Newsletters

A new document outlining responsibilities and operational requirements for the correct use of Choose and Book was published on 8th December 2009 and is available at:

http://www.bma.org.uk/ethics/health_records/connecting_for_health/cabrandrs.jsp

In January 2009, the BMA published ’Choose and Book - Learning Lessons from Local Experience’. The research found that implementation of Choose and Book goes far beyond installing systems and problems are often not due to the functionality of the system but due to broader issues such as national and local policies, processes in place and capacity issues.  The BMA discussed these findings with the Department of Health and the outcome of the discussions is the ’Responsibilities and operational requirements for the correct use of Choose and Book’ document, which has been co-signed by the BMA.  The document is intended to help organisations understand the importance of using Choose and Book correctly. Requirements include promoting rather than mandating the use of Choose and Book, allowing electronic referrals to named clinicians if paper based referrals to named clinicians are accepted and encouraging clinicians to initiate and review referrals themselves online. 

 

The second edition of the joint GPC / RCGP / DH pandemic flu guidance for GP practices has now been published. The original guidance was designed to help general practice plan for the possibility of having to work during a severe pandemic, such as avian flu. The updated guidance has been reviewed to take in to account this year’s swine flu outbreak and the guidance that has been published in relation to this.
It is available from the BMA website:

http://www.bma.org.uk/health_promotion_ethics/influenza/panflugp/panfluguide.jsp 
 

The RCGP is working with the Department of Health, patients and the BMA to develop and deliver a series of national workshops for GPs and Practice Managers to support practices in responding more effectively to patients' needs and preferences. The aim of the national events is to raise awareness of and interest in responsiveness issues, to inform practices about available solutions and to encourage practices to develop and implement their own solutions.   Ten regional events will be held across England during February 2010. Sessions will include:

·         Managing workload and demand

·         Making technology work for you

·         Marketing your practice

To find the nearest event to you, and to register please visit: www.rcgp.org.uk/gpaccess

Practices in South Worcestershire should have received a letter from the 3 Counties Cancer Network inviting them to take part in a funded audit about the Early Diagnosis of Cancer. The audit is being rolled out nationally and they have been successful in receiving some funding from NCAT to help fund and support it. This means they can offer each practice that agrees to participate:

For any practice that has not received this invitation letter could you please contact Emma Walsh, Project Manager of the 3 Counties Cancer Network on emma.walsh@glos.nhs.uk.

 

GPs need to be grateful to the ‘eagle eyed’ Dr Lynne Butcher who noticed that the 3 Counties Network when they initially contacted the LMC were offering a significantly lower fee than had already been paid by the Greater Midlands Cancer Network who did this audit in the Wyre Forest area earlier this year.  This was brought to the attention of the 3 Counties Cancer Network and they have now agreed to pay the more appropriate figure.

 

Amendments to the standard GMS contract were made in September 2009.  These can be found at the following web link:

http://www.dh.gov.uk/en/Healthcare/Primarycare/Primarycarecontracting/GMS/DH_4125638
As a result GMS GP practices may be asked to sign a variation agreement/notice.  They should not be asked to sign an entirely new GMS contract.  

 

Well we have some good news for once! Last week Ipsos-MORI, who is carrying out the survey on behalf of the DOH, published the results of the first two quarterly collections of the 2009-10 GP Patient Survey. The headline results are as follows:

If you would like to see the full results please go to:

 

As you should all be aware the LMC took great exception to this LES that was rolled out from the SHA. It was the most bureaucratic, unworkable document and was roundly condemned by the majority of practices. We were greatly concerned that this would lead to a reduction in anti smoking services rather than an increase in services which is what everybody wanted. The PCT felt unable to cancel the LES although many other PCT’s in the West Midlands had chosen not to adopt it. Frankly because take up has been poor it has been agreed that existing providers can continue to provide their current service using the existing LES. The LMC very much welcomes this decision and hopes very much that this is the last LES like this we shall see! Practices are swamped with bureaucracy and simply cannot cope with increasing amounts of work if they are associated with vast amounts of form filling. This is simply not the way we do things in General Practice.
  

Version 16 of the Business Rules has now been published and is available on the NHS PCC website. Please note that the QOF CVD PP1 indicator has been amended to exclude patients under 30 years of age from indicator PP1. The age range for this indicator is now set at 30-74 years. Patients outside this age range should still be assessed individually and their risks reduced, although risk equations do not apply and thresholds for reductions are currently not available. PP2 applies to all age groups, as do the blood pressure control indicators in the hypertension set.

 

The idea of vascular screening has not gone away but has a new name and a proposal is being drawn up to offer a LES to practices from 1^st April 2010. The Health Checks programme is open to everyone aged between 40 and 74 years and the proposals being looked at will aim in the first year to target a high risk group which for an average 6,000 practice population will be approximately 260 patients. These patients will be identified by some software that the PCT is proposing to roll out onto all our systems. This has been discussed with the PCT and the LMC is certainly very concerned by a number of aspects to the proposals. We obviously are seeking reassurance that this software will be available and up and running for all practices by the start of the next financial year. We are awaiting reassurances from the provider of the software they will be able to do this. We have strongly put to the PCT our case that this is a significant amount of additional new work and that practices will have great difficulty fitting this into their existing working week. Clearly if these patients are to have blood tests it will be appropriate for them to be done at the same time as the health check rather than asking them to come back again for another appointment. We put to the PCT they need to look at whether we need two collections for laboratories and possibly even one on a Saturday morning. Another alternative was to use desk top analysers to do cholesterol testing. A follow up appointment is needed to present the results of the risk assessment to the patient and we have suggested to the PCT that it should be allowed for this to be done over the telephone. Many of us do a lot of telephone work and we see no reason why we need to drag patients in simply to tell them their cholesterol is normal. We hope that early in the New Year it will be possible to share with you further details so you can start planning for this work if practices choose to take it up.

 

When Worcestershire PCT was formed the LMC brought to their attention the fact that we had anomalies regarding LES’s which had come from the three previous PCTs. This has never been addressed until now. Work is taking place to review the whole issues around minor surgery. There are some clear problems and some practices are being very well remunerated whilst others are being underfunded for this work. It is hoped that early in the New Year we will be able to agree a fair LES to be rolled out across the whole county. In addition to this the PCT is very keen to see the role of minor surgery enhanced in general practice and take work away from secondary care. Part of this LES will be looking at this with additional higher rates of remuneration to cover more complex work. Again it is hoped it will be possible to share some more information with practices about this shortly. (A similar situation exists regarding RUCDs/RUS Services).

 

All practices should have received a copy of a joint letter from Laurence Buckman and Steve Field regarding training GPs require for maintaining their skills on the issue of Child Protection. In addition to this there is a Gateway document, reference 13083 giving more details on this. We would encourage all practices to review their current policies and ensure that appropriate training has been received. The documents are available on our website for your information.

 

Once a year all the LMC Secretaries in the country get together for a day of briefing and discussion. This year a significant part of the discussion related to the state of relations between GPs and the Government and their current policies and also the policies of the other parties if we have a change of Government. Clearly whoever wins at the next election we are in for yet more change! The other major part of the discussion related to Revalidation and Re-accreditation. The Secretary attended a major national briefing about this in January and interestingly almost 12 months down the line not a lot seems to have changed. The scheme still seems to have enormous gaps and deficiencies in it. Interestingly now the issue of who is going to pay for it seems to be coming to the fore and this also could be one of the areas that is affected by the new financial climate. It is still far from clear what the final process will be like and worryingly a large part of the discussion related to the continued lack of support mechanisms to deal with doctors who are found having performance problems. This is something this LMC has always stressed very much and it is sad to find that almost no progress has been made on this count. 

 

This year’s event took place over two days and the second day related to the Government’s new Quality Agenda and Practice accreditation. Many of us felt that suddenly raising quality as a new issue is frankly insulting. All of us have been doing our utmost to maintain, improve and develop our practices ever since starting. It is part of being a professional. Nevertheless the politicians have picked on this and are proposing all sorts of changes. The presentations we had on practice accreditation frankly left most of us none the wiser. We were given a presentation about the pilots that have taken place and even this seemed to have been pretty unsuccessful. Even the audience were not allowed to see the details of what was piloted. Nevertheless by 2012 the Care Quality Commission will acquire all practices to be accredited and there will be some minimum standards. Clearly if standards are set too high this will have major financial implications, for example a large number of practice premises will be rendered inadequate. One hopes that some degree of common sense will take place and that a practice quality scheme will be organised and administered by the profession. This will very much feature on the agenda for next year and we will be watching these developments clearly.

 

2009 has been an interesting year for general practice but probably not one most people would regard as a good one! The NHS continues to be a political football and GPs as always are in the thick of it. It is very sad how much the media seems to continue to publish derogatory material about general practitioners and primary care as a whole. The Government continues to micro manage and politicise the NHS and this year has been a very good example of how not to do it. The debacle over Darzi centres, GP Led health centres and the Darzi Quality Agenda has frankly been a joke. Primary Care has been and remains the ‘jewel in the crown’ of the NHS. The amazing amount of work done by GPs and their staff for relatively small amounts of money should be trumpeted loudly and something to celebrate. The amount of chronic disease management now effectively carried out in primary care is remarkable. No other countries achieve such results. What is most sad about 2009 is the fact that morale in primary care has slipped so badly again. This was the reason for the negotiation of the new GP contract and clearly all the political interference has wrecked that. Practices are swamped with work, bombarded with bureaucracy and are struggling to cope. What 2010 will bring who knows? Maybe a change of Government but certainly a different financial climate. The LMC will continue to do its upmost to support practices and their staff in the work they do caring for the patients of this county. We wish you all a very happy Christmas and a Stress free a New Year as possible!

 

 

 

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

 

 

  

 

 

 

Choose & Book – Responsibilities and operational requirements for the correct use of Choose & Book

 

 

 

 

 

Safeguarding children and Primary Medical Care – Gateway ref: 13083

 

 

BMJ Patient Information on Swine Flu – updated December 2009