LMC Bulletins 2009

Bulletin 40


Pandemic Flu - vaccinating under 5's, updated Q&A and vaccinating pregnant women

You will have received an email from the LMC last week with regards to the arrangement across Tees re the H1N! vaccination of under 5s. The LMC Executive agreed to support the PCTs offer of direct financial of £5.25 per immunisation for the under 5s. In supporting this direct financial payment and in recognising the concerns about the impact of this campaign all parties are fully committed to local discussions about the actual impact on workload and delivery of practice activity. We urge you to continue and complete the immunisation of the at risk and under 5s groups and will be in touch about the work we are doing on impact and practice activity. You should have seen copies of these letters from the GPC and the DH with regard to local agreements being required.

A reminder that, currently, the antiviral collection point for Tees is at the Primecare Centre, Massey Road, Teesdale, Stockton on Tees and due to a decrease in demand it is now only open between 10am and 12 noon seven days a week.

The RCGP, Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) have issued this joint statement to nurses and midwives highlighting the importance of H1N1 vaccination for pregnant women and to allay fears that the vaccine is in any way ‘dangerous’ for this priority group or their babies. An updated version of the BMA Pandemic Flu Q&A is also available here.

Guidance on Correct Use of Choose & Book

A new document outlining responsibilities and operational requirements for the correct use of Choose and Book was published on 8th December 2009. The document is also on the BMA website here. You will note that in Section 6 : Page 14 it states that where providers offer named referrals on paper-based referrals they should do so on electronic-based referrals. This has been raised with the Tees PCTs and the LMC will be pursuing this where it is not available.

In January 2009, the BMA published ’Choose and Book - Learning Lessons from Local Experience’. The research found that implementation of Choose and Book goes far beyond installing systems and problems are often not due to the functionality of the system but due to broader issues such as national and local policies, processes in place and capacity issues. The BMA discussed these findings with the Department of Health and the outcome of the discussions is the ’Responsibilities and operational requirements for the correct use of Choose and Book’ document, which has been co-signed by the BMA. The document is intended to help organisations understand the importance of using Choose and Book correctly. Requirements include promoting rather than mandating the use of Choose and Book, allowing electronic referrals to named clinicians if paper based referrals to named clinicians are accepted and encouraging clinicians to initiate and review referrals themselves online. It is hoped that this document will ensure that all Trusts and PCTs deliver an appropriate level of support.

Requirements for Death Certificate

Some Registrars of Death have been requesting unnecessary information from GP practices because of a misunderstanding about the implications of the new GMC license to practice - for example, practices were asked to supply the names of GPs who were licensed to sign death certificates, together with their GMC registration, their GMC licensing number and details of their qualifications allowing them to sign the forms. GPC can confirm that there will be no GMC license number and there will be no further qualifications required of a GP to sign a death certificate. With the introduction of the license to practise in November 2009, Registrars just need to check that the doctor signing a death certificate is licensed with the GMC at the time of signing the form. There should not be a need to supply information to the Registrar prior to completing the form (particularly as the information could be out of date if supplied in advance). However, it would be helpful to Registrars if GPs could include their GMC number on death certificates so that it is easier for the Registrars to do the necessary checks.

Vetting and Barring Guidance

This guidance explains the steps that GPs need to take individually and as employers to ensure that they comply with the Safeguarding Vulnerable Groups Act 2006. This guidance is also available on the BMA website here.

Bulletin 39


Pandemic Flu - Sharing batches of H1N1 vaccines between practices and various updated guidance

MHRA have agreed have agreed that in order to immunise patients in the priority groups, vials of swine flu vaccine can be transferred between GP practices. Such transfers between GPs are not normally accepted practice. However, during the early phase of the swine flu vaccination programme, should it prove necessary for inter-practice transfers to take place, the health professionals involved should ensure, when dispatching and receiving vaccines, the maintenance of the cold chain, traceability, and provision of current patient information leaflets and summaries of product characteristics - latest versions available from here.

Quality Control North West has produced 'Safe Handling Standard Operating Procedure for the Repackaging of Bulk Packs of H1N1 Influenza Vaccines under the Supervision of a Pharmacist' on behalf of the NHS Pharmaceutical Quality Assurance. The Chief Pharmaceutical Officer has also published a this letter which includes information about repackaging boxes of H1N1 vaccine for onward distribution .

We will forward information on the vaccination of children under 5 as soon as we have it. In the mean time there have been a number of updated/new documents all of which can be accessed by following the links below:

Second edition of ‘Preparing for pandemic influenza - guidance for GP practices’
- this will be available shortly and reflects the current situation rather than the severe and aggressive pandemic originally prepared for.

DH Delivery and distribution of H1N1 vaccines FAQ

Updated BMJ H1N1 patient information leaflet

DH Flowchart for triage: swine flu patients
- for GP practice managers and receptionists.

DH Swine flu and rough sleepers
- for organisations working with rough sleepers in England.

Med1web/Novachannel, developments on being removed from their directory

We have written many times with warnings about Med1web otherwise known as NovaChannel but this time we hopefully bring a ray of hope for those registered with them! The organisation has now ceased trading from Switzerland but GPC believe payment for the Med1web forms is now being pursued by United Lda (a Portugese company). However we are aware of one doctor who has recently received a letter from United Lda notifying him that they had reviewed his file and that, because he is not an independent doctor, they have deleted his particulars from the directory and that the contract is null and void. We therefore advise all NHS GPs who unwittingly signed up to the Med1web form to contact United Lda asking for their details to the removed from its directory and for any contract to be terminated. United Lda's address is: PO Box 1571, 1056-001 Lisbon, Portugal or email: info@med1web.com.

Bulletin 38


Pandemic Flu

Do not start to vaccinate under 5's not at risk until negotiations are concluded.

Last week, the DH announced that private primary care providers are now able to obtain the H1N1 flu vaccine from PCTs in order to vaccinate private patients in the priority groups, as well as frontline healthcare staff providing direct patient care.Further information is available in the statement from the BMA’s private practice committee here.

The DH has also published this guidance on mental health services to support mental health trusts and other specialist mental health service providers implenting their plans for responding to the pandemic.

This is a national summary providing an overview of ten regional exercises which documents the high-level areas for further action. The exercise confirmed the extent and depth of planning that have already taken place in the NHS in preparing for an influenza pandemic.

Child Protection , requests for information

This is a joint GPC/RCGP letter to the profession on the issue of child protection. Please note that this will also be available on the BMA website. The RCGP may also distribute it to its members and the English DH is writing to PCTs with a copy.

Training Courses on GP Employment Law 2010

Please note that the programme of one day training courses for GP Partners and practice managers has been confirmed for 2010, including 'Managing Change', 'Managing Performance' and 'Managing Staff'. Full details of the courses including registration fees are included on the webpage here.

Bulletin 37


Pandemic Flu - 2nd Phase Vaccinations inc. letter from Ian Dalton

Last week it was announced that healthy children aged from 6 months up to 5 years (around 2.7 million) are to be included in the second phase of H1N1 vaccinations. This is due to an increase in GP consultation rates amongst school-aged children after half term, and a substantial increase in the number of under 5s in hospital, including in critical care. The CMO also announced that carers (1.5 to 5 million) are to be added to the group of front line health and social care workers to be prioritised for vaccination in the second phase.

Details of this announcement can be viewed in this letter from Ian Dalton.

The NHSE has indicated that it wishes to discuss the vaccination arrangements for the under 5s with the GPC. However, formal negotiations have not begun and there are not yet any arrangements in place for how the work will be organised or recognised. There have been suggestions that phase one is expected to be concluded by mid December, but the GPC has stressed to the DH that it is more likely that the first phase will conclude in mid January, after which time the second phase can commence. Until the first phase is finished, vaccination of the healthy under 5s should not begin.

Child Protection , requests for information

The LMC is concerned to learn that practices are not responding to all requests for information in relation to child protection in a timely and appropriate fashion. Please view and act on the details in this document from the Secretary. This is extremely important and must be rectified.

NHS Choices Practice Feedback

Since patients have been able to post comments and rate practices there have been 3060 live comments posted but only a small number of practices have taken time to respond to comments made on their services/practice (131 practice replies). Those practices with comments are advised to read and consider responding; NHS Choices automatically notifies practices when comments have been posted.

It is important to remember that the website is a public one and any comments which are, for example, factually incorrect will leave a false impression if there is no response from the practice concerned. We also advise that practices regularly check their profiles regarding the accuracy of information about opening hours, staff details and services available to patients. Practices that do not currently edit their own data on NHS Choices can do so by obtaining a login/password from the dedicated GP help desk on 0845 402 3089.

Locum GP Pension Contributions

In order for locum GPs' pension contributions to count towards the NHS pension, they should be paid within 10 weeks of the corresponding work being completed. Some practices may not have been paying locum GPs within this 10 week period for work carried out in their practice, leading to locum GPs missing the contribution deadline. Although some PCOs are more strict on this than others, a PCO certainly can decide not to pension contributions sent outside of the 10 week limit. Although it is our view that locum GPs would not be forced to opt out of the NHS pension scheme as a whole in this circumstance, they would lose out on pension benefits for that specific piece of work. It is therefore important that practices pay locum GPs within this timeframe, and preferably much earlier than this.

Interim Seniority Figures

Interim seniority factors for 2009/10 for England and Wales have been published today and figures and details of the methodology may be viewed on the NHS Information Centre website at www.ic.nhs.uk/tsc. The figures are: £94,743 for England and £84,667 for Wales.

Bulletin 36


Pandemic Flu - Pregnancy Leaflet

This week the DH has published a leaflet ‘Swine flu and Pregnancy: How to protect yourself and your baby’ (click here to view), which gives information about the swine flu vaccination, precautions to reduce risk of infection and available treatments.

Bulletin 35


Pandemic Flu - national guidance inc. Vaccinating locums, updated Green Book

BMA guidance
The latest news and guidance is available in the newly spruced up GP flu pages on the BMA website here.

There have been some additional questions about the nature of the DES agreement as below:

Q: Will the income from the vaccinations deal harm the prospects of a GP pay rise for next year?
A: The health departments have recognised that the vaccinations are being delivered at cost and that no profit will be made. However, the current financial climate does make it unlikely that there will be a significant pay rise regardless of the vaccinations deal.

Q: Has a dangerous precedent been set by agreeing to a financial reward below that of other vaccinations?
A: This had been one of our biggest concerns and fundamental to our negotiating position, since this could potentially have devalued all vaccine payments in the future. Given that the Government were unwilling to negotiate payment at the seasonal flu rate, we negotiated the “basket” of concessions to equate to the value of an item of service and ensured that the payments will be made via a Directed Enhanced Service (DES). The swine flu vaccinations deal is NOT an item of service. We have a clear written assurance from the Government that this deal will not set a precedent.

H1N1 Vaccination for Locum GPs
This is a reminder for GP practices to include any registered locum GP patients in your list of patients to be vaccinated, if they request this. You may also wish to vaccinate locum GPs who are working in your practice. The practice will not receive a fee for vaccinating the locum GP (or any frontline staff), and no charge should be made to them for the service. There will only be a payment for patients/healthcare professionals that fall within the JCVI risk groups. The advice in the joint DES guidance is as follows:

3.1 Will there be any payment for the vaccination of practice staff and doctors?

No. Practices can freely use the vaccine for these groups but payment is only in relation to the JCVI at-risk groups. If a member of staff or a doctor falls within one of the at-risk groups, the expectation is, subject to patient preference, that they will be vaccinated by their registered practice.

Delivery of H1N1 vaccines
The CMO hopes that by the end of next week, most GPs will have received their first delivery of swine flu vaccination. Ian Dalton, National Director of Flu Resilience, has also written this letter to all PCOs to update on the vaccination programme and about the delivery and re-supply of the H1N1 vaccine.

Updated Good Medical Practice: Responsibilities of doctors in a national pandemic guidance
The GMC has updated their guidance to take into account the fact that a pandemic can break out regionally, so while some doctors may be working normally, others may be struggling to cope with the additional workload. The guidance allows those most affected to work flexibly.

Practical guide for preparing and administering H1N1 vaccine

The DH has published this practical guide on how best to administer the H1N1 vaccine, which answers questions about the vials and syringes, infection control and whether swine flu vaccine can be administered at the same time as other vaccines.

Vaccination of Pregnant women

Professor Salisbury has written this letter to GPs providing information to support the vaccination of pregnant women.

Green book updates:
Chapter 19 Influenza - Immunisation against Infectious disease (revised chapter)

Chapter 19 Influenza - Immunisation against Infectious disease (list of updates)

Chapter 23a Pandemic influenza A(H1N1)v 2009 (swine flu) (revised chapter)

DH patient leaflets
Patient leaflets for recipients of the new vaccine that could be included with any invitation letters sent out, posters that can be used to advertise local clinics and raise awareness and vaccination appointment/record cards – can be ordered through www.orderline.dh.gov.uk quoting:

DO NOT SIGN ANYTHING. Once again this scam is operating in our area. We are aware of a number of GPs who have personally received letters. Running under a number of guises (European Medical Directory or Novachannel are other names) they are trying to get their hands on your money. This time they are targeting individual GPs by sending out directly addressed letters.

2008/09 (main) Certificate of GP (& non-GP) Provider NHS Pensionable Income

The pensions department have circulated this attached email - there is a lot of information contained in the links.

This is the main 2008/09 Certificate and guidance notes. It is similar to the 07/08 Cert except that we now have to take account of tiered contributions and the new Additional Pension. Here you can view FAQs and further information on overlaps.

Please remember that a GP Provider must a complete a Certificate for each GMS, PMS, APMS contract that they are a party to even if the contracts are all with the same PCT/LHB. This means that you may have several Certs to complete. Non-GP Providers however can only be pensionable in one of their posts by virtue that they are afforded WT Officer Scheme status; not Practitioner.

At the end of year 2009/10 (and in future years) salaried GPs/long term fee based GPs will have to complete a Certificate in order to reconcile their tiered contributions...so watch this space.

The same broadly applies to GP Locums however they have tweaked forms A & B so that they do not need to complete yet another form in 2008/09. If a GP Provider is also a GP Locum any arrears (or overpayments) of their GP Locum employee contributions in 2008/09 must be reconciled with the relevant PCT/LHB via the forms A & B and not via the Cert.

The 2008/09 Ltd Company Certificate plus guidance notes and a FAQ are also available by following the respective links.

Bulletin 33


Pandemic Flu - DH Support materials practices and patients

For practices - DH swine flu information materials, including template consent forms and invitation letters have now been published on the DH website and can be viewed here. Note that FAQs on the vaccination deal will be published shortly as well as an update of the flu Q&A already available on the GP flu pages of the BMA website here.

For patients - The DH has published a swine flu patient leaflet available here. There is also advice for pregnant patients here.

Pandemic Flu - guidance for pregnant health care workers

DH H1N1 guidance for pregnant health workers is available here. It will be published on the DH and BMA website shortly.

BMA Employer Advisory Service (EAS)

Many of you are aware that the BMA launched this service in England in January. This service specialises in providing advice, guidance and support to members who have employer related queries.

This service is available to any member who is an employer of staff. It is supported by a dedicated team of advisors who only deal with employer related queries. This team operates independent of the service that supports employed staff.

The advisers work with you and your Practice Manager, as appropriate, on a day to day basis to guide you through the relevant internal processes and procedures that you are required to follow.

They are also looking to develop strong links with LMCs and Practice Manager groups and are to provide seminars on Employment Law. This is in addition to the national programme of training available to GPs (Managing Change, Managing Performance and a new programme called Managing Staff which is to begin next year)

In addition to being well versed in employment law and current good HR practice our advisers have specialist knowledge of the medical profession and our familiar with the issues facing general practice. They also have established links with SHAs, PCTs and LMCs.

Typical work that advisers deal with on a regular basis is guidance and support related to:

An Employment Handbook is also being developed by this team,due for issue in early 2010. This service is available as part of your BMA membership.

Bulletin 32


Pandemic Flu - North East SHA; vaccination of independent domiciliary and residential care sector staff.

There has been some discussion between the North East SHA and the LMCs with regards to vaccinating independent social care staff. It was agreed that this would be best carried out by GP practices. A letter from the SHA outlining the proposal
can be viewed here.

Pandemic Flu - vaccination programme update

We are awaiting details of the Swine flu DES agreed between the DH and BMA but in the meantime please find a summary of the current situation below:

Practices will be paid only for the vaccination of patients in at risk groups.
Payment will be made for every dose of vaccination given at a rate of £5.25 per dose.
All housebound patients will be vaccinated by the District Nursing service. (DNs) This means all patients identified by the practice as housebound. Details of any criteria that can be used in defining the housebound will be within the DES
Practices will be paid £5.25 per dose for all vaccinations given by DNs. There will be no charge to practices for the work undertaken by DNs. This is the responsibility of the PCT
Practices are advised to offer vaccination to all of their own front line staff. It is for practices to define who comes within this definition. Medical defence organisations have confirmed cover for vaccinating those staff members who are not patients of the practice
Proper records of staff vaccinations, and refusals, must be kept and the GP of the staff member must be informed. Information to be recorded and sent to the GP should include: Name, DOB, reason for vaccination, date of vaccination, manufacturer and batch number. If the staff member is in an at risk group then their GP will receive payment
Any locum GP requesting vaccination from a practice in which they are working should be offered vaccination at the earliest mutually convenient time. This should be within the vaccination programme of front line staff and so there is no payment to the practice, nor should the locum GP be asked for any payment
Vaccination is voluntary and any citizen has the right to make an informed decision to refuse this treatment
It is our current understanding that Hajj pilgrims will not be asked for a certificate of vaccination against swine flu (H1N1) to acquire a Visa as it is not yet 'universally available' due to only the at-risk groups being vaccinated
Further detail on the vaccination programme outlines above are contained in the latest edition of the GPC news which can be viewed here.

Pandemic Flu - sick certificates

The DH has published guidance on sick certification in a swine flu pandemic which can be viewed here.

Pandemic Flu - guidance on prophylaxis

DH guidance is available here.

Replacement for QMAS (Quality Management Analysis System)

The Department of Health and NHS Connecting for Health are currently considering replacing the Quality Management Analysis System (QMAS) with a more flexible calculating and reporting system. DH and CfH are looking to extend the payments supported beyond QOF to the following:

the Quality and Outcomes Framework (the national QOF)

• quality indicators recommended by NICE that are not negotiated into the national QOF

• most directed enhanced services (DES)

• local enhanced services (LES) that work in the same way as the other payments that are supported by the new system.

DH and CfH are asking for the views of frontline staff, such as practising GPs, practice managers and PCT staff. The results of the consultation will be reviewed by representative groups such as the GPC and the RCGP. To participate in the survey, which is running during October, go to the Connecting for Health website.

Vetting and Barring Scheme

The GPC will shortly be issuing guidance for all GPs (including what a GP employer should do) on the new vetting and barring scheme. This scheme comes into play 12 October 2009, and is being introduced in stages. From the 12 October, the following applies:

1. It will be a criminal offence for a person who is on a barred list (e.g. the PoCA, POVA and/or List 99) to seek or undertake 'regulated activity'. Regulated activity includes working as a GP, as a practice nurse and may also include working as a healthcare assistant. It applies to those who are already in post or are seeking a new post
2. It will be a criminal offence for a practice knowingly to appoint a barred person to a 'regulated activity' post. Also practices should require an enhanced CRB check of all new recruits and of those changing jobs who will be undertaking 'regulated activity'. Please note that the PoCA, PoVA and List 99 are being replaced by two new barred lists managed by the Independent Safeguarding Authority (ISA - www.isa-gov.org ) - one for barred from working with children, and one for barred from working with vulnerable adults. The enhanced CRB check will now provide information held on these two ISA barred lists
3. Employers have a duty to inform the ISA if they have reason to believe that an individual has caused harm, or posed a risk of harm, to children or patients that they work with.
Please be aware that no central funding available to practices for CRB checks. Therefore the question of who pays for the check will be one for the employer and the applicant.

Sickness Certification on discharge from Secondary Care

The LMC have received examples of a number of instances when secondary care (inc. community services and hospitals) are not certifying when appropriate. Whilst you may feel it is in your patients interests to provide a sick note please be aware that this simply perpetuates the problem and it may be more appropriate to refer the patient back to the doctor responsible - GPs not treating the patient should NOT issue a sick note.

Bulletin 31


Pandemic Flu - new version of guidance

The Department of Health are preparing a range of materials for GPs including a new Immunisation Green Book chapter, fact sheet, Q&A, consent template, Patient Group Directive (PGD) template and patient vaccine invitation letters. Training materials to support NHS staff are also being developed. A new version of the joint GPC/RCGP/DH flu guidance Pandemic influenza – Guidance for GP practices is available here.

Pandemic Flu - H1N1 vaccination staff training video

The Department of Health has published a training video to show Health Care Professionals how to prepare the H1N1 vaccines for adults prior to administration. The video provides information about the two different brands of H1N1 swine flu vaccine (by GSK and Baxter) and shows how to draw up each vaccine, with some important differences between the two products:

The video can be accessed here.

Pandemic Flu - Swine Flu clinical packages

The swine flu clinical package, which is a set of tools for use by frontline healthcare professionals during a pandemic is now available here. This has been updated to reflect changes in the guidance on the use of antibiotics and on oseltamivir prescribing in young.

Pandemic Flu - Additional guidance to meet workforce supplies during a pandemic flu.

The Department of Health has also published the document Pandemic influenza: additional measures to meet workforce supply . It is available here.

GMC Introducing the Licence to Practise - 16 November 2009

You will all be aware that with effect from 16th November 2009 doctors will need to be licensed to continue to perform Primary Medical Services or other clinical work both within the NHS and in a private capacity. This will mean that any doctor who is not licensed on 16th November cannot see patents and to do so will be a criminal offence, and breach of the Practice’s NHS contract. Practice Managers/contract holders are asked to confirm to the NEFHSA that all GPs in their practice have provided evidence to demonstrate that they have obtained a Licence to Practice from the GMC. NEFHSA can be contacted on 0191 333 3275.

An essential information pack for organisations that employ doctors produced by the GMC is available for download by practices here. The information pack aims to help employers prepare for the introduction of the licence to practise, which is the first step towards revalidation, the biggest change to medical regulation in 150 years. The pack explains how organisations can go online to check the GMC status of their doctors and provides information about important changes the GMC is making to the certificates it issues to doctors.

Bulletin 30


Pandemic Flu - DH letter sent to SHA

Professor Salisbury, Director of Immunisation, has written to all SHAs and PCTs in England, to assist immunisation leads, pandemic influenza leads and flu co-ordinators in further planning for the swine flu (influenza A (H1N1v) 2009) vaccination programme. The letter includes information about the vaccination deal, the licensing and delivery plans of the vaccines, as well as information about issues such as the Guillain-Barré Syndrome and the use of thiomersal in some vaccines. The letter can be accessed here.

Pandemic Flu - Indemnity for GPs vaccinating own staff

The GPC have had confirmation from the MDOs that GPs who vaccinate their own staff, who are not registered as patients at the practice where they work, would be indemnified as it would be part of their provision of professional services. The DH has deemed it appropriate for GPs to use NHS vaccines on practice staff who are not registered with them. There is more work to be done locally on the logistical issues for GPs vaccinating their own staff.

Pandemic Flu - Sickness Certification

DH will shortly be sending information about certification in the event of a pandemic. You can view some of the key messages it will contain here.

QOF Results 08/09 and business rules

As you will be aware, the QOF results for 2008/09 have been published. They've gone down slightly overall as a result of a drop in the Patient Experience domain, which itself was caused by the Patient Experience Survey being incorporated into the QOF.

Commenting on the publication of the QOF results for 08/09 by the NHS Information Centre, Dr Laurence Buckman, Chairman of the BMA’s GPs committee, said: "The continuation of high scores in the clinical domain shows that patients are still getting extremely good care from their GP practice. Much of this work is preventative, meaning patients are benefiting from early diagnosis and treatment. The dip in the Patient Experience QOF scores is a direct result of changes to the funding of the Patient Experience Survey and not because quality in this area has dropped. Practices got very similar, high patient satisfaction results to last year’s Patient Experience Survey, yet this year they have lost points and resources. It means that if patients look at their practice’s QOF results they could end up with the impression that the quality of the practice, and patients' satisfaction with it, has declined, when this isn’t likely to be the case. So as well as unfairly reducing resources for patient services the results are inevitably likely to be misinterpreted, and this is why GPs have so little faith in this survey."

You can view the full results here.

Version 15 of the business rules have now been published. They are available to view on the NHS PCC website here.

LMC useful reminders list

Occupational health services available to GPs and Practice Managers: GP Health (www.gp-health.org.uk) offer free occupational health services for GPs and their spouses/partners, and Practice Managers and their spouses/partners in the Tees Valley and Hartlepool area (includes sessional GPs and registrars). Identities of those seeking assistance are kept anonymous and not notified to any PCTs. If you would prefer to talk to someone about the different fields of assistance available, please contact: Dr Leslie Dobson (01287 610901) or Dr Ed Selby (07712 531 932).

The LMC sponsor two charities that offer help and support for GPs and their families:

· The Cameron Fund is the only medical charity which provides help and support solely to general practitioners and their dependants. It aims to meet needs that vary considerably from the elderly in nursing homes to young, chronically sick doctors and their families and those suffering from unexpected and unpredictable problems such as relationship breakdown or financial difficulties following the actions of professional regulatory bodies. Anyone who knows of someone experiencing difficulties, hardship or distress is urged to draw attention to the Cameron Fund’s existence or alternatively to contact Jane Cope, the Services Manager. E-mail: janecope@cameronfund.org.uk / Phone: 0207 388 0796. Address: The Cameron Fund, Tavistock House North, Tavistock Square, London WC1H 9HR.

· The Royal Medical Benevolent Fund provides help and support for all doctors and their dependants in serious difficulty. Amongst the help they give are: back to work support packages, specialist debt management advice, regular financial support where there is long-term need due to accident or illness and one-off grants to help adapt homes or vehicles for independent living despite disability. To find out more about eligibility for assistance please see the link ‘How we can help you’ on their website www.rmbf.org. RMBF also host information and advice websites: www.support4doctors.org for those beginning their medical careers and www.money4medstudents.org is a resource for medical students to help them manage their finances. Contact address and phone number are: Royal Medical Benevolent Fund, 24 King’s Road, Wimbledon, London SW19 8QN : 0208 540 9194.

Movement of GPs: Practice Managers should contact FHSA Contractor Services on 0191 333 3275 whenever a GP is commencing or leaving the practice. The LMC is then provided with this information which enables us to keep a list of GPs in the area.

Email addresses: Practice Managers should contact the PCT IT Help Desk (0845 234 0233) with the names and email addresses of GPs or members of staff joining/leaving the practice so that email addresses used by the PCT and LMC can be kept up to date. Specify that the GPs and Practice Managers names/email addresses be inserted into:
· the “Global Address List”; and
· the “All Groups” section under the specific PCT GPs or PCT Practice Managers entries

Practice letterheads: Should show the names of all partners. If letterheads include non-partners such as salaried GPs, locums, nurses, Practice Manager or Business Partners, their role should be made clear otherwise there are circumstances in which they could be assumed to be partners thus exposing the partnership to financial and other risks.

Requests for short term sicknotes: employers / students: The LMC has produced this standard letter for practices to use for patients seeking short term sicknotes (less than 7 days including a weekend). Practices should hand this letter to patients for employers OR this letter to students for schools/universities.

Requests for Hep B in connection with employment/university: Here is a standard letter to be handed out by practices to patients seeking Hep B in connection with employment / university. To assist patients requesting Hep B for employment / university related purposes, you should be aware of Hep B arrangements at neighbouring practices/alternative providers, who can charge a fee for the vaccination and blood test, but you must not discuss charging arrangements. Any such arrangement must be for the convenience of the patient and no discussion or agreement over charges must take place with those practices as this may breach Competition Law with serious financial and criminal consequences. Here is an additional letter for GPs/Practice Managers from the LMC outlining this guidance.

Clinical waste (GMS/PMS practices in non-Trust owned properties): The latest version of clinical waste letters can be found by following the links below. All practices who produce 500 kg of hazardous waste annually (clinical waste comes under this category) must be registered annually with the Environment Agency for the production of hazardous waste. If you have any queries please contact Christine Knifton at the LMC office on 01642 737744 or email: christine.knifton@middlesbroughpct.nhs.uk.

Letters to Practice Managers on different aspects of clinical waste:

· Clinical waste

· Collection and labelling of all clinical waste

· Collection and labelling of 1L diabetic sharps boxes from patients

· Collection and labelling of cytotoxic waste

· Collection and labelling of toxic waste

· Waste disposal easy reference

Bulletin 29


Pandemic Flu - Vaccination Arrangements

The National Director of NHS Flu Resilience, Ian Dalton, has clarified that in England, GP practices will not be charged for the time of District Nurses (DNs) engaged in the vaccination of housebound patients in the priority groups for H1N1 vaccination. PCTs have been asked to plan their vaccination programmes on this basis.

GPs, as employers, should be making arrangements to secure the appropriate vaccination of themselves and their staff. It is the responsibility of GPs to organise the vaccination of eligible front line staff, either via existing occupational health schemes or by putting in place other local arrangements to vaccinate practice staff. The Swine Flu vaccination agreement was specifically about payments to practices in respect of the 9.5 million people in the Joint Committee on Vaccinations and Immunisations recommended priority groups. View the letter from Ian Dalton here.

The dosage of Tamiflu for babies aged 6 months to 1 year has been changed by the European Commission. Full details can be found by following this link to the DH website.

Please see the Pandemic Flu Q&A (updated 14 Sept) here.

Audit of 'E' Discharge Letters

The PCTs carrying out an audit on discharge letters from each clinical directorate following the highlighting of some problems with the 'e' letter - misdiagnosis, lack of information regarding procedures, incorrect admission and discharge dates etc. The simple audit will require GPs to take a couple of minutes to complete a short audit form which will be sent with the discharge letters which were being audited by the Clinical Directors. We hope all practices will assist with this audit as it will enable the system to be more effective.

QOF Topic Suggestion Facility

As part of the new QOF process, NICE wants to ensure that all stakeholders from all participating countries have the opportunity to contribute to the development of future indicators for the QOF. NICE have launched two new online facilities to enable people to suggest topic areas for the development of new QOF indicators and also comment on existing indicators. The facilities can be accessed from 15 September – 13 October.

The GPC will not be involved in the suggestion of clinical areas for the QOF as it negotiates the final framework. However, individual GPs are encouraged to submit their personal views and experiences as part of this programme.

Suggesting a Topic

The online topic suggestion facility provides a list of evidence-based recommendations drawn from NICE clinical and public health guidance that could provide potential new QOF indicators. Over time this facility will be expanded to provide the opportunity to suggest a wider range of evidence-based sources, accredited through NHS Evidence. Each suggestion will be reviewed against the criterion presented in the submission form and suitable suggestions for the QOF will be presented to the independent Primary Care QOF Indicator Advisory Committee for consideration.
Suggestions can be made here.

Comment on Existing Indicators

The online facility to comment on QOF indicators enables people to input into the review of existing indicators. Comments will be used to review existing QOF indicators against criteria including, evidence of unintended consequences, significant changes to the evidence base or changes in current practice. Comments will be fed into a rolling programme of reviews and considered by the independent Primary Care QOF Indicator Advisory Committee. All contributions will be reviewed following the process laid out in the QOF process guide and only those suggestions and comments that fulfil the criteria for consideration will be presented to the Advisory Committee.

The online facility for commenting on existing QOF indicators can be accessed here.

Referrals to Complementary Therapists Regulated by Statute

Guidance has been produced in response to evidence of continuing interest amongst patients in the use of treatment modalities which are currently outside NHS healthcare provision but which are delivered by professionals who have statutory regulation in place. This guidance was first issued in September 2006 and has now been updated. It is available on the BMA website.

LMC Meeting Minutes

Are available on the LMC meeting pages or by clicking here.

Bulletin 28


Local Involvement Networks (LINks)

The BMA has produced these FAQs to provide information to practices on the introduction of Local Involvement Networks (LINks) and how this will affect GPs and practices in England. The information is also available on the BMA website.

European Medical Directory

Scam alert! Yet again the physician therapist guide has reincarnated itself and is trying to get your cash. We refer you to the original GPC warning (see bulletin 16 further down this page) re the organisation behind it known as Novachannel and/or Med1web but the short and simple advice - don't sign unless you have checked out the company and crossed your t's and dotted your i's.

GP Access & Responsiveness Workshops

A series of workshops, supported by the RCGP and BMA, are being planned to support practices with access and responsiveness. Please help to shape them by clicking here and completing the short survey. All the data is anonymous and results are automatically captured electronically. The same set of questions will be used in a survey via Management in Practice, to capture practice manager views.

Bulletin 27


PE7 & PE8, Patient Survey

The LMC is collating information as to how practices have faired with the patient survey and in particular PE7 & PE8. Please can you drop us a quick email (to janice.foster@middlesbroughpct.nhs.uk) to let us know:

a) how did you fair with your scoring on PE7 e.g. was it higher, lower or as expected?
b) how did you fair with your scoring on PE8 e.g. was it higher, lower or as expected?
c) did you appeal your results and if yes what was your evidence and what has been the outcome?

Please do try and provide as much information as possible to enable the LMC to build up a true picture to, if required and appropriate, decide on next steps.

Continuation of Treatment for Terminally Ill Patients

Practices may already have read the July LMC Minutes (Min. Ref. 09/07/22), which refer to the case of a terminally ill patient whose own practice felt unable to continue the care in the terminal period because the patient was outside of the practice area. There are a number of issues which are raised in situations such as this. Principally, how patients are admitted to nursing homes and, from the practice point of view, whether or not GPs feel that they are able or willing to provide services in exceptional circumstances outside of their normal practice area; more widely there is a need to consider how GPs are seen by the public.

The LMC is pursuing the question of admissions to nursing homes and hospices separately but would like to take the opportunity of reminding practices that there is nothing which prohibits them from providing care to patients outside their normal area or even outside their own PCT, so long as it is clear that this is being done on the basis of a definite practice decision which has been based on grounds which in no way discriminates unfairly against categories or types of patients.

If a decision is made to provide care in such circumstances, it is important that the whole of the practice team is aware of this so that there is no confusion about whether or not care is being provided by the practice.

Information Commissioners Office (ICO), Registration Costs

The LMC has been made aware of a bogus organisation that is targeting practices requesting they make a payment to renew their Data Protection Act registration. There is a tick box on the form which asks if the respondent is a public body (the Data Protection Act website clearly states that this applies to practices) and if this box is ticked the registration fee jumps up from the current £35 to (up to) £500.

The ICO are aware of this and have issued a warning to be extra vigilant. They have clarified that GPs are defined as Public Authorities wit regard to the Freedom of Information Act as they provide NHS services but they still only pay £35 when it comes to paying the fee for registration under the Data Protection Act - not the £500 as suggested.This agency is fraudulently asking you to make payment to them in order to complete your registration.

In short, if any agency requests you make a payment of more than £35 to complete you Data Protection Registration then avoid these services altogether and contact your Local Trading Standards Office and inform them of the situation.

BMA Employer Advisory Service Flyer

In past bulletins we have included information regarding the BMA Employer Advisory Service. The service has been set up specifically to provide advice and support to BMA members who employ staff to assist them in dealing with a variety of employment relation and employment law matters.
Click here to view their flyer with further information.

Bulletin 26


Pandemic Flu Update

There has now been national agreement (England only) regarding flu vouchers versus scripts. It has been agreed that GPs will use flu vouchers for the under 13s and when visiting patients at home and that GPs will use the blank side of computer scrip stationery when in the surgery, with a simple three-letter endorsement 'AVC' . Furthermore, GPs will not have to fill in anything on the vouchers apart from using a normal surgery address stamp and date stamp and signing it. A letter has been sent to all PCTs, via the SHA, to confirm this. You can view that letter here. PCTs in Tees will be providing further information about this process to all practices shortly but will currently continue to accept any vouchers issued.

BMJ Best Health have published a 'Patient Information Leaflet' on swine flu which can be printed out by practices to give to patients. You can download the document here. Please note that this document is BMJ Group Copyright so should not be amended in any way but may be updated by the BMJ in the future.

DH have recently produced a guidance document for PCTs on planning for and responding to pandemic flu, titled 'Pandemic Flu: Planning & Responding to Primary Care Capacity Challenge'.This document mentions the payment rate for locums agreed between NHSE and other issues, including accessing retired medical practitioners. You can view the guidance here. It is also available on the DH website by following this link www.dh.gov.uk/en/Publicationsandstatistics

LMC Guidance - Dealing With Complaints or Investigations

The LMC has produced a 'guidelines' letter which hopes to provide support to practices when dealing with complaints or investigations. The LMC has requested the PCTs forward this letter to practices when they contact practices about complaints. You can view the guidelines here.

Bulletin 25


Pandemic Flu Update

Tees PCTs have forwarded an important 'special edition' briefing containing important information about the closure of the North Ormesby the Anti-viral Collection Point. For your ease, if you haven't seen it yet, you can view it here.

DVLA - Consent for the Release of Relevant Medical Information for Patients

From Monday17th August, new rules called Consent by Assurance were implemented by the DVLA relating to the release of relevant medical information for patients applying for driving licences.

The BMA has given agreement that DVLA no longer need to provide the patients written consent from the patient for access to the relevant parts of their records for the purposes of being granted a driving licence. The new rules to GPs and to driving licence applicants are explained here.

The BMA are aware that this agreement might generate concerns amongst GPs about patient confidentiality. The GMC web site has a frequently asked questions supplement to their confidentiality guidance –
www.gmc-uk.org/guidance/current/library and one query advises that doctors should:- “Obtain, or have seen, written consent to the disclosure from the patient or a person properly authorised to act on the patient’s behalf. You may, however, accept written assurances from an officer of a government department that the patient’s written consent has been given.”

The BMA has taken legal advice about a system of accepting such assurances from a government department, and received written assurances from the DVLA, in the form of a written legal indemnity.

NHS Complaints Procedure

A guidance document has been produced to provide practices and GPs with guidance on the requirements of the NHS complaints system, including advice on how to deal with complaints that come into the practice. This guidance also addresses some of the concerns GPs and practices may have about the way the complaints system operates and offers advice on ensuring that the system works for GPs and practices as well as patients. This document covers England only. You can view the document here. The guidance can also be found on the BMA website here  www.bma.org.uk/employmentandcontracts
This guidance is supplemented by the 'New Complaints Process FAQs' which can be found here www.bma.org.uk/employmentandcontracts/independent_contractors

Look After Our NHS Campaign Posters

A recent edition of BMA News (15/8) features a campaign poster- 'Worried about the commercialisation of the NHS?' - as a centrefold to display in GP practices, hospitals, community settings, etc. This and another poster which uses the ARM photo are now available to order. View the posters here - poster a and poster b. Each poster is available in two sizes: A4 (ideal for noticeboards) and A2 (420mm x 594mm). To order your FREE copies, please email info.lookafterournhs@bma.org.uk stating which poster(s) you want, size and quantity, and delivery address. You can also download pdfs. All details are also on the campaign website - www.lookafterournhs.org.uk

Bulletin 24

Tees PCTs have issued a second ‘special edition’ briefing containing important information about opening times of the Antiviral Collection Points at North Ormesby Health Village and Primecare Centre. For your ease, if you have not seen it yet, you can view it here.

Bulletin 23

Tees PCTs have forwarded an important 'special edition' briefing containing important information about opening times of the Anti-viral Collection Points. For your ease, if you haven't seen it yet, you can view it here.

Locum GP Death In Service Payments (Flu) Guidance

This guidance supersedes the BMA's previous interim advice to locum GPs on death benefits during the flu pandemic. For many months the BMA has been working with NHSE officials to ensure that the dependants of locum GPs would be fully protected should the locum GP die while working for the NHS. The English Department of Health has now issued a letter to primary care trusts (PCTs) setting out how it considers the matter should be dealt with, and this guidance relates to that. The guidance can also be accessed here www.bma.org.uk/health_promotion_ethics/

Administration of Medicines in Nurseries Framework

Some nurseries are still referring to out-of-date guidance from the Department for Children, Schools and Families and refusing to administer over-the-counter medicines to children without a doctor’s prescription. The guidance on the provision of medicines to children in nurseries was amended in May 2008. ‘The Statutory Framework for the Early Years Foundation Stage’ permits the provision of both prescription only and of over the counter medication to children, with a guardian’s written permission (see page 25). The framework is available to download here http://nationalstrategies.standards.dcsf.gov.uk

Learning Disabilities DES

The DH policy team working on Learning Disabilities will take into account all the issues the GPC have been telling them about when they review the DES internally. If anyone has problems with this DES, please could you contact Cleveland LMC.

NICE Guidance Development Group Recruiting GPs

NICE guidance on improving outcomes for people with skin cancer including melanoma - NICE are reviewing their guidance and are asking for GPs who are either minor surgeons or dermatologists or both to support their deliberations.

The National Collaborating Centre for Cancer (NCC-C) has been commissioned by NICE to update its guidance on Improving Outcomes for People with Skin Tumours including Melanoma (2003) http://guidance.nice.org.uk/CSGSTIM relating to the management of low risk basal cell carcinomas (BCCs) in the community. The NCC-C is now looking to recruit members to an expert Guidance Development Group (GDG) to formally review the original recommendations which relate to management of low risk BCCs in the community.

Dr Julia Verne, Deputy Regional Director of Public Health (South West Region) and Director of the South West Public Health Observatory, who chaired the original Guidance Development Group has agreed to Chair the new group to look specifically at this issue.

It is vital that the voice of genuine GPs is heard and that those who apply to do this are not intimidated by the volume of work or the volume of invective from hospital colleagues. If you are suitable, or know someone who you trust who is, please apply. GPs need to be involved with this . Further details of role and commitments required can be found here.

Bulletin 22


Pandemic Flu Update

On Friday (31/7) the PCT sent an important update to all practices. If you haven't had the opportunity to look at it,for your ease we have updated a link and you can do so here.

Assessing Children with Swine Flu

The GPC, RCGP and RCPCH have published a joint statement for assessing children with suspected swine flu (H1N1). Children under 1 with flu-like symptoms should be seen and assessed by GPs to exclude other serious treatable diseases, to establish the severity of illness and assess whether additional treatment is required (e.g. oral antibiotics). Some older children may need face-to-face assessment. regarding guidance for assessing children with a possible diagnosis of swine flu. Read the full statement here www.bma.org.uk/health_promotion_ethics 

Reporting Adverse Side-effects for Antivirals

You may already be aware of this, but the MHRA has a dedicated page on their website where patients and Healthcare professionals can report adverse side effects for the antivirals Tamiflu and Relenza: swineflu.mhra.gov.uk

Child Death Review Process

The Department for Children Schools and Families document, 'Working Together to Safeguard Children’, 2006 sets out guidance intended to protect and promote the welfare of children. The document outlines the responsibilities of Local Safeguarding Children Boards (LSCBs) to ensure effective co-ordination between individuals and organisations throughout local authority areas and sets out the review process following a child’s death. As part of the Children Act 2004, LSCBs became mandatory in April 2008 and as a result, the procedures set out regarding the Child Death Review Process became statutory. You can view the document here. It is also available on the BMA website www.bma.org.uk/employmentandcontracts

Final Seniority Figures for 04/05 & 05/06

The NHS Information Centre has published the Final Seniority Figures for 2004/05 and 2005/06 for GMS in England and Wales. The figures for England are: £81,123 and £91,123 respectively and for Wales £71,535 and £81,413. The figures for the other nations are being published separately. After taking legal advice, the Department of Health has decided that the NHS Information Centre should not work out a Final Seniority Figure for PMS because PMS contracts are local contracts. The GPC therefore advises PMS practices and LMCs that they should also use the GMS figure. Further details about how the Final Seniority Figures have been calculated are available on the NHS Information Centre's website at www.ic.nhs.uk

LMC GP Conference - Date for your diary

Early notification - Cleveland LMC is organising a conference for all GPs across Tees at Middlesbrough Football Club on 24 November. Agenda items will cover Partnership & Partnership Agreements and Revalidation. It is hoped that Dr Laurence Buckman, Chairman of the GPC will top the bill as the guest speaker. Further information will be circulated shortly but in the meantime ensure you put the date in your diary.

Bulletin 21


Pandemic Flu Update

We are aware that patient requests for sick notes are posing some questions/issues for practices in the area, particularly where patients have been diagnosed by someone other than the practice and have self certified for 7 days but are now approaching the practices for a note as they require additional time off work. We have raised this nationally and will update you as soon as we get an official response. As you will be aware, government is considering increasing self certification to 14 days for swine flu cases but until this decision is made there is no easy solution practices will need to continue to manage this situation as best they can. The pandemic flu Q&A has been updated and you can view the latest version here www.bma.org.uk/health_promotion_ethics

National pandemic Flu line

The national English pandemic flu service has been now been launched by the DH. There is a dedicated website where people can get their queries answered on-line, or via the flu line
0800 1 513 100, where trained staff will be able to assess patients over the phone. Following an assessment, they will be given an authorisation number to give to the nominated person to collect antivirals from their local antiviral collection point.

It is hoped that this will allow GPs to focus on more serious/at risk groups and all the patients they have who are ill with things other than swine flu, as the patients who are currently ringing surgeries worried about swine flu will now ring the flu line for advice instead.

Fitness to fly notes

In the light of the confusing press coverage over fitness to fly notes, after discussion with the airlines, we can confirm that GPs will not have to give out fitness to fly notes.

Airlines have made their staff aware of the swine flu situation and have given them broad instructions on how to spot possible symptoms. This is standard practice - they issued similar guidance during the SARs incident. If their staff have concerns, they can refer the passenger to their onsite medical service - Medlink - who will then assess, in cooperation with the patient, their fitness to fly. If they are not regarded as fit, they won’t be allowed to fly and will be asked to ring the NHS flu line or go online to the symptom checker and then follow the normal advice for people who suspect they have swine flu.

Holiday insurance cancellation certificates

The Association of British Insurers have stated that they will accept the submission of the antiviral authorisation number and the label from the Tamiflu packet as evidence of a patient having had flu.

Guidance for Assessing Children in Primary Care with Possible Swine Flu

Please find attached a joint statement from GPC, RCGP and RCPCH regarding guidance for assessing children with a possible diagnosis of swine flu here.

Improving GP Services

The management of GP contracts in England is set to change following the publication in January 2009 of the document ’Primary and Community Services: Improving GP services’ by the Department of Health (DH). This document  www.dh.gov.uk/en/Publicationsandstatistics follows on from the NHS Next Stage Review, and is part of the World Class Commissioning (WCC) initiative. Where many GPs previously considered WCC to involve the commissioning of services in secondary and community care, this document seeks to manage the quality of primary care services commissioned by primary care trusts (PCTs) from all GP practices, and provides practical advice on how PCTs can do this. Throughout 2009/10, PCTs will look to begin a process of monitoring practice performance in a number of areas and managing practice contracts with these new data.
This represents a significant shift in the relationship between practices and PCTs. It is essential that practices familiarise themselves with this document. This DH guidance will become a central part of the function of PCTs; ‘Get the commissioning of GP services right and the benefits will extend to the commissioning of wider NHS services, including hospital care’ (p13).
Th e BMA have produced a ‘Focus on…’ that intends to explore: how PCTs will assess practice performance and how GPs/LMCs can influence this process; how PCTs have been advised to manage all primary care contracts; and the opportunities that this DH guidance presents for GPs. You can view the document by following this link. The guidance is also available on the BMA website. www.bma.org.uk/employmentandcontracts

NE Wide Work On Improving Communications

Following the Accelerated Learning primary care event led by Chris Willis, there is a group with representation from all ‘clusters’ developing a NE wide framework which will inform and support the development of local primary care strategies. One of the key issues identified is around improving communication.

The NE group have been developing a short questionnaire that will provide you with an opportunity to influence how practices are provided with different forms of information and how the practices would like to develop a more two way form of communication. We would encourage you to look out for this questionnaire and endeavour to complete and return it .

We appreciate that questionnaires are not always popular but it was felt that this base line information would be really important to find out what works and what doesn’t so that mistakes from the past aren't replicated.

Guidance on Sealing Electronic Patient Records

Some GP clinical systems include functionality that allows a GP to restrict access to elements of patients’ electronic health records to different levels of user within the practice. This functionality is not consistent across systems and any data that is hidden is likely to be revealed when the patient record is transferred to another GP clinical system. This can happen when a patient’s record is transferred to another practice via traditional paper record transfer or GP2GP or following a data migration to another GP clinical system in the practice.
GPs are therefore advised to inform patients, who want elements of their electronic health record to be kept confidential, that the information is not likely to remain hidden when the record is transferred to another system, either electronically or via paper transfer.

Look After Our NHS - a further letter from Hamish Meldrum

Dear colleague,
Have you signed up to the BMA's eight key Principles for the NHS yet?
If you haven't yet visited www.lookafterournhs.org.uk and registered your support for an NHS which is publicly funded, publicly provided and publicly accountable, now is the time to do so. Every vote counts so please visit the website today, and register your support. But whatever your views, we’d like to hear them.
Local examples of NHS market reforms
We’d particularly like to hear how NHS market reforms are affecting you, your patients and your working lives, as well as how they’re affecting existing NHS services and public finances. Again, you can do this at www.lookafterournhs.org.uk – it’s in complete confidence and we won’t share the information further unless you’d like us to.
Pass this email on to at least 5 colleagues – or even more!
Since the campaign was launched, hundreds of doctors have been spreading the word about the campaign by email. This is making a real difference to the number of people visiting the website and pledging their support. You can too. Please forward this email to your colleagues - the more the merrier - and encourage them to visit the website and get involved.
The more people we can galvanise to cascade emails and the website link to colleagues, the more effective the campaign will be. By working together we can ensure our message is spread far and wide - and acted upon.
Thank you.
Hamish Meldrum, Chairman of Council, BMA

GP Trainees Subcommittee Elections

GP Trainers - Please pass this on to your GP trainees

The GP Trainees subcommittee recently invited nominations for representatives for each of their 19 regional constituencies. The nomination process has now ended. We received more than one nomination for each of the constituencies below, and will therefore be holding elections in these constituencies. The boundaries for these constituencies are organised along deanery lines.

• East Midlands

• Eastern

• Northern

• Oxford

• Scotland (West)

• West Midlands

• Yorkshire

Ballot forms will be sent out on 27th July, and the closing date for the return of ballot papers is 17th August.

Bulletin 20


Pandemic Flu Update

Liquid Tamiflu/Oseltamivir Solution - This solution must be limited for use in children under 1

There are reports from all across the country that GPs are authorising the use of oseltamivir solution for adults and children who are not able to swallow capsules. This is causing an unprecedented demand for the solution and if GPs continue to use this strategy, we will run out of solution for babies under 1. GPs should be advising the emptying of the appropriate strength capsules onto something palatable and NOT prescribing the solution. PCTs have been provided with templates for labels and these clearly state that the contents of the capsules can be emptied into a sweet, sugary solution.
GANFYD/Doctors Notes - We do not provide 'Fit Notes' in relation to swine flu
GPs are getting a number of requests from patients requesting 'fit notes' to say they are free from infection and fit for work. Added to this 2 of the major airlines (Virgin and BA) are now requesting GANFYDs to the effect that patients are fit to fly . GPs should refuse to provide these notes - they are worthless, a precious waste of time and detract from GPs real work. The GPC is tackling this nationally (with the airlines). Follow the  link here for a template letter that you may like to provide to your patients to pass on to employers who make a request for a 'free from swine flu' note.
Please keep the LMC updated of any problems/issues you are encountering.

Hep C

The LMC have been asked for comments about whether or not practices should be involved in testing for Hep C. Whilst there is no clear answer, I suggest that if a person attends and has a reason to be tested, including an appropriate contact with a Hep C person, then testing would be part of the Essential Services. My advice to the PCT which raised this question, is that screening is not part of Essential Services and would normally only be carried out as part of an Enhanced Service. If you have any questions or queries, please ask for advice.
John Canning,Secretary, Cleveland LMC

Improving Access to Psychological Therapies (IAPT)

The GPC has provided the LMC with a number of CD-ROMs regarding Practice Based Commissioning and the Improving Access to Psychological Therapies programme. The Department of Health has provided this CD-ROM, which contains a number of documents about how the IAPT programme works, as well as a business case for those interested in commissioning the service. The disk contains useful information about how to use practice based commissioning to maximise the potential benefit of the IAPT programme and strong evidence of the effectiveness of the service in treating people with long term conditions and medically unexplained symptoms, as well as in treating the common mental health conditions of depression and anxiety disorders. The involvement of general practitioners is central to the development of the new services.

The GPC, together with other primary care organisations including the RCGP, signed a consensus statement supporting the drive to improve access to psychological therapies for our patients. This statement reflected the findings of the Joint Scoping Document from the Royal College of General Practitioners and the Royal College of Psychiatry on psychological therapies. Previously access to such psychological therapies has been limited, and characterised by very long waiting times. In 2007, the Department of Health announced new funding rising to £170m by 2011 to train 3,600 new therapists to provide an improved service.

If you would like to receive a copy of this CD-Rom please contact the LMC office (please note there is not enough for every practice so first come basis!). For further information please visit the IAPT website www.iapt.nhs.uk

Somebody Else's Child, Everybody's Responsibility

The British Association for Adoption & Fostering (BAAF) has launched a new campaign which is aimed at health care professionals. The campaign is called Somebody Else’s Child and is concerned with private fostering. This is an arrangement for 28 day or more, which is when children are cared for by someone other than a close relative. By law, parents and carers must notify their local authority before entering into these arrangements. But sadly many don’t.

There are an estimated 10,000 children living in private fostering arrangements in England and Wales, but last year only just over 1,500 notifications made with local authorities. While most of these children will be safe, others may be at risk of abuse and neglect at the hands of their private foster carers. Without social services intervention, this could go on for years.

Although the legal responsibility lies with the parent and the carer, the campaign is urging anyone who works with children to play their part. If you know of a child living with someone who isn’t a direct relative, for 28 days or more then, please don’t ignore it. You should either speak to the child’s carer, if appropriate, or inform your local social services. Keeping children safe is the responsibility of the whole community.

For more information visit the campaign website http://www.privatefostering.org.uk

BMA Employer Advisory Service

The BMA Employer Advisory Service provides practices with free comprehensive, impartial and authoritative advice on a huge range of employer-related matters.

The team of specially trained and experienced advisers is ready and able to deal with queries on issues such as recruiting and employing staff, contracts and terms and conditions of service, appraisals and performance management, disciplinary procedures and dismissals. They are also well versed in current employment legislation, discrimination, the development of appropriate HR policies, and how to implement best practice.

The advisers are not only experts in their field but understand general practice and employer matters relating to doctors:

They also have excellent knowledge of local issues and well-established contacts with local and strategic health authorities and primary care trusts.

For free comprehensive, impartial, authoritative advice you can trust call the BMA Employer Advisory Service on
0300 123 123 3 anytime between 8.30am and 6pm (Monday to Friday, except UK-wide bank holidays) and you'll be connected directly to one of our expert advisers. Or you can email your query to support@bma.org.uk.

To access the service at least one partner needs to be a BMA member although we would recommend all doctors are members of the BMA.

Bulletin 19


Pandemic Flu Update

As you will be aware, last week the H1N1v flu pandemic in the UK moved from the containment phase to that of outbreak management. This prompted a number of letters from the GPC and DH to update GPs on the current arrangements all of which you will find by following the links below:

Letter from Laurence Buckman to all GPs

Letter from English CMO, Sir Liam Donaldson, to all GPs

Letter from National Director of NHS Flu Resilience (DH), Ian Dalton, to PCTs and SHAs plus guidance issued re the move to the treatment phase

The GPC has also updated the pandemic flu Question & Answers document to take these changes into account . You can find the updated Q&A by following this link 
www.bma.org.uk/health_promotion_ethics. The GPC continues to work with the DH (England) to produce a new Pandemic Flu SFE that will be a national framework that would temporarily the GPC would urge affected practices to keep details and reasoning of actual expenses as practices may need to use these in evidence to their PCO in any subsequent claim for exceptional reimbursement.

As you will be aware, in Tees the current operation Antiviral Collection Centre (ACP) is located at the PrimeCare Centre in Thornaby. You may have seen this message in the latest edition of the Contractors Chronicle but for those who haven't - 'The Tees PCTs have procured Personal Protective Equipment (PPE) for GP practices. Supplies will be couriered out on Monday 13 and Tuesday 14 July to all GP practices across Tees. Practices should, However, ensure that they have sufficient PPE available at this stage without using the top up supplies.'

We will keep you updated on developments.

Introducing the Licence to Practise in 2009

The General Medical Council have written to the LMC confirming that they will introduce the licence to practise on 16 November 2009. From this date any doctor wishing to practise medicine in the UK will, by law, need to hold both registration and a licence to practise.

Earlier this year the GMC launched their campaign – Licensing: it’s time to decide – and since then more than half of all doctors have told the GMC their licensing decision. Over the next few weeks the GMC will be writing to those doctors who have not yet responded, asking them to tell the GMC before 14 August 2009, whether they will require a licence.

To help doctors make their decision, the GMC have launched their Licensing help website at www.gmc-uk.org/licensinghelp. More information about licensing is available on their website at www.gmc-uk.org/licensing and if you have any questions about licensing, please email licensing@gmc-uk.org.

Hep C

The LMC have been asked for comments about whether or not practices should be involved in testing for Hep C. Whilst there is no clear answer, I suggest that if a person attends and has a reason to be tested, including an appropriate contact with a Hep C person, then testing would be part of the Essential Services. My advice to the PCT which raised this question, is that screening is not part of Essential Services and would normally only be carried out as part of an Enhanced Service. If you have any questions or queries, please ask for advice.

John Canning,Secretary, Cleveland LMC

PE7 & PE8

The LMC has undertaken initial discussions with the PCT with regard to PE7 and PE8 (Patient Survey) and can inform that the PCT is actively looking into this and the PCT should be able to get back to practices w/c 20 July.

Primary Care and Community Services - Improving GP Access and Responsiveness

DH have released their latest guide from the world class commissioning suite. This document is a practical guide for PCTs to improve the accessibility and responsiveness of local GP services. The GPC realise GPs will dislike this simplistic document and the encouragement it will give to PCTs to damage practices, but simply cannot stop them producing this kind of stuff. GPC thoughts on world class commissioning have been made numerous times before, however it is clear that DH are going ahead with their plans. GPC need to focus on how best to take advantage of the good parts and how best to ameliorate the bad parts.

The document can be accessed by following this link  www.dh.gov.uk/en/Publicationsandstatistics

Carson Paper on Urgent Care

On 25 June the Carson paper on urgent care was launched. This attempts to give practices ideas about how to improve urgent access without wrecking the practice. At the launch David Carson spent considerable energy telling the PCO people there why he thought target setting was damaging, The paper is useful, hence the GPC letter of support within it, and you may like to look at it as it might make practice pressures that bit less. You can view the paper by following the link here.

Important Note from Hamish Meldrum, 'Look After Our NHS'

Since 'Look after our NHS' was launched on 1st June the BMA have received a constant stream of emails supporting our Principles for an NHS which is publicly funded, publicly provided and publicly accountable, as well as examples of how NHS market reforms are affecting doctors.

The BMA need to ensure that the campaign's message and calls to action are reaching all doctors, and encourage GPs to support the campaign. GPs can do this is by providing local case studies of how market reforms are affecting them. For example, the BMA would be interested to hear GP views on:

The BMA would therefore formally ask that you:

Bulletin 18


Physicians Therapists Guide

Whilst we have not yet had any reports in Tees we wanted to alert you to the fact that individually named GPs in other areas of the country are receiving literature and sign-up form (for 957 Euros per year) to be included in the Physicians Therapists Guide. Whilst there is now no mention of Nova Channel within the blurb this could be related as SAE is included to a registered office in Portugal. Please be extra vigilant when considering proposals of this nature and ensure you study the small print.

Bulletin 17


Pandemic Flu Clinical Assessment Tools

A pandemic flu page with information specifically aimed at GPs has now been set up on the BMA web site (accessible to members and non-members) you can view it by following this link  www.bma.org.uk/health_promotion_ethics/.You can also view the latest version of the pan flu Q&A here.

Entitlement to (Free) NHS Treatment

A recent incident reported to us about a patient required to pay a large sum for urgent cardiology treatment is an opportunity to remind practices that GPs referring patients to hospital may wish to point out that not all treatment to patients registered with a GP will be free.

Practices will also want to note that reciprocal arrangements with the Channel Islands were discontinued earlier this year; there is still an obligation to provide emergency and immediately necessary treatment, but you may treat any other problems on a private basis. Don’t forget that means the patient pays for practice time and all medication which should be issued on a private prescription. Private prescriptions for CDs must be issued on the appropriate form available from the PCT, all other private items must have the prescribers and patients details clearly shown.

Full details of eligibility for secondary services is to be found here www.dh.gov.uk/en/Healthcare/Entitlementsandcharges/ but in summary:

Nationality or past or present payments of UK taxes and National Insurance contributions are not taken into consideration when establishing residence. The only thing relevant is being ordinarily resident in the UK
“Ordinarily resident” is a common law concept usually taken to mean resident in the UK for more than 6 months and for settled purposes as part of the regular order of their life for the time being, with an identifiable purpose for their residence here which has a sufficient degree of continuity to be properly described as settled
anyone who spends more than 3 months living outside the UK is no longer automatically entitled to free NHS hospital treatment in England
people in receipt of UK state retirement pensions who have lived in the UK for at least 10 continuous years at some point in the past remain entitled for certain levels of coverage. The extent of coverage depends on where outside the UK you live, and how long you live there. See www.dh.gov.uk/en/Healthcare/
If you go anywhere abroad for more than three months, either for a one-off extended holiday for a few months or to live permanently for several years, but then return to the UK to take up permanent residence here again, then you will be entitled to receive free NHS hospital treatment from the day you return. So will your spouse/civil partner and children (under the age of 16, or 19 if in further education) if they are also living with you permanently in the UK again. A hospital may require to see evidence that you have returned to the UK on a permanent basis.


Please follow this link to view a number of FAQs that are raised to the LMC. Many are a reminder of those previously posted in Bulletin 6 but please take time to refresh yourself as this is important information.

Bulletin 16


Pandemic Flu Clinical Assessment Tools

You will have doubtless dusted down your cluster plans and talked to your “buddies”. So far, the impact locally has been minimal but things are moving. At the time of writing (Monday morning) we hear that the situation in Birmingham and West of Scotland is quite serious and that things are taking off in London. It surely won’t be long before things reach us in a bigger way.

The LMC will continue to liaise with the PCTs and especially the Public Health Department. You may wish to re-visit the various guidance documents issued on flu by following these links - www.hpa.org.uk and www.bma.org.uk/health_promotion_ethics/influenza/

The clinical assessment tools that can be used during the phase of a pandemic when there is an increased demand for clinical care are now available on the DH website. This includes community assessment tool for adults, paediatric community assessment tool and adult hospital pathways. Please follow this link to view the tools. www.dh.gov.uk/en/Publicationsandstatistics/Publications/

If you have any questions or concerns, please do not hesitate to contact us at the LMC office.

Child Protection

The GPC have received numerous queries concerning what a GP is expected to do in order to comply with child protection procedures. This is due, to a large extent, to the recently published government’s response to Lord Laming’s report, entitled ‘The protection of children in England: action plan’.
In this action plan, there are two recommendations from Lord Laming (ref 34, 35) that outline more involvement of GPs and more training for GPs. The government’s response is broadly supportive of these recommendations, and it appears that many PCTs have gone ahead and begun to implement these recommendations without waiting for further guidance from the Department of Health.

The GPC will be discussing these recommendations with DH later in the summer and we expect to be formally consulted before any action plans are implemented. We fully support improving child protection, however we know that the GPs unique position means that a carefully thought out and well constructed action plan is necessary to ensure that GPs can participate, and be involved, without significant detriment to their practice and patients.
In the interim, if your PCT has written to you regarding new child protection procedures that they are implementing, please remember the following:
1) A PCT cannot make changes to the national contract
2) GPs do have a duty to be involved in child protection
3) PCTs have a duty to remunerate GPs for their involvement in any child protection procedure
During this interim period, it would be helpful GPs to inform us of their experiences with their PCT attempting to implement new child protection procedures. Please send them to Genevieve Casey at gcasey@bma.org.uk

Confirmation and Certification of Death

Please see the updated Confirmation and Certification of Death guidance note. Please note that this is for England and Wales only. View guidance here or follow this link www.bma.org.uk/ethics/end_life_issues/

Novachannel AG/Med1web Medical Directory

We have raised this issue in the past but have heard that the above company is re-invoicing some practices for a second year. In light of this we are issuing the original guidance provided by the GPC.

The GPC have received a number of reports from GPs who have signed up to be included on a medical directory operated by Novachannel, also known as Med1web, only to later receive a bill for 983 Euros a year. Notification of this charge is hidden within the small print but there is no other clear indication that there will be a charge. The GPC are advising members that, whilst they have had soundings that this company is operating in bad faith, they have no concrete evidence to this effect, upon which to base our advice.

Therefore, whilst it is always an option for a practice to ignore the requests for payment by the company, there is a risk that the practice will be obligated in law to render the amounts claimed in full plus interest.

The Swiss Embassy has advised the GPC that if someone has been deceived into signing a contract, he or she can challenge the contract by writing to the counterpart within one year of discovering the error, stating that they have been deceived and therefore consider the contract to be invalid. The Embassy has stated that the contract is then considered to be annulled, and that if a debt collection company or other representative of the counterpart insist that the money be paid, the debt collection company or representative should be informed that the contract has been annulled. The Embassy has advised that only a judge has the power to definitely state whether the contract is really invalid, providing that the party insisting on the validity of the contract initiates civil proceedings. The GPC would like to emphasise that the Swiss Embassy advice is given on the basis of a person being deceived into signing a contract. The affected person would have to be able to prove they have been deceived in order to rely legally on the advice.

Developing General Practice: Listening to Patients

The GPC have produced the above guidance document. You can view it by following this link www.bma.org.uk/employmentandcontracts/

GP Trainees Subcommittee Newsletter

Follow this link to view the latest, spring/summer, GP Trainees newsletter. It is also available via the BMA website via this link  www.bma.org.uk/news/branch_newsletters/

GP Trainees Subcommittee Regional Elections

The GP Trainees subcommittee will be holding elections in all of its 19 regional seats this summer.
All doctors who are/will be on a GP Training programme at any point during the period 2 July 2009 to 30 June 2010 are eligible to stand in this election, regardless of whether or not they are a BMA member. For the avoidance of doubt, GP Trainees in hospital placements or GP practice placements are able to stand for election, as are Foundation Year doctors who will begin a GP Training programme during the above period.
Full details of the election, including nomination forms, and introduction to the work of the subcommittee and a full list of regional constituencies, can be found on the BMA website: www.bma.org.uk/gptraineeselections
Completed nomination forms must be received in the GPC office by 5pm on Friday 3 July 2009.
In regions where there is a contested election, we can only send ballot papers to those trainees for whom the BMA has up to date contact details. However many GP trainees have not recently updated their contact details on the BMA website.
It is important that each GP Trainee check and update their details so that, if there is a contested election in their region, we can make sure they receive a ballot paper.
For more information on how to update their contact details, GP Trainees should visit the BMA website: www.bma.org.uk/gptraineeselections
If you have any questions about this election that are not covered on our website, please contact Andrew Young in the GPC secretariat: ayoung@bma.org.uk

Bulletin 15


Pandemic Flu Q&A
The 'Pandemic Flu Questions and Answers' has now been published on the BMA website via the following link:
This web page will be updated regularly as each query or problem is resolved. Thank you to those who have already brought our attention to the problems that you are experiencing locally with the implementation of the pandemic flu plan. Please continue to share information in this way.
You may also contact Marianne Simmonds (msimmonds@bma.org.uk ) in order to describe problems that you are experiencing, or to share examples of good practice/solutions implemented locally.

IT Support
Three practices have contacted the LMC in the last week concerned about IT support. We are not sure whether this is a blip or something more serious and would be interested in your views. Please respond to christine.knifton@middlesbroughpct.nhs.uk  in the first instance

Pharmacy Names on repeat Prescriptions
The Local Pharmaceutical Committee has expressed concern that practices are naming specific chemists on repeat prescription request forms and the LMC has considered this matter and is also concerned. The LMC believes that practices are exposing themselves to accusations of bias and financial or other interests if they do this, and the LMC would counsel practices against the practise.

Any practice which wishes to make arrangements with pharmacists should ensure that they are able to do this with all local pharmacy contractors and not just one or two specific organisations

Message from Hamish Meldrum - 'Look after our NHS'
Since Look after our NHS was launched on 1st June we’ve received a steady stream of support for the BMA’s 8 Principles, and examples of how NHS market reforms are affecting doctors – whether it’s affecting their patients or their own working lives.

We need to keep these examples coming in! We need your support to spread the word – and the web link – to your colleagues. Put the web address on all emails and pass it on. Use every opportunity talk to doctors about these issues and encourage them to visit the website. The more we can spread the message and the web address, the more we can encourage doctors to pledge their support for our Principles.

So please put the following on your emails as part of your ‘signature’ and ask colleagues to do the same:

Have your say about NHS market reforms
Visit www.lookafterournhs.org.uk

And if you haven’t already, I urge you to visit the website, get involved and encourage your colleagues to get involved too. Together, we can look after an NHS led by professionals who put quality before the delivery of crude financial targets.
Thank you.
Hamish Meldrum, Chairman of Council, BMA

Bulletin 14

Patient Survey
The GPC has produced further guidance. You can view this by following this link.

A number of practices have raised concerns with the LMC regarding the Patient Survey; in particular around the results of PE7 and PE8 and the consequential financial impact they will have on practice income.

The LMC strongly recommend that any practice which is concerned lodges a right to appeal with the PCT using the GPC produced template letter. You will find the template letter by following this link  Please be aware, you can sign off your QoF whilst simultaneously lodging a right to appeal so as not to delay other financial settlements.

One particular area of concern voiced by practices is around the adequacy of samples used and the unexpected results produced. You can request your confidence intervals from the PCT. Your confidence interval should be 7% or less to get a 'true' result to PE7 and PE8. We strongly recommend that you request your full information from the PCT if you have not received this already.

The concerns across Tees echo those voiced throughout the country and the GPC are exploring this at a national level. We will issue further advice and information as it becomes available.

The DH has published some guidance for PCTs. Whilst the GPC still has serious concerns with this document you may find it interesting reading. You can view the document by following this link
If you have any further questions or would like to voice your concerns to the LMC please do so via janice.foster@middlesbroughpct.nhs.uk  in the first instance.

BMA Employer Advisory Service
The BMA now has a BMA Employer Advisory service which is available to support and advise GP employers as opposed to GPs, who are now often salaried as well. Practices can access the service by contacting, in the first instance, David Carter the regional BMA Industrial Relations Officer. David is happy to visit practices (as long as one GP is a BMA member) to make a presentation in relation to protocols for employing staff. Practices should contact David directly to book an appointment.

BMA Launches 'Look after our NHS'
The aim of this campaign is to raise awareness of the impact that market-driven reforms are having on the NHS. The BMA have long argued that Government policy to allow commercially-run firms to provide NHS services are not delivering as promised. If these reforms continue, the BMA believe the impact on patient care, doctors' working lives and the local health environment will be damaging.

The BMA has drawn up a list of 8 key Principles for its vision of the NHS which we are urging all doctors to support.

A new website - www.lookafterournhs.org.uk  - is the hub of the BMA's calls to action.
These are:

• Support the BMA's key Principles

• Provide examples of how NHS market reforms are affecting doctors and their patients

• Share views and experiences

Bulletin 12

Patient Survey
The GP patient survey was established in England in 2006/07 to support PCT assessment of general practices’ achievements against national standards set out in DES agreements. These agreements linked results from the administered surveys with the rewards made to GP practices. The arrangements for this year's survey have been different from the past two years as the government decided to replace the previous arrangement with a national postal survey, payment for which is now through the QOF.

SGPC has already been dealing with some serious problems with the Scottish results, of which practices were notified a few weeks ago, in particular because they seemed to be based on small response rates. Practices in England are now receiving their own results, though the national-level data will not be published until late June. The GPC debated this yesterday, and is very concerned that problems similar to those in Scotland may be reported in England and in the other nations. If this does happen, some practices may have their results and therefore some QOF points and a significant amount of funding determined by a very small proportion of their total practice population. It is quite possible that practices will receive a good response rate to the survey as a whole, but low levels of response to one or both of the key access questions. It seems that this may be a particular problem with the PE8 questions on advanced booking.

If a practice feels that their results do not reflect the reality of what they offer patients then they should put in a QOF appeal to their PCT. The LMC will shortly provide a template letter so that you can be reassured that the wording you use is legally watertight. The latter and any further information will follow as soon as we have it. Follow this link for interim information from the GPC.

GPC Chairman, Dr Laurence Buckman, has addressed a letter to all GPs which you can view by clicking here.

NHS Branding
Practices may use NHS branding - should they wish - as long as they follow the national guidance. Some practices may find this useful in letting the public know they provide NHS services, particularly in response to the broadening of healthcare provision in the area. Follow this link to view the brand guidelines.

Bulletin 11

Swine Flu
The situation with swine flu i continues to change and we urge you to view the HPA website, http://www.hpa.org.uk  , for the latest information We STRONGLY advise all GPs to follow the HPA guidance . Across Tees there has not been any notable developments over the last week. However, PLEASE NOTE that there is a meeting to be held Thursday 14 May, 6.30 - 7.30 pm at Eaglescliffe Medical Centre as a briefing on the current situation and to review the GP cluster planning arrangements. Each cluster has been invited to send a representative - please ensure you are represented. You can follow this link to view the local (Tees) updated protocol for the collection of viral and anti-viral swabs .

Sessional GP Newsletter
The GPC have produced a newsletter for sessional GPs. The aim of this newsletter is to keep salaried and locum GPs (known collectively as sessional GPs) up to date with the wide range of new and ongoing issues affecting them, as well as the hard work that the GPC’s Sessional GPs Subcommittee undertakes behind the scenes on their behalf. To see the newsletter, please click on this link.

MMR Vaccinations for Health Professionals
You will have received information re the recent outbreak of measles on Teesside from Health Protection which stressed the importance of health care workers being immunised and as a consequence may find you receive an increase from patients who are health care workers requesting to be immunised . It is worth noting that there is an obligation under the contract to do vaccinations at the request of the DPH in case of an outbreak.

Bulletin 10

Swine Flu
The situation with swine flu is changing rapidly. The BMA's website has the latest guidance plus links to other key websites, including the Health Protection Agency at http://www.hpa.org.uk . We STRONGLY advise all GPs to follow the HPA guidance and specifically not to prescribe Tamiflu to anyone unless advised by the HPA as per their algorithms. Also only to take swabs after discussion with the HPA as well. GPs are also advised to keep abreast of developments on a daily basis. The Teeswide Flu Pandemic Steering Committee held a meeting on Friday 1 May and you can click here to view the main bullet points.

Introducing the License to Practise in 2009
The GMS will introduce licensing in Autumn 2009 and this will be the 1st step towards the introduction of revalidation. In order to practise medicine in the UK after licensing is introduced you will, by law, need to be both registered (as is currently required) AND hold a license. This applies whatever the basis on which you practise. All registered doctors are entitled to a license if they want one and you need to decide if you will need and want to hold a license for the activities you undertake. You have 3 options and you now need to decide which best suits your needs and requirements.

a) registration with license to practise;
b) registration without license to practise;
c) no longer registered.

You can find more information about the introduction of licensing click here and there are some useful FAQs click here.

Bulletin 9

New Complaints Procedure FAQs
These FAQs have been produced to provide information on the new complaints procedure and how it could affect GPs and practices. The new procedure was introduced on 1 April 2009. More detailed guidance on the new complaints procedure will follow. You can view the FAQs through this link click here, as well as via the BMA website click here.

Letter from GPC Regarding Revalidation

This is from Hamish Meldrum, Chairman of Council for the information of all GPs and LMCs. Click here.

Guidance on Preventing Child Accidents in the Home
The Child Accident Prevention Trust (CAPT) have produced some publications to help parents of young children and the practitioners who work with them keep children safe from accidents at home:

- Accidents and Child Development. An easy-to-use guidance booklet for any practitioners involved with the safety, or care of children. reference DCSF-00255-2009BKT-EN

- How Safe is Your Child at Home? A short leaflet for parents and carers, covering common risks to children in the home and how they can be reduced. reference DCSF-00254-2009LEF-EN

You can download or order hardcopies of both publications (quoting the references above) free from the ECM Online Publications page or from the ECM Resources and Practice Page or write to: DCSF Publications, PO Box 5050, Sherwood Park, Annesley, Nottingham, NG15 0DJ.Tel: 0845 60 222 60. Fax: 0845 60 333 60. Textphone: 0845 60 555 60

Bulletin 8

Improving Pharmaceutical Services guidance - World Class Commissioning
The DH has produced guidance for the NHS on how to commission Pharmaceutical Services on the back of last year's Pharmacy White Paper. GPC and the Dispensing Doctors' Association were consulted on the sections relating to dispensing doctors. The Guidance, and letter to CEOs from the Minister, Phil Hope MP, can be accessed through the following links.

Freedom of Information Act - GPC updated FAQs
Following the information provided in bulletin 5, by CLMC, in relation to the new publication scheme, please note that the GPC have updated their Freedom of Information Act 2000 frequently asked questions and these are available through this link as well as via the BMA website.

Video Clips on Pay Award and Q&A with GPC Chairman
The GPC have produced two online video clips with Laurence Buckman that are on BMAtv. The first deals with the 2009 pay award and the second is a Q&A with Laurence answering questions from GP members, including those on MPIG and salaried GPs. They are available through these links.

Bulletin 7
07.04 .09

Full DDRB Report
Last week we published guidance as to what the DDRB's recommendations meant for you practice. The report of the Doctors' and Dentists' Review Body (DDRB) has now been published.
You can view the full report by following this link.

Stamp Duty Land Tax (SDLT) guidance
The GPC has published general guidance on Stamp Duty Land Tax (SDLT) as it applies to GPs. SDLT is payable on transactions relating to UK land and buildings and although not all transactions involving GPs will be liable for SDLT, it is likely to affect an increasing number of practices in the future, due to the increasing number of practices occupying leasehold premises and the varying nature of the property market. Note that this guidance is not a substitute for individually tailored professional accountancy and tax advice and that GPs should always seek such professional advice when considering a transaction that may be subject to SDLT. You can view the guidance here.

National Complaints Procedure
As you will be aware, the new national complaints procedure came into being 1 April 09. On the same date the Care Quality Commission also came into being. People wishing to complain may choose to make their complaint orally, in writing or electronically to the PCT rather than the practice and there will now only be 2 stages to resolving complaints; local resolution at practice/PCT level and referral to the Ombudsman. Guidance on the new complaints procedure is available in a document titled ‘Listening, Responding, Improving: a guide to better customer care’.
You can view the document and supporting literature by following this link.

You can view the new complaints regulations here.

Bulletin 6

QoF Guidance 09/10
The QOF guidance for 09/10 has now been published. This is the third revision of the Quality and Outcomes Framework (QOF), which was introduced as part of the new GMS contract in 2004. Revisions to the QOF were made in 2006 and 2008 and, following a review of the evidence by the QOF expert panel, a further revision has taken place to commence from 1 April 2009. This includes a re-allocation of points to heart failure, chronic kidney disease, sexual health, anxiety & depression, chronic obstructive pulmonary disease, hypertension and diabetes. The guidance provides the detail to the initial agreement reached between the GPC and NHS Employers announced in October 2008. View guidance here. This is also available on the BMA website here

These changes are independent from the changes to prevalence which are to be introduced from April 2009. More detail on the prevalence changes is available on the BMA website here

What will this year's DDRB report mean for your practice?
Publication of this year's Doctors and Dentists Review Body (DDRB) report is expected very soon. This year's arrangements for translating any uplift recommended by the DDRB into practice resources are more complicated than in previous years. So, what will the DDRB's recommendations mean for your practice?
View guidance here.

Cleveland LMC FAQs/GP Reminders
We have had a number of questions on similar/related topics so have collated these into a simple 'reminders' list. Please take time to look over these to refresh yourself as the topics are very important.
Review reminders here.

Managing disputes with PCO's
Updated guidance is available to all BMA members by following this link.

Bulletin 5

Clinical DES for GMS contract 2008/09: guidance and audit requirements.
NHS employers and the GPC have agreed five new clinical DESs as part of the 2008/09 contract negotiations. These DESs focus on health and service priorities of the Department of Health that will benefit patients.

Focus on 2009-10 GMS Contract
The GPC reached agreement with NHS Employers (NHSE) in October 2008 to apply several changes to the GMS contract in 2009-10. This Focus On guide outlines each of these changes with particular emphasis on this year’s arrangements for contractual uplift. View the guidance here. This is will shortly be available on the BMA website

Freedom of Information Act (FOIA): Practice Publication Schemes
The Information Commissioner’s Office (ICO) started monitoring the new model FOIA publication scheme March 09. The LMC has not yet received guidance from the GPC or ICO. In the absence of this we have pulled together a few FAQs which we hope will be helpful. View the guidance here.

Bulletin 4
Patient Registration FAQs
Patient Registration FAQs have been produced to replace the 'Focus on Patient Registration' and update the previous FAQs. The document covers a range of issues including eligibility, ID provision, allocated patients and removal of patients. View the document here.

Bulletin 3
Focus on Salaried GPs
The Focus on Salaried GPs guidance has been revised, and incorporates guidance for salaried GPs on negotiating their salary and handling requests to change hours of work. View the guidance here. This is also now available on the BMA website

Bulletin 2
LMC Board Meeting Minutes
Minutes from the latest LMC Board Meeting held on Tuesday 17 February 2009 can be found by following this link. Click here.

GP Health
Information on GP Health which is available to all GPs and their partners/spouses, and all Practice Managers and their partners/spouses can be found by following this link. Click here.
Further details are available via their website www.gp-health.org.uk

Bulletin 1,
Statement of Financial Entitlements (Amendment) Directions 09
The Statement of Financial Entitlements (Amendment) Directions 2009 are now available on the DH website:
Their primary purpose is to introduce payment mechanisms relating to the five new clinical DESs relating to alcohol (new section 7H), ethnicity and first language recording (new section 7I), learning difficulties (new section 7J), heart failure (new section 7K) and osteoporosis (new section 7L).

There are also minor changes to some definitions in Annex A of the Statement of Financial Entitlements.

The GPC negotiators are discussing with the NHSE the problems associated with the delay in the publication of these Directions and we will keep you informed of any developments.

Appointment of Development Manager
Janice Foster joined the team at Cleveland LMC as Development Manager on Monday 12 January.
Janice has moved to the organisation from Sport England and has a vast background in business development, media, marketing, communications and customer relationship management.
Janice’s primary role is to build relationships and in time she will become a pivotal point for information in and out of the LMC with the overarching aim of improving service.  
Over the next few months she will take time to absorb the vast amount of information that is out there and will endeavour to meet as many people as possible to help to develop the role in the way that will best meet your needs. 
We value you views and are sure that this role will prove to be an invaluable addition to our services. 
You can contact Janice on 01642 737627 or janice.foster@middlesbroughpct.nhs.uk

 Pandemic Influenza
You will have seen publicity about pandemic influenza and the recently published guide for practices.   We are pleased to say that in Teesside is significantly “ahead of the game” on this.   Indeed, much of the guidance in the document has already been implemented in Teesside based on the “buddying” arrangements. Nevertheless, practices will wish to review the guidance which is available at:
This guidance is not written in the normal health service speak and is immensely practical and we commend it to you. This section cannot be concluded without paying tribute to a local Eaglescliffe GP, Simon Stockley, who has been intimately involved in the provision of the guidance.

LMC Elections
The LMC elections are taking place later this year and this will provide an opportunity for new people to get involved, as well as existing members to continue their contribution.   Anybody who is uncertain as to what the commitments and requirements are may wish to discuss this with their local representative. If anyone feels this would be inappropriate as they may be challenging their local representative, John Canning (John.canning@middlesbroughpct.nhs.uk) would be more than happy to provide the information.

 New Practices
The PCTs have announced that the new practices will be run by: 

Scheme No


Practice/Health Centre




GP led Health Centre

Assura Hartlepool LLP



GP Practice



Stockton on Tees Teaching

GP led Health Centre

Assura Stockton LLP



GP led Health Centre

Care Integration Partnership


Redcar and Cleveland

GP led Health Centre

Teesside Primary Care Community Interest Company

 The LMC will continue to work with all practices to ensure that GPs and general practice receive the recognition and support they require as the providers of the vast majority of medical care in the NHS.

Extracts from GPC - Sept 2008