Fit Note Data Extraction & Publication
Practices have received a communication from the Health and Social Care Information Centre (HSCIC) on the extraction and publication of fit note data. The extraction is intended to allow the Department for Work and Pensions (DWP) to collect data on fit note usage to inform policy development and evaluate the Fit for Work service.

The data being collected will be fully anonymised and will include:
• The number of computer-generated fit notes issued;
• The number of patients recorded as ‘unfit’ or ‘maybe fit’ for work;
• Fit note duration;
• Gender;
• Health condition type aggregated to high-level diagnosis code;
• Location, including CCG area;
• Whether workplace adaptations were recommended.

The Joint GP IT Committee of the BMA and RCGP (JGPITC) was consulted on this data collection and has taken steps to reduce the burden on practices and clarify the legal position. The legal basis for the collection of this data is the issuing of Directions under section 259 of the Health and Social Care Act, and as such it is recommended that practices comply with this legal requirement.

There is also a legal requirement under the Data Protection Act (DPA) for practices to inform patients of the extract through fair processing. The DWP has recommended practices provide a brief overarching statement for patients, for example, on the practice website or notice board. The statement should include links to further information for patients seeking more detail. The template statement, plus links, is available within the briefing pack sent out to all practices. Practices may also wish to inform patients in person when attending the practice for a fit note. Please note that data will not be extracted for those patients with a Type 1 objection recorded i.e. those who have objected to their identifiable data from leaving the practice for purposes beyond their direct care. These objections will be respected, even though the extract does not include any patient identifiable data. Data will be collected in February 2016 (to include fit notes issued from December 2014) and published from spring 2016. Aggregated data will be published on the HSCIC website at CCG level and above.

Further information for practices is available online.

Maternity Locum Reimbursements
NHS England has now sent a clear communication out to local teams that the maximum period of non-discretionary locum reimbursement for GPs on maternity leave is 26 weeks. It is hoped that this will stop local teams’ attempts to limit reimbursement to 20 weeks – if practices find they are still encountering a 20 week conversation please email the LMC office - janice.foster@nhs.net

Avoiding Unplanned Admissions & Core Plan Reviews
The Avoiding Unplanned Admissions (AUA) enhanced service specification states that patients who remain on the case management register from the previous year will need to have at least one care plan review during 2015/16. Elsewhere in the guidance the timeframe for reviews is stated as within the last 12 months. GPC understand a number of practices have been penalised due to this ambiguity, having planned to complete care plan reviews during the course of 2015/16. GPC formally raised this issue with NHS England on the basis that it is unacceptable for practices to be denied payment due to a discrepancy within the guidance. Practices have incurred significant work in implementing this enhanced service, acting in good faith in their interpretation of the specification. We are awaiting a response from NHS E.

Expiry Date of FluMist Nasal Vaccine
This year the FluMist® Quadrivalent vaccine is available as well as Fluenz Tetra® vaccine, due to a shortage of Fluenz Tetra. However, practices need to be aware that the expiry date of the FluMist vaccine is 24 February 2016, and should not be used thereafter. The following information was included in the PHE vaccine update (no. 237):

When does the FluMist nasal vaccine expire?

To ensure timely supply, changes in the supply schedule were required. This has resulted in a mismatch between the actual expiry date and that printed on the packaging and labelling. The two batches of FluMist quadrivalent being supplied (FL2113 & FL2118) must not be used after the 24 February 2016. This does not affect the safety, quality or efficacy of the batches. In agreement with the MHRA, a pre-planned withdrawal of any unused stock of FluMist quadrivalent will begin on the 25 January 2016. This will help ensure that no time-expired vaccine remains in circulation. AstraZeneca’s logistics provider, Movianto, will contact you to arrange collection. Please quarantine any unused FluMist quadrivalent ahead of 24 February 2016. This should avoid accidental administration prior to collection.

Batches of UK labelled Fluenz Tetra will not be subject to the withdrawal and may be used up to the expiry date stated on the carton and nasal applicator.

Cessation of National Supply of Paracetamol Sachets for the MenB Immunisation Programme
Public Health England (PHE) informed that as the temporary supplies of paracetamol sachets, to be given after the doses of the Men B vaccinations for infants have been given, have been fully distributed, the central supply of paracetamol sachets is being phased out. The updated patient leaflets make it clear that parents will need to make arrangements to have infant paracetamol at home in time for their baby’s first immunisation appointment, and practices will be able to order these leaflets in paper copy, to be handed out at the time of the vaccination, from late December through the DH Orderline.

MDU Medico Legal Advice
The MDU has advised GPC that it wishes to dispel the myth that MDU members could be disadvantaged if they contact their 24 hour medico-legal advice service. One of the MDU’s core services is to provide expert medico-legal advice to members and they positively encourage members to call for advice at any time; whether pre-emptively when they need guidance on how to approach a potential matter, or when something has gone wrong. The MDU receive over 30,000 calls from members to its advice-line every year helping members to avoid potential problems and to mitigate the position if a problem has arisen. The MDU very positively encourages members to contact it whenever they need it’s input.

Contact details are:
UK 0800 716 646
Ireland – 1800 535 935
Fax (UK) 020 7202 1662
Email: advistory@themdu.com
Website: http://www.themdu.com/about-mdu/contact-us

NHS England Funded OOH Indemnity Cover
Following intense lobbying by GPC, NHS England has announced plans to make £2m available, to help with GP indemnity costs to GPs providing OOH (out-of-hours) care this winter – December through to March 2016. In partnership with medical defence organisations, NHS England has developed a time-limited scheme to offset the additional indemnity premium GPs would incur when working additional OOH sessions. GPC has long argued that the significant extra costs to GPs doing OOH work is disproportionate, often deterring many from providing this extremely valuable aspect of general practice care. While GPC welcomes NHS England’s announcement this is a temporary short-term solution to what is a much wider problem, with indemnity costs having rocketed across all aspects of general practice provision, which is in need of a considered longer-term response. It is also unclear whether those doctors who have already paid additional fees to cover extra OOH shifts this winter, will have their costs reimbursed. GPC is seeking clarity on this.

GPC Primary Care Infrastructure Fund Survey Results
The GPC survey of practices’ experience of the primary care infrastructure fund (now called the primary care transformation fund), was launched in response to a growing number of concerns about difficulties with practices receiving support and funding to progress schemes. The four-year £1bn infrastructure fund is intended to provide practices with much needed financial support to improve their premises, and on the back of four in 10 practices stating that they do not have the space to provide adequate core services. The responses the GPC received sadly reveal a picture fraught with delays, lack of clarity in processes and threats to the funding of approved schemes.

The key findings show:
• Of those with supported bids, 54 per cent experienced delays of more than six months
• ‘Lack of leadership or clear process’ and ‘lack of expertise within the local NHS England team’ were the main reasons cited for these delays
• Of those with approved bids, 83 per cent believe that the project will need to be extended beyond the March 2016 deadline to receive funding
• Around one in five (22 per cent) of those facing delays have been advised by their local NHS area teams that they could lose their funding altogether
• For all those that received initial approval, ‘refusal to meet recurrent costs by NHS England or the local CCG (clinical commissioning group)’ is cited as a major obstacle by a quarter (22 per cent) of respondents.

GPC maintain it was always unrealistic to expect such building projects not to suffer unexpected delays, and this has been fuelled by lack of clarity and delayed processes on NHS England's own part, in particular via its area teams. It is therefore unacceptable that any area team should rescind funds on approved projects which have experienced delays. GPC have taken this up with national director for commissioning development at NHS England Ros Roughton, who has provided written assurance that there will be reasonable allowance for slippage into next year. Some area teams are clearly diverging from this assurance, creating further uncertainty and delays, and it is vital NHS England ensures consistency in implementation nationally. It is important to restate that these funds are vital for GPs and practices to deliver core and expanded services, and patient care will suffer if resources are not deployed to improve the impoverished infrastructure of the GP estate. GPC will continue to press for the funds to remain in general practice and for a more robust framework to be put in place for the future years of the fund.

Elections to BMA Council
Nominations open on 7 January 2016 for the election of 18 voting members of the UK council of the British Medical Association to serve for a two year term of office for the sessions 2016-17 and 2017-18. The sessions normally run from June to June. Further details on the activities of council will be available from the website and the details of the election will be advertised in the December editions of the BMJ. Candidates must be current members of the BMA and nominations must be made via the following weblink: www.votebyinternet.com/bmanoms2016. The link will be open from 7 January 2016. The deadline for completed nominations is 4pm Friday 5 February 2016.

GPC Sessional GP Newsletter
This edition focuses on the Special LMC Conference in addition to features, news and information aimed at supporting sessional GPs as well as blogs from sessional GPs; including one from newly quailed Pooja Arora on her experience of getting ill whilst working as a locum and another from Paula Wright on how to use clinical IT systems effectively whilst working as a locum GP. The e-newsletter also highlights useful appraisal tips for sessional GPs.

Royal Benevolent Fund Support
The Royal Medical Benevolent Fund, the charity for doctors, medical students and their families, has recently released its Annual Review. In 2014-15 the RMBF helped 212 beneficiaries with financial support, nearly 50% of whom were GPs or GP trainees. The charity has been helping doctors and their families for nearly 180 years, giving support through times of adversity and hardship which may have been caused, for example, by personal tragedy, financial problems, ill health or an accident. Reaching the doctors who are most in need continues to be both a top priority and a challenge for the charity. You can contact the RMBF if you are in need of financial support or if you know of a colleague who may need help – please visit the RMBF website.

Cameron Fund & BMA Law Partnership Clinics
The Cameron Fund, in association, with BMA Law is offering a series of partnership clinics early in 2016.Further information on how to access these is available here.

Bulletin 288
07.12.15

Christmas & New Year Opening Hours
We understand NHS England have now issued a letter to all practices confirming our original thoughts hared in eth mid November bulletin - practices who usually provide Saturday opening as part of their extended hours will be expected to do so on Boxing Day as the Bank Holiday is Monday 28^th December NOT Saturday 26 December. System Resilience Groups (SRGs) will be required to provide assurance for this period. This GPC guidance from previous years should be read in conjunction with the NHS England letter. The CQC has also issued this myth-buster on opening hours that is worth reading.

Patient Registration
GPC has published this updated guidance on patient registration which aims to clarify the conditions surrounding patient registration in GP practices. The key point to remember is that anyone, regardless of nationality and residential status may register and consult with a GP without charge.

NHS England has worked with patient groups and advocacy organisations to produce this guidance on registering with a GP. It clarifies that patients do not legally need to provide documentary evidence of identity, immigration status or proof of address, to register with a GP. Practices should not refuse registration on such grounds and there is no contractual duty to seek such evidence. This approach is supported by the BMA General Practitioners Committee. The Department of Health will shortly be consulting on extending charging of overseas visitors. However, the consultation does not propose introducing charges for anyone attending an NHS appointment with a nurse or GP in primary medical care.

CQC Registration Requirements for GP Federations
The Care Quality Commission (CQC) guidance on CQC registration requirements for GP practices working together as part of federations has recently been updated with more information. The guidance will help groups of registered providers who wish to form a federation to understand their duties in regard to CQC registration. The guidance summarises the issues that federations should consider and provides case studies to illustrate different registration scenarios. CQC National GP advisor Nigel Sparrow has also discussed what the guidance means in a new myth-buster.

1995 NHS Pension Scheme, Final Pay Controls
Practices may be aware that final pay controls were introduced this year for those in the 1995 NHS Pension Scheme. As a result of these controls, a penalty may be applied to an NHS Employing Authority, including GP practices, where a scheme member is awarded an increase to pensionable pay which exceeds CPI plus 4.5% and where this increase will be included in the calculation of the best of the last three years pensionable earnings increase. Guidance and working examples can be found on the BMA website.

Men ACWY Vaccination for Freshers
As you may recall we sent a message out in October about the missed cohort of Men ACWY vaccination for freshers. NHS Employers’ FAQ in relation to this has now been updated to accommodate those who left school but may be older than 17 or 18 but don’t fall in to the freshers programme. This is to ensure practices are remunerated for vaccinating these patients. The updated FAQ reads as follows:

Q: What about teenagers and young adults who left school in the last term of the 2015/16 school year and may be going to university in autumn 2015 but do not meet the age criteria for the two MenACWY programmes?

A: Children who finished school year 13 in August 2015, but are either younger or older than the normal age and are therefore outside the cohorts defined in the specification are expected to be at similar risk to their peers. As these patients fall outside of the eligible cohorts defined by the NHS England service specifications, they would not covered by the automated data collections. Where these children self-present for vaccination, practices should discuss the vaccination of these patients with their commissioner on a case-by-case basis. In line with established procedures, where the practice and commissioner agree to the amendment the commissioner will adjust the practice achievement.
In the spirit of the agreement, GPC would expect these practices to be remunerated for vaccinating these patients. All of NHS Employers’ FAQs on vaccinations and immunisations are available here.

Antimicrobial Resistance, e-learning Package
As part of the 5 year antimicrobial resistance strategy, Health Education England has produced an e-learning package to help healthcare staff understand the threats posed by antimicrobial resistance  (select the open access session on the link).

The updated Health & Social Care Act Code of Practice now contains 'Antimicrobial stewardship' (AMS), defined as 'an organisational or healthcare‑system‑wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness' and recommends:

“3.6 Providers should ensure that all prescribers receive induction and training in prudent antimicrobial use and are familiar with the antimicrobial resistance and stewardship competencies.”

The NICE AMS systems and processes guideline also recommends:

1.1.10 Consider using the following antimicrobial stewardship interventions:

• education‑based programmes for health and social care practitioners, (for example, academic detailing, clinical education or educational outreach).

Request for GPs to Help with Audit of Research Requests
The BMA’s Ethics department is seeking GP practices who are willing to provide examples of requests for patient information that they receive from researcher to help them work with the Health Research Authority (HRA) to develop a set of standards for researchers. The aim is to hopefully reduce the work required for GP practices to comply with requests for research.

Researchers regularly approach GP practices to provide patient information or support with recruitment for research projects; often there can be gaps in the information provided in these requests, which can leave doctors unsure if they would meet their legal and professional obligations if they complied with the request. GPs would often like to support research, but are unable to because they do not have time to find out the additional information they need.

The standards the BMA are developing with the HRA will inform researchers about when it is appropriate to contact GPs with requests for information, and what information to include. To do this, they need to know more about the nature of the requests that practices currently receive. For example, they would like to know what kinds of people or organisations are making these requests, what type of research they are doing, and what kind of information and/or support they are requesting from the practice. The BMA are seeking the help of any GP practice that is willing to send photocopies of all requests for information that they receive from researchers between now and 29 Jan 2016.  If you are interested in helping, or would like more information, please contact Hannah Quigan - hquigan@bma.org.uk or 020 3058 7463.

Bulletin 287
17.11.15

GPC Sessional GP Newsletter
The latest edition of the sessional GPs e-newsletter is available to view.

Patient Registration, Updated GPC Guidance
The GPC have updated their patient registration guidance.  The key message is that any patient in England, regardless of their residency status, regardless of where in the world they are from, and regardless of how long they will be in England, must be treated in exactly the same way as a UK resident. This applies in respect of emergency and immediately necessary treatment, application for temporary resident registration and application for permanent registration.

Intelligent General Practice Reporting Tool (iGPR)
The iGPR tool allows practices to respond to requests for patient health information electronically. The tool has been produced by Niche Health and is available to EMIS, INPS Vision and TPP SystmOne practices. The iGPR provides an electronic process for practices to provide patient information to requesting third parties, such as insurers and solicitors. Requests can include Subject Access Requests (SARs) and GP Reports (GPRs). There are other systems that provide similar functionality. The LMC is unable to ‘approve’ or ‘endorse’ third party software products, however we are able to provide the following generic advice.
Firstly, with regard to any SAR from an insurer, practices should read the BMA guidance on how to manage SARs for insurance purposes. The guidance was issued following a review by the Information Commissioner’s Office and advises practices to contact the patient where a SAR from an insurance company is received, rather than sending the full medical record direct to the insurer. A template letter is included in the guidance, which asks the patient to choose between receiving the medical record themselves (so they can decide whether to send this onto the insurance company), or to ask their insurer to seek a GP Report from the practice. It should also be noted that when a SAR is produced, the Data Protection Act (DPA) requires certain types of data to be redacted. Any additional redaction offered by any reporting tool over and above the legally required redaction would, in the GPC IT Subcommittee view, mean that the resulting report no longer constitutes a SAR. Where practices wish to use these tools for purposes other than an insurance company SAR, this is a matter for individual practices to decide. Separately, practices have asked for advice on electronic patient consent, and the legal position is that electronic patient consent is acceptable. However, where there is any doubt that the patient has consented to the report, practices should check with the patient. Please note there is no requirement for practices to use these reporting tools, and it is for practices to decide whether they receive requests through them (rejecting these requests should prompt the third party to request the information by alternative means) or whether to deactivate the tool.

Bulletin 284
27.10.15

Patient Objection Data, HSCIC Request
Practices receive an offer from the HSCIC, available from 21 October, to participate in the collection called ‘Patient Objections Management’ within CQRS. The deadline for participation has not been specified, but practices have been asked to participate as soon as possible ahead of the first extract. Extractions will run monthly from December 2015. GPC strongly recommends practices participate in this collection to allow the HSCIC to uphold patient objections to their data being shared in line with the directions under section 259 of the Health and Social Care Act 2012. Patients are able to register objections with their practice to prevent their identifiable data being released outside of the practice for purposes beyond their direct care (known as a Type 1 objection), or to prevent their identifiable data from any health and social care setting being released by the HSCIC for purposes beyond their direct care (known as a Type 2 objection). The HSCIC will be collecting the following data:

• For patients with a Type 2 objection (or a withdrawn Type 2 objection), the NHS Number, objection code(s) and code date will be extracted. The collection of patient identifiable data (NHS Number) is necessary to allow the HSCIC to uphold these objections. The data will be used internally by the HSCIC and will not be published or released;

• Aggregate data on the number of Type 1 and Type 2 objections. This will allow the HSCIC to monitor the rate of objections.

Queries on how to participate should be directed to the HSCIC contact centre via enquiries@hscic.gov.uk with ‘Patient Objections Management data collection’ in the subject line, or by calling 0300 303 5678.

Dedicated End of Life Transport
A dedicated transport service for patients who are imminently dying will be available until 31 March 2016. Please refer to this booking process and information document for further details Referrals should be made, only when the patient is ready to travel, by ringing the ‘Urgent’ line on 0191 414 3144. The Tees service is available between 11am and 7pm 7 days per week (including Bank Holidays) and but bookings can only be taken between 8.30 and 5pm. The dedicated booking line is available 24 hours per day to receive cancellations.  This is not a dedicated helpline for end of life/palliative care transport requests so please clearly state you are requesting ‘palliative care transport’. If your call is not answered immediately, please remain on the line as the call handlers will be aware of your call. For more information about this service, please contact Andrew.Airlie@neas.nhs.uk. This service has been added to the LMC Patient Transport to Hospital flow chart.

Childhood Flu Vaccine Shortage
Due to shortages of the childhood flu vaccine Fluenz, Public Health England and MHRA have agreed that practices can instead use the US labelled FluMist® Quadrivalent, which is fully licensed for use in the UK. Public Health England has published FAQs, which explain about the batch expiry date, includes a link to a template PGD, and how to record it on the clinical system (either as ‘Influenza vaccine (Live attenuated)’ or ‘Fluenz Tetra’). Public Health England has also produced separate guidance on cold chain failures. Further information is available in the special edition of Vaccine Update, Live attenuated influenza vaccine (LAIV) for the UK childhood flu programme.

TPP Data Extraction Issues
We have been made aware of an issue affecting TPP SystmOne practices and the automated extract for childhood flu and shingles – this is due to problems with TPP’s data extract accreditation. TPP practices are being asked to revert back to manual claims for this activity, and will be contacted directly by the HSCIC, who sent the following information with regard to the flu issues:

‘This note is to alert you to a problem that has arisen with one of the GP systems providers, TPP. The HSCIC has discovered that the TPP validation and assurance for the automated extract for childhood flu does not meet the required standards set by the HSCIC. This means that the data these practices present for payment cannot be guaranteed as being accurate and as a result the reported activity may not be correct, and practices could be either under or over paid. As the planned extract was scheduled to run last night and to delay could impact on payments for all practices, the HSCIC made the decision to exclude TPP from this run. We support HSCIC‘s recommendation that until TPP can provide assurance that meets the required standards, their practices should be advised that they must revert back to manual claims for flu activity.

The HSCIC will immediately progress communications with practices and regional team users to advise them of the change in procedure and what they must do. They will work with TPP to deliver this.  As the manual system is in place and well established, practices are aware of what is required to make a claim. In addition, under the manual system which is directly into CQRS, claims do not need to be in until later in the month, so payment can be processed in time for the due date.

We will ensure that you are kept informed of the actions that HSCIC are taking to mitigate the risks of this failure by TPP to follow HSCIC’s validation and assurance procedures. HSCIC will send out a message to regional teams and TPP will also send a communication out to their practices.’

GPC have raised concerns with NHS England/HSCIC about the burden this may place on practices, and asked if future extractions may be affected and what steps are being taken to ensure TPP’s validation and assurance are fit for purpose in future.

PGDs for Travel Immunisations
There has been a cession of travel vaccine Patient Group Directions (PGDs) for practice nurses in some areas. NHS England and Public Health England have restated that individual prescribing is the normal preferred route for patients to receive medicines; however PGDs should be used where there is a clear benefit to the patient. NHS England agreed with GPC that nurses should still be able to give travel vaccines under a PGD. Where a PGD is in place patients can have their travel immunisation needs assessed on an individual basis by a health care professional, and if vaccines are indicated and a PGD is in place these could be provided without unnecessary delay or inconvenience. Public Health England are currently working on a national template PGD for Revaxis (Td/IPV) which includes travel indications, which underlies their support for the concept of PGDs for travel.

Cameron Fund Christmas Appeal
It is that time of year again when the Cameron Fund seeks your support for their Christmas Appeal – it seems to get earlier every year so apologies for mentioning Christmas in October! The Cameron Fund is the only charity which solely assists General Practitioners and is grateful for the support it regularly receives; since its creation in 1970, the Fund has assisted over 1,450 GPs, former GPs and their families. The Christmas Appeal to colleagues has made a real difference to the Cameron Fund in the past and the continuing work they do to support your colleagues.

Bulletin 283
20.10.15

Workforce Minimum Data Set
For clarity, only information marked as ‘essential’ in the workforce minimum data set is mandated under the Health & Social Care Act. Some items such as ‘absence type’ and ‘reason for sickness absence’ are listed as ‘not required’ and it is practice decision as to whether or not they provide information marked as ‘not required’.

Pertussis Data Collections
Following a high volume of amendment requests due to incorrect Read Coding, HSCIC would like to remind practices that in order to ensure accurate data collection and payment, payment guidance for the pertussis service must be adhered to for the October collection. This collection will use the codes quoted in the guidance and practices will need to code appropriately in order for the automated collection to calculate the correct payment. Failure to do so will result in practices not being paid for activity undertaken unless practices spot a discrepancy. To correct this practices would have to agree adjustments with their regional team, creating additional work for all concerned.

GP Workforce, Research GPs Joining & Leaving the Profession
Ipsos MORI are conducting some independent qualitative research with GPs to explore their views of joining and leaving the profession. They are especially interested in hearing from GPs with a health condition which, at times, makes them question how easy it is for them to continue working as a GP; GPs currently caring for another adult or who think they might need to care for another adult in the future, which may challenge their ability to stay in the profession; GPs who returned to practice in England following a period of not working as a GP or as a GP in England; or GPs who trained in England but are now working as a GP outside the UK. If you’d like to know more about taking part in their research, and to find out if you are eligible, please email ResearchGP@ipsos.com. If you are eligible and able to participate in an interview, Ipsos MORI will be able to pay an incentive to thank you for your time.

Indicators of Quality of Care in General Practice, Health Foundation Report This report is the outcome of the Health Foundation review into indicators of the quality of care offered by GP practices in England assessing if comparable indicators of the quality of primary care were sufficiently developed to be used to help practices improve quality, and whether such indicators help patients and carers gauge the quality of care their GP practice provides. It also considered whether credible indicators were available for specific population groups and the services available to them. The review was commissioned by the DoH and made a number of recommendations to the government including consolidating the multiple information sites, developing a small set of indicators that show information about what matters most to the public, health care professionals and those accountable for the quality of general practice and providing support to those working in general practice about how to understand and use information to improve patient care. The review also strongly advises against making a composite score out of selected indicators to indicate the quality of care overall in general practice, or for particular population groups.

State of Health Care & Adult Social Care, CQC Report
CQC has published its annual analysis of the quality of Health and Adult Social Care in England. This is the first such national assessment since the introduction of the new inspection regime in October 2014. Key findings include: despite increasingly challenging circumstances, the majority of services across health and social care have been rated as good, with some rated outstanding; in the case of primary medical services, 85% of GP practices were rated either good or outstanding; strong leadership and collaboration emerged as a key factor in delivering good care; GP practices deliver a better quality of care when sharing learning and providing joined up care through multi professional networks. CQC recognised the pressure GPs face from a rise in the number of patients registered with them and the number of unfilled GP posts, with fewer people entering the profession (in 2014 12% of GP training posts went unfilled) and 34% of GPs considering retirement in the next five years. It is these statistics (taken from the BMA’s own survey) that should be considered when reading the conclusions reached in the report.

NHS England Urgent Care Commissioning Standards
An updated version of urgent care commissioning standards has now been published. A 'post event messaging (PEM) problems' site that provides guidance for overcoming any outstanding issues relating to PEMs can also be accessed HERE.

Bulletin 282
13.10.15

GP Health Continues
The GP Health scheme has been extended until 31 October 2015. You can find further details including how to access services here.  GP Health has generously decided to continue to provide their mental health and wellbeing services to all GPs in Tees at their own expense. As you know, there have been many discussions with both CCGs in Tees with regard to the provision of a GP wellbeing services but such a service has not yet been commissioned. It is likely that there will be a service commissioned in the near future but GP Health recognise how valuable this service is to GPs in the area and did not wish to see GPs left without support. We are sure you will share our appreciation of the generosity of GP Health in providing this service.  

CLMC Secures Funding to Assist GP Groups
CLMC has successfully secured GPDF funding to support practices in the development of joint working/working at scale. This is time and funding limited resource. In the first instance we will be contacting the ‘groups’ that are already emerging and have been in contact with CLMC but if you would like to discuss what may be available or are looking to form a group of which you have not yet made us aware, please contact janice.foster@nhs.net. We will ensure we keep all practice informed as to the funding usage and subsequent opportunities.

QOF Collection Failure Notice
The Health and Social Care Information Centre (HSCIC) sent an email to all practices to advise of a technical issue resulting in the September data Quality Outcomes Framework (QOF) information collection not being successful. There’s no payment directly attached to information from this collection, as payment is made annually at the end of the 2015/16 financial year. NHS Employers have confirmed that the GPES business team is implementing the changes to resolve the issue. The September data collection will now take place at the end of October/early November once the assurance process has been completed. The October data will then be scheduled as soon as the September data has been successfully collected. The GPES team do not believe that this issue will impact local system supplier reports, as the issue related to data being processed in GPES (GPET-Q) and not on the GPSS GP extraction (GPET-E).

Leases: Negotiating Head of Terms
Looking to lease new premises or coming to the end of your current agreement? BMA Law have provided these top tips via BMA Communities to ensure you know what to look for when negotiating the key commercial terms of your lease – from service charges to your rent review, it is all covered.

Sharps Bins & Pharmacy Collection
We have been made aware that practices are directing patients to pharmacies in order ‘hand in’ yellow sharps bins. The LPC has highlighted that whilst pharmacies can issue sharps bins they are not obliged to accept them back from patients and, indeed, cannot accept them unless appropriate arrangements are in place. GP practices should also decline to accept sharps bins unless they have issued them to the patient in the first instance. Where the sharp bin originated from community or Trust services practices should direct patients to these providers. We appreciate this leave a gap for pharmacy issued bins and we are working with the LPC to resolve this as it appears to be a commissioning oversight. As soon as we have clarity as to where to direct patients with these sharps bins we will forward this.

Healthwatch & Fees for Work Not Covered in the GP Contract
GPC has met with Healthwatch England to discuss charges that GPs can make for work not covered by their contract. The patient group understands the reasons behind charging, their main concern was a lack of consistency between practices and sometimes even within practices. It was explained that the BMA is not able to set fee levels for this work and is expressly prohibited from doing so; GPC would like to to remind practices of their current guidance on charging. It may also be helpful for practices to display information about fees and the reasons where they can easily be seen by patients.

Royal Benevolent Fund Annual Review
The RMBF (Royal Medical Benevolent Fund) – the charity for doctors, medical students and their families – has just released its annual review. In 2014/15 the RMBF helped 212 beneficiaries with financial support, nearly 50 per cent of whom were GPs or GP trainees. The charity has been helping doctors and their families for nearly 180 years, giving support through times of adversity and hardship which may have been caused, for example, by personal tragedy, financial problems, ill health or an accident. Reaching the doctors who are most in need continues to be a top priority and a challenge for the charity. If you are in need of support, or if you know of a colleague who may need help you can contact the RMBF/visit the RMBF website. 

Bulletin 281
05.10.15

Pharmacy Flu Vaccinations in Care/Nursing Homes
We have been made aware that some pharmacies have proactively contacted care and nursing homes and arranged to vaccinate all residents. There is nothing within the pharmacy contract which prohibits this and we strongly recommend practices contact the homes in which their patients reside to ensure this arrangement has not been put in place prior to planning/completing vaccination timetables/plans. Additionally, we have been aware that in some circumstance the pharmacies have suggested they are vaccinating on behalf of practices. We have contacted the LPC to challenge/prevent this misleading information and, if you have experienced this, please contact janice.foster@nhs.net with specific examples where this has happened – preferably with the name of the pharmacy so this can be addressed.

Tees Sexual Health Service Procurement
The integrated sexual health service in Tees is now open for tender via NEPO. Stockton BC are leading this procurement on behalf of all the LAs and they have provided this briefing for GPs. The intention is to continue with the current model of provision, as outlined in this model vision document i.e. a prime provider who will have overarching responsibility for quality and performance across all service provision and the provision of services by General Practice and Pharmacies is still considered fundamental to the delivery model and is explicit within the specification.  We remind practices that they may also wish to view these documents with the view to tender to provide this service as well as providing as a sub-contractor. Following consultation feedback there is a strengthened the requirement in relation to Primary Care Subcontracting that includes training to maintain subcontractor competencies, support to staff and a dedicated point of access for clinical advice.  Bidders will be tested on their ability to engage and work with practices and pharmacies and the transition to new subcontract arrangements is a critical phase in the mobilisation period. 

GP Calls to AAU at James Cook
ST CCG has advised that GP consultant ‘triage service’ has been reinstated. Concerns from previous experiences have been taken on board and a trial period has taken place to ensure the new system works, particularly the telephony element. Conference call phones that are being utilised are with a different network to ensure no black spots within the hospital.  If for whatever reason the GP and consultant do not get to speak together the default position is that bed bureau will admit the patient. During the trial week the service demonstrated that the phone calls have worked well with no complaints or issues from GPs or consultants being raised - 80 calls were taken during this week, of which 56 patients were still admitted and 16 were referred onto and seen in the ambulatory clinic.  The remainder were a mix of referral onto other hospital services or an alternative clinical review/advice provided. The service will now run from 9am-5pm Monday to Friday and 9am-2pm on a Saturday.

Overseas Visitors & Onward Referral
There is much confusion with regard to overseas visitors given the recent media and shift in NHS agenda. Whilst there has been no change in policy for General Practice, Trusts are increasingly vigilant – including community services as well as the more traditional secondary care services. In order to assist patients, Trusts and the NHS in ensuring charges are appropriately made; GPs are recommended to advise patients who are not ordinarily resident in the UK that they may not be entitled to free NHS services by other providers e.g. Trusts. Whilst the GP should always refer as clinically appropriate, a patient can be advised to check eligibility via an NHS Choices questionnaire and it would be helpful if the GP could include a line within the ‘additional information’ section of the referral form to alert the Trust to the fact that the GP has advised the patient to check eligibility as they suspect this patient is not ordinarily resident in the UK. Ultimately, responsibility for entitlement to NHS care remains with the Trust. This patient leaflet may provide helpful.

Men ACWY for Uni Freshers, Missed Cohort
Practices are alerted to a missed cohort of Men ACWY patients – namely patients born after 1 Sept 1997 who have just started University. Those in the current year 13 (DOB 01/09/1996-31/08/1997) would be in the school catch-up cohort and for a patient to be in the University freshers cohort they must be 19 years on 31 August 2015 in order to be eligible. GPC raised this issue with NHS England who have confirmed that, as per the tri-partite letter, patients born between 01/09/1997-31/08/1998 will be eligible for vaccination from April 2016 leaving a group of patients unprotected against meningitis until then. NHS E refused to amend the service specification to ensure this group (although likely to be small) could be included in one of the cohorts and thus funded nationally. Instead the following FAQ has been provided:

Q: What about teenagers and young adults who are going to university early but do not meet the age criteria for the two MenACWY programmes?
A: As these patients fall outside of the eligible cohorts defined by the NHS England service specifications, they would not be covered by the automated data collections. As such, practices should discuss the vaccination of these patients with their commissioner on a case-by-case basis. In line with established procedures, where the practice and commissioner agree to the amendment the commissioner will adjust the practice achievement.
In the spirit of the agreement, we would expect these practices to be remunerated for vaccinating these patients.

Whilst this allows for these patients to be protected and should allow for payment to be made, this is far from ideal as the workload involved in claiming may negate any overall income received for the practices.

Men B for Infants, FAQs
NHS Employers have updated their vaccs and imms FAQs in relation to meningococcal B for infants to explain the eligible age cohort (2 – 13 months), as well as a catch-up cohort up to 2 years for children born on or after 1 May 2015. The FAQs also explain what practices can do if parents approach them about having children outside of the cohort vaccinated privately:
Q. Can parents or guardians whose children don’t fall into the eligible age groups get their child vaccinated against MenB? If so, how?
A. Children can be vaccinated through a private clinic that is able to obtain the vaccine from the manufacturer. However, parents or guardians should be aware that they will be responsible for the full cost of the vaccine. Under the current contract for general practice, practices are restricted from providing private services to their own NHS patients except in very specific areas, such as travel advice.
For clarity, whilst GPs can provide private prescriptions, they are not allowed to charge their own NHS patients and we, therefore, recommend that patients (outside the cohort) access a comprehensive private service provided by another practice or service provider, who would then be able to charge an appropriate fee for this private service.

Phasing Out Seniority Payments, GPC Guidance
This new GPC guidance provided details on the phasing out of seniority payments.

Indicators No Longer in QOF
The Indicators No Longer In QOF (INLIQ) Business Rules v32.0 have now been published.

Bulletin 280
29.09.15

Private Prescriptions for Medication/Treatment Available on FP10
We have been made aware of patients approaching a GP to request a private prescription for their NHS care. Practices are reminded that when providing NHS treatment under their contract they must prescribe on an FP10. Practices are cautioned against providing a private prescription for FP10 available medication/treatment for a number of reasons including the obligation to provide an FP10 under the contract, the risk of double prescribing should an FP10 and private script be given and the risk of accusations of fraudulent behaviour. Whilst we understand a patient may request a private prescription if it is considered a cheaper alternative to NHS charges,  a practice cannot be certain of the dispensing fee unless there is an arrangement with a pharmacy which could be seen as improper. Additionally, both patient and practice leave themselves open to accusations of conspiring to defraud the NHS of the FP10 fee - the consequences of which are serious.  CLMC urge practices to use FP10s wherever applicable to avoid this minefield. For further details/queries please contact janice.foster@nhs.net.

Dementia Extract, HSCIC Request
HSCIC have written to practices who have not already accepted the GP extract entitled ‘Quality and Outcomes Framework (QOF) Subset Extract for Dementia Prevalence 15/16’ (also known as SoS Dementia) to request they accept the extract by the end of Thursday 29 September 2015. GPC recommends that practices comply with this request, which is a legal requirement under the HSCA. The HSCIC confirmed that practices were required to participate in this extract through CQRS by 31 August, and that they are legally required to comply under Section 259(5) of the Health and Social Care Act (HSCA). To clarify, this extract is unrelated to QOF, despite being labelled a QOF subset. It was given this name because the data closely matches a subset of QOF indicators. GPC has asked the HSCIC to use different terminology in future to avoid any confusion. The Joint GPC & RCGP IT Committee (JGPITC) was consulted on this extract, as confirmed in the HSCIC’s communications. The Committee accepted the legal basis of this collection through the HSCA, and that the extract had been approved by both the General Practice Extraction Service (GPES) Independent Advisory Group (IAG) and the Standardisation Committee for Care Information (SCCI).The collection is of non-identifiable, aggregated data specifying the number of people at each practice with a diagnosis of dementia, broken down by age and gender, as well as the number of the practice’s total registered population. This is non-identifiable data and therefore not subject to the fair processing provisions of the Data Protection Act. There is therefore no requirement to inform patients. Further information is provided within the Data Provision Notice. The 2015/16 collection follows a similar collection from practices in 2014/15. The HSCIC intends to publish 2015/16 data on its website from October.

Tamiflu for the Prophylaxis of Influenza in Nursing & Care Homes
GMS regulations are clear that prescribing of Tamiflu for the prophylaxis of influenza in nursing and care homes where there have been confirmed cases of influenza is not included under essential services that practices are required to provide for their registered patients.  Essential Services are defined in the GMS regulations with reference to regulations 15(3) (5) (6) and (8). Although PHE disagreed with this view, GPC sought legal advice on this issue and would like to re-iterate to practices that this work is not covered by their contracts and that if requested, practices should advise PHE (or whoever else who requests this) that unless this service is properly commissioned, they will not be providing it in the event of a flu outbreak. Additional work must be commissioned and funded separately as an Enhanced service. Examples of these are the influenza vaccination programme and catch up MMR vaccination campaign.

Passport Applications
Practices are reminded that doctors/GPs are no longer accepted as counter signatories for passport applications. This was in response to medical profession complaints about the unnecessary workload/high demand and wads put in place March 2015. However, if you are a friend or colleague of the applicant this is still permitted.

GP Workforce Data Collection
The second phase of the GP workforce data collection will commence on 1 October for a 6 week period (close midday 11 November). Practices are required to submit this data and should do so via the via the Primary Care Web Tool (as per the previous submission). This data collection now includes all practice staff (including admin/nonclinical staff) in addition, absence and vacancy data is required and there are changes to mandatory data fields. Clarification of the Fair Processing Notice (FPN), and updates to the guidance documentation are all included on the website. The data collected in March is also now available here.

Responsible, Safe and Sustainable: Towards a New Future for General Practice, GPC Report
GPC have launched their vision for the future of general practice in England; Responsible, safe and sustainable: Towards a new future for general practice. This report is the culmination of a major project launched over a year ago which has included: regional GP consultation events hosted by LMCs; a regional event specifically targeted at sessional and trainee GPs; patient deliberative events; and the major GP survey undertaken in the early months of this year. GPC website contains further information/resources and key recommendations from the report will be taken forward in further activity over the coming year.

Investment in General Practice
Reports on investment in general practice and payments to general practice have been published. It will not surprise practices to learn that yet again there has been a reduction in the general practice share of NHS spend – falling from 10.0% in 2005/6 to a current low of 7.9% in 14/15 (7.4% excluding dispensing drugs).

CCG/Practice Agreement for the Provision of GPSoC & GP IT Services
Many practices have now received an agreement setting out the provision of GP Systems of Choice (GPSoC) and GP IT services for signature by practices and CCGs. The CCG-practice agreement sets out the relative responsibilities of CCGs in providing these services, and each practice’s responsibilities in receipt. The agreement replaces the previous PCT-practice agreement. The deadline for signature of the agreement by practices and CCGs is 31 December 2015. Signature is necessary to ensure each practice’s right to a choice of clinical system is protected, and to help ensure CCGs meet their IT obligations. Where signature is not possible, a resolution should be sought through CCG escalation to their area team. The HSCIC has stated that central IT funding could be withdrawn from practices that have not signed the agreement by the deadline. HSCIC has also published some FAQs.The HSCIC has advised that CCGs and practices are only able to update the three specific appendices. Appendices 1 (summary of services), 2 (support and maintenance service levels) and 3 (escalation procedure), listed below, are subject to local agreement and should be completed by the CCG in consultation with practices. The agreement itself should remain as per the version on the HSCIC/NHS England websites.

Bulletin 279
22.09.15

Vaccine Supply, Fluenz Tetra Ordering
Ordering of Fluenz Tetra for GPs for the children’s flu programme in 2015/2016 is expected to commence week ending 2 October. Ordering will open for the 2015/16 season with no restrictions for either schools or GPs in the first instance. However, the ability to allow free ordering throughout the programme requires customers to adhere to the guidance that has been issued to order/hold no more than 2 weeks stock at any time. Applying restrictions such as an allocation system, or order cap will be considered by PHE at a later date if stock runs low. Fluenz Tetra is a live attenuated vaccine and as such has a very short shelf life. Please bear this in mind when ordering. The first batches will have December 2015 expiry dates. Practices will be able to place an order every week and deliveries will be made weekly alongside usual deliveries of vaccines. Where possible do not order more than required for the next two weeks. This is to minimise vaccine wastage due to the vaccine passing its expiry date before it can be administered. The vaccine will be available to order throughout the entire flu season to ensure there is in date stock available into the New Year. Subsequent deliveries of vaccine will have later expiry dates.

Flu Immunisation for Patients with BMI>40
Practices are advised that there is no obligation to vaccinate patients with BMI over 40 and that no pressure can be applied to practices as this is not about clinical risk, but due to a funding decision by NHS England.

Following national discussion as to whether practices should or should not immunise those with BMI over 40 as per the JCVI recommendations, GPC contacted NHS England for clarification. It has confirmed that there will be no changes to the current enhanced service to include the morbidly obese as a stand-alone cohort, as the recommendation for this cohort came in after the funding had been secured for 2015-16. The wording in the service specification addresses this (page 24, footnote 33 of the specification): ‘33 JCVI have advised that morbidly obese people (defined as BMI>40) could also benefit from a seasonal influenza vaccination. Many of this patient group will be eligible for vaccination under another risk category due to other health complications that obesity places on them. However, funding has not been agreed to cover this cohort as part of this ES. Practices are able to use clinical judgment to vaccinate patients in this group, but vaccinations for morbidly obese patients with no other risk factor are not eligible for payment under this ES. The inclusion of this cohort in subsequent years is under consideration. In addition NHS England confirmed that the morbidly obese are not included in the pharmacists additional service so they should not be directed to pharmacists unless recommending a private vaccination. If practices find themselves with flu vaccinations left over due to pharmacists' activity, the obese (of any BMI) might be an appropriate population to use them up on.

Guidelines on Malaria Prevention in UK Travellers Update
The Advisory Committee on Malaria Prevention (ACMP), an expert advisory committee of Public Health England (PHE) has updated its guidelines on malaria prevention for medical professionals and other travel medicine advisors based in the UK. The key changes are:

• updated guidance on the use of insect repellent and sun protection

• clarification on the use of hydroxychloroquine

• updated guidance on the use of anticoagulants with antimalarials

• updated guidance on the use of doxycycline in epilepsy

• changes to the country recommendations for Vietnam and Malaysian Borneo, and clarifications on the recommendations for India

• clarification of advice for travellers moving through areas where different antimalarials are recommended

Recommendations for antimalarials should be appropriate for the destination and tailored to the individual, taking into account possible risks and benefits to the traveller. As part of an individual stringent risk assessment, it is essential that a full clinical history is obtained, detailing current medication, significant health problems and any known drug allergies. A suggested risk assessment template is included with the guidelines.

ACMP position on the use of mefloquine
Falciparum malaria is a common, preventable and life-threatening infection. Mefloquine is an extremely effective antimalarial and is currently recommended as one of a number of antimalarials for travellers to high risk areas following an individual risk assessment. During the ACMP meeting in June, the committee reviewed current evidence on the use of mefloquine (proprietary name Lariam), including data provided by the manufacturer Roche, and recommendations on the use of mefloquine for malaria prevention made by other countries. The ACMP concluded that all the currently available evidence had been examined and, on the basis of this, determined that there should be no changes to existing ACMP recommendations regarding mefloquine. Details on the use of mefloquine in travellers, including contraindications and drug interactions are detailed in section 4.2.4 of the revised guidelines.

NHS Property Services Warning Note
It has been brought to our attention that in presenting Heads of Terms and a pro forma lease, NHSPS are intimating that they follow a format that is reflective of the national template documents currently under negotiation between NHSPS and GPC.  In addition GPC are aware of suggestions being made by NHSPS that these documents are largely agreed and that such statements are being used to encourage practices' to sign up. In both cases such statements are misleading. To be absolutely clear, the national template lease and supporting Heads of Terms under negotiation have not been agreed. As it stands there are fundamental issues that remain outstanding and GPC await a response from NHSPS and NHS England to their letter which sought to have these addressed. For your reference these outstanding issues include, without limitation, the fact that there remains a fundamental discrepancy between the rent review provisions being sought and the sums that are capable of reimbursement. As a consequence of the above we would not recommend that practices sign anything unless they have taken appropriate legal advice and are 100% happy with the terms therein. Please note, in providing this warning GPC would like to stress that there is no legal obligation for practices to sign any such Heads of Terms, or related lease documents. Indeed, it is highly likely that any practice that is in occupation of NHSPS premises without a formal lease will be regarded as "protected" business tenants under the Landlord & Tenant Act 1954. As "protected" tenants practices' would effectively have a statutory right to remain in occupation. There are very limited exceptions to this and even where these exceptions apply they can only be invoked where a formal statutory process is followed by the landlord. If you are in any doubt as to your statutory rights and strength of position to remain in occupation (or are in any doubt given pressure being exerted by NHSPS) seek legal advice. Once the outstanding issues have been addressed in a manner which does not expose practices to unreasonable risks or burdens, GPC will look to agree the final version of the standard lease and Heads of Terms. As soon as this occurs we will formally issue confirmation that the negotiations have been successfully and satisfactorily concluded and issue guidance notes on the agreed pro forma lease. Until this occurs the position remains that GPC has not agreed the standard lease nor any form of Heads of Terms.

Sessional GP Newsletter
This month’s sessional GPs e-newsletter focuses on the national occupational health service for GPs suffering from stress and burnout and a further update on what GPC are doing to change the unfair rules on death in service benefits for locum GPs. Included in the blogs this month is one from sessional GPs subcommittee member Mary Anne Burrow on doing out-of-hours work.
 

Bulletin 278
15.09.15

CQC Duty of Candour
The CQC Duty of candour came into effect for all GP practices on 1 April 2015 and is covered in this myth-buster. This is covered by Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which sets out all of the Fundamental Standards. It aims to ensure that providers are open and honest with people when something goes wrong with their care and treatment. When a service is meeting the duty of candour patients should expect:

• A culture within the service that is open and honest at all levels.

• To be told in a timely manner when certain safety incidents have happened.

• To receive a written and truthful account of the incident and an explanation about any enquiries and investigations that the service will make.

• To receive an apology in writing.

• Reasonable support if they were directly affected by the incident.

If the service fails to do any of these things, CQC can take immediate legal action against that provider.

National Occupational Health Service for GPs
You may have seen the recent announcements (pillar 2) by NHS England about plans for a national occupational health service scheduled to start 1 April 2016 for GPs suffering from burnout and stress. We do not know the full details of this proposal but it is suggested it will provide specialist support and build on a number of existing, successful programmes elsewhere in the country. CLMC will continue to work with both CCGs with regard to GP health and retention and the proposals will be factored into our discussions. However, it is considered by CLMC and the GPC that these proposals do not go far enough as they focus on treatment rather than prevention. All GPs should be offered a comprehensive service – not just those who are stressed or burnt-out; it is as crucial to prevent ill health as it is to treat it, and services that meet the unique needs for the provision of GPs, who may at times have concerns about seeing other local GP colleagues are incredibly important.

GP Earnings & Expenses Enquiry Report 2013/14
The GP Earnings and Expenses Enquiry Report 2013/14 has been published by the Health and Social Care Information Centre. Please note, the main figure used in the report is that of the average of combined GPs (contractor and salaried), rather than that for contractor GPs which has been the case formerly. It is also important to note that at a time of rising workload, GP income has fallen by around 2.1% year after year in real terms since 2004/5.  It is also important to be aware that, in contrast to published NHS pay for other NHS staff, the figures for GP income include non-NHS income.

Bulletin 277
08.09.15

Meningitis B Vaccination Update
As from 1 September 2015 the Men B vaccination has been added to the Childhood Immunisation Programme in England. The programme is for all infants born on or after 1 July 2015, and consists of three doses at 2, 4 and 12 to 13 months, with a catch-up element for children born on or after 1 May 2015, who can be vaccinated up to 2 years on an opportunistic basis. JCVI has recommended three doses of prophylactic paracetamol (2.5ml of infant paracetamol 120mg/5ml suspension) following the vaccinations at 2 and 4 months. 5 ml sachets and dosing syringes are available to order via ImmForm. We are aware that many practices have been asked by parents to provide this vaccine privately to children outside the cohort. Although practices would be able to offer this on private script they would not be able to claim the cost of the vaccine, nor would they be able to charge the patient for providing it (as per Schedule 5 of GMS Regulations 2004 which lists the limited circumstances in which GPs may charge fees for providing treatment to their NHS patients). We would recommend that practices advise their patients requesting this to attend another practice, who are then able to charge for providing the vaccine. Further information about the meningococcal vaccine, including a protocol for healthcare professionals for Men B and paracetamol use is available on the Public Health England website. Full details are included in the service specification and Vaccine Update also has some useful information, including a parent information leaflet.

Overseas Visitors & Registration Requirements
GPC is aware of concerns about the lack of clear advice from NHS England about the obligations of practices with regard to registration and are taking urgent steps to ensure NHS England produces clear and definitive guidance to resolve this uncertainty. GPC have been consulted on guidance which they have insisted should be published as soon as possible. In the interim practices are reminded that people applying for registration cannot be turned down for reasons relating to the applicant's race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition. Practices should not refuse registration on the grounds that a patient is unable to produce evidence of identity or immigration status or proof of address; there is no contractual duty to seek such evidence. Anyone who is in England is entitled receive NHS primary medical services at a GP practice.

New Insurance & Indemnity Requirements
It’s now a statutory requirement for doctors to have appropriate insurance or professional indemnity covering the full scope of their practice when working in the UK.  Good medical practice already places a professional duty on all doctors to have appropriate insurance or indemnity, but these changes reinforce the importance of having this in place.

These new regulations mean:

• The GMC can check that any doctor practising in the UK has the appropriate insurance or indemnity in place, when they have concerns that this might not be the case.

• If the GMC learn that a doctor doesn’t have appropriate insurance or indemnity in place or if they fail to give the GMC the information they ask for, the GMC could remove a doctor’s licence to practise.

• The GMC can refuse to grant a licence to a doctor if they can’t assure the GMC that they’ll have the appropriate insurance or indemnity in place by the time they start practising in the UK.

It’s important to review your insurance and indemnity regularly, to make sure that it continues to provide sufficient cover for all your medical work. The GMC have published some new guidance on insurance, indemnity and medico-legal support which you may find helpful. It sets out different scenarios and important factors to check when assessing if you are fully covered. If you’re still not sure whether you need insurance or indemnity, or the level of indemnity you need, you should speak to your medical defence organisation or any other professional indemnity or insurance provider. They should be able to give you advice that’s tailored to your circumstances.

Nurse Revalidation
From April 1st 2016, all Nurses and Midwives on the NMC register will be required to Revalidate every 3 years as part of their confirmation as being fit to practice. This includes Practice Nurses and Registered Nurses working in General Practice who will need to ensure they are prepared for this new process, which builds upon their existing requirements to confirm their fitness to practice. Please take a moment to read this letter from NHS E which outlines the requirements and some local implementation support.

NICE Antibiotic Prescribing Guidance
NICE have published new guidance on antimicrobial stewardship. It covers the effective use of antimicrobials (including antibiotics), aiming to change prescribing practice to help slow the emergence of antimicrobial resistance and ensure that antimicrobials remain an effective treatment for infection.

GP Intending Trainers Course
Health Education North East are looking to increase the number of GP Trainers with the next course running in February 2016 and FAQ document contain useful information for all interested.

NHS Flu Fighters Free Resources
The Free Resources page on the NHS Employers website contains a number of free resources for the NHS Flu fighter campaign, such as free letters that you can send to staff to encourage them to have the flu vaccine, induction slides for new starters, and a comprehensive communications toolkit that you can use to support your local flu campaign. 

Bulletin 276
01.09.15

Subject Access Requests for Insurance Purposes, Updated Guidance
Please note that the advised approach to responding to a SAR for insurance purposes has now been updated following the ICO's input. This updated version of the SAR for Insurance Purposes guidance includes guidance on responding to SAR requests from third parties for non-insurance purposes.

Practice Nurse Guidance for Paracetamol and Meningitis B Immunisations
BBOLMC have worked with a PHE Immunisation Lead to develop this guidance which we hope will be a useful alternative to a RCN “Homely Remedies Solution”.

Fit for Work Scheme
GPs throughout England can now refer employed patients who have been, or are likely to be, off sick for four weeks or more for a voluntary occupational health assessment. Government information states that: 'The occupational health professional will identify obstacles preventing the employee from returning to work. A Return to Work Plan will be agreed providing recommendations tailored to the employee's needs, which can replace the need for a fit note.' Further details are available on the Fit for Work website, in addition to this specific guidance for GPs and the GPC guidance and FAQs.

Access and Copying Fees for Medical Records, Reminder Guidance
We regularly receive calls on this topic and there are a number of exceptions to fee charges for access to and copying of medical records. Practices may find this BMA’s guidance helpful.

2015/16 Vaccinations and Immunisations, Guidance Update
The 2015/16 vaccination and immunisations guidance and technical requirements to support GMS changes have been updated to include the new and amended meningococcal programmes.

Sessional GP Newsletter
The August edition of the Sessional GP eNewsletter features the busy summer period, top tips to help ensure locums pay pension contributions within 10 weeks, and a number of blogs discussing the benefits of joining a local Sessional GP group,  things you should consider before resigning, a GPs difficult experience completing  a ALS course and how one Sessional GP made sport their day job; as well as introducing Dr Faisel Baig (the newest member of the Sessional GP Subcommittee Executive).

Bulletin 275
04.08.15

PGD and PSD, Updated GPC Guidance
The GPC’s guidance on Patient Group Directions (PGD) and Patient Specific Directions (PSD) in General Practice has been updated to clarify the rules surrounding private PGDs.

Focus on Subject Access Requests for Insurance Purposes
The GPC has provided this updated guidance covering Subject Access Requests for Insurance Purposes.

Practice Support Needed for All Practices, GPC Letter to NHS England
Following the health secretary’s announcement of a £10m programme of support for struggling practices last month, Chaand Nagpaul, GPC Chairman, has written to NHS England proposing it funds a national proactive programme to identify and support all practices that are vulnerable or at risk of becoming so. This would be voluntary for practices, and must be done in a non-threatening and non-judgemental way, given that many of these pressures are a result of a reduction in resources, escalating workload, recruitment problems and understaffing. This would be followed by local, targeted support, resourced via a practice-stabilisation fund. Practices would be supported by transitional funding or a local healthcare resilience task force, which could, for example, host a pool of GPs, nurses and managers to work proactively with affected practices to enable stability, as well as being called on at short notice in response to a practice crisis. The GPC have also called for an organisational development fund to resource the development of GP networks to create a locus for peer support, practice collaboration and increased resilience. GPC believe that failure to act now is likely to result in much greater costs to the NHS and risks to the wider health economy, given the impact and domino effect of practice closures, re-tendering and service reduction.

Creating Teams for Tomorrow Report, Primary Care Workforce Commission
The primary care workforce commission, headed by Professor Martin Roland has published a report, Creating Teams for Tomorrow on the primary care workforce. This work was specifically requested by health secretary Jeremy Hunt and vindicates the GPC view that there are ‘unprecedented pressures’ in general practice arising from gross under-investment, escalating workload and poor workforce planning, and in turn, resulting in a significant reduction in the GP numbers as a proportion of NHS doctors, and fewer GPs per head than in 2009. The review speaks of the need for ‘significant additional investment’ and a range of measures to support practices, from using technology, the use of skill-mix, through to collaborative working between practices. The report also challenges political assumptions of recruiting thousands more GPs, even stating that GP workforce numbers are first likely to become worse. The clear message from this report commissioned by the Government is the need to act swiftly and decisively in providing resources to support general practice through tangible measures today, while planning for expansion in the GP workforce tomorrow.

Pharmacists Delivering Flu Vaccinations
It has been announced that from September 2015, adult at-risk patients will be able to access seasonal flu vaccinations in participating community pharmacies. Pharmacy staff will be expected to identify eligible patients and encourage them to be vaccinated. There will be a payment of £7.64 per vaccination administered, with an additional £1.50 payment in recognition of costs incurred such as training, revalidation and disposal of clinical waste. The GPC will request that the fee for this service for GPs is now reviewed given that pharmacists do not have responsibilities for record keeping or call/recall procedures that GPs have. More information about this is available here.

Bulletin 274
21.07.15

Focus on Global Sum Allocation Formula
The global sum allocation formula, or Carr-Hill Formula, has been used as the basis of core funding for GMS practices since the inception of the new GMS contract in 2004. This short explanatory paper has been produced because the allocation formula is newly relevant to many GP practices.

CQC, ‘What to Expect When We Inspect’
The CQC has produced a ‘what to expect from an inspection’ video which is a mixture of interviews with an inspector, GP and practice manager explaining their experience of an inspection. It is supported by a number of other documents giving practical advice as to what to expect from an inspection including a quick guide as to what to expect.

Use of SARs by Insurance Companies to Obtain Medical Records
The GPC has received a reply from the ICO regarding the use of Subject Access Reports under the Data Protection Act by insurance companies rather than requesting GP reports. The ICO has ruled that this use is inappropriate:

"The right of subject access is a key element of the fundamental right to the protection of personal data provided for under Article 8 of the EU Charter of Fundamental Rights which is conferred upon individuals. It is not designed to underpin the commercial processes of the life insurance industry. The Commissioner takes the view that the use of subject access rights to access medical records in this way is an abuse of those rights." A 'Focus On' will follow shortly, but in the interim, we recommend practices not to respond to these requests but rather advise insurance companies you decline as a SARs request is not appropriate in these circumstances.

FGM Prevention Programme, Letter from Minister of Public Health
A letter from Jane Ellison, Minister for Public Health, has been sent to NHS Trust Chief Executives, Directors of Public Health and Chairs of CCGs across England on FGM prevention. Within the letter, the Minister highlights the need for extra vigilance across the NHS in the lead up to the school summer holidays, a time when female genital mutilation is often performed on young girls who are taken abroad for this purpose. She outlines the main ‘warning signs’ for NHS staff to look out for, and the range of support and training materials available. The letter reiterates that FGM is illegal, and that safeguarding procedures must be followed every time there are concerns.

Bulletin 273
13.07.15

Duty of Care for Hospital Test Results and Drugs Recommended from Outpatient Clinics
The joint GPC and Consultant Committee statement on hospital test results has been updated as follows:

Duty of care regarding communication of investigation results

We are aware that in some areas, some hospital doctors have been instructing GPs to find out the test results which the hospital had ordered.

Both the General Practitioner Committee and the Consultants Committee of the BMA agree this practice is potentially unsafe, and that the ultimate responsibility for ensuring that results are acted upon, rests with the person requesting the test.

That responsibility can only be delegated to someone else if they accept by prior agreement.

Handover of responsibility has to be a joint consensual decision between hospital team and GP. If the GP hasn't accepted that role, the person requesting the test must retain responsibility.  

This advice is in line with both National Patient Safety Agency guidance and the Ionising Radiation (Medical Exposure) Regulations

The following statement on Duty of Care regarding drugs recommended from out-patient clinics has also been issued:

Duty of care regarding drugs recommended from outpatients
Communication of prescribing recommendations from out-patient clinics to patients and their GPs is a complex area where patient safety can be compromised. Policies with regard to this should include the following general principles:

• Drugs required for urgent administration should be prescribed by the hospital doctor, and if appropriate dispensed by the hospital.

• Responsibility for the provision of a prescription for non-urgent medications should be determined and agreed locally, but must recognise that delegation of responsibility for prescribing from hospital to GP can only take place with the explicit agreement of the GP concerned.

• All communications should be in writing with the responsible doctor identified.

• Where communications are sent via the patient, there should be clear instructions to the patient regarding the time scale for completion of the prescription, and this should be in addition to and not instead of a formal communication.

• The doctor recommending a prescription should ensure that the prescription is appropriate, including carrying out any tests required to ensure safety.

• The doctor recommending a prescription should provide counselling for the patient about important side effects and precautions, including any need for ongoing monitoring, which if needed should be agreed between primary and secondary care clinicians.

• Recommendations should be in line with any agreed local formularies. Individual judgements should be made about the desirability of recommending a particular drug as opposed to a therapeutic class.

• Where a GP feels that a prescription recommendation is inappropriate, the secondary care clinician should be informed.

• Notwithstanding any of the above, all prescribers must be aware that the ultimate responsibility for the prescription lies with the prescribing doctor and cannot be delegated.

NHS England Notification Required for Changes in Service Delivery/New Models of Care
Some practices are developing innovative solutions/ways of working in response to resource pressures to assist in managing capacity and workload. This includes looking at new models of care similar to those outlined in the Five Year Forward View. There is no desire to stifle this innovation BUT we remind all practices/organisations of the contractual requirements surrounding service provision. It is essential that everyone involves NHS England at an early stage, when appropriate, so they can advise as to whether contract variations or new contracts may be required. We have been made aware of some practices who have fallen foul of this requirement and have developed well worked plans only to find they cannot implement these without NHS England approval.

MDO Fees for OOHs, Extended Hours and Working at Scale/Treating the Patients of Others
It is important you inform your defence organisation about any working at scale, collaborative working/looking after another practices’ patients and CCG work as well as all out of hours and extended hours work. Put simply, ensure they are aware of your full work commitment to ensure you have appropriate cover. Many GPs are now shopping around for the best value cover, when doing this please be very careful about the terms and conditions to ensure you are covered for past events and anything that may arise post retirement etc. as well as you current full work commitment.

New Accessible Information Standard
The Accessible Information Standard will be implemented on 31 July 2016 and aims to provide people who have a disability, impairment or sensory loss with information that they can easily read or understand. This means informing organisations how to make sure people get information in different formats, for example in large print, Braille or via a British Sign Language (BSL) interpreter. All organisations that provide NHS or adult social care are required to follow the new standard, including NHS Trusts and Foundation Trusts, and GP practices. As part of the accessible information standard, these organisations must do five things:

• Ask people if they have any information or communication needs, and find out how to meet their needs. Record those needs clearly and in a set way.

• Highlight or ‘flag’ the person’s file or notes so it is clear that they have information or communication needs and how those needs should be met.

• Share information about people’s information and communication needs with other providers of NHS and adult social care, when they have consent or permission to do so.

• Take steps to ensure that people receive information which they can access and understand, and receive communication support if they need it.

Further details are available here.

GMC Duty of Candour
The GMC have released this joint guidance with the NMC on duty of candour which sets out the standards expected of all doctors, nurses and midwives practising in the UK. It also aims to help patients understand what to expect from healthcare professionals. The GMC can deliver sessions on duty of candour. If you would be interested in attending a session please email janice.foster@nhs.net and we can liaise with the GMC to try and organise this.

Community Pharmacy Pilot
NHS England launched a new £15m three year pilot to fund, recruit and employ clinical pharmacists in GP practices. This pilot is part of the GP workforce 10 point plan, Building the Workforce – the New Deal for General Practice, and is the result of close collaborative working between NHS England, Health Education England, the GPC, the Royal College of General Practitioners and the Royal Pharmaceutical Society.

GPC has been heavily involved in the design of this pilot and sees this as another step in the right direction towards reducing workload pressures and improving recruitment. This scheme is of course by no means the answer, but is part of a series of initiatives that they hope will ensure struggling practices get the sustained resources they need to safely manage their workload. The pilot will be comprehensively evaluated by an independent academic institution and NHS England plans to invest at least £350,000 in this evaluation process. Further information about the pilot is available via the BMA website.

The deadline for applications is Thursday 17th September and a decision will be taken on successful bids around mid-October.

The pilot will be funded for three years with an expectation that practices will continue with the role into year four and beyond. NHS England will provide practices with match funding of 60% in the first year, 40% in the second year and 20% in the third year. It is anticipated that in the region of 250 clinical pharmacists will be involved over this period. The focus will be on areas of greatest need where GPs are under significant pressure, and the pilot should build on the success of those GP practices already employing pharmacists in patient-facing roles. Practices working collaboratively, multi-site practices or GP networks / federations that are interested in offering patients different approaches to accessing care will be able to bid for funding from today. The pilot proposal has two grades of clinical pharmacist working together:

• experienced clinical pharmacists who will be prescribers or working towards to prescribing qualifications and who will begin to see patients immediately, whilst developing additional skills such as leadership and change management;

• less experienced clinical pharmacists will be employed as part of the same development programme, working with and mentored by the experienced pharmacists, developing their clinical skills in the context of general practice with the intention of taking on prescribing responsibilities in the course of the programme.

Innovation Funding
The Health Foundation is looking for projects to improve health care delivery and/or the way people manage their own health care. Each team will receive up to £75,000 of funding, over 15 months, to support the implementation and evaluation of their health care innovation project. The deadline for applications is 12 noon, 4 August 2015. Further information available here.

GMC Consultations on Generic Professional Capabilities, Credentialing and Publication & Disclosure
The GMC are currently running three consultations covering:

• Generic professional capabilities (joint consultation with the Academy of Medical Royal Colleges) - a new approach to making sure that all postgraduate courses for doctors cover common areas such as leadership and communication. This consultation is open until 22 September 2015. Further information and details on how to respond here.

• Credentialing - a new system to recognise competence and expertise in areas of medicine not covered by current specialties. This consultation is open until 4 October 2015. Further information and details on how to respond here.

• Publication and disclosure - changes to the information they publish about a doctor's fitness to practise. This consultation is open until 23 September 2015. Further information and details on how to respond here.

Bulletin 272
30.06.15

Certification and/or GP Appointments for School Absence
We have been made aware of schools Tees seeking sick notes or authenticity of absence due to illness. We are currently writing to all Local Authorities on this issue and the CCGs are supportive of our position as this places unnecessary demand for GP appointments. This CLMC policy letter has been updated and may prove useful for practices to provide to patients in response to these requests.

Meningococcal B (Men B) for infants
This enhanced service specification to deliver Meningococcal B vaccination has been agreed. The programme is for three doses of vaccine at 2, 4 and 12 to 13 months. This programme will commence on 1 September 2015 and will run to 31 March 2016. There will be a payment of £7.64 per dose plus £2.12 (to recognise additional workload) with a total fee of £9.76 per dose.

Government’s New Deal, GPC Focus On
This GPC Focus on .. guidance note provides an overview and brief analysis of the Rt. Hon. Jeremy Hunt’s ‘New Deal for General Practice’, set out in a speech delivered on 19 June 2015.

GP IT Lot3
GPs can begin ordering from Lot 3 straight away with details about services offered available in an online catalogue - this catalogue, to which GPs are entitled, includes Docman and BMJ Informatica Frontdesk. Services will be funded by local organisations via a call-off agreement and they will be able to negotiate some of the contract terms relating to delivery of the services, such as service management and implementation provisions.

Bulletin 271
22.06.15

Removal of Patients from GP Lists (Violent Patients)
This updated guidance covers the situation where a violent patient needs to be removed from the practice list. In particular it emphasises the responsibility of the practice to ensure a violent patient is removed in accordance with the provisions introduced in 1994 allowing the immediate removal of any patient who has committed an act of violence or caused a doctor to fear for his or her safety, so as to reduce their liability for any further acts of violence committed by the individual on other NHS premises.

Rent Reimbursements and Owner Occupied Premises, GPC Focus On
This guidance gives an explanation of the different types of ‘rent’ reimbursements for GP premises: notional rent (for GP owner-occupiers), borrow costs reimbursement (for GP mortgage holders) and leasehold rent reimbursement (for GPs in rented premises) plus other FAQs about premises costs.

CCG/Practice Agreement for the Provision of GPSoC and GP IT Services
NHS England has published the CCG-practice agreement, which sets out the responsibilities of CCGs in providing GP Systems of Choice (GPSoC) and GP IT services to practices, and each practice’s responsibilities in receipt of these services. Further details and supporting documents are available on the NHS England website. The agreement replaces the previous PCT-practice agreement. Each practice and CCG will need to sign the agreement by 30 September 2015 to ensure the practice’s right to a choice of system is protected, and that the CCG and practice meet their obligations. Where signature is not possible, and a resolution is not reached through CCG escalation to their area team, practices will risk the withdrawal of central funding provisions.

Examinations and Sickness Certificates
It should be noted that GPs are not required to provide sick notes for schoolchildren. When children are absent from school owing to illness, schools may request a letter from a parent or guardian, and this is no different during an exam period. However, children who have missed exams due to illness are frequently told by schools that a note from a doctor is required; but there is no requirement for this to be provided by a GP. Aside from the fact that parents/guardians are responsible for excusing their children from school, GPs cannot provide retrospective sickness certification. When a child suffers from a long-term condition, any certification will be provided by the responsible specialist. The GPC has sought and received confirmation from the Office of the Qualifications and Examinations Regulator that Awarding Organisations make no requirement for pupils to obtain a medical certificate in support of their application for special consideration. Students are asked for information in support of their application, but this may take the form of a statement by the school. The Joint Council for Qualifications has confirmed that as far as they are concerned, if a student was absent from an examination as a result of illness and has the support of the school or centre to be absent, special consideration will be granted on that basis. Awarding organisations do not insist that medical proof is provided.

Carr Hill Formula Review
NHS England has started its work to review the Carr Hill Formula. This will probably be a challenging piece of work which is unlikely to conclude before next year. Any recommended changes from the review would then need to be negotiated with the BMA before being made. The GPC have formally raised their concerns that the review will distract from the real funding problem facing all practices, which is inadequate overall investment in primary care. They have also pointed out the risk of destabilising practices if changes are made to the formula without sufficient additional investment. Nevertheless, the review may be able to use up- to-date information to identify areas in which the current formula is failing some practices. The GPC have urged NHS England to include in the review’s remit the particular needs of practices with atypical patient populations and consideration of an off formula component to cover basic practice running costs.

Update on Supply of BCG Vaccine
Public Health England (PHE) has been notified of a further delay to deliveries from the manufacturer (the Statem Serum Institute) of the BCG vaccine and expect ordering for BCG vaccine to reopen on ImmForm in mid-June. Practices should continue to prioritise remaining local stocks as outlined in Vaccine Update issue 227.

Focus on PMS Review, Transition from PMS to GMS
This week the GPC published a new Focus on PMS reviews and transition from PMS to GMS. As PMS reviews are ongoing in many areas the GPC expect to update this guidance as necessary in response to problems and solutions that arise over the coming year.

Jeremy Hunt, ‘New Deal for GPs’ Speech
Practices may find this DoH transcript of the Secretary of State’s speech in which he announced his ‘new deal for GPs’ useful. Jeremy Hunt set out plans to boost the general practice workforce by 5,000 more GPs and increase investment in surgeries and services. In return he is asking GPs to work towards offering appointments seven days a week. The BMA’s response is as follows:

“The Secretary of State is right to highlight the great strengths of general practice and the need to increase investment to support this vital service that is so valued by patients.

"GPs want and need more time to care for their patients, but at the moment, nine out of 10 GPs feel that excessive workload is damaging the quality of care they can provide patients, and this is having a major demoralising effect on the profession – one that’s pushing more and more doctors toward the exit. At the same time, this pressure cooker environment is putting younger doctors off a career in general practice. The Health Secretary himself recognises the impact of the ‘hamster wheel’ that is the reality of general practice.

“The priority must be to first address this overwhelming workload pressure GPs face, in order to re-establish general practice as a career that is rewarding and appealing - only this will improve GP recruitment and retention. It is vital that government moves beyond rhetoric and brings forward tangible resources and practical solutions to stabilise general practice, and give GP s the time and tools to care holistically for patients. We need urgent action now, not just aspiration for the future.”

"It is positive that the government has listened to our calls to resource and support struggling practices – but this needs to be adequate and available now to for the escalating numbers of practice who are vulnerable."

Commenting on the health secretary’s pledge on seven-day services, Dr Nagpaul added:

“At a time when even the government recognises that general practice is under resourced and practices struggling with GP vacancies, with some even closing, it is not logistically possible for GP surgeries to be open nationally seven days, without stretching GPs so thinly so as to damage quality. Further, it is crucial that taxpayers money is not diverted from frail elderly patients in greatest need given that pilots of seven-day routine working are increasingly demonstrating a low uptake of routine weekend appointments. The government should focus on supporting practices to provide accessible services during the day and further develop the current 24/7 urgent GP service, so that patients can be confident of getting access to a quality GP service day and night.”

New and Amended Meningococcal Vaccination Programmes for 2015-16
Meningococcal B (Men B) for infants - an enhanced service to deliver Meningococcal B vaccination has been agreed. The programme is for three doses of vaccine at 2, 4 and 12 to 13 months. This programme will commence on 1 September 2015 and will run to 31 March 2016. There will be a payment of £7.64 per dose plus £2.12 (to recognise additional workload) with a total fee of £9.76 per dose.

Meningococcal ACWY (MenACWY) - due to a rapid increase in meningococcal group W (MenW) disease in England, JCVI recommended an emergency programme to vaccinate all 14-18 years-olds (school years 10-13) with a quadrivalent MenACWY conjugate vaccine.  This new programme will commence on 1 August 2015, and is a single-dose programme for all patients aged 18 years on 31 August 2015.   There will be a payment of £7.64 per dose plus £2.12 (to recognise additional workload) with a total fee of £9.76 per dose.

Mengingitis C vaccination for University freshers - the Men C University freshers programme, which was due to start on 1 April 2015, has been on hold until the MenACWY vaccine becomes available. The MenACWY vaccination programme will now commence on 1 August 2015, which is when the MenC vaccination programme for freshers will also commence.

The Men C booster will be offered to freshers (first time university or further education students who have received notification via UCAS to obtain MenC vaccination – aged 19-25) not previously vaccinated with MenC since reaching age 10 who self-present at their practice for vaccination. There is a flat fee of £7.64 for one dose.

Further information about all these programmes is available in this table and on the BMA website. The service specifications are available here.

GP Trainees Subcommittee Elections 2015 - 17
The GP Trainees subcommittee are holding elections for the North East region constituency. If you would like to get involved in the work of the subcommittee, and really make a difference to the lives of your fellow GP trainees, please consider standing for election. Candidates do not have to be BMA members. Anyone can stand who is either:
a) on a GP training programme that will not finish before 23 September 2015; or
b) starting a training programme between 26 June 2015 and 1 July 2016.

Successful candidates will be elected to serve for two full sessions; 2015/16 and 2016/17 unless the representative is set to qualify as a GP during the first session, in which case they will only serve for one session. Full details of the election and nomination forms can be found here. Nominations close at 5pm, Friday 17 July 2015. If you have any queries, please don’t hesitate to contact Holly Higgs in the GPC office.

Bulletin 270
16.06.15

Female Genital Mutilation (FGM) Guidance
Health Education England has just produced an e-learning tool which had RCGP input and includes an introduction to FGM; communication skills for FGM consultations; legal and safeguarding issues regarding FGM in the UK; issues, presentation and management in children and young women; and issues, presentation and management in women and around pregnancy. Some of the material from this has been packaged into a DVD for GPs and has just been sent out to all GP practices in England in a ‘Female Genital Mutilation Resource Pack’ which includes:

• Raising Awareness of Female Genital Mutilation – a training DVD developed by Health Education England

• Female Genital Mutilation Risk and Safeguarding – Guidance for professionals

• 2 copies of the Patient Information Leaflet in English, available to order from DH Orderline in other languages and English.  All language versions are available to download from NHS Choices.

• 2 copies of ‘A Statement Opposing Female Genital Mutilation’ also known as the FGM Health passport, available to order from Home Office or to download from NHS Choices 

• FGM Enhanced Dataset: Implementation Summary for GP Practices – for further information please visit the HSCIC website.  Please note, all GP practices will be required to submit information under the Enhanced Dataset when treating patients who have FGM from October 2015.

Any questions about the resource pack should be directed to FGM@dh.gsi.gov.uk.

The BMA’s Medical Ethics department are currently in the process of updating the BMA’s FGM Guidance of 2011 but are awaiting the secondary legislation on mandatory reporting and the FGM statutory guidance consultation.

Please visit the diary dates page to find details on a FREE workshop to be held in Middlesbrough 30 June which practices may find helpful.

Paramedic2, Funded Trial in the North East
We have been advised the University of Warwick are working in partnership with NEAS (and other Ambulance Service Trusts across the UK) on the Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug administration In Cardiac arrest. This is a Department of Health National Institute of Health Research funded trial and has been approved by the South Central Oxford C Research Ethics Committee (14/SC/0157). Organisers have asked practices to display this poster and leaflet in waiting rooms or on notice boards so members of the public can be made aware that this trial is taking place. If possible they would also like practices to consider putting information through their TV screen (these slides could be used). The first slide is animated, so feel free to remove the animations if preferable and the second slide is purely an image of the poster. Please use whichever you feel would be best. Hard copies have also been sent directly to practices and pharmacies in the area.

Sessional GP Newsletter
The June edition of the sessional GP enewsletter focuses on the recent LMC Conference. It also features news and information aimed at supporting sessional GPs as well as blogs from sessional GPs, including one from Dr Mark Selman on his experience working in OOH supervising GP Trainees.

Bulletin 269
09.06.15

Annual Complaints Data Deadline, Wednesday 8 July
NHS England has written to GP practices asking them to submit data on written complaints received by the practice between 1 April 2014 and 31 March 2015. This is an NHS-wide data collection and asks practices to submit numbers of written complaints made by patients (or others acting on their behalf) about GP services. The figures to be submitted are total numbers of complaints by service area and subject of complaint, and the number of these that were upheld. No personal confidential data is included in this collection. The questions are unchanged from previous years’ collections, but will now be collected through the Primary Care Web Tool. NHS England has stated this is a statutory requirement under The Local Authority Social Services and NHS Complaints (England) Regulations 2009, and practices are therefore advised to complete the return. The deadline for submission is Wednesday 8 July 2015. This letter was sent to practices, together with this guidance on completion.

Reminder, Dridex Malware Attack Remedial Action
ONLY PRACTICES WHOM ARE ALREADY IN RECEIPT OF CORRESPONDENCE FROM THE HSCIC ON THIS SUBJECT NEED TO TAKE ACTION. The Health and Social Care Information Centre (HSCIC) wrote to a number of GP practices in March and April that had been identified as being infected with malicious software known as ‘Dridex’, which inflects systems via macro-enabled documents and .xml attachments sent by email. The letter from HSCIC contained advice on the actions that need to be taken by practices against this malicious software, and requested that practices confirm with the HSCIC that the necessary actions had been taken. Of 1200 GP practices affected, only around 500 so far have provided such confirmation to the HSCIC. Please ensure you have taken the important actions required – we are advised they are relatively straightforward and do not require the installation of software. Where practices require further advice, they can contact the HSCIC via enquiries@hscic.gov.uk quoting ‘cyber incident’ in the subject line or by calling 0300 303 5678, selecting option 2.

Overseas Visitors, Updated GPC Guidance
The Department of Health has recently issued guidance on implementing the overseas visitor hospital charging regulations 2015. This BMA guidance on this and the impact on primary care has been updated accordingly.

Bulletin 268
02.06.15

Workforce Data Submission Deadline Extension to Sunday 7 June 2015
It has been agreed nationally to extend the deadline to submit the required workforce information to Sunday 7th June 2015 to assist practices in completing this exercise and avoid a potential contractual breach. All GP practices are required to submit their Workforce Census electronically through the primary care website: www.primarycare.nhs.uk. If there are difficulties in achieving this requirement please contact Jenny Long, jenniferlong@nhs.net. The GPC have provided this guidance to assist with FAQs. If you experience any technical difficulties related to not being able to view the content of the WMDS, questions about its content or technical issues related to submitting the workforce census then please contact HSCIC enquiries service at enquiries@hscic.gov.uk or call 0300 303 5678. Further guidance and support have also been provided on the HSCIC website. If you have already been in contact with your NHS England Region about this or have since submitted your workforce information then please ignore this message.

Named GP, GPC Guidance
GPC have published updated guidance on the requirements under the contract for named GP.

Digital Signatures as Consent
Many practices will have received a letter from Legal & General advising they will only provide digital signatures as proof of patient consent. There is good legal basis and precedence to accept digital signatures only. However, GPC have been in discussion with the insurance industry about this proposed change. GPC are satisfied in principle but have requested the insurance companies make some further changes to their proposed process before the GPC agree to them. Therefore, GPC advise practices to decline digital signatures at present citing that there is not agreement with GPC yet. After there is agreement it will be up to practices whether to accept these or not. GPC will circulate details once the process is fully agreed. On the same note, GPC have still not agreed with ICO whether it is lawful for insurance companies to use SAR instead of a PMAR. There is a recommended proforma letter on the BMA website that practices can send to their patients when one is requested

Complaints Procedure Data Return
The 2014/15 K041b complaints data return for general practice will be collected by the NHS England Primary Care Website. It is a statutory and contractual requirement to declare complaints information. The collection period is now open and available to complete a submission between: 27th May 2015 through to 8th July 2015. Your practice will have received a letter from NHS England with further details about the collection. Practice staff who have the permission to submit the annual practice declaration to NHS England will inherit the permissions and ability to be able to submit the K041b. Guidance is also available on the HSCIC website.

Changes for Temazepam & EPS
Please note this memo regarding legislation changes to Temazepam and EPS previously circulated to all practices.

Ebola, DoH Reminder for GPs
The Department of Health have requested we circulate this one page document to all GPs together with the reminder that while the risk of Ebola in the UK remains low, the DoH want to ensure that GPs remain vigilant and prepared in case someone with possible Ebola symptoms presents at their practice. 

2015 LMC Conference
This latest edition of GPC news shows the conference resolutions, election results, motions not reach and motions lost.

Bulletin 267
26.05.15

CQC Registration for GP Federations, CQC Guidance
CQC has published this guidance for GP federations on registration requirements in response to the increasing groups of registered GP practices and primary care teams who are collaborating. These groups, sometimes known as ‘federations’ can be either a formal or informal association of practices that work together to provide a greater range of services or to share knowledge. This guidance will help groups of registered providers who wish to form a federation to understand their duties and responsibilities around CQC registration. The CQC have summarised the issues that federations should consider and provided case studies to illustrate different registration scenarios.

Childhood Immunisations, Drop in Payments
Some practices may have experienced a drop in childhood immunisation payments against targets. This is due to a change to the SFE stems from the changes made to the Men C schedule in 2013-14, in that it now only requires 1 dose rather than 2, which only came in to effect from 1 April 2015. This change is also briefly mentioned in the 2015/16 GMS guidance document (page 36, footnote 61), and is also highlighted in the document Implementing the 2015/16 GP contract - Changes to Personal Medical Services and Alternative Provider Medical Services contracts (page 8).

DES Business Rules 15/16
The first of the Enhanced Service Business Rules for 2015/16 have now been published and includes Dementia, Learning Disabilities, Rotavirus and Pneumococcal with others to follow as and when completed and timeframes agreed. 

LMC Annual Conference Agenda 2015
The Agenda for the LMC Annual Conference has now been published.

Sessional GP Newsletter
The May edition of the sessional GP newsletter features Top Tips on Working in OOH, and some interesting blogs – 'I wanted so much to respect his last wishes' and ‘How sport keeps me sane’. The Chair’s message focuses on the LMC Conference.

Bulletin 265
12.05.15

GMS Ready Reckoner
You may be interested to know that NHS Employers has published a GMS ready reckoner for 2015/16.  It is the spreadsheet labelled GMS ready reckoner.

EMIS Named GP Read Code
The EMIS National User Group has now confirmed that the ‘patient allocated named accountable general practitioner’ (9NN60) code was included in this month’s drug and Read code update MKB102.

Bulletin 264
28.04.15

Sexual Health Service Review Survey
The current contract expires on the 31 March 2016 and a full sexual health review and procurement is being undertaken with a view to re-procuring an integrated sexual health service for Teesside to be in place for 1 April 2016. To help inform commissioning plans views of those General Practices that provide services either under their core contract or as part of a subcontract arrangement with Virgincare are being sought to help shape the redesign of sexual health services across Tees. Further information is available here.  Anyone in the practice can complete the survey online and it can be completed by more than one person. Alternatively, you can download a paper copy of the survey and return to the freepost address on the bottom of the survey. 

EHIC Incentive Scheme & Charging for Primary Care, GPC Update and FAQs
This document updates the position with regard to charging for primary care and also provides FAQs on the EHIC scheme for secondary care that was introduced in October 2014.

Bulletin 263
21.04.15

Change in Average List Size for 14/15 QOF Calculations
Following some queries on the change in the average list size figure used in the CPI for QOF purposes, the Health and Social Care Information Centre (HSCIC) has provided the following explanation:
"There have been a number of questions raised concerning the recent change to the average list size figure used in Contractor Population Index (CPI) that is used as part of the year end QOF achievement.

NHS England would like to assure users that the figure of 7,087 is the correct figure for use and is the average list size figure as at 1 January 2014 as required under the Statement of Financial Entitlements.

There has been no change in the calculation of CPI other than to ensure an incorrect figure is replaced with the correct figure in time for calculation of 2014/15 QOF Achievement.

It was identified that the previous figure (7,052) was incorrect and communicated in error having been calculated based on the data available at the time rather than using the information calculated and reported directly from Exeter Registration System (which is the correct and routine procedure for confirming average list size for use in CPI). The error was spotted and amended immediately and before the calculation was used, this ensured that all practices will be paid the correct amount due and we would not be in a situation where funds had to be reclaimed.

NHS England apologises for the misunderstanding and confusion caused by calculating and publishing the incorrect figure."

Legislative Changes to Electronic Prescribing of Schedules 2 & 3 Controlled Drugs
As a result of the public consultation and advice from the Advisory Committee on Misuse of Drugs (ACMD), legislative amendments have been made to enable the electronic prescribing of Schedules 2 and 3 controlled drugs for NHS and private prescribers. Prescriptions will be signed with an advanced electronic signature and sent via the electronic prescription service (EPS), with its additional security features. The amendments require the total quantity of Schedules 2 and 3 CDs dispensed to be recorded in words and figures within the electronic prescription, as is the case for paper prescriptions for these drugs. This public consultation response document and letter containing advice from the ACMD have both been published on GOV.UK. Three statutory instruments underpin this change:

NHS - comes into effect from 1 July 2015 and enables:

• those providing GMS and PMS to issue electronic prescriptions (including instalment prescriptions) for Schedules 2 and 3 CDs via EPS

• those providing GMS and PMS to issue electronic prescriptions via the EPS for prescriptions written as part of a private arrangement but within an NHS consultation, when the medicine required cannot be prescribed at NHS expense. Where the electronic prescription contains Schedules 2 or 3 CDs, the EPS is the only electronic system which can be used.

• providers of pharmaceutical services and local pharmaceutical services to dispense electronic prescriptions for drugs listed in Schedule 2 or 3 of the Misuse of Drugs 2001Regulations (MDR) when they are sent via the EPS.

Human Medicines - comes into effect from 1 July 2015 and:

• enables prescriptions for Schedules 2 and 3 CDs to be signed with an Advanced Electronic Signature (AES) - this will be limited to the EPS

•  corrects a transposition error which arose during the consolidation of the Medicines Act into the Human Medicines Regulations 2012 (HMR) – see below for background.

Home Office - comes into effect from 1 June 2015 and contains provisions which enable:

• electronic prescription forms to be sent via the EPS for Schedules 2 and 3 CDs.

Prescription Pad Security Policy
The LMC has been made aware of a performance issue with regard to Rx pads. Practices are reminded that they require a robust policy for the security management of their Rx pads.

Gender Dysphoria
The GPC was invited to comment on a draft version of the NHS England guidance 'Primary Care responsibilities in relation to the prescribing and monitoring of hormone therapy for patients undergoing or having undergone gender dysphoria treatments'. Although some changes were agreed, NHS England refused to specify that these services should be commissioned outside the GMS contract through shared care arrangements. The key phrase in the document is this:

"Once a patient has completed the care pathway and has been discharged by the GIC [Gender Identity Clinic], GPs should offer them the usual range of primary healthcare services that are available to other patients."

This is absolutely correct as these are defined in the GMS contract (Part 8.1.2, Essential Services). However, GPC believes that as treatment for gender dysphoria requires specialist input, therefore, should sit outside GMS and needs separate commissioning and funding to ensure patients with gender dysphoria receive the specialist service they require.

GP Networks, amended GPC guidance
The GPC has recently added to its guidance on forming GP networks. The BMA has also launched a database of GP networks and is inviting GP networks to register for inclusion. If any newly emerging GP networks are interested in joining, please contact Janice.foster@nhs.net with a few contact details (name, area, email address, number of practices) and we will arrange your inclusion in the database.

Sessional GP Newsletter
The April edition of the sessional GP newsletter includes major features on the new national GP Induction and Refreshers Scheme and the sessional GP specific findings from the recent GP survey. It also features news and information aimed at supporting sessional GPs as well as blogs from sessional GPs.

Bulletin 262
14.04.15

Care Certificate, GPC Guidance
Following the introduction of the Care Certificate in April 2015 please refer to this Focus On document which outlines the key details and the GPC position.

Premises Infrastructure Fund
This briefing outlines the regional recommendations arising from the assessment of bids received for funding in 2015/16 under the General Practice Infrastructure Fund. Nationally, 1000 practices will benefit from the first tranche of £1bn to improve premises. Further tranches will be rolled out over the next 3 years and practices who would like to bid but were not in a position to do so for the first tranche due to the extremely short notice should consider preparing a business case in advance.

QOF Business Rules v31.0
The QOF Business Rules v31.0  have been published.

QOF Data Extraction by CQRS, NHS E Delivery Plan
NHS England and the HSCIC have put together this delivery plan (with link to attached document titled QOF Data Extraction by CQRS 2015) for the 2014/15 year end QOF data collections. It has also been confirmed that a threshold of between 84- 85% of practice data returns is acceptable to trigger achievement and aspiration payments. The process and return level mirrors previous years.

MenC/MenW Vaccination Programme
Public Health England asks GPs not to start MenC Freshers programme because of the current MenW outbreak. Following a rapid increase in meningococcal group W (MenW) disease in England, the JCVI  recommended an emergency programme to vaccinate all 14-18 years-olds (school years 10-13) with a quadrivalent MenACWY conjugate vaccine to provide direct and herd protection to the whole population. PHE is urgently trying to procure sufficient MenACWY vaccine to vaccinate those currently in Year 13 the summer. Therefore, PHE is asking GPs to delay the current MenC Freshers programme  due to start in April until the MenACWY vaccine becomes available. This will avoid the need to revaccinate this group to provide additional protection against MenW.

Following a JCVI recommendation to vaccinate against MenW, NHS England has made provisions in the MenC freshers programme to accommodate a change of vaccine from MenC to MenACWY mid-year. To ensure the freshers receive the most effective vaccine and avoid the need to recall them at a later date, PHE and NHS England are requesting a delayed start to the delivery of the MenC freshers programme until the new MenACWY vaccine is available. This decision is based purely on clinical grounds to ensure that patients receive the most appropriate vaccine. This delay will not change the agreed terms of the freshers programme or have any impact on the payment practices receive once the programme commences.

• the legal profession’s expectations of doctors as expert witnesses
• good and bad practice in report-writing
• setting fees and charging appropriately

Flu Vaccination, Practice Staff Data Collection
Reminder – January collection of practice staff flu vaccination uptake is now open and will close Tuesday 10 February. This collection is mandatory and data should be submitted manually via Immform. Please note that an extra survey month has been added in March for data up to 28/02/2015 - the March survey will be open from 2 – 10 March.

Audit of Potentially Avoidable Appointments and Reducing Bureaucracy
Notwithstanding that GPs are already overloaded with paperwork, we encourage as many GPs as possible to take a little time to engage in the Primary Care Foundation work (commissioned by NHS England) looking at ways in which practice workload might be reduced.  The Primary Care Foundation has developed an audit tool to collect information on shaping demand to reduce avoidable appointments.  Practice managers are also invited to respond to the survey on reducing bureaucracy.
The GPC is supportive of this initiative and are confident it will help to demonstrate the excessive pressures facing general practice. The results will also be an important lever to achieve system and commissioning changes to reduce inappropriate demand and workload.  If three or more members of a practice complete this audit, the Primary Care Foundation will prepare a report for the practice, comparing results. You can find out more about both the audit tool and survey here.