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Just in time for our July meeting the Government produced its long heralded White Paper. There is so much to take in and digest with this that we only touched on the surface at our last meeting and will no doubt will be discussing this further at the next meeting. Many of us were surprised at how radical a document this is. We should remind everybody that this is a consultation document and that a further series of government papers are due out in the coming weeks. The end of the consultation period is October and it is more than likely that some of these proposals will be modified during that period. It may well be appropriate for now to start at least thinking about the future but we should be mindful that the definitive proposals have not yet been published. There are already lots of questions coming forward and it is for LMCs to feed these back to the GPC so they can be part of their discussions with the Department of Health and the Government. 

 

Perhaps the most important thing for GPs is to read and study the documents and start to consider how individual practices will fit into the new NHS. It is important to remember that this is not Fund Holding mark II and that this time it will be compulsory. Contractual and commissioning payments are however completely separate. In the meantime we have been forwarding to practice managers any useful documents that we have been receiving. As always your feedback will be most welcome. 

 

This very large document was only published on Thursday, 15^th July and is available on the CQC website.  The report includes a summary but the main document is devised into three documents. Part one deals with the death of Dr David Gray, part two deals with the issues of Take Care Now and provision of out of hours services and part three relates to commissioning and monitoring of out of hours contracts by PCTs. There is a whole chapter devoted to Worcestershire that makes very interesting reading. The LMC takes no pleasure in saying ‘I told you so’ but our actions in this matter have been totally vindicated. There are a number of issues included in this document about which we are most unhappy. In the next few weeks a sub-group of the committee will be reviewing this paper before deciding on our formal response. It does make sobering reading and clearly there are some very important lessons to be learnt locally and nationally. 

 

Of particular concern to the LMC is the fact that nobody will eventually be held accountable for the actions of TCN. This cannot be right. If an individual doctor in practice had performed in this way they would find themselves in front of the GMC. The committee finds it very bizarre that a private provider seems to escape this scrutiny and sanction. We believe this issue has been discussed at BMA and LMC Conferences but this is a clear example of this iniquitous situation.

 

The GP Management Board has produced a questionnaire which will be sent out in the next month to all GPs in Worcestershire. It is a very simple document but this is one of the three key performance indicators on which the Management Board are assessing the performance of Harmoni. A decision on the long term future of our Out of Hours Service will take place at their meeting on the 7^th September. We would strongly encourage everyone to complete this questionnaire. KPIs that have been agreed are as follows:

1)      The actual number of GP hours worked in July and August 2010 should be 95% of planned hours based on the GP hours for July of 2992 and August 3158.

2)     The number of GP hours covered by agency doctors working less than 8 hours per month in July and August should be 10% or less of the total GP hours worked.

3)     An Out of Hours satisfaction survey of practices will be conducted by an independent organisation. The intention is to specify an agreed response rate by GPs and an expected satisfaction rating for this KPI.

 

Harmoni have had real problems obtaining a controlled drugs licence for the Out of Hours Service. This has been due to Home Office bureaucracy and has been entirely outside of their control. For that reason we have been asked if we will highlight to all GPs the need for terminally ill patients to have their rescue medications prescribed and supplied at an early stage. A particular example is the current lack of supplies of Medazalam for Out of Hours doctors.

 

It seems very bizarre that just before the General Election, work took place on the transfer of community services out from the PCT. Those plans have changed and further work is being done on how this will take place in the new NHS. The LMC has been concerned that work seems to be taking place to reorganise Community Nursing Services. We raised this with the Director of Provider Services and have had a letter reassuring us that they have no intention of altering nursing services without discussion and agreement with Practice Based Commissioners exactly how the Community Nursing Services should be provided. The transfer of the Provider Arm Service to another organisation is of major importance to general practice. We strongly believe that no decisions should be taken without wider GP community having had the opportunity to comment and discuss this.

 

The ongoing saga of requests for GP reports continues. The latest comes from Worcester City Council who has been writing to GPs asking for reports and saying that they cannot pay for them. We have had assurance from the Head of the Strategic Housing Services that on the rare occasions that they do request a report this will be sent with consent and an agreement that the practice fee will be paid for. A copy of their letter is on our website for your information.

 

Dr Creaney, the Director of Medical Development at Worcestershire Mental Health Partnership Trust has written to the LMC advising us that as part of the development of the Primary Care Business Unit they are looking to recruit an interested GP to act as Lead Clinician for that business unit working alongside Kate Glenholmes, the Business Unit Lead. If anybody is interested in this position they might like to contact Kate Glenholmes at the Mental Health Trust at Isaac Maddox House. 

 

The LMC is grateful that Dr James Rankin is leading up for us on this work with the PCT. It is as yet unclear how significant these PNAs will be. Questionnaires will be sent out shortly and in September the draft Pharmaceutical Needs Assessment document will be presented. This is supposed to be a three year document but how this will fit into the changes in the NHS is not yet clear. We are taking advice from the GPC sub-committee about this and if it appears the process could result in significant changes to pharmaceutical services in Worcestershire (including GP dispensing) we propose to hold a special meeting in September.

 

Despite raising our concerns about the very slow roll out of MSDi at the last GMS/PMS meeting little progress seems to have occurred. The LMC is very grateful for the quick response to our snap shot survey which resulted in 42 replies. 33 of those practices have had MSDi installed but only 13 were confident that it was working properly. 14 said it was not working at all and the others were not sure or felt it was not working correctly. Most worryingly only 7 had received some sort of training and this seemed rather limited. We are aware a training session is organised for August. Considering the LES started on the 1^st April this slow implementation is completely unacceptable. Prior to its roll out all these issues were raised by GPs at the GMS/PMS sub-committee and we were reassured it would all work as planned.   Additional concerns have been raised by GPs regarding security, governance issues and confidentiality matters. We have again raised these with the PCT and asked if this issue can be put on the Agenda for the next GMS/PMS sub-committee. The way things are going we will be half way through the year before practices are even able to start doing this work!

WORCESTERSHIRE LMC WEBSITE

The following guidance has been added to the LMC website during the last month:

 

 

NHS White Paper – letter to all GPs in England.