that constituency. As Laurence Buckman is on the GPC through LMC Conference his move to chairman means that Dr Gill Beck is now elected to the GPC through LMC Conference.
Department of Health survey on practice based commissioning
As set out in the GPC’s guidance on practice based commissioning (PBC) for 2007-08, this year, the Department of Health (DH) is taking a new approach to monitoring the development of PBC.
The DH has commissioned Ipsos MORI to design a national survey that will be sent out to a sample of approximately 2,000 practices each quarter. In order that no PCT receives useless data, the sampling will vary between PCTs to ensure that a minimum number of practices are surveyed in each PCT. This will mean that practices in smaller PCTs may be surveyed more frequently, while those in larger PCTs may not be surveyed at all; however it is anticipated that most practices will be surveyed in the year.
The survey for the first quarter was sent to practices in June with a deadline of 13 July.
The intention is for all the data collected from practices to be inputted into a spreadsheet to allow individual PCTs and SHAs to look at their feedback from practices. The spreadsheet will include a benchmarking facility to help PCTs put the feedback in context. All information is to be anonymised and no practice will be identifiable from the data. In addition, the DH will publish a report on its website summarising the key findings from the survey results, aggregated at a national level.
We would encourage GPs to complete this survey if/when they receive it as this is a good opportunity for individual practices to have their say on the local implementation of PBC and to give a vote of confidence or no confidence in their PCT.
A rational way forward for the NHS in England: BMA discussion document
Following detailed discussion on the BMA Council Working Group ‘green paper’ or discussion document ‘A rational way forward for the NHS in England’ at the May meeting, members considered a draft GPC critique of the document. Some minor amendments were suggested – including adding as an appendix the resolutions on the paper passed at the Annual Conference of LMCs – and a final version of the critique will be submitted by the deadline of 7 September 2007.
The committee was informed that the Council Working Group would be reconstituted in the new session in order to produce a more defined ‘white paper’ later in the year.
The discussion document ‘A rational way forward for the NHS in England’ can be accessed online at the following address: www.bma.org.uk/ap.nsf/Content/rationalwayforward.
Modernising Medical Careers
We are currently working with the BMA's Junior Doctors Committee and directly with COGPED to ensure a smooth process for potential GP trainees. To date we have been assured that there is flexibility with regard to inter-deanery transfers when one GP trainee has been accepted for training in one area and their partner in another. We have also been informed that feedback has been made available to those who were not successful in their application for a GP training placement in round one (for the August 2007 intake), and that an appeals process is available. However, we do have concerns that the timeframe for appeals is too long to provide those applicants with a placement in 2007. We would be interested to hear of any cases which cannot be resolved locally.
The GPC's report on the selection process can be found at www.bma.org.uk/ap.nsf/Content/agptrainposts0607.
Mental Health Act 2007
The Mental Health Act 2007, revised to introduce new mental health legislation based on amendment of the 1983 Mental Health Act, received Royal Assent on 19 July 2007. The BMA’s Parliamentary Unit and the Ethics Department have been working to ensure that the Act promotes the highest clinical and ethical standards of practice. Despite positive changes secured by BMA campaigning, concerns remain over these new mental health laws.
The legislation, which comes into force in November 2008, introduces the wider use of SCTOs (supervised community treatment orders), under which patients can be required to take medication in their own homes. It could also raise the number of people categorised as mentally ill. As a result, it could mean that GPs find themselves increasingly responsible for a greater number of mental health patients.
A government consultation on a code of practice covering implementation of the new legislation is due out in September and the BMA will be fully engaged with the consultation to ensure that this legislation is as ethical as it possibly can be.
The BMA and other organisations campaigned against aspects of the Act such as the possibility those with untreatable personality disorders could be detained, even if nothing medical could be done for them. Although last-minute amendments alleviated a number of doctors’ fears, there is still concern that in some cases no psychiatrist would be involved in the care of a patient detained under the Act and that, in theory, a hospital detention order could be renewed without the recommendation of a medically qualified practitioner.
The amendments ensure that:
· Patients can be held against their will only if treatment is available to alleviate or prevent a deterioration in their condition, or one or more of its symptoms and manifestations
· Patients detained under the Act will have statutory rights of advocacy
· Treatment for children and young people with mental disorders must be given in an environment suitable for their age and geared to meet their needs
· Conditions imposed on patients under SCTOs must relate to their health and nothing else
· Renewal of a hospital detention order must be approved by the patient’s responsible clinician as well as another professional involved in the patient’s care.
The GPC, together with the Royal College of GPs, is in the process of developing an information pack on how the new law will work and its potential impact on GPs. The GPC is also working with other departments within the BMA to ensure that implementation of the new mental health legislation is as workable and ethical as possible.
NHS Choices website practice entries and possible errors
The NHS Choices website has now gone live. This is a NHS website detailing information online about all NHS services, including individual practices. Currently this only contains basic information (contact details, opening hours, location etc.) but the GPC has received feedback that, in some areas, the information available on the website contains multiple errors relating to these various practice details.
The GPC were advised by Dr Foster, who have designed and set up the site for the Department of Health, that practices affected should go on the NHS Choices website and log the inaccuracy for the NHS Choices web team to amend.
Dr Foster representatives came to the BMA to give a demonstration of the NHS Choices website, and the negotiators also had chance to discuss some of their intentions for the future. It is likely that NHS Choices will, at some point, include the ability for individual practices to post further information about their own practices (as is already in place for some NHS Trusts) and for patients to submit information detailing their experiences. These ideas are, at present, in a very early stage as far as general practice is concerned. The GPC will continue to work with Dr Foster as far as it can to try to ensure that such developments are implemented in a way that is valuable to both patients and practices.
National Survey of GP Opinion 2007
The deadline for completing the survey has now passed and the results are being analysed. The BMA has also carried out a patient survey based on the discussion paper ‘a rational way forward for the NHS in England’ and the results will be available in the near future.
HPV vaccine implementation
The Department of Health has announced that it has agreed, in principle, to accept JCVI advice that HPV vaccines should be introduced routinely for girls aged around 12-13 years. This national immunisation programme could start as early as autumn 2008. The Department of Health stated that this would be subject to independent peer review of the cost-benefit analysis and that funding for this will be considered in the context of the Comprehensive Spending Review. Details of the programme will be finalised over the next few months, following further advice from JCVI and discussions with the NHS on the implementation of the programme.
At the moment the GPC has not had any discussions on this with the Department of Health or NHS Employers. We are led to believe that they have not yet decided what, if any, role general practice will have in the delivery of this vaccine. Naturally, we have made it absolutely clear that if they do decide to deliver this through GP practices, they must discuss this with us before any decision is reached. There is a vaccinations and immunisations sub-group of the GPC-NHSE negotiating team who would progress this as necessary.
Pensions Judicial Review
On 25 June leave was granted for the judicial review of the Secretary of State’s intention to impose dynamising figures. It is likely that the judicial review process will be lengthy, as many legal processes are, with the result unlikely to be known until around the end of the year.
Tiered pension contributions
The negotiations on the new NHS Pension Review are ongoing. The headline gains – maintaining the normal retirement age of 60 and the continuation and improving the current scheme have been consulted on and agreed. The GPC and the pensions department are now looking at the finer details of the proposals and the process and detail of implementation.
One of the areas we are now working on is that of tiered contributions.
The proposed contribution rates are as follows:
• Drop to 5% for lowest paid (under £15,107pa)
• Increase to 6.5% for middle earners (£15,108 - £60,880)
• Increase to 7.5% for higher earners (£60,881 - £100,000)
• Increase to 8.5% for highest earners (£100,001pa and above)
(Note – the contribution rate is applied to the total income not just the proportion above the various thresholds.)
There are issues around salaried staff, part-time working, people holding more than one job, High Cost Living Allowances and practitioner (GP) superannuable earnings etc. Meetings are being held on both sides, and jointly, to examine each issue and to find ways to implement the proposals that will fulfil the aims of the proposals and minimise the workload on the NHS pension agency.
The BMA is aiming to ensure that no section of the medical profession will be disadvantaged by the new proposals. We do, however, need to recognise that in a mutual scheme of more than 1 million members, it is impossible for everything to be tailored to suit every separate group’s wishes, and this includes the various types of doctors working within the NHS.
The GPC’s aim is to make sure that GPs are treated no differently to any other member of the scheme and that the underlying principles of the scheme are applied equally.
Access and Choice DES Directions
The 2007-08 Access and Choice DES Directions have now been signed off by the negotiators. We are still awaiting Department of Health legal clearance but hope that these will be released shortly. The Directions will apply from 1 April 2007 and the same arrangements will apply as for last year’s DESs.
BMA business support
In recent years, significant changes have occurred to the way in which NHS-funded care is provided, particularly in England. This ongoing transformation of the healthcare market has already seen new patterns of employment and contracting develop and there are likely to be further changes that will influence the way in which some doctors choose to deliver care to their patients.
Consequently, BMA Business Support has been established to provide a resource for BMA members who wish to explore how the care they deliver to NHS patients can be facilitated through the development of new business models in the context of the changing health service. In developing this service the BMA is not making any political statement about the merits of any particular system of provision.
The first publication ‘Business structures – A guide for doctors’ (published May 2007) is now available. Further information about this and on further guidance to be produced in the near future can be found at the link below. Please note that you will need to be logged into the BMA website to access this.
http://www.bma.org.uk/ap.nsf/Content/HubBMABusinessSupport
GP Pay
Thursday 26 April saw the latest announcement on GP pay, which was, in fact, a downward correction of previous figures to exclude the employers’ superannuation amounts. However, the figures still include non-NHS earnings, dispensing and various other elements such as OOH work and the announcement resurrected, if only briefly, the arguments about GP earnings.
The BMA issued a press release highlighting that the figures include non-NHS work and out-of-hours payments.
The revised figures are available on the Information Centre's website: www.ic.nhs.uk/news-and-media
GP2GP transfer
This project continues to make steady progress. Upgrades to support the large scale transfer of larger records (over 5MB) over the spine are scheduled for November. A rollout program is being discussed with a current proposed endpoint of year end 2008 for GP2GP to be implemented in every practice in England. GP2GP functionality in core GP systems is likely to be available throughout the UK but mechanisms for supporting the request and delivery processes will require close collaboration between the four countries.
SNOMED
The concept of a single coding system for the entirety of the NHS has moved forward with the formation of an international collaboration to support the further development of SNOMED.