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Wessex LMCs Bulletin - July 2004
CONTENTS
1) Editorial
2) PMS Contractors
3) Appointment of Director of Liaison and Development
4) Delayed Retirement Scheme
5) Seniority
6) Agenda for Change
7) IT Update - QMAS
8) Letter which has been received from the PPSA in Hampshire
9) Developments on the LMC Website
10) Changes to Cervical Smear Programme
11) Quality and Outcome Framework Visits
12) Quality and Outcome Framework - Exception Reporting
13) Medical Records
14) The GPC - What is it and What does it do ?
15) NHS Direct Feedback Form
16) Guest Editorial - From the Chairman... of NE Hants LMC
17) Copying Patient Letters
Key to Contributors
1) Editorial
After a brief period of settling in as Joint Chief Executive, following a 2 year stint as the Deputy Chief Executive, Bob has finally relented and
given me permission to write my first editorial. He now believes my spelling and grammar are sufficiently improved to be set free (only joking Bob) - it is still as bad as ever!
General Practice is going through the most significant change which has occurred since the inception of the NHS. It is therefore not surprising as
a result of this, the workload and function of the LMC is also changing.
Over the last year a Review Group set up by the General Practitioners Committee (GPC) has looked at the problems relating to the Contract
and touched upon the function of the LMCs. Surveys performed at this time showed a greater degree of support for LMCs than it did for the GPC.
A report from Sheffield was also commissioned on a national basis to look at the roles and functions of the LMCs. This showed that there was
huge variation between those LMCs which consisted of a full time GP who served one Committee and basically performed a service in his or her spare time, to the large LMCs such as Wessex, Devon and London
which have a number of staff who support more than one Committee.
Recently in the same week as the LMC Conference, Doctor Magazine produced a very critical article of LMCs stating that they were failing to
protect GPs' interests. Therefore I thought it was timely in my first editorial to give GPs an insight into the workings of the LMC.
LMCs were established in the UK in 1911 and are the only local Representative Body of GPs and have statutory responsibilities. LMCs
consist of elected members of the local GP community for their area, and thus represent their colleagues from a position of day-to-day involvement. Wessex LMCs is a confederation of 5 LMCs and are
organised by a Secretariat consisting of the Chairmen and Vice Chairmen of the constituent LMCs.
The dedicated office in Winchester consists of 2 Joint Chief Executives, a Medical Secretary, as well as 6 other members of staff. We are soon to
be joined by a newly appointed Director of Liaison and Development, (see later) .
Wessex LMCs is the largest organisation representing GPs outside London. The Levy that funds LMCs is variable throughout the country, ranging
from 14p to 40p. In Wessex the current levy is just over 21p per patient.
I have asked many GPs if they understand the role and function of an LMC and the response I have received is interesting to say the least!
The LMC has many functions, some of which are visible and public and some of which are probably less well known.
Representing GPs in General Practice
Most GPs are aware of this role. Most PCTs need constant reminding; it is
the LMC which represents GPs and their views, and not GPs who sit on the professional executive committee (PEC) of PCTs.
nGMS
nGMS has brought this role to the forefront and all PCTs have found
themselves engaging in dialogue with the LMC, as they are required to consult LMCs in a number of areas specified in legislation, but some have been more reluctant than others. Many have found this experience of
great benefit and have expressed a wish to build on it for the benefit of patients, GPs, practices and PCTs.
Complaints
These are always difficult for GPs. The LMC gives practical advice as
well as support.
Partnership Advice
The New Contract has meant that all GMS practices will need to review
their Partnership Agreement. Often when an adequate agreement is not in place problems can develop practices do run into difficulties and the
LMC can offer help and support in mediating and seeking a solution.
Poorly Performing Doctors
The LMC plays an active part in supporting GPs who are performing
poorly. The LMC has worked closely with the PCTs to develop a policy to help such doctors, and this has been used by other areas to develop their own policies.
Sick Doctors
Even GPs can get ill. When this happens the LMC supports the individual
and the practice, liaising with the PCTs to establish entitlement to cover, and working with GPs to aid their return to work. In addition sometimes PCTs are concerned about a GP's fitness to practice on health
grounds and the LMC has a statutory role to seek an independent review of the GP's fitness to work.
Liaising with Professional Bodies
The LMC works with professional bodies such as the BMA regional office, the General Practitioner's Committee of the BMA, the GMC, Medical Defence Organisations and the National Clinical Assessment Authority.
They also liaise with local hospitals.
Currently Wessex LMCs works with at least 3 Strategic Health Authorities, 19 PCTs, 690 practices and 2,500 GPs.
The LMC is here to help all GPs and practices. There is a significant amount of information available on the LMC website, www.lmclive.co.uk, and we can be contacted by email, letter or even by telephone.
We value your comments and suggestions and need them to improve the service we give. If you feel we should be providing a service in an area
where we do not - please let us know because we are an organisation with just one loyalty - and that is to serve the interests of GPs.
Nigel Watson
Joint Chief Executive
2) PMS Contractors
PMS practices need to ensure that they have revised their PMS contract with their PCT by the end of September 2004, in a way that they are
happy with.
Some PMS contracts have previously been held with StHAs but all of them must be held with PCTs by 1st October this year.
With several different waves of PMS, the result has been there are variable contracts in existence. These were granted a dispensation to
continue from 1st April until 1st October but they must now be revised so that PMS practices are not disadvantaged in any way as a result of the new GMS Contract becoming operative.
Should practices not have satisfactorily negotiated agreements with their PCTs by 30th September then it is open to the PCTs to impose a
contract without further discussions.
Andrew Lockhart Mirams, a solicitor who regularly works for the GPC and who is an expert in the PMS contract, has developed a standard
contract which should be acceptable to both practices and PCTs and the implementation of this would appear to offer significant savings of time
and a degree of uniformity. Only the schedules in the contract will need personalisation.
The cost of this contract is only around £250 and this may be a very wise investment.
Details of how to obtain a copy for perusal before a final decision to purchase can be obtained from Jenny Steiner at the LMC office
(Telephone: 01962 867793; or
email: jenny.steiner@wessexlmcs.org.uk ).
RB
3) Appointment of Director of Liaison and Development
Mrs Sheila Williams who is presently occupying the post of Deputy Director of Primary Care at the Mid Hampshire PCT, has been appointed
by the Secretariat to the above position. Sheila has a nursing background but has been also a practice manager and a very effective Deputy Director of Primary Care. She has in particular played a major part in
implementing the new cluster arrangement for OOH care in Hampshire which went 'live' on the 1st July.
Her role in the LMC will be very much to do with liaising with the PCTs on behalf of the GPs and their practices and it is her intention to make
early visits to all the LMC areas so as to make their acquaintance and to assist this she will also be joining us at meetings at appropriate times.
She does not join the office fully until the 9th August 2004, but after that time if you wish to communicate with her, her e-mail address will be: sheila.williams@wessexlmcs.org.uk
We very much hope Sheila will enjoy working with us and I know she looks forward to taking queries from you.
RB
4) Delayed Retirement Scheme
It is not widely realised that this is now completely finished. It has been incorporated into the seniority payments set out in the SFE.
Unfortunately, the GPs who have really missed out here are the salaried GPs (including flexible career scheme GPs ) who don't get seniority payments and so are losing out. Unfortunately seniority is only payable to
'providers' rather than just 'performers'.
The GPC negotiators are aware of this and we have written to the DoH to draw this anomaly to their attention, asking for it to be rectified.
What it effectively means is that despite the reassurances given particularly to the flexible careers scheme and retainer doctors, that
they were eligible for these payments; which have been termed 'golden handcuffs'; that they are no longer going to receive them, even if they were told about this at the end of last year.
Should there be any further information on this we shall publicise it widely, probably using the website.
RB
5) Seniority
This area has caused a lot of confusion and I am not entirely sure that it is thoroughly sorted out yet. Effectively seniority is only paid to those
people who are part of the practice structure in the form of a partner and are thus classified as a 'provider'.
It is not sufficient merely, however to be a 'provider'. There is an assessment to be made of the percentage of superannuable income
derived from the practice to which they are entitled, which will determine how much of the seniority payment they will receive. A person receiving 2/3rds of the superannuable income of a provider
member of the practice will be entitled to a full seniority payment. Someone who earns between 1/3rd and 2/3rds will only receive 60% of the full annual amount in respect of seniority, whereas a person earning
an assessed amount which is less than 1/3rd of the superannuable income of another full member of the practice, will not receive any seniority payments at all.
It is important to note that work done outside the practice which is superannuable in its own right, will not accrue to the assessment of
income by the individual for the purposes of determining their superannuable income inside the practice for the payment of seniority.
I would strongly advise people who may be affected by this to read Section 13 of the Statement of Financial Entitlement, and if they have
any further queries as a result of that, to contact the office and we will try and clarify these issues.
RB
6) Agenda for Change
What does it mean for general practice?
Agenda for Change is a new framework which is being introduced for all non-medical staff within the NHS. It is an attempt to provide a fairer
pay system and create a better link between a person's career and their progression in pay. It is also intended that the role taken within a job
will be more accurately reflected in the pay levels. This area is causing a degree of concern in practices and especially practice managers as to
what the actual cost implication might be to an organisation such as a small practice.
NHS jobs will basically fall into one of 8 bands
- nurses will be in band 5 - 8; and
- health care assistants will be in bands 2 - 3.
This will essentially replace the old Whitley Council Grade. Each post could be evaluated using a weighted evaluation for the job. This will
depend on the knowledge and experience required to do the job and also the responsibility taken. It will also reflect the emotional, physical and mental effort required and also any additional demands made on the
working environment.
This would appear to be a complex procedure which is currently taking place within NHS Trusts.
Each year the person who holds such a post will agree to a personal development plan which would allow them to develop the skill and
knowledge to ascend the ladder to a higher pay scale. If practices decide to adopt the Agenda for Change the implications are significant particularly in relation to the New Contract where there will no longer
be a separately held staff budget. Practices will not be able to totally ignore this area, as nurses moving from hospitals etc. will be wishing to discuss the 'Agenda for Change' with future employers.
NW
7) IT Update - QMAS
Many GPs have heard of QMAS in relation to the Quality and Outcome Framework of the new GP Contract, but few seem to be aware of what
it is and what it will do!
QMAS stands for: Quality Management and Analysis System.
This is a new National System for England that is being developed to support the Quality and Outcome Framework.
QMAS will enable practices to:
- Assess their current quality achievement point against their aspiration estimated relative prevalence and the current achievement payments whenever they wish.
- Compare their current position with the average achievement in the PCT. Such comparisons would not involve disclosure of
information that would identify patients or practices.
- Check that the data they are providing is correct and complete.
The clinical achievement data will be sent automatically on a monthly basis from GPs' clinical system to QMAS. Practices will then be able to
send ad hoc reports whenever they wish. Non-clinical information will be added by the practice via a user friendly web-browser interface within QMAS. This will be along the lines of a 'yes/no' question for each
of the sub-sections of the non-clinical areas.
QMAS will enable the PCTs to access information on individual practices current point achievements, prevalence and payments. Secondly to
verify achievements and thirdly to see aggregated figures for all practices within the PCT.
QMAS should be installed on your clinical system during the summer and allegedly this will be available and functioning by the end of August.
NW
8) Letter which has been received from the PPSA in Hampshire
New Partners, Partners Leaving and Salaried Doctors.
Please remember to inform the PPSA of any changes in medical workforce within your practice. Whilst approval to replace partners or
enlarge a partnership is no longer required we do need notice to ensure that doctors are included in the Medical Performers list. We also need to
maintain records of superannuation and if these are not amended at the correct time it can result in significant additional work and accountant's fees to ensure contributions are attributed correctly.
A partner or salaried doctor leaving a practice can remain on the medical performers list and this will enable him to undertake locum
work or join another practice anywhere in England. If a doctor is moving to work in another PCT area and is unlikely to work in the PCT on whose
list he is on for a year he should apply to join the list of the PCT in whose area he is working and inform us of his resignation from his former list. This applies even if the doctor is moving from one PCT area
in Hampshire to another PCT in Hampshire.
A PCT may remove a doctor from its medical performers list if the doctor has not provided services in that PCT area in the last 12 months.
If you require any advice on these matters please contact in the first instance Lis Wicks on 01962 876602.
Similar advice would be appropriate in Wiltshire and Dorset
9) Developments on the LMC Website
Many GPs, Practice managers and PCTs make extensive use of the LMC website which is available at www.lmclive.co.uk
In order to try and develop the information available in an appropriate and timely manner the LMC has developed a new section on the website
called current LMC issues. On the 'Homepage' will be a link to go into this Section. This will be updated on a monthly basis and will include a
brief summary of issues which are currently causing concern or are being developed.
With such a service it is always useful to know what people think - 'positive' or 'negative'.
I should be grateful if you could perhaps e-mail any thoughts on the benefit of this section to the office.
NW
10) Changes to Cervical Smear Programme
Over the next twelve months there are 2 major changes going to occur to the National Cervical Smear programme. They are:
- The introduction of liquid based cytology
- A reform of the recall programme
1. Liquid Based Cytology
This has been trialled in various parts of the UK and is shortly to be rolled out nationally and has been approved by NICE.
Smear takers will need to be trained in how to perform the smears and a brush being used instead of the spatula and the brush being placed in
liquid medium rather than a slide.
The LMC has been informed a training video will be available once this has been introduced.
It is hoped that this will significantly reduce the total number of inadequate smears and therefore the total number of smears taken or
referred on to colposcopy will decrease.
Contrary to what has been said in some publications the LMC is not aware of any evidence that liquid based cytology will be any better at
picking up abnormalities than the more conventional method.
2. The Recall Programme
Throughout Wessex there has been a variation in the call frequency which ranges from between 3 and 5 years from 20 and 65. In the Autumn
of this year a national policy will be implemented which will mean that:
- Women will no longer be offered screening under the age of 25
- Women between the age of 25 and 50 will be offered screening every 3 years
- Women between 51 and 64 will be offered screening every 5 years
It is expected that the way this will be introduced is that once woman has had a smear with normal result then the next recall date will fall in
line with the National requirement. It is not envisaged practices will have to change all existing recall dates.
Further information will be updated by the Bulletin at regular intervals as required.
NW
11) Quality and Outcome Framework Visits
All practices will be visited by the PCT between September and January each year to look at their Quality and Outcome Framework.
The visiting team will comprise of 3 members, a lead assessor from the PCT, a clinician, who will usually be a GP and a Lay Assessor.
Prior to the visit the visiting team will have access to information about the practice to prepare for the visit.
From August of 2004 practices should have available to them the software called QMAS which is described in another part of the Bulletin.
This will enable the information to be downloaded on all the clinical areas. The visiting team will have access to this information with comparative data for PCT averages. It is therefore a certainty that the
visiting team will look at this data and if there are any of the 146 clinical indicators which are significantly different from the PCT averages, they may wish to explore the reasons why this has occurred.
It is therefore worthwhile for the practice to use QMAS accurately and look at their data compared to the PCT average, so that they will be
able to look at those areas which are significantly different.
The practice will also have to submit information prior to the visit, with regard to the non-clinical indicators. In the supplementary Blue Book,
these are listed in terms of graded evidence. There are grades A, B & C. Grade A evidence means that practices must submit the information in
advance of the visit. Grade B that the practice must have this evidence available at the visit and Grade C is looking at optional additional information.
When the visit occurs the PCT is not expecting practices to have completed all areas, but areas which the practice have not achieved, to
count toward the final points achievement, documented proof will need to be submitted to the PCT before the end of year.
These QOF visits are expected to be 'high trust and light to touch', but inevitably these are going to take between 2 and 3 hours and involve a
significant amount of time for practices.
The LMC is encouraging PCTs to see these as development and educational visits, but with sufficient rigour to ensure probity. The LMC
is not expecting these visits to be primarily a policing function.
The LMC will be working closely with the PCT to develop an Appeals mechanism for the Quality and Outcome Framework. The clear message
for this is that there is a lot work which needs to be undertaken not only in the clinical areas, but the non-clinical areas and as in many areas
practice managers are collaborating in the information required in the non-clinical areas, this is to be encouraged.
NW
12) Quality and Outcome Framework - Exception Reporting
Many clinicians remain confused about Exception Reporting and how this will work within the new Contract, specifically relating to the Quality
and Outcome Framework.
It is important that this is understood as for many practices this will make the difference between achieving the moderate number of quality
points and achieving the highest level.
Exception reporting can be looked at in two distinct areas. One is at the level on a clinical category and the second is for each individual sub-category.
As Practices are aware there are 10 clinical areas and patients may be exempted in a specific clinical area either because the doctor deems
that it is clinically inappropriate or that the patient declines care. These codes are all .9h code and these need to be added on an annual basis. If
a patient is excluded on clinical grounds, then it needs to be clearly recorded in the patient's notes why this has been done. A patient can
decline by either failing to respond to 3 letters or by verbally declining which can be on a face to face consultation or by telephone.
The LMC would suggest that each year the practice manager lists patients who were excluded from specific disease categories the
previous year and if clinically appropriate then these exemption codes are added again.
In terms of specific sub-category the exclusion codes available are split into 2 areas. 1 are life long exclusions. These for example would be
somebody who is asthmatic and a beta-blocker is indicated for their coronary heart disease. These sort of exclusions would be life-long and would not need to be added each year.
The second are some specific exclusions, e.g. maximum therapy for blood pressure achieved; maximum therapy for diabetes achieved,
these need to be added annually.
Some practices are concerned at what they should do with a 90 year old who has coronary heart disease in terms of measuring their cholesterol
and treating with a Statin to get this below 5mmol/l?
Practices should treat their patients in a clinically appropriate manner and should be rewarded for doing so. In terms of the patient mentioned
in the previous paragraph, if it is thought to be clinically inappropriate to measure the cholesterol the patient should be excluded on clinical grounds, but ANY SUB CATEGORIES WHICH ARE ACHIEVED IN THIS
CLINICAL AREA WILL BE REWARDED. So e.g. if the practice has 101 patients with coronary heart disease this will be the overall practice prevalent. If a single patient was excluded from the category, then in
terms of cholesterol measurements and cholesterol achievement this patient would not be counted and therefore any number which would be achieved in this sub-category would be deemed to be out of 100 patients.
But in terms of their blood pressure if this was measured and was below 150/90 the percentage achieved would be calculated out of 101
patients, and this patient would count in both the numerator and denominator.
This would mean that practices would be rewarded for all the work they do and not penalized for treating patients in a clinically appropriate manner.
NW
13) Medical records
One of our practices has received a number of incomplete computer printouts for new patients from computerised practices. In particular,
the printouts often include a number of entries shown as 'surgery attendance' which give the date, but no other details. The practice asked if this was permissible.
The simple answer is NO, for the following reasons;
- Schedule 6 of the regulations relating to Records, information, notifications and rights of entry is very clear and requires
that a GP "shall keep adequate records of its attendance on and treatment of its patients" using the official forms and/or a computerised record. The GP is also required to include clinical
reports from any other health care professional who has cared for the patient.
'Surgery attendance'
- Is an inadequate entry in terms of the regulations.
- Is inadequate for clinical governance and medico legal reasons.
Check that your practice keeps an adequate record of all consultations.
- Schedule 6 also requires a GP to send the complete patient record to the PCT if a patient dies or is no longer registered with the
practice. These records may be in the form of the manual record or a printed copy of the full computerised record. (If the PCT approves, the record may be transmitted in other forms.)
There are two possible reasons why these records are incomplete;
- The previous practice has kept inadequate records.
- The previous practice has returned an abbreviated printout by mistake.
(Different computer systems can produce various abbreviated printouts.)
The complete record may be essential for medico-legal reasons or for the continuing care of living patients.
Check that your practice always sends a complete copy of the records to the PCT if a patient is no longer registered.
Ask for the complete printed record to be sent as soon as possible.
If this is not forthcoming seek specific advice from the SHA and/or the LMC.
CD
14) The GPC - What is it and What does it do ?
To the average GP (if there is indeed such an animal) the GPC may seem more than a little distant!
After the last couple of years of negotiation and implementation of our new GMS contract, with its effects on PMS practices as well, many GPs
think of the GPC with the same delight as a 'tax inspector' or 'IB113-DLS'.
But what is the GPC?
Quite simply, it is the representative body for general practice nationally. It consists of between 65 and 70 members (depending on the
number of co-options). The majority represent regional seats, as I do for Wiltshire and Dorset and Nigel Watson does for Hampshire. Others come from elections from the LMCs conference or from the BMA ARM (where
Helena McKeown from Wiltshire was recently elected). A few represent special interest organisations such as the overseas doctors or the Medical Practitioners Union or the RCGP. We have representatives of the GP
registrars and the medical women's federation. There is also cross-representation from the dentists and the hospital doctors. The committee can co-opt from 'under-represented' groups although this
week's meeting, the first of the new season, is likely to witness a fiery debate about the merits of such co-option.
How do we function?
The full committee meets about 10 times a year. We have been known to have extra meetings at times of crisis - we even congregated on a
Saturday during the heat of the contract negotiations' final hours. These meetings are usually more useful for the networking that goes on before the meeting over a coffee or over lunch when we find out what has
been going on with the negotiators and in other parts of the country.
Debate in the meetings can get repetitious with the usual windbags standing up to say that they agree with everything everyone else has
said and to hear the sound of their own voices. I hope that the new chairman will restrict this.
We also have an e-mail 'listserver' which provides instant communication between members - I get 10-30 e-mails a day on average.
The nitty-gritty of the work of the GPC is done in committees which examine in detail matters related to statutes and regulations,
prescribing, premises, primary care development, education, IT etc. The committee chairmen meet the day before the full GPC meetings. The subcommittees meet 2-4 times per year as needed.
The inner cabinet of the GPC is the negotiating team. They have received a lot of stick during the contract talks. However, I think that
their achievements, negotiating with a monopoly employer, who could have told them to take a running jump at any stage, were remarkable but I will not rehash the benefits of the new contract here. The
negotiators usually end up working in London for 2-3 days a week but at the height of the talks were often meeting for 4-5 days a week and for whole weekends. The pressure on them was unremitting.
Backing up this visible activity is the secretariat. This is where the 'professional negotiators' forever called for at conference are to be
found. The depth of understanding of the business of general practice that these people have is remarkable and they usually come up with a reference to the correct statutory instrument or negotiating agreement
if we are having difficulties telling a PCT 'You can't do that!'.
The GPC is very imperfect and the 'Neal Report' put together by Julian Neal has come up with strong recommendations for reform. Whatever
shape it takes, it will continue to fight on for the national interests of GPs of any contractual status and respond to a fast changing world of medicine.
PS
15) NHS Direct Feedback Form
We have had a number of enquiries relating to an on-line NHS Direct feedback form. We were unable to find the form on-line and obtained
an electronic copy from the NHS Direct. This is available as a pdf file in the Info share section of our web site under Timesavers as NHS Direct feedback.
If you use the search facility on the website and enter "NHS direct feedback" it will also bring up the link to this document.
CD
16) Quest Editorial
From the Chairman... of NE Hants LMC
This is a new idea: a guest editorial! Perhaps Bob and Nigel have (temporarily) run out of inspiration. Or perhaps they think it's time that
the LMC Chairmen did a bit more for our honoraria!Well, whatever the reason, I've been asked to start the ball rolling.
North-East Hampshire LMC is a thinned-down version of the former North & Mid Hants area (Mid Hants moved to the enlarged West
Hampshire LMC 2 years ago). So we are the smallest of the 5 Wessex LMCs (at least in population) and cover just 2 PCT areas in the north and northeast of Hampshire - North Hants PCT and Blackwater Valley & Hart
PCT. Our area covers the towns of Basingstoke, Alton, Farnborough, Aldershot, and Fleet and surrounding areas on both sides of the M3. The Blackwater Valley area sits on the county boundaries with Surrey and
Berkshire, with our main hospital (Frimley Park) in the Surrey area. This boundary has been the cause of problems for many years in commissioning healthcare, with a large population (350k) living astride a
boundary with 3 counties, local authorities and social services departments!
So how is General Practice coping with the new era? The majority of our practices are nGMS, although a significant minority have moved to
PMS. The implementation of the new GMS contract has gone smoothly, with excellent working relationships with both PCTs, notably in the Implementation Groups (Bob sat on the North Hants group and I
represented the LMC in BWV). On the positive side, practice areas have been agreed with relatively little need for diplomacy, and so forced allocations are currently at a low level. The Quality and Outcomes
aspiration by practices show most aspiring to 1000 points or more: we shall have to wait and see, but my feeling is that most practices will achieve at least 900 points.
And of course PMS doctors will all benefit from the Q&O income. By and large GPs have (as we always do!) adapted to this new requirement
(actually it's voluntary) with enthusiasm, and look forward to a bumper cheque in April 2005. And I have to say that most of the Q&O cannot be faulted in terms of it being good medicine and therefore good for
patients. Yes, it does take me more time, but I can't deny that it stimulates me to think about the patient's real health needs, rather than just the URTI that is presented!
And thirdly, from 1st October all GPs in our 2 PCT areas will be able to cease OOH work. This was a huge plus in the negotiations, including the
end of the Saturday morning slot. Of course there are risks that a poorly-run OOH service will have an adverse knock-on effect in-hours, which is why many GPs will opt to continue to work (at better pay) for
the new OOH organisations - it's in our interests to do so - but at least it is now voluntary.
So what's the downside? Well the Enhanced Services are an on-going source of frustration, as we seek to persuade our PCTs that they really
have to spend up to (or indeed beyond) the 'floor' that the Government has set. Yes, they're strapped for cash, but why does secondary care always get funded first? What does being a Primary Care Trust mean?
And the LMC have had to remind our PCTs that doing a secondary care service outside a hospital does not necessarily mean that it can count towards the floor (our guidelines are that the work is done by a Primary
Care practitioner, is available to all practices and that referral to the service is voluntary).
The other source of uncertainty is the issue of superannuation, and the source of the funding of the 'employer's' tranche of the payments.
National negotiations continue on this, and our accountants still have no guidelines about how their certificates of practice profits will be calculated. However with profits set to rise significantly, and with the
effect of the dynamising system on our pensions, my advice is that nobody should retire in the next 3 years! The reason is that (unless the Government change the rules) the rise in average profits for GPs should
be mirrored in the same percentage rise in our dynamised career earnings on which our lump sum and pension are based. So hang on in there for jam tomorrow! (And seniority rises until you've worked for the
NHS for 47 years - £13645 in 2004/05!).
All in all, my feeling is that GPs in NE Hants are feeling positive about nGMS (and PMS GPs are benefiting too - which shows we must stick
together at GPC and LMC level). If that is good for morale, it will be good for recruitment, and good for patients too. And I still think we do the best job in the NHS. We are the multi-skilled clinical generalists,
who look after most of the patients most of the time, and our patients trust us more than anyone else! I think it's time to talk up General Practice as a huge asset to the NHS and a great career for the
enthusiastic young doctors emerging from our medical schools.
Best wishes from NE Hampshire!
SL
17) Copying Patient Letters
The LMC would like to make it plain that there is no legal requirement for GPs to copy patients letters.
This is a government initiative announced in the NHS plan and not a mandatory matter.
Until the GPC have negotiated the full reimbursement of costs involved to the practice we firmly recommend that no routine copying to patients is performed.
Should practices wish for clinical reasons to discuss with patients elements of referral, or even dictate the referral in the patients
presence, this is a matter for them to determine.
Until such time as Regulations are made and formal arrangements are put in place, GPs should indicate clearly to PCTs that it is not something that
PCTs may insist upon.
RB
Key to Contributors
RB Dr Bob Button Joint Chief Executive
NW Dr Nigel Watson Joint Chief Executive
CD Dr Christine Dewbury Medical Secretary
SL Dr Stephen Linton Chairman North East Hants LMC
PS Dr Peter Swinyard GPC Representative Dorset/Wiltshire
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