Newsletter Index NEWSLETTER NOVEMBER 2002Allocations
and Patient Removals Phonographic
Performance Limited
Countering violence
against GPs and their staff European
definition of general practice
National
GP registrars conference - 2004 and beyond Coroners
and death certification review
New Contract
The GPC has issued its timetable for
the release of the new contract and forthcoming ballot as
follows:
This is a very tight timetable and I
do question whether it is achievable. I have asked the
BMA that the "Roadshows" should be more
accessible to GPs in North Staffordshire during this
time. It is extremely important that we all make an
informed decision on this issue.
Allocations
and Patient Removals
The committee is concerned about the
number of patients being allocated to practices who are
already over stretched. Some practices are already
removing other patients in order to accommodate those
allocated, or removing allocated patients after three
months. We have recently written to both the MDU and MPS
seeking advice about this problem The MDU advises that there are some
serious pitfalls that can await the GP who removes
patients from his list. In particular, the requirements
of the GMC are very important and must be followed.
Attention is drawn to “Good Medical Practice”
and in particular paragraphs 5, 24 and 25. The effect of paragraph 5 is that
GPs must be extremely careful about which individuals
they chose to remove from the list. The temptation to
remove high workload patients must be avoided. This would
be unethical and lead to potential problems with the GMC.
To avoid any allegation of unprofessional behaviour,
there must be no discrimination, e.g. the use of “last
in – first out”, or selection of a block of
patients based on address. Each one needs a letter from
the GP explaining the exact reason why they are being
removed. Removal may, of course, produce a local outcry,
and the letter of explanation needs to be carefully
worded. The MPS cautions against such
action. They stated that GPs who remove patients without
good reason may find themselves subject to complaint and
even criticism by the Ombudsman. They say that the Royal
College of General Practitioners does provide guidance on
when it is reasonable to remove a patient from the GP’s
list. Resourcing issues and workload do not fulfil
criteria of reasonable cause.
Blue Badge
Claim Forms
I have written in very strong terms
to the Stoke-on-Trent City council informing them that
the lack of claim forms for GPs filling in "Blue
Badge" applications forms is totally unacceptable. I
have received a reply from the Assistant Director,
Organisational Services who inform me that the problem
has arisen due to two issues. Firstly, there was a lack
of awareness within the Car Parking and Security section
of the Council's Department of Environment and Transport
that the forms were not held in stock but needed to be
requisitioned. They cannot be photocopied because there
are individually numbered for accounting purposed.
Secondly, the City Council is now charged for the supply
of these forms (they were free when Social Services
administered the scheme). It is admitted that this seems
to be bureaucracy gone mad, but this also resulted in
delays while hard-pressed budgets were scoured to enable
the cost to be borne. The new supply of forms should be
available soon.
Phonographic
Performance Limited
A local practice has been requested
by the above organisation to pay it a licence fee as well
as a licence fee to the Performing Rights Society for
playing music in the surgery waiting room. I have
enquired from the BMA as to whether this is necessary,
they have taken legal advice and have informed me that
the Copyright and Patents Act 1988 states that it is not
an infringement of any right conferred by Part 2 of the
Act to play a sound recording as part of any activities
of, or for the benefit of a club, society or other
organisation if certain conditions are met. These
are that the Club etc is not established or conducted for
profit and its main objects are charitable or otherwise
concerned with the advancement of religious education or
social welfare. The question is whether a GPs
surgery is established for profit and is it established
for social welfare. A BMA lawyer would be prepared
to argue that it was the latter and that it was not
established for profit, but as most surgeries operate
under a partnership agreement and a partnership is
defined as persons coming together in business with a
view to profit, he suggests that we pay a licence to the
Performing Rights Society and not to the Phonographic
Performance Ltd.
Shotgun
Licence Certificates
This topic has recently been
discussed between LMCs on their email discussion list.
The consensus of advice is that GPs should not sign these
forms. The following relevant comments were made by
Gloucestershire LMC: The arrangements for Firearms
certification are a mess as far as GPs are concerned. The
problem originally arose because the BMA agreed with the
Home Office that doctors would sign the certificate
without charge. 1. There are different forms and
different requirements for shotguns and firearms 2. If you sign a firearms form you
cannot charge a fee, but you can charge for a shotgun
signature. 3. GPs should not agree to sign
firearms or shotgun certificates because of the potential
"duty of care" that is unique to doctors by
virtue of knowing the medical records. 4. Where the police approach a GP
for medical information relating to a firearms licence
application, the appropriate fee for a factual report
should be expected. 5. Information given in such a
report should be confined to factual information only,
without the expression of an opinion. 6. No undertaking to inform the
police of a change in the patient's health should be
entered into.
Outreach
INR Clinics
There is now a waiting list for
patients taken on by these clinics and colleagues should
be aware that monitoring may not start as quickly as we
would like. The clinic should inform referring GPs that
they will need to continue monitoring until they are able
to take on the patient, however I would advise colleagues
that they ensure arrangements are in place for the
continuing monitoring of patients until the outreach
clinic appointments are in place. There is a bid in for
increased funding for this service next year.
PCT Policies
PCTs have approved a number of
policy documents. Some of these apply to all NHS
organisations. There is a misconception among some, that
they therefore apply to General Practices, this may not
be the case, e.g. General Practices do not have to
appoint Cauldicott Guardians. If practices feel they are
being pressurised into implementing policy documents,
please contact the LMC for advice.
Adoption
Medical Examinations
Practices will have received
notification from John Chesworth that the new forms
issued by the British Agency for Adoption and Fostering
are not included for payment in the collaborative
arrangements between Local Authorities and the Health
Service. It is the BMA's view that the fee of £34.40 in
the 'collaborative arrangements' specifically applies to
Form Adult 1 and not to Form AH. The British Association
for Adoption and Fostering consulted the BMA Professional
Fees Committee with regard to what would constitute a
reasonable fee for the work. Last year the Committee
considered that such a report would take approximately 45
minutes to complete and therefore a sum of £69.30 would
be appropriate. In the absence of a fee agreed with the
NHSE for completing this form, individual GPs should set
their own fee for this work, although they would need to
have it agreed in advance of doing the work. Birmingham LMC have that advised GPs
work on the £144 per hour rate and calculate according
to their work rate remembering to include the time for
writing the report as well as carrying out the
examinations. If you are anxious about bad debt, release
the report when the payment is made. GPs should, therefore, ensure that
the requesting agency is willing to pay the appropriate
fee before the service is provided. The BMA have
suggested the following rates: Form IHA - initial health
assessment, preliminary examination of child £54.55
(£56.50) Forms M & B - obstetric/neonatal
report £42.20 (£43.70) Form AH - medical examination to
report on prospective parent £69.30 (£71.80) The fees in brackets have been taken
from the BAAF website.
Donna
Louise Trust
The Donna Louise Trust is at the
moment building a Children's Hospice at Trentham Lakes
and the building is well advanced. It is hoped that
children will be admitted for respite care early in 2003
and certainly by Easter 2003. The Professional Committee
of the Trust is formulating the medical needs of the
Hospice as regards General Practitioner cover and the
duties of a Medical Officer. If any practitioner has an
interest in becoming a Medical Officer of the Hospice
could they please contact Dr Gordon Carpenter at
Moorlands Medical Centre Dyson House, Leek (Tel 01538
399008) for further information.
Items from
the GPC
Countering
violence against GPs and their staff
Nigel Crisp (English DoH Chief
Executive) has given PCTs until 31 October 2002 to set up
action plans on how they intend to counter violence (i.e.
how and where to set up secure facilities for the
treatment of violent patients). Such plans should be
prepared in conjunction with LMCs. Nigel Crisp has reminded PCT chief
executives of this and also set a deadline of 31 January
2003 for implementing these plans. The GPC will be
undertaking a survey after 31 October 2002 to ascertain
whether PCTs have action plans in place and whether these
have been agreed with the LMC.
Childcare
The GPC negotiating team has been
pressing for funding for childcare provision in order to
recruit and retain GPs, and we continue to press for
this. The English DoH has allocated
several million pounds for childcare initiatives for the
whole of the NHS. We therefore need to ensure that a fair
proportion of this benefits primary care. We suggest that
LMCs liaise with their PCT childcare co-ordinator as soon
as possible on how much money they have been allocated
for this year and next year, and work to ensure that this
is spent in ways which will benefit local GPs and their
staff. Suggested ways of using this money include: · childcare vouchers to be used at
local crèches or for live-in help; · PCTs setting up and/or
subsidising after-school services at locations which will
benefit GPs; · PCTs setting up and/or
subsidising crèches in areas of convenience to GPs
(please note that where subsidised crèches have been set
up in some NHS trusts these may be at locations which are
too far away from many GP surgeries; we do however
recommend that LMCs seek agreement that, where such
crèches are in place, GPs nearby are eligible to use
them.) LMCs may have additional or
alternative ideas on how this money should be spent in
their area.
Out-of-hours
implementation
The out-of-hours regulations for
England were laid on 10 October and will come into force
on 1 November. We were previously concerned that
the regulations would apply to GPs doing their own
out-of-hours work, whether individually or in informal
rota arrangements, and to transferee doctors. These
concerns have been met, in that the final regulations
only apply to accredited service providers. The
Department’s guidance on out-of-hours is to be
amended to reflect this change. The final regulations contain
provisional arrangements so that providers who make an
application for approval on or before 1 December 2002 are
to be treated as accredited service providers until their
application is determined or any right of appeal has been
exhausted.
European
definition of general practice
The GPC welcomes the WONCA Europe
document - The European definition of general practice,
(which is available at
www.sgam.ch/pdf/Europ_Definition_GP_FM1.pdf) and strongly
recommends it as a valuable distillation of the role of
the general practitioner and the core competencies of the
job. Members of the committee felt that this document
reminded them of the essence and value of general
practice and suggested that it be disseminated as widely
as possible, in particular to the Junior Doctors
Committee of the BMA. Its clear vision of what it is to
be a GP could help attract more young doctors into the
profession, and provide a strong definition for the
profession at a time of constant change. One of the most welcome aspects of
the document was its emphasis on competency, rather than
time-based training for the discipline. This is
particularly topical, as discussions at European level on
the minimum training time for general practice are
reaching a crucial stage. The GPC continues to play an
influential role in these discussions through the strong
delegation it sends to the European Union of General
Practitioners (UEMO)
National GP
registrars conference - 2004 and beyond
With the success of the GP
registrars conference in July of this year, the GP
registrars subcommittee is keen to ensure that funding is
available every year in order to support its planning and
organisation. Next year’s conference on 3rd and 4th July 2003 is being organised by a joint consortium of the Midlands RCGP local faculty, the Defence Medical Services and a local vocational training scheme. However, for 2004 onwards the BMA will be seeking to work with the Royal College of General Practitioners to organise a joint venture to enable medico-political and educational issues to be tackled year on year. The GPC believes that the BMA and the RCGP can benefit greatly from being involved in this conference with a greater profile and recognition for the BMA, RCGP, GPC and the GP registrars subcommittee. Local GP registrars and RCGP faculties will also be involved in the planning stages. Assurances have been given that for
2004 and beyond, national GP registrars conferences will
be underwritten by the GP Defence Fund so that the BMA
can lead in their organisation and ensure that GP
registrars are given the opportunity to meet at a
national conference.
Coroners and death
certification review
It is widely acknowledged that
current coroners’ and death certification procedures
are out of date and no longer fit for purpose. An
independent review of the system has been released for
consultation (http://www.coronersreview.org.uk). Amongst other changes, the document
proposes the creation of a Medical Audit Service to
provide training and support for doctors and other
professionals involved in death certification. This body
would monitor and assess doctors’ certification
practices. It may also advise and make decisions in
individual cases where the doctor who attended the
patient in the last illness is unable to certify the
death. The GPC will be sending a response,
in which it will be stressed that a doctor is not
necessarily the most appropriate professional to confirm
the fact of death, and that encouraging other health
professionals to do this would be a desirable outcome. LMCs who wish to contribute to the
GPC response should send or preferably e-mail comments to
John Maingay at the GPC office at jmaingay@bma.org.uk
by Friday 18 November. Paul Golik Secretary |