NEWSLETTER MARCH 2007
Useful information about General Practice
Access and Choice and Booking DES
Controlled Drugs in Primary Care
Action following the Doctors’ and Dentists’ Review Body (DDRB) report
Patient Liaison Group projects and the GPC
CPD payment of £750 to GP trainers: 2006/07
Editorial
The last month brought the disappointing news that there will be no uplift in the GMS contract payments for the coming year. Negotiations between the GPC and the DoH broke down and the GPC decided to approach the DDRB for their opinion. The DDRB recommended a zero increase in General Practitioner pay this year. The government has interpreted that as meaning a zero increase in fees. In reality the government's action results in a pay cut for GPs unless we can make our businesses more cost effective. The GPC has been discussing what action to take over this, it is having to draw a balance between the hawks who suggest immediate action and the doves who feel that there is no ground swell of feeling which will make any action successful. The GPC will shortly be producing a list of actions practices can consider which will make their practice more cost effective and help maintain GP income. Each individual practice should be looking at the services it provides, deciding whether they are cost effective and if not deciding appropriate action to take. There are important legal considerations which need to be taken into account in this guidance to ensure that it complies with the legislation governing trade unions and employment. The GPC have therefore been working closely with the BMA's legal department and taking advice from a leading QC to ensure that the guidance is as legally watertight as possible. However, GPs will need to be aware that, because of the law covering industrial action, the GPC and LMCs are constrained in what they can advise and the guidance will need to be carefully worded. It is hoped that the guidance will be finalised before Easter and issued to GPs.
Useful information about General Practice
Norfolk and Wessex LMCs have produced a leaflet listing some information about General Practice which you may find useful. A copy can be found here.
Access and Choice and Booking DES
These DES end on 31st March and whether they will be continued in 2007/8 remains unclear. There was initially a commitment for reviewing the current situation with negotiations between the GPC and the DoH means that there has been no formal discussion. Practices will have to decide whether it is in their and their patients interests to continue with these schemes without the guarantee of any future resource.
This IT initiative is being rolled out locally and will be beneficial to both practices and patients. The Joint General Practitioners IT committee (JGPITC) of the BMA’s General Practitioners Committee (GPC) and the Royal College of GPs (RCGP) have endorsed the use of the version 1.1 Emis and InPS products for both ‘same system’ and ‘inter system’ GP2GP record transfers.
Controlled Drugs in Primary Care
There have been many changes to prescribing in general practice post-shipman. There is new DH guidance on Standard Operating Procedures which can be found in the policy and guidance section of their website. The National Prescribing Centre has also just updated it's guidance on controlled drugs management in primary care and takes into account all the recent changes. A copy can be found here.
Documents from the GPC
During the last few weeks a number of "Focus on" documents have been produced by the GPC.
Focus on QOF Payments contains the information on QOF payments which
can be found in the Statement of Financial Entitlements. It aims to be a
more user friendly text than the SFE. This is because there are probably
many GPs who are not aware of the SFE and the way in which QOF payments
are fully calculated. A copy can be found
here.
Focus on QMAS is a revised version of the original Focus on QMAS
bringing it up to date in terms of dates, the IT institutions involved
and links to the relevant devolved nations QMAS systems. A copy can be
found here.
Focus on Quality and Performance Management Standards answers a
number of questions which have been raised around Standards for Better Health
and 'Balanced Scorecards' which are appearing in PCO areas. The GPC have
sought their lawyers view on the extent to which practices need to
comply with these and provide the PCO with information. A copy can be
found
here.
The Focus on Read Codes 2006-07 guidance that deals with some of the
outstanding read code issues that still exist with the current version.
Some of these issues may affect your QOF score. A copy of the document
can be found
here.
Focus on dynamisation has been amended and the new version can be found here.
"Primary Medical Contracts - Who can hold what", this guidance explains the eligibility criteria for holding different types of primary medical services contract and eligibility to be a member of the NHS Pension Scheme. The guidance also sets out the circumstances under which more than one contract may be held. A copy can be found here.
Two more document are "Enhanced Services and Floors from April 2007" and "Payment of component 2 of the towards PBC DES"
"Primary medical services contracts: advertising and appeal", this paper discusses requirements for advertising and outlines appeal mechanisms for parties that feel the tendering process has been unfair or obscure. A copy can be found here.
Microsoft Offer
The NHS subscribes to the Microsoft Home Use Programme. This means that any GP, or their staff (including receptionists, managers, secretaries etc) can get a copy of Microsoft Office for use at home for the cost of the media and p&p only (£17.31) The new Office 2007 has just been added to this deal (the 2003 version is still available). The way of ordering this is via a website: http://www.microsoft.com/uk/nhs/.The only requirement is for an NHS email address.
Mental Health Capacity Act
The Mental Capacity Act 2005 for
England and Wales will come into force in 2007. This act governs
decision-making on behalf of adults, where they lose mental capacity at
some point in their lives or where the incapacity condition has been
present since birth. Although parts of the Act will be available from
April 2007, including the introduction of the Independent Mental
Capacity Advocate (IMCA) service and guidance on principles, assessing
capacity and determining best interests, most of the Act will come into
force in October 2007.
The BMA Ethics Department have produced guidance for health
professionals on the Act which is available here:
http://www.bma.org.uk/ap.nsf/Content/mencapact05
This guidance gives a good overview of the Act however it is unlikely
that it will impact significantly on GPs until October 2007 and through
the BMA’s Professional Fees Committee (PFC), work is ongoing to
negotiate the associated fee for undertaking Court of Protection work.
The GPC and the PFC will issue further guidance over the summer on the
practicalities of completing the new Court of Protection assessment of
capacity form which will replace the current CP3 medical certificate.
Some GPs have been told that they have to attend mandatory courses on
the Mental Capacity Act 2005. There is no requirement on GPs to attend
these courses but they may, of course, attend if they wish. Provided GPs
continue to do any work associated with the Act with full understanding
and within their capabilities as defined by the GMC, there should be no
need for additional training.
Items from the GPC
Action following the Doctors’ and Dentists’ Review Body (DDRB) report
In light of the DDRB’s recommendation that GPs should receive no increase in pay, the GPC is preparing guidance suggesting ways to practise cost-effectively, thereby helping GPs to maximise efficiency and help maintain practice profits in 07/08 at a time when costs will rise with no commensurate increase in income.
The emphasis of this guidance will be on encouraging practices to refuse new underfunded work and to reconsider involvement in any work which is government-driven, inefficient and of no real benefit to patients. The GPC was of the firm opinion that the disappointing recommendation in relation to GP income should not be allowed to prevent fair and appropriate increases for practice staff. This guidance will be developed over the coming weeks and should be published shortly
Pension dynamisation
Since the Secretary of State announced her intention to impose dynamising factors for 2003-2008 in December 2006, the BMA has sought detailed legal advice about the best course of action. As a result the BMA has now formally lodged its application for Judicial Review action with the courts. To reflect developments, an updated version of the 'focus on dynamisation' guidance note can be found here: www.bma.org.uk/ap.nsf/Content/focusdynamfactor0305 . This replaces all previous guidance on pension dynamisation.
Summary Care Record (SCR)
The first two practices in Bolton have gone live on the Summary Care Record, involving some 14,000 patients.
The practice patients will receive a copy of the information leaflet. They will then have eight weeks to indicate whether they want a SCR or not. If they say nothing, a SCR will be created but will not be shared. They will then have a further eight weeks to say whether the SCR can be shared or not. After this 16 week period if patients have said nothing, then the consent model changes and practices will work on implied consent and the SCR could be shared.
Other practices in Bolton are expected to join the pilot next month, whilst other PCTs are expected to join later this year.
GP trainers
The GPC remains concerned that, in many areas throughout the UK, GP trainers have not yet received their CPD payment for 2006-07. We will be writing in the strongest terms to the Health Department about this.
GPs as specialists
The GPC voted by a large majority to seek recognition for GPs as specialists in general practice. The GPC will be taking this forward through BMA Council and the RCGP.
White paper: ‘Trust, assurance and safety – the regulation of health professionals in the 21st century’
The White paper sets out a programme of reform to the UK system of regulation for health professionals. It is based on the consultation of two recent reviews of professional regulation ‘Good doctors, safer patients’ and ‘The regulation of the non-medical healthcare professionals’. It is also complemented by the government’s response to the Fifth Report of the Shipman Inquiry and to the recommendations of the Ayling, Neale and Kerr/Haslam inquiries.
Some of the proposals are that doctors will have to be regularly re-licensed and consultants and GPs will also have to be re-certified under the proposals. The composition of the GMC will change to ensure that professionals will not form the majority whilst the adjudication function of the GMC will be removed. The civil standard of proof will also be adopted on a sliding scale in fitness to practise cases.
The paper was discussed by the committee and concern was expressed at some of the proposals. The BMA will be involved with other key stakeholders in discussing the details of implementation.
Referral Management
The GPC continues to promote the principles which should be adhered to when referral management is introduced. The BMA also maintains dialogue with local clinicians regarding the proposed introduction of nationally procured Clinical Assessment, Treatment and Support (CATS) services in the North West of England. There is a range of opinion, particularly amongst GPs, with many giving the introduction of the schemes a cautious welcome, especially now that some initial concerns, such as choice of provider and further referral on to specialist care, have been addressed. Concerns do still exist that the introduction of CATS may destabilise existing health care and one major concern is that private providers are being given preferential funding and support over and above that offered to existing NHS providers. The BMA maintains its position that there should be a level playing field and is encouraged that more detailed discussions between GPs and consultants about the nature of service provision are taking place in light of these developments.
The BMA responded formally to the consultation document ‘Improving our patients’ experience of health care in Cumbria and Lancashire: Clinical Assessment, Treatment and Support (CATS) Services’ setting out its concerns about the proposed scheme and highlighting areas for improvement.
VAT
Further to previous GPC News items, practices should be aware that Parliament has approved the implementation of VAT on medical services from 1 May.
Those practices already registered for VAT are advised to familiarise themselves with the details of items for which they will have to charge VAT from 1 May.
Detailed guidance can be found on the HMRC website and also the BMA's website at the links below.
www.bma.org.uk/ap.nsf/Content/VATonmedicalservicesFAQs?OpenDocument&Highlight=2,VAT
Patient Liaison Group projects and the GPC
The BMA's Patient Liaison Group (PLG) presented the GPC with a number of projects on which they would like the committee's support. These included a policy paper and web resource for GPs on the Expert Patient Programme and a web resource helping GPs to set up Patient Participation Groups. In order to make the resource valuable the PLG is seeking responses to the following questions:
· Do you have a patient participation group?
· If not, have you tried to set up a group and what stopped you?
· How long have you had a patient group at your practice?
· How many members does it have?
· How did you advertise for members?
· Is the membership diverse (eg age range, gender, religion, race) according to the population the practice serves?
· Were there any problems in recruiting members?
· What staff members are involved with the group (eg in attending meetings)?
· What have the successes been?
· What have been then major challenges/hurdles in running a patient group?
· Do you think having a representative patient group benefits all patients?
· Is there any further information or assistance that would be helpful in order to make the group more effective?
Please could practices who have particular experience of this send their responses to Simon Young at: SYoung@bma.org.uk.
Formula Review Group
Friday 9 February saw the publication of the long-awaited report from the Formula Review Group Review of the General Medical Services global sum formula. This has been published for consultation and we would encourage LMCs and GPs to read the review and respond. The results of the consultation will help inform discussions between the negotiating parties to determine if, how and when, the report’s recommendations should be implemented. See the link below for the GPC’s FAQ document, which provides important contextual information. The report and consultation response form can be found on the NHS Employers website. The deadline for responses is Friday 11 May 2007.
www.bma.org.uk/ap.nsf/Content/Formulaconsultation?OpenDocument&Login
www.nhsemployers.org/primary/primary-891.cfm
It is important to remember that there is no certainty that the new formula will be implemented. The Formula Review Group’s remit was only to review the formula. Any decision to adopt a revised formula would be a matter for negotiation and would depend on factors outside the terms of reference of the review, such as the availability of significant additional funding. Once the formula review consultation period has ended, the negotiating parties will discuss with the relevant health departments how, when, or if at all, the recommendations of the review group will be taken forward.
CPD payment of £750 to GP trainers: 2006/07
The English Department of Health has confirmed that, following the recommendation by the Doctors' and Dentists' Review Body (DDRB), GP trainers will be receiving a £750 CPD payment in 2006/07 (as they did in 2005/06). However, unfortunately GP trainers have to date not yet received this money, despite calls from the GPC for this to be paid to them as soon as possible. The Health Department has so far refused to say when the payment will be made and has noted that it is for SHAs to decide how they manage this and to what timetable they make the payments. We find this unacceptable, and have therefore drawn this to the attention of the DDRB.