LMC Bulletins

Bulletin 84


GPC & PHMC Joint Statement Public Health White Paper

The GPC and BMA Public Health Medicine Committee have published this guidance document on how both groups of clinicians can most effectively work together in the commissioning environment proposed in the NHS White Paper.

Bulletin 83


Tees Commissioning Event 2 (18 Nov) Scribe Notes

You can view the notes from each locality breakout group by following the links below. These notes are as recorded at the event to aid practices and have been kindly collated and provided by the PCT. The LMC will also be discussing these notes and considering next steps.

Hartlepool Notes
Middlesbrough Notes
Redcar & Cleveland Notes
Stockton Notes

Public Health White Paper

The White Paper on Public Health has been released along with a consultation document. You can view both documents here.

Practice Registered Patients List Cleansing

As you will be aware, a list cleansing exercise was recently undertaken across Tees by the NEFHSA. However, last month the Department of Health wrote to all SHAs asking them to work with PCTs, who in turn will work with LMCs, to carry out patient list cleansing exercises but to ensure that the process is sensitive to the many requirements being placed on practices at this time, and that due recognition is placed on the many demands on individuals’ time and expertise. PCTs have also been asked to make sure that they recognise the most vulnerable in this process: that those without a fixed address or with communication issues arising from language or literacy needs are not disadvantaged in the list cleaning processes.

GPC Sessional GPs White Paper Guidance

The GPC has published a new guidance document in its series on the NHS White Paper. The guidance outlines to sessional GPs the changes proposed in the NHS White Paper, explains how and why they could become involved in these changes, and discusses other potential impacts on the working lives of sessional GPs. The document is available here.

'Difficult to Obtain' Medicines List

All doctors should be aware that The Pharmaceutical Services Negotiating Committee publishes a list of medicines that pharmacies have reported having problems obtaining. This list is regularly updated and is available here.

Warning, Debt Collectors and Patients Confidentiality

We have been made aware of concerns (elsewhere in the country) that debt collectors have been contacting practices, pretending to be healthcare professionals, in order to get personally identifiable information about patients. If you have any requests of this kind or are suspicious of a request please notify the LMC.

Bulletin 82


Tees Commissioning Event (18 Nov) Presentations

You can view the presentations from the latest Tees Commissioning event by following the links below and we will circulate the feedback notes from each group as soon as they are in a readable format.

PCT Functions - presented by Celia Weldon

Finance, current position - presented by Audrey Pickstock

Many thanks to all who attended and made this another successful event on GP Commissioning on Tees. We hope that you found the event useful, feedback on the day was positive though it was suggested that we need to head towards locality meetings next time round and look again at the attendee list. If you do have any feedback on the event or any suggestions/comments for future events please do not hesitate to email them to janice.foster@middlesbroughpct.nhs.uk. The events we plan are for you and we want them to be of maximum benefit to you - to do this we need your views.

LMC Board Meeting November Minutes

The minutes for the November Board meeting are now available here.

GPC Sessional GPs Subcommittee Election Results

The results of the election to the GPC Sessional GPs Subcommittee for 2010-2013 have now been announced and the full list of members is available here. Congratulations to Rachel McMahon and Paula Wright who are your elected representatives for the North East. The subcommittee will hold its first meeting on 2 December.

Bulletin 81


GPC Guidance Documents - structure of GP-led commissioning and developing a shadow consortia

The GPC have produced two important guidance documents - they provide advice on the form and structure of GP-led commissioning consortia and developing a shadow consortia. 'The Form and Structure of GP-Led Commissioning Consortia' identifies a range of considerations regarding the discussions that will need to had locally, the relationships will need to built and the decisions that will need to made as this agenda moves forward. 'Shadow Consortia: Developing and Electing a Transitional Leadership' outlines a number of options that will need to be considered when developing the transitional leadership structures that will take shadow consortia forward. It also gives guidance on how to appoint the transitional leadership, giving information about elections, and selection / election processes. It would be beneficial for you to view these documents ahead of the GP Commissioning event on the 18 Nov to help inform discussions and focus your thoughts.

Two New White Paper Consultations Open for Comment

Both consultations close 14 January. Have your say!

'An Information Revolution' is about transforming the way information is accessed, collected, analysed and used by the NHS and adult social care services so that people are at the heart of health and adult social care services. 'Greater Choice and Control' explains in more detail the proposals which envisage a presumption of greater choice and control over care and treatment, choice of treatment and healthcare provider becoming the reality in the vast majority of NHS-funded services by no later than 2013/14 and seeks the views of patients, the wider public, healthcare professionals and the NHS.

LMC Guidance re Confidentiality and Security Policy Compliance - Cancer Screening Programmes

Practices will have received a request from the PCT with regard to completing confidentiality and security policy compliance paperwork linked to the Cancer Screening Programmes. The LMC believes that this is an unreasonable request given the governance/confidentiality procedures and policies that are already in place and adhered to. We consider practices may decline to complete the paperwork if they feel they wish to. We have taken this request to the GPC in order that it may be pursued at a national level as, it is understood, that this is the consequence of a request made nationally in the first instance. If you have any questions regard this, please do not hesitate to contact janice.foster@middlesbroughpct.nhs.uk.

Bulletin 80


NICE Guidance in General Practice

NICE have launched a new website to keep primary care professionals up to date with NICE guidance. It gives access to guidance during a consultation, steps to ensure a practice is up to date with clinical guidance and support for commissioners. NICE are accepting feedback on the site until 1 December. Further information available here.

Revalidation: The Way Ahead

The General Medical Council has published this response to their consultation on proposals for medical revalidation in the UK.

Bulletin 79


CQC Registration Reminder

We would like to remind NHS GP practices that they do not yet need to comply with Care Quality Commission standards. The registration window for CQC will open from October 2011 and NHS GP practices will need to be registered from 1 April 2012. Monitoring of compliance with the CQC standards will not commence until 1 April 2012. However, it is worth noting that PCTMS practices should be registered with CQC because PCTs needed to be registered from 1 April 2010. Also organisations that provide some NHS primary medical services but whose main purpose is to provide other services, such as private healthcare, social care or NHS acute services need to have been registered for all of their services from 1 October 2010.

The GPC in tend to publish ‘CQC for GPs’ guidance in the first quarter of 2011. This will explain registration and provide advice on compliance with the CQC standards with the aim of reducing the burden and bureaucracy for practices.

NHS Appraisal Toolkit Update

As you are aware, the DH contract for the provision of the NHS Appraisal Toolkit expired at the end of this October . The DH have written this letter to PCTs & SHAs regarding arrangements following the expiry of the contract. For your ease the MS Word version of the appraisal forms referred to in the letter are here. Locally, you should have received an email (which was sent out to all GPs) a little while ago, advising you that a return to a ‘manual’ system was anticipated. GPs should use an electronic template, not unlike the current Toolkit template, which can be emailed between appraisers/PCT appraisal team, with supporting information being presented ‘manually’ to appraisers. There has been discussion at a regional level over the adoption of a uniform template for appraisal, which Dr Lone has seen and commented on.

White Paper, BMA Resources and GPC Guidance

The BMA has developed a number of resources available to members to support further engagement on NHS White Paper proposals. This introductory letter from Hamish Meldrum contains all the links to access the resources. The series of guidance notes, produced by the GPC, to advise and inform practices and LMCs as to what the new proposals may mean for them, and what they should think about as they consider how they would be implemented are available here.

QoF, Achievement Data 09/10 and Indicator Diabetes 23

The QOF achievement data for 2009/10 was published this week. A summary of the results and full spreadsheets can be found here. Following on from an article published by GP Notebook on 30 September titled ‘Targeting Type 2 diabetes’, NHS Employers and the GPC would like to clarify that there have been no changes to the HbA1c targets for diabetes in 2010/2011. NICE published their menu of recommended changes on 3 August 2010 which included a recommendation to increase to the HbA1c target for DM23 from 7, as it is currently, to 7.5. In line with the new QOF process, this menu of recommendations is now subject to agreement through formal negotiations between NHS Employers and GPC on changes to QOF across the UK. Once negotiations have concluded, any changes to the QOF will be published by NHSE and the BMA and the QOF guidance will be updated and published on the relevant websites ahead of the new QOF year.

Delegation of GPC Powers to Sessional GPs Subcommittee

The GPC has changed its standing orders and formally agreed to delegate power to act on matters that relate wholly or primarily to sessional GPs to the GPC Sessional GPs Subcommittee. The delegation of powers will take effect from the subcommittee's first meeting of the session, on Thursday 2 December.


The SCR review is now complete and guidance from NHS Connecting for Health (CfH) has been sent to PCTs/SHAs. Currently, the main implications from the review are to GP practices that have created SCRs containing more than the core clinical information of medication, allergies and adverse reactions. As we understand, practices in Tees have only included core clinical information but if you have any concerns please contact the LMC or PCT. Further guidance will follow from NHS Connecting for Health for the practices concerned. In addition, constructive discussions are taking place around the practicalities of implementing the SCR Review recommendations and further communications/guidance will follow in due course. Until this guidance is forthcoming, we would advise practices to continue dialogue with PCTs but practices should not feel pressured to create SCRs.

Bulletin 78


Tax Relief on Pensions, update on changes

Following the publication in July of the discussion document entitled "Restriction of pensions tax relief: a discussion document on the alternative approach", the Government has now announced the changes that will take place for restricting pensions tax relief. The main points are:

  1. Annual Allowance reduced from £255,000 to £50,000 from April 2011.
  2. Lifetime allowance (LTA) reduced from £1.8 million to £1.5 million from April 2012.
  3. Deemed contributions to defined benefit schemes calculated using a simple "flat factor" method set at 16.
  4. Proposal that unused allowance from up to three previous years will be carried forward to offset against the excess contribution.
Further details on how the Annual Allowance test would apply on cases of ill-health have not been fully concluded yet, but it has been confirmed that exemptions will not be granted in cases of redundancy.

The Government has also announced that it will consult on options to give individuals and schemes more flexibility over the payment of these charges in November 2010, for cases where the tax charges incurred are unmanageable from current income. The Treasury’s paper, which includes a summary of the responses to the previous discussion document, can be read here.

The BMA, named in the list of respondents in Annex D.1 of the paper, are pleased to note that the original proposals have been toned down considerably and that relief has been granted to members who receive 'spikes' in pay. As suggested in the BMA response, unused annual allowance will now be able to be carried forward for up to three tax years which would mean that a Specialist Registrar, on qualifying as a Consultant, would in the vast majority of cases no longer face a tax charge of up to £25,000.

Even the highest earners in the NHS Pension Scheme are likely to avoid tax charges. The document confirms that the valuation factor for annual increases to pension against the Annual Allowance will be 16:1. This means that as long as an individual's pension accrual doesn't increase by more than £3,125 (£50,000 divided by 16) in a single tax year then they would not face a tax charge. The BMA will continue to monitor developments in this area and notify members accordingly.

QOF Indicators, Depression 2 & 3 Business Rules

In response to a number of queries regarding the business rules for Depression Indicators 2 and 3, NHS Employers has published a clarification here.

Real-time Patient Feedback to GPs

Six key findings from a pilot study into how real-time patient feedback could help GP practices to better understand patients’ views on services, identify opportunities for improvement and evaluate whether changes made in response are effective have been set out in the Best Practice Guide to using Real-time Patient Feedback. This Guide shows, using case studies, that it has had a positive impact on practices’ performance and patient engagement where it has been piloted.

Sessional GPs Subcommittee Elections

Ballot papers for elections to the sessional GPs subcommittee will be sent out on Tuesday 19th October. If you are a sessional GP and would like to vote, you should contact the BMA to update your contact details and ensure that you are registered with us as a sessional GP. You can do this regardless of whether you are a member. There are a number of ways in which you can update your details. You can use the BMA website:

- If you are already a registered member of the BMA website, log in, then click on "my details"
- If you are not a registered member of the BMA website, visit the homepage and click on "register"
- Alternatively you can email the BMA's membership and professional records department at membership@bma.org.uk or you can telephone the BMA's membership and professional records department on 020 7383 6595

Bulletin 77


Patients with Dental Problems

Patients with dental problems requesting a GP appointment because they have been unable to procure a dentist to treat them, seem to be on the increase. Doctors do not treat dental problems, however, treatment can be given for the pain. Having contacted all the PCTs, should a patient attend your surgery, apparently unable to find a dentist to treat them, please give them the contact number shown below:

To find the nearest dental practice taking on NHS patients in the Tees area, visit www.tees.nhs.uk or call the dental helpline on 0345 045 0620, or Text: 07700 380000.

If you need a dentist in an emergency, call 0845 603 3131. You will be given the next available emergency appointment at a dentist somewhere in Teesside.

You may wish to use this poster.

Hep B for Employment /University Related Matters

Unfortunately NHS regulations prohibit a GP practice in contract with the PCT from providing occupational health related Hep B vaccine on a private basis when funded by the patient. You may wish to provide your patients with a version of this template letter the LMC has developed. You will also wish to ensure a proper risk assessment has been carried out in such circumstances, and the LMC’s current advice is that this should normally be provided by an occupational health service provided by the person’s employer. Hep B must, of course, be provided when this is part of a treatment programme for an individual following an incident such as a human bite.

Performers List Responsibilities

There are a number of commitments doctors entered into when joining the Performers List. These include keeping the NEFHSA informed of home addresses and where you are working; informing the PCT of any criminal charges, convictions or cautions but not fixed penalty notices; informing it of any investigation of your conduct by the GMC any other professional body or another employer. Please ensure you notify Sue McGann at NEFHSA, 01325 553 071 or NEFHSA, The Old Exchange, Barnard Street, Darlington, DL3 7DR, of any change to your contact details. This is particularly important for locum GPs who may working in a number of practices.


Ensure your GMC/MDO subscriptions are up to date and that the organisations know your current address. Inadvertent slippages are often avoided by having Direct Debits rather than waiting for a reminder. GPs may wish to review subscriptions periodically and ascertain from their MDO, the services available to them in case of need to ensure it still provides appropriate and satisfactory services to meet their requirements.

Requests for Letters and Certification

Policy set out by the Cabinet Office in 2002 addressed reducing the unnecessary red tape and bureaucratic burdens placed on GPs such as reducing the levels of paperwork GPs have to contend with to ensure as much time as possible is used for patient care. This includes removing the need to provide certification of sickness when a student misses exams, certification for short-term sickness for employers and various letters from public bodies to confirm residency etc. There may be some instances when it is appropriate to respond to these requests e.g. clinical or child protection issues, but the majority can be politely refused. Please seek advice fro the LMC if you are unsure as to whether refusal is appropriate

Bulletin 76


9th Sept LMC/PCT Event - Summary of Facilitated Groups Feedback

We have now collated all the feedback gathered at the event. Thank you once again for engaging fully on the day, there were a lot of comments to work through. The LMC has tried to reflect the general feelings expressed and draw conclusions on taking commissioning forward on a single page for each question. The LMC summary can be viewed here. The PCT have provided a full copy of the information captured on the flip charts here.

If you would like to arrange a meeting with Janice to discuss any elements of the event or GP commissioning going forward please do not hesitate to call 01642 737 627 or email janice.foster@middlesbroughpct.nhs.uk.

NHS White Paper, BMA Response to Consultation

The BMA has published its response to the NHS White Paper ‘Equity and Excellence: Liberating the NHS’. This response sets out the BMA’s position on the key themes and overall direction of travel for the NHS described in the White Paper, as well as views on specific reforms and initiatives. A briefing page can be viewed on the BMA website and all of the associated documents and BMA responses can be found on the website here or by following the links below:

This report of a round-table meeting hosted by the GPC and attended by a range of national health organisations and local commissioning groups explores the White Paper commissioning proposals and identifies key issues for GP Consortia commissioning.

You may also wish to take time to listen to this interview with Hamish Meldrum on the implications of the White Paper via this BMA Podcast link.

Bulletin 75


9th Sept LMC/PCT Commissioning Event Papers

We are planning a follow up event mid November so please keep an eye on the diary dates. Below are links to all the http://www.mysurgerywebsite.co.uk/website/IGP367/files/supporting information to support the 9th Sept event. We hope to share a full summary of feedback from the facilitated groups next week but a brief overview of the outcomes shows:

Supporting Documents If you would like to arrange a meeting with Janice to discuss any elements of the event or GP commissioning going forward please do not hesitate to call 01642 737 627 or email janice.foster@middlesbroughpct.nhs.uk

WARNING, SCAM ALERT - European Medical Directory

A scam by any other name is still a SCAM! European Medical Directory letters are landing in practices all across Tees. The person they are addressed to vary (you may receive more than one directly to individuals) but the content is still the same - they want your money!! DO NOT SIGN AND/OR RETURN ANYTHING! You will know this scam as either European Medical Directory, Med1web or Novachannel.

Lansley Letter to GP re Commissioning

Andrew Lansley has written this letter to all GPs as part of the ongoing engagement with the profession on the White Paper proposals and to set out the next steps on commissioning. The letter discusses the responsibilities of GPs with respect to the commissioning proposals, the support GPs will receive and the organisational and governance arrangement of commissioning consortia. There has been no decision on the value of the management allowance, while the letter re-iterates that the size of consortia will not be determined centrally, and there is no pressure to form new arrangements at this stage.

Partnership Agreements

We make no apologies for mentioning this again as it is more important than ever as we move into the new age of GP consortia! We strongly recommend that GPs in partnership have a signed, written partnership agreement and seek legal and accountancy advice in doing so. Partnership Agreements reduce both financial and non-financial risk and provide a detailed framework on which the ongoing management and administration of the partnership can be based.

The BMA offers a partnership agreement drafting service exclusively for general practitioners. The service is provided by Neal Hooper, a BMA lawyer, offering high-quality legal advice and drafting, and can be accessed by calling 020 7383 6128 or emailing info.pds@bma.org.uk. To take advantage of the service at least one of the partners in your practice must be a BMA member. BMA members are entitled to the service at a competitive price of £1,500 plus VAT. Members can also take advantage of a fee of just £25 per annum plus VAT for the BMA to hold and store a final signed version of their agreement on behalf of their practice.

SFE Amendment on Learning Disability DES

The latest SFE amendment incorporates a minor feescale correction relating to the Learning Development DES (changing the fee from £50.87 to £51.08). This will have virtually no implications for GPs as it should only apply where the contractor: In addition this paragraph 7JA.25 payment is an aspiration type payment that is fully recovered when the annual payment is calculated at year end (it is a cash flow issue). We are informed by the DH that PCTs should have no difficulty in identifying these merged practices. This change will take effect from 1 October 2010.

Bulletin 74


NHS General Practice Workforce Census

We would encourage practices to participate, particularly this year , as it is important that accurate and complete information is available to inform the discussions on the implementation of the NHS White Paper and particularly GP led commissioning.The NHS Information Centre will be distributing templates to PCTs shortly and PCTs will then contact practices to ask for this information.

The GPC generally supports this annual census as a means of getting accurate information negotiators on both sides, to support negotiations in the coming year. This census (as at 30 September each year) is one of three which together deliver statistics on the total NHS workforce. The other two censuses relate to hospital and community health service staff in medical, and non-medical, roles. General practice workforce statistics in England are compiled from data supplied by or on behalf of around 8,200 GP practices. The NHS Information Centre for health and social care liaises with these organisations and their agents to encourage complete data submission, and to minimise inaccuracies and the effect of missing and invalid data. The general practice census aims to gather information on all practices and practice staff in England, including GPs. It delivers a detailed view of the workforce including staff type, headcount, full-time equivalence, age, gender, and country of qualification (in the case of GPs). It also delivers information on practice size (in terms of number of GPs, and list size). It has historically been published at the level of SHA and PCT. You can view recent census publications online.. The collection of information is rigorously vetted and controlled by the Review of Central Returns process which demands ministerial approval for any collection and specifically seeks to reduce the burden imposed on the service.

The majority of the information for the census is obtained automatically from the Connecting for Health / NHAIS / 'Exeter' GP practice re-imbursement system, the aim being to reduce the burden imposed on practices. The census has a number of uses, including workforce planning; planning and development of education and training; evidence to Doctors’ and Dentists’ Review Body (DDRB); policy development; monitoring changes in general practice provision (eg by contract type); parliamentary accountability (eg. in answering parliamentary questions); public accountability under the Statistics and Registration Act.

Occupational Health Advice Lines

The Department of Work and Pensions has set up two new types of occupational health advice line for GPs and small businesses in England, Scotland and Wales. One provides guidance to GPs on health and work issues affecting individual patients. The other provides support to small businesses on all occupational health issues, including those raised by the new Statement of Fitness for Work. Both services are staffed by qualified occupational health nurses. The two types of advice line have different contact numbers. The phone number for the occupational health advice line for GPs in England is 0800 022 4233 and the phone numbersfor the occupational health advice line for small businesses in England is 0800 077 8844. Further information available here.

Family Health Service Appeal Unit New Address

The Family Health Services Appeal Unit, responsible for determining contractual disputes between GPs and their PCT, now has a new address and contact details. These are:
1 Trevelyan Square
Boar Lane

Telephone: 0113 86 65500
Fax: 0207 821 0029
DX: 26416 Leeds Park Square

BMA 2011 Research Grants

The 2011 research grants will be available to apply for online here from mid-December this year. The application deadline is 11 March 2011.

The BMA was among the first of the professional bodies to award grants and prizes to encourage and further medical research. Today, around 12 research grants are administered under the auspices of the Board of Science, all funded by past bequests to the BMA. Grants totalling approximately £500,000 are awarded annually. Applications are invited from medical practitioners and/or research scientists and are for either research in progress or prospective research. Subject specifications for each grant vary. For example, in 2011, research areas range from rheumatism and arthritis, cardiovascular disease and cancer to asthma, social determinants of health and neurological disorders. A leaflet providing more information on the grants on offer in 2011 is available here. If you have any questions about the BMA research grants, or would like to receive alerts about them, please contact Evelyn Simpson at info.sciencegrants@bma.org.uk or telephone 020 7383 6755.

Bulletin 73


NHS White Paper, GP Consortia Commissioning: initial observations

The GPC has now published GP consortia commissioning: initial observations, which contains a set of principles and practical observations that GPs and LMCs should consider when beginning to explore how White Paper proposals should be put into practice. This is the fourth in a series of GP White Paper guidance papers. It can be found here

Follow up information, 9 September event; GP Commissioning in Tees

Many thanks to everyone who attended the event and ensured it was a success. The discussion groups were certainly active and there were a lot of valuable views and information collected. We will share this information once it is all pulled together along with plans on how we are now going to take this forward. An electronic version of the information contained in the packs along with the 2 presentations, the LMC questionnaire on commissioning and an additional 2sided brief on the White Paper has been sent to all practice managers to share with their GPs. If you have not received this please contact the LMC office. Janice Foster at the LMC will contact all the practices who were unable to send a representative to arrange a date to visit the practice and run through the information. If you would like to arrange a meeting with Janice to discuss any elements of the event or GP commissioning going forward please do not hesitate to call 01642 737 627 or email janice.foster@middlesbroughpct.nhs.uk

This is a very important time for the health economy and practices so it is vital that we hear your views and the LMC is more than happy to facilitate and assist however possible.

Reminder, Sessional GP Subcommittee Elections

The deadline for nominations for election to the GPC Sessional GPs subcommittee is Friday 17 September 2010 - please ensure that all sessional GP receive this message and are encouraged to respond if they are interested and have not done so already. Completed nomination forms should be sent to the GPC office to arrive by 5pm on Friday 17th September and if elected, candidates will take up their seats on the subcommittee in November 2010 and serve for three BMA sessions, until summer 2013. You can find out more about the elections and download a nomination form here

The subcommittee represents all salaried and freelance GPs. Major changes have been made to the subcommittee this year, following the report of the Sessional GPs representation working group. The subcommittee is now much larger, with sixteen members, instead of eight, it will meet more frequently, have an executive committee to handle day to day work, and will have a much stronger presence on the General Practitioners Committee (GPC).

Bulletin 72


NHS White Paper, GPC legal overview and guidance on commissioning

This guidance is an introduction to issues that GPs may have to consider in terms of legalities, education and training in preparation for the outcome of the current consultation on the White Paper.

Bulletin 71


NHS Appraisal Toolkit

DoH will be allowing their contract with SCHIN, the providers of the NHS Appraisal Toolkit, to expire at the end of October. We will inform you of the impact this will have on the process in Tees as soon as we have official confirmation from the PCTs. In the meantime, the Department have clarified with the GPC that up until 31 October 2010, users of the toolkit will be able to download their appraisal documentation from the system in Word (Forms 1-3) and PDF (Form 4) format. Following 31st October 2010, it is GPC understanding from the Department that users of the toolkit will still be able to request their data from SCHIN, and that SCHIN will not levy a charge for users to receive their data, irrespective of which appraisal system they have adopted. However, GPC also understand that accessing the data will take longer after 31st October as users will need to prove their identity to access their information and would therefore advise users of the toolkit to download their appraisal documentation as soon as possible.

NHS White Paper - GPC positioning statement

The GPC has published this statement outlining the principles of GP commissioning in the context of the White Paper. It is intended that these principles should be used to define policy, inform debate and negotiations, and ensure that good medical practice is enshrined within the changes proposed in “Liberating the NHS”.

QOF prevalence calculation 2009/10

The GPC has produced this Q&A document in light of the unexpected prevalence figures for 2009/10.

Cleanliness guidance

The National Patient Safety Agency (NPSA) has now published guidance on cleanliness in the NHS for primary care providers, which is aimed at helping primary care providers set up simple, easy-to-follow processes to ensure that their premises are clean and safe. Using these specifications is not mandatory, but may be a useful guide for providers and may help towards registration with the Care Quality Commission (CQC) from April 2012. The NPSA has also produced this Q&A which explains the how the cleanliness specifications work.

Community Services, GPC Focus on the NHS Standard Contract

In April 2010 the NHS introduced a standard contract for acute, community, ambulance and mental health services. The contract is designed to cover agreements between PCTs and all types of providers that deliver NHS funded services. This guidance note is designed to alert GPs to what this change will mean in practice.

Bulletin 70


Patient Group Directions and Patient Specific Directions

The GPC has reviewed the complex legislation surrounding the administration of medicines and has clarified the advice on the use of Patient Group Directions (PGDs) in general practice. This guidance can be viewed here. Please note: this guidance will be updated as and when further issues are raised

New vetting and barring scheme, GPC guidance for GPs

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

Advice relating to longstanding Cervical screening issues

The GPC have created an advice note to address a number of longstanding issues relating to cervical screening following a recent meeting with Professor Julietta Patnick, Director of NHS Cancer Screening Programmes. Covering topics such as vault cytology, re-training requirements, smear processes/programmes and QOF indicators, this note is available from janice.foster@middlesbroughpct.nhs.uk on request.

Sessional GPs Subcommittee Elections

Nominations are now open for election to the GPC Sessional GPs subcommittee. Please pass this on to all your sessional GP colleagues. The subcommittee represents all salaried and locum/freelance GPs. Major changes have been made to the subcommittee this year, following the report of the Sessional GPs representation working group. The subcommittee is now much larger, with sixteen members, instead of eight, it will meet more frequently, have an executive committee to handle day to day work, and will have a much stronger presence on the GPC. Completed nomination forms should be sent to the GPC office to arrive by 5pm on Friday 17th September and if elected, candidates will take up their seats on the subcommittee in November 2010 and serve for three BMA sessions, until summer 2013. You can find out more about the elections and download a nomination form here.

Bulletin 69


Health White Paper

You can keep up to date with BMA summaries and thoughts on the White Paper here.

There is still a lack of important detail around the White Paper and whilst it is beneficial to open dialogue and explore ideas with as many stakeholders as possible both the GPC and LMC strongly urge GPs to resist forming any firm agreements at present. Please bear in mind that the ideas presented in the White Paper are still at consultation stage. Please do keep the LMC informed of any debates/discussions you are planning as we would like to attend as many as possible to get a greater understanding of the true feelings amongst Tees GPs and assist/advise where possible/relevant. Please do not hesitate to contact Janice at the LMC if you would like to discuss any of the above further.

Bulletin 68


Consultation Documents, Health White Paper

The White Paper mentions a number of consultations due to take place. Four of these are now open for input:

Transparency in outcomes - a framework for the NHS consultation

Increasing democratic legitimacy in health

Commissioning for patients

Regulating healthcare providers

The above consultations close 11 October - ensure you have your say. Even if you do not respond it is well worth reading the consultation documents as they provide a little more detail around the proposals in the White Paper.

The White Paper and all the associated implications it brings is taking some time to understand, not least due to the lack of important details and the many questions it raises. There are many discussions going on in Tees across a number of groups to capture initial thoughts as to how Tees practices can respond. The LMC is working as closely as possible with as many people as possible to try and ensure a coordinated approach which is going to be critical to success, whatever the implementation model we take forward. Please do keep the LMC informed of any debates/discussions you are planning as we would like to attend as many as possible to get a greater understanding of the true feelings amongst Tees GPs. As mentioned before- we are keen to hear from all practices of suggestions/comments on how we can progress in Tees and also from any practices who would be interested in working with the LMC and PCT in exploring ideas. Please register your interest or forward suggestions/comments to Janice at the LMC . Please do not hesitate to contact Janice if you would like to discuss any of the above further.

Revised Tax Guide Following Emergency Budget

Following the announcement of the emergency budget on 22 June, specialist accountants have now reviewed the Focus on new tax bracket guidance. The previous advice about superannuation has been removed as it is no longer applicable, as well as the spreadsheet illustrating how the tax could affect income for the year 2009-10 as it is out of date. Otherwise the guidance remains the same and we would urge practices to seek advice where necessary from an accountant. The revised guide is available here.

DWP DBD36, DS1500 Forms and GP Factual Reports

DWP's Pension, Disability and Carers' Services (PDCS) would like to make GPs aware of changes to and information regarding DBD36 forms, GP factual reports and DS1500 forms. Full details can be accessed here.

Bulletin 67


The Health White Paper

The BMA have now produced a helpful summary of the White Paper available here. You can also view the White Paper in full here.

I am sure you will have picked up the various news stories with regards to the implications of this document. Without a doubt there will be major changes ahead in terms of the way we work but there are also some major opportunities so it is important that practices in Tees embrace the changes. Remaining the same is not an option.

The LMC is currently examining the Paper in detail to gain a greater understanding of how we can progress. We will work closely with practices to support them through the transition period and develop the infrastructure required to succeed. We will also work closely with all PBC Groups in Tees as there is a great deal of experience and expertise from which we can learn and share to help consolidate and coordinate possible commissioning approaches. A coordinated approach across all practices in Tees is going to be key.

The LMC has already begun to work more closely with the Teeswide PCT, but the White Paper has highlighted the need for working together. This approach is going to be crucial as we will need to develop as a team in approaching the challenges to best meet the needs of patients and to maintain high quality health care in Tees. We will keep you updated on developments.

We are keen to hear from all practices of suggestions/comments on how we can progress in Tees and also from any practices who would be interested in working with the LMC and PCT in exploring ideas. Please register your interest or forward suggestions/comments to Janice at the LMC. We have also directly contacted the PBC Groups to ensure they are an integral part of the joint working. Please do not hesitate to contact Janice if you would like to discuss any of the above further.

The White paper mentions a number of consultations due to take place. The first of these is now open: Transparency in outcomes - a framework for the NHS consultation is now available for access and input here. The consultation closes 22 October - ensure you have your say.

SCR - position on Tees, FP69s and GPC stance

We wish to clarify our position on the SCR. The LMC is aware that the GPC considered the recently published evaluation report of the Summary Care Record (SCR) by UCL and passed the resolutions shown below. The GPC and LMC both believe that it is for individual practices to decide whether they wish to proceed with uploads to the SCR.

In making their decision practices will need to be satisfied that:

  1. they are content that their patients have been adequately informed
  2. that they believe that they have received adequate training for uploads
  3. that they believe that their data is fit for sharing.
We hope this information is helpful. If you have any questions please contact the LMC office on 01642 737 744 or email Janice at the LMC office.

Where practices participating in SCR uploads have received FP69s from their PCT due to undelivered PIP (Public Information Programme) letters, they should also have been advised to flag the records affected as “not for upload” until processing has been satisfactorily completed.

The GPC resolutions are:

That GPC believes that, after consideration of the UCL Report in respect of the Summary Care Record (SCR) in England:
  1. the clinical benefits are insufficient to justify continuation at present, particularly at a time when patients are being denied proven clinical services on the grounds of expense;
  2. the clinical benefits are insufficient to justify the creation without fully informed explicit consent;
  3. the clinical benefits are insufficient to justify GPs consenting to the upload of data on behalf of patients who have not expressed consent;
  4. the creation of SCRs in England should be halted until the full review of the model, and other models, has taken place to address cost-effectiveness and the need for informed and explicit consent of patients.
The GPC believes that in view of the risks to patient safety caused by the failures of SCRs to be reliably and consistently updated, access to existing SCRs should be immediately suspended by the government until all patient safety issues have been fully investigated and satisfactorily resolved.

Scam Alert- City Map Town Map

We have heard of another scam that is currently operating. Practices have been contacted by a company called City Map Town Map who advised them that their 'free' online advertising trial period was due to end and that they needed to sign a disclaimer to be 'released' from the 'contract' the practice had agreed last year. In actual fact it appears practices may be signing up to £1697 of 'advertising'. The company is also following this up by telephone, firm in wanting their 'disclaimer' (which is actually an order form) signed and faxed back. This scam is currently operating in Scotland but the company is based in Europe and it is only a matter of time before it spreads wider. Do not sign anything or part with any money.

Bulletin 66


Tees Confidential Deaths Inquiry Process

Just a quick note to reassure practices that the inquiry to address the high suicide rates in Tees as mentioned in Bulletin 63 (22/6/10) will not lead to duplicate work for practices. You will be aware that there is an on-going request (coordinated by Denise Colmer) made to GPs to complete an audit proforma each time a death by suicide or undetermined injury is identified. This work will continue but the PCT are aware how busy practices are so they will select the cases that are to be examined in more detail through the new Inquiry Process and will ensure practices only receive the relevant form to complete - be it the new form or the existing form you are familiar with. In short, you only need to complete one form and the relevant form will be sent to you.

QoF Business Rules

Version 17 of the QOF business rules have been published here.

QMAS 09/10 Achievement Calculation - sexual health

This note from Connecting for Health addresses errors in the calculation of QMAS sexual health indicators.

Sessional GPs Newsletter

The Sessional GPs Newsletter, Summer 2010 covers a number of topics including GPC Sessional GPs Representation Working Group report, Salaried GPs’ Pay, BMA Salaried GPs’ handbook - 2010 edition, Revalidation and Locum GP pensions .

Kings Fund Inquiry into Quality of General Practice

As the initial results become available the King’s Fund is very keen to gather the personal views of the profession on the research they have commissioned, so that they are able to frame their ideas for the final report. Details of the reports that have been published to date are below; the King’s Fund would welcome your comments and feedback. There is an on-line resource page here:

Continuity of care
Diagnosis and referral
End of Life care
Therapeutic relationships

Bulletin 65


SCR Update following BMA ARM

Following the publication of the UCL evaluation and the ARM debate about SCR, the GPC position is that Public Information Campaign (PIP) and uploads should be suspended. GPC do not believe that practices should feel pressurised by PCTs into participating in uploads to SCR. GPC have written to the Minister requesting a moratorium and await his reply.

Eligibility for QoF PE7 & 8 Easements

By July 30, the ImmForm programme team had archived the swine flu vaccination data from October 09 to February 10 to free up storage space on the ImmForm system. This means that the vaccination data for this period will no longer be accessible to practices (although it will remain available to the PCT). The March data, which will still be available, is cumulative so includes the uptake figures from October - February. The March data will remain accessible until the end of October 2010 at which point the data will only be accessible via PCTs and SHAs.

In the event that a practice is disputing their figures, a copy of the extraction reports could be useful, and as such the practices should save a copy of the report on their internal system to ensure they can access it in the future if necessary. This letter has been sent from the DH to SHAs/PCTs to outline this.

Bulletin 64


SCR Tees Drop-in Sessions

NHS Tees are running a number of drop in sessions for patients to help enable them to become more informed with regard to the Summary Care Record. The meeting dates and information can be viewed here. If you would like further details on SCR or would like to arrange a meeting/consultation/drop-in session for your practice please contact ruth.atkinson@middlesbroughpct.nhs.uk who will be able to help.

Breast Cancer Care Research Project

Breast Cancer Care is looking for GPs to help shape one of its services for people who have come to the end of active treatment for breast cancer. This press release contains further details, including how to get involved.

DH Spending Challenge Consultation

A major public engagement exercise was announced today to help shape the forthcoming Spending Review. NHS staff are hugely involved in this process and the Prime Minister, David Cameron is asking for them to share their ideas on how we can rethink public services to deliver more for less. An engagement programme is being run from 24 June to 9 July to collect ideas on how the Government can deliver services more efficiently while maintaining and improving quality. This website has been specifically set up to gather up these ideas, with every serious idea being considered by government departments, the Treasury and by teams at No 10 and the Cabinet Office.

GP Trainee GPC Elections

Nominations are now open for regional representatives to the GPC GP Trainees subcommittee. Please tell any GP trainees you know to visit www.bma.org.uk/gptraineeselections to find out more about the election process and what being a member of the subcommittee involves. Even if they are not considering standing for election, they should visit the site to make sure they are registered to vote

Bulletin 63


Focus on New Tax Brackets

The “Focus on new tax brackets” guidance has been revised and a spreadsheet added which illustrates the financial implications of taking on a salaried GP. Please also note the addition of the Mazars LLP letter report and the General Practitioners Defence Fund Limited (GPDF) disclaimer, both of which are integral to a proper understanding of this guidance and of its accompanying schedules, which are presented for illustrative purposes only. Note that this guidance may have to be revised again after the emergency budget has been announced on 22 June.

Patient Survey and Calculating Eligibility for QOF PE7 & PE8

Full details of the Patient Survey results can be found here. PCTs will now use the patient access data in the survey for calculating practice payments under the QOF. As part of the H1N1 vaccination DES, those practices that meet the minimum target for vaccinations will receive a 10 per cent drop in the upper - and 20 per cent in the lower - thresholds in PE7 and PE8. Practices should be aware that the ImmForm Swine Flu data extraction programme, which has been used to assess uptake levels for the QOF easements, calculates the denominator on the age of the eligible patient population at the date of extraction, rather than the age of the patients at the time of vaccination. This is likely to have a minor impact on the number of patients in the six months age range because those who were previously not eligible, will now appear as eligible. This is not expected to be a large number and will mainly impact on those practices that are close to the 50.7 per cent target. Practices who do not believe that the figures are an accurate reflection of their eligible patient population can, with the agreement of their PCT, perform a manual calculation to work out if they have qualified for the patient experience easements. Practices can use the data extraction report as a template to perform this calculation. An example of the report and details of the formula to be used, are available in annex 4, page 15 of the H1N1 vaccination DES guidance, available here.

Tees Suicide Prevention & Confidential Death (Suicide) Inquiry

In order to address the high suicide rates in Tees (some of the highest in the country) the PCTs have appointed David Robinson in a new role of Confidential Deaths Inquiry Coordinator (Suicide). David will carry out confidential inquiries into suicide and undetermined deaths for the Tees wide area and be the single point of contact for you on this area to aid a coordinated approach to improving this terrible issue in Tees. We urge practices to work with David as there will be real benefit for everyone in understanding these deaths better. The purpose is not to repeat an inquest but to understand more so interventions can be put in place to help prevent it from happening again. You can follow the links below to a number of PCT documents providing background on this and you will find a sample questionnaire here. We appreciate that the questionnaire does appear long but can reassure that we are talking very small numbers and not all sections need to be completed so it should not be too onerous. David will be contacting Practice Managers shortly to provide further details and discuss resources to support practices with this. He will then work with Practice Managers on an individual basis when a specific case comes up as some practices may (hopefully) never have a case that touches on this.

Interim Seniority Figures

Please note that the Technical Steering Committee has published the Interim Seniority Factors for GMS GPs in England for 2010/11. The figures are £95,802 for England. Further details are available here.

National Diabetes Audit

The National Diabetes Audit Executive Summary and the Paediatric Report are available here. This will be the fourth year where an automated data extraction is available to gather data for the audit. As in previous years, the audit keeps identifiable data to a minimum and has NIGB Ethics and Confidentiality Committee approval to hold and link patient level data (using NHS number). All the analysis is produced at aggregated level for GP practice, PCT or SHAs. As part of the extract process the Information Centre will write to every GP practice to let them know that the audit extract will be taking place, how to participate without the automated extract and the key dates for the audit period. Practices should expect to receive this letter shortly.

Pandemic Flu, CMO '1 Year on' Letter

The Chief Medical Officer has sent this letter to the profession reviewing the H1N1 influenza pandemic a year after the first cases were reported.

Vetting & Barring Scheme Update

This update will provide further update on the halted vetting and barring scheme and explains the impact on CRB check and a proposed revised time scale. As updated last week- you DO NOT need to register new employees with the scheme as previously directed. However, you DO still have a duty to inform ISA if you have any concerns about an individual and you DO still have a duty to ensure that new employees are not included on the barred list and you need to carry out the CRB checks prior to employment.

Bulletin 62


Distribution of Pay Uplift Across GMS

We are sure you will have seen the details around the distribution of the gross 0.8% uplift for 2010/11 across GMS but for clarity it is outlined below. The methodology recommended by the DDRB will be used to distribute the 0.8%. Application of this methodology translates into an uplift of 0.41 per cent for the Quality and Outcomes Framework (QOF) and 0.41 per cent uplift to enhanced services and locum payments. The weighted price per patient will increase from £63.21 in 2009/10 to £64.59 in 2010/11. In England, payments inclusive of these uplifts will be made to practices from 1st July and backdated to 1st April 2010.

Focus on DHs Improving GP Services

Following the publication in January 2009 of the document ’Primary and Community Services: Improving GP services’ by the Department of Health (DH), the management of GP contracts in England has changed, with a new role for PCTs. This ’focus on…’ document looks at the way that PCTs are being encouraged to assess practice performance and how GPs/LMCs can influence this process, the use of balanced scorecards, how PCTs have been advised to manage all primary care contracts, as well as the opportunities that the changes present for GPs.

BMA Law - Federations & Business Structures

There has been much talk about practices working as federations and in new business structures. As a response to this BMA Law are offering assistance to practices to aid understanding. This assistance includes the offer to attend practice meetings free of charge to answer questions. This special BMA Law bulletin provides more details.

Patient Choice of GP Practice Consultation

Please be aware that the national online consultation looking at how to give patients greater choice as to which GP practice they register with has been extended until 2 July 2010. If you or your patient group/forum has not yet responded to this you may wish to consider doing so. The consultation can be accessed on line here.

Bulletin 61


European Medical Directory Scam

WARNING - it's here again! We have had reports, locally and nationally, that there is another round of circulars from the European Medical Directory/Med1web/Novachannel scam. What ever it is calling itself this time round it is the same wolf in sheep's clothing. DO NOT SIGN ANYTHING! It will cost you!

Employment Contract Reflecting ISA Registration

As of November 2010 it is mandatory for all new clinical staff (GPs, HCA, Nurses) employed by practices, directly or through an agency e.g. locums, phlebotomists, to have ISA registration to comply with the vetting and barring scheme. In preparation for this we would suggest practices may like to consult their professional advisors to ensure that there is a clause written into all employment contracts to cover ISA registration. This should extend to contracts/agreements covering the use of agency provision to ensure staff through this route also comply. Amending contracts can take some time due to the staff consultation requirements so it is advisable to think about the implications and start the process now. Further details on the vetting and barring scheme and ISA registration can be found here and in this useful FAQ.

NICE Topic Selection Panels

The National Institute for Health and Clinical Excellence seeks new professional members for its Topic Selection consideration panels. This panel invitation letter from NICE provides more details.

BMA/GPC Sessional GP Report

The GPC's Sessional GPs Representation Working Group, set up to review the representation of sessional GPs at a national and local level, has published its report which can be viewed here. To inform its work, the working group also commissioned an extensive research exercise, taking in the views of sessional GPs, LMCs and other external organisations. The report recommends a number of reforms to the way in which sessional GPs are represented within the GPC. These are as follows:

Bulletin 60


Striking a Balance, GPC Consultation

The GPC "Striking a balance" consultation asks how, especially in the context of the current economic climate and increasing demand for services, General Practice can be protected, developed and strengthened in line with patient, public and GP priorities. Please forward this consultation to your patient participation groups. The consultation website is www.strikingabalance.org.uk and a pdf copy of the consultation can be downloaded from here.

CQC Registration - prevention and control of healthcare associated infections

CQC registration will apply for NHS GPs from April 2012. However, in some areas (though we have not been alerted to this in Tees) PCTs are telling practices that, because of CQC, they must fully comply now with the Health and Social Care Act 2008: Code of Practice for the NHS on the prevention and control of healthcare associated infections. There is an ongoing consultation on how the Code of Practice will relate to primary care but at the moment it is guidance only and it is not yet necessary to fully comply.

Pension Contributions

In 2007, the GPC agreed that for the year 2008/09 there would be a one off arrangement between the Department of Health and BMA that GP tiered contributions would be based on their 2006/07 pensionable pay as declared on their annual end of year 2006/07 certificate regardless of what they actually earned in 2008/09. Further details on this tiered contribution system are available here.

NICE Skin Cancer Update

Please note that the NICE skin cancer guidance update has now been published. Cancer service guidance – skin tumours including melanoma (2006) & Skin cancer partial update (2010) documents can be viewed here.

Bulletin 59


Notification of Infectious Diseases

Under the Public Health (Control of Diseases) Act 1984 (as amended), GPs are required to notify the proper officer of the local authority when they have reasonable grounds for suspecting that a patient:

There was previously a nominal fee set out in the Act for such notification, however this fee has now been removed by recent regulations. Nevertheless, GPs must still continue to notify. The BMA was consulted on the removal of the fee and objected to it. However, the legislative change was made.

The Claire Wand Fund

The Claire Wand Fund is a trust working to provide grants for research and the further education of doctors working in general practice. Grants can be given towards the cost of administrative assistance, for stationery costs, conference fees, dissemination of information and travel costs if the project cannot be undertaken in the UK. Awards are generally granted for sums up to £2,000 and trustees meet in May and December to consider applications. To apply please contact the Secretary, Mrs Jane Cope, Claire Wand Fund, BMA House, Tavistock Square, London WC1H 9JP. Email: Clairewandfund@bma.org.uk.

Bulletin 58


Medical Notes for Students Missing Examinations

The GMC has recently written to Ofqual informing them that GPs are not required to write letters in support of special consideration applications for students taking examinations. Ofqual has informed all examination centres of this and JCQ regulations for 2010/2011 will be amended to reflect it. Medical notes should not be required as a matter of routine but the circumstance in which students might ask their GP to provide confirmation of illness and further details are available here.

Bulletin 57


SCR Statements (update)

Statements have been released by the BMA and DH (to SHA) to update all involved on the current stance with regard to SCR. They can be viewed here: joint BMA/NHSE statement, statement/letter to SHAs

GP Patient Survey Update

This update aims to explain the results process for the 2009/10 GP Patient Survey, directing practices to sources of information and helping to prepare for the release of final survey data for this year.

Learning Disabilities DES Guidance

The DH has published guidance on the LD DES which is available to download here. Following the introduction of the LD DES, the GPC requested that NHSE and the DH provide further guidance on the DES to assist with implementation. Unfortunately, although the guidance answers some of the concerns, many outstanding issues remain. The DH guidance has failed to address concerns about the ambiguity in interpretation of the DES, the scope for room for unacceptable local variations in its implementation and the resulting potential for disagreements between GPs and PCTs to arise. GPC has written to Anne Williams, National Director for Learning Difficulties at the DH to raise these issues.

Bulletin 56


H1N1 Vaccination Agreement Q&A Update

The joint GPC / NHSE document, "Question and answers – the swine flu (H1N1) vaccination agreement", has now been updated and includes guidance on calculating the vaccinations uptake for the purpose of receiving patient survey threshold easements. It is available here.

Bulletin 55


Revalidation Consultation

1 March the GMC launched a consultation on its proposals for how revalidation will work in practice and on 31 March launched a consultation toolkit to help local groups of doctors have their say on GMC plans. The toolkit, which is web-based, can be found at here; where you can find out more information about the consultation and download a consultation document. If you have a question about the toolkit, please email thewayahead@gmc-uk.org. The GMC hope you find the toolkit helpful and look forward to receiving your views on their proposals. They do want to hear from as many doctors as possible as the feedback they receive as part of this consultation will help further develop plans for revalidation.

H1N1 for Travel

A reminder that GPs can generally charge patients for administering an H1N1 vaccine in connection with travel abroad and there is no funding available through the PCT for H1N1 purely for travel purposes -unless the patients are:

and you are participating in the DES or LES then no charge can be made. Patients in these groups should receive the vaccination free of charge in accordance with the directed enhanced service or in accordance with the local agreement even if their request is related to travel abroad.

Vaccinations and Immunisations National Support Team Visit

The Vaccination and Immunisation National Support Team (VINST) will be visiting our area Teesside on 5, 6 and 7 May and this is your opportunity to ensure the GPs voice is heard with regards to vaccs & imms in across Tees.

Their remit is to support improving the immunisation uptake to help deliver the public health, Public Service Agreements, local targets and vital signs. As you can imagine it is important there is a partnership approach locally to be successful in achieving immunisation targets, therefore the PCT are inviting practice managers, GPs and practice nurses to take part in a focus group 9 - 11am, Wednesday 5 May at the Education Centre in Norton.

The purpose of the visit is to identify opportunities and provide support to enable the delivery of the immunisation targets.This support visit from VINST takes the form of a local visit by a team of experienced practitioners to look at the processes, policies, strategies and also the opportunity to speak to individuals who can influence the immunisation rates on Teesside.

Please contact Wendy Francis (wendy.francis@northteespct.nhs.uk) or Bette Simpson (bette.simpson@northteespct.nhs.uk) if you are able to attend. We appreciate the difficulties in managing surgery time but it really is important that we get the practice voice heard at these events when we get the opportunity.

Bulletin 54


Summary Care Records (SCR)

The GPC has received an assurance from the Department of Health that the upload of the Summary Care Record in PCTs subject to accelerated roll-out will be suspended. The Department of Health informed the GPC that records will not be uploaded in PCTs subject to accelerated roll-out until there is greater public and professional awareness. The committee is very pleased that Connecting for Health has listened to its concerns and welcomes the decision to suspend uploads. The GPC will be working with the Department of Health in future to ensure that GPC’s concerns about the Summary Care Record continue to be listened to and addressed. Press release.

Bulletin 53


H1N1 Flu Line

Please can you ensure all posters and material which direct patients to the dedicated Swine Flu website/phone line are removed from your practice as this is no longer in operation and is confusing for patients. Apologies if you have completed this already but the SHA want to ensure this has taken place.

General Practice and Community Pharmacy Guides

NHS Employers, the General Practitioners Committee (GPC) and the Pharmaceutical Services Negotiating Committee (PSNC) have produced two guides to support GPs and community pharmacists in developing more effective working relationships. This covering letter introduces the guides which are available on-line only and can be accessed here.

The guide to pharmacy for GPs is designed to increase awareness of the work of community pharmacies and to encourage joint working. You may also find it beneficial in educating trainee GPs about community pharmacy. The second guide provides an overview on general practice for community pharmacists. The guides, on the work of community pharmacists and GPs, cover the following areas:

Following a joint letter last year, practices are also encouraged to meet their local pharmacy colleagues to discuss ways in which you may be able to work together to enhance patient care. If you have any comments about the guide, please email pharmacy@nhsemployers.org.

NHS Leadership Awards

The NHS Leadership Awards are in their second year, and aim to recognise outstanding leadership talent in the NHS today. They are aligned with the National Leadership Council which was created to underpin, and champion the new priority attached to leadership in the NHS. The nine categories for the 2010 awards are: All of the awards recognise individuals, with two exceptions, the NHS Partnership Award of the Year, which is open to teams, public and private partner organisations, stakeholders etc.; and the NHS Board of the Year, which is open to executive board and trusts. The call for entries is now open, and close on 28 May 2010. It is open to everyone working for, or on behalf of, the NHS in England. Nominations are peer-to-peer.

Fit for the Future; The Evolution of General Practice

The General Practitioners Committee has published a 50-point plan for the future of general practice in the UK. Fit for the Future: The Evolution of General Practice sets out the committee's current thinking on a number of policy areas, including out-of-hours care, quality and outcomes framework, workforce and IT. You can read more and access a podcast from Laurence Buckman on the issues raised here.

Dynamising Factor

The NHS Pensions Agency has produced new figures for the dynamising factors in 2009/10. They are available here.

Bulletin 52


GPC Annual Report

This year's GPC Annual Report is available to view here.

NICE Consultation, New QOF Indicators

NICE have launched a consultation on thirteen possible new indicators including mental health, diabetes and palliative care in QOF and are seeking views on implementation challenges, possible unintended consequences and impact on health inequalities. The deadline for comments is 11 April 2010. Comments received during the consultation will be considered by the independent Primary Care QOF Advisory Committee in June along with the results of the pilot which saw the testing of potential new indicators across a representative sample of general practices. NICE will then publish a menu of recommended 2011/12 indicators in August which will feed into negotiations between the GPC, the Department of Health and NHS Employers. You can view and respond to the consultation here.

Bulletin 51


Extended Hours DES 2010 and DES Directions 2010/11

As previously reported, the GPC and NHS Employers have agreed that the extended hours access scheme will continue for a further year from 1 April 2010. The main change from the existing arrangements will be that practices will be required to indicate by 30 June 2010 whether they are proposing to participate in the new extended hours access scheme (or equivalent local arrangements) in 2010/11, so that PCTs are clear early in the financial year which practices will be involved. PCTs must, before 30 April 2010, offer all existing GMS and PMS contractors in their areas the opportunity to enter into arrangements for extended hours access under the DES Directions. Contractors that wish to participate in these arrangements must submit a written proposal to the PCT within 28 days of the PCT’s offer to enter into arrangements under the DES Directions. Where possible, PCTs must enter into these arrangements with practices before 1 July 2010. PCTs will not normally be obligated to enter into extended hours access arrangements after 30 June 2010 (exceptions are set out in the Directions). However, PCTs retain the discretion to do this if they wish. Any agreement made under these DES Directions will last until 31 March 2011.

Extended access to GP services remains a priority of the English government. The DH has made it clear that PCTs should try to maximise the number of practices offering extended hours access and is keen that PCTs commission additional appointment times in line with patient preferences as expressed through the GP patient survey. Once PCTs have established which practices will be involved in the scheme, they are expected to commission alternative arrangements for patients whose practices are not involved in the DES or equivalent local arrangements. PCTs will be advised to use the balance of the funding available for extended opening to commission these services from other GP practices already participating in this initiative, GP health centres or out-of-hours providers.

There is obviously a risk in this policy of further fragmentation of routine patient care, especially as information sharing between practices is far from straightforward. The reality is that consultations taking place outside a patient’s normal practice may be limited for practical reasons to treatment of minor illness.

The new Directed Enhanced Services Directions for 2010/11 are available here along with the associated SFE amendment; coming into effect 1 April 2010.

Practice Boundaries Survey

The Department of Health has released a public consultation on its proposal to remove boundaries from general practice. We would encourage practices and individuals to submit a response, online here. The GPC set out its views on practice boundaries in this position paper in January and will submit a response based on the ideas it contains.

H1N1 Vaccination for travel use

Practices should have received this letter informing of provision of the H1N1 swine flu vaccine for protection of travelers to Southern Hemisphere countries from Professor Salisbury, Director of Immunisation at DH. Practices can use their existing stocks of H1N1vaccine as a travel vaccine for members of the public intending to travel to the Southern Hemisphere during their influenza season. GPs are able to charge patients for administration of the vaccine and GPs can set their own rates for this service.

Note the paragraphs in the appendix which state that:
Whilst GPs can generally charge patients for administering an H1N1 vaccine in connection with travel abroad, if the contractor is participating in the Swine Flu directed enhanced service or any local enhanced service that provides for a payment in relation to an H1N1 vaccination, no charge can be made to:

Patients in these groups should receive the vaccination free of charge in accordance with the directed enhanced service or in accordance with the local agreement even if their request is related to travel abroad.

Revalidation, GMC consultation document

The committee discussed the GMC Consultation Revalidation: The Way Ahead, which was published on 1 March. The consultation sets out the GMC's view on how revalidation will work in practice. The BMA will be responding to this consultation in due course.

Locum GP Pension Contributions

This is a reminder of the importance of practices paying locum GPs for their work as quickly as possible, thus enabling them to pension their income. The GMC are aware of anecdotal evidence of PCTs increasingly enforcing the rule whereby locum GPs engaged by GP practices have a ‘10-week window’ in which to pension their income. Practices not paying locum GPs within this timeframe can lead to locum GPs missing this contribution deadline.

Consolidated GMS Regulations

This consolidated version of the NHS (GMS Contracts) Regulations 2004 as amended incorporates the changes that will be coming into force on 1 April 2010.

Bulletin 50


DDRB Report letter

We are sure you will have seen the recommendations for 2010/11 published by the DDRB last week and the subsequent government decision to overrule some elements. This GPC letter to GPs is in response to these recommendations.

SCR, message re opt-out and GPC Guidance

It is important for practices to raise patient awareness of SCR, including the patients' rights to opt out. You should provide balanced, unbiased information to empower patients to make an informed decision. Please note: if patients use the envelopes in their patient information packs to return their opt out form it will be destroyed. This may result in patients thinking they have opted out when in fact they haven't. You may wish to have a supply of the opt out forms and promote the correct address for patients to return the form in your practice as this information is otherwise only available via internet/telephone.

The address for Tees patients to return forms is:
Summary Care Records
Healthcare Technology Commissioning
Teesdale House
Westpoint Road
Stockton on Tees
TS17 6BL

This guidance represents the GPC's views and may be helpful in answering any questions you may have.

Withdraw: Focus on Tax Bracket information

The Focus on Tax Bracket information published last week as been withdrawn and should not be used. GPC advisers have confirmed that there is an error in the figures and other matters in the guidance also need to be reviewed. This information has been removed from our website and it is hoped a corrected version will be issued as soon as possible. Please accept our apologies for this and any difficulty it may cause.

BMA Charities Letter

This letter contains details of 2 charitable funds that could be of benefit to you or a doctor you know.

Bulletin 49


Future of GP Practice Premises, updated document

This updated guidance examines the current state and future of the various primary care premises development options available and describes the premises provisions of the GMS contract. It incorporates GPC guidance on the premises costs directions and on the impact of the Disability Discrimination Act.

CQC Quick Guide to Registration

The Care Quality Commission is introducing a new registration system for all NHS Trusts, independent healthcare providers and adult social care providers. The new system comes in gradually from April 2010. This guidance provides a quick guide to registration.

GP Earnings and Expenses 2007/8, final report

The GP Earnings and Expenses 2007/08 Final Report has been published. The Provisional Report for 2007/08 was published in September 2009. This Final Report for 2007/08 contains additional information on earnings and expenses by practice size, Strategic Health Authority and rurality.

Salaried GP Handbook (BMA members only)

The 2010 version of the salaried GP handbook is published 8 March and is free to all BMA members on request via e-mail, support@bma.org.uk or telephone 0300 123 123. Salaried GP BMA members should receive a copy automatically by 22 March, if you have not received your copy by this date use the above details to make your request. The Handbook explains the legal entitlements of all salaried GPs as employees. It therefore helps to ensure that salaried GPs are aware of their statutory and contractual rights, and helps to prevent GP employers unwittingly falling foul of the law. It also contains sections on other topics such as how to become a salaried GP and the work involved.

This 2010 version of the Handbook has been updated to take account of changes in employment law and other areas, as well as clarifying guidance from the previous handbook. It includes new sections on maternity leave and redundancy, and updated information on many other areas such as salary, hours of work, sick leave and employment protection. The 2010 handbook is also be available to members here.

Bulletin 48


Summary Care Records (SCR)

There are serious concerns about the implementation of the SCR across the country. The BMA/GPC continue to press CfH for more resources to publicise and to assist practices with the work involved and have produced this guidance to assist practices. Londonwide LMCs are kindly sharing some useful information they have produced which is available here and for your ease the opt-out information and form (which is hidden at the end of the document!) is here.

Fit Notes

From 6 April 2010 the current Med 3 and Med 5 medical statements are being replaced with the new Statement of Fitness for Work. The DWP have produced a short guide on these changes here.

Pandemic Flu - ready reckoner (PE7 & PE8 easements)

NHS Employers have sent this letter to all PCTs with details of a ready reckoner that has been produced to calculate the easements to the thresholds for QOF indicators PE7 and 8 as part of agreement for the phase 1 swine flu vaccinations.

Impact of 2009 Budget on NHS Pensions

In his Budget on 22 April 2009, the Chancellor announced the introduction, from 6 April 2010, of a new additional rate of income tax of 50%, applying to taxable income over £150,000. In order to prevent this resulting in an increase to the tax relief granted on pension contributions, the Chancellor also announced that from 6 April 2011, tax relief on pension contributions for high earners will be restricted. The BMA has produced guidance that looks at the changes to tax relief on pension contributions, along with the ’anti-forestalling’ measures that the Government has put in place to limit individuals who may otherwise have been tempted to maximise their tax relief by making additional contributions before 6 April 2011.

GP Academic Fellowships

Are you a GP with an academic interest? The National Institute for Health Research has recently launched in-practice fellowships which aim to offer academic training to fully-qualified General Practitioners and General Dental Practitioners who may have already spent some time in NHS practice and who have had little formal academic training at this point in their careers. Further information here.

Bulletin 47


Interim Guidance on Erroneous Transfer

This interim guidance has been developed by the GP2GP project and the Joint GP IT Committee to advise practices how to reduce the risk of making an erroneous record transfer request and advising practices and PCTs how to manage such erroneous requests when they do occur.

Pandemic Flu - vaccination programme

Letters regarding the H1N1 vaccination programme have been sent out from the Department of Health advising practices to continue vaccinating at risk groups opportunistically beyond the end of March. For this they will continue to receive payment, though not the related DES concessions. Practices will be advised to stop vaccinating children under 5 from the end of March. The Joint Committee on Vaccination and Immunisation has suggested that the vaccine can now be offered as a travel vaccine for those travelling to Southern Hemisphere countries during their flu season. This is likely to be provided through private travel health providers. The letters are available here.

2010/11 Certificate of estimated pensionable income

The Estimates of NHS Pensionable Profits/Pay form for 2010/11 can be found here. Every practice must in law complete this before April 2010. Medical accountants have been made aware of this form.

BMA Research Grants

Reminder that the deadline for applications for research grants totaling approximately £500,000 is 12 March 2010. Subject specifications for each grant vary. For example, in 2010, research areas include heart disease, cancer, inflammatory bowel disease and schizophrenia. More information on the grants on offer in 2010 and details of how to apply here.

Consolidated SFE

The consolidated SFE, taking into account amendments to the end of 2009, can now be found here.

Bulletin 46


NHS Appraisal Toolkit

Last week the government announced that they have identified a security problem with the NHS appraisal toolkit. DoH have released this statement. As a result of this, the toolkit is to be shut down for three weeks, so that the suppliers can modify it to ensure security. There is advice for GPs from the people who run the toolkit at its website and in this FAQ document. Please note that the option given for accessing appraisal documentation when the website is down appears to involve sending and receiving information by registered post.

There are two clear aspects to this problem - data security and the appraisal itself. Taking these in turn:
Data Security
GPC have been unable to ascertain exactly how long the security problem existed for before it was identified yesterday. However, they have no reason to believe that an actual security breach occurred - i.e. that anyone accessed data that they were not authorised to see on any doctor(s) using the toolkit. The government have assured the GPC that steps will be taken to ensure the full security of doctors' data before the toolkit is re-launched. It is expected that this will take about three weeks.
The shutting down of the toolkit will affect the appraisal of any GP who uses the NHS appraisal toolkit, and whose appraisal is due to take place during the three week period (and possibly after). GPs who are unable to participate in their arranged appraisal due the toolkit being shut down should organise an alternative date for their appraisal. PCTs are being told about this tonight and are being told to be reasonable.

This situation may lead to some GPs being unable to meet the normal deadline for the completion of their appraisal through no fault of their own. The GPC have written formally to the Department to ask them to write to all PCTs, advising them to be flexible in their use of appraisal deadlines for any GPs affected by the problem. They have also asked for any costs incurred by appraisers and appraisees to be met, as well as re-affirming the importance of the security of information uploaded on to the toolkit. They have not asked them to revise the three week shut down period, due to the importance of the security problem being resolved properly.

Pandemic Flu - prescribing antivirals

The DH has sent guidance on the prescribing of antivirals to SHAs, which can be accessed here.

QOF Topic Suggestion

NICE has opened the second of topic suggestion for the 2012/13 Quality and Outcomes Framework (QOF). The online topic suggestion facility allows stakeholders to submit suggestions for new indicators for QOF based on NICE guidance or other NHS Evidence accredited sources. Health professionals, patients, community groups and voluntary organisations are being encouraged to contribute. This phase of topic suggestion is open from Monday 8 February 2010 until Monday 8 March 2010.

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. This facility will be expanded to provide the opportunity to suggest a wider range of evidence-based sources, accredited through NHS Evidence. When this four-week period closes each suggestion will be reviewed against criteria provided in the submission form and suitable suggestions for the QOF will be presented to the independent advisory committee for consideration. The indicators for the 2012/13 QOF will be the first set to pass through the new NICE process in full, and the topic suggestion represents the first stage of their development. The facility can be accessed here.

The online facility to comment on QOF indicators is continually available on the NICE website and enables people to input into the review of existing indicators, this can be accessed here.

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. The recommendations of the Advisory Committee will then be fed into negotiations between the NHS Employers and GPC. If you have any queries contact NICE at: qof@nice.org.uk.

Final Seniority Figures 06/07

The Final Seniority Figures for 2006/07 For England have now been published by the Technical Steering Committee. The figures are £92,140 for England and £82,399 for Wales. Further details are available on the NHS Information Centre's website.

Vault Smears

Within the national cervical screening programme, the responsibility for follow-up vault smears has been shifted from GPs to the gynaecologists who performed the hysterectomy. We want to ensure that GPs are aware of this change, as some women requiring vault smears may not be called for them.

There are two main reasons for this shift:

  1. it is essentially a post-operative follow-up issue, as if there has been incomplete excision of neoplastic changes, this will require further intervention by the gynaecologist;
  2. there has been considerable difficulty in performing vault smears (knowing which part of the vault to smear and ensuring that the 'corners' of the scar are adequately sampled); this is very difficult to do properly in the primary care setting, so national advice is now that it should be done by colposcopic viewing and sampling, thus ensuring a good valid sampling and greater safety for the patient.
Patients requiring vault smears should not be referred back to the GP for this at any stage; it is the responsibility of the gynaecologist to follow up his/her patient, whether this entails a single vault smear and discharge from screening, or smears every 6/12 months for 9 years or more. The only patients that vault smears are (possibly) required in will be those with vaginal intraepithelial neoplasia (VaIN), who should really be under colposcopic management since vaginal cytology is very unreliable. This move will probably uncover a number of women who have been having unnecessary vault smears, since the evidence relating to their effectiveness has evolved significantly over recent years.

GPs with patients already listed for post-hysterectomy follow-up should be transferring their care to colposcopy/gynae clinics via the referrals process.

For further details see the colposcopy and programme management guidelines for the NHS Cervical Screening Programme.

Look After Your NHS - message from Dr Hamish Meldrum

When we launched Look after our NHS last summer the campaign was targeted primarily at doctors. Today, we have the backing of 80% of doctors for our position on NHS commercialisation and the campaign. With such strong support we are now ready to take our campaign to the public. We believe that, like doctors, they too will be concerned about what is happening to the NHS when they know the facts.

Public information campaign
From the 15th February we’re taking the campaign direct to the public with a leaflet and poster written and designed specifically for a public audience. These will be made available in GP surgery and hospital public areas via Practice Managers and Local Negotiating Committees (LNCs). The leaflet features a simple reply-card which we hope patients will use to tell us their views on NHS commercialisation. The campaign website has also been redesigned to be more public facing, with new content and features. This includes guidance and links to further sources of information should people wish to find out more, either about their local health services or about campaigning. The new site is due to go live Friday 12th February. Of course, it still continues to be an important resource for doctors.

Doctors can still support the campaign
All members in England will receive a pack of campaign materials which includes a new brochure on NHS reforms, a copy of the public poster and a simple questionnaire. These will also be mailed during the week of 15th February. This is a crucial stage of the campaign. To maximise its effectiveness, we need the active support of as many doctors as possible. Please could you: These and other ideas can be found at www.lookafterournhs.org.uk If you have any queries, please email Helen Wright on hwright@bma.org.uk.

Thank you for your support. Together, we can help put patients before profits.
Best wishes,
Dr. Hamish Meldrum,
Chairman, BMA Council

Bulletin 45


Pandemic Flu - Claiming DES Payment and HPA Questionnaire

Following a query where some practices thought that the wording in the H1N1 vaccination DES around validation and payment meant that practices had to provide written information to PCOs, the DH has confirmed that this is not the case and if an extraction process (such as the FHSA) is available, then using this route is acceptable. This is outlined in this letter which has been sent to SHAs.

Some practices have received a questionnaire from the Health Protection Agency (HPA) to evaluate swine flu vaccine efficacy following confirmed cases of swine flu in their area. This is a sampling exercise and the questionnaire is in effect a ‘Yellow card’ form because the vaccine is new. We believe it would be good practice to fill in such a form, and no fee can be charged by the practice for doing so.

GP IT System Survey

NHS Connecting for Health is undertaking a survey of GPs and their staff to gain an insight into opinions on various parts of the GP IT service. It will be used where appropriate to inform discussions with suppliers and enable service improvements in the most valuable areas. Please spare 10 minutes to complete the survey and there is space at the end to add additional information. It is open until Friday 5 March and can be accessed here.

GP Employment Law Courses

This is a reminder for a series of BMA 1 day courses that you may find useful. They cover key issues in employment law - managing change, performance and staff. Further details can be found here.

Bulletin 44


Kings Fund Inquiry Survey

The King’s Fund has launched an on-line opinion survey about the quality of care in general practice. It is absolutely essential that every GP responds to this in order to ensure GP opinion is heard. Please contribute to the survey here. Full details of the inquiry are available here.

Pandemic Flu - planned stand down of NPFS 11 February

Due to the decrease in the number of H1N1 cases over recent weeks it has been decided to stand down the NPFS web and phone service, effective from 1am on 11 February 2010. You will need to ensure communications to patients - including websites, posters and leaflets - exclude reference to NPFS, and that you can respond to any H1N1 queries. Note that the service can be restored in seven days, should it be needed. Further information and a communications check list for practices and PCOs are available in Ian Dalton’s letter here and by following this link. A reminder that locally the ACP at Primecare has now closed and 4 pharmacies are now providing this service (PCT are contact for further details if required).

Revalidation Update

You can view the latest edition of the BMA's Revalidation Newsletter here.

National Audit of Fall and Bone Health in Older People

This letter from the Royal College of Physicians provides outline information with regard to a national clinical audit that will take place between September and December 2010. You may be contacted regarding a small number of patients in this audit period.

GP Health offer CBT

GP Health have now extended service to include Cognitive Behaviour Therapy (CBT). Visit their new website for details on this and the other services they offer.

Survey for Sessional GPs

As part of a GPC review into the arrangements for the representation of sessional (salaried and locum) GPs within the GPC and BMA, and at a local level, a working group has put together a survey that will be sent to sessional GPs, who are members of the BMA, next week. The survey will be vital in informing the working group and helping it make recommendations on how sessional GPs will be represented at a national and local level. The results of the survey will also be used as part of next year’s evidence to the Doctors and Dentists Review Body (DDRB) on the remuneration and working patterns of sessional GPs. We would very much encourage sessional GPs who receive the survey to take the time to complete the questionnaire. Sessional GP members who have not received the questionnaire by the end of February, or have questions about this process should contact the BMA’s research department at: info.hperu@bma.org.uk.

Sessional GPs Newsletter

The Sessional GPs Newsletter, Winter 2010, can now be viewed here. Issued quarterly the aim of this newsletter is to keep sessional GPs up to date with the broad range of new and ongoing issues affecting them, and the hard work that the Sessional GPs subcommittee undertakes on their behalf.

Bulletin 43


HMRC New Penalty Regime Briefing

Last week I sent some very important information from the GPDF regarding HM Revenue & Customs' new powers, procedures and penalties. For ease it has now been loaded on our website here. We strongly recommend you read and take on board this information as errors in tax returns could have serious consequences, for both individual GPs and their practices. You must ensure that you are fully compliant or a likely consequence may be referral to a GMC Fitness-to-Practice hearing.

'Your Surgery, Your Say' poster and leaflets

Last year the government imposed several changes to the patient experience survey. A by-product of these changes was that some practices ended up losing a significant element of their funding, partially because of low response rates among patients. In order to help address this problem, GPC has developed the 'Your Surgery, Your Say' poster and leaflet for practices to display in their surgery.

The poster and leaflet explain what the practice is doing to offer patients the best possible access, and also explains how patients can give their views directly to the practice. The poster also reminds patients of the importance of completing the Government's patient survey, and explains directly what many might not understand - that their practice's funding depends on their responses. Copies of the poster and leaflet should have arrived at your practices on either Friday 15th January or Monday 18th January. Electronic copies of the poster and leaflet are available here where you can print additional copies for display.

Bulletin 42


084 Number Guidance

A ban on 084 telephone numbers that charge the public or patients a premium rate came into force 21 December 2009. However, 084 numbers that are no more expensive than the equivalent of a local call can continue to be used. There are a few practices in Tees that have 084 numbers and we believe the PCTs were working with these practices directly in preparation for the ban. We advise practices to get, if they haven't already, a guarantee with regards to appropriate call charges from their 084 number supplier. Please ensure you are familiar with the following documents and are operating within the guidelines.

DH’s response to 084 consultation

Directions to NHS bodies concerning the cost of telephone calls in relation to health services - 21 December 2009

GPC Practice Finance subcommittee guidance on the use of 084 numbers in the NHS

Updated Disability Discrimination Act Guidance

The original DDA guidance for GPs, published in 2003, has now been updated. You can access the revised guidance, The Disability Discrimination Act: Physical adjustments to GP premises required under the Act, here.

Flu Respirator Fit Testing Leaflets and Posters

The DH has published downloadable posters and leaflets on how to use and fit test FFP3 respirators when carrying out aerosol-generating procedures patients with symptoms of influenza.

BMA 2010 Research Grants - available to apply for now

The 2010 research grants are now available to apply for online. Applications are invited from medical practitioners and/or research scientists and are for either research in progress or prospective research. The application deadline is 12 March 2010. Subject specifications for each grant vary. For example, in 2010, research areas include heart disease, cancer, inflammatory bowel disease and schizophrenia.

For more information on the grants on offer in 2010 and details of how to apply, click here. Around 11 research grants are administered under the auspices of the Board of Science, all funded by past bequests to the BMA. Grants totaling approximately £500,000 are awarded annually.

2010/11 GMS Negotiations

Following negotiations between the GPC and NHS Employers, five existing Directed Enhanced Services (DESs) due to finish in March 2010 will be extended for a further year for 2010/11. There will be no other changes to the GMS contract next year, with the intention that practices experience a period of contract stability. The five DESs that will be extended to 2010/11 are the:

There will be a cut off date for practices to inform their PCT if they wish to take up the Extended Hours Access Scheme DES, after which practices will no longer have an automatic right to participate. We will inform you of this date as soon as it is agreed. Please note that existing arrangements will apply to all these DESs.

NHS Pension Choice

The NHS Pension Choice exercise is programmed to start (in the North East) July - September 2010. Further details are available here.

Bulletin 41


Pandemic Flu - dosage schedule update and revised version of clinical management guidelines

The licence for Pandemrix has now been amended to allow one dose (0.25ml) in children. Patients who are immunocompetent and who have already received one dose of the vaccine do not need a second dose even if this has already been scheduled. Immunocrmpromised individuals should still receive a second dose as scheduled. Further details here.

The DH has published revised versions of the Pandemic H1N1 2009 influenza; Clinical management guidelines for adults and children. The change is in paragraph 5 on page 9, which has been extended to define what 'high dose' means in the context of this document.

The DH has also updated the Pandemic H1N1 2009 influenza: Clinical management guidelines for pregnancy. There are two changes: a footnote has been added to paragraph 5 on page 17 reflecting the different requirements of the abortion legislation in England and Northern Ireland; they have also added a new paragraph 5 on page 19 to deal with the outcome of the ORACLE study which implicated co-amoxiclav with necrotising enterocolitis in preterm rupture of membranes.

QOF Business Rules

Version 16 of the business rules has now been published and is available here. Please note that for the QOF CVD PP1 indicator (Cardiovascular disease - primary prevention 1), the business rules have been amended to exclude patients under 30 years of age from indicator PP1. The age range for this indicator is now set as 30-74 years. Patients outside this age range should still be individually assessed and their risks reduced, although risk equations do not apply and thresholds for reductions are not currently available. PP2 applies to all age groups, as do the blood pressure control indicators in the hypertension set.