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Perhaps the most important thing to happen this month was our Annual Conference in London. This year we took our biggest ever delegation which perhaps reflects what a key time this is for general practice as a whole in this country (our delegates were as follows: Dr Bob Ingles; Dr Martin Ounsted; Dr Simon Parkinson; Dr John O’Driscoll; Dr David Lewis; Lisa Luke and Michelle Hallahan). The key part of the Conference was the opening which included the key note speech from Dr Laurence Buckman which received an unprecedented three standing ovations. He clearly outlined our unhappiness with the Department of Health and the Government over current policy particularly in regard to privatisation and the polyclinics and the GP Led health centres being set out in the Darzi Reform. It was a very determined speech and rather threw down the gauntlet. This was backed up by the wonderful news that over 1.2 million people had signed the petition on the NHS Birthday Card in only 3 weeks. The ongoing media coverage of this has clearly rattled the Department of Health and maybe the reason why their response has been so hostile.

 

Locally the LMC continues to raise this issue as much as possible and nationally we are promised more media coverage. It certainly is not over yet!

 

Overall we felt it was a very positive conference and there was a strong unity across the board and a determination that this time we are not going to sit back and allow things to happen which we profoundly feel are wrong. It is too fundamental for that. 

 

As you will all be aware the adverts have gone out and the tendering process will be starting shortly. We understand that there were a large number of expressions of interest but are not clear yet how many people formally applied to take over this service. However there does remain some confusion, even amongst people in the PCT about what this new health centre will provide and how this will be done. In fact the LMC is fascinated to find out that Herefordshire PCT have very sensibly rejected the black and white Darzi proposals but have been able to adapt them to provide something much more useful to the needs of the city of Hereford. It is a great shame our PCT did not have the insight to do this at the time but we have written to them again requesting that they reconsider the current proposals, particularly in the light of developments by our colleague just over the border into Herefordshire.

 

All practices should have now received the final documents from Heather MacDonald at the PCT. The LMC has agreed this and has very much welcomed the flexibilities the PCT has included but we remain of the view that this is an unnecessary procedure and we are bitterly upset on the way the Government has foisted this upon us. Interestingly the DES which was promised in June is yet to appear. One begins to wonder whether it will ever see the light of day and whether in fact the Department is quietly allowing PCTs to do their own thing. As you can imagine we will be watching with great interest. In particularly the issue of working on Saturday mornings is something the LMC is very concerned about. At our open meeting a great many of the GPS present said they felt that was a line in the sand  and that they simply did not wish to open again on Saturdays. The PCT is very much aware of our thoughts on this.

 

We have been trying to find out what is going on. The GPC and the Department are still in dispute over the Review Body’s interpretation of the new contract and the Governments implication and there is a strongly held view that what is suggested is illegal. However it appears that this award should be implemented for PMS practices. We have raised this with the PCT and have been shown the response they have had from the Department of Health advising them to do nothing whilst the main part of the reward is in dispute. We simply have no idea when and if this will be resolved.

 

New clinically DES’s are being looked at for enhanced treatment of heart failure; osteoporosis and health checks for patients with severe learning difficulties. There is also some work being looked at for harmful drinking and more complex ethnicity recording. We understand these are being discussed and when they are close to a final form, details will be sent out.

 

A number of LMCs in the area have been reporting strange phone calls to practices from market research organisations. We also understand that some patients have been sent questionnaires. Investigation has revealed that an independent market research company, GfK NOP has been commissioned to do a study amongst key NHS staff on behalf of the Department of Health. We have full information about this if anybody is approached. Certainly one Worcestershire practice has been contacted and the doctor found it far from clear who or what this was about. As you can imagine in the current climate this is regarded with some suspicion. If any practices are concerned they are welcome to contact the LMC office.

 

The GMC has clarified their regulations in paragraph 58 of the Good Medical Practice document. The existing guidance requires doctors to notify the GMC if, anywhere in the world, they accept a police caution, are charged with or convicted of a criminal offence or have had their registration restricted, or have been found guilty of an offence by another professional regulatory body. It makes clear that doctors do not need to notify the GMC about road traffic offences, where they accept the option of paying a fixed penalty notice. The guidance to clarify doctors’ obligation to tell the GMC about certain fixed penalty notices for other offences as well as including a duty on doctors to notify the GMC if they receive a warning for the possession of cannabis or are issued with Anti-social Behaviour Orders. For guidance look at: https://gmc.e-consultation.net/reportingconvictions.

 

We would like to remind practices that the BMA Partnership Agreement Drafting Service is up and running and we understand that well over 80 practices have so far used the service. The current price for this is £1,500 plus VAT and is provided by the BMA Legal department on 0207 383 6128 or email info.pds@bma.org.uk.

 

I continue to be stunned that so many organisations are happy to believe statements written by me on my stationery with my letterhead and not by the person who gave me the information in the first place. It is that time of year again when GPs are regularly asked to provide certificates for special consideration of examination performance. Basically GPs can only certify sickness if he or she actually saw the patient on the day in question otherwise the exam centre can certify the validity of the absence or the parent or patient can self certificate. There is no obligation to provide a short term certificate. The JCQ website includes details and also includes the appropriate documentation for patients to use. Patients should fill in application form 10 which is available near the end of the document. Form 14 is a self certification form which is also available there. This has a space for the doctor, nurse or doctors receptionist to fill in if they actually saw the patient. The patient or parent may also provide a medical report but this is not essential. As it is not a prescribed certificate, you are not obliged to provide a report and a charge may be made when the report is received. The website is as follows:

 

Whilst on this issue of “silly forms” the blue badge saga continues to irritate doctors all across the county. We are relieved to find out that the documentation from Worcestershire County Council continues to state “Please do not request evidence from your GP. If you are having problems supplying written evidence please visit your local Worcestershire Customer Service Centre for further information”.

 

Both they and the LMC agree patients should not be contacting their GP for blue badge forms.

 

Another area that irritates GPs is the provision of medicines for children in the early years foundation stage. Childcare providers currently have under the National Standards for Day Care and Childminding to give non-prescription medication when they have parents written consent. Family guidance for them has recently been rewritten by the Department for Children, Schools and Families. Therefore with written consent prescribed medicine can be administered. There should be no need for these organisations to write seeking letters from GPs.

 

The BMA Regional Council had an interesting meeting on the 18^th June at the BMA Medical Institute which started with a presentation by Steve Coneys, the Director of Communication and Public Affairs at the SHA talking about proposed changes and the Darzi Review. A number of GPs attended and heard a very political presentation clearly following the current party line. Interestingly the ten streams of work that has been done by the West Midlands SHA as part of the Darzi Review will be a major issue for each PCT. We tried to clarify how much PBC would have a role in this and we were left in little doubt that the central targets will be the key areas for PCTs regardless of the needs of localities. We tried to question Mr Coneys on our concerns about the inappropriateness of the GP Led Health Centre and he simply was not prepared to engage in any discussion about this. At the end of the meeting there was a vote on our confidence in the Darzi Review, the process and the implications and there was almost no support for it whatsoever from the doctors present who came from a range of different crafts and were not just GPs. If you are interested in looking at the work that has been done it is available on the West Midlands SHA website. The National Darzi Review is due to be published on the 30^th June.

 

The PCT have informed us that there may have been instances around the country where doctors have signed forms B or C without having seen and examined the body of the deceased after death. We have been asked to remind you that this is a criminal offence under the Cremation Act 1902 with a possible punishment of up to two years imprisonment! Furthermore the GMC is likely to view this as a serious misconduct on the completion of form B or C with a statement the body has been seen when in fact this was not the case.

 

The Society has been reformed and Dr Lesley Smallman has taken on the role of Secretary. If anybody who is interested in joining the Society should contact her at the following address:

 

Dr Lesley Ann Smallman

Secretary

Pint Bar Cottage

Foredraught Lane

Tibberton

Worcestershire   WR9 7NH

Email : rob.grimer@btopenworld.com

Fax: 01905 345601

 

At the last LMC meeting a number of issues were raised.  It appears that no progress has yet been made on revising the INR LES but that meeting is taking place shortly to discuss this in more detail.  We have raised concerns about the change in the anticoagulation service at the Alexandra Hospital.  There was a long discussion about the Choose and Book LES which met with a lot of criticism from LMC members. Clearly Choose and Book does not work in Worcestershire and the fault for this lies with the Acute Trust who are not putting appropriate slots on the system. Simon Haresnape from the PCT was present and I think was left in no doubt at the concern of GPs about the failures of Choose and Book and also the LES. Interestingly he told us that Worcestershire were the champions in the West Midlands with the worst failure rate for Choose and Book at a stunning 50%. How the PCT believes it will reach a 50% target of Choose and Book usage by September is beyond us. Many practices are simply giving up because of the failure rate and lack of appropriate slots. He assured us that additional slots are being put on the system but we have no evidence to support this as yet. 

 

The LMC also discussed the Out of Hours Service which will be taken over by TCN in September. Practices have been invited to their open meetings. Members who have attended felt they were not given very much information. Apparently the number of doctors at night will remain the same at three with a nurse practitioner but during the day there may well be less doctors working and more emergency care nurses. We have invited a representative from TCN to attend the September meeting and brief the committee about this. One good note however is that different software will be used instead of Adastra which apparently is much more user friendly. We will obviously be watching the developments of the Out of Hours service with great interest.

 

The Secretary has already met Trevor Netherway who is the new Acting Head of Primary Care. He has moved here from Gwent on a six month basis although he has indicated that he will be applying for the substantive post which is currently being advertised. He will be attending the next LMC meeting on the 3^rd July to meet members. The LMC had started to build up a very good working relationship with Andrew Hughes and we do hope we will be able to continue along that road with Trevor. He is currently on an induction process and has been made aware of the current outstanding issues which will be lying in his intray.

We have been informed that at least one insurance company is contacting practices and stating that consent has been received from the patient but this has been a verbal consent that has been recorded by the insurance company. We have some concerns about this and have raised this with the BMA. The Chairman of the Professional Fees Committee is saying that the BMA has not been consulted about this and they are now taking this up with the Association of British Insurance Industry.  The insurance company is apparently saying to GPs “If you would prefer not to provide the report on this basis we could either ask your patient to call you or alternatively write to them requesting written consent, however, this will delay the application process.” Until something more definitive is agreed we would advise GPs to do that and explain to patients that this has been foisted onto them by the industry.  The BMA is very keen that they don’t start to receive complaints about GPs being difficult.

 

I’m afraid it’s that time of year again when we have to review its finance and expenditure and set a levy. We are rather late because we have not had the figures from the GPC until recently and the GPC Levy is a major part of our expenditure. The LMC has also been through a process of reconsidering our payment scheme for all the doctors who do work for the LMC including the Secretary. A small committee of LMC members put forward a proposal and have come up with a formula whereby doctors will be paid a sessional rate which correlates with GP earnings and so practices will not be out of pocket. This has been put to the committee and agreed. On this basis the levies for next year will be as follows:

Statutory Levy: 26.52p; Voluntary Levy: 6.07; Total Levy: 32.59p per patient.

 

We hope that you all value what we try to do on your behalf and that you will continue to support your LMC.

 

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

 

 

 

 

 

 

 

 

Press releases:

 

 

 

 

HMRC:

 

Worcestershire Safeguarding Children Board: