LMC Bulletins 2013

Bulletin 209

Updated FAQs, 14/15 Contract
The GPC FAQs have now been updated to include some questions in relation to funding.

PMS Letter
NHS England has sent this letter to its Area Teams, confirming arrangements for the uplift for PMS practices relating to locum employer superannuation costs, which for those practices who have not already received it will need to be backdated to April 2013. This confirmation comes after a long period of lobbying from the GPC for this issue to be resolved. If you have not received this uplift, now this letter has been circulated, please email Janice.foster@tees.nhs,uk. The letter also refers to announcing wider steps on PMS in around a month's time, linked to applying equitable funding to PMS practices. Again, the have been pushing for some time for a resolution to this issue, in order to provide more certainty to practices about their funding in the coming years. We will provide more information about this when it is available.

Reconciling GP Payments Guidance
NHS England has been working closely with stakeholders, including GPC, to tackle the issue of some GP practices experiencing difficulties receiving and reconciling payments. To help practices on payments, NHS England has published a new NHAIS Statement & NHS Shared Business Services Remittance Guide document, to highlight the improvements made to practice statements generated by the National Health Application and Infrastructure Services (NHAIS) system. The guidance is available on Health and Social Care Information Centre (HSCIC) website, but is only accessible to those on the NHS web.

Care.data, Important Information
In January 2014, every household in England will receive a leaflet from NHS England which will support practices with their public awareness raising activities. The leaflet will describe how information in medical records is used for purposes beyond the direct care of the patient, including the care.data programme. It is important that GP practices continue to raise awareness proactively with their patients about the ways in which patient information is used and shared beyond direct care. The content of the leaflet being sent to households is very similar to the leaflets provided to practices in September 2013 and will include the telephone number of a dedicated patient information line that will come into operation on 6 January. The BMA and patient representatives have been involved in the wording of both leaflets. GPs will receive an email communication shortly before the household leaflet drop. This will include a link to the leaflet and updated GP and patient FAQs. Once the leaflet has been delivered to households, patients will have a minimum of four weeks to read the leaflet and register their objection at the GP practice, if they wish to do so before the first extract begins. Extractions of GP data for care.data will begin in Spring 2014. We will keep you informed of developments. Background information and existing guidance are available here.

CQRS, Latest Bulletin
This latest CQRS bulletin was sent out to subscribers this week. The bulletin provides updates and information on the manual data entry for the Enhanced Services, QOF 2013/14 and preparation for year-end, reports available on CQRS and GPES awareness sessions. Following the simple guidance I provided, if you are still having problems with CQRS, be it the manual data entry or awaiting approval from the Area Team, please do email Janice.foster@tees.nhs.uk and I will do my best to assist. 

NHS England Audit of 084 Numbers
Area Teams were recently instructed to carry out audits of practice telephony arrangements by NHS England. This is to determine the scale of continuing non-compliance with regulations. As stated in the GPC guidance on the use of non-geographical numbers, practices that signed contracts with telecommunications providers prior to 1 April 2011 should have taken all 'reasonable steps' (as referred to in the regulations), with the support of their provider, to ensure practice telephony arrangements are compliant. It would not, however, be reasonable for practices to re-negotiate, vary or terminate these existing contracts (signed before 1 April 2011) if this meant a significant financial penalty. In these cases, the vast majority of telecomms providers are able to offer alternative solutions to ensure practice arrangements are compliant. Practices should only sign new or renewed contracts if the provider can assure them that the arrangements will comply with the regulations.

Prime Minister’s Challenge, Expressions of Interest Invited
On 1 October, the Prime Minister announced that there would be a new £50 million Challenge Fund to help extend access to general practice and stimulate innovative ways of providing primary care services. The Government has asked NHS England to lead the process of inviting expressions of interest and oversee the pilots. Details on how to apply to become a pilot site, the application criteria and timescales are all now available on NHS England’s website.

Charges for Occupational Health Vaccinations
Nationally, some GP trainees working in a general practice setting are being asked to pay for occupational health vaccinations. Under no circumstances should GP trainees or any other doctors in the NHS be required to pay for vaccinations where they are involved in direct patient care. This is outlined in the Department of Health ‘Green Book’ on immunisation against infectious disease (pages 83-90), which states:

“Employers need to be able to demonstrate that an effective employee immunisation programme is in place, and they have an obligation to arrange and pay for this service.” The Control of Substances Hazardous to Health (COSHH) Regulations also requires an assessment to be made (by an employer) of a range of hazardous substances, including “biological agents”, in order that suitable “control measures” can be implemented to minimise the risk. Where a risk has been identified and where effective vaccines are available these should be used as a method of control. The employer is required to make provision of the vaccines to staff who are not already immune. Section 9 of The Health & Safety at Work Act 1974 requires that this be offered free of charge to staff. If you are a GP trainee and have been charged for occupational health vaccinations please contact Christopher Scott via cscott@bma.org.uk.

GP Trainee Subcommittee Newsletter
This GP Trainees Subcommittee's winter newsletter includes, top tips for the Applied Knowledge Test (AKT), important information on charges for occupational health vaccinations, 'to do' list for GP trainees going on maternity leave and the details of the elected regional representatives.  

Bulletin 208

SCAM – Temdi.com
It seems that we have a new name on the block doing the same old scam. A company called TEMDI is writing to practices asking them to confirm details are correct or send any changes so their directory can be amended if necessary. IF YOU RETURN ANYTHING YOU WILL BE BILLED!! DO NOT SIGN AND/OR RETURN ANYTHING! You may also know this scam as European Medical Directory, Med1web or Novachannel.

Updated GPC Guidance for Christmas and New Year Opening
The GPC have issued this further guidance on Christmas and New Year opening times.

Winter Pressures, GPC Posters for Practices
These posters have been mailed to practices and are also available to download in a form that you can use on screens if you wish.   This is part of a wider initiative on winter pressures in the NHS, and other material, including a briefing paper on winter pressures and information about self-care, are also available on the BMA website.

Bulletin 207

CQRS – Make sure you get paid!
I sent an important email to all practice managers on Monday 9 December outlining common mistakes that are preventing practices from completing CQRS manual data entry. The email covers 4 simple steps to take. I am chasing up the Area Team with regard to practices who are still awaiting ‘approval’ after they have ‘accepted the offer’. If you did not receive this email, please contact me directly. IF YOU FAIL TO COMPLETE CQRS CORRECTLY BY 31 DECEMBER YOU WILL NOT RECEIVE PAY IN JANUARY.

Urgent Care Services, Sir Bruce Keogh’s Review
Professor Sir Bruce Keogh's ‘Transforming Urgent and Emergency Care Services in England’ review report refreshingly recognised that hospital pressures require a 'whole system approach', with integration between the range of providers in urgent care, rather than the non-evidence based portrayal that GP opening hours are somehow the cause of hospital pressures. There is a strong focus on patient self-care at the beginning of an urgent care pathway. The Government has also announced £150 million to reduce A&E winter pressures. In the context of Sir Bruce's review, it would be wholly logical to use this resource in a whole system approach including investment in general practice and community services, to enable more proactive management of patients in the community, aiming to avoid hospital attendance.

Winter Pressures, GPC Posters for Practices
Every GP practice will soon receive two posters from GPC to display in their surgeries advising patients about self-care this winter.

Bulletin 206

QOF Changes 14/15
The BMA have published this full summary of all the QOF indicators that will be removed from 1 April 2014.

Safer Use of Controlled Drugs: CQC Guidance
The CQC has produced some information sheets on use of controlled drugs which may be useful for GPs.

Surgery Thefts
We have made aware of surgery thefts which are taking place elsewhere in eth country and advise you and your staff to be extra vigilant. Their MO is to dress smartly, wear false ID badges and gain access to non-clinical areas. They steal purses from unattended bags and later phone in asking for the victim by name (Taken from the stolen credit/debit cards). They purport to be from the bank and illicit personal information, including the PIN from the victim and then clean out their accounts. In the past, this has always been in acute settings. However, it now looks like they are targeting health centres but are keeping contact with targets to extend the length of time they can use cards and get information.

Bulletin 205

FAQs GP Contract 14/15
Following the announcement of the greatest set of contract changes since 2004 the GPC has produced a short FAQ. The GPC priority was to address the greatest concerns expressed by grassroots GPs - the damaging impact of last year's sweeping imposed changes, exacerbating bureaucracy and box ticking medicine to unmanageable levels – and, as with all negotiations, there was some give and take by both parties. 

Flu Vaccinations for GP Locums
NHS England and GPC have agreed that locum GPs should attend the practice where they are registered as patients to get their flu vaccination, and that practice can then claim the payment via CQRS using the Read code 9OX4. which will be acceptable by the Area Team. A statement to this effect have been added to the BMA website. Vaccination of all other staff falls under the practice occupational health responsibility and it is for individual practices to decide how they will organise a provision for their staff to be vaccinated. A number of approaches have been used across the NHS including buddy/reciprocal agreements with neighbouring practices to vaccinate each others staff and a voucher scheme with pharmacists.

Short Shelf Life of Fluenz
We have been asked to remind practices that Fluenz® has a shorter shelf life (18 weeks) than other influenza vaccines and some of this will have passed by the time the vaccine has been supplied to you. The expiry date on the nasal spray applicator should always be checked before use. Vaccine has been ordered to cover the period over which historically the flu vaccine has been used, extending from September to mid-December. All the Fluenz® will have expired by 16th January 2014. In the light of this it will be important to ensure that efforts are made to vaccinate children before the Christmas holidays.

GP Services over Christmas and New Year
This GPC guidance
designed to provide clarity around what is permitted with regard to Christmas and New Year opening was shared with via email last week. The Area Team have also had sight of this guidance and will be issuing a letter to practices this week to clarify their position with regard to Christmas and New Year opening.

Issuing Medical Certificates of Cause of Death or Cremation 4 (“Part 1”) Forms Outside the Practice Area
We have been contacted by practices concerned that funeral directors are increasingly requesting GPs to travel outside their practice area following the deceased being moved to a chapel of rest. With regard to “death certification” i.e. issuing an MCCD - if you have been looking after the patient in their last illness then you are obliged to issue, free of charge, a medical certificate of the cause of death. However, you do not always need to see the body to do so. With regard to Cremation 4 (“Part 1”) forms – there is no obligation to carry out this work and it does levy a fee. It goes without saying that GPs will do their utmost to assist the family and normally do carry out this work. However, if it is proving difficult/prohibitive owing to the deceased being moved outside your practice area you can request the funeral director arrange for the deceased to be brought to a suitable place to allow you to complete the work or you can request a higher fee to cover mileage and time. You can decline to complete cremation certification work but you may wish to try whatever possible to comply with the request first – for example offer to meet at an alternative place or at a time outside surgery hours. If you are unwilling or unable to undertake the work you have a responsibility to inform the undertaker as soon as possible after the request is made.

Bulletin 204

GP Contract 14/15
Negotiations on changes to the GP contract in England for 2014/15 have been concluded and announced. The GPC believes that this package, as a whole, puts general practice and all GPs in a better position to deliver improvements to patient care. An email from Chaand Nagpaul, GPC Chairman, was sent to all GPs in England on Friday to inform them of the position and outline the key points of the package. Full details of the agreement are available on the BMA website. Work will now being on the detailed arrangements for implementation. An email was sent from CLMC to all practice managers on Friday. If you have any questions or did not receive the emails on Friday please contact Janice.foster@tees.nhs.uk.

Future of General Practice: BMA Response to ‘Call to Action’ and BMA ‘Developing General Practice’ Paper
The GPC has published its vision discussion paper, ‘Developing general practice: Providing healthcare solutions for the future’, setting out proposals and ideas on the future of general practice. Views are being sought on the paper and it will be taken forward through a programme of activity over the coming year. A BMA Health Policy and Research Unit paper outlining the findings from some GP focus group work on views for the future was issued to accompany the paper. Alongside the GPC vision paper was also published the BMA’s response to NHS England’s Improving General Practice Review – the Call to Action.

Legionella Risk Assessments
We have been made aware of a company approaching practices with regard to legionella risk assessments. This is not required by CQC or anyone else and you do not need to waste money getting an outside organisation to do this. Under HSE law you are required to consider the risks and take suitable precautions. Considering the risks is straightforward and it is highly unusual for an external agency to be required. If you have any questions, please do not hesitate to contact Janice.foster@tees,nhs.uk. 

GP Practice Premises Development
David Geddes, Head of Primary Care at NHS England, has confirmed to the GPC that Area Teams do not currently have allocated funding to progress premises developments that, though considered previously by PCTs, had not received final approval and confirmation of funding by PCTs before 1 April 2013. Area Teams will not be in a position to progress business cases which are still pending approval, or to consider any new developments until April 2014 at the earliest. NHS England has confirmed its intention to remove barriers to future premises development from 2014/15. Following on from a recent review of capital commitments by Area Teams, NHS England is now undertaking an audit of the current backlog of business cases. David Geddes has asked Area Teams to prioritise all outstanding business cases against set criteria which match the NHS England business case approval guidance for capital investment.

New BMA QOF Guidance
The BMA have updated their guidance Focus on QOF payments for 2013-14 and NHS Employers has also updated their QOF FAQs. You can view both documents on the BMA webpage for QOF guidance for 2013-14.

Pharmaceutical Regulations 2013
The guidance on market entry and performance sanctions, within the Pharmaceutical Regulations 2013, has been updated.

Sick Leave Guidance for GP Trainees
The updated version of the sick leave guidance for GP trainees is intended to clarify sick leave arrangements in line with the Framework Contract agreed between GPC and COGPED.

GMC State of Medical Education and Practice 2013 Report
The GMC have published a report, State of Medical Education and Practice 2013, which focuses on key trends around complaints and identifies some of the challenges these reveal for doctors and those working in healthcare.

Bulletin 203

Focus on Vaccinations and Immunisations Guidance Update
The Focus on Vaccines and Immunisations Guidance has now been updated following the many recent changes to the vaccinations programme. This document explains the various payment mechanisms available, and the new sections include information about shingles, pertussis, childhood flu, rotavirus and meningitis C vaccinations.

HIV Testing Week
This letter  provides detail on HIV testing week (22-29 November) led by the Terrence Higgins Trust and funded by the Department of Health. This may result in your services receiving requests for an HIV test or information about HIV. National HIV Testing week promotes the benefits of HIV testing to gay and bisexual men and African communities. The British HIV Association and the British Association for Sexual Health and HIV are supporting this by encouraging clinicians in both hospital and primary care to be alert to the need to offer and recommend an HIV test. This may result in your services receiving requests for an HIV test or information about HIV.

Bulletin 202

QOF Achievement Data
The 2012/13 QOF achievement and prevalence data have been published by the HSCIC, including a statistical bulletin, an online database and a set of detailed data tables. The average achievement decreased from 96.9% in 11/12 by 0.8 % to 96.1 %.

QOF Business Rules v27
Version 27 of the QOF Business Rules have now been published on the PCC website.

Improving General Practice: A Call to Action
The NHS England review of general practice is ongoing. The consultation aims to gather views on how general practice can best meet the challenges of an ageing population, increased patient demand and growing recruitment and retention problems. NHS England has also said it wishes to address inequality of and patient dissatisfaction with access to GP services. Both the GPC at a national level and the LMC at a local level are coordinating a response to the consultation, but individual GPs can also provide a response. You can fill in the online survey form on the NHS England website.

CCG Constitutions and Conflicts of Interest
The GPC has issued these FAQs and updated guidance on CCG constitutions (focusing on what to do if you are unhappy with something in your CCG constitution and the process for requesting changes) and conflicts of interest (providing advice for GPs as commissioners, covering issues such as the GMC guidance for doctors in management or commissioning roles and how to manage conflicts of interests when commissioning services from member GP practices).

Read Code for Dementia DES
The Read codes for the Dementia DES are available in the version 2 enhanced services guidance. NHS Employers have advised that although the guidance refers to the October Read code release, which is not yet available, practices should be able to use these on their systems already. However, the codes may not yet be picked up as part of reporting until system suppliers have put the necessary templates in place. The Read codes in italics in the guidance should be the correct codes, as there have been no changes since the publication of the enhanced services guidance, but they had to include a line around the possibility of change in case they did.

Local Enhanced Services
During 2012-13, NHS England guidance stated that all existing local enhanced service contracts should be extended into 2013-14, in order to provide stability during the transition period as PCTs transferred commissioning responsibility to CCGs. The guidance recommended that the contracts be extended with a six month review clause, so that CCGs, if they wished, could choose to change or decommission services during the current commissioning cycle. In addition, all local enhanced services (now referred to as community-based services) commissioned by CCGs would need to be contracted using the NHS Standard contract from April 2014. As such, our CCGs are reviewing current LES contracts and making decisions about services to be commissioned for 2014-15, using the NHS Standard Contract. We would urge you to read the GPC FAQs on the NHS Standard Contract. NHS England has this further details guidance on how to contract using the standard contract.

Firearms Policy
The GPC has published this updated interim version of the firearms policy.

BMA 2014 Research Grants
The BMA was among the first of the professional bodies to award grants and prizes to encourage and further medical research. Today, ten research grants are administered under the auspices of the Board of Science, all funded by legacies left to the BMA. Grants totalling approximately £500,000 are awarded annually. Applications are invited from medical practitioners and/or research scientists, for research in progress or prospective research. The 2014 research grants will be available to apply for online from 10 December this year. The application deadline is 14 March 2014 at 5pm. Subject specifications for each grant vary. For example, in 2014, research areas range from rheumatism and arthritis, cardiovascular disease and cancer to neurological disorders and clinical outcome measures. For more information on the grants on offer in 2014 and details of how to apply follow this link. Please disseminate this information as widely as possible, in particular to any potential applicants. If you have any questions about the BMA research grants, or would like to receive alerts about them, please contact Hugh Garnett at info.sciencegrants@bma.org.uk or telephone 020 7383 6755.

Bulletin 201

Care.data Information from the Area Team Communications
The Communications Team who support the Area Team have provided this Q&A document which they hope you will find useful. A leaflet drop, taking place throughout January to all 30 million households in England, is the next stage of NHS England’s public awareness plan and follows wide consultation with a range of stakeholders including GPs and patient groups.

Bulletin 200

Care.data Fair Processing, Additional Guidance
Further to the announcement by NHS England with regard to their national awareness raising plans for care.data, this fair processing guidance has been produced for practices by NHS England and the HSCIC, with ICO, GPC and RCGP input, and sets out the responsibilities of practices in meeting their fair processing obligations under the DPA.

GPC Guidance on Alliances, Federations and Sharing Staff
The GPC has produced guidance for practices considering forming alliances or federations and sharing staff. The guidance gives advice on what practices should explore before taking decisions, possible structural and legal models and provides case studies on the different organisations some GPs have already created. The related advice on sharing staff includes secondments, joint employment, VAT considerations, alternative arrangements and managing change.

Vaccines & Gelatine
Following reports in the media about the use of gelatine in Fluenz, the vaccine recommended for use for children, Public Health England has published a statement on this issue. More in depth guidance has also been published in a recent Vaccine Update.

Vaccine Supply – Zostavax Temporarily Unavailable

National distribution of Zostavax® vaccine began on 1 August 2013. However, due to an ongoing delay in the supply of the vaccine into the UK, PHE has temporarily removed Zostavax® from the ImmForm website, and it is not currently available to order. PHE expect further limited deliveries during October, at which point ordering will be resumed, with more substantial volumes due in November and December. It is likely that the order level cap for England will remain in place during this period. PHE apologise for the inconvenience caused.

Multiple ordering to circumvent the cap has presented a number of challenges both for the distributor in distributing those orders, and for PHE in managing the remaining stock. Further orders will be monitored. When ordering resumes, Zostavax® must only be ordered for the 70 year old and 79 year old cohorts this year. PHE have asked GP practices not to stockpile the vaccine as the vaccine is expensive and it is important to minimise wastage. Please note that the vaccine can be administered to the two eligible cohorts at any time between 1 September 2013 and 31 August 2014.

2013/14 Enhanced Service Guidance and Audit Requirements Update
NHS Employers, NHS England and the Health and Social Care Information Centre (HSCIC) have updated their guidance and audit requirements for the 2013/14 enhanced services and the vaccination programmes supported by automated extractions. This guidance is intended to support area teams and practices in delivering these services, and includes the new read codes and business rules, including for childhood influenza. Note that guidelines and a template for all the flu vaccines (including childhood nasal spray) are available for Vision practices. The business rules have also been published.

Bulletin 199

Data Entry for Quality Services with CQRS
CQRS has sent out a communication providing GP practices with information on manually entering data for Enhanced Services. GP practices will need to manually enter data on CQRS for supported Enhanced Services in order for payments to be calculated via CQRS for the remainder of the 2013/14 financial year. This decision has been made to provide more time to successfully deliver the QOF 2013/14 extractions. The full CQRS message can be read here.

Prescription Direction
The GPC has published a joint statement with the PSNC and Pharmacy Voice on prescription direction which reminds practices and pharmacies that proper prescription practices should be followed and highlights activities to avoid in order to maintain good practice. A related online article has also been published by BMA News.

NHSmail User Survey 2013
The NHSmail user survey 2013 is now open. The NHSmail team at the Health and Social Care Information Centre are currently planning for NHSmail 2 which will replace the current service – they are keen to hear your views and understand how you use your account. Every NHSmail account will have received an email inviting them to complete the survey, but if you can’t find it please email feedback@nhs.net. We recommend that users take part - it should only take a few minutes of your time and the survey is open until 28 October. The full results of the survey will be published in the NHSmail newsletter.

Bulletin 198

Vaccine Update
Public Health England has sent out this special issue of Vaccine update, which deals with the temporary suspension of the acceptance of orders for Zostavax® following the recent capping of orders.

Bulletin 197

As you will be aware, there has been a lot of discussion about this – locally, regionally and nationally. I sent an email to all GPs and practice managers on Friday (20.09.13) outlining our position to date. If you have not received this please get in touch I will resend. The BMA has received a number of concerns from practices and LMCs about the level of patient awareness, and whether an eight week period of activity undertaken by the practice will be sufficient in informing all patients of the extract. Some practice shave suggested applying the objection code to all their patients’ records and removing the code once patients have provided explicit consent.

The BMA strongly advise practices against doing this because the HSCA creates a statutory obligation for GP practices to disclose data to the HSCIC. In addition, it is a patient’s right to object, not that of the practice. As the law creates a legal obligation to disclose data, consent is not required. GP practices must meet their legal obligations under the HSCA, as well as their obligations under the DPA to undertake fair processing. The BMA has been in regular contact with NHS England and have been advised that they will be providing further information about awareness raising activities. Practices should, therefore, be reassured that they will not be solely responsible for making patients aware of care.data and they will be informed before any extractions take place. NHS England has been working with the ICO so that there is clarity about what GPs have to do in order to meet the fair processing component of the DPA. I have suggested something in writing from the ICO for practices to use in recording the sharing would be helpful but we do not know if anything will be produced. It has also bee confirmed that data will not be extracted until the awareness raising activities have taken place.

Collaborative Arrangements/Fees
There has been confusion since April 2013 amongst everyone as to who is responsible for payment to doctors for work that falls under the term collaborative arrangements (including mental health act and child protection work). Sadly this confusion remains. Until a longer term solution is reached, it has been agreed centrally that Area Teams will pick up the payments unless direct arrangements for the LA to pay were already in place or there is evidence that the funding was included in the CCG budgets. We do not believe the latter was the case in Tees so we are trying to get clarity as to whether direct arrangements were in place with the LAs. As soon as we receive a definitive answer on this I will provide the details as to where to send those invoices you have been saving!

Primary Medical Services Assurance Management Framework
Following legal advice, the BMA can confirm the extent to which there is a contractual obligation on practices to provide the information requested as part of the Primary Medical Services Assurance Management Framework is as follows:

The web interface that is being shared with practices also includes data about practices based on NHS England’s high level indicators and outcome standards. The information on the interface relates to every practice in England, with the intention being to allow comparisons with local practices within the CCG or Area Team and also to practices with similar demographics. Even though the process has been improved through discussions, the BMA does still have some concerns about this process and the validity of some of the data, including how this data might be used in the future. Both the BMA (nationally) and CLMC locally (through discussions with the DDT Area Team) are continuing to try and minimise the risk through continued engagement.

Migrant Access to Healthcare
The BMA has responded in full to the government consultation on implementing new rules for migrant access to primary care. Whilst agreeing to the principle of protecting the public purse and preventing the deliberate misuse of scarce resources, the BMA has raised concerns about cost and complications with some of the proposals.

The Revalidation Support Team has published 4 surveys to collect information on the current and expected impact of revalidation from the perspective of doctors, appraisers, responsible officers and designated bodies. We strongly urge you to complete this doctor’s survey which will take around 5 minutes.

BMA GP Contract Survey Results
In September the BMA launched the largest survey of GPs since the latest contract was imposed in April 2013. The survey aimed to find out how the contract had affected their practice and the impact this had on patients. A total of 3,629 GPs, more than 1 in 10 GPs in England, took part. GPC Chairman, Chaand Nagpaul has sent the results to all GPs in England; headlines include:

History of the BMA
The third volume of ’History of the British Medical Association’ brings to life and places into context the tumultuous last 30 years in UK health policy and medical ethics. Bookshop price is £25 or BMA members and staff receive a £5 discount. This flyer provides further detail, including how to order.

Broadening your Horizons – International Guidance for Doctors & Medical Students
The BMA has launched ‘Broadening your Horizons’, updated guidance on international experience for doctor's and trainee. It supports UK doctors at all stages of their careers who are considering working or training in developing countries, and helps employers and medical educators in the NHS understand how best to assist those who choose to undertake work abroad.

Bulletin 196

Enhanced Services FAQs
FAQs on the four new enhanced services are now available on NHS Employers’ website.

Additional MMR, Childhood Flu & Shingles FAQ re Read Codes
The following FAQ has been added to those previously published:

Q) Where a practice has been using Read codes not included in the service specification, guidance and audit requirements or Business Rules for enhanced services and vaccination programmes, are practices expected to re-code patients?

A) Yes, all services being supported by CQRS, require that practices who intend to participate in these services record their achievement in the clinical systems using the appropriate Read codes. This should be recorded using the relevant Read codes in the service specification, guidance and audit requirements or Business Rules from the date those services commence. As such, practices would need to re-code using the relevant codes.

NHSmail for Sessional GPs
As you will be aware, there was recently an overhaul of all NHSnet accounts where email addresses previously linked to PCTs were reallocated to CCG as the new host organisation. The same work is happening for sessional GPs previously linked to their previous PCT. The NHSmail team have issued the following advice:

If you are a sessional/locum/salaried GP and require an NHSmail account for securely exchanging data, please contact the GP practice NHSmail Administrator for which you carry out most work. The Administrator will need to liaise with the CCG Local Organisation Administrator (LOA) to request an account is hosted and administered via the GP Practice on your behalf. If you work across several GP practices on a regular basis, it may be more appropriate to have your account hosted and administered by the CCG. If this is the case, please contact the Local Organisation Administrator (LOA) in your local CCG, who can normally be found via the IT department. If you have any issues registering an NHSmail account please email feedback@nhs.net.

Vaccine Update re Current Shortages of Shingles Vaccine
Public Health England has sent out this special edition of their 'Vaccine update' about current shortages of the shingles vaccine.

Bulletin 195

Advice for Overseas Doctors Thinking About Working in the UK
As a part of the BMA's commitment to supporting BME doctors in their career progression, as well as implementing positive solutions to overcome the barriers they face, the BMJ has published an online e-learning module, authored by the BMA, which provides overseas doctors with advice on coming to work in the UK. The module is free to access for BMA members and aims to provide doctors with the following skills:

Bulletin 194

Care.data Information for Practices
Further to our update in the last bulletin (see below) we can now advise that in the next couple of weeks you will receive an email containing links to various resources and guidance, together with a communications pack with patient information materials. You can view some of the information here.
The documents include:

Once received, you should display the poster and make leaflets available in the practice without delay as extractions will be begin approximately 8 weeks after you receive the materials. FAQ 6 provides some further guidance on what practices should do to raise awareness. The guidance also explains how to manage patient objections to the disclosure of their personal confidential data. Additional supporting activity to help raise awareness is being planned by NHS England at a regional and national level and we will provide further details of this as soon as possible.

The Health and Social Care Information Centre (HSCIC) are providing a helpline for GPs with queries and can be contacted on 0845 300 6016 or by emailing enquiries@hscic.gov.uk, quoting 'care.data - GP' in the subject line. The helpline can also be used where practices need further guidance in responding to queries from patients that are not answered by the patient FAQs.

NHS Community Pharmacy Advanced Services Briefing
This Briefing has been developed jointly by NHS Employers, the Pharmaceutical Services Negotiating Committee (PSNC) and the General Practitioners Committee (GPC) to provide information for GP practices about advanced services provided by community pharmacies in England under the new NHS structures implemented in April 2013.It covers both Medicines Use Reviews (MURs) and the New Medicine Service (NMS).

Childhood Influenza Vaccination Programme FAQs
The GPC have published joint FAQs together with NHS Employers and NHS England, to help answer questions about the childhood influenza vaccination programme.

Bulletin 193

Possible Scam Under Land Registry Heading
We have been made aware of a possible scam whereby practices receive an email detailing direct debit payments. The email has an attachment. We believe this could be a scam and you should NOT open any attachments until you have verified this with the Land Registry directly (tel: 0844 892 1111). The Registry advise the following action if you receive phishing emails, which we believe this to be:

Unsolicited emails
Be suspicious of unsolicited emails, even if they look like they're from a trusted source.

Land Registry will never ask you to disclose personal or payment information by email. If you have any doubt that an email you receive from Land Registry is genuine, please do not follow any links or open any attachments, disclose any personal details, or respond to it. Please forward it to Land Registry at phishing@landregistry.gsi.gov.uk then delete it.

Land Registry is unable to investigate paper copies of phishing emails/websites. In order for us to take any action, you will need to forward the original phishing email to phishing@landregistry.gsi.gov.uk .

Land Registry will review all e-mails received but will not respond to them individually.

CQRS Rotavirus
You should have received a message from the Health and Social Care Information Centre advising you are now able to manually enter data for July if you are participating in the Rotavirus Enhanced Service. It is important that you enter data by 31 August in order to receive payment by the end of September – declaring achievement after the 31 August is possible but may result in a delay in payment. Guidance on how to manually enter data is available on the CQRS webpage and this guidance provides further details including read codes, calculations and payment details on Rotavirus and other new or amended services.

Care.data Information for Practices
The new care.data service commissioned by NHS England is the first use of the new powers under the Health and Social Care Act 2012 to extract confidential data from providers into the Health and Social Care Information Centre (HSCIC). The intention is to make increased use of clinical information with the aim of improving healthcare, for example by ensuring that data are made available to NHS Commissioners so that they can better design integrated services for patients.

The BMA supports the use of data for secondary uses but also recognises the importance of confidentiality and have negotiated the right for patients to object to the use of confidential data for these secondary uses. The BMA have also considered the GP dataset to be extracted which appears to be appropriate for commissioning purposes and have jointly badged the GP guidance with the RCGP, NHS England and the HSCIC as it is important that GP practices understand their obligations under both the Health and Social Care Act and the Data Protection Act. The HSCA removes the duty of GPs to seek consent prior to extractions but it does not remove the duty to raise patient awareness about the extractions.

Materials have been tested in a small number of practices and their feedback has been incorporated into a revised set of materials and resources. From mid August, over a 4 week period, practices will begin to receive an email containing information about the implementation of care.data. The email will include links to a number of resources and materials. Practices will also receive a separate communications pack containing patient information and materials. It is important that you are prepared for this information. The ICO has been involved in these discussions and has made it clear that GPs as data controllers are responsible for patient awareness raising. It is important that when you receive this information you display the poster and make leaflets available in your practice without delay as extractions will begin approximately 8 weeks after you receive the materials. Other resources will also be included in the email communication to practices. As soon as we receive any further guidance we will forward this to you.

Bulletin 192

Possible Scam Targeting Elderly Patients
We have been made aware of a possible scam whereby market researchers target elderly patients. Elderly patients in the Middlesbrough area have received telephone calls from market researchers who have a lot of the patient’s personal details, including medical conditions, and seek to make an appointment with the patient in their own home. This could be a genuine organisation but it did cause alarm to the patients and prompted them to contact their GP practice to ask if the practice had provided personal/medical details to this organisation. This has been reported to the police. If any other practices are alerted to this activity please advise your patients to double check the organisation before making an appointment and alert the police if they are concerned or, with patient consent, you can alert the police on behalf of the patient if you consider it appropriate to do so.

CQRS Bulletin
HSCIC has published a CQRS bulletin which practices may find useful. For any queries regarding CQRS, please email
cqrsfeedback@hscic.gov.uk or cqrsservicedesk@gdit.com.

Childhood (2 – 3 yr old) Influenza Vaccination Programme
The Department of Health, Public Health England and NHS England have published this letter and service specification. explaining the extension of the 2013/14 flu immunisation programme to healthy children (two and three year olds). From 1 September, practices should vaccinate children who attain the age of two and three years, but not yet four, on 1 September 2013 on either:    

  1. a proactive call basis, if not considered at-risk, or

  2. a proactive call and recall basis, if considered at-risk

Fluenza is the recommended vaccine which is administered as a nasal spray and an item of service fee of £7.64 will be paid for each eligible patient.

MMR Guidance and Audit
NHS Employers has published further guidance about the MMR catch-up campaign and the audit requirements for this. This is in addition to the already existing service specification which was introduced on 25 April 2013.

Bulletin 191

Remote Care Monitoring (Preparation) Scheme Year End Reporting Template  
NHS Employers have now  published the final template in word and excel for practices to use when reporting progress on the remote care monitoring directed enhanced service. GPC continue to believe the scheme is simply too bureaucratic and that practices need carefully consider how worthwhile it is for them and their patients before they participate.

NHS Litigation Authority Dispute Resolution Guidance Note
This useful guidance document provides advice on how to make an application for dispute resolution to the NHSLA. Practices should escalate contractual disputes to the NHSLA’s Family Health Services Appeals Unit (FHSAU) if all local dispute resolution procedures have been exhausted and no satisfactory outcome can be agreed by all parties.

Primary Medical Services Assurance Management Framework
You should have received a raft of letters and policies from NHS England Area Teams about the NHS England primary medical assurance management framework. The framework involves the use of a web interface
that is being shared with practices. The interface includes data based on some high level indicators and outcome standards - the General Practice High Level Indicators (GPHLIs) and General Practice Outcome Standards (GPOS). The information on the interface relates to every practice in England, and the intention is to allow comparisons with local practices within the CCG or Area Team and also to practices with similar demographics. This has been developed on the basis of work previously undertaken by NHS London, who worked in collaboration with Londonwide LMCs.

As part of this process, practices will be asked to submit an annual self-declaration using the web interface. The declaration will commence in September, and practices will be notified when the submission is open for completion. The policies, web interface and practice declaration have been discussed with GPC representatives and a group of LMC secretaries and some of their content has been changed as a result of these discussions. Concerns still remain about this process, including how the information on the web interface might be used in the future and the GPC are continuing to try and minimise that risk through their engagement. 

Multi-Compartment Compliance Aids (MCA) (also known as Monitored Dosage Systems
The Royal Pharmaceutical Society (RPS) has published a report: Improving patient outcomes: The better use of multi-compartment compliance aids which includes guidance and recommendations for health and social care professionals. Most GPs and community pharmacists have experienced demands for multi-compartment compliance aids from patients, their relatives and social care workers, to assist patients to use their medicines correctly.  Following such demands there has often been little reflection as to whether that intervention improves patient outcomes – and the MCAs have been supplied almost on-demand.

RPS has considered the evidence base, which indicates that MCAs are not a panacea for medicines use, and that they should not automatically be the intervention of choice for all patients.  Not all medicines are suitable for inclusion in MCAs and health and social care professionals should recognise that re-packaging medication from the manufacturer’s original packaging may often be unlicensed and involves risks and responsibility for the decisions made.

Reminder, Stamp Duty Land Tax
Stamp Duty Land Tax is payable on transactions relating to UK land and buildings.  The GPC has now received updated legal advice
(available to BMA members only) on SDLT and its application to GP practices. Although not all transactions involving GPs will be liable for SDLT, it is likely that it will affect an increasing number of GP partnerships in the future, due to the numbers of practices occupying leasehold premises. Before signing or altering lease terms, practices are strongly advised to obtain independent financial advice on potential liabilities for SDLT for any premises transactions. Further information on SDLT can be found on the HMRC website.

Bulletin 190

Warning, Scam Alert
We enjoyed 6 months peace but the old scam appears to have returned under it’s original name ‘European Medical Directory’. You will know this scam as European Medical Directory, Med1web, TEDMI.com or Novachannel but the message is always the same – DO NOT SIGN AND/OR RETURN ANYTHING!  

GPC Election Results
As you will be aware, Laurence Buckman reached the end of his tenure and stepped down as GPC Chairman last week. Elections were held and your new GPC Chairman is Chaand Nagpaul. We wish him and his negotiating team for 2013-2014 every success. The new team are:

Chaand Nagpaul (Chairman)
Peter Holden
Dean Marshall
Beth McCarron-Nash
Richard Vautrey
Charlotte Jones (GPC Wales)
Tom Black (GPC Northern Ireland)
Alan McDevitt (GPC Scotland)

Migrant Access to Healthcare, Consultation
Parallel consultations on migrant access to health services in the UK have been published by Department of Health and Home Office. The consultations essentially split patients into four categories:

  • Permanent residents, who have a right to free NHS care. The consultations propose that the definition of ordinary residence, which entitles patients to free NHS care, should be changed so that non-European Economic Area migrants must have indefinite leave to remain (ILR) in the UK before they can attain this status.

  • Temporary migrants - non-EEA migrants who are subject to immigration control and do not have ILR. It is proposed that this group will in future have to contribute separately to their healthcare costs through a new levy on their visa of at least £200 per year. There would be an initial NHS registration process which would assess the need to pay this levy, be run externally to GP practices and be separate to practice registration.

  • Short term visitors from outside the EEA and illegal migrants, who would be charged directly at the point of use for treatment, both by hospitals and by GP practices.

  • Expatriates and former legal residents of the UK not subject to immigration control. It is proposed that this group would have a right to free NHS care if they have paid National Insurance contributions for a significant period.  

Other issues considered in the consultations are:

  • Whether non-EEA visitors and other chargeable migrants should be charged for access to emergency treatment in A&E or emergency GP settings.

  • Whether the levy for temporary migrants should be at a fixed level or vary, for example, according to the age of the applicant.

  • How to improve current hospital processes for collecting income from chargeable patients.

  • How to improve the effectiveness of cost recovery from other member states for EEA citizens who receive NHS treatment.  

The GPC has a number of concerns, including that the NHS access status of all patients would need to be checked by GP practices on registration, placing a further administrative burden on practices and risking damage to the doctor-patient relationship. The GPC believes there is currently no regulatory basis for NHS England Area Teams not to accept the registration of patients whose immigration status has not been checked. If you respond to the consultation please make the LMC office aware of your response. 

Monitor Call for Evidence on General Practice, Consultation
Monitor has launched a call for evidence on general practice in England, following a recommendation to that effect from its Fair Playing Field Review. Monitor has given two main reasons for the need for a more detailed look at general practice:

  • To determine the extent to which commissioning and provision of general practice services is operating in the best interests of patients.

  • To gain a better understanding the challenges faced by an important part of the health sector at a time when it is operating under increased pressure.  

The BMA will be responding with the following points, amongst others: the high levels of patient satisfaction with current GP services, the fact that patients rarely encounter issues with changing their GP practice, that greater investment in funding for current practices is required in order to allow expansion of services and that Monitor should be encouraging integration of services rather than further competition. Once again, if you respond to the consultation please make the LMC office aware of your response. 

Criminal Injuries Compensation Authority
The Criminal Injuries Compensation Authority (CICA) is a government body which provides compensation to blameless victims of violent crime and relies on evidence from the medical authorities to help its work. As a result of the Government consultation “Getting it right for Victims and Witness”, the Criminal Injuries Compensation Scheme was revised on 27 November 2012.

Under the new provisions of the 2012 Scheme the applicant must now obtain and pay for the initial medical evidence to up to a maximum value of £50.

To ensure suitable information is requested, the CICA will send the applicant a blank medical report to take to their GP to complete (TCX1). The applicant is expected to pay the GP/Practice for the completion of the report up to a maximum value of £50. The completed report should be returned direct from the GP to the CICA. Where an applicant cannot afford to meet the cost of the initial medical report, the CICA will send the applicant a blank medical report to take to their GP to complete (TCX2) or where an applicant cannot obtain the report due to a medical condition which prohibits them from attending their GP, the CICA will issue the TCX2 direct to the GP. The completed report including the payment voucher should be returned direct from the GP to CICA. On receipt the CICA will ensure payment is made for the report. Where the CICA is required to pay for the initial medical evidence, the value of the initial report will be deducted from any award of compensation given. Any follow up reports requested will be done so direct by the CICA and will continue to be processed in the normal manner. If you have any questions about the new provision, please contact the CICA on 0141 331 5495 or alternatively email their relationship managers; relationship.managers@cica.gsi.gov.uk.  

OOH Care, GPC Position Paper
Following input and comments from members and stakeholders, the GPC has now published this position paper with regard to OOH Care.

Community Pharmacy, a Guide for GPs and Practice Staff
An updated version of the community pharmacy - a guide for GPs and practice staff has been published jointly by the BMA, PSNC (Pharmaceutical Services Negotiating Committee) and NHS Employers. It provides support for GPs and community pharmacists in developing more effective working relationships as well as providing an insight for NHS commissioners, for improved working in primary care. 

GP Trainees Subcommittee Newsletter
Please widely circulate this latest GP trainees subcommittee newsletter to any GP trainees who may be interested

Bulletin 189

Flu Vaccine for Children
Following some confusion about the process for ordering flu vaccine for children, NHS England has confirmed that Fluenz is the recommended vaccine for children and that this will be centrally supplied. Practices will be able to request the vaccine via IMMSFORM. Where two and three year olds are contraindicated to Fluenz, contractors will be required to make an alternative Inactivated Trivalent Influenza Vaccine (TIV) available. Inactivated TIVs which have already been ordered by GPs for two and three year olds in clinical risk groups can be utilised for the contraindicated two and three year olds. Practices will be reimbursed for this as per children in clinical risk groups. If practices experience difficulties in sourcing inactivated TIV for the contraindicated 2 and 3 year olds please contact the ImmForm helpdesk on 0844 376 0040 which will be able to assist in ordering inactivated TIV. Further information will be available in the tri-partite letter which will be issued shortly.  

Flu Advertising Campaign and Vaccine Shortage Notifications
Due to lack of evidence that advertising campaigns have any positive effect on seasonal flu take-up rates, NHS England has decided against having a national flu campaign this year. Their research found that whilst seasonal flu advertising did raise awareness of the vaccine it did not motivate people to get vaccinated. It found the biggest positive influence on seasonal flu vaccine uptake was a recommendation from a health care practitioner, be that in person, via letter or telephone. Additionally, there have been no reports from suppliers of potential shortages this year but Public Health England will inform of any problems via the vaccination newsletter for health professionals and immunisation leads.

Shingles Vaccine FAQs and Supporting Information
NHS England, Public Health England and the Department of Health have published this letter and FAQs explaining the introduction of a vaccine programme for people aged 70 years (routine cohort) and 79 years (catch-up cohort) to protect against shingles, available on the DH website. Links to these documents will also be available on the on the BMA website vaccination page.

Major Drug Recall by Wockhardt
The MHRA has issued a precautionary major drug recall of products manufactured by Wockhardt. Pharmacies, dispensing clinics and wholesalers have been asked to return 16 different prescription only medicines in a variety of strengths, made by Wockhardt Ltd, following manufacturing deficiencies identified by the MHRA at Wockhardt’s Waluj site in India. Note: patients do not need to return their medicines because there is no evidence that the medicines affected by the precautionary recall in the UK are defective, and patients should, therefore, continue to take their medicines as prescribed.

The drugs affected and further information is available on the MHRA website.

Premises Development Previously Approved by PCTs
Issue 6 (5th July) of the NHS England primary care commissioning newsletter contained this article
regarding premises developments that were approved by PCTs before 1 April 2013, stating that if an agreement for premises development had been agreed in writing with the PCT then NHS England are bound to honour this.

Action on Hearing Loss
One in six of the population has some form of hearing loss, rising to over half of people over 60 years old. This is a condition affecting a high proportion of patients, and yet they can face issues when visiting their GP, from communication problems to difficulties booking appointments, as outlined in a recent report from Action on Hearing Loss entitled Access All Areas. Action on Hearing Loss (formerly RNID), have asked us to promote the information they have for GPs
to assist in understanding how surgeries can be made more accessible to people with hearing loss.

Bulletin 188

GP Locums Employed Through Limited Companies
You may have seen an article in The Times on 28 June that referred to dozens of NHS Trusts in England being under investigation by HMRC over their alleged use of schemes to avoid VAT when employing locum or part-time doctors. In light of that, please be aware of the position of GP locums employed through a Limited Company, often referred to as a service company.  The services they provide are subject to VAT when the registration threshold for VAT has been reached.  The threshold level includes all charges made by the company including but not limited to fees and the recovery of expenses.  The registration threshold is currently £79,000. Doctors working as locums through an agency should, if they have not already done so, take advice on the application of VAT to their work and if registration has not been effected on time how to mitigate any penalties and interest charges accruing for late registration by making voluntary disclosure. The GPDF, the LMC nor the BMA can assist with VAT or other form of taxation, but do encourage all doctors to seek appropriate professional advice on taxation matters.

QOF Business Rules v26
Version 26 of the QOF business rules have now been published on the
PCC website.

Intending Trainer’s Course 2014
Applications for the 2014 Intending Trainer’s Course are now open. Further information about the course is available in this course information pack and this frequently asked questions document. Closing date for application is 17th January 2014 and applications made after this date cannot be accepted. If you are interested please complete this application form and return it via email to susan.convery@nhs.net.
Once the application form has been received you will receive further information about the pre-course tasks.

Bulletin 187

CQRS has gone live and is now being rolled out across England.  The service will support QOF, Learning Disabilities Health Check Scheme, Rotavirus (Routine Childhood Immunisation) and Alcohol Risk Reduction Scheme from go live with other services supported later in the year. NHS England Area Teams have identified and set up where possible, a CQRS User Administrator within each GP practices to CQRS. To ensure users understand how the service will work and what they need to do to declare/approve achievement activities CQRS have developed the following implementation guidance
for GP Practices and Area Teams.  For further information on CQRS rollout, view the latest newsletter. For any concerns or queries related to CQRS, including training, practices should email: cqrsfeedback@hscic.gov.uk.

Business Rules for Enhanced Services
The business rules for the alcohol, learning disabilities and rotavirus enhanced services are now available to download via the
PCC website.

Change in QOF Business Rules for MH002 (mental health care plan)
The HSCIC has provided this explanation about changed business rules for QOF indicator MH002.

Updated v25.0 of QOF Business Rules
The HSCIC has made some changes to v25 of the QOF Business Rules to the following rulesets:

  • cardiovascular disease primary prevention

  • hypertension

  • rheumatoid arthritis

  • secondary prevention of coronary heart disease.

These four documents have now been updated to v25.1 and have been added to the PCC website to replace their v25.0 versions.

Vaccinations and Immunisations Update inc. flu, shingles and MMR
Recently, a number of changes have also been made to the vaccination programmes. This summary includes information on flu, shingles and MMR as well as useful links to the BMA website for more detail.

AQP Information Governance Toolkit Assessments
The Health and Social Care Information Centre (HSCIC) confirmed this week that the requirement for an AQP IG Toolkit assessment is placed on the legal entity that has access to NHS patient information. Therefore:

  • If the legal entity offering AQP services is the GP practice then the current published assessment will suffice.  A top-up assessment may also be necessary, but this will depend on the AQP service to be provided.

  • If a new legal entity has been created to deliver AQP work, e.g. limited liability companies or partnerships, then a separate AQP assessment is needed.

CQC Consultation
The CQC has published a consultation on changes to the way it regulates, inspects and monitors care and it is available on the CQC website. Some parts of the consultation relate to hospital inspection only, but there are sections that will have an important impact on the regulation of primary medical services.

In particular, Section 2 of the consultation applies to all providers that the CQC regulates and sets out the following:

  • The five questions they will be asking of every service they regulate: Is it safe, is it effective, is it caring, is it responsive to people's needs and is it well-led?

  • Three concepts to help the CQC judge the quality and safety of services: the "fundamentals of care", which are the basics of care below which standards of care should not fall, "expected standards of care", based on the five questions they will be asking of every service and "high quality care", which is intended to help the CQC make judgements about a provider's overall quality of care.

  • Their proposals to appoint expert inspection teams, led by expert Chief Inspectors.

  • A proposal to develop a ratings system for most providers of health and social care, including in primary medical services. The consultation does not provide details of how this will work in general practice; these will be developed in the next two years, led by their Chief Inspector of General Practice.

Section 4 of the consultation also applies to all providers registered with the CQC. It sets out proposals for changes to the CQC's regulations to introduce fundamentals of care, to introduce of a statutory duty of candour as one of the organisational requirements on all registered providers, and to strengthen the CQC's powers in holding providers to account. The Department of Health will publish draft regulations following the closing of the consultation. We encourage you to read and respond to the consultation, which closes on 12th August 2013.

GP Subcommittee Regional Elections 13-15
The GP Trainees subcommittee are holding elections for 14 of its regional constituencies (including the north east) this summer. Nominations are open now until 5pm, Friday 19 July 2013. Nomination forms and further information about the elections are available
here. Posts are held for two years, unless the representative qualifies as a GP during the first year, in which case they will only serve for one year.

Anyone can stand who is either:
a) on a GP training programme that will not finish before 24 September 2013;
b) starting a training programme between 28 June 2013 and 29 June 2014.

Candidates do not have to be BMA members. Please spread the word to any GP trainees you know who may be interested. If you have any queries, please contact Karly Jose (kjose@bma.org.uk) or Christopher Scott (cscott@bma.org.uk).

Crisis Support for Victims of Domestic Abuse
Many victims of domestic abuse come in contact with their GP long before seeking help elsewhere - on average, female victims of domestic abuse are subjected to 37 beatings before they involve the police. In addition to the healthcare needs these victims may have, they commonly need help in getting immediate protection from their abuser. A non-molestation order, granted by a civil court, can provide this protection by preventing the abuser from using or threatening violence against the victim, or intimidating, harassing or pestering them.

While it is possible for victims to apply for this injunction themselves, they are often unsure how to do so, and are commonly put off from seeking legal support because of the cost of seeking advice. The National Centre for Domestic Violence (NCDV) provides a free, fast emergency injunction service to victims of domestic abuse, regardless of their financial circumstances, race, gender or sexual orientation. They help anyone apply for an injunction within 24 hours of first contact (in most circumstances), and work closely with the police, local firms of solicitors and other support agencies to help obtain protection.

To help victims get this support, the NCDV provide a range of materials (posters, cards or other literature) about this service, which can be distributed directly to a patient, or in waiting areas. More about the NCDV, and how to order any materials can be found at www.ncdv.org.uk.

Bulletin 186

084 Numbers
Imminent Ofcom changes will mean that any bodies that use 08 revenue share phone numbers will be required to advertise the part of the call charge they receive wherever that number is published, so that consumers know what service charge the bodies receive from each call. Ofcom cannot tell any organisation which number to use, but are concerned that individual surgeries may not be aware of their forthcoming changes. The changes will come into effect in early 2015. As soon as Ofcom publish their final statement in the summer, the changes will occur exactly 18 months after that. We would like to remind GPs of this guidance on the use of 084 numbers. Practices should note that the regulations require them to satisfy themselves as to the cost of calls.

DVLA Survey
The DVLA have asked us to send a short online survey to practices on the questions about cognition which are currently used on DVLA questionnaires. This survey is entirely voluntary but if you would like to take part the link for this survey CLICK HERE. Please note: you need to read this NEURO2 questionnaire before you start the survey. The aim is to improve the DVLA questionnaires so that they best capture the necessary information to enable a correct licensing decision. This survey is being undertaken to canvas the views of GPs about the ‘red flag’ questions which are currently used on DVLA questionnaires, to determine what you anticipate is the effect of your answer to these questions on licensing decisions. The DVLA have asked for suggestions from you for additional ‘red flag’ questions the DVLA could ask which might help GPs to inform DVLA more comprehensively about your patient’s likely fitness to drive.

GPC Sessional GP Election Results
The results of the election to GPC's Sessional GPs Subcommittee for 2013-2016 have been announced CLICK HERE. The North East Representative is salaried GP Paula Wright.

Premises Cost Directions Guidance (provided by Capsticks)
Capsticks have drafted some guidance with regard to the changes in the Premises Costs Directions. Cleveland LMC cannot recommend or promote the services of any one company/solicitor but believed practices may find this information useful. It looks at the reimbursement of GP practice premises costs, now dealt with by NHS England, and the Premises Costs Directions, which previously, under the 2004 Directions, dealt with reimbursement of premises costs to GPs but have been replaced and include a number of subtle but significant changes under the new 2013 Directions.

Bulletin 185

111 Repeat Callers
This update 'repeat callers to NHS 111' provides and explanation as to how 111 repeat callers will be managed in Tees. Put simply, a safety net is being added so that if a GP has been unable to make contact with a patient within 1 hour the patient is advised to re-contact 111 where they will be sent to a walk-in centre.
Please ensure you continue to provide feedback on the 111 service using the feedback form 'NHS 111 Issue Management provided. It is essential that the 111 team continue to receive this in order to assess and improve the service.

"MMR Outbreak Control and Catch up NES
Currently we are still under ‘outbreak control’ in Tees and practices are carrying out MMR catch up under a LES arrangement whilst a school programme takes place. We would like to remind practices that the school programme will finish at the end of June and notice of the ending of the LES will also be issued at this time. We strongly recommend that practices sign up to the NES as soon as possible (there is a deadline to notify the AT by Friday 14 June) to continue to receive funding for any catch up vaccinations they offer in the future. Public Health are aware of the urgency to ensure the data with regard to school programme vaccinations is up to date on GP systems and they will send a notification just as soon as the uploading of all data is complete so that practices have comprehensive information as to how many children still require immunisation. Information about the MMR catch-up programmes in England and Wales, including the specification and new joint FAQs [GPC/NHS England and NHS Employers], is now available here

Conflicts of Interest Guidance
Decisions about allocation of resources, population need and service design are complex, particularly at a time of financial constraint. As CCGs adopt their statutory duties, doctors in commissioning roles have responsibility for significant amounts of public money. The GPC have produced guidance Ensuring transparency and probity on conflicts of interest for GPs as commissioners and providers. The guidance covers issues such as the governance of CCGs, GMC obligations for doctors in commissioning roles, primary care incentive schemes and what membership of a CCG means for GP practices.

AST002 Indicator – Coding in business rules to be reverted
The coding in the business rules for QOF indicator AST002 has to be reverted. Amendments were proposed to the relevant codes for Asthma8 (now AST002) during the 2013/14 QOF business rules review in order to refine the code clusters. The usual process when introducing changes to the code clusters for cumulative indicators such as AST002 is to reset the indicator so that historical diagnoses do not need to be revisited. On this occasion, this process did not take place. NHS Employers has discussed this further with NICE and HSCIC and have agreed to revert to the previous code clusters for the AST002 indicator (i.e. to use those applied to Asthma8 prior to 1 April 2013 – v24). The changes to the business rules will be made to v26 meaning that it will not be necessary for practices to recode any patients this year. Please note that until such time as the code clusters are updated in clinical systems, any extracts being run will show an under achievement. This will, however, correct itself once the code clusters are updated.

Meningitis C Booster for Adolescents
Following the announcement by the Department of Health about changes to the Men C vaccination schedule, that as from 1 June 2013 the second dose currently given at four months would be replaced by a booster dose given in adolescence, NHS England has now confirmed that the booster dose for 14-year-olds in academic year 2013-14 will be given in school based programmes (i.e. not in GP surgeries). We await further details about the catch-up programme for first time university entrants under the age of 25 years, to be introduced from mid-August 2014.Further information, including FAQs  Meningococcal C (MenC) vaccination programme have been published by NHS England.

PMS Equitable Funding Reviews
NHS England wrote this letter 'Personal Medical Services Reviews' to Area Teams about PMS funding reviews.

GPC Campaign – helping patients understand NHS changes
The GPC has been working on a new initiative to communicate with patients and public about the various issues facing general practice and the wider NHS. The first phase of their programme of communications - a new, public-facing section of the BMA website at changingnhs.com  A patient's guide to the new NHS  - is now live. It explains to patients and the public what’s happening, while also communicating our concerns and reassuring them that doctors will always put patients first. You may wish to display this poster 'GPC Poster' in your practice. The pages on the site have been designed to be print-friendly, so you may also want to run off copies of some of the information for patients who do not have internet access. The GPC will be raising awareness of the site further through online advertising, contact with other organisations, and media coverage. Please note that all of this is only the first step in a longer term campaign seeking to engage doctors and patients in a dialogue about the future of general practice. Hopefully you find these resources useful but do let the GPC know what you think by sending any feedback or questions to info.gpc@bma.org.uk.

LMC Annual Conference 2013 Resolutions
These LMC Annual Conference Motions and Resolutions 'General Practitioners Committee, Conference News' have now been published.

Bulletin 184

111 Repeat Callers

The national service specification for handling repeat callers (i.e. patients who call NHS 111 three times in four days) states that these patients should receive an assessment from a GP within one hour.

The GPC and NHS England reached an agreement that GPs are neither contractually obliged nor indemnified to make call backs and assess these patients within one hour and they have agreed the following joint statement:

NHS 111 commissioners and providers have a responsibility to ensure that repeat callers (those who have called the NHS 111 service 3 or more times in 4 days and, because of the potential risk, require a thorough senior clinical re-assessment by a GP within the hour) receive the service as specified.

There is no national mandate as to how this service should be provided or resourced, nor is there a contractual obligation for practices to do this work. However, it is the responsibility of CCGs as the local commissioners of NHS 111 to ensure an appropriate service is commissioned. If local GPs are not satisfied with the current local arrangements for dealing with repeat callers, then commissioners and providers should work to find another solution.

Cleveland LMC has been involved in lengthy discussions with the 111 team to try and find a local solution to this problem that is as safe as possible for patients and all GP practices. The simple fact is that it is not contractual for anyone to do this, including GPs, 111 or any other provider. This is an inherent problem of the system that has been created nationally then passed for local solution with no guidance other than nobody is contractually obliged to deal with this pathway but this pathway will still continue to exist!

We are not happy that the ‘your GP will call you back within one hour’ element is to continue within 111 for repeat callers. However, we have compromised with a solution that will offer a safety net to practices and patients whereby, when a GP is not able to contact the patient within 1 hour (be it due to capacity, GP is unavailable, patient is unavailable, triage deems it inappropriate or you are simply not contractually obliged to do so) the patient is advised to return to 111 who will direct them to a walk-in centre to see a GP.

Hopefully this safety net will catch any patients who GPs have not been able to contact in the hour and, to a degree, puts the onus back on the patient to notify 111.

Below is the new system that is now in place for repeat caller:

  • 111 disposition tells the patient that their GP practice will call them back in 1 hour but if they have not heard back within 1 hour the patient should call 111 again
  • 111 make call to GP practice to try to speak to a clinician to provide details of repeat caller and a) pass on details directly to a clinician or b) pass on details to the receptionist. At this point responsibility is passed to the GP practice and the practice should deal with this as they see appropriate e.g. call within the hour or not dependent on capacity, triaging, other factors
  • If the GP has not called the patient with 1 hour the onus returns to the patient and when the patient does call 111 they will be advised that they should attend the nearest walk in – details given – to see a GP

As explained earlier, practices are not contractually obliged contact patients within 1 hour but responsibility will still be passed to practice by 111 and you need to triage appropriately – as you would any urgent call to the practice. It is anticipated that practices should on expect a couple of repeat callers per year.

Everyone involved accepts that this solution is far from ideal but given the constraints of contracts, budgets and a nationally produced specification it is the safest and best practical solution that can be put in place within a tight timescale as, since 111 went live in April, there has been no safety net for patients or practices and potential for a serious untoward incident. We will closely monitor the number of repeat callers and the outcome of this element of 111 and we will continue to work with 111/CCG to find a longer term solution to this ‘specification v contract’ issue. It is imperative that something is put in place so that there is a contracted/resourced solution with a provider for this element and we are urging CCGs to look closely at the contracts of providers in the new commissioning round to resolve this nationally created problem.

If you have any question on this element of 111 please do not hesitate to contact Janice.foster@tees.nhs.uk

Interim Seniority Payments
The Health and Social Care Information Centre has published the interim seniority factors 2013/14 for GMS GPs in England, Wales and Northern Ireland today.  The figures are: England £96,183, Wales £84,479 and Northern Ireland £82,176. Further information about the calculations and the methodology may be seen on the primary care section of the Health and Social Care Information Centre website.

CQRS Phase 2 Training
Please see attached information regarding phase two training sessions for CQRS. We strongly recommend that ALL practices ensure they attend the phase two training sessions for CQRS as much of the practice funding streams will rely on timely and accurate completion of CQRS data by the practice. In summary:

  • CQRS will go live early June (replacing QMAS).

  • GP practices may find it useful to undertake phase two training to learn how CQRS works and what is required to ensure that practices continue to receive accurate payments throughout the financial year.

  • Phase two training sessions will run from the 29 May to the 26 June and are bookable via the CQRS Learning Management System (LMS).

  • To book onto phase two CQRS training GP practices will need to be registered onto the LMS and have access to an N3 connection. To register and book on the LMS, please read the details on the how to book onto a training session page.

  • QMAS will remain operational until the 31 July 2013 to allow for end-of-year activities for the QOF for 2012/13. On 2 July 2013, at 8pm, all submissions to QMAS from GP system suppliers and any manual updates or adjustments will be suspended. From this date QMAS will only be available in 'view only' mode for all users until 31 July 2013.

  • Existing data from QMAS will be migrated to CQRS, giving users on going access to their QOF reports from previous years.

GP Central Data Base Patient Opt Out
The care.data service is a new project that
is designed to link information from general practice, with information from hospitals and community health care services. It is not the same as the national spine and if patients wish to opt out they have to do so again. It is hoped the project will help the NHS evaluate and improve the quality and safety of the NHS, and enables patients to make more informed choices about the treatments and services they use. The relevant READ CODES are contained in the information sheet and the associated FAQs, developed in partnership with the British Medical Association and Royal College of General Practitioners. Further information is available on the NHS England website and explains the process of how data from general practice will be collected, anonymised and used to improve patient care. The posters and leaflets are not yet available and we understand that GP practices will be contacted directly with further details and materials in June.

Bulletin 183

Locum Appraisals Contributions
NHS England have confirmed, in a letter to English responsible officers, direct payment to locums undergoing appraisal has now ceased. This is being challenged nationally. In the same letter, NHS England have confirmed they believe a fair level of remuneration for appraisers is £500 per appraisal, with an additional amount of £70 for employer on costs. They have asked responsible officers to make efforts to move towards this standardised approach as quickly as possible, and by no later than 1 April 2014.

GP Health Services
Due to the national withdrawal of occupational health funding, GP Health (the local service) will cease as of 31 May. The service is a great loss to local GPs but GP Health have been running without funding since 1 April 2013 and are no longer in a position to do so. The detrimental impact of the lack of occupational health services and loss of funding (which just appears to have been sucked into the system somewhere and disappeared from all budgets) is being raised at a national, regional and local level.

Sessional GP Newsletter
This Spring issue of the Sessional GP Subcommittee’s Newsletter contains updates relating to pensions, injury benefit, claims for unfair dismissal and revalidation & appraisal. It also features articles from several contributors detailing their experiences with support groups for Sessional GPs, including advice on how to set up your own.

Bulletin 182

Petussis Vaccination Programme Continuation
The Department of Health has announced the extension of the extension of the Pertussis vaccination programme for pregnant women for a further 6 months and sent this letter to area teams and practices. We have contacted the Area Team to confirm the extension of this arrangement in practices from a contractual perspective.

Meningitis C Vaccination Programme Changes
The Department of Health has also announced that, following advice from the JCVI, there will be some changes to the current vaccination schedule for Meningitis C in that the second dose currently given at four months will be replaced by a booster dose given in adolescence. The initial change will be to cease giving the four month dose as from 1 June 2013, and from mid-August 2014, there will also be a catch-up programme for first time university entrants under the age of 25 years. We await further details on this catch-up programme.

Bulletin 181

Commissioning & Conflicts of Interest
The new NHS England guidance on conflicts of interest for CCGs, ‘Managing conflicts of interest: Guidance for Clinical Commissioning Groups’ outlines the statutory governance requirements of CCGs and provides advice for CCGs on managing conflicts of interest. The guidance provides details on the CCG’s register of conflicts of interest such as how often CCGs should update the register and the steps they should take to ensure that patients and the public have access to the register. The guidance clearly states that an individual with a ‘material interest’ in an organisation which provides or ‘is likely to provide substantial business’ to a CCG (and this encompasses commissioning support services) should not be a member of the governing body. The GPC’s guidance on conflicts of interest is being updated in the light of the new edition of the GMC’s Good Medical Practice, new GMC guidance on conflicts of interest and the NHS England guidance on conflicts of interest.

Fitness to Drive Regulations
The DVLA has amended the epilepsy and vision elements of the minimum medical standards for group two drivers (driving lorries and buses) in the UK. They have updated the form for doctors reporting on patients' fitness to drive and their information leaflet (with link to attached document) about the requirements. Because the visual standards now require a higher level of response from doctors, the GPC advise GPs to refer patients requesting certification to optometrists for the vision section of the assessment, unless the patient has either 6/6 vision uncorrected or 6/6 vision corrected and with recent evidence of prescription strength.

Taking a Career Break Guidance
The GPC guidance for GPs considering taking a career break gives information about Induction and Refresher (I&R) schemes and lists the important factors to consider before deciding whether to take a career break.

GP Trainees Newsletter April 2013
The latest edition of the GP trainee newsletter covers MRCGP pass rates and costs, charges for occupational health vaccines for trainees, useful documents for trainees, and why you should join the subcommittee, amongst other issues.

DH Letter Confirming Continuation of Premises Payments
The Department of Health has circulated this letter regarding the continuation of existing premises related payments

Bulletin 180

GP Contract Imposition Survival Guide
The GPC is developing survival guides for practices and GPs to help guide them through the contract imposition.  Parts of this guidance are already available on the BMA website.
Further guidance will be published over the next few of weeks so keep an eye on the website. Current survival guidance include:

  • Locum pension contributions – for both locums and employing practices

  • QOF – clinical changes, increase in upper thresholds, reduce time periods

  • Funding and finance

  • Enhanced services – risk profiling and care management, dementia, online access, remote monitoring

  • Vaccinations and Immunisations

Premises Guidance
This guidance provides information on various elements of premises information including stamp duty land tax, lease arrangements and the new premises costs directions.

New Enhanced Services Guide
NHS Employers and the NHS England have published this guidance on Enhanced Services (ES) in 2013/14 that will make use of the General Practice Extraction Service (GPES) and Calculating Quality Reporting Service (CQRS). The guidance includes the two extended Clinical Directed Enhanced Services (DES) and other new/existing ESs including the 4 new DESs and immunisations and provides primary care organisations with information to help support the continuation or introduction of these services.

111 Feedback forms
As you will be aware 111 has now gone live in Tees. We would be interested to hear your comments as to how the service is working – good and bad. It is also important that you ensure that you raise any concerns with the providers and the CCG using the healthcare professional feedback form in order that these can be addressed to ensure the service is a safe and effective as possible. Please also send any issues that arise to the LMC so we are aware as to what is being experienced on the ground. Questions have been raised with regard to 111 repeat callers and how these will be handled. This has been discussed nationally with regard to patients taking responsibility for contacting GP practices rather than the GP being responsible for contacting the patient. This is certainly an approach we have requested for the start and are encouraged that national discussions have resulted in this. As soon as we have a local update as whether the new national line will be adopted we will forward this to you.

QOF Business Rules v25
The new QOF Business Rules v25 have been published here.

Error in Prescribing General Practice Guide
There is an error in the
Prescribing in General Practice guide previously circulated 26.03.13 please use this new guidance. In the Q&A section, in response to the query 'Can my GP supply me with drugs directly rather than going to a pharmacist?' the guidance states: 'a dispensing doctor is allowed to supply drugs to named patients who live more than one mile by road from a pharmacy' where as it should say, 'one mile as the crow flies'.

Study Leave Guidance for GP Trainees
Study leave enables trainees to direct their own learning, meet their educational needs as set out in their personal development plan, and cover the wide range of knowledge and skills required by the RCGP curriculum. This guidance note has been produced by the GP Trainees Subcommittee to provide GP trainees with the information they require for a broad understanding of their entitlements to study leave and how the process works.

NICE QOF Advisory Committee
NICE is currently recruiting for specialist membership of the QOF Advisory Committee, and are seeking applications from GPs (salaried and trainee), Practice Managers and Practice nurses and a range of other groups. GPC urge members and practice staff to apply and would suggest that those that do so have not just a clinical interest but some political understanding, bearing in mind how the group's recommendations have been imposed this year. Further information including how to apply is available on the
NICE website. The deadline for applications is Wednesday 24 April. Note that NICE changed its name to the National Institute for Health and Care Excellence from Monday 1 April 2013.

Bulletin 179

CQC Regulation Fees
Care Quality Commission (CQC) has published details of the fees to be paid by providers, including newly registered NHS primary medical services (GP practices) from 1 April 2013. All services registered with the CQC are required under the Health and Social Care Act 2008, to pay fees to cover the cost of registration and inspection. Full details of the fees, including a fee calculator so you can work out exactly how much you will pay as a practice, are published here.

QOF Guidance 2013/14
QOF Guidance 2013/14 has now been published.

Good Medical Practice 2013
The GMC have published an updated version of Good Medical Practice together with explanatory notes. The GMC publish a raft of guidance
which practices may find helpful and, also, host a website ‘Your Health Matters which aims to support doctors with health concerns.

Bulletin 178

Procurement, Choice & Competition Regulations
The Procurement, Choice and Competition Regulations have been rewritten and laid under Section 75 of the Health and Social Care Act. This BMA briefing provides more information about the regulations. The Government maintains that the Section 75 regulations are intended to 'ensure good procurement practice'. However, the BMA is only one of a wide range of organisations who have expressed serious concerns that the regulations are unduly restrictive and will, in effect, mean that CCGs and other commissioners will be required to use competitive tendering when contracting for the vast majority of services. The GPC was of the view that the rewritten regulations offer little to assuage these concerns. In particular, there is a worrying lack of clarity for commissioners about the circumstances in which competition does not have to be used. The committee therefore resolved that it opposed and called for the withdrawal of statutory instrument 2013/500. We will forward the GPC guidance on procurement as soon as it has been updated in the light of the new legislation.

Prescribing in General Practice Guidance
The GPC has updated its Prescribing in General Practice Guidance, to include new and updated guidance on medicine shortages, the transcribing of medication directions, the use of multi-compartment compliance aids (previously referred to as Medidose or Dosette boxes) and supplementary and independent prescribers. Please note that this guidance replaces the Information and guidance for prescribing in general practice from 2004.

Injury Benefit Scheme
Ensure you are aware of the changes to the NHS Injury Benefit Scheme
, which currently provides for the payment of either a Temporary Injury Allowance (TIA) or a Permanent Injury Benefit (PIB) and is being removed on 31 March 2013.

Locum Employer’s Pension Contributions Guidance
This guidance on the change in locum superannuation/employer’s pension contributions offer further advice for practices and locums.

Information Commissioners Office (ICO) Advisory Visits to GP Practices
The ICO is the UK’s independent regulator of the Data Protection Act and is offering ‘advisory visits’ to GP practices. The purpose of these visits is to provide practices with specific, tailored data protection advice. It is a free service and practices are legally protected against being penalised for anything discovered by the ICO during the visit. These are one day visits to help organisations develop good practice and identify areas of potential improvement. They may also provide practical recommendations and advice on data security and records management. Practices will be provided with an informative follow-up report to showing any next steps to take. Further information, can be found on the ICO’s website, including details on what the sessions cover, what the follow-up reports can contain, and how you can request a visit.

GPC Annual Report 2013
The 2013 GPC Annual Report - written before the publication of the latest DDRB report and the details of the GP contract for 2013/14 – is available.

Trevor Silver Memorial Essay Prize
Are you interested in primary care musculoskeletal medicine? If so, you may be interested in the Trevor Silver Memorial Essay Prize
. It is open to all GPs and GP trainees registered in the UK.

Bulletin 177

DDRB Report and Uplifts 2013
The 2013 report of the Doctors’ and Dentists’ Review Body (DDRB) was published on Thursday 14 March and recommended an uplift of 1% for all doctors.  Regrettably, the government in England has not accepted the DDRB’s recommendations in full for GP contractors and has decided to reduce the uplift recommended for this group. The Review Body recommended a 2.29% uplift to the overall value of GMS contract payments, intended to deliver a 1% net uplift for GPs after allowing for staff costs and non staff expenses. This recommendation was based on a formula carefully constructed to recognise rising costs in general practice.  The government in England has however imposed a reduction in the uplift recommended by the DDRB.  The GP contract will receive a 1.32% gross uplift, which the government says is designed to deliver a 1% net increase to GP income by restricting increases in practice staff pay, also to 1%.  It has not yet confirmed whether this uplift will be applied differentially across the various funding streams.  If this is the case, some GPs will receive a lower uplift than others. We are bitterly disappointed but not surprised that the government has decided to interfere in the uplift deemed to be fair by the review body. We believe that in view of rising expenses, this level of gross uplift is likely to deliver little, if any, net increase in income, even if the structure of the contract were to remain unchanged. The impact of this 1.32% gross uplift must be seen in the context of the imposition of far reaching contract changes from April 2013; we expect the detrimental impact of this year’s imposed contract changes on the income of most GP contractors to offset any uplift to contract prices. GPs will not forget this in a hurry and will bear it in mind when asked to put themselves out for the CCG. To expect GPs to happily participate in an agenda that involves cutting NHS resources, privatising the NHS, and then GPs getting the blame when it fails, shows that someone somewhere isn’t thinking very clearly.  GPs may have to help them see through the fog of their own making. We will provide a further update once we know how the 1.32% uplift to GMS contract prices will be delivered. The following uplifts have been recommended and accepted:

  • Salaried GPs - the Review Body has recommended that the minimum and maximum of the salary range be increased by 1% for 2013/14.  As a result of the DDRB’s recommendation, salaried GPs on the model salaried GP contract should receive an uplift of at least 1% to their salaries.

  • Trainee GPs - the Review Body has recommended an increase of 1% to GP trainees’ basic pay.  For 2013/14 the supplement for trainees will remain at the current rate of 45%. 

  • GP Trainers - the Review Body has recommended a 1% uplift to the GP trainers’ grant for 2013/14.  This is in addition to the £750 per annum continuing professional development supplement. 

  • GP educators - the Review Body has recommended a 1% uplift to their pay scale for 2013/14.

Contraceptive Implants Enhanced Service
The Department of Health (DH) has confirmed that as from 1 April 2013, the IUCD NES will come within the remit of Public Health England, and will, therefore, be for local agreement. Locally, all sexual health services – including IUCD – are provided through Assura with practice subcontracting arrangements. The DH are planning a wider review of contraceptive services, which would be likely to be led by Public Heath England, and we will update you if there are any changes that may impact on the Tees delivery model e.g. the development of a DES. As it stands at the moment, practices will see no changes.

Focus on Excessive Prescribing Guidance Update
The GPC has published this updated version of its Focus on excessive prescribing guidance (to follow), which includes a new section on shorter duration prescribing, highlighting that shorter duration prescribing can be associated with increased costs and decreased compliance.

Locum Employers Pension Contributions
Practices and individual locum GPs are understandably concerned about the proposed changes to locum employer’s pension contributions, which are currently paid by PCTs and are asking many questions on how the contribution payment will be managed when, it is proposed,  practices become responsible for the payments on April 1st. Although not confirmed, it is understood, from the Pensions Agency, that it is very likely that this change will be implemented from 1st April and that the process for making the payments will be as below.

  • Locums themselves will physically make the payment to the Local Area Team. They will pay their employee’s contribution and the employer’s contribution at the same time.

  • 'GP Locum Form A', which validates that a locum has worked for a practice, will still be used. The form will include a statement to say that the locum wishes to pension the income and will also detail the amount of employer’s contribution to be paid.

  • The same deadlines for payment will still apply – the locum will still be required to send the cheque and form by the 7th day of the month following the month in which the income was earned.

  • 'GP Locum Form B' (a record of all locum work undertaken in that month) will also be retained.

For GMS practices, the additional costs will be reimbursed via global sum. Practices should, therefore, expect to pay the 14% employer’s pension contribution on top of any locum fees. The GPC are seeking urgent clarification from the Department of Health as to how the costs will be reimbursed for PMS practices. Once we have received confirmation of the process for making the payments, we will be sending out a template pro forma invoice for locums to use to set out their fees in detail, including the 14% employer’s pension contribution. 

The Information Governance Toolkit
Version 10 of the Information Governance Toolkit for General Practice went live in June 2012 and the deadline for final submission is 31 March 2013. The toolkit encompasses 13 requirements for general practice to self assess against. Connecting for Health (CfH) state that completion of the toolkit is necessary in order for practices to ensure that their CfH (or, from 1 April 2013, the Health and Social Care Information Centre) services continue to be provided. One person from a practice will have been nominated as the IT lead and they will register for a user account and complete the online self-assessments on behalf of the practice. We recommend that practices submit their 2012/13 self assessments by the deadline. This guidance on information governance for GPs clarifies what is and is not mandatory. PCTs have traditionally provided support to practices in regards to their information governance arrangements. If practices require assistance with completion of the online toolkit the national information governance team can also be contacted via the ‘help’ section of the toolkit.

Bulletin 176

Prescription Charges
This full list of NHS charges from 1 April 2013, includes the prescription charges increase, in England, from £7.65 to £7.85. The BMA continues to call for prescription charges to be scrapped in England in line with the policy in the devolved countries.

Vault Cytology
We would like to re-iterate our advice to practices, in that this work should never be delegated to GPs and that GPs should not to feel pressured to undertake the recall and continued surveillance for their patients, whose indication for ongoing vault smears will have been a malignant diagnosis. In 2011, the Advisory Committee for Cervical Screening and the British Society for Colposcopy and Cervical Pathology (BSCCP) confirmed that the responsibility for follow up care of women who require vault cytology lie with their gynaecologist, not their GP. There is still some flexibility so GPs who wish to continue this practice, can do so on a case by case basis in agreement with their local gynaecologist, but that there is no contractual requirement for GPs to do this. Subsequently, NHS Cancer Screening Programmes have reconfirmed that ‘gynaecologists are expected to take individual responsibility for a woman’s follow up and if they wish the woman’s GP to undertake cytological follow up, they would expect that to be organised between them and the GP on an individual basis’. We believe that this could still be interpreted as if gynaecologists have the discretion to delegate cytological follow-ups to GPs. This would be unsafe and clinically inappropriate, and, therefore, dangerous for patients.

Revalidation Guidance
This guidance on revalidation, provides clarification on how the GPC expect the process to work and deals specifically with some of the practical questions that are arising as revalidation is implemented.

GMS/PMS Regulations
Amendments to the GMS contract and PMS agreement regulations coming into force on 1st April 2013 have now been published.

DWP Fit Note Guidance
The DWP has published revised guidance on usage of the GP fit note. The guidance provides information on completing each section of the fit note, using case studies to illustrate different situations that may arise.

Display Energy Certificates
The DH has confirmed that practices should show Display Energy Certificates. The Department for Communities and Local Government has published this guidance which states 'a DEC and advisory report are required for buildings with a total useful floor area over 500m2 that are occupied in whole or part by public authorities and frequently visited by the public'. Further, general, details are available on this website.

Bulletin 175

Sharps Guidance
The Health and Safety Executive are introducing new Regulations in response to a new European directive on preventing sharps injuries in the healthcare sector (Council Directive 2010/32/EU). The HSE have not yet confirmed when the regulations will come into force, but the directive must be implemented by 11 May 2013. We advise all practices to make use of the outline of the requirements of the directive available on pages 8-9 of the Royal College of Nursing's Sharps Safety leaflet, and the employers' checklist on page 17.

NHS (Pharmaceutical & Local Pharmaceutical Services) Regulations 2013
The NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 were laid on 22 February and will come into force on 1 April 2013. Most PCT duties and functions will transfer to the NHS Commissioning Board, and Local Authority Health and Well Being Boards will take over responsibility for the development and publication of local pharmaceutical needs assessments from PCTs.

Error in 2012/13 QOF Guidance Indicator OST1
The GPC and NHS Employers and have been made aware of an error in the 2012/13 QOF guidance for indicator OST1. The sentence 'the DXA scan codes will only be those that indicate a positive result of osteoporosis, and T score codes will not be included' under the reporting and verification section is incorrect (see page 140 of the 12/13 guidance) and contradicts the business rules. It should read 'The DXA scan codes will only be those that indicate a positive result of osteoporosis'. This correction does not impact the supporting business rules that are correct. Note that a revised version of the 2012/13 guidance will not be issued, and the full guidance is available here.

Bulletin 174

Patient Group Directives Post April 2013
The Department of Health (DH) is making changes to PGDs to reflect the organisational structures that will be in place from April 2013. The NeLM
website  highlights planned changes to medicines legislation to enable CCGs, local authorities and the NHS Commissioning Board to authorise PGDs. It also outlines the transitional arrangements that the DH aims to put in place to support transition of services to the organisations that will be responsible for authorising PGDs from that date. These arrangements will allow PGDs to remain legal after the authorising body has been abolished, and until expiry or authorisation by the new body responsible for the service in question. It will be essential that organisations 'inheriting' PGDs (e.g. CCGs) put in place arrangements and a timetable for review and adoption/authorisation of all existing PGDs. The NHS PGD website team is updating the current guidance, and the existing PGD guidance document produced by the National Prescribing Centre (now the Medicines and Prescribing Centre at NICE), is also in the process of being updated, expected to be published in June. As the principles and legal requirements remain the same, organisations will still be able to use the existing document to guide them through the legal framework governing the use of PGDs, and as a practical guide on their use.

N3 Next generation Access
The N3 network is being upgraded under the GP Next Generation Access programme, which will help ensure that many GPs in England are equipped with faster broadband technology to help improve access to clinical applications and services. All practices under this scheme will have access to broadband of at least 2mbps (megabits per second). Funding has been made available for every practice in England to be upgraded under the programme, but we understand not all have been registered for the upgrade by their PCT. Practices should now have heard from their local IT service or the N3 service provider (BT) about their upgrade, and indeed many will have already had a new router. If you are not clear on this you should check with the PCT to ensure that the order for an upgrade has been implemented or requested prior to the end of March 2013. If you have any problems please contact Janice.foster@tees.nhs.uk.

PIP Breast Implants
Following the advice given last year in a letter by the CMO (England) and in the report by Sir Bruce Keogh that NHS patients who have decided against having an PIP breast implant explanation should have an annual follow up by their GP, the GPC has highlighted concerns in a number of meetings and letters.  Although the advice in the guidance from the surgical associations remains unchanged, and still suggests that GPs need to see all those women who have a PIP implant annually, the GPC advice would be to refer any eligible patients to a consultant breast surgeon for review. This view is also shared by the Department of Health. Carrying out PIP breast implant reviews are outwith a GP’s remit and should a patient attend a practice and the GP feel assessment of their implants is outwith their skills and experience, they should be referred to secondary care.

Francis Report & GPC Response
The GPC have had an initial discussion about the Francis Report into the care provided by Mid-Staffordshire hospital and its implications for general practice. The committee was particularly concerned about the report’s conclusions on target-driven cultures in light of the government-proposed changes to the GP contract, as these proposals would introduce an even greater focus on targets and box ticking and damage patient care. Key points raised in the discussion were:

  • Suggestions that a regulatory body was introduced for NHS managers.

  • The need to develop tools and systems to enable clinicians to draw together and report on concerns about patient care and the importance of a duty to listen to go alongside the duty to speak out.

  • The need for patient-centred holistic care was an important factor in the findings.

The Committee will discuss the report in more depth at March’s meeting. The BMA has posted this response and  as a whole is also reflecting on and considering the findings of this report very carefully, pledging  to work with others in developing a new NHS culture where doctors feel supported and protected to raise concerns.

Latest NHSCB Guidance for CCGs
The latest commissioning guidance from the NHS Commissioning Board (NHSCB). ‘Everyone Counts’ outlines how the NHSCB will hold CCGs to account, including the financial allocations CCGs will receive in 2013-14 and the incentives and outcome measures the NHSCB will use to measure commissioning performance. The NHSCB will focus on five areas, which are drawn from the NHS Outcome Framework:

• Preventing premature mortality;
• Long term conditions;
• Reducing hospital readmissions;
• Improving patient feedback;
• Reducing the incidence of MRSA and C Difficile.

The GPC expressed fears that the proposals in this guidance will foster a target driven culture that would also be contrary to the aims and recommendations of the Francis Report. Whilst it is important that commissioning bodies are accountable for how they spend public money, the GPC was of the view that the outcome measures identified were too detailed and often without the remit of commissioning bodies.

Quality Premiums
Further proposals for the Quality Premium – the financial incentive for CCGs to reward commissioning performance – were also published by the NHSCB. The Quality Premium will be based on four national measures and three local measures, to be determined by CCGs and the NHSCB Area Teams. Award of the Quality Premium will be dependent on CCGs achieving financial balance. Some of the BMA’s initial concerns about proposals for the Quality Premium have been taken on board in these latest proposals, including the need for local targets to prevent the Quality Premium to become a lever for central control. However, GPC is strongly of the view that an incentive based on financial performance has serious potential to exacerbate health inequalities. The GPC will continue to raise these concerns with the NHSCB and government.

Bulletin 173

LESs & the NHS Standard Contract
From April 2013 CCGs and local authorities will commission Local Enhanced Services. Public health services will be commissioned by local authorities and CCGs will commission all other LESs. These services will be called 'community-based services' and will be commissioned using the NHS Standard Contract. You can read more about the NHS Standard Contract here
. These FAQs will be regularly updated so please send any questions you would like answered to Janice.foster@tees.nhs.uk

Official Lease Documentation for Practices in PCT Owned Premises
It is imperative that arrangements between GP tenants and PCT landlords are officially documented and, as independent contractors, GPs should always seek their own expert legal advice before signing any type of commercial agreement such as a lease. Some lease agreements do attract stamp duty land tax (SDLT). The Department has informed the GPC that this will be a one-off payment, but may not apply in every case (consideration will be given on a case-by-case basis. GPs should, however, still seek advice from the practice accountant. SDLT can be very costly and can cause cash flow problems if, for instance, it is not given consideration before agreeing to move premises. SDLT will continue to be reimbursable via the 2013 Premises Costs Directions (up to 100%), but this will require PCT / Area Team approval as they have discretion on all new reimbursements provided for within the Directions. GPC understands that, following the transfer of premises ownership from PCTs, NHSPS plans to negotiate better deals on service charges for its premises estate. This could include utilities costs, cleaning, maintenance of communal areas etc. Finally, the Department of Health and the NHS Commissioning Board have decided that it is impractical to obtain official documentation for all PCT-owned premises before 1st April 2013 (i.e. the deadline for the transfer of ownership to NHS Property Services). The process will roll into the new financial year, providing adequate time to negotiate lease agreements or agree on suitable updates to existing leases.

Bulletin 172

CQRS – Training and Registration Issues
NEPCSA have made us aware that some practices are experiencing difficulties in registering with CQRS and booking training places. Please note the LMS is only accessible via the N3 network. If you have experienced any issues relating to booking a training slot and/or logging onto the Learning Management System (LMS) in the past week, please visit the
FAQs webpage in the first instance and if you are still experiencing difficulties please email Janice.foster@tees.nhs.uk with details of the problem and your practice and we will escalate this to the CQRS team who will assist.

Booking for CQRS (the programme that replaces QMAS) training opened on 24th January for GP practices and CCGs. The first phase of training will begin on 25th February and will be conducted over a three week period. The sessions will be run via Adobe Connect, a web conference application. They will be hosted by a facilitator and users will be able to interact and ask questions. All the material from the training sessions, along with an audio recording, will be made available from 25th February 2013.Places are limited to one person per organisation. Further information is available here if you or a member of your GP practice or CCG would like to participate in this first phase of CQRS training.

Appraisal & Revalidation – GPC/RCGP Statements
The GPC and RCGP have agreed two statements on Safeguarding Children and Young People and Quality Improvement Activity
, written in conjunction with COGPED. The statements were agreed following numerous reports of PCTs requiring all GPs to attend training on child safeguarding and young people, and to clarify the revalidation evidence requirements for quality improvement activity.

Interim GPC Response on QOF Proposals
The GPC has published this interim response
(with link to attached document) to the clinical QOF sections of the GP contract proposals. They are also in the process of drafting a full response to the rest of the proposals. Please help shape the GPC response by feeding in your views by responding to the BMA survey.

Bulletin 171

Measles and Management of Staff
There is some confusion as to what practices need to do for staff with regard to the recent measles outbreak. Practices should review the immunisation status of staff as appropriate, particularly those whose work involved face to face contact with patients. This means you should check staff have 2 recorded doses of MMR or recorded confirmed exposure (pre 1970 age group). If not then you may consider testing immunity of staff or recommending MMR if appropriate though there is no obligation to do either unless a confirmed case has been recorded within your practice/patients. If specific action is required by your practice the HPA will usually contact you (usually following a confirmed case within your locality or practice). Immunity testing falls under occupational health obligations and, as such, the cost sits with the practice. If your staff have been exposed to measles (you have had confirmed cases within your practice/patients), you should follow this guidance on the management of healthcare workers. If you are still unsure of the action you need to take please contact Janice Foster 01642 745 813 or Julia Waller (HPA) on 0844 2253550.

Chest Pain Patients Checklist
We have been working with NEAS with regard to 12 lead ECG recording and vital signs on chest pain patients referred to the 999 ambulance service and have agreed this checklist as good practice for all practices. NEAS understand the concerns primary care clinicians will have when they come across patients at the surgery who have a history of chest pain and need prompt hospital assessment/subsequent management. As treatment for MI is time critical, it is standard practice for the surgery staff to request a 999 ambulance. While awaiting the ambulance, a patient with an infarct/severe ischaemia is at risk of abrupt deterioration due to ventricular arrhythmias. For this reason they should be observed in a suitable clinical area until the paramedics arrive. Aspirin should be given as soon as possible, in doing so, and whilst waiting for the ambulance to arrive, the vital signs should be measured and the ECG should be recorded, where possible.

Copies of Medical Records Fees
To further clarify advice we have previously given and questions we are receiving; the following fees apply to copies of medical records. This guidance applies to the fees only and does not cover consent. If you have specific questions on consent or what information should be included please contact Janice Foster – 01642 745 813.

Deceased Patient:
Request should be made under Access to Health Records Act (AHRA)

For access only = £10 max
For copies = £10 + cost of copying and postage
For access or copies of records pre Nov 1991 = practice to set charge (possibly in line with collaborative arrangement fee if it is considered appropriate to disclose this information at all as there is no right of access)
To provide advice to the PCT = practice to set charge (possibly in line with collaborative arrangement fee where the PCT holds the records and, therefore, responsibility as the statutory provider and copier of the data)

Living Patient:
Request should be made under Data Protection Act (DPA)

For electronic records (including access and/or copies) = £10 max including postage (very few, if any practices have ALL electronic records so check if you are unsure)
For paper or part paper (including access and/or copies) = £50 max including postage

We appreciate the agreed fees under the DPA rarely cover the cost of postage etc as they were set such a long time ago. You can raise this with the person making the request and ask that they cover the reasonable charges (e.g. additional postage) involved as the guidance does state that the charges should be proportionate and justifiable and reflect the actual costs incurred. However, should the requestor decline, unfortunately, you are still obliged to provide the information at the agreed fee.

Bulletin 170

GP Trainees Subcommittee Newsletter
You can view the latest newsletter from the GP Trainees Subcommittee here.

BMA Research Grants 2013
The 2013 research grants are now available to apply for online on the BMA website. The application deadline is 15 March 2013 at 5pm. The BMA was among the first of the professional bodies to award grants and prizes to encourage and further medical research. Today, around ten research grants are administered under the auspices of the Board of Science, all funded by legacies left to the BMA. Grants totaling approximately £500,000 are awarded annually. Applications are invited from medical practitioners and/or research scientists and are for either research in progress or prospective research.

Subject specifications for each grant vary. For example, in 2013, research areas range from rheumatism and arthritis, cardiovascular disease and cancer to neurological disorders and terminal care.

For more information on the grants on offer in 2013 and details of how to apply, please see: www.bma.org.uk/researchgrants. If you have any questions about the BMA research grants, or would like to receive alerts about them, please contact Hugh Garnett at info.sciencegrants@bma.org.uk or telephone 020 7383 6755.

Eric Gambrill Travelling Fellowship
Applications are invited for up to two Eric Gambrill Travelling Fellowships, to be awarded in Spring 2013.  The value of each Award is £3,000 and the closing date for the receipt of applications is 07 April 2013. Those eligible for the Award will be fully trained and practising UK general medical practitioners. In recognition of Dr. Eric Gambrill’s interest in general practice, education and travel, the successful applicants will be expected to undertake a study or project as part of his/her professional career development. Application forms and further information may be obtained via the website, or from: The Honorary Secretary to the Trustees, Eric Gambrill Memorial Fund, Altyre House, Church Lane, GRAYSHOTT, Hindhead, Surrey GU26 6LY or via email: vanessambmason@aol.com.

Bulletin 169

Medicines Supply Chain Guidance Update
The Department of Health has updated its guidance on ‘Trading Medicines for Human Use: Shortages and Supply Chain Obligations’ and ‘Best Practice for Ensuring the Efficient Supply and Distribution of Medicine to Patients’ to take account of the introduction of the Human Medicines Regulations Act 2012. Trading medicines has also removed mention of registered pharmacists exporting drugs and updated references to RPSGB to the General Pharmaceutical Council and their principles and standards.

Bulletin 168


GP Locum Handbook
The BMA recently published the GP Locum Handbook, ’The Essential Guide for Freelance GPs’ which provides advice on setting up as a locum, starting a new business and establishing a contract for services with a provider.  It also looks at different types of locum work and contains information on professional issues such as appraisal and networking.  The Handbook is available for BMA members only - please log in to the website to access it at www.bma.org.uk/sessionalGPs.

GP Trainees Newsletter
The latest edition of the newsletter for GP trainees, including advice on expenses and information on the Junior Members Forum, is now available.

Bulletin 167

Locum Superannuation
The government is proposing that from April 2013, GP practices will pay locums’ employer pensions contributions, which are currently paid by PCOs. The GPC understands that the intention is that the funds would be moved into global sum. This change would be introduced via amendments to the NHS Pension Scheme Regulations, which are currently being consulted on by the government. The GPC is very concerned about the implications both for practices and for GP locums and the BMA will be responding to the consultation to express these concerns, as well as raising it via GPC negotiations with the Department.

NHS Commissioning Board (NHSCB) ‘Everyone Counts’ Planning Guidance
The NHSCB has published planning guidance for CCGs ‘Everyone Counts’ which outlines priorities set by the NHSCB, financial allocations and contains details of the Quality Premium. The GPC has opposed plans for the Quality Premium – a financial incentive for commissioners – on the grounds that it has potential to exacerbate health inequalities, as CCGs commissioning for more challenging populations may find it more difficult to achieve any award available. Further details about how the Quality Premium will be calculated are expected in January 2013, however, the reward will be dependent on CCGs achieving:

  • High standards against four outcome measures drawn from the NHS Outcomes Framework, which for 2013/14 will be:

o potential years of life lost from causes considered amenable to healthcare

o avoidable emergency admissions

o patient feedback - the Friends and Family Test

o incidence of MRSA and C Difficile;

  • Three locally identified measures to be agreed between CCGs and the NHSCB in consultation with Health and Wellbeing Boards and patient representatives;

  • No ‘significant quality failures’ during the year;

  • No overspend on approved Resource Limit in 2013/14;

  • The NHS Constitution Rights and Pledges.

The GPC will continue to work to influence plans for the Quality Premium and will be lobbying on the calculations guidance and regulatory framework when they are published.

Further to the recent questions relating to the local Directory of Service (Dos) the NHS 111 National Clinical Advisors have provided this FAQ document on behalf of the Department of Health.

King's Fund – Time to Think Differently
The King’s Fund has recently launched their new Time to Think Differently programme. A central aim of Time to Think Differently is to stimulate debate about the changes needed for the NHS and social care to meet the challenges of the future. Firstly, the King’s Fund has created some online content on the trends that will influence the way health and social care is delivered in future. Secondly, over the next few months the King’s Fund will be looking at the challenges that lie ahead and discussing potential solutions and providing the opportunity for individuals and organisations to feed into this debate through their website.