NEWSLETTER MARCH 2003
Medication on Discharge from Hospital
New Contract
What a fiasco. LMC representatives attended a meeting in London on 21st February only to find that publication had been delayed due to problems with approval of the contract at the Department of Health. Since then the contract has been published but details of the complete pricing are still awaited. The GPC has produced a spreadsheet to enable practices to estimate their income under the new contract but it is impossible to work this out accurately without knowledge of income from any enhanced services a practice might choose to offer. These include payments for the higher rate targets for childhood vaccinations, flu immunisations, minor surgery and anticoagulation monitoring.
Reports from around the country indicate that a lot of GPs feel that they will lose out financially under the new contract. It would be helpful if local practices could let me know much their weighted practice list size differs from their actual and if they feel they would gain or lose by the new contract.
The ballot on the New Contract has now been postponed, while the GPC and NHS Confederation investigate the problems. The GPC say they are committed to an outcome in which all practices will be winners and have been discussing how this might be achieved with the NHS Confederation. They have also had discussions with the Minister. There is a rumour that a solution has been found but there are no details as yet.
Termination of Pregnancy
There has been some dissatisfaction with the current system for referral of patients for this procedure. Although ideally the service should be brought back into North Staffordshire, this is not possible at least in the short term. GPs should soon be notified of a change to the system which should lead to some improvements. It is planned that all patients, except those with a history of diabetes, DVT, Cardiovascular disorders or a BMI over 35, will be referred to the BPAS service at Newcastle. The patient should be seen within 3 working days. A scanner has been installed to allow accurate dating of the pregnancy. An appointment for the procedure at South Manchester should be arranged within the following 10 working days.
Violent Patients
Progress by PCTs in ensuring that all GPs are able to refer to, or have access to a secure facility for the treatment of violent patients is proving to be extremely slow. They have recently surveyed all practices about this problem and have concluded that the number of violent incidents in primary care is small. However, this does not absolve them of their responsibility to provide this accommodation. A further meeting is to be held on March 26th. In the meanwhile, I remind practices to report all episodes of patients exhibiting violent behaviour towards doctors or staff. Doctors can remove immediately patients who "have committed an act of violence against the doctor or has behaved in such a way that the doctor has feared for his safety". The doctor must report the incident to the police, for this rule to apply. Removal should then be actioned immediately by the PCT. The seven-day rule does not apply in these circumstances. GPs have a responsibility to report incidents of violence to the PCT so that this information can be forwarded if the patient is allocated to a new doctors. There is, however, a gap in the information flow if a patient is voluntarily accepted by another practice. A clear note in the patients record should alert the new practice although there will be a time delay in this information being available to the new practice.
Methotrexate
Following a recent incident, in which a patient took an accidental overdose of Methotrexate tablets, the Local Pharmaceutical Committee and the LMC have agreed that as a matter of policy, only 2.5mgs tablets should be prescribed and dispensed. The PCT pharmaceutical advisors agree with this policy and some have already written to their GPs and Pharmacists concerning this. Practices are recommended to review their patients who are on Methotrexate and to abide by this policy.
Intermediate Care
Some patients are being discharged from hospital early with an arrangement for "intermediate" care in their own homes. This has caused some concern and problems for GPs. Firstly, although the scheme was presented to the September LMC meeting, GPs have not been informed that the scheme has commenced. Neither have they been informed that they can refuse to accept responsibility for providing care to these patients. GPs should have to actively opt into providing this care rather than having to opt out. If they do accept, a fee is payable each time a General Practitioner is required to visit during the time the patient is in intermediate care. Nurses looking after these patients should have re-admission rights if problems occur. A number of colleagues have expressed concern that this system is not working as anticipated. It should be made explicitly clear to the GP before the patient is discharged into intermediate care that 1) they do not have to provide this service and 2) if they choose to do so, they will receive a fee for each call out. It is up to individual practices to decide whether they have the capacity to provide this additional service and whether they wish to do so for the fee on offer.
Medication on Discharge from Hospital
The Acute Trust have agreed to dispense 28 days supply of medication when patients are discharged from hospital. This applies only to the Acute Trust. However, in line with the Spoonful of Sugar and National Framework for Older Persons, Combined Healthcare has adopted a policy of one-stop dispensing with near patient medication systems and self-medication where appropriate. This means that the patient leaves on discharge with a supply of medication that may range from 28 days supply to a minimum of 7 days. The National Strategy for Prevention of Suicides stops this being put in place for Mental Health, as they are required not to supply more than 14 days supply for anyone known to have self harmed within the last three months.
Paul Golik
Secretary