Newsletter
Index
NEWSLETTER OCTOBER 2002Cauldicott Guardians and Reports The Commission for Healthcare Audit and Inspection (CHAI) Employing staff: important information IntroductionDue to illness of our lay secretary this newsletter will not be circulated in hard copy for a while. Therefore I ask those GPs who collect this from their email to ensure that all their colleagues receive a copy. Problems in MAUAs you will know the Acute Trust has been under
severe pressure with acute admissions recently. I, therefore, remind you
of the advice given last year, that whilst sympathising with their plight,
GPs have a duty to refer patients when their condition requires it. Not to do so is against our Terms of Service and I would not
advise any GP to put themselves in such a position. General Practice is also facing severe strain and we cannot take on the responsibilities of the secondary care sector neither should not deprive patients of the care they need by not referring them. Studies have always shown that the vast majority of acute referrals to the MAU are “appropriate” and so there is no leeway in this. If a hospital refuses to accept a referral the advice obtained by the GPC is that the GP should send the patient to the local Accident and Emergency Department with a letter of referral. This discharges the duty of referral under paragraph 12(2)(d) of our “Terms of Service.” Following discussion with the LMC, the trust and PCTs will in future just notify GPs of problems occurring in the MAU and not suggest that we should take any action to help the situation. Email is to be used for this notification as it is no doubt quicker and should be more efficient than fax. AllocationsThe number of patients who require allocation to practices has risen considerably in the past few months. With the increasing shortage of GPs and pressures on practices, closing lists is one way in which GPs can try to manage their workloads and increasing numbers of practices are resorting to this. We all realise that allocation causes stress in the system. The PCTs have tried to assured us that the process of allocation is as fair as it can be. The staff first look at the location of the patient, then look to see which practices have patients in the area of the address. Reference is also made to the order in which practices have been given allocations. It is not policy to split families and doctors who have a list size of over 3500, who are ill or about to retire are excluded. However, having seen data on the numbers allocated to each practice it appears that some modification of the system is necessary to make the process more equitably. We are continuing to discuss this problem with the PCTs. The PCTs are extremely keen to change the notification of allocations to a fax only system. The committee is resisting this and feel it is important to continue the present system of notification by phone. However, North Staffs Health point out that this is becoming very time consuming and that their staff are receiving verbal abuse from some practices. This abuse will not be tolerated and the Health Authority will be using fax notification to offending practices. AppraisalsDiscussions on the introduction of “Appraisals”
have continued over the summer and agreement has now been reached on the
framework for the process. However, there is some disagreement over the
payment to practices who wish to provide internal cover during the
process. 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 £300 from the PCT The LMC and
some PEC members feel that this latter figure 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 £300 is
inadequate. The GPC’s view is that GPs
will only be required to participate in appraisal when and if properly
resourced and supported appraisal schemes are in place Practices will, no doubt, come under pressure from PCTs to accept option 3, because it avoids the finding of a locum and is could be cheaper. GPs who do not wish to use this option will be supported by the LMC and GPC. Locum BankI recently circulated all doctors on the supplementary list enquiring whether they would be prepared to have their name included in a “locum bank”. We have received only seven positive responses to this request and a number some of these doctors are restricted in the hours or locations in which they will work. Details can by obtained from the LMC office. Any principal who is available to do any locum work could also be included. Please let the office know if you are in this position and wish to be included. Asylum SeekersThe problems surrounding the treatment of asylum seekers have been discussed at recent LMC meetings. We have tried to find out how many asylum seekers there are in the area, but surprisingly no one seems to know. Many thanks to all returned the circular sent out from the LMC. We received responses from 27 practices. These practices have between 0 and 383 asylum seekers, a total 938. Consultation times seem to be between 15 and 30 minutes on average. We are aware that there are some serious problems with the use of the language line. PCTs are arranging to train some asylum seekers as translators for their own ethnic groups although there have been delays with the implementation of this. We will now be discussing the way forward with the PCTs. Flu VaccinationsThe committee reluctantly agreed to the Local Development Scheme for the provision of vaccination to those in at risk groups under the age of 65. Our view remains that the fee should be equal for both groups. However, to reject this LDS would have meant colleagues not benefiting from the amount on offer and still having to go ahead with vaccination to meet good practice and patient demand. Hopefully the problems around this will be resolved if a new contract is introduced. Guidance for SolicitorsThe government has expressed concern at the burden placed on the resources of general practice when accident victims are advised to visit their GP by solicitors where no treatment or diagnosis is required but merely a note on the record of the injuries sustained. This problem was highlighted in the Cabinet Office report, “Making a Difference: Reducing GP paperwork”, published in May 2001 and a commitment was given to issue best practice guidance. The following guidance for best practice has been issued and is aimed at ensuring that patients only visit their GP when appropriate. 1) Solicitors should not automatically advise all accident victims to visit their GP following an accident unless they need diagnosis or treatment 2) It is not appropriate to advise accident victims to see their GP for no other reason than to have minor injuries recorded. This is not a service provided by the NHS 3) Where no diagnosis or treatment is sought, but the solicitor considers that a record of the injuries is advisable, for evidential purposes, other methods of recording the injuries should be considered first, for example: i) taking photos where the injuries are visible ii) the solicitor making a detailed note of the apparent injuries iii) referral to a forensic medical examiner or other appropriately trained doctor who has indicated that they are willing to provide this specialist service 4) Solicitors should consider the circumstances of each case and use their judgement about whether to advise a visit to a GP. Cauldicott Guardians and ReportsThe BMA’s legal department have confirmed that GPs are not required to appoint a Caldicott Guardian at practice level. All NHS organisations were required to appoint a Guardian from March 1999. However, GPs, being independent contractors, are not bound by these conditions. There should be a single Guardian appointed by each Primary Care Group, but within each practice there should be a nominated lead person for confidentiality and security issues. CHIThe Commission for Health Improvement is currently undertaking a series of clinical governance reviews of Primary Care Trusts. There will be a visit to North Stoke PCT early next year. Concerns have been voiced about the inspections and the processes in which GPs will be involved. According a document produced by the Cabinet Office “The clinical governance reviews will be focused on the Primary Care Trusts and the processes and systems that they have in place to assess and monitor clinical governance. CHI has committed itself to conduct several pilots that will be used to test their inspection procedures before the nationwide rollout. CHI have indicated that they do not expect the burdens on GPs to exceed 2 – 3 hours maximum in most cases. ”PCTs should not expect more from General Practices than is required. CHI is inspecting them, not us. WebsiteThere is a new address for the LMC website at www.northstaffslmc.co.uk Copies of the newsletter are posted on the website and I will try to post articles there has they arise rather than en-block at the time of circulation of the newsletter. Regional Evaluation PanelA vacancy has occurred for a representative on the Regional Evaluation Panel (a local NICE). Meetings occur four times per year and are held on an afternoon in Birmingham. Expenses and locum fees are paid. If you are interested in this post, further information can be obtained from the Regional Local Medical Committee on 0121 454 9677. MTRACThis committee is seeking a new chairman. This high profile post is open to practising general practitioners only. There is a £1000 quarterly honorarium. Ten meetings are held each year on the last Thursday of each month, except August and December, at the Birmingham Medical Institute. Again further details can be obtained from the Regional Local Medical Committee. I also have a copy of the Job Description and Personal Specification. A
few items from the GPC
GP
contract negotiations
Since the last GPC meeting in July, the work on the details and pricing of
the new GMS contractual framework has begun in earnest. In addition to the plenary sessions involving the full GPC and NHS
Confederation negotiating teams, the negotiations are being taken forward
via nine working groups and two sub-groups. Each group consists of members
of the GPC and NHS Confederation core negotiating teams, other GPC and NHS
Confederation members, observers from the four Departments of Health and
independent experts where appropriate. Many meetings have taken place so far and there are many more convened for
the coming months. Unsurprisingly, given the breadth and depth of the
negotiations in hand, the process is not easy.
Nevertheless, the NHS Confederation and the GPC negotiators believe
it is vital that we remain on course to conclude the negotiations and to
hold the second ballot in time for substantial implementation from April
2003. There is no doubt on either side that the resource allocation formula for
the global sum is critical and this is still being developed by York
University. Once this work
has been completed, significant progress can be made on the pricing of the
contract. The Committee expressed its considerable anxieties about the Government’s willingness to address GPs’ concerns given the current state of general practice. GP
appraisal
The committee expressed concern that many PCTs were unwilling and/or
unable to all allocate appropriate resources for GP appraisees. The
appraisal must be properly supported, otherwise GPs are not obliged to
participate in the process. Further details on the current appraisal situation are set out in the
September edition of the GPC negotiations bulletin. The GPC has also produced appraisal guidance In addition to
this, the following should be considered:
Please note that appraisal and revalidation are not, as yet, linked and so
GPs should not be pressurised into doing this work if it not properly
supported. Patient group directions
The GPC wishes to clarify their advice on PGDs. PGDs are a liberalising measure designed to enable health professionals
other than doctors to supply and administer medication to groups of patients who are not individually identified before
presentation for treatment (HSC 2000/026). PCTs themselves therefore need to sign PGDs in order to permit their own
staff to supply and administer medications in such circumstances. However, there has been a tendency for PCTs to put pressure on GPs to sign
up to PGDs due to a misunderstanding of this measure. This has created
uncertainty among GPs and their practice nurses alike, to the point where
some practice nurses are being encouraged to believe that they it is
illegal to carry out routine immunisations, such as influenza, on their
practice patients without a PGD being signed by their employing GP for
each and every medication. Our clear legal advice is that this is not the case. For independent contractor GPs and, in particular, their practice nurses,
there is no requirement to sign up to PGDs. Such PGDs are often very
complex and bureaucratic. The circumstances of GP practices are quite
different to those pertaining for the PCT itself. GP’s patients are
already individually identified before presentation for treatment by
virtue of being registered, either permanently or temporarily. Moreover,
in general practice, relevant medical records will be available to the
nurse at the time of presentation. GPs are already permitted to delegate
the supply and administration of medication to their practice nurses,
provided a clear instruction has been given, preferably in the form of a
simple written practice protocol GPs and practice
nurses should therefore be reassured that they may continue to supply and
administer to their registered patients medications such as influenza
vaccine, provided a clear written instruction or protocol exists, without
the need to sign up to a PGD. The
Commission for Healthcare Audit and Inspection (CHAI)
Following the budget statement in April, the Government has announced that
it will create a new health inspectorate called The Commission for
Healthcare Audit and Inspection (CHAI).
CHAI will incorporate the following functions
·
the NCSC’s
responsibilities for inspecting the private health sector
·
the Audit Commission’s
value for money studies in health With regard to
the last of these functions, members were of the opinion that CHAI should
have the same level of independence as the Audit Commission.
It is likely that the establishment of CHAI will form part of the
health bill at the end of this year.
The GPC will work closely with the BMA’s parliamentary unit to
pursue amendments to the bill and to seek reassurances of CHAI’s full
independence of Government. Employing staff: important information
Are you aware that you should offer the same terms and conditions of
service to all comparable staff regardless of whether they work part-time,
full-time or on fixed-term contracts? The Part-time Workers (Prevention of
Less Favourable Treatment) Regulations 2000
state that part-time staff who undertake comparable work to that of
full-time employees should receive similar benefits, including access to
training, as those enjoyed by their full-time counterparts.
Examples include pro-rata maternity pay and leave, pro-rata sick
pay, pro-rata annual leave and pension benefits.
Different treatment will only be lawful if it is for the purpose of
achieving a legitimate objective, for example, a genuine business
objective, it is necessary to achieve that objective and is an appropriate
way to achieve it. Similarly, the Fixed-term Employees
(Prevention of Less Favourable Treatment) Regulations 2002 look to
protect those working on fixed-term contracts and ensure that they receive
comparable benefits to permanent staff.
These Regulations come into force on 1 October 2002. The BMA’s legal department advises that it would be prudent to give all
staff access to similar benefits and where appropriate these should be on
a pro-rata basis for part time workers. We strongly advise that you reconsider all your contracts of employment to ensure that part-time workers and those on fixed-term contracts are offered the same benefits as those working full-time. Pharmaid week
The annual
collection of recent editions of the BNF will take place in the third week
of November. The need for recently outdated BNFs in the developing world
is desperate. The Commonwealth Pharmaceutical Association’s local
representatives will ensure that the books go to where there is most need.
Please keep copies of the BNF 42nd and 43rd
Editions. Give them to your nearest pharmacy that stocks AAH
Pharmaceuticals Ltd products (call Kay Collings on 02476 432453 for
details) in the week before 11 November. They will be collected from the
pharmacy at no cost. This year also sees the publication of the 33rd
edition of Martindale, so if you no longer require your old 32nd
edition, Pharmaid would be grateful to receive it. Paul Golik Secretary |
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