LMC Bulletins 2012

Bulletin 166


QMAS is closing in July 2013 – what you need to know
The Calculating Quality Reporting Service (CQRS) is replacing the Quality Management and Analysis System (QMAS), the system currently used to calculate payments to GPs under the Quality & Outcomes Framework (QOF). While QMAS will be used to calculate QOF achievement for 2012/13, CQRS will be the new system for calculating and reporting on QOF for GP practices across England for the 2013/14 financial year. Registration for training on CQRS is scheduled to open in early January 2013. This letter
provides more information on what practices need to do in preparation for QMAS closing down, and CQRS going live. All practices should have received an email from NEPCSA with regard to this but I will reissue as a reminder in eth New Year as it is very important that you register for the local events to understand how this will work.

Bulletin 165


Warning, Scam Alert 
It seems to be a while ago since this company were last on the scene but the scam is back. The name has changed yet again but the message is still the same – DO NOT SIGN AND/OR RETURN ANYTHING!  TEMDI.com (the new ‘old’ name – The European Medical Directory) are trying to get money from you by suggesting you are already in a contract with them but you can cancel this for a number (hundreds) of Euros! You will know this scam as either European Medical Directory, Med1web or Novachannel.

NHS Pension 11/12 Certificate Guidance
NHS Pensions have revised their certificate guidance
This applies to Box 38b, outlined in red in the attachment for ease of reference.

Reimbursement and Claim Forms of High Volume Personally Administered Vaccines
NHS Prescription Services has published a letter
reminding practices that certain high-volume personally administered vaccines must be claimed by using the FP34 appendix claim form. Dispensing doctors should use the FP34D appendix form (pink), and any other GPs should use the FP34PD appendix form (salmon). As from January 2013, if practices erroneously submit such payment claims on FP10 prescriptions, the incorrect forms will be returned, and resubmission of the FP34 will be accepted.

Bulletin 164


QOF Business Rules V24 
Version 24 of the business rules, which supports QOF 2012-13, has been published (this will include the October code release).

European Study on eHealth Usage Among GPs 
The European Commission has sponsored a study on the use of information and communication technologies among General Practitioners in all European countries. The aim of the study is to improve understanding of the use of technology by GPs in their daily activities and how this may vary. The study is supported by the GPC and 4,000 GPs (principals and sessionals) selected at random from the BMA database have been invited to complete an online questionnaire. Contact details have been disclosed on a secure and confidential basis with an appropriate confidentiality agreement in place. All information provided in the survey will also remain strictly confidential. Please note that participation is by invitation only to ensure a randomised sample. GPs who receive an invitation are encouraged to complete the online questionnaire, which should take no longer than 15-20 minutes - your participation will ultimately benefit both healthcare professionals and patients.

Bulletin 163


Rotavirus Vaccination Programme 
Following the
announcement by the Department of Health about the introduction of the Rotavirus vaccination programme from autumn 2013, they have provided this Q&A. The Rotarix® vaccine is for two doses of an oral vaccine to be given to children under 24 weeks, which would fit within the current childhood programme. All infants aged 6 weeks to 3 months at the start of the programme should be offered vaccination and there must be a four week gap between the doses. The vaccine supply will be centrally procured and therefore not liable to PA fees.

CMO Annual Report
The Chief Medical Officer for England, Dame Sally Davies, has published the first volume of
her annual report. This volume focuses on epidemiology and public health and contains information that may be useful to CCGs and GP practices. The report notes an increase in liver disease, and also looks at old age surveillance, access to healthcare, heart disease, obesity and cancer.  It looks like it will be a mine of information about our populations.

CQC Registration
The CQC has published a report on its pilots of inspection methods for primary medical services providers. It includes recommendations about how the CQC will check that providers meet the essential standards once they are registered. These recommendations include that providers should be given a 48-hour notice period for scheduled inspections and that these inspections should take place every two years.

Patients with Dental Problems
Doctors do not treat dental problems - however, treatment can be given for the pain. Should a patient attend your surgery, apparently unable to find a dentist to treat them, please give them the contact number shown below:
To find the nearest dental practice taking on NHS patients in the Tees area, visit www.tees.nhs.uk or call the dental helpline on 0345 045 0620, or Text: 07700 380000.
If you need a dentist in an emergency, call 0845 603 3131. You will be given the next available emergency appointment at a dentist somewhere in Teesside.
You may wish to use this poster.

Financial Element in Recovery Plans
Given all the changes currently taking place in the NHS we recommend that all practices ensure that a financial element is built into their disaster recover plans – considering financial contingency plans and/or surplus finances in the event on any payment delays as the PCT switch to the new world of the NHS.

Updated Clinical Waste Letters
Please observe these updated letters for GMS/PMS practice in non-Trust owned properties whose waste is collected by SRCL.

Bulletin 162


General Practice IT Services from 2013 
From April, the NHS Commissioning Board (NHSCB) will become accountable for the delivery of primary care IT, with the services PCTs currently provide (i.e. funding and responsibility for hardware, practice networks and support services, including training) being delegated to CCGs.
We urge practices to keep an inventory of the IT systems, software and services currently used and which are being funded and provided by the PCT in order to keep track of this information and lose nothing in the handover.

Although reassurances have been given by the NHSCB that PCTs will accurately identify the IT services they provide to practices, and that there will be a safe transfer of these services, keeping an inventory of the IT provisions currently provided by their PCT will help ensure this happens.

Although decisions on the funding to be devolved to CCGs in 2013-14 are yet to be finalised, the NHSCB has, at the GPC IT Subcommittee’s suggestion, indicated its intention to recommend that current actual spends on general practice IT provision are maintained for at least two years to ensure continuity of service.

Whooping Cough (Pertussis) NES for Pregnant Women Update
Further to the GPC discussion with NHS Employers regarding the additional monitoring requirements for this NE, NHS Employers has stated that it is a local matter as to whether the PCT varies the NES and\or secure additional information from GP practices. As you will be aware, we have raised this with the PCT who have decided to issue the NES with the additional monitoring requirements. It is now practice choice as to whether or not they sign up to the NES. It should be noted that the NES did include some requirements in relation to data capture and sharing by GP practices. This is in relation to the information required by paragraph 9 of the NES but more specifically 9(ii): "Producing and maintaining a satisfactory register of all eligible pregnant women on the contractors registered list during each financial year of the programme. Simple registers of pregnant women are all that is required although these will need to be updated regularly to capture the target population and record EDD so it is known when they are eligible for vaccination."

Patient On-line Access to GP Records and Transactional Services
The government has committed to provide all NHS patients with secure online access to their personal GP record and transactional services (electronic booking and cancelling of appointments, ordering of repeat prescriptions and communication with the practice) by 2015. The NHS Mandate from the government to the NHS Commissioning Board, published 13 November 2012, reiterates this commitment and goes a step further by saying that e-consultations should become more widely available by 2015, and that people with long-term conditions should be able to benefit from telehealth and telecare by 2017. The RCGP was asked by the government to work in partnership with patient groups and other professional organisations to lead on the development of a plan, policy and procedures to support patient access and engagement with their GP records. GPC representatives have attended meetings of this project. While the GPC is supportive of the principle of patients having easier access to their record, and also support some of the transactional services being proposed as long as they are adequately resourced and straightforward to deliver (such as electronic ordering of repeat prescriptions), there are a number of outstanding concerns with the proposals. These include third party information held in the record, patient understanding of the record, workload implications for practices, security and confidentiality and patient consent to sharing, among other issues.

Care Home Patient Reviews
We have been made aware that some care homes are contacting practices to arrange an agreement to put in place additional/regular patient reviews. Practice should provide patient reviews (not always face to face) as per their contract and according to individual patient needs. Any additional arrangements would require an additional contract with the care home.

Reminder, Registration of GPs as Patients
We strongly recommend GPs – salaried or partner - should not be registered as a patient within the practice where they work. This recommendation extends to other staff working within the practice as managing consent, confidentiality and disagreements can become very complex when the patient/doctor dimension is added within the workplace.

Reminder, Practice Agreements
Due to changes in the NHS and General Practice many practices are dusting off their practice agreements. If you have not done this already we strongly recommend you review your agreement to ensure it is up to date, relevant and signed. This Partnership Agreement Checklist may assist your review and also incorporates previously circulated guidance on wording for minutes to ensure CQC/CCG decision making is correctly documented.

Bulletin 161


Sharing Electronic Records for Direct Patient Care 
This set of principles has been developed to support GP practices that are considering implementing shared record systems. Until relatively recently, data recorded in GP systems have not been directly accessible by other organisations. Data have previously been shared via specific clinical communications, such as referral letters. A number of GP clinical system suppliers have developed systems which allow healthcare professionals across different organisations to access directly the detailed information recorded during patient consultations. These are high level principles, which the BMA believes represent best practice in terms of allowing records to be shared in order to facilitate patient care, whilst maintaining high standards of confidentiality. All system suppliers should aspire to meet these standards.

Whooping Cough (Pertussis) NES for Pregnant Women
It has come to our attention that the data that all PCTs have been instructed to request from practices varies from that which was previously agreed between the DoH and the GPC (see a bulletin 157 below for a copy of the agreed NES). The agreed NES only requires practices to provide the following information for monitoring purposes:

The DH has given guidance to PCTs which supersedes this and additionally asks practices to provide:

Both the GPC and the LMC are concerned about the additional workload this is creating without any additional funding and find it unacceptable that additional reporting requirements have been added to the NES after the agreement was made. The GPC have written to NHS Employers asking for urgent clarification on this issue. The PCT have forwarded us a copy of a revised NES which reflects the new data collection – we have advised we are awaiting further national guidance before we can comment on such changes.

Focus on Travel Immunisations Updated
Focus on Travel Immunisations has been amended to add a note about the reimbursement of oral typhoid vaccine, and to clarify which travel immunisations are not reimbursable on the NHS.

CQC Consultations
The CQC has recently published two consultations, on fees and their strategic direction. The consultations are available at
http://www.cqc.org.uk/feesconsultation and http://www.cqc.org.uk/thenextphase.
The BMA will be responding to both consultations, but GPs are also encouraged to respond.  The more who respond, the better CQC will understand our unhappiness with being charged to be inspected.

Area Health Guides
You may be approached by a company producing something called the Area Health Guide. Please be advised that they do not, currently, have PCT authorisation to sell advertisements on the PCTs behalf. If you are approached please contact alison.hyde@tees.nhs.uk.

QOF Achievement & Prevalence Data
The 2011/12 QOF achievement and prevalence data has been published by the NHS Information Centre, including a statistical bulletin, an online database and a set of detailed data tables.

Bulletin 160


Oral Typhoid Vaccine
Following reports of the injected single typhoid vaccine being unavailable, GPC were asked whether the oral single typhoid vaccine could be given instead and whether the vaccine cost could be reimbursed on an FP34 when it is in fact a self-administered tablet. The NHS prescription Services has confirmed that the situation with the oral typhoid vaccine is somewhat unusual in terms of what is allowed. It is classed as personally administered and although it is not a vaccine in the conventional sense, it is listed as an Oral Vaccine and is a High Volume Vaccine on their system, and can therefore be claimed on the FP34 appendix. They will also accept it if practices were to print it on an FP10 and submit it with the end of month submissions. GPC have also had reports of shortages of the Oral Typhoid vaccine Typhim Vi, and in the September Vaccine update it is suggested that practices contact Crucell as they reportedly have stock of the Vivotif vaccine which can be used instead.

BMA 2013 Research Grants
The BMA was among the first of the professional bodies to award grants and prizes to encourage and further medical research. Today, around ten research grants are administered under the auspices of the Board of Science, all funded by legacies left to the BMA. Grants totalling approximately £500,000 are awarded annually. Applications are invited from medical practitioners and/or research scientists and are for either research in progress or prospective research this year - open from 11 December 2012. Further information on the grants and details of how to apply are available here - subject specifications for each grant vary so please check the information first (e.g. in 2013, research areas range from rheumatism and arthritis, cardiovascular disease and cancer to neurological disorders and terminal care). The application deadline is 15 March 2013 at 5pm. If you have any questions about the BMA research grants, or would like to receive alerts about them, please contact Chris Wood at info.sciencegrants@bma.org.uk or telephone 020 7383 6755.

GP Trainees Subcommittee Newsletter
This is the October edition of the GP Trainees Subcommittee newsletter.

Bulletin 159


Primary Care Incentive Schemes
A number of primary care incentive schemes that reward arbitrary reductions in clinical activity without evidence that this is in the best clinical interests of individual patients are being developed throughout the country. There are also schemes with little or no restriction on the reward given to practices, for example, the stipulation that the money should be reinvested in patient services. The GPC and the BMA Ethics Department have significant concerns about the professional and ethical implications of these schemes. In particular, the schemes may breach paragraph 74 of Good Medical Practice (GMP):

"You must act in your patients' best interests when making referrals and when providing or arranging treatment or care. You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients. You must not offer such inducements to colleagues."

The BMA asked the GMC for its view of these incentive schemes. The GMC is clear that, in general, incentive schemes should specify that payments arising from the scheme should be used for improving patient services and not for the financial benefit of individual doctors. The BMA urges any doctor making decisions about commissioning or participating in an incentive scheme to consider the schemes carefully. Any GP with concerns about a proposed incentive scheme should seek advice from their LMC. Doctors should, where possible, review the evidence base for the schemes and satisfy themselves that, in participating, they will not be compromising patient care.

Crucell Flu Vaccines Update
Crucell has now sent this letter to its customers confirming that they are withholding all their deliveries of the Viroflu/ Inflexal flu vaccine.

Zostavax Vaccine Update
The Department of Health has confirmed that if a GP makes a judgment that vaccination against shingles would be clinically indicated and beneficial for an individual patient, Zostavax can be prescribed on the NHS. The DH is also planning to make a statement about the possible introduction of a shingles vaccination programme for those people aged 70-79 years, as recommended by the JCVI. Their position on this issue has also been published in this edition of 'Vaccine update'.

Stamp Duty Land Tax
The GPC is currently seeking specialist advice on the subject of Stamp Duty Land Tax (SDLT), a tax on land transactions that, in the context of general practice, is liable on any lease of a GP practice or acquisition of freehold. The issue is complicated and further advice will be forthcoming once representatives of GPC have met with the Department for Health and received legal advice. In the meantime, GPs who are about to acquire land for a new practice, enter a new lease, or whose leases are up for renewal, are urged to seek advice from a specialist property lawyer. Please note that if your practice has a Licence to Occupy then there is no SDLT liability.

Door Entry Codes & the Patient Demographic Service
Practices are reminded that confidential door entry codes must be recorded correctly in patient electronic records. Practices are sometimes provided with four-digit codes by their patients to allow them access to a door entry system, or to a box containing a key for the patient’s front door. Last year, Connecting for Health wrote to practices to alert them that door code details were being stored incorrectly in the address, telephone number or name fields of patient records, which were subsequently uploaded to the Patient Demographic Service. This creates a serious security risk with, for example, the codes being included as part of the address on letters sent to patients. Practices should instead add the information to the patient record using Read Code 915L ‘Patient door access via key code’, and then record the code using free text.

From April 2013, the NHS Commissioning Board (NHSCB) will be accountable for the delivery of primary care IT, with funding and responsibility for hardware, practice networks and support services (including training) being delegated to CCGs (i.e. the services PCTs currently provide). CCGs as commissioners will need to own a locality informatics strategy. The Local Service Provider contract and GP Systems of Choice programme will continue to be managed and funded at a national level. Work is underway with PCTs to determine the current level of spending on GP IT before decisions on the funding to be devolved to CCGs in 2013-14 are finalised.

The NHS CB has provided the following update on arrangements for GP IT systems:

The following information is in support of the information released in issue 20 of the CCG bulletin. Primary care trusts (PCTs) have led on the provision and support of GP IT systems and therefore the safe transfer into the new commissioning system is highly important to ensure that GPs continue to have a choice of quality solutions which meet local needs. The future operating arrangements for GP IT, to apply from 1 April 2013, are due to be published in the autumn. GP IT services comprise of IT support services for GP practices as set out in GMS and PMS contracts (plus APMS contracts that specifically include these IT services) plus implementation and support for all appropriate nationally mandated systems. They also include discretionary, locally determined IT support services. The NHS Commissioning Board (NHS CB) will be accountable for these services. The NHS CB will continue to set overall direction, standards, strategy and budgets, such as the GPSoC contract and maintaining national infrastructure. Clinical commissioning groups (CCGs) are best placed to plan the use of IT systems to support service delivery and service change to enable better patient care across local health communities. The NHS CB will therefore discharge its operational responsibilities for GP IT services by arranging for CCGs to provide these services locally on its behalf and by devolving associated funding to CCGs. IT support for other primary care contractors will be incorporated into the NHS CB’s operating arrangements. The proposal is that the NHS CB, through its local area teams, will be the registration authority for all primary care contractors (administration of access to clinical and business systems) and will be responsible for clinical safety and assurance (adherence to dataset change notices). We anticipate that local area teams will arrange for commissioning support units or other IT providers to provide these services.

If you have any questions about these future arrangements please contact ccgdevelopment@nhs.net.

Bulletin 158


Seasonal Flu – Correct Coding and a SystmOne Issue
We have been made aware that some practices are still using old coding details for flu vaccination reporting. Please check that you are using the new codes as per QOF 12/13 or you may hit payment problems. Additionally, there are concerns about the reports provided by TPP intended to identify the ‘at-risk’ patients eligible for flu vaccination.  It appears that TPP have included a larger range of codes than necessary and this is resulting in inappropriate patients being identified.  TPP have confirmed that there is a separate set of reports used for upload into ImmForm but there is no access to these reports so the PCT cannot check whether there will be a negative impact on reported achievement. Please ensure that you double check that you are calling and vaccinating the correct cohort bearing in mind this issue.

Overseas Patients
The aftermath of the Panorama programme has led to increased interest in this. Please do not hesitate to contact the LMC for advice pertaining to individual request. The latest DH statement is as follows:

Treatment provided by a GP is free of charge, whether registering as a temporary patient (when you are in the area for more than 24 hours and less than three months) or registering as an NHS patient. There are certain types of service in the NHS that are currently free of charge irrespective of country of normal residence. These are outlined in the National Health Service (Charges to Overseas Visitors) Regulations 2011 as:

Procurement Guidance
The GPC has published this guidance explaining the basics of procurement law and policy.

Bulletin 157


Pertussis (Whooping Cough Vaccination Programme for Pregnant Women
Following on from advice from the JCVI, the CMO (England) have asked that commissioners urgently put in place a pertussis (whooping cough) vaccination programme for pregnant women to respond to the outbreak of infection. The GPC and the Department of Health have agreed this National Enhanced Service (NES) specification for practices to undertake the vaccination of pregnant women from 1 October 2012.

A summary of the NES agreement is below:

This temporary programme commenced on 1 October 2012 and will be funded centrally. The LMC have had discussions with the PCT who confirm that this DH letter is a letter of authority/guarantee and the NES will be issued to practices ASAP. If practices are approached by patients prior to the NES being issued, they should progress with vaccination and reporting for payment is likely to follow that used for flu vaccinations.

If you have any questions please contact Toks Sangowawa (toks.sangowawa@nhs.net) or Jane Lawson (janelawson@nhs.net) at the PCT for further information.

The LMC and PCT will have further discussions as to how midwives can contribute to this vaccination programme – until this is finalised midwives will be asked to refer patients who have not yet been vaccinated to their GP practice.

Please note that although Infanrix is licensed for Pertussis vaccination, it does not provide the same protection as provided by Repevax. As such, JCVI has only recommended Repevax for this programme, which practices can order via ImmForm./font>

Bulletin 156


The Government published the Public Service Pensions Bill on 13 September. It claims that changes to public sector pensions are needed for sustainability. However, the BMA strongly believes that the scope of these changes is unfair, unnecessary and will adversely impact staff in the NHS Pension Scheme:

  • Demanding the same savings of all public sector schemes across the board is unfair – the NHS Pensions Scheme underwent major reform only 4 years ago, and continues to deliver a positive cashflow to the Treasury.

  • Some healthcare workers will pay 66% of the cost of their pension benefits by 2014-2015 but the highest earning civil servants will pay a maximum 26% of theirs.

  • The Government wants to link the Normal Pension Age for NHS staff to the State Pension Age, but work in the NHS is often physically, mentally and emotionally demanding, and some staff will not feel able to work effectively beyond the age of 65.

The BMA will be proposing affordable ways in which the changes can be made fairer, both now and in the longer term. The BMA’s activity on these plans involves a number of strands. First, the BMA is playing an active part in the Working Longer Review, involving the Department of Health, NHS Employers and health unions examining the impact of NHS staff working longer. Additionally, together with other health unions, the BMA is building a campaign against the planned increase to the NHS retirement age. Also, the BMA are using the publication of the Bill to lobby Parliamentarians, to make them aware of doctors’ concerns about the changes to NHS pensions and to offer alternative solutions. The BMA is among the unions currently in talks with the government about the detail of the changes to the NHS pensions scheme.

The UK Revalidation Programme Board considered preparedness for the roll out of revalidation. The BMA believes that while there is significantly more work to be done to get revalidation into proper shape, its seven principles for implementation have been broadly recognised and sufficiently addressed to enable the General Medical Council to proceed with its timetable. This is partly due to a commitment given that the NHS Commissioning Board (NHSCB) will establish funding to support GPs who need remediation away from their place of work, and confirmation that the responsibility for funding remedial placements and assessments for GPs will rest with commissioners. Fair and reasonable access to funding will be determined through a set of criteria determined by the NHSCB working with the BMA. The GPC will continue to work to ensure that the ongoing issues that require further work are addressed, and that revalidation is reviewed regularly to assess whether it is proportionate and appropriate, and benefits patients.

Flu Vaccinations for Healthcare Workers
Due to the continued low uptake of the flu vaccine in healthcare workers (45% for 2011/12), the Chief Medical Officer for England, Professor Dame Sally Davies, and the BMA’s Chair of Council, Dr Mark Porter, have written this letter to doctors to ensure that as many frontline staff as possible get vaccinated.

Pharmaceutical Service Regulations Amends
The Department of Health has made the following amendments to the NHS (Pharmaceutical Services) Regulations 2012, which will come into force on 1 November:

  • restore rights of appeals included in the NHS (Pharmaceutical Services) Regulations 2005 but not included in the 2012 regulations;

  • make it clear that members of limited liability partnerships are to be treated, for information providing purposes, in the same way as directors of corporate bodies;

  • correct the list of conditions that have to be met if a dispensing doctor is to dispense a repeatable prescription in Schedule 6 to the 2012 Regulations (terms of service for dispensing doctors).

Bulletin 155


GP Practice Staff Census
This week, practices will receive a request, from NEPCSA, to provide data with regard to GP practice staff numbers. This is part of an annual national census. We support this process and urge practices to provide the data as it feeds into necessary workforce planning

Medicines Use Review Feedback Forms
On 1 September a new Medicines Use Review (MUR) feedback form was introduced, so practices may soon start receiving such forms. This form is for pharmacists to advise GPs of any issues that had been uncovered during an MUR consultation that the GP may wish to be aware of. 

GPC Message re CCG Constitutions
The GPC are receiving reports of CCGs placing increasing pressure on practices to ‘sign up’ to constitutions by a certain deadline in order for the CCG to meet the timescales of authorisation. The NHSCB have been clear in meetings with the GPC that CCGs will only be authorised if they can demonstrate adequate engagement with practices. CCGs that rush or skip this engagement may find that in their rush to be authorised, they jeopardise their chances of progressing successfully to authorisation. It is vital that time is taken to ensure that the early development of CCG is well thought through and involves all the member practices. If you are concerned about the development of your CCG please email the GPC at info.commissioning@bma.org.uk.

Bulletin 154


Red/Amber Drugs
We have been made aware that practices are increasingly being asked to prescribe red/amber drugs, under shared care arrangements, for which no local agreements exist. The LMC advice remains that you should only prescribe medication for which you feel competent to prescribe/monitor. Once you issue a prescription, you become clinically responsible for that patient not the consultant who may be overseeing the patient. Additionally, please remember that red/amber drugs should only be transferred by agreement with funding in place for monitoring.

Cleveland LMC Organisational Change
Cleveland Local Medical Committee has established a Limited Company which runs in parallel with the Committee. This protects Officers, Members and Constituents of the Committee as it limits their liability. All advice is now provided by Cleveland LMC Limited; the LMC is responsible for formal representative activities including elections and levy collection. In practise this will make no difference to the service that GPs receive and has been undertaken following extensive legal advice. If you have any questions or wish to have further details, please contact the LMC office.

Bulletin 153


Sessional GP Newsletter
This summer edition of the Sessional GP Newsletter includes key articles on issues relevant to salaried and locum GPs, including items on pensions, taxable expenses and insurance cover. A feature article on sessional GP involvement with LMCs is also included in this issue.

GP Trainees Subcommittee Elections
As of August 3rd, ballot papers will be sent out for elections to the GP Trainees Subcommittee in the Northern Deanery. The deadline for votes to be received by the Electoral Reform Society is 5pm on Friday 24th August, so if you have not yet received a ballot paper (by August 10th) and you feel that you should have, please get in touch with Christopher Scott via
cscott@bma.org.uk who will make sure that ERS send out ballot papers to all eligible voters.

Bulletin 152


Updated Focus on Travel Immunisations
This Focus on Travel Immunisations, has now been updated taking in to account the recent amendments to the Statement of Financial Entitlements as set out in Annex BA ‘Vaccines and immunisations’.

Bulletin 151


Seasonal Flu Call & Recall Arrangements
The DH provided the following clarification of assurance on flu vaccination planning:
Following the publication of the CMO’s letter of 3 May, there has been some concern raised by GP practices about the GP checklist for assurance on flu planning, specifically the entry:
Robust call and recall arrangements

1. Patients recommended to receive the flu vaccine will be sent a letter, inviting them to a flu vaccination clinic or to make an appointment.

The flu DES requires practices to adopt robust call and reminder systems to contact patients in order to maximise uptake. It is not explicit about the system adopted. Research shows sending a letter to be effective and is therefore included in the checklist as one of the ways PCTs can be assured of GP practice plans. GPs are expected to use their judgment on the best way to reach patients in order to meet the DES requirement and so this should be taken into account when seeking assurance of local plans.

Guide to a Session for GP Trainees & Trainers
The GP Trainees Subcommittee has published this "Guide to a session for GP trainees and trainers" in conjunction with COGPED that has been drafted to replace the previous 'Guide to a session' (January 2009).

GP Trainees Subcommittee Newsletter
This newsletter covers matters of interest to doctors in GP training including information on education, training, contracts, terms & conditions of service and the NHS reforms in England, as well as information on getting involved with the subcommittee.

Locum GP Forum
The online community for doctors, doc2doc, has recently launched a dedicated forum for GP locums. This forum provides an arena where locum GPs can get involved and network with fellow locum GP colleagues - discussing experiences with colleagues from across the UK and gaining insight from others in similar situations. Registering online to create an account is quick and straightforward.

Bulletin 150


Focus on Hep B Immunisations
This Focus on Hepatitis B Immunisations aims to clarify the circumstances where charges can be made and where active attempts to encourage hepatitis B immunisation ought to be made. Note that the occupational health section replaces and updates the former guidance Hepatitis B vaccination for employees at risk.

General Practice Extraction Services (GPES)
GPES is a new service, delivered by the Health and Social Care Information Centre (HSCIC). From April 2013, GPES will make data available from GP clinical systems with the intention of improving the health and wellbeing of patients in England and the first request will be the data required for QOF 2013/14. It is important that you are aware of GPES because each GP practice will be asked to consider whether to participate in the service.

From January 2013, HSCIC will be asking all GP practices about their preferences for participation in GPES data requests. For effectively anonymised data requests, you can either choose to automatically opt in to all requests, or alternatively make a decision on a case by case basis upon receiving details of each request. For identifiable data requests, you will NOT be able to make a general choice to opt in to all requests but will be asked to opt in to each individual request. The GPES software is being designed to minimise the workload for GP practice staff. Extractions of data will be undertaken by your GP system supplier and sent on to HSCIC. The data will be held in a secure environment and then sent to the customer in the required format. The data held in the HSCIC secure environment will then be destroyed.

GPs are rightly cautious about the information they hold on behalf of their patients – the BMA believe GPES strikes the right balance between patients individual rights to privacy and the need to share for the greater good.

The BMA has been involved in advising on GPES from the outset, particularly in relation to information governance and ensuring that the confidentiality of patient data is protected. This included agreeing GPES information governance (IG) principles which recognise the role of GPs as data controllers. One fundamental IG principle is that general practices, as data controllers, decide whether data should be extracted. Another is that anonymised data will be extracted wherever possible. Identifiable data can only be extracted if there is a legal basis, for example with explicit patient consent or approval by the Ethics and Confidentiality Committee (ECC) of the National Information Governance Board. New Read codes have been developed to allow patients to opt out of appropriate identifiable data extracts. Customers of GPES must be approved by the DH and/or the NHS Commissioning Board. The GPES Independent Advisory Group (GPES IAG), which includes BMA representation, considers each data extract request ensuring GPES IG principles are met and there are sufficient benefits for patients.

Further information on GPES will be provided shortly, but you may wish to access the current GPES information, including the GPES IG principles agreed with the GPC, on the HSCIC website.

Flu Immunisation Programme – Patient Leaflets

The DH has clarified that they do not intend to fund any distribution of communication media for the flu immunisation programme and that the patient leaflet that is available on the DH website is for practices to use should they wish to. Given the view that we do not believe GPs should be expected to print such leaflets at their own expense we would advise GPs not print such leaflets as there is no funding available for doing so.


Management of Adult Diabetes Service in NHS
At the end of May, the National Audit Office (NAO) published this report
on the management of adult diabetes services which highlighted the differences in reported achievement between QOF and the National Diabetes Audit (NDA). NICE has subsequently been asked by the Department of Health to consider the issues raised in the report and have initiated a review of DM13 which is the QOF indicator for micro-albuminuria. The GPC had several concerns with the recommendations set out in the report, in particular Recommendation b.

Recommendation b.

Payment mechanisms currently available to GPs are failing to ensure sustained improvements in outcomes for people with diabetes. The current system of incentives needs to be reviewed and renegotiated to improve outcomes for people with diabetes in accordance with clinical practice recommended by the Framework and, more recently, by NICE. GPs should only be paid for diabetes care if they ensure all nine care processes are delivered to people with diabetes. The threshold at which GPs are remunerated for achievement of treatment standards should also be reviewed and increased at regular intervals.

The GPC disagrees with both parts of this recommendation. The suggestion that GPs should only be paid for diabetes care if they ensure all nine processes are delivered would have unintended consequences where patients did not wish to engage in some checks or continue to attend. They also believe that payment thresholds are outside NICE’s remit and have, therefore, written to Professor Sir Bruce Keogh, NHS Medical Director, to highlight their concerns over this report.


Vaccine Update June 2012
The Department of Health published this vaccine update for June, which contains useful information on: HPV immunisation programme - change of supply from Cervarix to Gardasil from 1 September 2012; Flu vaccination uptake reports for Winter 2011/12;
Deliveries of vaccines during Olympic and Paralympic games; and Process of ordering of vaccines through ImmForm.

Reimbursement of GP Trainee Travel Expenses
GP trainees who use their cars to conduct home visits during their placements are entitled to claim mileage expenses. The journey to and from work (up to 10 miles in each direction) can also be claimed, but only if a home visit is made that day. Travel expenses can be reimbursed for deanery-organised educational events or programmed teaching, but this does not seem to apply to all deanery areas. Training practices and trainees are advised to check this with their deanery.

Trainees are either able to claim this allowance through the training practice, which in turn claims reimbursement from the regional Deanery, or directly though the PCT. The training practice is expected to signpost the trainee to the correct person at the PCT if necessary.

The rates at which trainees can claim are set nationally by the Directions to Strategic Health Authorities Concerning GP Registrars and the amounts they can claim vary according to the cc of their car - up to a rate of 58.3p per mile for certain cars. This is over the rate permitted for the purposes of tax (45p per mile) and so any amount above the 45p per mile rate is seen as a benefit and should be taxed as such.

This means that the employer (practice) should then either complete a P11D form  for the Inland Revenue detailing any of this and any tax owing will be taken out of the trainees National Insurance contributions the following year; or, some practices may have pay roll software that can do the tax calculations for them as they go along. Trainees and practices should ensure that they keep a record of any mileage claims for up to six years for tax purposes. The BMA is working with NHS Employers to see if the GP Registrar directions can be changed to come in line to reflect taxable allowances.

Locum GP Handbook (BMA members only)
The BMA GP locum handbook has now been published for the benefit for BMA members and provides useful advice on a range of issues to consider when working as a locum GP. The handbook includes specific sections on starting out as a locum GP, as well as others sections on setting up a business and agreeing contracts for services with different employers. It will also be a useful guide for practices that engage locums.  The official launch of the handbook will take place at Sessional GPs: Redefining Success, a one day conference to be held at BMA House on Thursday 11 October 2012. Attendees will be the first to receive hard copies of the handbook.

Bulletin 149                                                


As you will be aware, the CCGs are currently working on their Constitution in preparation for Authorisation. The CCGs have been working with the LMC and the Constitutions will be considered at the LMC Board meeting on Tuesday 10 July. Once we are in a position to share our views on the documents with all practices we will do so prior to any practice signatures being requested. The GPC has provided this information
on a number of CCG related topics.

The CQC are sending out this letter to practices registering with them by April 2013, inviting you to set up an online account on their website. As part of this process, you will be asked to pick a 28 day window between September and December 2012 for submitting the application form. If you have not received a letter by the end of July, and you think you should register, you should contact the CQC at
2012registration@cqc.org.uk. This LMC PowerPoint presentation (from the LMC event of 5 July) together with this GPC guidance about the registration process and accompanying appendix has been designed to assist you but if you have any questions at all please do not hesitate to contact the LMC or CQC.

Sharing Patient Information
Practices are increasingly receiving requests on sharing patient information, particularly with regard to risk stratification. Risk stratification is considered as a secondary use of data and, therefore, any release of patient identifiable information must be subject to existing legal and ethical principles. Patient identifiable information should remain within the practice unless explicit patient consent is obtained or there is another legal basis for the disclosure such as approval under section 251 of the NHS Act 2006.  Identifiable patient information should not be accessible to other staff, including clinicians, unless they are providing direct care for that particular patient. The BMA has produced this guidance to assist in dealing with requests for data for secondary purposes.   

Agency Workers Regulations Guidance
This guidance on the Agency Workers Regulations
will be useful for all locums who are engaged by agencies, as well as practices who hire them.

GMC Continuing Professional Development Guidance
This GMC Continuing Professional Development guidance for all doctors has been developed in co-operation with doctors, medical Royal Colleges, employers, patients and the public, and follows widespread public consultation earlier this year. It is hoped doctors will use it to reflect on how their learning and development improves the quality of care they provide to patients and for the service in which they work. The guidance describes:

  • How doctors should plan, carry out and evaluate their CPD activities.
  • The importance of taking account of the needs of patients and of the healthcare team when doctors consider their own learning needs.
  • How doctors should reflect on the Good Medical Practice domains when evaluating their CPD needs.
  • The relationship between CPD and revalidation.
  • The use of appraisal, job planning and personal development plans in managing CPD and how to record CPD activities.
  • The responsibilities of others, such as employers and Colleges, in supporting doctors’ CPD.

Vaccine Update June 2012
The Department of Health published their vaccine update for June
, which contains useful information on: HPV immunisation programme - change of supply from Cervarix to Gardasil from 1 September 2012; Flu vaccination uptake reports for Winter 2011/12; Deliveries of vaccines during Olympic and Paralympic games; and Process of ordering of vaccines through ImmForm.


Services That Should Not Be Provided By GPs Guidance
GPs are increasingly being asked to provide services to patients residing in institutions or homes where the types of services expected do not fall under the responsibility of primary care. This revised GPC guidance
has been developed to help GPs decide whether or not the treatment they are providing in institutions and residential homes falls within the remit of standard primary medical services contracts.


Control of Asbestos Regulations
Given the number of queries raised on Asbestos Inspections following the Annual Returns earlier this year we thought it may be helpful to share the link to this short guidance note
on the implications of the Health and Safety Executive’s revision of the Control of Asbestos Regulations.

Bulletin 148


PIP Silicone Breast Implants
The expert group on PIP implants chaired by Sir Bruce Keogh published its report earlier this week. A summary of the findings and recommendations of this expert group is included in these letters to MDs and GPs
. The criteria for referral remains as outlined in the expert group interim report published in January, and is also included in the letters.

Joint BMA and NHS Employers guidance on QOF frequently asked questions for 2012/13 has been published here. These FAQs apply are for primary care organisations and general practices covering a number of historical issues and commonly asked questions.

NHS 111 Services
The Secretary of State for Health announced last week that he recognises that an extension of up to six months is required before local NHS 111 Services can be implemented in certain regions of England including the North East. The DH is keen to get as much clinical input as possible and Berenice Groves (berenice.groves@nhs.net) is the person in the North East responsible for coordinating the work and engagement with local CCGs in order to get local 111 services in place.

Bulletin 147


Changes to Group 1 & 2 Driving Licensing Standards for Vision
The DVLA driver licensing standards for vision have now changed. In summary:

Group 1 (cars and motorcycles): applicants and licence holders will need to have a visual acuity of 6/12 (0.5 decimal) as well as being able to read the number plate from the prescribed distance.

Visual field: the present standard of a total field width of 120 degrees remains but in addition, there will need to be a field of at least 50 degrees on each side.

Group 2 (buses and lorries): applicants and licence holders must have a visual acuity, using corrective lenses if necessary, of at least 6/7.5 (0.8 decimal) in the better eye and at least 6/12 (0.5 decimal) in the other eye. If corrective lenses are worn, an uncorrected acuity in each eye of at least 3/60 (0.05 decimal) is needed. All Group 2 drivers must also meet all the Group 1 visual acuity standards as outlined above. Where glasses are worn to meet the minimum standard for driving, they should have a corrective power of no more than plus eight (+8) dioptres.

The full standards are available on the DVLA website.

Diabetes UK also has information about the recent changes.

RCN Indemnity Guidance
The GPC has updated this guidance following MPS clarification on its advice to its members.

Updated Focus on Vaccines & Immunisations
The Focus on Vaccines and Immunisations guidance, which was originally published in 2004, has now been updated following the publication of the amendments to the Additional Services section of the NHS Regulations 2004 (Annex BA of the Statement of Financial Entitlements) on 30 April 2012.

In 2004, everything in the Red Book was transferred unchanged and carried into the new GMS contract as an additional service. These regulations became out of date because of changes in the vaccines themselves and continued to contain inappropriate references, such as smallpox. This did not prevent their being carried over into the new contract. The amendments to the SFE now reflect current practice and attempts to clarify the previous regulations to make them fully up to date, and are not intended to introduce any new work.

ePACT Data for Quality and Productivity Prescribing Indicator Achievement
ePACT data to measure achievement was made available on 17 May 2012 and PCTs have been advised to use the ready reckoner (or formula on page 166 of the 2011/12 QOF guidance) to calculate the points achieved for each of their practices. Due to the additional time required by PCTs to calculate achievement for a number of practices, practices should not delay signing off QMAS (approving and declaring achievement), as a PCT could withhold an achievement payment if QMAS has not been signed off. Early sign off will enable PCTs to complete pre-verification checks before payment is due. In particular practices do not have to wait until they receive their QP3 – QP5 results to sign off QMAS, as signing off QMAS does not prevent a practice from appealing their QP3 – QP5 results or raising a dispute.

Step by step process:

  1. Practice signs off QOF achievement (approves and declares achievement) for QOF 2011/12 on QMAS minus the QP3,4 and 5 results which only PCTs can input. This enables PCTs to carry out pre-payment verification checks.

  2. In order to make sure that QOF payments are made by end June, PCTs may need to generate advance payments for QOF achievement on Exeter (not through QMAS) based on rest of QOF achievement plus an estimate of the QP3, 4 and 5.

  3. PCTs await the ePACT results, calculate the actual prescribing achievement using the ready reckoner and input final results in QMAS.

  4. QMAS calculates the final achievement payment and this generates the correct payment through QMAS. If the PCTs made an advance payment on Exeter, they need to recover the amount through an equivalent negative ad-hoc variance.

Changes to Community Pharmacy Medicines Use Review Scheme
From 1 July 2012 changes will be made to the community pharmacy Medicines Use Review (MUR) service. The main changes that will affect GPs are the introduction of a feedback form which will be used by pharmacists to inform GPs of any issues that arise during the MUR consultation and the removal of the requirement for pharmacists to inform GPs that an MUR has taken place when no recommendation has been made by the pharmacist to the GP. These new requirements are subject to a change of directions in due course.

Seasonal Flu Arrangements
The CMO wrote to practices on 3 May about the seasonal flu arrangements. Annex B (the GP check list) on page 9 says:

Robust call and recall arrangements

1. Patients recommended to receive the flu vaccine will be sent a letter, inviting them to a flu vaccination clinic or to make an appointment.

The GPC was concerned that the checklist does not reflect the requirements of the DES, and that it is up to practices to decide how they advertise to and follow up patients. We brought this issue up in a recent helpful meeting with the CMO, who noted that it was less specific in the DES. Our advice remains that the DES is followed and that the important point is that robust systems should be used to notify patients, although there may be local variations. It is up to the practice, not the PCT, to decide what these are.

LMC Conference Motions
These LMC Annual Conference Motions have now been published.

GP Trainee Elections
Nominations are now open for regional representatives on the GPC GP Trainees Subcommittee. Elections are being held for each of the 19 regional constituencies - nominations are open to all those on, or about the begin, a GP training programme - whether they are BMA members or not. Full details, including nominations forms, are available on the BMA website here. All nominations must be received by the GPC office by 5pm on Friday 22 June 2012.

Bulletin 146


Outer Boundaries
You will shortly receive information from NEPCSA regards outer boundaries (together with a contract variation/Statutory Instrument). When considering outer boundaries it is the practice decision as to what this boundary will be and there is provision for outer and normal boundaries to be the same where areas are extensive. If you have any concerns/questions when agreeing outer boundaries please do not hesitate to contact the LMC and we will be happy to discuss this with you.

Jubilee Bank Holiday
As you are aware, next weekend is a ‘double bank holiday’ (Bank Holidays are 4th and 5th June) which will bring with it the usual capacity and surge issues that we always see over a 4 day weekend. The PCT are looking to do some communications with patients around making the right choices as to where to go for care and also to order repeat prescriptions in plenty of time (similar to that which they did for the Royal Wedding last year). We have also requested they notify of which pharmacies are open to assist all providers to appropriate direct patients. I am sure this is all in hand but posters to patients and timely reminders to ensure they have ordered their repeat prescriptions are always helpful as, inevitably, someone will pitch up expecting you to be open!

QMAS Underpayments
The Department of Health has informed PCTs that they are required to correct payments to practices for the 2010/11 QOF achievement payments now that actual data is available. This guidance highlights an error within the QMAS and includes an action to make the necessary adjustments by the end of June 2012.

Supplying Medicines within Healthcare Services
The MHRA have issued a statement in advance of the imminent repeal of section 10 (7) of the Medicines Act 1968. This change, part of wider consolidation to the Medicines Act, removes the exemption for pharmacies required to hold a Wholesale Dealer's licence for the supply of medicines other than directly to patients or members of the public. This letter to organisations clarifies how the MHRA plans to enforce this legislative change. To summarise their position, the MHRA have taken the view that "the supply of medicines by community and hospital pharmacies to other healthcare providers in the UK who need to hold stocks for treatment of, or onward supply to their patients represents an important and appropriate part of the professional practice of both community and hospital pharmacy, and falls within the definition of provision of healthcare services. In such circumstances the MHRA will not deem such transactions as commercial dealing and pharmacies will not be required to hold a Wholesale Dealer’s Licence".

GP Trainee Elections
Nominations are now open for regional representatives on the GPC GP Trainees Subcommittee. Elections are being held for each of the 19 regional constituencies - nominations are open to all those on, or about the begin, a GP training programme - whether they are BMA members or not. Full details, including nominations forms, are available on the BMA website here. All nominations must be received by the GPC office by 5pm on Friday 22 June 2012.

Bulletin 145


CQC Registration Guidance
The BMA have published revised guidance
 on CQC registration together with these policies and protocols. The purpose of the guidance is to provide a straightforward explanation of the registration process, to help providers determine whether they are compliant with the CQC’s essential standards, and to explain what will happen once providers are registered. Cleveland LMC will be holding a CQC event early July for all practices in Tees to assist you with your registration questions. We recommend all practices have 1 representative attend this event and will publish full details on the website ASAP.

Smoking Indicators in QOF Business Rules
Further to our bulletin on 1 May, where we explained that the two code clusters PHARM_COD and REFERSSSA_COD would be merged, it has now been decided that the business rules for indicators Smoking 6 and Smoking 8 will look for a record of support or treatment, i.e. a suitable code from either the REFERSSA_COD OR the PHARM_COD clusters. The reason for this is in order to get this changed for the April READ code release, rather than having to wait until October. The intent of the indicator is for patients to be offered ‘support and treatment’ whether this means a referral to a smoking cessation service, drug treatment or follow up appointments with the practice (GP/nurse etc.) and not for a patient to accept ‘support and treatment’. If a patient declines support and/or treatment, then suitable codes have been included in the relevant clusters to accommodate this. This query will be added to the QOF FAQs currently being updated, due to be re-published this summer.

Bulletin 144                                                


Patient Registration, LMC Guidance 
We often receive questions with regard to the rules and regulations around registering (or not) new patients. This is increasingly becoming an issue in some areas where there may be an influx of patients within practices. Please take time to read this LMC guidance
to ensure you are aware of the current regulations - the guidance also includes the recent changes to the legislation around patient registration and closed lists.

Seasonal Flu Plan 2012 
annual seasonal flu plan letter from the England Chief Medical Officer, along with the 2012/13 flu plan have been published on the Department of Health website. As in 2011, the plan for 2012 includes an ambition to significantly increase uptake among under 65 patients with an underlying clinical condition, as well as to push for a higher uptake among pregnant women and health care workers. Annexe B of the letter includes a 10 point good practice checklist commissioned to help GP practices ensure high uptake of flu vaccinations locally. For ordering flu vaccines, the system remains the same as last year with GPs responsible for ordering adequate stock for all eligible patients, recognising the increase in size of the target population.

Bulletin 143


Nurses and Pharmacist Independent Prescribing of Controlled Drugs
Government agreed changes to the Misuse of Drugs Regulations 2001 mean that nurses and pharmacists registered as independent prescribers will be able to prescribe controlled drugs where it is clinically appropriate and within their professional competence. They will also be able to mix a controlled drug with another medicine for patients who need drugs intravenously, as well as supply or administer morphine and diamorphine under Patient Group Directions (PGDs), for urgent treatment of very sick or critically injured groups of patients. Further details on the update to the Misuse of Drugs Regulations 2001 relating to nurse and pharmacist independent prescribing of controlled drugs (Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations 2012 (Statutory Instrument 2012/973)), which came into force on 23 April 2012 are available on the DH website

Smoking Indicators in QOF Business Rules
There is an error in the current business rules (v22) regarding the QOF indicators Smoking6 and Smoking8. The business rules currently state that there has to be a referral date AND a delivery of pharmacological agent date for a patient to belong to the numerator (i.e. a code is needed both from the REFERSSA codeset AND a code from the PHARM dataset). NICE have confirmed that the intention of the indicator is to get practices to offer support and treatment (with the emphasis on ‘offer’ not the patient ‘accepting’ ) and have agreed to merge the two code clusters for PHARM_COD and REFERSSSA_COD, which means only one code will be required to cover both 'referral and treatment'. This will be changed in the April READ code release.

RCN Guidance
Following the changes the RCN made to their members’ indemnity scheme, GPC has produced this guidance for practices to ensure all staff are suitably covered for the roles that they perform.

Direct Access to Diagnostic Tools for Cancer
The Department for Health has published Direct Access to Diagnostic Tools for Cancer: Best Practice Referral Pathways for GPs guidance here.

Changes to Practice Boundaries
Permanent changes to practice boundary arrangements and the relaxing of the closed list regulations come into place at the end of April. We are awaiting the new Regulations but, in the mean time, please take time to re-read the GPC guidance linked to Bulletin 140 on this bulletin page. Secondary guidance is available here

European Funding Opportunities
The BMA Brussels office have produced a European funding guide which provides an overview of the European funds that offer grants for health-related projects.

Bulletin 142


Fair Commissioning Charter
The GPC carried a motion that stated that the GPC would encourage any clinical commissioning group (CCG) which wishes to sign a Fair Commissioning Charter that includes that the CCG will:

  1. Work to improve the quality of and access to local health services, and reduce health inequalities;
  2. Develop a culture of genuinely clinician-led commissioning, taking decisions in the best interests of the local population;
  3. Engage with patients and the public with respect to decisions taken about their health services;
  4. Operate in a transparent and open manner, and in the interests of transparency, not engage in any contracts or negotiations which impose conditions of commercial confidentiality;

    In the further interests of transparency will take decisions in public unless required to hold them in private for legal reasons.
  5. Resist any qualified provider being imposed from sources outwith the CCG;
  6. Always take decisions in the light of the likely effect on the important relationship between individual GPs and their patients.
  7. Establish and strengthen working relationships with local medical committees, further enabling successful outcomes in commissioning.

CCG Constitutions
As CCGs focus attention on authorisation, many are drawing up constitutions. The existing GPC constitution guidance outlines key elements of a constitution that GPs should check are included. It is vital that the CCG constitution has the support of member practices and that the constitution outlines how the CCG will engage with the LMC.

GPC / BMA Law have always advocated that any CCG constitution should be clear, robust and comprehensible. Although the NHS Constitution is helpful, it is not really a template constitution, it is more along the lines of detailed guidance. Huge sections of the Department of Health (DH) document are devoted to quotes and references to the Health and Social Care Act, which is confusing and unnecessarily burdensome in the context of a comprehensible template. This makes it unduly difficult to convert into a working practical document. Furthermore, the DH Constitution states that it has yet to be approved by lawyers. BMA Law has a template constitution in place which is being updated in line with both the Act and in respect of any agreed policy and guidance (whether current or future). This is accompanied by a detailed seminar which addresses all salient issues such as conflict of interest, procurement, engagement of consultants, internal governance, application for membership of the CCG etc. This includes advice on how to handle these issues in a practical way and how to keep good audit trails. If you would like more details please call Diane Smith on 020 7383 6019 or email at info.bmalaw@bma.org.uk.

Enhanced GP Training
The RCGP's educational proposal for extending the GP training programme to four years was approved by the Medical Programme Board on April 18. This follows an agreement between the RCGP, COGPED, COPMED and GPC on a set of principles for the implementation of the enhanced programme. An agreement will be required between the aforementioned organisations as to how the implementation will work in practice, and the proposal remains subject to confirmation by Medical Education England on 26 June.

Supply of Non-Compliant Nutritional Products
The Department of Health Advisory Committee on Borderline Substances (ACBS), which is responsible for advising on the prescribing of certain foodstuffs and toiletries, has produced this guidance note on the supply of non-compliant nutritional products which highlights the problem of clinical errors created due to non-compliant stock entering the medical supply chain. Non-compliance can include instances where nutritional products have different formulations, are incorrectly labelled, or where there is incorrect information provision.

Cancer Awareness Campaign
This letter provides and overview of the national and local cancer awareness raising campaigns.

Bulletin 141


Anticipatory Prescribing for End of Life Care
The GPC Clinical and Prescribing subcommittee has published this guidance to clarify issues on anticipatory prescribing for end of life care. It includes an example of a drugs administration document used for 'Just in Case' boxes.

Prescription Charges
As you will be aware, from 1 April 2012, the prescription charges in England increased from £7.40 to £7.65. The BMA has repeated the call for prescription charges to be scrapped in England in line with the policy in the devolved countries. PCTs were informed via this letter from the Department of Health.

Business Continuity Plans
With an imminent fuel strike expected we would like to remind all practice of the need to ensure they have an up to date business continuity plan and give thought to how a fuel strike could impact on daily work e.g. home visits, difficulty for staff attending work. It may be worth dusting off buddying arrangements that were put in place for flu.

Change to Community Pharmacy New Medicine Service Payment Structure
NHS Employers and the Pharmaceutical Services Negotiating Committee (PSNC) have agreed changes to the community pharmacy new medicine service payment structure and have published  this  briefing document to explain these changes. It is hoped that the changes will fairly reward contractors and encourage them to deliver the service to the greatest number of patients. Further information is available here.

Interim Seniority Factors
Interim Seniority Factors for 2012/13 have been published as £96,646 for GMS GPs in England. Further details and an explanation of the methodology are available on the NHS Information Centre's website.

What We Know So Far - NHS Reforms
Follow this series of new briefing papers and be informed on 'what we know so far' on a range of key topics related to the Government's health reforms, and where questions remain unanswered. The titles in the series are: 

  1. The NHS Commissioning Board
  2. Health and Social Care Act at a glance (produced by the Parliamentary Unit)
  3. Choice and any qualified provider
  4. New providers
  5. Foundation trusts
  6. Monitor and regulation
  7. Local accountability

Numbers 1 and 2 are new, and the rest have been updated to reflect any changes made in the last stages of the Bill becoming an Act. Each briefing has an accompanying 2-side executive summary. 

Bulletin 140


Changes to Practice Boundaries
As part of the agreement negotiated between GPC and NHS Employers for 2012/13, changes are being made to regulations from this April to allow practices to create ‘outer boundaries’. These changes have been introduced to help improve patient choice of practice and to amend the closed list regulations, but they are unrelated to the piloting of remote registration and consultation. Changes to practice boundary arrangements and the relaxing of the closed list regulations, as described here, are permanent and apply across England.

Cervical Screening Training Update
The GPC would like to remind practices of their responsibilities as both providers and employers who have a duty to ensure that staff are up-to-date. It is recognised that existing training packages may not meet the needs of all, and practices may wish to explore different modes of training delivery e.g. via cascade training or on-line tools. In a recent meeting, officials from GPC, Department of Health and NHS Cervical Screening Programme discussed the ongoing update training requirements for health professionals performing tests for cervical screening in line with the principles for training set out in Barbara Hakin's letter of 15th December 2011 and agreed that:

  • sample takers need to be fully competent and appropriately trained in sample taking and cognisant of the latest developments;

  • the GMS contract places a responsibility on practices both as providers and employers to be satisfied this is the case;

  • the NHS Cervical Screening Programme supports practices both as a provider and employer through its training and update programme;

  • individual training needs will differ between practices and between health professionals and clinical governance systems should be in place to identify the training needs of all clinicians involved in the screening programme (nurses and GPs).

We would also recommend that practices familiarise themselves with the primary care guideline on unusual bleeding in young women.

Business Continuity Plans
With an imminent fuel strike expected we would like to remind all practice of the need to ensure they have an up to date business continuity plan and give thought to how a fuel strike could impact on daily work e.g. home visits, difficulty for staff attending work. It may be worth dusting off buddying arrangements that were put in place for flu.

BMA Guidance on Firearms Licensing
The current letters being sent from the Police to GPs to enquire whether there is any medical information that might have a bearing on the individual’s suitability to hold a firearm is causing concern for GPs. The BMA and Association of Chief Police Officers (ACPO) are looking for a longer and more enduring solution, however owing to the current legislation governing firearms licensing it is anticipated that this will take longer than expected. In the interim, the BMA has agreed that the letters will continue to be sent out to doctors. Doctors are reminded that they are under no obligation to respond to these letters, but should they decide not to, doctors should inform the police as it will otherwise be assumed that there is nothing relevant on the medical record. Where doctors are happy to respond to these letters, consent to the disclosure of any information should be sought as the letter does not currently indicate that consent has been given. If the patient does not consent to disclosure, this should ordinarily be respected, although the police must be informed to that effect. If, however, the doctor believes that the patient presents an immediate risk of serious harm to themselves or others, information should be disclosed even in the face of an explicit refusal. Although the current letter from the police states that it does not have to be retained, the BMA has been advised doctors can record the request for information in the medical record and indicate what action, if any, they have undertaken. The BMA are seeking to change the wording of the letter to reflect the position. There is no nationally agreed fee for this work. It is the BMA’s view that the Police should pay for any work. Serious concerns about a person’s suitability will always take precedent over payment.

NICE Infection Control Guidelines
NICE has published clinical guidelines for Infection control.  These are available at the NICE website. The consultation comments and responses can also be found  here

Reminder, Changes to HPV Vaccinations
From September 2012 the HPV vaccine supplied as part of the HPV immunisation programme will change from Cervarix to Gardasil. Until that time Cervarix should continue to be used, with the aim of completing all courses by April 2013. A small supply of Cervarix will be available to order after September 2012 for outstanding courses, but please note that quantities of this vaccine will be capped. For further guidance, please refer to this letter from the Department of Health Director of Immunisation which includes some helpful FAQs.  

GPC Message, CCG Constitutions
As CCGs focus attention on authorisation, many are drawing up constitutions. The NHS Commissioning Board has published a model constitution and the GPC will be providing short guidance on this soon.  The existing GPC constitution guidance  outlines key elements of a constitution that GPs should check are included. It is vital that the CCG constitution has the support of member practices and that the constitution outlines how the CCG will engage with the LMC. One final point - we have seen some draft constitutions that outline how practices can be 'expelled' from CCGs. This makes no sense - the legislation states that every practice must be a member of a CCG, and furthermore that CCGs should cover a coherent geographical area (i.e. no gaps!). Therefore, unless a practice is located precisely on the boundary between two CCGs there is no option for a practice to be 'removed from a CCG' as this would compromise coherent geographical coverage.

Bulletin 139


Vitamin D Supplements for At-Risk Groups
UK Chief Medical Officers have provided this response/advice following concerned raised by the GPC with regard to the implications of advice issued on Vitamin D supplements .

Practice Leases and Service Charges
It is important that practices have a lease for the premises from which they operate rather than a licence to occupy. We understand the PCT is working through the lease arrangements and you can request a copy of your lease if you require it to check details. If you have any lease arrangement or abatement of service charges/facilities management issues please contact the LMC.

Ethnicity and First Language Recording Guidance Updated
The Ethnicity and first language recording guidance has been updated to include extended classifications to the list of NHS Data Dictionary codes for ethnic origin, which are based on a more comprehensive ONS 2001 census list, available within the Read Codes. Note that although practices may wish to continue to record their patients’ first language and ethnicity as a matter of routine in order to assess the needs of their population, this is a practice choice as there is no longer any contractual requirement to do so.

GPC Annual Report
This year's GPC Annual Report has now been published.

GP Trainees Subcommittee Newsletter
The March 2012 edition of the GP Trainees Subcommittee Newsletter is has now been published. The GP Trainees Subcommittee is a subcommittee of the BMA's General Practitioners Committee and provides national representation for all doctors in GP training, whether they are members of the BMA or not. The subcommittee meet four times a year and will be producing a quarterly newsletter covering matters of interest to doctors in GP training. The newsletter is intended as a useful resource covering education, training, contracts, terms & conditions of service and any other issues of importance to trainees, as well as information on getting involved with the subcommittee.

Bulletin 138


BMA Message - BMA worried and saddened by the passing of the Health and Social Care Bill
You cannot have failed to notice that, despite last minute attempts to stall and derail the legislation, the Health and Social Care Bill completed its final debates in Parliament this week. Hamish Meldrum (Chairman of Council) wrote to all members outlining all the BMA’s key issues and next steps. We will continue working hard to minimise the risks of this dangerous legislation as we move in to the implementation phase. If you have any questions or concerns about the legislation or development of CCGs, please info.commissioning@bma.org.uk.

Laurence Buckman
Chairman, General Practitioners Committee

BMA Law/Solicitors
BMA Law have an arrangement in place with Gateley's Solicitors to offer preferential rates to members for the following services:

  • Property / Lease / Landlord and Tenant Issues

  • Dispute Resolution and Litigation matters including Defamation

  • Family Law (Divorce, Co-habitation, Residency Applications and Pre-Nuptial Agreements)

  • Corporate, Banking, Finance and Commercial matters in so far as they fall outside of BMA Law's remit

These services can only be accessed via BMA Law (info.bmalaw@bma.org.uk or 020 7383 6976) and Gateley will not accept instructions from members direct under this scheme.

Bulletin 137


Pension Update
This brief summary will help ensure you are up to date on this important issue:

• Roadshow dates have been published, mass-emailed to members, and publicised on the front page of BMA News. Details are also on our Diary Dates page.
• The e-petition now has almost 28,000 signatories
• A timeline has been added to the BMA pensions web-pages to show the history and background of the changes and associated BMA activity
• A new "mythbuster" is being published on the BMA website shortly
• The government has published its 'Proposed Final Agreement' on the pension changes - a response has been prepared and is being published shortly on the BMA website
• Detailed planning for the next phase of activity is underway

QOF Guidance 12/13
This QOF guidance for 2012/13 has been produced jointly by GPC and NHS Employers and forms part of the GMS contract changes for 2012-13 as from 1 April 2012. Further information on QOF is available here.

Talking Health
In the run up to the UK Council elections, the BMA are launching a new microsite, Talking Health, aimed at encouraging doctors and medical students to get more involved in shaping the work of the BMA. Talking Health will enable members and non-members to give views on the key challenges facing them in their everyday working lives. It will also provide further information about the upcoming BMA UK Council elections including, from Monday 19 March, details of the candidates. Please feel free to leave comments in the areas that you are interested in, and to forward the site to your colleagues. If you are on twitter then use the #tlkhealth hashtag to join the debate.

CQC Reminder
We are aware that some private organisations are approaching practices and so we would, once again, like to draw your attention to this joint statement issued by CQC and the BMA: There is no need for practices to purchase expensive software or consultancy services in order to register with the CQC. Most practices delivering good quality care will already be meeting the majority, if not all, of the essential standards.

Final Seniority Payments 08/09
The Final Seniority Factors for GMS GPs in England and Wales for 2008/09 have been published by the NHS Information Centre. The figures are £92,955 for England.

GP Health
We would like to remind practices of the GP Health service that is available to all GPs, practice managers and practice staff in Tees. GP Health is a free and confidential health and wellbeing service, offering counselling, mentoring and psychiatric help to GPs, dentists, practice managers, nurses and practice staff in the Tees Valley Area. Further details are available here.

Bulletin 136


Continuity in a Changing World; 100 years of GP Representation
In the ever changing NHS landscape we often cite how the LMC is one of the few, if not the only, local organisation with a long memory. Faces have changed but the knowledge is passed on and continues to be available to assist local GPs in representing their interests in a local, regional and national forum. LMC, along with the BMA, have just celebrated their 100th birthday. Continuity in a Changing World; 100 Years of GP Representative Bodies reflects on the last century and GPC Chairman, Laurence Buckman recently wrote this letter to all GPs marking the celebrations with views on representation in the current NHS.

Commissioning Outcomes Framework
The BMA has submitted a response to the NICE consultation on the proposed Commissioning Outcomes Framework stressing the need to ensure that outcome measures are achievable and within the influence of CCGs, and that CCGs and practices are not overburdened with bureaucracy. It is proposed that the Commissioning Outcomes Framework (COF) will be used by the NHS Commissioning Board (NHSCB) to measure the performance of CCGs in relation to the NHS Outcomes Framework. Indicators will be developed from NICE quality standards, the NHS Outcomes Framework and existing indicator collections.

The BMA have also restated their opposition to proposals for a 'quality reward' for commissioning. It is vital that CCGs are fully resourced from the outset in order to commission effectively and any financial incentive for commissioning raises serious ethical concerns about the doctor-patient relationship and risks cultivating compliance with central direction, as opposed to promoting a locally-focussed and truly clinician-led commissioning system.

QOF Version 22 Business Rules and Quality & Productivity Guidance
The GPC and NHS Employers have published this joint supplementary guidance and FAQs for the 2012-2013 QOF quality and productivity (QP) indicators which is intended to assist practices and primary care organisations (PCOs) in understanding and working through the new QP indicators. Version 22 of the business rules, which supports QOF 2012-13, has also been published. The Average Contract Register Population (CRP) value has been updated on QMAS from 5891 to 6775 (in England). The 6775 figure was calculated using the list sizes from Exeter as at 1 January 2012. The updated figure will now be used going forwards in all additional services calculations. The change went in on 18 February 2012 and will result in an increase in achievement for all practices in the additional services domain.

CQC Guidance
The CQC has published its new Overview of Registration guidance, providing general information about how the registration process will work.

Website Cookies - Important Practice Information
If your practice website uses cookies you may need to be aware of recent changes to the law, outlined in guidance from the Information Commissioners Office. Cookies are small files of letters and numbers downloaded to a user’s computer when they access certain websites. They allow a website to recognise the user’s device. The previous rules on cookies said that websites had to inform users how they use cookies and that they could ‘opt out’ if they wished. Most websites did this through their privacy policies. In 2011 the laws on cookies were extended. Cookies can now only be placed on machines where the user or subscriber has given their consent, although this does not apply to cookies that are ‘strictly necessary’ for a service requested by a user. An example of a ‘strictly necessary’ cookie would be when a user chooses goods they wish to buy from a website, clicks ‘add to basket’ and then proceeds to the next page - the site ‘remembers’ what they chose on a previous page using a cookie. User consent would not be needed for this type of cookie.

The ICO does not produce a definitive list of ‘strictly necessary’ cookies. In the context of GP practice websites, cookies might be used to allow users to request a repeat prescription, or book appointments. If the cookie is strictly necessary for the service requested by the user, then explicit user consent is not required. Other cookies, such as those used to collect statistical information on usage of the site, are not strictly necessary and user consent is needed. Each organisation has to decide whether user consent is needed for each cookie they use. We recommend that practices read the ICO guidance, which includes practical advice on types of cookies and how to comply with the regulations.

Transparency Agenda
In May 2010 the Government made commitments as part of a ‘Transparency Agenda’ which came into force from November 2010 stating that all new contracts agreed by NHS bodies should be published. The BMA have received confirmation from DH Procurement, Investment and Commercial Division that this applies to private sector providers and will include all contracts for goods and services. If the contractor wishes to state that something is commercially sensitive that they do not want to publish as part of the contract this could be communicated to the authority in a separate letter. However, any commercially sensitive information is subject to the Freedom of Information Act as is the rest of the contract.

The Transparency Agenda additionally made the following commitments which are now reflected in the NHS procurement policy:

  • All new Information and Communication Technology (ICT) contracts over the value of £10,000 to be published in full online from July 2010.

  • All new tender documents for contracts over £10,000 to be published on a single website from September 2010, with this information to be made available to the public free of charge.

  • New items of spending over £25,000 to be published online from November 2010.

  • All new contracts to be published in full from January 2011.

The Cabinet Office published this guidance on publication of new contracts, which applies to all NHS bodies. See section 2.16 on Contract Extensions (for renewal of contracts) and 2.17 on Re-tendering a contract (for new contracts).

The guidance states that departments are recommended to publish, where relevant, the following, or the nearest equivalent, as a minimum:

  • Advertisement of the requirement (e.g. Prior Indicative Notice, OJEU notice)

  • Estimated procurement timescales

  • Pre-Qualification Questionnaire (PQQ)

  • Invitation to Tender (ITT) – includes requirement and Terms and conditions.

Bulletin 135


Clinical DES Guidance 2012/13
This Clinical DES Guidance outlines the requirements for 12/13 including details on the alcohol and learning disabilities DESs which will continue until 31 March 2013 and the osteoporosis DES will no longer be available from 1 April 2012.

Commissioning - Key Questions for ALL GPs to Consider and Key Issues for CCGs
This summary briefly outlines the key issues for CCGs and all GPs to consider as clinical commissioning groups develop and seek authorisation. Additionally, to help empower GPs the GPC has produced these key questions and urges you to ask these questions of your CCG and LMC. GPC Chairman, Dr Laurence Buckman, has circulated this message:

Dear colleagues,

The Health and Social Care Bill purports to develop a commissioning structure that is clinician-led and locally focussed. This aspiration is looking ever more difficult to achieve due to the increasingly complex and confused legislation and the rushed implementation of the reforms.

If the Bill becomes an Act, GPs and practices will be the constituent bodies of clinical commissioning groups (CCGs), and will play an important role in holding them to account. The General Practitioners Committee (GPC) is concerned that due to the fast pace of developments, many GPs are not aware of the decisions being made on their behalf, or which will impact on them and their practice in the future.

To help empower GPs and practices we would urge you to ask these questions of your CCG and local medical committee (LMC).

Yours sincerely
Dr Laurence Buckman
Chairman, BMA General Practitioners Committee

Cervical Cytology Good Practice
Following the recent letter from Barbara Hakin regarding mandatory cervical cytology training, we would still advise practices to make sure that anyone conducting smears are cognisant of the latest guidance on good practice e.g. the need for the cervix to be visualised for a smear .

084 Telephone Numbers Compliance with Regulations
DH has published this further guidance on the use of 084 numbers in the NHS. For clarity, the DH position has not changed and the regulations remain the same. Consequently, the legal advice the GPC has obtained also remains the same. The issue revolves around the word 'reasonable' within the regulations. All the suggestions about termination or varying the terms of the contract are always going to be based on 'reasonable steps'. Any practice would have a very strong arguable case to say that, albeit all 'reasonable steps' had been taken to try and cancel the contract or vary it, to do so would mean the practice would be subject to a financial penalty. The regulations do not say the practice must cancel or vary the existing contract. If this were to be the case, 'reasonable steps' would be replaced with 'best endeavours'. Subsequently, it would not be possible to argue that the acceptance of a financial penalty is reasonable. If practices ensure they have correspondence from their telephony provider on record stating that they will be financially penalised if they vary or cancel the contract, this should be enough to satisfy that 'reasonable steps' had been taken. All practices will be expected to become fully compliant with regulations once their existing contracts are up for renewal or they wish to contract with a different provider. At this point, practices will be expected to ensure they contract with a provider who is compliant with regulations. Practices are advised to obtain a copy of the statement of compliance with NHS regulations from their telephony provider when entering into new or renewing contract arrangements.

CQC Registration - Joint GPC/CQC Statement
The GPC and CQC have agreed the following statement about CQC registration:

Under the Health and Social Care Act 2008, all providers of primary medical services will be required to be registered with the CQC by 1 April 2013. The process leading to registration will begin in July 2012. As part of registration, practices will have to tell the Care Quality Commission (CQC) whether they are meeting the essential standards of quality and safety, which are derived from regulations governing the CQC's work.

The essential standards are based on legislation and cannot be altered. However, the British Medical Association’s General Practitioners Committee (GPC) and CQC are currently discussing how the standards will apply to primary care providers. Work carried out by the CQC, during the delay to the registration of most providers of primary care, has focused on the need to be proportionate and appropriate, reducing bureaucracy to a minimum. The CQC and the GPC have been working together to achieve this and to ensure that the registration requirements are understood across the primary care sector.

To that end, the CQC is working with stakeholders to improve the logistics of its registration process. This is partly taking place through the CQC's Stakeholder Advisory Group, on which the GPC is represented.

Discussions are also taking place between the CQC and GPC about how compliance will be demonstrated and monitored following registration. The CQC is working to ensure that the compliance monitoring process is proportionate and appropriate. As part of this, the CQC will be carrying out a pilot in the summer, to test how its model of compliance monitoring will work in primary care.

There is no need for practices to purchase expensive software or consultancy services in order to register with the CQC. Most practices delivering good quality care will already be meeting the majority, if not all, of the essential standards.

The GPC and CQC will continue to issue updates in the coming months, including further detailed guidance on registration.

Important Reminder - Nurse Registration
We would like to remind you of the importance of ensuring sure periodic checks of registrations take place as we have been made aware of a small number of cases where qualified nurses failed to keep up their registration. It is an offence to work as a nurse without the required registration in place and practices will have to deal with any consequences should this occur. The NMC website has 2 separate means of checking registration, a simple pin number check that is open to the public and an employers check. It is important that practices register as employers and undertake the enhanced employers check as this gives additional information including the employment history of the nurse.

Locum Payment Form Error
We have been made aware of an error in the letter to locums provided by NEFHSA with regard to payments. This error has been highlighted to NEFHSA to be rectified. The letter states "Each month you should send to me the completed forms and a cheque made out to the PCT of whom you are listed with on the Medical performers List. They should reach me no later than 7 days into the following month after the month the work relates to, i.e. forms for work done in April should reach me no later than 7th May". To avoid any confusion, the rules have not changed and the correct rules are that the money should reach the pensions dept no later than 7 days into the following month after the month in which the payment is received.

NHS 111
This document clarifies the GPC view, supportive but with implementation/procurement concerns, with regard to NHS 111. The GPC supports the principle of developing an easily accessible national telephone number for patients who have urgent health problems, as proposed by the new NHS 111 system which has recently been piloted but are extremely concerned that the new NHS 111 service is being rolled out without full, truly independent and thorough evaluation of pilots and without adequate input from local clinicians. A comprehensive NHS 111 service is currently expected from April 2013. The GPC has written to the Secretary of State for Health, calling on the Government to slow procurement of NHS 111 services to allow for proper evaluation of the pilots, and to adopt a flexible deadline for full implementation of the service to ensure that fledgling clinical commissioning groups can become fully established and ready to drive local procurement decisions at a pace that will ensure that the right decisions are reached.

Bulletin 134


It is currently expected that, subject to an assessment in the Summer, the revalidation legislation will be enabled in December and doctors will start to undergo the revalidation process from early 2013. PCTs should, therefore, not be implementing new appraisal frameworks on this basis.  We will notify you once we are aware when new appraisal processes may commence but, until this time, please notify the LMC if you experience any changes to your appraisal under the guise of the planned introduction of revalidation.

Guidance on Commissioning Support
The GPC have produced this Commissioning Support Guidance that you may find helpful.

Bulletin 133


084 Telephone Numbers
The GPC understands that a nationally coordinated initiative has recently begun by PCTs to remind practices that they must take 'reasonable steps' when reviewing arrangements for the use of 084 telephone numbers, as defined by the Directions to NHS bodies concerning the cost of telephone calls 2009 in paragraph 2(3b), to ensure that the cost of calls made by patients is kept to a minimum.

There are now very few practices in Tees who have an 084 number and, we understand, all those who do have reviewed their arrangements and are operating within the Directions. However, we would like to remind you that GPC's legal advice on this matter is that practices should take 'reasonable steps', but this does not mean practices should break existing agreements with telephony service providers that will incur financial penalties. When the time comes for new agreements to be made with telephony service providers, all practices will be expected to adhere to the regulations in full. For those practices who remain in existing agreements, they should still take all 'reasonable steps' as far as is possible, but they are not expected to incur financial penalties as a consequence.

Practice Lease Arrangements
Following the implementation of the Department of health's Stocktake and Stabilise Project, an auditing initiative designed to ensure PCT documentation is in order prior to handing over responsibilities to the NCB and CCGs, it has come to the GPC's attention that, in many cases, practices do not have premises leases but licences to occupy. These licences carry fewer liabilities, but are weaker to defend legally and some PCTs will be asking practices to sign formal leases. Cleveland LMC has discussed this with Tees PCTs who are working through the process but do not currently envisage any problems for Tees practices as it seems that Tees leases have succession arrangements already so we only anticipate a change in landlord details. We will maintain dialogue with the PCT on this and if the picture changes we will keep you informed but if, in the meantime, you are approached with a new formal lease you are advised to contact the LMC in the first instance and not to sign leases until you have sought legal advice as they may make you responsible for any unnecessary liabilities.

Updated Medicines Section Patient Liaison Group Patient Resource
The BMA's Patient Liaison Group (PLG) has updated its ‘Working together for better health' patient resource to provide more detailed information on medicine waste. The resource features practical tips for patients on how to avoid wasting medicine, together with details of how to dispose of unwanted medicine safely.

Bulletin 132


Commissioning News
This week the Government published more information about the development of CCGs, including final guidance relating to the authorisation of CCGs and proposals for commissioning support. Although timescales are tight, it is important that GPs and CCGs do not make decisions about their structure or support until they are ready - these decisions need to be well thought through and have the support of local practices, GPs and LMCs. This BMA Guidance highlights key issues to consider as CCGs enter into the authorisation process, such as the role of LMCs and appointment and elections to CCGs.

Medicine Reconciliation
NHS Employers have produced a film about medicines reconciliation which may be of some interest to GP practices. This film aims to highlight the role each sector plays in medicines reconciliation, particularly hospital pharmacy and goes through the medicines pathway from a patient's point of view, demonstrating that both hospital and community pharmacists can work together to improve patients' understanding of their medicines. The film builds upon this guidance published by NHS Employers and the Pharmaceutical Services Negotiating Committee (PSNC) for hospital colleagues and community pharmacists to help the transfer of care between settings.

BMA Research Grant
The BMA was among the first of the professional bodies to award grants and prizes to encourage and further medical research. Today, around ten research grants are administered under the auspices of the Board of Science, all funded by legacies left to the BMA. Grants totalling approximately £500,000 are awarded annually. Applications are invited from medical practitioners and/or research scientists and are for either research in progress or prospective research. Information and application details for the 2012 research grants are now available here. The application deadline is 16 March 2012 at 5pm. Subject specifications for each grant vary. For example, in 2012, research areas range from rheumatism and arthritis, cardiovascular disease and cancer to the uptake of preventative measures and the use of information and communication technologies in medicine. If you have any questions about the BMA research grants, or would like to receive alerts about them, please contact Chris Wood at info.sciencegrants@bma.org.uk  or telephone 020 7383 6755.

Bulletin 131


Commissioning News
The GPC discussed recent developments affecting Clinical Commissioning Groups (CCGs), in particular the need to CCGs to develop clear and comprehensive constitutions. It was strongly reiterated that local medical committee (LMC) involvement and engagement would be imperative to the success of successful clinical commissioning. The authorisation process will require CCGs to demonstrate that they have good relationships and engagement with member practices and local GPs (principal and sessional). CCGs will be accountable to member practices for the decisions that the CCG takes on their behalf. LMCs, as statutory representatives of the profession, should work with their CCGs to ensure that the local profession is consulted in the development of their CCG. The GPC has published this guidance which highlights essential elements that should be included in a CCG constitution.  Further to the recent messages, the GPC have been pleased to hear examples of GPs feeling empowered to resist pressure locally for their CCG to reach rapid and unacceptable agreement on commissioning support or CCGs ‘clustering’. They hope other GPs will take heart from this and feel similarly empowered to resist such pressure.

The DH steering group on remediation has published this report
which sets out the following recommendations:  

  • performance problems, including clinical competence and capability issues, should normally be managed locally wherever possible;

  • local processes need to be strengthened to avoid performance problems whenever possible, and to reduce their severity at the point of identification;

  • the capacity of staff within organisations to deal with performance concerns needs to be increased with access to necessary external expertise as required;

  • a single organisation is required to advise and, when necessary, to co-ordinate the remediation process and case management so as to improve consistency across the service;

  • the medical royal colleges should produce guidance and also provide assessment and specialist input into remediation programmes;

  • postgraduate deaneries and all those involved in training and assessment need to assure their assessment processes so that any problems arising during training are fully addressed.

Although the issue of funding fell outwith the remit of the group, a range of options were developed on the assumption that there was unlikely to be any additional money in the system. The BMA’s view is that remediation must be fully funded to ensure equality across the different branches of practice, and they will continue to lobby the Department of Health for this to occur.

Extending GP Training
GP trainees and trainers may recently have seen a document produced by the Committee of General Practice Education Directors (COGPED) outlining proposals for extending GP training to four years. The GPC is urgently seeking to discuss this with the relevant parties to establish a suitable way forward as the GPC does not believe that these proposals are sufficiently focused on educational benefit for GP trainees, nor do they outline a suitable implementation process, particularly sufficient funding.

NHS 111
The GPC has concerns that the new NHS 111 service has not been properly piloted or evaluated and shadow CCGs are already being asked to make procurement decisions, despite the fact they have not been properly established themselves. Procurement decisions are also being driven at excessive speed and influenced by the Stocktake, Stabilise and Shift project that PCTs have been asked to undertake in preparation for the handover to CCGs. It appears that the exercise may be being used to bring forward reviews of or renegotiate existing out of hours provider contracts. There is a serious risk of a potentially costly, ill-conceived and unalterable urgent, emergency and unscheduled care solution being imposed upon / inherited by CCGs, with consequent detriment to GPs and their practices. GPC representatives are taking forward these concerns with those responsible for the project.

Sessional GPs Newsletter 
The Sessional GPs newsletter draws together information about new and ongoing issues affecting sessional GPs and this issue covers pensions reform, NHS reforms update, guidance on setting up and developing sessional GP groups, locum agreement guidance, devolved administration updates, information cascades, revalidation, retainer and returned schemes and sessional GP conferences. We encourage members to forward this newsletter to any locum and salaried GP colleagues.

Bulletin 130


Dealing with Complaints or Investigations Advice
Cleveland LMC represents and assists all GPs in Tees - irrespective of employment status and contract type. We always recommend that you contact us as soon as possible if you have any questions or find yourself in circumstances where support could be beneficial. The LMC can particularly provide assistance with regard to any performance issues if you are contacted by NEPCSA/PCT. This letter was drafted to assist you at, what could be a difficult time, and remind you of the support that is available when you need it most. Please remember to contact us as soon as possible for confidential support however trivial the issue may appear.

Commissioning News
It is important that ALL GPs are aware of key developments in GP Commissioning. GPC would like to highlight that the NHS reforms in England are moving at breakneck speed and in different directions depending on where you live. The decisions being made now (about democratic processes in CCGs, constitutions of CCGs, appointments and plenty besides) are crucial for many reasons, not least in determining whether in future, the local profession will be able to hold their CCG to account. If you feel concerned about any commissioning developments in your area or need advice, then you should get in touch with the LMC. The BMA have also published this commissioning update which includes the latest on the Health and Social Care Bill and how the reforms are impacting on the ground. This issue focuses on the Authorisation Process for Clinical Commissioning Groups.

Eric Gambrill Travelling Fellowships
The Eric Gambrill Memorial Fund is seeking applications for up to two Travelling Fellowships, to be awarded in Spring 2012. The value of each Award is £3,000.Those eligible for the Award will be fully trained and practising UK general medical practitioners. In recognition of Dr. Eric Gambrill’s interest in general practice, education and travel, the successful applicants will be expected to undertake a study or project as part of his/her professional career development.

For more information, see the Fund’s website.

Bulletin 129


How to Set Up a Sessional GP Group
This guidance aims to share some of the models of good practice, and successful ideas and raise awareness about pitfalls of Sessional GPs groups which have been recognised as providing invaluable peer support for sessional GPs. Models differ but there are some common themes and challenges with groups offering a range of services and benefits, including educational and social meetings, electronic mailings systems for vacancies and educational events. Sessional GPs may experience professional isolation and reduced access to education, clinical information and career opportunities. Newly qualified GPs and GPs new to an area are particularly vulnerable to this. Whilst newly qualified GPs now have access to a range of 'First5' initiatives, sessional GP groups have the advantage of putting younger GPs in contact with more experienced GPs.

Cervical Cytology Training
Further to our update in our last bulletin we would like to clarify that the principles (of there being no contractual requirement for update cervical cytology training) outlined in the letter extend not only to GPs but to others employed by practices to carry out the services including practice nurses.

Injury Benefits Review
The outcome of an NHS review of its injury benefits scheme, which currently provides benefits to GPs who suffer injuries and a resultant loss of earnings as part of their employment , is that the current Injury Benefit Regulations are to be replaced by contractual provision held within a new section of the Agenda for Change (A4C) Terms and Conditions Handbook. Future injury benefit provision would be limited to the period of the employment contract only. GPC's legal advice on this matter is that GPs should consider getting their own injury benefits insurance.
Full details of what is covered as part of the benefits can be found here

Retainer Scheme
Despite a decrease in the number of participants in recent years, the retainer scheme remains a good option for those GPs who, for a variety of reasons, such as family commitments, need to undertake a reduced number of hours. It allows GPs to retain their skills and keep in touch with general practice. GPs who are interested in the scheme should contact their Deanery.

Blue Badge Scheme
Please be aware that under the new Blue Badge Scheme payment for the completion of any factual evidence provided by a GP to support an application should be paid by, and requested by, the LA under a collaborative arrangement. If a patient approaches you directly on LA advice you should direct them back to the LA. Please contact the LMC if you patients contact you directly.

Revised Focus on Travel Immunisations
The BMA have published this revised Focus on Travel Immunisations guidance following some minor amendments to the document printed last year.

Business Insurance Reminder
Practices are reminded to ensure that all staff who use their own transport for business purposes (to travel to and from branch surgeries, patient homes, care homes etc) are covered for business use on their personal/private motor insurance.