WORCESTERSHIRE LMC LTD
NEWSLETTER
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NEW HEAD OF PRIMARY CARE
The LMC met for the first time and welcomed Linda Dando to our meeting. She is the new Director of Primary Care and just in post. Prior to working here she had similar roles in South Gloucestershire and Herefordshire. We look forward to establishing a good effective working relationship with her to try and take forward the primary care agenda within the PCT. We are also pleased to find out that the PCT have now appointed two more commissioning and contracting managers. We hope this will allow them to re-establish the good links that practices need with their PCT. A major issue for the PCT will be the roll out of World Class Commissioning.
PCT ISSUES
The LMC has discussed further at this last meeting the INR LES and we hope that this will finally be ready for perusal by practices shortly. Clearly the PCT needs to know how many practices are going to take on this work to organise the changeover from secondary to primary care. There are a number of issues relating to the range of LES’s on offer that needs to be resolved and also the process for production of new schemes in the future.
The take up of the Extended Hours DES remains a big issue for the PCT. They have to have a 50% implementation target by the end of the year. The LMC understands that the take up of the DES and the DES Plus is so far low. We have continued to express our view to the PCT that the biggest obstacle in the way of this is the lack concurrent working by a doctor or nurse. The LMC believes that Worcestershire appears to have been unfairly picked upon by the Strategic Health Authority. Clearly interpretation of the DES and the regulations is different around both the West Midlands and nationally. We will continue to discuss this with the PCT.
GP EDUCATION MATTERS
Dr Schrieber informed the committee that the Deanery is trying to encourage practices to take on more learners but that there have been very few bids. Money is available for equipment and structural changes and currently figures between £1-£5,000 are on offer although this might be increased if there is a specific need. Currently work is taking place on new contracts which will be with the practice rather than with the trainer. The LMC also brought to his attention a letter that was sent out in August from Viv Tsesmells, Director of Operations at the SHA regarding a provision of indemnity for GP training practices. This has caused some real concern and we are led to believe this has been an ongoing problem for some time. We have raised this with GPC West Midlands and this will be discussed at the next meeting of that committee as this is clearly an issue across the whole of the SHA.
PHARMACY WHITE PAPER
We had a very helpful open meeting on the 10th November attended by a large number of GPs from across Herefordshire; Gloucestershire; Warwickshire and Worcestershire. Dr Russell Walshaw who leads on these matters at the GPC gave a very clear and helpful presentation which certainly put everything in perspective. Our LMC submission has gone forward and we are grateful to Dr James Rankin for putting this together. (It is on our website).
PREVALENCE
As you are already aware the GPC has agreed with NHS Employers that the current prevalence arrangements used in determining QOF payment payments will move to true prevalence. In view of concerns of this we have already emailed to practices some information about this and the link to the BMA website where there is a spreadsheet which allows you to calculate the impact of change on individual practices. This is available at
www.bma.org.uk/ap.nsf/Content/QOFPrevalence. The department of health has issued guidance to PCTs stating that they should work with practices which identify themselves as experienced a significant loss to their income to understand the impact of the changed arrangements on their current service provision. We would encourage all practices in the coming weeks to go through this process and estimate how their QOF income will change. Should there be any practices seriously affected by this please contact the LMC.
We strongly encourage all practices to do their calculations as soon as possible. Already we have identified one practice that will lose significant sums of money due to these changes. The LMC has already raised this with the PCT.
MPIG
Continuing investigations are taking place into the inexplicable reductions apparently experienced by some practices last month. It was thought that there was a fault in the Exeter system but further analysis has shown that the system is working correctly. The BMA’s Health Policy Economic Research Unit is analysing specific individual practice data to make sure they have understood the process and that they believe they have come up with an explanation for this. The BMA is confident that the SFE is working correctly and further guidance and information is expected shortly. If any practices have noticed any significant changes to MPIG please can you let the LMC know.
QUALITY AND OUTCOMES FRAMEWORK
The Department of Health has recently published a consultation document entitled ‘Developing the Quality and Outcomes Framework: proposals for a new, independent process’. NICE leads the new process, overseeing the review and development and that there may be some local PCT indicators that would reflect local priorities. Many of us have real concerns about both aspects of this. A consultation process is available and the LMC will be discussing this at the next meeting. Full consultation can be accessed at
INTRODUCTION OF VERBAL CONSENT FOR EMPLOYMENT AND SUPPORT ALLOWANCE (ESA) CLAIMS
The Department of Works and Pensions have introduced verbal consent for the release of medical information from GPs in claims to the new Employment and Support Allowance. The Information Commissioner and the GMC have advised the GPC that they find these proposals and safeguards acceptable and so GPs should continue to accept the assurances from the DWP officer that consent has been given. The introduction of the Employment and Support Allowance will mean the following:
- GPs will still be asked to provide statements of incapacity for work until the Work Capability Assessment is carried out, which is usually within the first 13 weeks of a patient’s claim (Meds 3, 4 or 5).
- GPs may also be asked to complete form ESA113. This is similar to the old form IB113 and can be completed from medical records. GPs are not required to carry out a separate examination on their patients.
- GPs may also be asked to complete form DS1500 to provide information about patients who are terminally ill or who are not expected to live longer than 6 months. This is a factual report in which GPs provide details of their condition and any current, planned or future treatment. GPs are not expected to give an opinion on prognosis or life expectancy. A fee of £17 is available for completing a DS1500 and VAT registered practices should also charge VAT on top.
At present there are no changes to the arrangements whereby the DWP obtain information for Disability Living and Attendance Allowances on DBD series forms for which the DWP pay £13.50 and, where appropriate VAT.
HOW YOUR PRACTICE IS FUNDED
The GPC has published guidance on practice funding to help GPs; Practice Managers and LMC staff understand how individual practices receive funding under the GMS Contract. The guidance is UK wide and can be found at the following:
CHANGES TO CREMATION REGULATIONS
The Ministry of Justice Coroners Unit have sent information on the new cremation regulations which will be coming into effect on 1 January. They have sent the attached guidance for medical practitioners and medical referees and the new regulations are available to download on –
The main policy changes to the regulations are that they now allow bereaved families to inspect the medical forms of a deceased family member before cremation takes place. Families will also be able to draw the medical referee's attention to any concerns about unexpected symptoms or discrepancies in the case.
There have been some changes to the forms, most notably, cremation forms B and C (which two separate medical practitioners have to complete) are now called cremation forms 4 and 5.
The Regulations are expected to come into force in January 2009. They are an interim measure and will precede longer-term Department of Health plans to create the role of a Medical Examiner, who will deal with all deaths.
The new regulations and guidance will be publicised in BMA News and BMA website as well as a letter being sent to all crematoria medical referees.
Essentially the biggest change for doctors will be the ability of next of kin to see cremation forms. There is also a move to standardise cremation forms across the country. At present they are different in different council areas. There is also a requirement that the form should be completed within 3 days of the death to try and avoid delays. Finally the responsibility for checking the first part of the form will lie with the doctor completing the second part. Both of these doctors will need to be made available for the referees to contact them. This currently causes problems if doctors are not in the practice and the medical referee needs to speak to them urgently. There is some concern that these regulations might make this problem worse rather than better.
PHASE TWO OF THE SUPPORT YOUR SURGERY CAMPAIGN
It is clear that the first phase of the campaign certainly raised awareness in the media and the public about some of the issues facing general practice and there have been some changes in the attitude of the media towards GPs. There also appears to have been some softening in current negotiations. We have been made aware that some practices did not receive their Save Your Surgeries Phase Two packs and so if any GPs have not received them or would like to feed back to the GPC about them please email Andy Young at
ayoung@bma.org.uk and he will chase up the packs for you. The LMC has been informed that this is only the next stage in an ongoing process which will continue particularly following the end of the procurement process for the polyclinics and GP Led Health Centres.
TRANSFER OF PATIENT RECORDS
A local practice has contacted the LMC recently with an instance of three new patients all from different surgeries whose notes were sent to the practice by the PCT with only a computerized summary enclosed. This is not acceptable. We would remind all practices that until GP to GP transfers are used they must print out a complete set of the patient record and letters and send this back to the PCT with the Lloyd George Envelope when a patient leaves their list. The full set of patient notes must move to the new practice.
GENERIC NHS EMAIL ACCOUNTS
The issue of General Practice E-mail accounts was discussed at the last LMC Meeting. We have been informed that all practices can have a generic NHS email account set up to receive a copy of all PCT; LMC and other correspondence if they so wish. This proves to be a reliable backup should practice staff that currently receives this correspondence leave the practice.
PRACTICE CONTACT DETAILS
It has been brought to our attention that some practices have not been receiving information direct from the LMC via the email system. We recently posted to all practices a contact form to complete and return to the LMC so we can make sure all contact details are correct and to make sure that all practices receive up to date information and guidance.
Unfortunately we have only received half of these forms. Please could we urge you to contact Michelle Hallahan in the LMC office at mhallahan@worcslmc.co.uk if you have not returned this form and a new form can either be posted or emailed out to you. If you would prefer all LMC emails to go to a generic email account rather than individual email accounts then please can you let us know.
WORCESTERSHIRE LMC WEBSITE
The following guidance has been added to the LMC website during the last month:
BMA/GPC Guidance:
LMC Guidance:
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