NEWSLETTER OCTOBER 2007
Confidentiality and disclosure of information
Accepting donations from patients
GP involvement with the Health Screen Clinic
Self-care and patient participation
Choice Read codes for the 2007/08 Choice and Booking DES
GP patient survey and Choice and Access DESs 2007/08
Access
The figures published in the recent "access" survey show that a few practices in North Staffordshire fall into the worst 10% in the country for access. Whilst the LMC feels that there may be inaccuracies in the survey the findings are generally supported by the experience of the PCTs in their contacts with the practices concerned. These practices will be contacted by the PCTs shortly and expected to improve their access to services.
Given the current political climate all practices are encouraged to look at their accessibility and where possible improve the situation. PCTs have been asked by the Strategic Health Authority to look at a number of ways on improving access to primary care. Needless to say some of the methods suggested would radically alter the way primary care is provided.
Whilst the majority of practices do not have major problems with access those that do will need to look at the management of their systems to improve access. The LMC debated this issue at its last meeting and the feeling was that practices who need to improve should do so within existing resource allocations unless they have serious resourcing problems which put them out of line with neighbouring practices. The committee also agreed with the PCT view that practices who do not offer good basic medical services should not be considered for the provision of additional services such as GPSI services and intermediate care.
Pandemic Flu Planning
Discussions will be taking place in the near future with PBC clusters on the planning for a potential flu pandemic. North Staffordshire and Stoke-on-Trent PCTs are working together on this to provide a North Staffordshire plan. A lot of work has already gone into this and it has been suggested and agreed in principle by the LMC that should an epidemic materialise, patients with flu like symptoms should be managed by a North Staffs Agency. This would relieve practices of the burden of dealing with the majority of flu cases, apply a consistent approach and provide relief for practices whose staff and doctors go down with the illness. It would leave practices free to deal with other urgent medical problems which will continue to present during a flu pandemic. It has been suggested that practices should provide a proportion of their staff to the running of the agency. The expected nature of any flu pandemic makes it unlikely that robust enough plans could be developed at a PBC cluster or practice based level.
Practices will need to consider their own planning for a pandemic, including which services they could safely suspend and how to deploy/train their staff to ensure that the roles of key personnel can be covered in the case of absence. It is difficult with the present level of knowledge to produce precise plans but having the framework in place will help when the need arises for more action.
GP Systems of Choice
Eight suppliers have been awarded a GP Systems of Choice (GPSoC) Framework Contract by NHS Connecting for Health (NHS CFH) following the procurement process initiated in February 2007. The first five suppliers have already signed contracts and the remaining three should sign over the next month. This Framework will provide practices with a choice of upgraded GP clinical systems from NPfIT alongside the systems offered by the Local Service Providers.
The award of contracts paves the way for Primary Care Trusts and practices to start taking up the new services under the GPSoC contracts and will provide practices with a choice of accredited clinical systems whilst formally bringing the existing GP clinical system suppliers into the National Programme. NHS CFH will ensure that all suppliers, whether on the GPSoC framework or as an LSP, deliver applications into general practice to ensure that patient care benefits can be realised quickly and efficiently
More information and guidance about the services and products available via the national contracts and how the NHS can access these are available at: http://www.connectingforhealth.nhs.uk/gpsoc
The web site has been developed as a guide to help understanding of
the activities needed to progress, and the reasons behind, GP Systems of
Choice and a full guide can be downloaded in pdf format.
CfH anticipate that this will be the first point of contact for any
guidance or questions you may have as the site will be updated regularly
with the most up-to-date information as the programme commences.
The eight suppliers awarded contracts for the GPSoC framework are: CSC Computer Sciences Ltd (providing TPP’s SystemOne), Egton Medical Information Systems Ltd (EMIS), Healthy Software Ltd, In Practice Systems Ltd, iSOFT plc, Microtest Ltd, Seetec Business Technology Centre Ltd, Waveform Solutions Ltd.
The LMC has serious reservations about moving in this direction at the current time. The problems we are experiencing with Choose and Book and eprescriptions suggests that we should take a cautious approach to any suggestion that our patients records should be hosted outside our surgeries. Colleagues need to think very carefully before signing up to this initiative.
National Diabetes Audit (NDA)
Practices will soon receive a letter regarding data collection for a National Diabetes Audit (NDA). The NDA is developed and delivered by the National Clinical Audit Support Programme (NCASP), which is part of the Information Centre for health and social care. The audit provides an infrastructure for the collation, analysis, benchmarking and feedback of local clinical data to support effective clinical audit across the NHS.
The GPC have seen this letter and support the change of process and the NDA’s information governance controls. Data will be extracted via Apollo software that will facilitate the required report run, this process will not to add to practice workload in any way - in previous years PCT staff have had to visit practices to run MIQUEST queries for the data extract. The NDA has PIAG approval to collect the data required to conduct the audit. The query will also recognise those patients that have opted out of audit involvement and no data will be collected for these patients. Additionally we have been reassured that no patient or practice data will be released to anyone outside the NDA and that no information will be passed to PCTs in a practice-identifiable form.
It is also worth noting that this audit is completely different to the Healthcare Commission Diabetes survey which was issued last year. Practices can opt out of this audit if they wish to.
Ambulance Service
On 1st July 2006 ambulance services in England were re-organised to form larger Trusts. In the West Midlands this merged Coventry & Warwickshire; Hereford & Worcestershire and the old West Midlands and Shropshire Ambulance Services together to form the new Regional West Midlands Ambulance Service. Staffordshire Ambulance Service was not included in this amalgamation initially but they will join the West Midlands Ambulance Service on 1st October 2007. The new trust is looking at the way it deals with 999 calls and dispatches vehicles to the scene of emergencies. The present system is working closed to capacity at times with little or no reserve should a call centre become inoperational. The service has produced a consultation document on the re-configuration of its emergency operations centres. It is proposed that the existing system of five centres is replaced with two regional centres, one at Brierley Hill and the other at Stafford, along with a support centre in Leamington Spa. The centres would use state of the art technology to allow them to operate as a "virtual" operations centre allowing calls to be passed between centres if one centre was busy, it would also allow all centres to communicate with and pass calls to any ambulance service vehicle within the West Midlands.
Confidentiality and disclosure of information to PCTs in primary care settings
The BMA has produced guidance which covers confidentiality and disclosure of patient identifiable information to PCTs for secondary purposes when the data are held by contractors/GPs who provide or perform general practice services. A copy of this document can be found here.
Choice and Booking DES - use of Choice Read Codes
The arrangements for measuring the Choice component of the 2007/08 Choice and Booking DES have yet to be finalised but achievement is likely to be measured using the GP patient survey, with sampling based partly on data extracted using the new Choice Read codes.
The following Read codes have been available since October 2006:
9kK.. Choice and Booking – enhanced services administration (4 byte and version 2)
XaMJa Choice and Booking – enhanced services administration (version 3)
222711000000102 Choice and Booking – enhanced services (SNOMED)
These are designed to record patients who have been referred for a first consultant outpatient appointment to a service where Choice is offered.
Most practices will not be using these yet but should start doing so as soon as possible if they wish to participate in the Choice element of the DES. Practices will receive a letter from the Department in the next few days about the use of these codes.
It is important to note that if practices choose not to use the new Choice Read codes they will be ineligible for the Choice payment.
Accepting donations from patients
This is an area which is governed by both contractual and ethical perspectives. Both emphasise the need for transparency and accountability when considering accepting donations from patients. The BMA has produced some guidance on this which can be found here.
VAT on Medical Services
As you know, from 1st May this year doctors who are registered for VAT had to charge this tax on medical reports (for which a fee is payable) supplied to the Department for Work and Pensions (DWP). There are no changes for doctors who are not VAT registered. Most of these reports will be requested by the Disability and Carers Services (DCS) in relation to claims for Disability Living Allowance and Attendance Allowance.
In order to add VAT to the fee the DCS need to know whether the doctor is VAT registered. The reports where VAT is chargeable are:
 | GP factual report |
| DS 1500 |
In order to facilitate these changes the DCS have made changes to their fee claim form (DBD36) which accompanies the GP report. Section B4 has been updated and will now include a section asking whether the doctor is VAT registered and if so to give their VAT number. Whenever this section has been completed the DCS will add VAT (at the standard rate of 17.5%) to the fee.
The fee claim for DS1500 is included
with the pack of forms. These forms are being amended in the same way as
the GP fee claim form for the factual report. However doctors may
already hold stocks of these reports and accompanying fee claims. In
such cases the DCS has requested that doctors should write their VAT
number on the fee claim or alternatively attach a VAT invoice. Whenever
this additional information is supplied VAT will be added to the fee at
the standard rate of 17.5%.
Further guidance regarding VAT
on Medical Services can be found on the BMA website
http://www.bma.org.uk/ap.nsf/Content/VATonmedicalservices or by
clicking on to the "doctors' fees" link from the BMA website homepage.
Further guidance regarding the
completion of forms and certificates for the Department can be found on
www.dwp.gov.uk/medical.
GP involvement with the Health Screen Clinic
The GPC is aware that a company called Health Screen Clinic has been targeting practices in different regions with regard to its screening services. The company involves the practice by paying a fee to rent space at the weekend to carry out in particular Abdominal Aortic Aneurysm screening. It also involves the practice in sending out letters to the target group of patients, on practice headed paper, inviting them to take up this private screening service.
The GPC has asked LMCs to warn all practices in their area of the significant risks they take should they involve themselves with this company and its current business model.
- The practices could be deemed in breach of their GMS or PMS contract for breaking regulation 24 in relation to fees and charges, as they are receiving an indirect fee for their involvement in letting this private company screen their patients. The level of involvement in the company’s operations and the payment of a fee for rent, means that this goes beyond any allowance to rent practice space to an individual practitioner or company as permitted in the Premises Directions.
- The practices are in breach of the Data Protection Act. They hold patient data as part of their NHS contract. It was never intended, and patients are not aware or indeed have consented to their personal data being utilised for the purpose of advertising private services.
- The practices could be deemed to be in breach of the GMC’s Good Medical Practice (probity guidance) and therefore may be open to ‘fitness to practice’ procedures.
Salaried GPs
The GPC has produced a revised version of its guidance on salaried GPs. It now includes a detailed legal view on calculating entitlement to maternity pay, sick pay and redundancy pay for those employed under the model salaried GP contract. The "Focus on salaried GPs" document can be found here and the redundancy guidance here.
Items from the GPC
Sickness certification
In 2007, LMC Conference passed the following resolution “That conference believes that the time has come for a revision of the medical certification system, such that patients seen by other healthcare clinicians may be issued medical certificates without recourse to a GP.”
The Department of Work and Pensions (DWP) rule that only a ‘registered medical practitioner’ can issue official statements of a person’s incapacity for work. A sickness statement is not mandatory for either a claim for statutory sick pay (SSP) or incapacity benefit (IB), but is part of the evidence required to support such a claim. The DWP is aware that other practitioners do provide non statutory certificates and that these are accepted by employers and the DWP.
The GPC has continued to work with the Cabinet Office with regard to reducing bureaucracy and has been involved over the past year with the DWP initiative Health, work and well-being, but there has been no movement to change the rules about who can issue sickness certification.
It is imperative that delegation of this function by a GP to a non-doctor member of the practice team must benefit both patients and the profession, and that the responsibility should be kept within the practice team. GPs continue to play a key role as patient advocates, and this relationship should not be weakened, however appropriate delegation and the ability of the person who is managing and treating the patient to issue an appropriate statement can only be beneficial to patients.
The GPC will continue discussions with DWP and related organisations to implement this policy. The long-term aim to improve sickness absence management will also require further investment in good occupational health services.
Self-care and patient participation
Following initial discussions at the GPC meeting in March 2007, the GPC and the BMA’s Patient Liaison Group (PLG) have issued a policy paper entitled 'Improved self care by people with long term conditions through self management education programmes'. The paper, which looks at self care for people with long term conditions with a particular emphasis on self management education programmes, is available through the following link:
www.bma.org.uk/ap.nsf/Content/selfmanagementpolicy
The GPC and the PLG have also launched a web resource which, coupled with the policy paper, aims to support doctors in helping patients to self-manage their health and improve their condition. The resource will be updated as further material becomes available and can be accessed through the following link.
www.bma.org.uk/ap.nsf/Content/selfmanagementresource
Formula review report
The joint GPC/NHS Employers report on the outcome of the consultation on the recommendations of the review of the GMS global sum formula for England and Wales was published on 10 September.
The report followed a three month consultation to seek the views of GPs, PCOs and other stakeholders on a number of proposals to change the formula. It is the result of over 18 months of work in which the Formula Review Group (FRG) conducted a detailed examination of all factors in the current General Practice funding formula and investigated a number of additional factors for possible inclusion in a revised formula.
Not surprisingly, the outcomes of the consultation showed marked differences between GPs and PCOs in their attitudes towards a revised formula to decide on basic practice funding. In the present financial and political climate, it is clear that a very small minority of GPs want to proceed to implementing its findings at the moment, whereas most managers seem relaxed about the damage that such a change might make to practices.
The FRG’s report will be submitted to the health departments who will consider how, when, or if at all, they wish to see the recommendations of the formula review group taken forward. We have made it very clear that the GPC would only consider implementation when the time was right.
Choice Read codes for the 2007/08 Choice and Booking DES
It was agreed last year that codes would be developed for identifying a survey sample population for the Choice aspect of the Choice and Booking DES this time round. We were informed at a GP Patient Survey board meeting the codes to be used with each referral for the basis of the sampling method. In order to ensure that GPs could start using these codes as soon as possible, we wrote to GPs on 9 August setting out the details of the codes to be used. The codes should have been used from 1 September. However, following this letter, there were a number of queries raised in relation to the use of these codes.
There has been a lot of confusion among GPs about the use of these codes, particularly confusion between the ‘Choice’ and ‘Choose and Book’ aspects of the DES. It is important to note that GPs only need to use the codes for the choice part of the consultation. These codes allow the patients who have been identified as having been referred for a first consultant outpatient appointment which is subject to choice by a GP for inclusion in the survey. These codes have nothing to do with Choose and Book. There was also some disquiet that practices had been using other codes for choice referrals and that the introduction of these new codes required practices to change the codes used. Further questions were asked by practices about which of the three codes detailed in the letter should be used.
GP patient survey and Choice and Access DESs 2007/08
The GP patient survey board has continued discussing the operation of the survey for 2007/08 and evaluating the process from last year. Essentially there will be no change made to the survey questions at all this year and very little change to the process. One important change concerns the use of Choice Read codes for the 2007/08 Choice and Booking DES, as detailed above. The choice element of the Choice and Booking DES will, from this year, be included in the patient postal survey and we are in the process of clarifying the sampling methods that will be used.
The SFE amendment directions which introduce the two new sections to the SFE reflecting the carrying forward for a further twelve months of the Improved Access Scheme DES and the Choice and Booking DES were released by the Department on 3 August 2007. These are available here:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_077188
National Diabetes Audit (NDA)
The NDA is developed and delivered by the National Clinical Audit Support Programme (NCASP), which is part of the Information Centre (IC) for health and social care. The audit provides an infrastructure for the collation, analysis, benchmarking and feedback of local clinical data to support effective clinical audit across the NHS.
This audit has taken place for some years but, this year, the process for data collection has changed. It was agreed that the data would be extracted via Apollo software that would facilitate the required report run - in previous years, PCT staff have had to visit practices to run MIQUEST queries for the data extract. We did meet with the IC prior to the letter detailing the change in process being sent to all practices. We were assured that the NDA had PIAG approval to collect the data required to conduct the audit, and that the query would recognise those patients that have opted out of audit involvement and that no data would be collected for these patients. Additionally we were reassured that no patient or practice data would be released to anyone outside the NDA and that no information will be passed to PCTs in a practice-identifiable form.
We are aware that, despite these assurances from the IC, practices remain concerned that a query has been installed on their computers without prior consent being given to Apollo and that identifiable patient data will be taken from the practice system by Apollo medical systems, without explicit patient consent when it is not intended for direct patient care. There is also concern that practices can only opt to have data removed from the audit analysis after the extraction has taken place.
We raised these issues directly Apollo and have had discussions which, we believe, confirm that appropriate legal and confidentiality approvals are in place. This is a very sensitive issue and we understand the need of LMCs and practices to be fully informed about consent and confidentiality issues before practices feel comfortable having data extracted. We will continue to work with Apollo, through the IT committee, to ensure that these concerns are addressed in future including communication to practices, the ability of practices to opt out if they are not content to participate, and appropriate consent models. We are also working on some Q&As to address some of more common queries with regard to extraction of data by Apollo.
Workload survey
The 2006/07 UK General Practice Workload Survey was published on 31 July. The report was produced by the Technical Steering Committee (TSC), which includes representatives from the four UK health departments, NHS Employers and GPC. As the survey was targeted at work in the practice it excludes work done elsewhere as well as any work identified as out-of-hours (OOH) not relating to the GMS/PMS/ PCTMS practice contract. Staff in a representative sample of 329 practices across the UK completed diary sheets for one week in September or December 2006.
There were some attempts to compare these results unfavourably with those of the last major survey carried out in 1992/3. Direct comparison of the two surveys is difficult because they were carried out in very different ways and measured different aspects of workload. In particular, the 1992/3 survey included out-of-hours work, which was not recorded in this survey. There have also been significant demographic changes in the GP workforce in the last 15 years, not least the increase in part-time working, employment of salaried GPs and changes in skill mix.