WORCESTERSHIRE LMC LTD
NEWSLETTER
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UPDATE FROM THE OCTOBER LMC MEETING
At the last LMC meeting we were aware that the interviews had taken place for the appointment for a Medical Director and it has now been confirmed that Dr Jonathan Leach has been appointed. We are looking forward to meeting him in due course. The LMC has been asked to take part in the appeals process for PE7 and PE8 disputes and this is taking place shortly.
A number of committee members advised the committee that the PCT have been looking at practice list sizes and some significant errors have been found resulting in significant possible overpayments. Since then a number of practices have contacted the LMC for guidance about this. There is precedence for this and a number of cases have gone to the Appeals Authority in Harrogate. If practices are concerned about this in any way we suggest they contact the LMC directly.
The LMC has written to the Finance Department at the PCT expressing concern about the number of late payments coming from the finance department. We understand the PCT has produced a new standardised claim form which we felt was reasonable other than the deadline. This could mean that if a practice for quite legitimate reasons is unable to complete the form no payments relating to the claim form would be made at all for that quarter. This would have serious impacts for practice cash flow and does seem excessive. We are awaiting a response from the PCT on this issue.
The Committee discussed the recent reduction in funding for dispensing practices and recognise this could have significant impact on a number of practices across the county. We also discussed at length concern about parallel exporting and we have raised this issue with all the MPs in Worcestershire. A number of them have already responded saying they will lobby the Department of Health on this issue, which is affecting our patients.
LMC VACANCY
A vacancy has arisen for a co-opted member to join the LMC. The committee is particularly keen for a non-principal to apply. Either somebody who is doing locums or a salaried doctor in a practice in Worcestershire would be very welcome. It is very important to maintain a wide base of members in order to represent all the GPs currently working in Worcestershire. If anybody is interested in applying please will they contact the Secretary.
EDUCATION UPDATE
Dr Schrieber reported that the Deanery is currently looking at how additional training can be continued but with a reduced budget. He pointed out however that there are some new trainers courses being planned and an announcement is due shortly. Their website
www.hwgpe.org.uk has been updated.
OUT OF HOURS
The LMC has had further concerns brought to its attention about the TCN service, particularly with regard to visiting rota’s and the roll out of extended care practitioners. We understand this has already hit the media and has featured in a number of local papers. In order to seek clarification on this the LMC has organised a meeting with the PCT to explore some of the issues that have been raised. Without having detailed information the committee were certainly concerned about what it heard about the reduction of GPs working in ‘red eye shifts’ and the roll out of additional extended care practitioners. We also understand that these staff will be working alone and will not have drivers. The committee were also informed that the Quality Care Commission was visiting Worcestershire again in the week commencing 19
th October. The TCN interim report from the CQC is now available online to view and can be found
here.
MENTAL HEALTH ISSUES
A raft of issues have been brought to the LMCs attention regarding the Mental Health Trust. It is hoped that representatives of the Trust will be able to come to the November meeting. One particular issue relates to the discharge of stable patients on depot injections back to primary care. A number of GPs have raised this with the LMC as a matter of concern. The Mental Health Trust assured us this is not happening. Members of the committee were not convinced by this and therefore we would welcome specific information from GPs if they feel patients with chronic mental health issues have been discharged back to primary care inappropriately. Please could these be sent to the LMC as soon as possible.
We have also had concerns raised about accessing services for learning disability patients who are boarded at homes within Redditch but remain the financial responsibility of their home PCT. Additional problem appears to be uneasiness amongst GPs about the use of central hubs for referral to Mental Health Services and also ongoing problems obtaining urgent mental health assessments during the daytime.
SMOKING CESSATION LES
The committee remains concerned about the bizarre new LES that has been rolled out from the Strategic Health Authority. We have raised this with the PCT but have yet to have a response. The committee remains of the view that the process is unworkable and it seems likely that many practices will simply boycott it.
CONFIDENTIALITY –NEW GUIDANCE FROM THE GMC
- Reporting concerns about patients to the DVLA or the DVA
- Disclosing records for financial and administrative purposes
- Reporting gunshot and knife wounds
- Disclosing information about serious communicable diseases
- Disclosing information for insurance, employment and similar purposes
- Disclosing information for education and training purposes
- Responding to criticism in the press
All doctors are familiar with the duty of confidentiality; yet it’s the topic about which the GMC receives most ethical enquiries. This new guidance should help. Confidentiality is the product of more than two years work involving extensive consultation with doctors, patients and the public, and others with an interest, led by an expert working group chaired by Dr Henrietta Campbell, former CMO for Northern Ireland. This will be sent to all doctors on the medical register.
PANDEMIC FLU
The Department of Health have issued guidance on sickness certification in response to the Swine Flu Pandemic. The key points this guidance contains are as follows:
- At present, the level of activity relating to swine flu remains low, therefore, the Government has not yet made any changes to the normal provisions for sickness self certification or the arrangements for GP’s to provide medical statements for patients who are ill for longer than seven calendar days.
- The situation is being kept under close review to enable action to be taken quickly, should it be necessary.
- The Government recognises the importance of reducing the pressures on front-line services during a pandemic. This was one of the primary objectives of the launch of the National Pandemic Flu Service in England in July 2009.
- Regulations state that doctors cannot issue medical certificates without having examined the patient on that day or the previous day. However, where a patient has previously been assessed as having swine flu, either by the National Pandemic Flu Service or their GP and has been advised to stay at home whilst ill, a GP may, at their discretion, issue a medical statement after a telephone consultation, once assured of the identity of the caller as a registered patient.
- Employers and employer organisations have been reminded of the need to reduce the burden on frontline health services during a pandemic and of the range of forms of evidence that they can use to satisfy themselves that an employee is unable to work due to sickness.
The guidance can be found on the DOH website, gateway reference number 12709 or on the LMC website at:
Please note that the Department of Health have also issued guidance on the following (please find links under the LMC website section):
- Guidance on the use of prophylaxis with antiviral medicines during the H1N1 (swine flu) pandemic
- Information materials to support the swine flu vaccination programme (information materials, including template consent forms and invitation letters)
- Pandemic Flu - Letter regarding dosage of oseltamivir in children under one year of age with swine flu
- Pandemic Flu – Authorisation of antiviral medicines (Guidance on the use of FP10SS forms and Antiviral Authorisation Vouchers during the H1N1 (swine flu) pandemic in England
- Pandemic influenza – additional measures to meet workforce supply – gateway ref 12679
- Pandemic Flu News – October 2009
- Swine Flu clinical packages – gateway ref 12368
- Swine Flu : Vaccination Programme Update – Letter from Ian Dalton to the profession
- Swine Flu patient vaccination leaflet
SWINE FLU - VACCINATION PROGRAMME UPDATE
Ian Dalton, National Director of NHS Flu Resilience, has sent a letter to all PCTs and SHAs in England setting out further details on the vaccination programme planning. The first possible delivery date for supplies of vaccines to general practices is the week beginning 26 October with all practices receiving one box of 500 doses of the Pandemrix (GSK) vaccine. In addition one box of Celvapan (Baxter) will be delivered to PCTs who will be responsible for making arrangements to vaccinate those few people for whom Pandemrix is not suitable. Thereafter practices in need of more vaccine will be able to order additional supplies from the manufacturers.
Contrary to previous advice that two doses would be needed for the H1N1 vaccines to take full effect, the Chief Medical Officer has now announced that there are in fact different rules for different groups as set out below:
Pandemrix (manufactured by GSK)
For all children aged from 6 months of age to less than 10 years of age:
• Two half doses (0.25m1 each) should be given with a minimum of three weeks between doses.
For individuals aged from 10 years to less than 60 years of age:
• One dose (0.5mI)
For individuals aged 60 years and over:
• One dose (0.5m1) (may be reviewed after further evidence)
For immunocompromised individuals aged 10 years and over:
• Two doses (0.5m1 each) should be given with a minimum of three weeks between doses
Celvapan (manufactured by Baxter)
For children from 6 months of age and adults
· Two doses (0.5m1 each) of should be given with a minimum of three weeks between doses.
The GPC is in the process of signing off SFE amendments, Directions and guidance related to the vaccinations DES. It will also be publishing its own FAQ document in the near future. We hope these documents will be finalised before the vaccination campaign begins in earnest. In the mean time, we recommend that GP5 go ahead and start vaccinating once they have received the first delivery of vaccines.
GPs will be paid £5.25 for every H1N1 vaccination given to clinically at-risk patients on their registered list, regardless of who administers it. District nurses will not be allowed to charge GPs for their time.
There has been some debate about the definition of housebound. This will be clarified in the Directions and Guidance, but housebound patients are those to whom a contractor would normally offer home visits as the only practical means of enabling a face to face consultation. Final details of these issues will be in the vaccination DES.
For H1N1 vaccinations administered by GP staff, the DH has confirmed that, as with other vaccinations delivered in general practice, GPs can delegate responsibility to carry out the H1N1 vaccinations to any appropriately trained person (including practice nurses and healthcare assistances (HCAs). The GP takes overall responsibility for the procedure as a prescriber. As long as the GP is content with the health professional’s competence to vaccinate and has a written practice protocol in place, they can delegate responsibility for the procedure to them – they are acting as the GP’s agents/employees and the GP carries the medico-legal responsibility.
Patient group directives (PGDs) are not required when a practice is treating its own registered patients, however many practices find it useful to use PGDs as a protocol for their nurses to perform certain procedures. PGDs are necessary only when a non-prescriber is performing the procedure and there is no individual with prescribing authority taking overall responsibility for the procedure. The DH is planning to publish PGD and patient specific directions templates on their website shortly.
For H1N1 vaccinations and Hajj pilgrims, the Saudi Embassy advises that ‘Incoming travelers for Hajj from all countries must provide a valid certificate of vaccination at least 2 weeks old against Swine flu (H1N1) A before acquiring a Hajj Visa, if it is universally available’. As this is not currently the case, with only the at-risk groups and health care professionals being vaccinated, it is our understanding that Hajj pilgrims will not be asked for a certificate of vaccination, but may be screened for high temperature on arrival. Further advice about this is available on the Saudi Embassy and RCGP websites, and this issue has also been sent to GP flu operation groups for further clarification.
PATIENT GROUP DIRECTIVES
It has come to the LMCs attention that some misleading advice has been given regarding Patient Group Directives. We are not quite sure how this has arisen, certainly a number of practice nurses around the county seem to have got the wrong impression about the rules. Guidance was originally given in HSC1991/051 which enclosed copies of reports on the supply and administration of medicines under group protocols. These are written instructions for the supply and administration of medicines to a group of patients who may not be individually identified before presentation for treatment. Further document HSC2000/026 noted that the majority of clinical care should be provided on an individual patient specific basis. Supply and administration of medicines under Patient Group Directives should be reserved for those limited situations where it offers an advantage for patient care (without compromising patient safety) where it is consistent with appropriate professional relationships and accountability. GPC sought legal opinion at the time which confirmed that as patients within general practice are individually identified before presentation of treatment Patient Group Directives are not needed. If your practice nurse were to, for example, give flu vaccinations to patients from another practice, then a PGD would be required. This does not mean that practices should not consider their own policies, protocols for giving the same vaccinations.
We brought this to the attention of the PCT and asked if they would check that consistent advice is being given. Potentially who does what in your practice is entirely up to the partners. Nobody else can dictate this, and doctors and their practice nurses take professional responsibility for their actions.
PAT TESTING
Another myth relates to the idea that practices have to have all their electrical equipment tested very frequently. It seems that a significant number of practices are paying large amounts of money for this to be done inappropriately. The HSE myth poster can be found at
http://www.hse.gov.uk/myth/july.htm.
VETTING AND BARRING SCHEME (VBS)
The GPC will shortly be issuing guidance for all GPs (including what a GP employer should do) on the new vetting and barring scheme. This scheme came into play on the 12th October 2009 and is being introduced in stages. The following now applies:
1. It will be a criminal offence for a person who is on a barred list (e.g. the PoCA, POVA and/or List 99) to seek or undertake 'regulated activity'. Regulated activity includes working as a GP, as a practice nurse and may also include working as a healthcare assistant. It applies to those who are already in post or are seeking a new post.
2. It will be a criminal offence for a practice knowingly to appoint a barred person to a 'regulated activity' post. Also practices should require an enhanced CRB check of all new recruits and of those changing jobs that will be undertaking 'regulated activity'. Please note that the PoCA, PoVA and List 99 are being replaced by two new barred lists managed by the Independent Safeguarding Authority (ISA) - one for barred from working with children, and one for barred from working with vulnerable adults. The enhanced CRB check will now provide information held on these two ISA barred lists.
3. Employers have a duty to inform the ISA if they believe that an individual has caused harm, or posed a risk of harm, to children or patients that they work with.
Please be aware that there is no central funding available to practices for CRB checks. Therefore the question of who pays for the check will be one for the employer and the applicant. We would also like to clarify that it is now mandatory for those taking up a new post as a GP, practice nurse or healthcare assistant (as they undertake 'regulated activity') to have had an enhanced CRB check undertaken. This only applies to new recruits and those who are changing jobs who will undertake 'regulated activity'. It does not apply to receptionists, practice managers, cleaners, etc.
As noted above, GPC guidance on the new scheme will be issued in the very near future. The ISA's website is:
www.isa-gov.org
GPC WEST MIDLANDS E-NEWSLETTERS
Dr Grant Ingrams, Secretary of GPC West Midlands produces newsletters which we find very useful and informative, and thought we should share these with practices. Please find below a link to the latest newsletter.
WEST MIDLANDS QOF GUIDANCE 2009-10
WORCESTERSHIRE LMC WEBSITE
The following guidance has been added to the LMC website during the last month:
BMA/GPC guidance:
DOH
GMC
NHS Employers
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