NEWSLETTER JUNE 2005
Hazardous Waste Regulations 2005
Paediatric Orthopaedic Follow ups
Treatment of Patients from Overseas
BMA and ABI reach agreement on fees for GP reports
Criminal Record Bureau checks for all NHS staff
Postgraduate Medical Education and Training Board (PMETB)
Connecting for Health
PCTs are beginning to request practices to sign up for a “smart card” and registration for the “Connecting for Health” project. Registration creates an electronic identity for each individual on the central NHS user register. Registration will enable practices to use programmes such as Choose and Book, GP2GP transfer, the new email system and the Electronic Transfer of prescriptions (ETP). Registration does not oblige practices to use Choose and Book. The registration process involves completing a form to allocate roles to staff, which will determine the level of data staff can access e.g. receptionists will be unable to access full clinical details. The burden on practices in completing the form is being raised with "Connecting for Health" by the GPC.
Registration is not the same as “expressing an intent to use Choose and Book”. There is far more to this programme than “Choose and Book”. The GPC has concerns over the government’s plans to keep patient records on a central spine and discussion on this are on going.
PCTs have been set a target to register 30% of practices by the end of June. There is a financial carrot attached to this target. I cannot see any problem in registering for this project apart from the time spent in completing the relevant documentation. It does not commit anyone to using any of the new systems which will result from this project. In the longer term we will all need to be registered to make full use of the new system.
More information on the “Connecting for Health” programme can be found on their website at http://www.connectingforhealth.nhs.uk/”
Hazardous Waste Regulations 2005
New regulations for hazardous waste are planned to come into force on 16 July 2005. One of the changes to be made is the introduction of a requirement to notify the Environment Agency of premises producing hazardous waste. Most of those producing special waste will be caught by the new regulations. There are some wastes that are not defined as special, but will be “hazardous”. These include discarded single-use cameras, untreated end of life vehicles, dental amalgam, and some discarded electronic and electrical equipment including TVs and computer monitors and some waste wood. From 16 July 2005, the movement of hazardous waste from premises that are not either notified or exempt will be prohibited.
Producers who fail to notify and who are not genuinely exempt, will be committing an offence. The duty to notify premises rests with the producer of the waste. This would normally be regarded as the owner or occupier of the site. Where organisations have multiple premises, each premises will need to be notified to the Environment Agency, unless exempt, although a central office may do this on behalf of the individual premises if they wish. If single premises are occupied by a number of different organisations producing hazardous waste, the part of the premises occupied by each organisation should be individually notified. Certain types of premises will be exempt from the requirement to notify the Environment Agency if less than 200kg of hazardous waste is produced at that premises in any twelve-month period. There will be no limit on the number of consignments that can be made from the premises under this exemption as long as the total amount produced in that year is less than 200kg. The exemption will only apply where the hazardous waste is removed from the premises either by a registered carrier or a carrier exempt from the requirement to be so registered.
The guidance issued by the Environment Agency states that 200kg equates to approximately:
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10 small TVs; |
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14 lead acid batteries; |
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500 fluorescent tubes; |
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5 small domestic fridges. |
Not much help in terms of the waste produced by GP surgeries! However, if you produce more than 4kg of clinical waste per week you will need to register.
Once the Agency has processed the notification, it will issue the notifier with a premises code. This code will need to be used on consignment notes and consignee quarterly returns for all movements of waste from 16 July 2005. Notifications will be valid for a year. Those who continue to produce hazardous waste after the end of that year will need to renew their notification. Guidance on the renewals process will be issued in wider guidance that will be produced before the Hazardous Waste Regulations come into force.
Registration cost £18.00 on line and £28.00 on paper. Further details can be found on the Environment Agency website at http://www.environment-agency.gov.uk
Prospective Medical Students
Keele University is requesting prospective medical students to attend their General Practitioner to obtain their immune status to Rubella, Varicella and Hepatitis before they can be accepted at the Medical School. They are also requesting that they receive immunisation when required. It is the responsibility of the medical/dental school, not the GP, to ensure students are fit to start training and have been properly screened and immunised before starting clinical attachments that could place them or their patients at risk. This is an Occupational Health issue and Universities/Trusts should undertake to provide and fund this service themselves. GPs are not required to provide free occupational health services to employers or training establishments and the LMC advises GPs to refer the student back to the Medical/Dental school. I have written to Keele University pointing out their responsibilities.
Paediatric Orthopaedic Follow ups
Mr Dwyer has written to practices proposing that we have to re-refer patients who he feels need a review after a period of longer than six weeks. This proposal is not acceptable because of the following reasons:
Whilst acknowledging the large workload in paediatric orthopaedic, the workload in General Practice is extremely onerous and a number of practices are very near to breaking point. Recent government statistics show that whilst the number of secondary care consultants has increased by 5.4% year on year in the last ten years the corresponding data for General Practitioners shows only an increase of only 1.5&% year on year. Compounding this is the fact that although the average GP in England and Wales manages an average list size of 1666 patients, in North Staffordshire the average list size is significantly greater and around 2000. We are frequently requested to do a small amount of extra work to ease someone else’s burden. Unfortunately we can no longer agree to accept more work.
Historically General Practice has not had robust recall systems except for immunisations and cervical cytology. Both of these are managed by the PCTs recall system. We do not have sufficiently robust systems in place to ensure that a patient is recalled and re-referred for surveillance.
From a Medico-legal viewpoint the current system works but it is highly likely that a patient would slip through the proposed system. This could lead to severe medico-legal consequences both for Mr Dwyer and for the GP with whom the patient is registered.
We believe that if the current system regarding targets is causing problems then the way forward is to amend that system, not to increase the workload and responsibility of your General Practitioner colleagues.
I have written to Mr Dwyer with these comments.
BMA Fees Guidance
The BMA have recently updated the following fees guidance schedules on the BMA website:
| Fees guidance schedule 1: central government departments and agencies |
| Fees guidance schedule 2: work for local authorities |
| Fees guidance schedule 3: miscellaneous work in the NHS |
| Fees guidance schedule 4: family planning |
| Fees guidance schedule 11: where no agreement applies |
The remaining schedules are under review and they will be updated on the BMA website in the near future.
Revaxis
A number of queries have come into the GPC office about the situation
with Revaxis. As it is now only centrally supplied it's reimbursement
was going to be stopped from the 1 June.
The GPC have spoken with the PPA who have now clarified the situation.
The move to central supply was on 1April but because practices had stock
it was agreed this could still be reimbursed through April and May. That
is where the 1 June figure comes from. However, as the PPA have clearly
received many calls on this and the DH have told the PPA that is will
continue to be reimbursed for a time so those of you with stock should
be able to recompensed.
The PPA said that it was important than when seeking reimbursement you
did not use an FP34 nor the appendix form.
You would need to submit an FP10 in this instance to claim the PA fee.
Treatment of Patients from Overseas
In response to a number of queries for clarification on who you can treat from abroad on the NHS, and who you can charge the BMA has produced some guidance. The initial advice was revised on 16th May and can be found here.
Pensions
The Pensions Agency Newsletter contains a lot of useful information about the necessary forms and certificates. A copy of this newsletter can be found here.
Freedom of Information Act
The GPC has produced further guidance on the Freedom of Information Act. The document can be found here.
GPC News Items
IT Update (GPC - May 2005)
Registration for Connecting for Health (nee NPfIT) has commenced in some areas. Registration creates an electronic identity for each individual on the central NHS user register. Registration will enable practices to use programmes such as Choose and Book, GP2GP transfer and the Electronic Transfer of prescriptions (ETP). Registration does not oblige practices to use Choose and Book. The registration process involves completing a form to allocate roles to staff, which will determine the level of data staff can access e.g. receptionists will be unable to access full clinical details. The burden on practices in completing the form is being raised with Connecting for Health.
Registration is not the same as “expressing an intent to use Choose and Book”. Practices do not need to register in order to express an intent to implement Choose & Book, which could be verbal, on paper or by e-mail.
The committee expressed concerns about the Choose and Book process and requested clarification on the allocation of the £95 million capital funding. Issues relating to Choose and Book will be raised at a meeting with the Department of Health on 3 June 2005.
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The Government’s plans for a central care record are receiving greater public scrutiny. Patients are beginning to ask about this as awareness grows. Some patients are asking that their records do not go onto “NHS computers” or the “spine”. How should GPs respond?
- The GP’s paramount responsibility is to the patient.
- Except in certain specific circumstances patients have absolute control over who has access to their record.
- GPs have a duty to maintain a record and this can be on paper or computer.
- There are potential disadvantages, even dangers in having multiple record systems; some patients on one and others on another.
- Most GPs now use computer records and these are a vital tool for the GP, patient and practice.
- At the moment GP systems are not connected to the spine and it is both GPC and BMA policy that patient data should not go onto the spine until concerns about privacy and confidentiality have been answered.
- The electronic transfer of GP records (GP2GP) will soon be a reality and, although the records will transit over the spine, no data will be retained by (or leak onto) the spine during the exchange.
Patients should therefore be reassured that data collected locally on GP controlled systems, even though these are “NHS computers” is best, safe and essential for their care. Data collected in this manner will not go onto the “spine”. Data will only go to outside agencies with the patient’s express consent and that only relevant data will be shared. Patients should be encouraged to allow GPs to continue to build locally held and controlled electronic records.
BMA and ABI reach agreement on fees for GP reports
The BMA Professional Fees Committee and the Association of British Insurers have agreed a fee increase for GP reports and medical examinations undertaken for life assurance and income protection purposes. From July 1 2005 the new fee for a GP report will be £70.50. Medical examinations will be £77.50 and the fee for a supplementary report, at the time of the original request or later, will be £18.00. Increases are linked directly to pay increases for GPs and there is a clause allowing for adjustment in the fees for 2007/08 and 2008/09. BMA professional fees committee chairman, Peter Holden, has said that is important doctors produce reports in the format required, rather than reproducing a patient’s health record.
Criminal Record Bureau checks for all NHS staff
On 13th October 2004, John Hutton announced the government’s intentions to introduce Criminal Record Bureau (CRB) checks for all NHS staff. This would include receptionists, cleaners etc as well staff who have direct contact with patients. It is not a legal requirement for all NHS recruits to undergo CRB checks at present. If there are steps to introduce such legislation, the financial implications to practices will be raised by the GPC. Further information about CRB checks is available on the BMA website in the September 2004 edition of the Sessional GPs Bulletin.
Postgraduate Medical Education and Training Board (PMETB)
The GPC has concerns about the arrangements and ongoing uncertainties regarding the transition of the Joint Committee on Postgraduate Training for General Practice (JCPTGP) to the Postgraduate Medical Education and Training Board (PMETB). The committee is particularly concerned about the PMETB proposals to introduce a new fee scale for certification. The suggested fees are quite disheartening and could discourage doctors from becoming GPs. This issue will be widely raised to ascertain how potential GPs will be compensated for these significant additional costs. We have written to the PMETB expressing our disquiet and have requested that the PMETB delays the introduction of these charges until the issues are clarified.
PGEA Payments
Further guidance on the final payment of PGEA under the old contract and whether GPs have a possibility of a claim against their PCT has been issued by the GPC and can be found here.