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As you may be aware a great deal of work is taking place reviewing the existing LESs that exist across the county. Another meeting is due to take place on the 23^rd March. The committee was dismayed to find that the proposal for existing providers to continue with the old Anti-Smoking LES also means that they will continue to receive the lower level of payment and not the higher level provided by the Strategic Health Authorities tariff based LES. We have repeated that this is unacceptable and clearly the way this has been commissioned has been a disaster. Only 7 out of 17 PCTs in the West Midlands have adopted this scheme and yet it is still being promoted! The LMC strongly believes that Anti-Smoking services should be available in all practices and other agencies across the county. Anything that restricts this provision is obviously counterproductive. Nevertheless it would not be unreasonable for practices to cease to provide this service if they find they are being remunerated inappropriately for the not inconsiderable time involved in managing patients through withdrawal from smoking.

 

It has become clear that the arrangement for the Courier Service that operates to collect a range of specimens from GP practices is totally chaotic.   We have now raised this with the PCT as an area that needs reviewing. Some practices are fortunate to get two collections a day, others get only one. Some practices get their cytology samples collected directly by a courier from Cheltenham and others go through the local service. There seems no logic behind any of this and it is clearly that is something that has evolved over many years.

 

As you will all be aware Take Care Now are in the process of selling their business to Harmoni. A discussion has taken place over many weeks about this and the LMC has recognised that the PCT realistically had little option but to go along with this proposal. The initial scheme suggested by Harmoni however did not meet the expectations of general practice nor the PCT. The PCT consulted with the PBC leads, their Out of Hours lead, Clinical Senate members and the LMC. There was unanimity in the view that genuine robust local GP involvement needs to take place in the management of the new Out of Hours scheme. Harmoni have now agreed to setting up a GP Management Board which will closely scrutinise the work of the new OOH Scheme and will have a number of targets that they will be able to set and monitor themselves. The agreement further will state that if after six months the Management Board does not feel suitably reassured by the level of service provided they can make a recommendation to the PCT on whether Harmoni should be extended beyond 12 months. (Based on the agreed targets)

 

The LMC was asked to provide a representative for this board and Dr John O’Driscoll has agreed to take on this role. The LMC had also made a number of comments. It was initially intended that the GPs working in this role be paid for by Harmoni. We feel that it would be more appropriate for these people were there on behalf of the PCT and paid and employed by the PCT itself. During the interim period there is concern about the financial viability of TCN and if they will be able to continue paying staff. We feel that the PCT should offer guarantees to staff, both to maintain existing services and keep the core of experienced local staff that will be the foundation for a new improved OOH service. We simply cannot afford to lose any more OOH staff than those who have already disappeared during the reign of TCN. 

 

The PCT has established a working group that is looking at the roll-out of EPS release 2 across the county. The LMC has been asked to provide a representative and Dr James Rankin from Pershore has agreed to take on this role. The scheme is currently being piloted and it is the LMC view that we should not take this further until the results of the pilots are seen. It is our view that a properly working service could be of significant benefit to patients and practices.

 

The GPC has published guidance on the Summary Care Record which is being rolled out across a number of Strategic Health Authorities in England.   This guidance represents the GPC’s views and answers questions practices may have about the SCR. The guidance also provides information about the BMAs and GPCs involvement and any action they are taking, as well as the background on the SCR and its development. This guidance can be found at:

 

The GPC has recently debated the issue of faster implementation of the Summary Care Record. The following motion was passed nem con:

 

 “That the GPC deplores the recent fast roll-out of the SCR in England. We seek the halting of this roll-out, and that the Department of Health and Connecting for Health discuss these issues urgently with the profession.”

 

The BMA has written a letter formally expressing their serious concern and requesting the following:

1)      Improved information so that patients can make informed choices about the upload of their medical information;

2)     Additional support for practices to ensure the quality of records uploaded to the SCR are of the appropriate standard;

3)     Additional support for practices to deal with returned mail relating to patient consent and FP69 procedures;

4)     That roll-out of the SCR, where Public Information Campaigns have yet to commence, is halted until the University College London evaluation report into the project has been published and considered.

 

The LMC’s view is that many GPs are deeply sceptical and are increasingly worried about the roll-out of SCR. However, we do not know enough about most aspects of the proposed system to recommend it to patients. This particularly applies to the security of the system. Perhaps it is appropriate for practices to take a neutral stance and to hand out leaflets to patients saying it is a matter of personal choice. Despite media reports to the contrary we are currently not aware of any change to the roll-out of SCR in England.

 

We would draw your attention to the NHS Pension Agency newsletter. Under the section on Freelance GP Locums it says:

“GP practices and APMS Contractors are reminded that GP locum work in NHS pension terms is short term deputising work. Fee based GP work over a long period is regarded (under the Statutory NHS pension scheme regulations) as type 2 practitioners work with the practice/APMS contractor responsible for paying employment contributions.”

 

The Tax office helpline makes it clear that doctors working in practices as employees cannot be locums. 

 

The LMC is not able to give detailed advice on this matter but we would encourage all practices to check the status of all who work for them with the employment status indicator on the HMRC website. If practices are unclear about this please seek advice from your accountant. The employment Status Indicator on HMRCs website can be found at

www.hmrc.gov.uk/calcs/esi.htm. We recommend you follow this link at:

 

Below is a summary of the decisions/outcomes of the Family Health Service Appeal Unit from October 2009 to February 2010 (excluding decisions on premises issues). The full decisions can be found at:

Please note that many of the decisions have been made against the GP contractor, and in some instances this demonstrates the need to provide a well-argued case and to provide the Unit with all relevant information.

 

The Care Quality Commission is introducing a new registration system for all NHS trusts, independent healthcare providers and adult social care providers in England. The new system comes in gradually from April 2010 and can be found at:

 

An updated version of the Future of GP practice premises document has been published. The document looks at the various models of premises provision currently available and reviews the apparent preference of PCOs to finance third party developers involved in LIFT and PFI schemes, rather than GP developed premises using borrowing costs reimbursement, notional rent and improvement grants. New sections include service charges and GP training practices.  The document can be found on the BMA website and is also available on the LMC website at:

 

The Department of Health has published its consultation document on changes to practice boundary regulations in England. The consultation process will certainly straddle the election and will therefore take longer than 12 weeks. This clearly has significant impact but unfortunately the view is that there will be little support politically for a ‘stop this nonsense campaign’ as all the political parties seem to think it is a good idea. Fortunately for once GPs are not alone as many managers also think the idea of boundary less practices is daft. We would encourage as many people as possible to look at this consultation and respond to it either online or by post. Details can be found at:

http://www.bma.org.uk/healthcare_policy/reformgpboundaries.jsp and

 

The Safeguarding Children’s Board has flagged up as an issue the lack of any formal system in Worcestershire for the notification to Health Visitors of new children registering with practices. We understand that the Exeter system can do this and work is taking place to see whether this can be done centrally. In the meantime we believe it is good practice for individual practices to supply lists of newly registered children to Health Visitors. We know this takes place in many practices across the county but we would commend this to you all.

 

Professor Salisbury, Director of Immunisation at the Department of Health has sent a letter to all GPs informing of provision of the H1N1 swine flu vaccine for protection of travellers to Southern Hemisphere countries. Practices can use their existing stocks of H1N1 vaccine as a travel vaccine for members of the public intending to travel to the Southern Hemisphere during their influenza season. GPs are able to charge patients for administration of the vaccine and GPs can set their own rates for this service.

Please note the paragraphs in the appendix which state that:

Whilst GPs can generally charge patients for administering an H1N1 vaccine in connection with travel abroad, if the contractor is participating in the Swine Flu directed enhanced service or any local enhanced service that provides for a payment in relation to an H1N1 vaccination, no charge can be made to:

• patients in the priority groups defined in the Swine Flu directed enhanced service; or
• patients who are in a group covered by any local scheme under which the contractor is paid for administering the H1N1 vaccine.

 
Patients in these groups should receive the vaccination free of charge in accordance with the directed enhanced service or in accordance with the local agreement even if their request is related to travel abroad.

The letter can be found on the DH website at the following link –

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_114372.pdf

 

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