NEWSLETTER MAY 2003
Hib Vaccination Catch-up Campaign
Medical information and insurance
Locum reimbursement for Maternity and Adoptive Leave
28 day prescribing and EPACT Data
NHSnet connections: Bandwidth upgrade programme
National Association for People Abused in Childhood
New Contract
The problems with the New Contract continue. The Special Conference of LMC representatives was staged-managed in such away to ensure that the negotiators survived motions of censure. However a motion from Birmingham LMC requiring that the new contract proposals be re-examined, revised and returned to the GPC for debate was passed by a small majority. The contract as it stands is in serious difficulties. This amount of dissatisfaction is unacceptable; a new contract has to be acceptable to the vast majority of GPs. It should be capable of being promoted to the profession on its merits alone rather than on fear of the consequences of rejection, which appears to be the main means of selling the current version. Let’s hope that in the weeks to come an acceptable way forward is found. How different the new version will be remains to be seen. It is vitally important that our negotiators get it right, with a contract which is fit for purpose and will serve the profession for the foreseeable future.
SARS
Colleagues will have received a number of communications from the PCT and public health colleagues about this disease. These contain information, which is helpful in the triaging of patients who fear they have contracted this disease. The LMC does not believe that the diagnosis and management of SARS should be done by GPs in a community setting. We believe that a consultation in health protection (formerly public health) should be responsible for the management of these patients if the triage process identifies a risk of SARS. We should not have to visit patients at home dressed in protective clothing. This is not general practice. Colleagues are advised to contact Dr Hilary Thurston, Consultant in Health Protection (bleep 07693 962978) or Kim Gunn, Health Protection Nurse (bleep 07693 924500) for help with any patient presenting with probable SARS.
Communication
Email is becoming a common and important method of communication between Primary Care Trusts and practices. It is generally a lot easier to use and quicker. However it does rely on practices collecting their emails on a regular basis and reviewing them. Microsoft Outlook can fairly easily be set up to send and receive emails at regular intervals. Public Health have a responsibility to cascade information from the Department of Health about important issues such as SARS. This is done primarily by email and fax to those practices not yet connected to the NHS net. . Public Health Physicians and Clinical Governance Leads have expressed concern that some practices appear not to be collecting emails regular. Practices have a responsibility to ensure that they receive these communications and respond appropriately when necessary. Emails should be accessed regularly at least once daily and preferable twice daily. Any practice that requires help with their IT systems should contact their PCT IT department.
Hepatitis B immunisation
Colleagues have again been experiencing an increase in requests for this immunisation particularly from employees of some local nursing and care agencies. Employers have a duty to assess the risk to their employees’ health and safety and to make arrangements for implementing the health and safety measures identified as being necessary by the assessment. At least two agencies are sending patients to their GP to discharge their duty of providing Hepatitis B immunisation. I have written to these pointing out their duties and informing them of where they can obtain information on the provision of occupational health services and advice.
Removal of Patients
The committee and the PCTs are concerned about the removal of patients from practice lists. Whilst recognising a GPs right to remove patients, we feel that in a number of cases it could be handled better by both the practice and the Primary Care Trusts. Removals because of an acute breakdown of the doctor patient relationship or because a patient has moved away from the practice area usually cause little problem. However, when practice removes larger numbers of patients for administrative reason, e.g.. rationalisation of practice boundary, or in an attempt to reduce workload, then problems often ensue. It can easily result in bad publicity for both the profession and the Primary Care Trusts. Patients are increasingly complaining about such action and this can take up a disproportionate amount of time. We believe that this could be a more "managed" process and have produced guidelines for use in these circumstances. Closure of branch surgeries can also have similar effects and perhaps a similar process could be followed. Click here for these guidelines.
Intermediate Care
The committee wrote to the PCTs concerning the problems around intermediate care. South Stoke PCT has responded on behalf of the city PCTs. They replied stating that:
- All GP practices will be written to individually with details of the Intermediate Care Service.
- This correspondence and other information makes clear that care of these patients is above GMS contracts and is voluntary. Each practice will be asked if they wish to opt into the service or not. For logistical reasons we cannot accept practices agreeing or not on a patient-by-patient basis.
- Details of the payment and payment structure will be included with the information sent.
- Patients will be referred as soon as a qualified member of the team identifies that a visit by a doctor is required. It would not be appropriate to transport patients who are ill and require care and treatment above that given by nursing and therapy staff to the surgery. The fee is in recognition that a home visit will be required.
- Staff from the Finance Agency are currently working on the system for payment. Unfortunately as with all systems involving money, we can only make payments that can be properly audited.
- The City Intermediate Care Team has kept a record of all requests for a GP to visit and as soon as the payment mechanism has been approved these GPs will receive payments.
Newcastle and Moorlands PCTs should be following a similar procedure.
Appraisals
PCTs are now pushing ahead with these. We have not had any reports of problems as yet. However, the documentation sent to GPs is not always as clear as it should be about the locum arrangements. In some cases it appears to be assumed that the practice will cover the work internally for a fee. This fee is not the same in all PCTs. The options for the provision of locum cover are as follows:
1. PCT provides the locum and pays the fee (agreed between the PCT and locum
2. Practice finds and employs a locum. PCT pays the locum fee. (agreed between the practice, locum and PCT)
3. Practice agrees to cover internally and receives a fee from the PCT
The LMC feels that this latter fee is not adequate to recompense a practice for covering 7.5 hours of GP time. Practices are free to reject option 3 if they wish to or feel that the fee on offer is inadequate.
Disability Discrimination Act
The GPC has produced guidance on the Disability Discrimination Act and GP premises. Part III of the Act comes fully into force on 1st October 2004. This section of the Act requires providers of goods, facilities and services, which includes GP practices, to make physical adjustments to their premises to enable disabled people to use their services. This applies not only to patients using the premises, but also to staff employed by practices which employ 15 staff or more, whether full or part time. The exemption of employers with under 15 staff will be removed in October 2004. Employment issues are handled briefly in this guidance, but will be addressed in more detail in separate future guidance. This main purpose of this note is to give a general introduction to what the physical adjustments to surgery premises might be and how to approach the problem. A copy of the guidance can be found here.
Items from the GPC
Hib Vaccination Catch-up Campaign
GMS GPs in England will receive the higher rate B item-of-service fee for every child aged 6 months to under 4 years who is vaccinated with the Hib booster during the campaign period. As you know, the campaign starts on 12 May 2003 and runs for four months. The payment though will be available for six months from 12 May 2003 and there is additional flexibility so that:
 | the fee will be available beyond that period where the additional dose follows a primary course commenced within the four-month target for completion, e.g. commenced on or by 12 September 2003 |
| the fee will be available if children over four years of age have been called to see their GP and the vaccination is given within the six months from 12 May 2003. |
It has also been agreed that GPs who are unable to participate in the campaign (i.e. for workload reasons) should be supported by their PCT.
Destruction of Paper Records
The GPC is aware of the lack of clarity on the issue of retaining documents that form part of the patient record once an electronic copy has been created. This is an extremely complex area, which was discussed recently by the GPC IM&T subcommittee and the RCGP/GPC Joint Computing Group (JCG). We approached the Health Department and it recently commissioned the JCG to revise the Good Practice Guidelines for electronic patient records to incorporate guidance on scanning documents. A new edition will be published as soon as possible. Below is a summary of the position we intend to take on this issue, which will be developed further in the guidance:
Whether a practice should destroy documents containing patient data that have been transcribed into a computer system remains unanswered from a legal perspective and only future case law will determine whether this practice is acceptable. Currently, the decision rests with the individual practice, however, clearly a way forward for practices is required.
Following consideration of the issues, we believe that it is only acceptable to destroy the original documents if an image of the documents in their original form can be produced, i.e. it must not be possible to make alterations to the scanned version (we are seeking agreement on this point from the indemnity organisations). We understand that this is the position the legal profession has adopted for its own documents and that TIFF version 4 meets this requirement.
If practices intend to scan documents but are not using TIFF version 4 (or equivalent), any letters received should be kept and stored. We would deem it unnecessary for the originals to be filed in the patient's old paper record as this would take the practice more time, e.g. pulling the record, filing in date order etc, but this protocol would allow the GP to produce the original if he/she was required by law to do so. The number of file formats should be constrained, files must have a meaningful index and file names should relate to the patient.
IT Funding
The health departments' modernisation programmes for NHS IT infrastructure will continue regardless of the outcome of the ballot on new contract and it is likely that general practice would receive a proportion of the funding being made available. However, 100% funding of general practice IT by PCOs is dependent on the outcome of the ballot. Should the contract be rejected, a portion of the funding currently earmarked for general practice could be distributed to other sectors of the NHS. In this instance, the GPC would aim to discuss a suitable way forward with the health departments. In the meantime, current arrangements, as set out in the SFA, apply. Practices can expect up to 50% reimbursement for IT costs (although PCOs in some areas reimburse practices at higher levels).
Medical information and insurance
The BMA’s Medical Ethics Department and the Association of British Insurers issue joint guidelines on the use of medical information in insurance. They cover reports about GP’s own patients as well as independent report-writing, and offer guidance on the issues GPs raise with the BMA, including:
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Consent for disclosure of information |
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Access to medical reports |
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Disclosure of information about sexually transmitted infections |
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“Lifestyle” questions |
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Genetic information |
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Release of information about deceased patients |
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Fees |
The guidelines show important areas of agreement – including, for example, over the fact that insurance companies must not ask GPs to explain actuarial or underwriting decisions, and over non-disclosure of information about STIs where there are no long-term health implications. An electronic copy of the guidelines can be found here, and is available at www.bma.org.uk/ethics. Please contact the BMA’s Medical Ethics Department (020 7383 6286 or ethics@bma.org.uk) for hard copies.
Task group to investigate recent contract communication difficulties
The representation subcommittee put forward a proposal to GPC to set up a task group that would look into the recent events surrounding the publication, communication and pricing difficulties with the proposed new GMS contract. This was a direct response to the dissatisfaction expressed by many GPC members, LMCs and general practitioners with the way progress on the contract was communicated to them. The task group will examine the relationships and communications between the GPC, its negotiating team, LMCs and the annual conference of LMCs. It will also look at how the GPC works within itself and in relation to the rest of the BMA.
The intention is to have a small and mixed membership including: GPC members, LMC representatives, the company secretary of the GPDF and the BMA’s Director of Representational and Political Activities. Further details will be presented to LMCs at the special conference on 14 May.
Locum reimbursement for maternity & adoptive leave
Following representations from the GPC, the SFA has been amended as of 6 April 2003 to allow:
· 26 weeks maternity leave locum reimbursement for GP principals (this was previously 18 weeks)
· 26 weeks adoptive leave locum reimbursement for GP principals irrespective of the age of the child (this was previously 18 weeks if the child was below school age and three months for school age children) claims to be submitted after the 4th, 12th and 26th weeks.
Any GP who was on maternity/adoptive leave on 6th April will be entitled to extended leave.
The maximum weekly locum reimbursement is now £890.
Please also note that a practitioner in receipt of an allowance for an assistant, associate or salaried doctor may also be eligible to apply for payments under this scheme.
Following the recent announcement of the above, a number of PMS GPs have questioned whether they will also benefit.
PMS GPs should not be disadvantaged by their annual contractual arrangements with regard to maternity or extended sick leave reimbursements. The GMS SFA may be used by analogy to determine the level of reimbursement to ensure consistency between GMS and PMS GPs. Normally an 'in-year' re-adjustment to the annual PMS contract would be made by the commissioning PCT from their unified budget, when a PMS GP wished to make a claim for maternity or sick leave. The PCT would then claim this extra amount from the Department of Health as an exceptional 'in-year' adjustment to the PMS budget. It is intended that in PMS contracting, the commissioner accepts the risk of maternity/sickness absence payments and does not delay in reimbursing the PMS site whilst awaiting the adjustment from the Department of Health. Some PCTs draw down PMS 'contingency' money from the Department of Health at the start of the financial year for these eventualities, to be repaid in the event that no PMS site in their area has an extended sick leave or maternity reimbursement claim.
28 day prescribing and EPACT data
The prescribing subcommittee discussed a recent circular from Lloyds chemists sent to practices encouraging 28 day prescribing. The subcommittee reiterated its stance that doctors should prescribe as they saw clinically appropriate. Where a condition was stable or long-term contraception was being prescribed, it was normal for three or six months worth of prescription to be given. There are no rules that say a doctor must prescribe at 28-day intervals. The Department of Health encourages clinically appropriate prescribing that takes into account patient convenience, the danger of excess drugs in the home and the need to safeguard NHS resources.
The subcommittee also acknowledged that EPACT data shows prescribing patterns across areas. It is clear on this data when practices have changed prescribing intervals towards the end of the financial year in order to make their prescribing budget look lower than if they gave a longer interval prescription. Practices should be aware that this will be apparent.
NHSnet connections: Bandwidth upgrade programme
Central funding has been made available to increase the speed of English practices' NHSnet connections. Technically speaking, 256kbps Broadband (always on) connections will replace current 64kbps ISDN Dial connections to NHSnet providing a 4 times increase in speed. This means that practice personnel will have faster access to NHSnet based applications, information sources and the Internet than currently experienced. Practices will receive a letter informing them of the initiative, which LMCs can download from http://www.nhsia.nhs.uk/nhsnet (or nww.nhsia.nhs.uk for those with a NHSnet connection). The letter received by the practice will depend on whether it has a BT or Cable &Wireless connection. The enhancement will be free of charge, performed with minimum disruption and should require no intervention from GP system suppliers or alterations to existing computer systems. All practices should have been upgraded by March 2004. Practices that do not have direct NHSnet connections (i.e. those in "maverick" PCTs) will not receive individual letters, however, the NHS Information Authority is approaching the relevant PCTs to see if they wish to reconsider their connection policy.
National Association for People Abused in Childhood - helpline
The BMA has been contacted by the National Association for People Abused in Childhood, asking for help in promulgating details of its helpline to GPs. The information is as follows:
“We are NAPAC - The National Association for People Abused in Childhood - registered charity number 1069802. Our address is 42 Curtain Road, London EC2A 3NH. Office number is 020 8971 5099.
In November last year we launched the UK’s first national free phone helpline for adults who were abused as children. The number is 0800 085 3330. Opening hours are Monday to Friday 12 noon to 8pm and Saturday 9am to 12 noon.
We have 6 staff at the helpline - all qualified counsellors and all very experienced at dealing with ‘survivor’ issues. People are also welcome to write to us at Curtain Road and will receive a personal reply from a dedicated counsellor. The purpose of both services is to support and encourage survivors of abuse and enable them to take control of their own recovery and healing. To facilitate this we offer free resource packs and details of any local support in the caller’s area. Our services are provided with total confidentiality though we do, of course, follow strict child protection procedures where appropriate. We do not charge for our services but as a charity we must constantly look for funding (we receive a small grant from the Department of Health).
We have leaflets and posters (new stocks currently being printed) which we are happy to supply on request.”
Superannuation For Locum Work
GP Principals and Assistants who also do GP locum work can now claim for their locum work to count towards superannuation. This rule has been backdated to 1 April 2002. While these GPs do need to complete their application forms for any locum work undertaken between April 2002 to March 2003 ASAP, they do not need to panic too much as the NHS Pensions agency have not set a deadline for submission of the forms. Further details about this will shortly be posted on the NHS Pensions Agency website (www.nhspa.gov.uk) and will include frequently asked questions and answers.
Non-Principal Appraisal
Discussions are ongoing with the English Department of Health regarding the appraisal of GP non-principals. In the meantime, there is NO obligation on non-principals to participate in the formal appraisal process. The GPC are particularly pressing for adequate funding and support to be available to all GPs. The Department has agreed that GPs should not be out of pocket as a result of participating in appraisal.
Paul Golik
Secretary