Bulletin 156

25.09.12

Pensions
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.

Revalidation
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

18.09.12

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

04.09.12

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

14.08.12

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 10^th) 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

06.08.12

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

31.07.12

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

24.07.12

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                                                

10.07.12   

CCGs
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.

CQC
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

26.06.12

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.

QOF FAQs 
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

12.06.12

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

29.05.12

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

15.05.12

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                                                

08.05.12   

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 
The 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

01.05.12

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

23.04.12

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

17.04.12  

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

05.04.12

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.