Bulletin 128

20.12.11

Possible Scam Alert

We alerted you to this scam back in October but believe it may still be in operation so ask you to be especially vigilant when receiving 'orders' for materials. Practices have been contacted by a company called HCRA and advised that they placed orders for various materials in the summer (handbooks, CD-Roms, posters etc) that were evidently tailored specifically to the practices. The 'dispatcher' is adamant that the practices are liable and, as a consequence, the order is being dispatched and an invoice to the tune of £299 (including VAT and shipping/handling costs) would be sent to the practices. Needless to say the practices knew nothing about the order. Trading standards in the relevant areas have been contacted and we have been advised that the company website is registered in Canada and in all probability this is another scam. Please notify the LMC if you are approached by this company and take care to ensure that all your staff are aware of this scam and that they should triple check prior to signing any documentation/agreeing to receipt of any order.

Cervical Cytology Training

Earlier this year there was a question raised nationally with regard to mandatory cervical cytology training and whether this was appropriate for general practice. The Department of Health has sent this letter to PCTs confirming that there are no contractual requirements for GPs to have cervical cytology update training.

BMA Guidance on CCG Authorisation Process

The authorisation process is by which Clinical Commissioning Groups (CCGs) are deemed ready and able to take statutory responsibility for the commissioning budget. This guidance flags up risks and opportunities in this process, including how GPs and LMCs can ensure that CCGs develop into democratically robust organisations.

The National Dementia and Antipsychotic Prescribing Audit

Practices will receive a letter from the NHS Information Centre very soon with further information about the audit, including details on opting out for those practices that do not wish to take part. We support what the dementia audit is trying to achieve. The audit will extract a very limited dataset. GP practices are should opt in to the extraction of identifiable data for secondary purposes in accordance with agreed GPES principles and, though, unfortunately the circumstances and timing of this dementia audit do not allow for this, given the limited data to be extracted, we see no reason why practices should not take part.

Changes to the RCGP curriculum

The RCGP recently announced changes to the GP curriculum, which are due to be implemented from August 2012 , are being made in response to feedback gathered from users, and are largely focussed on making the curriculum more user-friendly with a clearer and more consistent structure. There will also be some updates to the content.

Bulletin 127

13.12.11

Pathology Update, South Tees

This Pathology Update has been provided by South Tees.

Cameron Christmas Fund

This letter provides details on the Cameron Fund annual Christmas Appeal. The Cameron Fund is the only charity which solely assists general practitioners and since its creation in 1970, the Fund has assisted over 1,200 GPs, former GPs and their families.

Bulletin 126

29.11.11

Removal of Patients, Violence in Practices and Violent Patient Procedure Reminder

It is vitally important that practices follow the correct procedure when handling violence in practice, especially in the correct removal of violent patients, to ensure that all who work in primary care are protected.  Please remember, violence includes behaviour that leads to any person legitimately in the practice premises to fear for their safety and includes aggressive behaviour and verbal or sexual harassment as well as physical violence.  Perceived threat is sufficient to enable a practice to take action.  It is important that practices adhere to the usual of rules of not discriminating on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.  You may find this LMC guidance a helpful reminder.  Please note the new contact details included in the guidance.

Focus on Travel Immunisations

The GPC has published this Focus on Travel Immunisations to explain which travel immunisations are available on the NHS and which can be charged for privately.  This document reflects the present situation and is intended to help practices by clarifying the existing regulations as they currently stand, as the availability of immunisations and the nature of foreign travel has made the Regulations surrounding this area difficult to interpret.  

Firearms Licensing

As a response to a number of questions we have received relating to Firearms Licensing we would like to share this interim guidance:

The BMA has agreed in principle that where an individual has been granted a firearms licence, or an existing licence has been renewed, the police will subsequently contact his or her GP to enquire whether there is any medical information that might have a bearing on the individual's suitability to hold a firearm.  Whilst the BMA intended to ensure GPs were fully informed and suitably advised prior to them receiving requests, we understand police forces have already begun to issue letters to GPs which lack specific instructions or advice.  Where doctors wish to respond to these letters and provide relevant medical information, consent to the disclosure of that information should ordinarily be sought as the letter does not currently indicate that consent has been given.  If the patient does not consent to disclosure, this should ordinarily be respected, although the police must be informed to that effect.  If, however, the doctor believes that the patient presents an immediate risk of serious harm to themselves or others, information should be disclosed even in the face of an explicit refusal.  Doctors are under no obligation to respond to these letters, but should they decide not to, doctors should inform the police as it will otherwise be assumed that there is nothing relevant on the medical record.  Although the letter from the police states that it does not have to be retained, in the BMA’s view doctors should record the request for information in the medical record and indicate what action, if any, they have undertaken.  

HPV Vaccinations Update

The Department of Health has announced that from September 2012 Gardasil, rather than Cervarix, will be used in the HPV vaccination programme. 

Bulletin 125

22.11.11

WARNING, SCAM ALERT - HMRC

We have been made aware of a possible scam operating in the area in the name of HMRC. If you are contacted by email with regard to the HMRC and/or in relation to tax arrears we would recommend you contact the HMRC directly prior to responding.

Children Who DNA Hospital Appointments

Following concerns with regard to children who DNA hospital appointments North Tees Foundation Trust have discussed a process for children who have been previously seen and new patients who DNA. The GP is asked to complete this proforma. The Trust will commence using these documents on 1 December 2011

Accountability in New NHS Structures

The GPC has recently published a discussion paper on scrutiny and accountability in the new structures, in collaboration with the Centre for Public Scrutiny (CfPS), a charity promoting transparent and accountable working in the public sector. The CfPS and GPC encourage GPs to ensure that their clinical commissioning group is working in a transparent and open manner, to help constituent practices and the local profession hold CCG leads to account, and to involve patients and the public in the decisions being made about their care. 

QOF Business Rules

QMAS has gone live with the 2011/12 changes to the QOF business rules.  Details of when GP System Suppliers have been certified to rollout their updated software can be found here.

Practice Nurse Indemnity

We would like to remind practices that indemnity cover for work undertaken by practice nurses as part of their employment will no longer be provided by the RCN indemnity scheme and, we again remind, practices that they should to check their indemnity arrangements to ensure that the work carried out by their practice nurses and all practice staff is appropriately covered.

Claire Wand Fund

If any GP would like to undertake research, or study for something that will improve their practice, or the wider community, then the Claire Wand Fund may be able to pay for some or all of the costs. Application to the Trustees is simple and the process will make it clear whether the Fund is likely to support you or not. This is a fund for GPs and is open to every GP. Follow this link to find out whether you are able to access this money set aside for GPs to improve their education for the benefit of patients.

BMA Research Grants 2012

Grants totalling approximately £500,000 are annually awarded by the BMA to encourage and further medical research. 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 2012, research areas range from rheumatism and arthritis, cardiovascular disease and cancer to the uptake of preventative measures and the use of information and communication technologies in medicine. For more information on the grants on offer in 2012 and details on the application process which commences 13 December 2011 and closes 16 March 2012, please see the research grant section of BMA website.

Bulletin 124

08.11.11

GPs' Contract Agreement 2012/13

The GPs’ contract for 2012/13 has now been agreed and announced by the Department of Health.  Changes to the contract include:

• a 0.5% expenses increase delivered to all through QOF

• the piloting of arrangements that will allow commuting patients in three cities a greater choice of which GP to use

• changes to practice boundary rules for patients moving a short distance

• the introduction of a new scheme that aims to reduce avoidable Accident and Emergency (A&E) visits, the indicators and guidance for which are appended to this week’s neg news

• revisions to the Quality and Outcomes Framework (QOF)

The BMA has published this letter to the profession together with this information on the QoF agreement and this summary of changes to QoF indicators. Further details on the contract agreement can be found on the NHS Employers’ website here.

QoF QP A&E Guidance

This QOF Quality and Productivity Accident and Emergency guidance has been published, separately and in advance of the national QOF guidance, to help practices and Primary Care Organisations prepare for their implementation. This guidance will be incorporated in the national QOF guidance document when it is published and will be supplemented by additional guidance and FAQs.

New Medicines Service Guidance

NHS Employers and the Pharmaceutical Services Negotiating Committee (PSNC) have jointly published this guidance for the New Medicines Service (NMS). An NMS feedback form and further information about the changes to the NHS Community Pharmacy Contractual Framework (CPCF) that came in to force on 1 October 2011 is available on the BMA website.

Adverse Weather Arrangements

On 1 November, following discussions with the LMC, NEPCSA sent a letter to all practices outlining arrangements with regard to provision of extended hours during periods of adverse weather. As winter starts to close in we would encourage you to take a moment to view this letter so you are aware of the arrangements in place and the options available to you.

Bulletin 123

01.11.11

Nov 30, Day of Action

The BMA has issued frequently asked questions (FAQs) and information regarding the forthcoming Pensions Day of Action on 30 November, including specific guidance for GP partners. The information can be accessed via the website here. If your practice is likely to be effected in any way (including staffing level concerns) please contact the LMC.

Instalment Prescriptions for Controlled Drugs

The LPC has raised concerns with the LMC with regard to the wording used when completing instalment prescriptions for controlled drugs and, in particular, the of a requirement to now itemise instalment dates and quantity for controlled drugs. You may find this template text a useful guide when completing these prescriptions.

QoF

The 2010/11 QOF achievement and prevalence data has been published by the NHS Information Centre here, including a statistical bulletin, an online database and a set of detailed data tables. Average achievement has increased from 93.7% in 09/10 to 94.7% in 10/11. The 2010/11 QOF exception reporting data will be published on 16 November 2011. QMAS has gone live with the 2011/12 changes to the QOF business rules. The Connecting for Health website has further details. Details of when GP System Suppliers have been certified to rollout their updated software can be found here.

Voluntary Recall of Preflucel Influenza Vaccine

The Department of Health has announced a recall of the influenza vaccine Preflucel, batch number VNV5L010C. This a precautionary measure taken due to a higher than expected frequency of reports of adverse reactions following use of vaccine from this particular batch. Alternative low-egg content influenza vaccines are available that can be used safely in those with severe egg allergy as described in the influenza chapter of the Green Book.   Further information is available in this letter from Professor David Salisbury, Department of Health (England).  Chapter 19 (Influenza) and Chapter 25 (Pneumococcal) of the Green Book have also been updated accordingly.

Seasonal Flu Vaccine Strategic Reserve

DoH hold a strategic reserve of 400,000 doses of flu vaccine for use in England in the 2011/12 flu immunisation programme, which can be used as an 'insurance policy', in case there are problems with supply. The reserve will be available through the ImmForm website only if manufacturers have no supplies available to order.  If practices have no stock of flu vaccine or is running out the DH advises the following steps:

1. First try contacting suppliers to buy additional stock.

2. If none is available, find out if this is temporary or permanent. If temporary, then place an order from that delivery date onwards.

3. Work out how much stock is required to meet patient needs until supplies are available from manufacturers, or to the end of the flu season.

4. Speak to local colleagues and the PCT flu lead or immunisation co-ordinator to see if any supplies are available locally.

5. If the PCT confirms that no stock is available locally, order stock from https://www.ImmForm.dh.gov.uk, to meet patient needs. Manufacturers advise the Department of Health on their stock levels and the reserve will only be accessible when there is no vaccine available to order from suppliers. Vaccines should be ordered sparingly to help prevent the stockpile running out. Vaccines will usually be delivered in one to two working days.

GP Provider (Non-GP Provider) Certificate of Pensionable Pay

Please be aware that every Salaried GP must, in law, complete the 'type 2 self -assessment form' (under heading GP Providers Certificate) at year end; this is to ensure that they have paid the correct rate of tiered contributions. There are also Newsletters published on the NHS Business Service Authority website which will keep you informed of any pensions issues such as tiered contributions, the £50k annual allowance, etc. The next Newsletter will clarify the '24 hour retirement rule' for Practitioners.     

Pensions Dynamising Factor

The dynamising factor for April 2012 will be 6.7%. This is as a result of the Consumer Price Index (CPI) figures, released this week, of 5.2%. The Retail Price Index (RPI) for September 2011 was 5.6%.

Bulletin 122

18.10.11

Prescribing Specials Guidance

The National Prescribing Centre (NPC) has published this guidance for prescribing specials. The guidance explains what specials are and advises on when to prescribe a special. Appendix 2, Prescribing Specials: a quick checklist for prescribers may be of particular use for GPs.

Social Determinants of Health - what can doctors do?

This BMA report about health inequalities gives some practical examples of what doctors can do to make a difference. This report follows on from the work led by the previous BMA President, Sir Michael Marmot, focusing on health inequalities as one of the many priority areas of work for the BMA. The BMA urge all GPs to consider what they could do to reduce inequalities.  We see it all around us and may well be immune to what we see, but we can still think about the issues, and the BMA hope we all will.

Vault Cytology

Following discussions in 2010, the Advisory Committee for Cervical Screening has written to GPC to reconfirm their views that the responsibility for follow up care of women who require vault cytology lie with their gynaecologist, not their GP. The Advisory Committee and the British Society for Colposcopy and Cervical Pathology (BSCCP) agreed that gynaecological clinics were the best place for cytology samples to be taken. There is still some flexibility in that GPs who wish to continue this practice, can do so on a case by case basis in agreement with their local gynaecologist, however there is no contractual requirement for GPs to do this work. The GPC recommends that this should be an exceptional situation and GPs should not be pressured to undertake the recall and continued surveillance for women whose indication for ongoing vault smears will have been a malignant diagnosis.

Bulletin 121

11.10.11

Possible Scam Alert

We have been made aware of a possible scam working it's way down from the Scottish Borders. Practices have been contacted by a company called HCRA and advised that they placed orders for various materials in the summer (handbooks, CD-Roms, posters etc) that were evidently tailored specifically to the practices. The 'dispatcher' is adamant that the practices are liable and, as a consequence, the order is being dispatched and an invoice to the tune of £299 (including VAT and shipping/handling costs) would be sent to the practices. Needless to say the practices knew nothing about the order. Trading standards in the relevant areas have been contacted and we have been advised that the company website is registered in Canada and in all probability this is another scam. Please notify the LMC if you are approached by this company and take care to ensure that all your staff are aware of this scam and that they should triple check prior to signing any documentation/agreeing to receipt of any order.

Dr Laurence Buckman, Letter to the Profession re NHS Reforms

Dr Laurence Buckman, Chairman of GPC, has written this letter to all GPs in England regarding the NHS reforms.

Bulletin 120

04.10.11

New Medicine Service (NMS) ,Tees Update

You may be aware of the New Medicine Service that commenced on Saturday 1 October. Both Cleveland LMC and Cleveland LPC are working together to try and ensure that the introduction of this service runs as smoothly as possible. To this end, we have produced this letter and briefing sheet with the aim of explaining what the new service will mean to Tees Practices. If you have any questions with regard to the NMS, please contact janice.foster@middlesbroughpct.nhs.uk

Nursing and Midwifery Council (NMC) Registration

Following an incident in Kent, we anticipate you may receive a request to ensure that you check all practice nurse(s) NMC Registration. It is important that you ensure periodic checks of registrations take place as we have been made aware of a small number of cases where qualified nurses failed to keep up their registration. It is an offence to work as a nurse without the required registration in place and practices will have to deal with any consequences should this occur. The NMC website has 2 separate means of checking registration, a simple pin number check that is open to the public and an employers check. It is important that practices register as employers and undertake the enhanced employers check as this gives additional information including the employment history of the nurse.

Summary Care Records, use of opt out codes

New READ codes were issued in April 2011 to support a wider range of patient consent preferences for Summary Care Records. GP Systems have not yet been upgraded to recognise these new codes. We would therefore remind everyone to continue to use 93C3 (or XaKRy, the CTV3 equivalent) to record the preference of a patient who has opted out of having an SCR, until you are notified that your GP system has been upgraded. This will ensure that Summary Care Records will not be created for those patients who choose to opt out. Further information is available here.

Commissioning Update

The first edition of Commissioning Update, giving GPs in-depth info on the latest developments within the NHS, focuses on the New NHS Structures and is available on the BMA website.

Information Cascades for Sessional GPs

Dame Barbara Hakin recently wrote this letter to all PCTs with regard to ensuring all important communications to general practitioners are also sent to sessional or locum GPs and encouraging PCTs/CCGs to work together to ensure the engagement of this group of GPs.

Locum Agreements Guidance

The BMA has posted locum agreements guidance on their website for BMA members. This guidance is aimed at BMA member locum GPs to help them put together written agreements with the practices for which they work, and should also be of interest to practices who engage locums. It assumes that the arrangements made will reflect the locum’s status as a self employed GP, and that the agreement will be a contract for services, rather than a contract of service, which would apply to an employee. If you have any specific questions with regard to engaging locum GPs please contact the LMC.

Patient Participation DES Guidance Reminder and Third Party 'Starter DES Sessions'

Practices may have received offers from third party organisations for 'getting started' DES packages in return for payment. This goes against the spirit of the DES and defeats the object of practices forging closer relationships with their patients, better understanding local need and improving outcomes. Please remember that the GPC and NHS Employers have published this joint guidance which clearly sets out the key objectives of the DES for practices and encourages practices to seek the support of voluntary organisations in engaging with marginalised or vulnerable groups. This should help ensure the Patient Reference Group (PRG) is representative of the practice profile, while the onus remains on practices taking the initiative in achieving each component of the DES.

Bulletin 119

27.09.11

RCN Indemnity Scheme, 1 Jan 2012

This RCN letter highlights details to a change in the indemnity scheme they offer and may have implications for practices if their nurses are not named on the doctors'/ practice cover.

Health & Wellbeing Boards Guidance

The GPC has released this guidance relating to Health and Wellbeing Boards. The Boards will work to encourage collaboration between local authorities and health professionals, linking health care, public health and social care. They will also have potential to yield considerable sway over CCGs, as they will have a role in scrutinising commissioning strategy (although this in itself could be very useful for CCGs seeking assurance that a commissioning plan is free from perceived or actual vested interest). This guidance urges GPs and CCGs to involve themselves in the establishment of the Boards and foster good relationships.

Bulletin 118

20.09.11

NHS Reforms Update

As you will be aware, the Health Bill has now passed through the House of Commons and will progress to the House of Lords. The latest GPC/BMA update can be viewed here.

Guidance on Request for Disclosure of Data for Secondary Purposes

Practices often receive requests for patient data for secondary uses. These requests may come from researchers, from NHS managers who require the data for health service planning or from private companies providing risk stratification services, for example. This document provides guiding principles to assist practices in considering how to respond to these types of requests.

Primary HIV Infection: Knowledge Amongst Gay Men

We have been asked to draw to your attention the National AIDS Trust’s (NAT’s) new report ‘Primary HIV Infection: knowledge amongst gay men’, outlining the results of a recent survey of over 8,000 gay men. Early diagnosis of HIV is very important, both in terms of preventing onward transmission and in terms of maximising the long-term health of people once infected. However, 52% of people diagnosed with HIV last year were in fact diagnosed late, meaning greater risk both of onward transmission and harm to future health. Primary HIV infection is for many a key early opportunity to diagnose HIV infection before a long asymptomatic period. The survey revealed that over 60% of gay men incorrectly believe there are no symptoms of primary HIV infection. However, when experiencing the most common combination of symptoms: sore throat, fever and rash, the most popular choice of action for respondents would be to go to their GP. GPs present an excellent opportunity to diagnose more people early, so it is vital that GPs have sufficient knowledge to recognise the indicators of primary HIV infection and feel comfortable suggesting an HIV test.

BMA Law CCG Service

BMA Law has launched a new service for member GPs involved in CCGs. The package includes advice from BMA Law on six legal questions on any issue falling within the description of services set out in BMA Law’s Terms and Conditions and 15% off total fees on any one BMA Law service. Further information can be found on the BMA Law web pages (you will need to log in to the BMA website to view these pages).

Bulletin 117

12.09.11

Seasonal Flu

The GPC has written a letter to all GPs to remind them of the arrangements for the seasonal flu vaccine programme in 2011/12. Evidence show that patients in at-risk groups are much more likely to die from seasonal flu than healthy individuals, and given that the seasonal flu vaccine uptake in the at-risk groups in patients under 65 and pregnant women was much lower last year than that recommended by the WHO, we would encourage practices to ensure that those in the at-risk groups are given priority. We would also encourage practices to ensure that staff are protected. You should have received a raft of 'flu campaign' promotional material from the PCT (Parkway Couriers) last week. Please display this material and if you have any queries or wish to order more, email Alison Sweeney. You may also wish to follow/share the Twitter campaign messages (@NHSFluFighter).

Patient Transport for Referral to Hospital - appropriate use of ambulances

As you will be aware, NEAS provides an urgent ambulance service for GPs to convey patients to hospital, within 1, 2 or 4 hours according to clinical need, as well as providing emergency 999 responses within 8 or 19 minutes. The PCT and NEAS have been carrying out a review of this service in a bid to better utilise existing resources to provide a more efficient and effective service for patients and GPs. This review has found a number of requests for emergency ambulances when an alternative method of transport (or 2/4 hour wait) may have been more appropriate. We appreciate that there are a number of routes and numbers to remember when arranging transport so we have produced this simple flow chart to assist practices with the booking process.

Please share this chart with all those in your practice who book/arrange patient transport. Considering the options on this chart will ensure that NEAS are better able to respond to 999 and urgent calls and will also, potentially, contribute to essential PCT savings (each urgent ambulance journey costs approx. £197). It is important that practices protect their patients, and themselves, whilst assisting NEAS when arranging acute admissions. We are currently reviewing a letter sent to practices some years ago and will shortly provide advice/checklist when arranging acute admissions, including transport.

BMA Membership - ensure your details are up to date

The BMA have asked us to assist them in ensuring all their members are aware of the need to ensure their membership details are up to date. NHS reform, public sector pension changes and the need for the NHS to make huge efficiency savings are very likely to create a period of unprecedented change for doctors. To protect yourself, it’s essential that you keep up to date with how your role and career may be affected. To do this and to allow the BMA to represent you as effectively as possible, the BMA need an up-to-date picture of all their members, including where you work. Don’t risk being left out – help the BMA to help you by checking your contact details and profile to ensure BMA records are accurate.

There are three ways to update your details, simply:
• update your details securely - www.bma.org.uk/myworkplaces
• Email: info.pow@bma.org.uk
• call our membership team on 0207 383 6955 (9am-5pm, Mon-Fri)

North East Health Protection Agency - new telephone numbers

Telephone numbers for all staff at the North East Health Protection Agency (Citygate office) have now changed to the following:

Telephone: 0844 225 3550
Fax: 0191 221 2584

The change will not affect the service the HPA provide. Please note that the address and email details remain unchanged.

Bulletin 116
23.08.11

BMA response to Seasonal Flu Vaccine Procurement Consultation

In this response to the DoH consultation on the review of seasonal flu vaccine, the BMA have highlighted their concerns about the proposals to move to central procurement of seasonal flu vaccines in England. The BMA believe that GPs should retain the right to procure the seasonal flu vaccine, but that the system could be improved by allowing practices and PCTs to share vaccines, and for emergency stocks to be available to be called on if necessary. They were also concerned about the lack of evidence that central procurement would improve vaccination uptake in England.

Emis System Failure

On Thursday 18 August (morning) there was a failure of the EMIS clinical system. Sean Riddell, EMIS Managing Director, made the following statement:

‘On Thursday 18th August 2011 EMIS had a series of hardware failures resulting in an outage at its data centre. This caused some performance and stability issues at 333 GP practices out of a total UK user base of 5,496 NHS UK customers. Unfortunately this problem had knock on effects to a further 446 GP practices at 11.50am. Our software engineers worked in conjunction with the suppliers of our data centre hardware throughout this period to restore performance. The data centre commenced normal operation shortly after 1pm and practices then began coming back online. EMIS have not identified any data loss resulting from this issue.

EMIS has now launched a detailed investigation into the incident, working closely with Connecting for Health and the suppliers of the data centre hardware. Our support departments have been in contact with practices and we will be contacting them again with the results of our investigation and the steps that we have taken to prevent a recurrence.

Our first priority at EMIS is and always has been our users and their patients. We recognise the vital role that EMIS systems play in the efficient running of GP practices, and we apologise to affected users for this regrettable disruption to service’.

Practices are reminded that contingency plans need to be in place for dealing with system failures. The Good Practice Guidelines for GP electronic patient records v4 (2011) include guidance for unplanned downtime in section 9.4.3.2 (page 157).

NHS Community Pharmacy Contractual Framework: New Medicine Service

The Professional Relationships Working Group (PRWG), which is a forum between the GPC, pharmacists and NHSE, has published this briefing for GP practices outlining the changes to the pharmacy contract, including the introduction of a New Medicine Service (NMS) and a nationally targeted Medicines Use Reviews (MURs). This is to help GP practices get up to speed on how the services will work from their implementation on 1 October 2011. The working group has also published a New Medicine Service (NMS) feedback form, which is designed to support the process by providing a practical channel that pharmacists can use to exchange information with GPs, by sending the form back to a GP practice if they have identified a problem which requires the prescriber to review a prescription.

Bulletin 115

16.08.11

CQC Registration

DH has formally announced that CQC registration for GP practices (including NHS walk-in centres) has been delayed until April 2013, subject to Parliamentary approval. The GPC believe that this intervening period should be used to radically reduce the requirements for compliance on GP practices. Practices should not undertake any significant preparatory work relating to registration at this stage and they should not engage others to do so for them as these third parties cannot possibly know what the final CQC process will include.

Clinical Hypnotherapy Survey

St Mary’s University College are conducting a short online survey  (less than 10 mins to complete) to audit the current perception and patient referral services for Clinical Hypnotherapy amongst GPs in the NHS. The research study aims to collect data from GPs across the England and Wales. This leaflet  provides further information and a link to the study which  will offer valuable insight on the current practice about clinical hypnotherapy in the NHS. The data from this study will include no individual’s names or identities.

Lyme Disease Survey

The James Lind Alliance Lyme Disease Priority Setting Partnership is working to identify the most important questions for diagnosis and treatment of Lyme disease and is asking GPs to participate in a short survey (deadline 30 Sept). Survey and further details.

Bulletin 114

09.08.11

SFE (amendment 02) Direction 2011

A number of minor amendments to correct typographical errors have been made to the SFE in England. These can be accessed here.

NHS Pathways and 111

As you may be aware, 111 is to be implemented across England from April 2013. The North East is looking to be ahead of the game, not least due to Darlington being a 111/single point of access pilot, and is planning to procure the service by April 2012. The service in Tees is being wrapped up as part of an overarching North East region procurement to find a 111 provider to cover the whole region. The tendering element of the process is now underway. I am sure you are aware of 111 and what it aims to achieve but for clarity, and put simply:

1. NHS 111 is about providing a memorable number that works nationally and has a clear service specification behind it.
2. Calls to 111 are to be answered by locally commissioned call answering services.
3. NHS Direct is one service that might bid to answer the 111 calls in any area, the ambulance services and GP out of hours services are other possible bidders for that business as well.
4. NHS Pathways is a clinical assessment suite, with an integrated directory. It has been selected for use in current NHS 111 pilots, and is also selected for use by around half the ambulance services for 999 call assessment and several GP out of hours and single point of access services across the country. A decision to use NHS Pathways will form part of local commissioner decision making in identifying the approach for handling 111 calls in their area.

Bulletin 113

02.08.11

QOF FAQs

NHS Employers and the GPC have published this joint QOF FAQs which covers a number of historical issues and commonly asked questions including the QOF queries process.

BMA Response to CQC Consultation

The BMA have now provided this response to the Department of Health consultation on their proposals to delay CQC registration for most primary medical services providers. While the BMA welcome the proposed delay, they make it clear in the response that they expect it to be used to radically reduce the compliance requirements on GP practices.

Firearm/Shotgun Licences

Following discussion between the BMA and the Association of Chief Police Officers (ACPO) in 2010 it was agreed that when an individual applies for a licence, or applies for a renewal of a licence for a firearm or shotgun, a letter will be sent from the police to his or her GP informing them of the fact. The purpose of the letter is to provide an opportunity for the GP to alert the police to any medical concerns that may have a bearing on the individual’s ability safely to possess a shotgun or firearm. If there are no concerns, the letter does not need to be replied to. Unless, in the GP's view, the patient presents an immediate risk of serious harm to themselves or another, consent for any disclosure will be required from the patient. If the GP does wish to disclose a concern, and the patient refuses consent to any disclosure, the refusal will have to be relayed to the police, thereby potentially jeopardising the application. Following advice from the Information Commissioner, copies of the original letter from the police should not be retained in the medical record. However, doctors are at liberty to make a note in the medical record, as they would with any other request for health information by a third party. This document provides full guidance on this subject, including on applicants who may pose a risk and the use of tags in the medical record.

GP Educator Seniority

Please be aware that GP educator work should be classified as NHS work for seniority/superannuation income purposes and that calculations of eligibility for seniority payments should be made on this basis.

Bulletin 112

25.07.2011

Clinical Waste, Update Letters - for GMS/PMS practices in non-Trust owned properties whose waste is collected by SRCL

Please observe these letters:

• Collection and labelling of all clinical waste

• Collection and labelling of cytotoxic waste

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

• Collection and labelling of toxic waste (mercury sphygmomanometers/thermometers)

• Easy reference waste disposal list

ANNUAL ENVIRONMENT AGENCY REGISTRATION:  Please remember that all practices that produce over 500 kg of hazardous waste a year, (which encompasses clinical waste, fridges, fluorescent tubes, autoclaves, etc), should be registered with the Environment Agency and have a six digit premises code which SRCL (who collect the clinical waste) use on their consignment notes.  Practices are responsible for payment of the registration fee involved. You can register with the Environment Agency using a variety of methods:

• Online using a credit card, at a cost of £18 here

• By telephone using a credit card, at a cost of £23

• By letter with a cheque, at a cost of £28

• Any queries contact: 08708 502858

If you have any queries or require any information with regard to clinical waste, cytotoxic waste, specialist toxic waste collections, or obtaining additional supplies, please contact me at the LMC office on 01642 737744.  Staff at your PCT/ NEPCSA will not be able to help you because clinical, cytotoxic and toxic waste collections from GMS/PMS non-Trust owned surgeries are organised by me at the LMC office on their behalf.

NHS Reforms & GPC Commissioning Update

This commissioning update has been published by the GPC Commissioning and Service Development Sub-Committee. Ensure you are up to date with all BMA information regarding the NHS reforms - including recent announcements and briefing papers by regularly viewing this page.

JCVI Advice, Over 65s Flu Vaccination Programme

Earlier this year a review by the Joint Committee on Vaccination and Immunisation (JCVI) advised that there was little benefit to continuing the programme and that it should be stopped. However, following comments from various stakeholders and new independent analysis the JCVI have concluded that the existing routine programme for those aged 65 years and older should continue, although be kept under review. This letter from Professor David Salisbury provides details on this advice. Whilst there remains some uncertainty about the effectiveness of PPV, there is now better evidence of the vaccine suggesting that PPV provides some moderate short term protection to those aged 65 years and older, although protection may be less and wane faster in older age groups and for some clinical risk groups. The new analysis also showed that the programme remains cost effective, despite the limited effectiveness of the vaccine, and may be more cost effective than implementing a risk group-based programme. 

Sessional GP Newsletter

This July Sessional GPs newsletter covers important topics affecting sessional GPs including:

• Annual Representative Meeting

• LMC conference

• NHS Reform and Sessional GPs

• Revalidation

• Information Cascades

• Sessional GP conference 2011

• Devolved nations updates

• Contacting the Sessional GPs subcommittee about issues in your area

084 Number Guidance

A brief reminder that the GPC have published this guidance to assist practices in understanding the new Regulations with regard to the use of 0084 numbers. If you have any questions please contact the LMC Office - 01642 737 744.
 

Bulletin 111

19.07.11

Registration of New Patients Guidelines

We have been made aware of some questions with regard to whether or not a patient’s request for registration can be refused by a practice. This is a complex area but the golden rule is that you must always use a consistent approach. A practice can refuse to register any patient as long as the grounds are not discriminatory on the usual grounds such as race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition. Any other reasonable reason is acceptable and this may include the inability of the practice to provide the service because of resource issues. It is, however, imperative that any application of a non-discriminatory reason is applied consistently to all applicants. There is also a requirement to notify the applicant in writing of the refusal and the reason for it, and to keep a record of refusals and the reasons for them and make them available to the PCT on request. There is one important proviso in all this, and that is the definition of an application. The regulations are clear that an application is made by delivering to the practice premises a medical card or an application signed by the applicant or a person authorised by the applicant to sign on his behalf; in practice this means that the majority of refusals do not follow an ‘application’ as they are oral applications with oral refusals. Whether or not the application is a formal written one or an oral one we must stress that there should be no discrimination and that a consistent approach is required.

Patient Transport & Bed Bureau (JCUH)

JCUH have been carrying out a review of their bed bureau in a bid improve the service it provides to GPs. They have asked the LMC to remind GPs that they should only call bed bureau if they are looking to make a referral and/or wish to discuss a patient with a consultant. In order improve the bed bureau service and minimise telephone queues/GP waiting times it is important that any 'other' calls are reduced and directed to the most appropriate place. The bed bureau is receiving a substantive number of calls with regard to to organising patient transport. Neither GPs nor the bed bureau are responsible for organising routine (non urgent) patient transport and requests should not be fielded this way. Patient transport is organised through an external company and GPs may wish to provide their patients with the relevent number for the Transport Information Service/Patient Ambulance Booking Line which is 0345 045 0160.

Electronic Prescription Service Survey

NHS Connecting for Health is keen to gather information from end users on their understanding and attitude towards the Electronic Prescription Service (EPS), and invite users to complete this online feedback form which is aimed at dispensing and prescribing staff who have access to EPS Release 1 and should take less than 5 minutes to complete. The information gathered will help to determine if there are any knowledge gaps and identify any improvements which can be made to the communications and guidance material available to support end users in getting the most from EPS Release 1 and Release 2.

LMC Conference Report

This 2011 LMC Conference Report summarises some of the Conference’s key policy decisions and how these are being taken forward by the GPC.

Eric Gambrill Memorial Fund Recipients

The Board of Trustees of the Eric Gambrill Memorial Fund, under the Chairmanship of the late Dr. Trevor Silver, FRCGP, would like to congratulate the recipients of £3,000 awards for 2011 - Dr. Deepun Gosrani, Barnstaple, Devonshire. for her project "Causative factors in the delayed presentation and treatment of illnesses in a rural South African Hospital", starting April 2011 and Dr. Sally Venn, Brynmawr, Blaenau Gwent for her project "Developing a Quality Assurance framework for a community health worker programme covering over 50 communities in India", starting April 2011. This Fund is an excellent source of support for GPs and a good way of getting funding for GP research, and travel and other costs in particular. There is no fixed limit to the awards. Sadly, Dr. Silver died on 22 June 2011, shortly after the latest trustees’ meeting. A new Chairman will be elected at the next Board Meeting on 10 November 2011. In the meantime, Professor R.G. Hornung has become Acting Chairman until that meeting.

Bulletin 110

12.07.11

NHS Choices Website/Managing Patient Feedback

As you will be aware, practices are notified of a comment pertaining to them following the publication of the comment. An alert is sent to a named recipient at the practice in question (usually the practice manager although this will be designated by the practice). Practices then have two options:

1. Post a reply, in order to put across the practice’s views and deal with any issues raised. This will appear immediately below the original comment.
2. Report the comment to the website moderator as unsuitable.

Bulletin 109

05.07.11

Home Oxygen Service

You may have received this information with regard to the contract for the Home Oxygen Service. This will be of particular interest if you are involved in the prescribing of oxygen.

Learning Disabilities Clinical Innovations Team, GP Engagement

The NE Clinical Innovation Team for Learning Disabilities, the NE Clinical Content Team are currently looking into how GP clinical systems manage information regarding patients with learning disabilities, and how they are flagged in the systems and what data is captured regarding their health check, etc. They are seeking GP practices who are participating in the Learning Disabilities Health Check scheme, as part of the Clinical DES, and in particular any GPs with a special interest in Patients with LD, who are using SystmOne and would be willing to take part in a pilot for the newly developed Annual Health Check template. Please contact Emma Hart: emma.hart2@nhs.net for further information/register interest.

Bulletin 108

28.06.11

Blue Badge Scheme Payments

Following a change in policy by the Department of Health, we can confirm that the four PCTs in Tees will continue to pay GPs for Blue Badge claims as a collaborative arrangement – not Local Authorities. In order to ensure efficient payment of these claims, can each practice submit to the relevant PCT a single monthly invoice for all Blue Badge claims. If practices could raise one invoice for the first quarter for April to June 2011, this will help the PCTs to clear the backlog outstanding as quickly as possible.

Care Pathways Indicators (QP6 - QP11)

Following a number of queries nationally asking whether the care pathways for Outpatient Referrals and Emergency Admissions indicators need to be new or not, we would like to issue the following clarification of the issue. There is some flexibility for practices to use developing pathways already in existence as long as they are in the development phase as far as the practice is involved. What you cannot do is to designate a pathway you already use as a "new" pathway for the purpose of QOF.

Patient Participation DES FAQs

These FAQs on the patient participation DES include links to online resources that practices might find helpful in meeting the requirements of the DES.

PSA Testing Event

Please be aware that an independent organisation are organising a prostate cancer awareness event on Thursday 30 June at the Middlesbrough TAD Centre. Whilst it is commendable that they are raising awareness, neither the LMC nor the PCT agree with planned PSA testing that is scheduled to take place at this event as we do not consider this an appropriate forum to carry out such testing without, at the very least, clinical advice./support present. We have expressed these views to the event organisers but they are proceeding with the testing. Any men tested will receive their results via post in the week following the event. Please be aware that you may see an increase of men presenting at your surgery as a consequence.

Bulletin 107

20.06.11

CQC Consultation


The Department of Health have launched a consultation on delaying the start date of CQC registration for GP practices to April 2013, while proposing that the registration of out of hours providers and NHS walk-in centres should still go ahead in April 2012. In the consultation, they have said that they remain committed to bringing GP practices into the registration system operated by the CQC, but that a delay would provide the opportunity to ensure that the CQC’s systems, tools and processes have been refined in the light of the experience of the earlier registration rounds and piloting with primary medical services providers. You can contribute to the consultation here. Do not do anything about registering your practice, nor enter into any kind of agreement with any third party to do so.

Blue Badge Scheme

We would like to draw your attention to this correction from the May 2011 DH GP and Practice Team bulletin. It clarifies that local authorities can still currently ask GPs to carry out eligibility assessments for the Blue Badge (Disabled Parking) Scheme. However, this will change from 2012, when local authorities will have to use mobility assessments that are undertaken by professionals who are independent of an applicant's care. Under the new system, GPs may still be asked to provide factual information to be used in these assessments. The intention of this change is to move from a system where GPs are perceived to make these decisions about patients to one where, when necessary, GPs only provide facts for the local authority to use in their assessment.  Providing factual information for a local authority is a collaborative arrangement function and is fee paid by the PCT at the practice's rate.

LMC Conference Resolutions

This LMC Conference Newsletter contains details of the outcome of all the resolutions debated as well as election results.

Business Rules V20.0

Version 20.0 of the QOF business rules have been published here.

2 Week Wait Advice to Patients

It is important that all patients are advised as to why they are being referred to a 2 ww service, including the concern that the symptoms and/or signs indicate the possibility of cancer. The mention of cancer is key as that is the whole reason that they are being referred so quickly. You may find it helpful to use these 2ww leaflets - North Tees Patient Information and South Tees Patient Information - which also include instructions to the patient about contacting the hospital the next working day to obtain their appointment date and time. Choose and Book has now been extended to include 2ww appointments in North Tees and South Tees will be following shortly. It is very important that patients are provided with as much information as possible irrespective of the referral path taken.

Homeless/Temporary Residents Access to Primary Care

A patient has the right to the appropriate NHS care irrespective of whether they are homeless/temporary resident and practices should provide an appropriate appointment to access appropriate treatment. If an individual presents you have a duty to provide immediate/necessary/emergency treatment and can provide this to the patient as a temporary resident or register them with your practice if it is appropriate to do so. If your list is open and/or you would see other temporary residents then you cannot discriminate on grounds of homelessness and direct the patient elsewhere.

An individual requesting to see a doctor ASAP should receive the same treatment/triage as any other patient would receive and it may be appropriate to inform the patient of the other options available to them but you should never direct them elsewhere purely to manage capacity.

General Practice Awards 2011

You may be interested in entering the General Practice Awards (formally known as the Management in Practice Awards, now also including GP Business and Nursing in Practice publications) to recognise and reward individuals as well as teams for the work they have carried out. Further details are available here and the closing date is 30 June 2011. This nomination pack contains everything you need and nominations can be emailed to emeliebratt@campden.com. The categories are:

• General Practice of the Year
• Commissioners of the Year
• Practice Manager of the Year
• Practice Administration Team of the Year
• General Practitioner of the Year
• Practice Nurse of the Year
• Health Visitor of the Year
• Community Nurse of the Year
• Nurse Practitioner of the Year
• Nursing Team of the Year
• Innovators of the Year
• Clinical Team of the Year - Children's Health
• Clinical Team of the Year - Sexual Health
• Clinical Team of the Year - Long-term conditions
• Clinical Team of the Year - Respiratory
• Clinical Team of the Year - Cardiovascular
• Clinical Team of the Year - Nutrition
• Clinical Team of the Year - Dermatology and Tissue Viability

Bulletin 106

14.06.11

BMA's Nation Survey of GP Opinion

Preliminary results from the BMA's National Survey of GP Opinion are now available. Full results will be available later in the summer.

Bulletin 105

07.06.11

Ensuring Transparency and Probity of GP-led Consortia, GPC Guidance

This GPC guidance sets out how the honest and transparent operation of the GP led consortia can be ensured so that they have, through their governance arrangements, the confidence and trust of the public. It also calls on the government to scrap the proposal to pay consortia a performance-related payment if they perform well financially.

Bulletin 104

31.05.11

QOF QP Indicators Guidance and Reckoner

The GPC and NHS Employers have published this joint supplementary guidance for the 2011/12 QOF quality and productivity (QP) indicators. This guidance is intended to assist practices and PCTs in understanding and working through the new QP indicators. In addition, NHS Employers, the GPC and the DoH have produced this ready reckoner to help practices and PCTs calculate the point achievement for QP prescribing indicators (QP3 to QP5).

Partnership Agreement Checklist

The LMC are often called upon by practices to assist in partnership issues. We often find that practices believe they have a partnership agreement only to discover that what they have is inadequate. To assist practices in ensuring they have a fit for purpose agreement we have produced this simple checklist. We urge you to check your agreement against this guidance - a couple of minutes now may save a lot of time and unnecessary expense in the future.

Central Procurement of Seasonal Flu Vaccine Consultation

The DoH has published a consultation on the central procurement of seasonal flu vaccine. This document, and accompanying letter asks for comments on the proposal that the DoH should procure all seasonal flu vaccine for the seasonal flu immunisation programme. You can submit a response here. These proposals do not affect the 2011/12 flu immunisation season. The consultation closes on 17 August 2011.

Governance of Consortia Guidance

The GPC has produced this guidance putting forward examples of possible models for the governance of consortia and advising that, as a minimum, specialists should be involved in the design of patient pathways.

Bulletin 103

24.05.11

CQC Registration Toolkit, Guidance for GPs

From 1 October 2011, all GP practices and other NHS primary medical services providers in England will be invited to apply for registration with the Care Quality Commission (CQC) and will need to be registered by 1 April 2012. The GPC has developed a toolkit together with a document outlining policies and protocols to attempt to reduce the burden of the application process by providing a straightforward, plain English explanation of CQC registration, provide information on applying for registration and suggestions on what you could be doing to meet the CQC’s Essential Standards of Quality and Safety. This toolkit also highlights the current situation regarding demonstrating compliance. The guidance in this toolkit will be updated if and when the expectations from CQC change.

Important Note: You do not need to do anything yet! CQC has proposed changes to its plans for registration of primary care medical services (GPs) to the DoH. The aim is to try to improve the process for GPs, to give CQC more opportunity to embed compliance monitoring in the sectors they already regulate, and to ensure registration is more closely aligned with accreditation schemes. Registration will open in October 2011 for dedicated ‘out of hours’ services, but the timing and make up of subsequent batches is still to be confirmed. CQC will make a further announcement about their plans in June. CQC will ensure providers have enough time to prepare for registration. There are no plans to change the scope of regulation - all primary care medical services will have to register with CQC.

Bribery Act 2010 Guidance

We The Government has produced this guidance and quick start document on the Bribery Act 2010 with the intention of helping organisations understand the legislation and deal with the risks of bribery. The Act comes into force on 1 July 2011.

Revised guidance, Ethnicity and First Language Recording

Please note this GPC guidance on ethnicity and first language recording has been revised to provide clarity that this work is no longer a contractual requirement; the guidance is to assist those practices choosing to continue.

Bulletin 102

17.05.11

Issue with Read Code MH14 within QOF Business Rules v19

An issue with the Mental Health HDL: total cholesterol cluster (HDLTCHOL_COD) within the version 19.0 ruleset of the Business Rules has been identified. This will be rectified by the NHS IC when producing the version 20.0 ruleset of the Business Rules that incorporates any relevant codes from the April code release. The Business Rules version 20.0 are expected to be made available to GPSS and published to the PCC website before the end of this May. The erroneous codes 44PG. and XaEil will be removed from this cluster and replaced with:

Read V2
44PF. Total cholesterol:HDL ratio
44l2. Cholesterol/HDL ratio
44lF. Serum cholesterol/HDL ratio
44lG. Plasma cholesterol/HDL ratio

CTV3:
44PF. Total cholesterol:HDL ratio
XaERR Cholesterol/HDL ratio
XaEUq Serum cholesterol/HDL ratio
XaEUr Plasma cholesterol/HDL ratio

Negative Comments Posted on NHS Choices Website

GPC has been made aware that there is some confusion concerning the procedures in place when a practice receives notification of negative comments posted on the NHS Choices website. To clarify, practices are notified of a comment pertaining to them following the publication of the comment. An alert is sent to a named recipient at the practice in question (usually the practice manager although this will be designated by the practice). Practices then have two options:

1. Post a reply, in order to put across the practice’s views and deal with any issues raised. This will appear immediately below the original comment. We strongly urge all practices to reply to negative comment very carefully as this can act as a very useful defence against an unfair comment, as well as enhancing the appearance of the practice in the eyes of the public. Keep it professional and factual rather than aggressive-defensive.

2. Report the comment to the website moderator as unsuitable.

NHS Choices have a ‘comments policy’ on their website which states that 'should a comment be flagged by a practice as unsuitable, then this will alert their moderators to take down the comment, consider it, and then either remove it or re-instate it as they deem appropriate'. The following NHS Choices guidance may assist practices in managing any comments they receive:

Managing patient feedback

Best practice – responding to patient feedback

Bulletin 101

09.05.11

NHS Reform Listening Exercise - Have Your say

The BMA is encouraging members to feed their views on the future shape of the NHS in England into the government’s ‘listening exercise’. You can complete a structured feedback form, on this new hub page, that will inform the BMA submission to the NHS Future Forum, due to be sent in the end of the month. The BMA are also using the page to inform members of how they can input their views to the Future Forum via the DH, and will be hosting a web-chat on the website on the evening of Monday 16 May, with members of the Future Forum taking part. You should have received this letter from Laurence Buckman last week encouraging you to put forward your views.

NHS Availability of Antivirals for Flu, Changes to Regulations

There has been some changes to the regulations regarding NHS availability of antivirals for flu, adding a new category of patient, to allow GPs to prescribe antiviral treatments on the NHS for patients not in one of the designated "at clinical risk" groups, but who are at risk of developing complications from flu. Therefore, oseltamivir and zanamivir may, in certain circumstances, be ordered for those who are under 65 years of age, who are not pregnant, nor considered to be at clinical risk, but who are considered to be at risk of developing complications from the symptoms of influenza.

The NHS (General Medical Services Contracts)(Prescription of Drugs etc.) (Amendment) Regulations 2011 came into force on 20 April and details of these are also published in Part XVIIIB of the Drug Tariff.

Fitness To Drive Guidance

GPC has received some queries regarding the status of changes to the rules regarding driving and diabetes. There appears to have been some confusion because in February 2011 the DVLA published a revised version of their "At a glance guide to the current medical standards of fitness to drive" at the same time as they published the Department of Transport’s consultation on UK driving licence standards. The ‘At a glance’ document contained some changes from the August 2010 version. These included changing the categories for diabetes “managed by tablets” and accommodating additional criteria for Group 1 and 2 drivers such as, the requirement that the person “must not have had more than one episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months”.

Ethnicity and First Language Recording Guidance

The Ethnicity and First Language DES was withdrawn on 1 April 2011, because it was intended as a two-year catch up to enable practices to record ethnicity and first language for patients already on their list, and following the third year extension for 2010-11, this has now ceased. Despite the withdrawal of this DES, it is expected that practices would want to continue to record their patients’ first language and ethnicity as a matter of routine in order to assess the needs of their population. This guidance highlights the published codes for ethnicity and first language so that practices can continue to record this data.

Changes to the ABPI Code of Practice

The BMA has joined 16 other organisations in a joint statement supporting two key changes to the Association of British Pharmaceutical Industries (ABPI) Code of Practice which was published in March 2011. From 1st May 2011, the pharmaceutical industry will no longer be allowed to provide branded promotional aids, such as pens, pads and mugs, to healthcare professionals. From 2012, companies will be required to collect and declare on an annual basis aggregate total amounts paid to health professionals and others for certain services such as speaker fees and participation in advisory boards. Similarly companies will be required to declare sponsorship for attendance at meetings organised by third parties. The first declaration of payments will be in 2013 for payments made in 2012. The Code does not require individual health professionals to be named but does require the total number of health professionals involved to be declared and the total number of meeting attendances sponsored.

Bulletin 100

03.05.11

Revalidation

Following last year’s revalidation consultation response in which they made a commitment to simplify and streamline the revalidation process, the GMC has now published guidance on the supporting evidence required for revalidation, along with a new framework based on Good Medical Practice. The guidance states that there are six types of supporting evidence that doctors will need to provide over the five year cycle. Whereas previously there had been a need to map the supporting evidence to each of the twelve attributes set out in the Good Medical Practice Framework, it will now be assumed that these attributes have been fulfilled by submitting types of supporting information:

1. continuing professional development
2. quality improvement activity
3. significant events
4. feedback from colleagues
5. feedback from patients
6. review of complaints and compliments

Bulletin 99

19.04.11

Focus on QOF and amended Guidance

The Focus on QOF payments has been updated to take in to account the changes in the GMS contract agreement 2011/12. The guidance gives a full breakdown of the methods used to calculate and make payments earned through the QOF. The information within it is drawn from the Statement of Financial Entitlements which can be accessed on the Department of Health website. The guidance note quotes the value per QOF point for 2010-11 as £130.51 for England.

Please note: the QOF guidance issued last week has been revised due to a typing error - please use this version of the guidance. The typing error has been discovered in the ‘Quality and Productivity 3.2 reporting and verification’ section in paragraph 4 (page 166) of the QOF guidance. The date on the second line incorrectly stated ‘31 December 2011’, this date should read December 2010. This is because the reductions calculated in the third quarter of 2011 will be compared against the last quarter of the previous financial year, rather than the previous quarter in 2011. As such the calculation will be made based on the achievement for the quarter ending on 31 December 2010. DH will be amending the SFE which mirrors this error.

Business Rules and QMAS Updates

The NHS Information Centre (IC) is currently working on the April READ code release and the NHS Employers are working with them to look at the code changes they have proposed. This information will form part of the business rules, which is the reason they have not yet been published. It is expected that v.19 of the business rules , including the 11/12 indicators, will be published shortly and will enable GP system suppliers to update their local searches and templates. The April code release (business rules v.20) is due to be published by the end of April. Due to the delay in finalising the GMS contract agreement, it is estimated to take until October for the QMAS updates to be available. This is not due to any changes in the process for developing business rules. The DoH and Connecting for Health (CfH) normally expect negotiations to be concluded by the turn of the calendar year, which would allow QMAS to be updated by the second quarter of the financial year to which the changes apply. CfH are currently procuring a new system to replace QMAS - the GP Payments Calculation Service - and one of the key requirements for the new system will be to ensure faster turnaround of changes to the system.

Updating Business Continuity Plans

We strongly recommend all practices revisit their Business Continuity plans to ensure that they are up to date if you have not done so recently, particularly with the extended Bank Holiday period on the horizon and change in out of hours provider. Key areas to consider are out of hours and emergency cover you have in place - be it with NDUC, Primecare or via another provider - to ensure these details are up to date and that you have adequate cover formally arranged.

Doctors for Doctors and GP Health

The BMA provides support to doctors in difficulty through two confidential telephone services, BMA Counselling and the Doctor Advisor Service, which can both be accessed on 08459 200 169. Issues dealt with include stress, bullying, GMC concerns, depression, debt and substance abuse. Further information can be found here or by writing to info.d4d@bma.org.uk.

Tees GPs can also enjoy free and confidential health and wellbeing services through the local organisation GP Health. GP Health offer counselling, mentoring and psychiatric help to GPs, dentists, practice managers, nurses and practice staff in the Tees Valley Area. They are funded jointly by all the Tees Primary Care Organisations. Further details can be found here.

Bulletin 98

12.04.11

Patient Participation DES Guidance

The monies released through the reduction in the cost of the extended hours DES will be reinvested into a patient participation DES in England, the aim of which is to promote the proactive engagement of patients through the use of effective Patient Reference Groups and to seek views from practice patients through the use of a local patient survey. This guidance gives more detail on how around £60m of released investment will be available to practices, provided that they successfully meet these requirements, which is equivalent in total to £1.10 per registered patient. The key requirements of the patient participation arrangements agreed by negotiators are that GP practices:

• develop a structure that gains the views of patients and enables the practice to obtain feedback from the practice population, eg a patient reference group
• agree areas of priority with their patient reference group
• collate patient views through a patient survey
• agree an action plan with their patient reference group
• publicise the results of the patient survey
• publicise the actions taken and what is achieved as a result

Bulletin 97

05.04.11

Updated SFE and DES Directions

The updated SFE and DES Directions were made public at the end of last week. Further details GPC guidance will be available shortly. We have had a number of enquiries with regard t the Extended Hours DES. As you will see in the Directions, the PCTs must offer the DES to all practices by 30 April 2011. NEPCSA and NHS Tees are currently discussing the new DES arrangements and will provide updated details to the all practices shortly.

Updated Summary of QOF Indicators

The summary of the QOF indicators has been updated to include more details about the Quality and Productivity indicators.

Media Handling

In the current climate practices may receive an increasing number of requests from the media. It would be extremely helpful if practices could advise the LMC if they have been approached by the media but practices are free to make their own decision as to whether or not they feel comfortable in speaking directly to the media. The LMC and PCT Communications Team are available to offer support in any media handling. You may also wish to consider contacting your MDO for support particularly with regard to performance complaints or GMC cases.

Clinical Waste

Waste disposal legislation requires all producers of healthcare waste, including GP practices, to complete an audit of their clinical waste disposals. The deadline for GP practices to complete their audits is 1 July 2011. You may find this Focus on Colour Coding for Sharps Box document useful.

GPC Annual Report

The GPC's 2010-11 Annual Report has now been published.

Bulletin 96

29.03.11

Legal Status of Consortia

The Department of Health has issued this document which clarifies the position regarding the legal status of consortia. Bearing in mind this document and the day to day and ongoing challenges for shadow consortia, the GPC's strong recommendation remains that consortia think very carefully before entering into contracts with third parties, in particular those of high value, exposure and/or long duration.

Seasonal Flu Vaccination Programme 2011/12

All practices should by now have received this letter from the Chief Medical Officer (England), which confirmed that the arrangements for procurement of vaccines for 2011/12 would remain the same as last year. Practices are responsible for ordering seasonal flu vaccine for the coming winter and should start ordering vaccines now, if they have not already done so. In the letter from the CMO, you will see that the government would like practices to order sufficient vaccine to cover 75% of their patients aged 65 or over, and at least 60% of patients under 65 in clinical risk groups (including pregnant women). The GPC have been informed that so far, practices have not increased their vaccine orders to take into account the localised shortages experienced last winter, and despite a rising number of patients in the at-risk groups. We would encourage practices to review their flu vaccine orders, to ensure that they have ordered sufficient number of vaccines for their patients in the at-risk groups.

Good Practice Guidelines for GP Electronic Patient Records

Version four of the Good Practice Guidelines has now been published. This latest version supersedes version 3.1, and will act as a reference and source of information for all those involved in developing, deploying and using general practice IT systems. This shorter quick reference guide and this Equality Analysis document are also available.

Focus on.. Taking on New Partners

This new guidance note looks at the factors GP practices may consider when deciding whether to take on a GP partner or salaried GP. Issues covered in the document include the cost of employing a salaried GP (including National Insurance contributions and employer’s superannuation), the impact of the tax burden for existing partners earning over £100,000, as well as the benefits of taking on a new partner.

Managing Medicines in Nursery Schools

This Statutory Framework for the Early Years Foundation Stage outlines the policy for administering medicines to children in nurseries. The Department of Education and Skills has also issued this 'Managing medicines in schools and early year settings' guidance which sets out the framework for Local Authorities, PCTs and schools to use to ensure that children requiring medicines receive the support they need. This guidance contains information about Health Care Plans for such children, involving the parents and relevant health professionals.

Bulletin 95

22.03.11

BMA SRM Resolutions

The BMA’s Special Representative Meeting to debate the Health and Social Care Bill held on 15 March produced this list of resolutions. In its meeting the following day, BMA Council confirmed its intention to step up its opposition to and continue to publicise the most damaging parts of the Bill. Council also considered a variety of options that would be necessary to achieve these aims. The role that competition, and in particular Monitor - as the economic regulator - will play in planning and running health care, is a key concern. The GPC discussed the areas of concern in the Bill on which it will be focusing in the coming months. These will include: highlighting the considerable unacceptable restrictions the legislation would place on commissioning consortia; the damaging implications of the quality premium; and competition and the role of Monitor.

In a press statement issued after the Council meeting, Hamish Meldrum, Chairman of Council, said: "Ministers can no longer continue to cite the often reluctant and pragmatic decision by GPs to get involved in commissioning groups as endorsement of their NHS reforms. Following yesterday’s SRM, the government should not be left in any doubt about the strength of feeling among the medical profession; many doctors recognise the need to change how the NHS is run but have serious concerns about scale and nature of the planned reforms which are hugely risky and, potentially, highly damaging."

Seasonal Flu Vaccination Programme 2011/12

The Chief Medical Officer (England) sent this letter to PCTs and GPs confirming that the arrangements for procurement of vaccines for 2011/12 will remain the same as last year, and urging practices to start ordering their vaccines now, if they have not already done so. This letter follows an announcement made earlier this year by Professor David Salisbury, DH Director of Immunisation, of their intention to carry out a review of current procedures, and the GPC asking the DH to confirm the arrangements for this year so that practices would know what they needed to do in preparation. The GPC would like to congratulate practices on their hard work in relation to seasonal flu vaccinations for 10/11, despite all the potential problems practices faced over the winter.

Chorionic Villus Sampling (CVS) Service

JCUH, in conjunction with the RVI, is implementing a new Chorionic Villus Sampling (CVS) service offering pre-natal diagnosis to all pregnant women in the North East. The service will commence on 22 March 2011 and full details are available in this letter.

Tees Senior Medical Advisor

We are sure you will be aware that Dr James Gossow was appointed as Senior Medical Advisor for NHS Tees, with effect 1 March 2011. In his role Dr Gossow will be working within the Corporate Affairs Team to provide clinical advice to the Boards and also input to contracting and procurement, local advice re complaints and Serious Untoward Incidents (SUIs), quality issues and improvement. The LMC would like to congratulate Dr Gossow on his appointment; involvement of a clinician with local knowledge and understanding is invaluable and we are delighted to continue to work with Dr Gossow. Dr Gossow will be attending the LMC Board, on a co-opted basis, in his capacity as Senior Medical Advisor.

Bulletin 94

15.03.11

GMS Contract Agreement 2011/12

Negotiations between the GPC and NHS Employers have now concluded and agreement has been reached with the Health Department in. All GPs in the UK have been sent this letter which sets out the details of the agreement. The agreement relates to the following areas of the contract:

• Practice Expenses
• The Extended Hours DES in England
• Certain QOF points, indicators & thresholds
• Clinical DESs
• A new Patient Participation DES in England
• New Quality & Productivity Indicators in the QOF

Bulletin 93

08.03.11

Royal Wedding 29 April

Reminder that 29 April 2011 has been declared a bank holiday in the United Kingdom by the Queen. Please note that PCTs rather than practices are responsible for resolving financial issues with contracted OOH providers. NHS Tees is working with providers on the necessary arrangements and a related media campaign to raise public awareness. The LMC will provide an update to all practices shortly.

Clinical Waste Pre-Acceptance Audit

The Environment Agency has now re-published its sector guidance 5.07 for operators of waste disposal facilities. The guidance requires all producers of healthcare waste, including GP practices, to complete an audit of their clinical waste. The deadline for this was originally set for October 2010 but was extended due to the need for further consultation with the waste management industry. GP practices must now provide the relevant information to their waste contractor by 1st July 2011. Practices can either collect the data themselves or employ a third party to do so. Alternatively, the practice’s waste contractor may offer to complete the audit but may charge for this service.

Consultant Involvement in Commissioning

The Central Consultants and Specialists Committee (CCSC) and GPC have produced joint guidance highlighting the implications of the Health and Social Care Bill and the importance of involving secondary and tertiary care clinicians in the commissioning process and enabling consultant involvement.

Bulletin 92

01.03.11

QoF/QMAS Underpayments

The BMA FAQs about the QMAS underpayments have now been updated to include questions about tax, pension and seniority issues. This is following the publication of Q&As by the Department of Health.

Overseas Visitors Guidance

The GPC has published 'Overseas visitors accessing NHS primary medical services' guidance. This guidance has been written with the assistance of the BMA's International and Ethics departments.

Vetting & Barring Scheme

The government has announced provisions to revise its vetting and barring arrangements. Information about the reforms, and the scheme remodelling review report, can be viewed here.

CQC Hoax Calls

The GPC have been made aware that the CQC has received reports from care homes and nursing homes that have been targeted by bogus callers requesting the names and PINs of nurses employed there, claiming to be from the Nursing and Midwifery Council or the Care Quality Commission. Phone calls requesting personal data are not the policy of the CQC or the Nursing and Midwifery Council, and GPs and their practice staff should not volunteer any information to these scam callers. Please take as many details from the caller as you can and send the details to the LMC or take the matter to the local police.

NICE Online Resource for General Practice

NICE has launched a new section of its website, designed to help staff in general practice get the most out of evidence and guidance provided by NICE. Specifically created to support the use of evidence-based medicine and public health practice, this online resource offers solutions to enable the uptake of NICE and other national guidance in primary care, and contains a section on how NICE can help GP consortia. Written with help from GPs, practice managers and practice nurses, it hoped it will prove a valuable tool to help to deliver high quality primary care and to improve patient outcomes.

Bulletin 91

22.02.11

Health & Social Care Bill 2011 & Lobbying MPs

You are strongly recommended to keep up to date with the BMA Health Bill webpage, where detail on the Bill can be found. The BMA has produced a useful toolkit to inform the profession about the draft Health Bill, and also to enable members to lobby their MPs on issues that concern them. In particular, please take the opportunity to write to your MP and express your concerns using the template letters. At the GPC meeting, the following motions relating to the Health and Social Care Bill were passed:

• That the GPC recognises there is ample international evidence to show that competition over price for health care results in a poorer quality of health care provided but that competition in quality of health care provided improves the quality of health care provided. The GPC therefore resolves to promote and support amendments to the Health and Social Care Bill that will preclude price competition within the National Health Service.
• That the GPC resolves to promote and support amendments to the Health and Social Care Bill that permit commissioning consortia to choose which licensed providers are entered on their local lists from which GPs can help patients decide which provider to choose. GPs should also have access to the national list of licensed providers for patients who wish to make an ‘out of area’ choice.

1. reducing health inequalities is a matter of fairness and social justice
2. the lower a person’s social position, the worse his or her health
3. health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health
4. focusing solely on the most disadvantaged will not reduce health inequalities sufficiently
5. action taken to reduce health inequalities will benefit society in many way
6. reducing health inequalities will require action on six policy objectives:
   • give every child the best start in life
   • enable all people to maximise their capabilities and have control over their lives
   • create fair employment and good work for all
   • ensure healthy standard of living for all
   • create and develop healthy and sustainable places and communities
   • strengthen the role and impact of ill-health prevention.

Bulletin 90

15.02.11

QoF/QMAS Underpayments

Last week we informed you of a DH letter to PCTs with regard to underpayments in QoF. Following the publication of this letter, PCTs should now have informed all practices what QMAS repayment they are entitled to and when it will be paid. The information that PCTs have been provided does not enable them to break the figures down on a year by year basis, and therefore practices should treat the income as relating to 2010/11 only. You can find out if your practice has been under paid and by how much by finding your practice code on this spreadsheet. The GPC has produced this FAQ to help answer questions that are arising including whether this will raise any retrospective superannuation issues; because the payment should be treated by practices as a one-off payment in 2010/11, then this will not affect superannuation payments, seniority or tax returns (for previous years).

As this is a one-off in year payment to the practice it is for each practice to deal with the distribution of the payment according to their normal practice and/or the partnership agreement. Practices may also need to take accountancy advice.

CQC Registration

All GP practices should have received this introductory letter and briefing note about CQC registration by post from the Care Quality Commission. The GPC intends to publish its 'CQC for NHS GPs' toolkit in early spring 2011. This toolkit will contain guidance on applying and complying. When practices apply for CQC registration from October 2011 they will be expected to declare compliance with the CQC's standards for the regulated activities that they perform but not actually have to demonstrate compliance at that point. Only practices that declare non-compliance with any of the standards should be contacted by the CQC before April 2012 about how to become compliant. Otherwise the monitoring of compliance by CQC will not commence until April 2012.

Bulletin 89

08.02.11

Appraisals Reminder and Updated Contacts

Participation in the PCT appraisal scheme is a condition of inclusion on the Performers list. The Tees PCT scheme is a compulsory annual appraisal in your birthday quarter. Please ensure you are up to date with your appraisals and/or contact Glyn Bosson, on 0191 502 6495 or glyn.bosson@northteespct.nhs.uk, for further details or to discuss your specific circumstance.

Performers List Responsibilities Reminder and Updated Contacts

There are a number of commitments doctors entered into when joining the Performers List including keeping the NEPCSA (North East Primary Care Service Agency) informed of home addresses and where you are working; informing the NEPCSA of any criminal charges, convictions or cautions but not fixed penalty notices; informing the NEPCSA of any investigation of your conduct by the GMC any other professional body or another employer. Please ensure you notify a member of the Performers List team at NEPCSA, 0191 275 4200 or NEPCSA, Performers List, 2nd Floor Partnership House, Regent Farm Road, Gosforth, Newcastle upon Tyne, NE3 3HD, of any change to your contact details. This is particularly important for locum GPs who may working in a number of practices.

Violence in Practices and Violent Patient Procedure Reminder

It is vitally important that practice follow the correct procedure when handling violence in practice, especially in the correct removal of violent patients, to ensure that all who work in primary care are protected. You may find this LMC guidance a helpful reminder. Please note the new contact details included in the guidance.

Underpayments in QoF

The Department of Health (England) will be writing to PCTs week beginning 7 February to inform them that an error has been identified within the Quality Management & Analysis System (QMAS), which calculates payments to GP contractors under the Quality and Outcomes Framework (QOF). GP contractors have, as a result, been underpaid for their achievement for the additional services indicators since 2004/05. These payments will vary as they will be based on the actual circumstances of individual practices. The letter will provide further information around how the level of underpayments has been calculated and outlines PCTs' legal responsibility to make good the underpayments. The DH letter and FAQs will be published here shortly.

Medicine Supply and Distribution to Patients, Best Practice Guidance

New joint guidance has been published by the "Medicines Supply Chain Forum" which was set up by the Department of Health in response to problems being experienced in the supply chain resulting in stocks of medicine being disrupted and depleted. This guidance is designed to address these problems and to secure the integrity of the supply chain. The GPC, along with various other stakeholders from different branches of the healthcare sector, were represented on this forum and helped to shape the guidance which sets out "best practice" for manufacturers, wholesalers, pharmacies and doctors' dispensaries, and prescribers. Note that this guidance supersedes the "Trading Medicines for Human Use: Shortages and supply chain obligations" which was published in 2009.

Partnership Agreements Reminder

We strongly recommend that GPs in partnership enter into a 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. BMA has produced this guidance on partnership agreements. 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.

Bulletin 88

25.01.11

Health & Social Care Bill 2011

As you will know the Health and Social Care Bill was presented to Parliament on Wednesday 19 January. It sets out the legislation required to implement the Government’s plans for major NHS reform, as outlined in its earlier White Paper "Equity and Excellence: Liberating the NHS" released in July 2010. Laurence Buckman, GPC Chairman, has written a letter to all GPs in England regarding this Bill, and its implications for the future of general practice.

Practice Profiles on Cancer

You may be aware that the National Cancer Intelligence Network and the Association of Public Health Observatories have developed GP Practice profiles on cancer to help drive forward the cancer agenda and improve patient care and outcomes. These profiles provide a rich source of practice data for you to consider as well as being able to compare local and national data. Practices can view their own profiles and comparative data here.

Early notification/date for your diary - 6/7 April 2011 North East Cancer Network will be holding an accelerated learning event at Hardwick Hall. Flyers will be circulated shortly with further details.

Eric Gambrill Memorial Awards 2011

The Eric Gambrill Memorial Award is open for applicants. The website provides full details of the awards - there are two awards each of £3,000, and GPs have until 21 April 2011 to submit an application.

Bulletin 87

18.01.11

Clarification of Legal Position re Flu Vaccine Sharing

The Department of Health (DH) have now advised regarding the legalities of practices (in England) sharing spare stock of flu vaccines with other practices. Normally, a wholesale dealers licence is required (by medicines legislation) for someone to supply a medicine to a person who is not the end user, i.e. the patient. Given the circumstances the MHRA have agreed the following response, which mirrors the position adopted during the swine flu pandemic: "The transfer of vials of flu vaccines between GP practices is not normally accepted practice. However, if for a specific patient need, it proved necessary for inter-practice transfers to take place, health professionals should ensure the maintenance of the cold chain, traceability, and provision of current patient information leaflets and summaries of product characteristics." So in this situation GP practices can transfer vaccine stock to another practice.

Flu Vaccination (Pandemrix) and QOF Changes

On 6 January the interim CMO for England, announced that practices would be able to use the monovalent Pandemrix H1N1 vaccine where there is a localised shortage of the trivalent seasonal flu vaccine for their eligible patient population. Following this announcement, the GPC and NHS Employers have agreed that for the purpose of QOF, for 2010/11 only, eligible patients who have received Pandemrix in place of the seasonal flu vaccine should count towards their achievement for the relevant QOF indicators.

Technical information: Codes to allow this to be calculated automatically as part of the 2010/11 QOF achievement have been requested and are expected to be available by the end of January 2011 and published on the PCC website.

The relevant clusters are FLU_COD and TXFLU_COD and relate to:

• The chronic heart disease (CHD) Ruleset
• The chronic obstructive pulmonary disease (COPD) ruleset
• The Diabetes ruleset
• The Stroke ruleset

• PA and vaccine costs for vaccines procured and administered to their own practice population
• An Item of service fee for vaccines administered to their own practice population
• PA and vaccine costs for those vaccines procured and passed to another practice – IOS fees should only be claimed by the practice that administers the vaccine

• An Item of service fee for vaccines administered to their own patient population
• PA and vaccine costs can only be claimed for the vaccines procured directly from the supplier and administered to their own practice population. PA and vaccine costs for vaccines procured from another practice cannot be claimed.

Bulletin 86

11.01.11

Seasonal Flu Vaccine

You should have received this letter from the acting CMO about influenza vaccination and also have seen a message from GPC Chairman Laurence Buckman with regard to flu vaccination with the following key points:

1. The vaccination priority remains the under 65s at risk, those who are pregnant, and others at risk. The under 5s who are otherwise healthy should not be vaccinated. Those not at risk are not entitled to get the flu vaccination on the NHS.
2. Please let your PCT know if you have spare stock of flu vaccines so they can offer it to others.
3. The Department of Health is trying to obtain more vaccine.
4. You may use Pandemrix (the monovalent pandemic flu vaccine), which you can obtain locally. PCTs can order more and get it sent to practices directly, using last year's arrangements. GPs registered to order directly can do so. You can use this for any at risk patient.
   
   The GPC urge every GP to offer whatever vaccine they have to those at risk and to let their LMC know if they are having problems obtaining supplies.

Bulletin 85

04.01.11

Seasonal Flu Vaccine - various important updates

The BMA is encouraging GPs to continue to vaccinate all patients at risk of developing complications of seasonal flu. Message from Dr Laurence Buckman, Chairman of the GPC: "Although this is a very busy time of year for GPs and patients, I urge GPs to vaccinate their at-risk patients who have not yet received the flu vaccination and would encourage all patients who are in an at-risk group to have the flu jab as quickly as possible as this will reduce the chances of them getting seriously ill with flu."

The GPC has written to the DoH to raise concerns about the seasonal flu vaccination campaign and the low uptake of the flu vaccination amongst at-risk patients. The GPC is urging the DoH to step up the public awareness campaign for the vaccination to encourage eligible patients to visit their GP surgeries to be immunised as soon as possible and explain the risks of leaving themselves vulnerable to the virus. Patients concerned about the vaccination containing the H1N1 flu strain also need to be assured of the safety of the vaccine. Professor Salisbury wrote this letter to Strategic Health Authority Immunisation Leads with data on vaccination uptake, encouraging SHAs to raise public awareness through the local media and work with practices to urge patients to get vaccinated.

Please note: all pregnant women who request the trivalent seasonal influenza vaccine should be offered it, irrespective of whether they have already received the monovalent H1N1v vaccine. This letter from Professor Salisbury clarifies the advice for the seasonal flu vaccination for pregnant women. This letter was also sent to the RCM and RCOG with regard to pregnant women and flu.

Government Response to White Paper Consultation

The government has published its response to the consultation on the NHS White Paper, titled ‘Liberating the NHS: Legislative Framework and Next Steps’. The full response can be read here. Although the government is going to continue with a majority of the proposals made in the White Paper, there have been a number of changes including the following:

- Maternity services will in the future be commissioned by consortia, rather than the NHS Commissioning Board
- Consortia will be required to have a written constitution
- Strengthened role for health and wellbeing boards
- Scrutiny functions will not be removed from local authorities

NHS Operating Framework 2011/12

The government has published the NHS Operating Framework 2011/12. This stated that PCTs would merge into cluster by June 2011 in response to the drive to reduce management costs. Clusters are to support the development of consortia by offering them a £2 per head development fund. This should be in addition to existing PBC DES funding.

GPC Chairman White Paper Update Letter

This letter was sent a couple of weeks ago from Laurence Buckman, Chairman of the GPC, providing you with an update on White Paper issues. It is included in this bulletin for your ease of reference.

Annual Certificate of Pensionable Earning

GPs and their accountants are reminded that, in accordance with the NHS Pension Scheme Regulations, they must provide their PCO with a completed certificate no later than one month from the date the HMRC tax return is due. The accumulated data are used to help confirm NHS information on GP earnings and it is important that this is as current as possible.

GP2GP InPS Vision Blank Attachment Problems

The GP2GP project has brought to GPC attention that there is a problem affecting practices engaged in GP2GP transfer using InPractice (InPS) System Vision 3. These practices appear to be sending blank attachments in the GP2GP transferred record. The issue has been identified by InPS as one relating to the configuration with DocMan, which is not being set up on the practice eBXML machine and the practice NACS code not being set up in the DocMan application. Further guidance on this can be found on the InPS website. InPractice is contacting all practices to assess if their system is configured correctly and correcting those systems where it is not. If a practice has any concerns they would like to raise with the GP2GP project regarding this matter please e-mail these to GP2GP@nhs.net. The GP2GP project is closely monitoring the current progress of this work, but would ask practices to:

1. Check if their system is configured correctly as per the guidance issued by InPractice in the link above;

2. Contact the supplier help desk for assistance if required;

3. If practices using other GP systems are receiving GP2GP transfers from InPractice Vision 3 practices, they are advised to check for any blank attachments. In the event that any blank attachments are found, they should await the attachments which should follow in the Lloyd George paper envelope. If information is required urgently the sending practice should be contacted directly.

SCAM ALERT, Physicians Register

There appears to be a new scam hitting local practices in the form of letter headed 'The Physicians Register'. It's subject is headed 'Data Control/Confirmation of Validity' and it states that 'basic data are published free of charge'. However, tucked away on the validation form in the 'order section' is, amongst other statements, a cost implication in Euros and that favourite line that unless cancelled the order will automatically be prolonged for a further year. PLEASE DO NOT SIGN ANYTHING as we are sure this is a scam - I am trying to seek confirmation that this is the case.

APHO General Practice Profiles

The Association of Public Health Observatories will shortly be starting user testing of APHO General Practice Profiles. The profiles may prove helpful to consortia, particularly in allowing them to identify specific demographic issues faced by individual practices and to identify practices of similar profile, be it in the immediate locality or other areas of the country, to enable best practice learning and sharing. The profiles contain 158 practice-level indicators covering demography, deprivation, patient satisfaction, the Quality and Outcomes Framework, and selected hospital activity indicators, using the latest data made available in October 2010. Users can view the profile for an individual practice, or they can define a cluster of practices and view the profile for that cluster or compare an individual practice with the whole cluster.

Practice-level profiles have been produced by some Public Health Observatories for a while but this is the first time that APHO has produced them for the whole of England. GPs and practice managers that have used the existing profiles have found them useful in assessing the health needs of their populations and in comparing their own practices with national benchmarks. As GPs focus more on the commissioning of services for their populations, the profiles are likely to be of increasing use, especially as they now offer the ability to define clusters. The profiles were demonstrated at the NHS Alliance Conference on 18/19 November and are now available here.

APHO is working on a formal public launch in early 2011. In the meantime, although they are keen to make as many GPs aware of the profiles as possible, they are not actively seeking media coverage or promoting the profiles to members of the public, so please do not promote the profiles outside the GP community. APHO is keen to collate feedback from users and to gather examples of how practices and consortia are using the profiles. For this purpose they have set up a short online survey, accessible from the profiles web page; supporting documents such as a User Guide, Frequently Asked Questions and a Metadata document are also linked from the same page, at http://www.apho.org.uk/pracprof.