LMC Bulletins 2014

Bulletin 248

Co-Commissioning, GPC Guidance
You have received information from your CCG with regard to co-commissioning – it is vital that you read this information and take this opportunity to inform their intentions. This is your opportunity to have your say – every practice should make their voice heard.
GPC Chair, Chaand Nagpaul sent this message to all GPs and the GPC recently published this guidance designed to inform GP practices about co-commissioning, including the commissioning and performance management of general practice contracts. It is important that all practices understand these changes and their implications. This guidance follows the release of NHS England’s plans for primary care co-commissioning, outlined in the ‘Next steps towards primary care co-commissioning’ report, and the request from NHS England for all CCGs to express their intentions for co-commissioning in January. The Next Steps report provides information on the scope of co-commissioning arrangements that CCGs can apply to take on board from April 2015. This includes the option for CCGs to maintain their current arrangements and not apply for any of the co-commissioning models proposed.

The three models described in the report are:

(1) greater involvement in primary care commissioning,
(2) joint commissioning with area team (application deadline is 30 January), and
(3) delegated commissioning (application deadline is 9 January).

Amongst the many changes outlined in the report, a number are of great concern to the GPC. These include the proposal to extend the following powers to CCGs who take on board delegated commissioning:

The GPC will be issuing further specific guidance covering conflicts of interest in early 2015. NHS England has released this Conflicts of Interest Guidance for CCGs.

CQC Intelligent Monitoring Update
The GPC is considering whether any further action might be possible on behalf of practices who were banded inaccurately. They would like to hear from any practices that were subsequently informed by the CQC that had been placed into the wrong band. Please contact Greg Lewis, glewis@bma.org.uk, in the GPC secretariat with details. Following the CQC’s introduction of intelligent monitoring, based on a narrow range of indicators, the GPC wrote to Professor Steve Field to express concern about the process and the way GP practices had been publicly banded ahead of inspection - arguing that the data used to band practices had been published without proper context and was misleading patients. The information did not take into account the differing circumstances in which GP practices operate, including levels of deprivation in the practice population, the level of support the practice receives from community services or the state of its facilities. These and other factors outside the practice’s control had a major impact on how well it performed against these indicators. It was predictable that the publication of the indicators and in particular the bandings for all GP practices in England would result in hostile press coverage that did not reflect the reality of good health care being delivered by the vast majority of them. While the CQC stated on its website that “intelligent monitoring” was not a judgement on GPs that is exactly what it became, with some uninformed and inaccurate stories at both a local and national level. The negative reporting in local media was particularly damaging as GPs and their practice staff, rooted as they are in local communities, had their reputation undermined with practices being subject to unfair criticism. Subsequently, on 5 December, the CQC announced that it was revising the intelligent monitoring indicators, as a result of which a number of practices were placed in different bandings. The GPC reacted strongly to this announcement, urging for the banding system to be withdrawn.

CQRS December QOF Reporting
There’s been an issue with the QOF reporting collection in December that has prevented QOF data from coming into CQRS. You won’t receive data back from this collection and you don’t need to take any further action.  The December collection is part of the normal reporting collections cycle for QOF. HSCIC will be running the next scheduled collection in early January. In line with previous years, payments for QOF 2014/15 will be based on final year-end achievement which can be made from April 2015 onwards. No payments are based on the data in the monthly reporting collections – other than the final year-end collection in April.

Managing Injuries to immobile Children, CCG Guidance
The CCGs have requested we forward this guidance and protocol/flowchart
on managing injuries to immobile children following publication of several SCR’s in neighbouring areas in relation to significant injuries/death of immobile children. It does not replace procedures however, the CCGs hope it will support appropriate decision making and communication to parents.

Sessional GP Newsletter
The second monthly e-newsletter for sessional GPs focuses on the recent BMA Conference for sessional GPs, initial findings from our survey on sessional GP experiences of appraisal and revalidation and working as a GP appraiser.

MEDFASH Educational Tools on HIV Testing in Primary Care
MEDFASH has developed HIV Testing in Practice (HIV TIPs), an online educational tool, to help increase rates of HIV diagnosis in primary care. Launched in National HIV Testing Week, the interactive web tool will enable GPs, practice nurses and their teams to raise their knowledge of HIV and enhance their confidence in offering HIV testing. This in turn will reduce the avoidable illness and deaths that still occur because of late diagnosis. It provides updates about HIV testing in primary care; includes patient stories, quizzes, group exercises, downloadable teaching materials and an HIV testing audit tool and will help GPs and practice nurses to:

Developing Patient Leaders
Practices may find this programme designed to develop patient leaders of interest to their PPG members. This is a free course and closing date for expressions of interest is 9 January 2015. Please find information attached regarding our Developing Patient Leaders programme. You can find further details and how to register in these supporting documents.

Bulletin 247

Referral Letters for Urgent Care
We have been made aware that there are sometimes delays in secondary care receiving GP letters following a GP referring patient for urgent admissions/AAU/ A&E. Please can you ensure that all patients are provided with a letter when you direct them to one of these services? If used consistently it can assist practices in supporting evidence where a patient may present at A&E/AAU stating a GP had sent them when they had, indeed, not attended the GP practice; as well as assisting the patient and the Trust.

Individual Funding Requests
We have been made aware of a change to the process for Individual Funding Requests. Correspondence will be sent from the CCGs but please be aware that this system is moving to an entirely online system and paper referrals will no longer be accepted as of 15 December. If you have not already done so, we recommend your practice registers an online account at https://ifr.sotw.nhs.uk.

Seasonal Flu Correspondence
We have been made aware that some practices may be deleting important public health messages with regard to seasonal flu without having read the content. We appreciate that you are inundated with messages from various sources but some of these messages do require action on behalf of the practice which is mandatory. Therefore, it is important you read these messages then manage them appropriately otherwise, by the time the urgent reminder arrives you are left with very little time to respond/collate information in order to meet deadlines.

Dementia Diagnosis Enhanced Service
We were pleased to note that NHS England has listened to concerns and will not be continuing the flawed dementia (diagnosis) enhanced service from April 2015. The GPC have always opposed the chasing of arbitrary targets in diagnosis rates, and believe that what is needed is to look holistically at the detection and management of patients with dementia. It was never believed appropriate to link payments to specific targets as this undermines the relationship GPs have with patients, and the GPC and LMC maintain that care should be based on clinical need rather than financial imperatives.

BMA Message, Chairman’s Email
Every two weeks the BMA distributes an email newsletter from Chaand Nagpaul, Chair of the General Practitioners Committee, to all GPs for whom we have email addresses, irrespective of whether or not they are BMA members. If you aren’t receiving Chaand’s newsletter direct from the BMA:

If you are experiencing problems with updating your details, please email membership@bma.org.uk.

Bulletin 246

Change in Immunisation & Screening Enquiry Line
From Monday 1st Dec the contact details for the Durham, Darlington and Tees (DDT) immunisation and Screening enquiry line are:

Tel: 01138253017
Email: england.cane.screeningimms@nhs.net

The process of accessing guidance and reporting incidents will remain the same however, our screening and immunisation colleagues in the Cumbria, Newcastle, Tyne and Wear (CNTW) team will participate in offering guidance and advice alongside the DDT team.

CQC Inspection Guidance
This GPC guidance page on CQC inspections will be a living web page and will include regular updates based on feedback and future developments. Any comments are, therefore, very welcome. In particular, GPC plan to include a link to a page detailing the personal experiences of those practices that have already been through the new inspection regime. Again, if you would be willing to contribute, please get in touch with Janice.foster@tees.nhs.uk.

Friends & Family Test Data Submission Guidance
This joint BMA, NHS England, NHS Employers guidance on data submission accompanies the GPC’s more general FFT guidance.

Bulletin 245

NHS Property Services Lease Guidance
GPC have collaborated with BMA Law to put together this short guidance note about the NHS Property Services lease that is currently in circulation. It provides an outline of the headline issues and key provisions arising from the lease including:

We are still seeking clarification with NHSPS on the exact nature of this document and the scope of its intended use.   To that end, we will be meeting the Chief Executive of NHSPS in early December, and intend to make it absolutely clear that the current document is inappropriate. GPC are meeting with the Chief Executive of NHSPS to raise concerns about the appropriateness of the current document and continue advise all practices in NHSPS properties is that they should under no circumstances sign any current standard lease or other document from NHSPS without receiving full legal advice in order to understand the consequences of signing the lease.   

Extension of Enhanced Service for MenC Freshers Vaccination programme
The enhanced service for the MenC Freshers vaccination programme is extended until March 2015 due to reported outbreaks. Area teams will be informing all practices of the extension and issuing this new specification shortly. Participating practices can continue to vaccinate patients. Practices who have not signed up must be offered the opportunity to do so.

Seasonal Flu Vaccinations for Patients with Learning Disabilities
There are a number of queries requesting clarification around the position on flu vaccinations for patients with a learning disability. Although this cohort is included in the service specification under the category for ‘neurological conditions’, the line ‘using clinical judgement’ has been causing some confusion. As such, NHS England intends to send out a bulletin to clarify this. GP practices should be aware of information material to support the drive to offer vaccinations to people with learning disabilities. NHS England SharePoint provides materials/information for parents of children with learning disabilities, adults with learning disabilities and Headteachers of Special Schools on the reasons for being vaccinated against flu. Practices and providers can use this information to encourage more people with learning disabilities to be vaccinated.

Friends & Family Test, Brief GPC Guidance
GPC have produced this brief guidance on the Friends & Family Test to accompany the more extensive joint guidance that was highlighted in bulletin 242.

GPSoC, Contracts Signed for Lot 2 Services
The Health and Social Care Information Centre (HSCIC) has announced that agreements have now been signed with 30 suppliers to enter into the new GP Systems of Choice (GPSoC) framework, to provide Additional GP IT Services (Lot 2). This will enable practices and CCGs to procure additional software, hardware and professional services, complementary to those available under Lot 1. A summary of the products and services each supplier intends to provide is available on the HSCIC website. The HSCIC will now work with suppliers on a Lot 2 online catalogue detailing their service offerings. This will be published in December 2014 and will be accompanied by 'how to buy' guidance to support local organisations in ordering services. Services will be funded by the local organisations and ordered through a Call Off Agreement. This will allow ordering parties to negotiate some of the contract terms relating to delivery of the Lot 2 services, such as service management and implementation provisions.

Armed Forces Covenant
We have been asked by NHS England to draw attention to the commitments of the Armed Forces Covenant that came into effect through the Armed Forces Act 2011 and NHS England has passed on this information

Sessional GP Revalidation Survey
If you are a sessional GP, please take a moment to complete this online GPC revalidation survey to provide your views on your experience of revalidation and appraisal.

Royal Medical Benevolent Fund Annual Appeal 2014
The Royal Medical Benevolent Fund seeks your support for their Annual Appeal

Bulletin 244

CQC Intelligent Monitoring Data on GP Practices
These FAQs provide details on the CQC Intelligent Monitoring Data tool, which helps inspectors prioritise when, where and what they will focus on when they inspect. This tool draws on existing national data sources, such as Quality and Outcomes Framework (QOF) and the GP Patient Survey, and includes indicators covering a range of GP practice activity and patient experience. Based on 39 indicators, each GP practice will be categorised into one of six priority bands, with band 1 representing the highest priority for inspection. CQC  emphasise these bandings are in no way ratings or judgements on the quality of care being given by a GP practice – that only comes after a CQC inspection. This is one tool of many, and one part of the wider information we gather to help inform our inspections. Practices can view their individual reports, including priority banding, via the CQC website and the public also have access via a postcode search.

Out of Area Registration
All practices have received the specification and guidance for out of area registration via email from the Area Team. If you have not received this please contact Janice.foster@tees.nhs.uk. Deadline for sign up is Friday 28 November and practices are advised to remind themselves of the GPC guidance on this issue. This agreement purely pertains to the delivery of care for patients choosing to register with a practice outside their area of residence. It is for individual practices to decide as to whether they wish to contract with the area team to provide care for patients who live within their practice boundary, or beyond, but are registered elsewhere bearing in mind the required information flow, monitoring, payment and validation requirements. Regulations are in place for practices to register out of area patients and you do not need to sign this agreement should you choose to do so. However, practices are strongly advised that they should NOT currently register any patients to whom they do not intend to provide home visits until they have sought and obtained assurances from the area team that arrangements are in place for individual patients. It would neither be clinically appropriate nor practical to register patients without home visits whilst there is no assurance that arrangements for their care outside of the practice area are in place.

Sessional GP Newsletter
This first monthly GPC e-newsletter for sessional GPs focuses on the implications of the 15/16 GP contract agreement for sessional GPs, a survey on sessional GP experiences of appraisal and revalidation and some guidance on the relationship between sessional GPs and LMCs.

Cameron Fund Loans Scheme and Christmas Appeal 2014
May we draw your attention to this Cameron Fund Guaranteed Loans scheme for GPs who are undergoing retraining and experiencing financial difficulty? Also, it is that time of year again when the Cameron Fund seeks your support for their Christmas Appeal - apologies for mentioning Christmas in November! The Cameron Fund is the only medical benevolent fund that solely supports GPs and their relatives at times of need. The Christmas Appeal to colleagues has made a real difference to the Cameron Fund in the past and the continuing work they do to support your colleagues.

Bulletin 243

Seasonal Flu – Immform Reporting Issue and GP Worker Data
Public Health have made us aware of a potential reporting issue for TPP practices. The uploading of flu vaccination figures via Immform for TPP practices is not currently accurate. IT are trying to resolve the issue but Public Health are concerned that it may cause some issues for practices from a claim perspective. Please double check the uploaded data and if you encounter a problem contact Aline.marron@nhs.net.

Seasonal Flu, GP Worker Data
All practices received an email from Aline on 7 November with regard to practices manually uploading data with regard to practice staff flu immunisation numbers. The first deadline for data completion is Tuesday 11 November! Aline has provided a table of subsequent deadlines to assist practices. If you have not received this email or have any problems completing the data please contact Aline.marron@nhs.net.

NHS England 5 Year Forward View, GPC Recommendations of Urgent, Short Terms Measures
NHS England has published its Five Year Forward View. The strategy is far-reaching and enters uncharted waters for the NHS, including proposals for radical new models of care, which would have significant implications for GPs and practices. The BMA GPs committee is giving this report full consideration. Meanwhile, the GPC has already given recommendations as to the urgent, short term measures the government and NHS England need to put in place.

Bulletin 242

Christmas and New Year Opening 2014
As the holiday season fast approaches it is only a matter of time before practices receive a message from NHS England with regard to opening hours. Please note that the Area Team is mandated by NHS England to collect information with regard to practice opening. Practices wishing to close early on Christmas Eve and New Year’s Eve should act in accordance with the BMA guidance which details contractual requirements and suggests actions practices might consider to ensure patient’s reasonable needs are met.

Summary Table of QOF Changes 2015/16 and QOF Business Rules v30.0
This full summary table outlines the agreed QOF changes for 15-16. Additionally, v30.0 of the QOF Business Rules have now been published on the HSCIC website.

Deprivation of Liberty Safeguards
The GPC has issued this guidance covering Deprivation of Liberty Safeguards (DoLS). It should be noted that there is no statutory requirement for the Registrar of Births and Deaths to refer the deaths of those who are subject to DoLs authorisation to the coroner. However, there is a common law duty which applies to everyone, to refer deaths to the coroner where there is reasonable cause to suspect that the person died a violent, unnatural or sudden death, the cause of which is unknown, or where a person has died in prison or policy custody. In the event that a person in their care should die whilst subject to a DoLs authorisation, care homes and hospitals who are managing authorities need to know how to contact the relevant coroner’s office. If in doubt, it is always preferable to report the death. The action taken by the coroner will vary and could include the commissioning of a post-mortem examination or the opening of an inquest (with or without a jury). Equally the coroner could decide that no further action is necessary. Until the coroner has made a decision on whether to undertake a further investigation, a doctor should not issue a medical certificate of cause of death.

Fluenz Tetra Read Code
The Read Code for Fluenx Tetra has now been added to the seasonal influenza and pneumococcal vaccination programme information. 

Patient Online Toolkit and Local Contacts
NHS England’s Patient Online Programme has developed an interactive Support and Resources Guide to help practices get started with records access, identity verification, coercion and proxy process. The aim of the materials is to help practices fulfil the IT requirements of the 14/15 GP contract by March 2015 i.e. online booking of appointments, online ordering of repeat prescriptions and online access to summary information held in patients’ records. The guide includes materials developed by the RCGP. For further information please contact england.patient-online@nhs.net. Please note that the toolkit is work in progress, with updates to the guidance and more resources to be added through 2014/15, therefore, the guidance and suggested actions for practices are subject to change. Locally, Fiona McDonald, who is working as a Digital Clinical Champion, and Kay Renwick, who is the Implementation Lead, are working to offer clinical support with this change. Additionally, throughout the Northern Region there are two other Digital Clinical Champions (Rose Curry and Taz Alawoud), and one other Implementation Lead (Pam Jenkins) working on the programme.  Kay has extended the offer to attend Practice manager or CCG meeting (individual practice meetings are not manageable at this time) to discuss the work further and ensure practices have the required support and information to meet contractual requirements.  If you feel that this support would be helpful in order to implement the programme please email your request via Kay Renwick (Kay.renwick@nhs.net), who will make the necessary arrangements.

Friends and Family Test Materials
NHS England has published a range of materials relating to the Friends and Family Test to assist practices in publicising the scheme. The Friends and Family Test becomes a contractual requirement fir practices from 1 December 2014 and this joint GPC, NHS England and NHS Employers guidance may assist practices with implementation.

Care.data Pathfinder Stage
The CCG areas for the care.data pathfinder have been confirmed (no north east CCGs) to trial, test, evaluate and refine the data collection process, including communications to patients. The care.data Advisory group is inviting participation in their third public discussion on the work they are doing in relation to care.data. The session will examine some of the proposed responses to issues raised by staff, patients and public. The meeting is to be held on 26 November 2014 (6pm – 8pm) in central Manchester and those interested can register here.

Department of Transport Guidance for Healthcare Professionals on Drug Driving
This guidance provides an explanation of the new drug driving offence including the statutory ‘medical defence’ available to patients who have taken their medicine in accordance with the advice of a healthcare professional and the information contained on the  leaflet accompanying the medicine. It also reiterates existing advice that healthcare professional would normally consider giving to patients about taking medicines that could impair their driving.

Payment of NHS Pension Scheme Contribution
During recent months a number of practices have not met the deadline for payment of pension contributions for their staff in the Scheme. From 1 April 2014, NHS Pension Scheme regulations changed authorising NHS pensions to charge interest at a rate of 4.7% APR and an administration charge of £75 to employers who pay late. An amount is deemed late where contributions do not reach the NHS pensions bank account by the 19th of the month, following the month in which the earnings were paid to the member. In order to inadvertently avoid paying late when using the GPI payment processing method, please note the following:

To assist employers in ensuring they meet the payment deadline, this GP1 payment processing schedule details the deadline dates for the remaining months of the 2014-15 financial year. If you have any questions please email nhsbsa.pensionsfinance@nhs.net. Further information regarding the introduction of the changes to the Scheme Regulations can be found in the March Employers Newsletter.

Maternity Pay for GP Trainees
The GPC understand there may be some confusion for area teams regarding the payment of maternity leave to GP trainees. To clarify, each new post on a rotation that a GP trainee undertakes does not constitute a break in service and there has been no change in policy to the contrary. Where practices have followed the provisions in the GP trainees framework contract on maternity pay, which are consistent with the Directions to the Health Education England (GP Registrars) 2013 and the NHS Litigation Authority (GP Registrars) 2013, the GP trainee is entitled to receive ordinary maternity pay (OMP) and should be fully reimbursed in accordance with the Directions. Paragraph 15.3(b)(iii) of the SFE 2013 (page 58) confirms that NHS England should reimburse maternity pay if ‘the performer on leave is entitled to that leave under…a contract of employment’.

Doctors in Training Contract Negotiations
Unreasonable demands from the Government have resulted in the year of negotiations on a new contract for doctors in training coming to a halt with no agreement. The BMA entered discussion to fight for positive changes covering a range of complex issues including unsociable hours, leave and business and travel costs. However, one sticking point appears to have been the training supplement. Given the Government’s stated aim of increasing the number of GP trainees it seems at odds that the supplement which was introduced for recruitment and retention purposes and is of vital importance appears to be one of the key sticking points in the negotiations. The DoH has now instructed the DDRB to make recommendations on a number of points. Full details are available here. The BMA has been given a deadline of 31 December 2014 and it is anticipated the DDRB will report in July 2015.

BMA 2015 Research Grants
The 2015 BMA Research Grants are available for application from 9 December 2015. The deadline is 9 March 2015 and applications are invited from medical practitioners and/or research scientists for research in progress or retrospective research. Alerts or further information can be requested via info.sciencegrants@bma.org.uk or 0207 383 6755.

Bulletin 241

CQC Guidance Notes
You may find it helpful to be aware of this CQC Guidance covering accessing medical records, dispensing practices signing prescriptions, Gillick competency and Fraser guidelines, and GPs and the Mental Capacity Act 2005 and Deprivation of Liberty safeguards may prove helpful in preparing for the new round of CQC inspections.

Bulletin 240

Additional/New Dementia Enhanced Service
It is for practices to decide whether to sign up for this new scheme, which is designed to operate in addition to the existing dementia enhanced service, not instead of it. Key points you may wish to consider in this decision making process are:

Avoiding Unplanned Admissions (AUA) and CQRS
Practices signed up to the AUA DES need to know their practice list size figures. Whilst initial guidance stated these figures will be provided via Exeter report, you will in fact be able to view your list size via CQRS. HSCIC will be advising practices of this in their information accompanying the launch of CQRS which is due shortly.

Flu Patient Information Leaflets
Patient leaflets on flu have now been published and will soon be available to order in hard copy through the order line or by phoning 0300 123 1002. As always, there has been a central delay in releasing these. The CCGs are also planning a flu communication campaign.

Practice Nursing
You may have received this letter providing an overview of ongoing work between NHS E, HENE and other organisations to support the  training and development of nurses working in general practice across Durham, Darlington and Teesside. Cleveland LMC has met with NHS E and HENE to discuss this important area work and we are encouraged that the need to support and training in this area has been recognised. This document provides further information with regard to the development of pre-registration placements in primary care for student nurses.  

Bulletin 239

2015/16 Contract FAQs
Practices may find these FAQs for the 2015/16 contract agreement helpful.

Additional/New Dementia Enhanced Service – Dementia Identification Scheme
You should have received/shortly receive details of a new 6 month national enhanced service (NES) – Dementia Identification Scheme - from NHS England.
This NES sits outwith the15/16 contract negotiations and was pulled together very quickly by NHS England as a result of Prime Ministerial pressure to improve national identification and recording rates of patients with dementia. The enhanced service will pay practices £55 for every new diagnosis of dementia made prior to March 2015. It is highly likely that there will be a number of questions raised as the detail of the specification is considered. We will provide guidance as soon as it is available but if you have any questions in the meantime please do not hesitate to email Janice.foster@tees.nhs.uk and we will try to provide answers to specific questions.

QOF Changes 15/16
Details of the QOF changes for 2015-16 have now been released. We hope practices will welcome GPC negotiating minimum changes for the coming year affording practices a little stability in one element of their work in these uncertain times and assisting practices through being resourced to provide clinically appropriate care, and with more appropriate weighting of QOF points.
As per the contract agreement, the overall points value and thresholds in QOF remain unchanged. However, 26 CKD indicators will end (the register remaining), with most of this transferring to the dementia domain, increasing the value of carrying out dementia care plans, to reflect the greater workload for GPs in this area. In addition, the CHD indicator (CHD006) will also end, with the points transferred to amended AF indicators to reflect the increased workload associated with current clinical management of AF with anticoagulation.  

CPR Guidance
The BMA, Resus Council and RCN have updated their joint guidance on the cardiopulmonary resuscitation.

Bulletin 238

2015/16 Contract
Negotiations with NHS Employers for the 2015/16 GP contract have concluded and an agreement has been reached. The changes provide some much-needed breathing space for practices, through further reductions in bureaucracy; with a decrease in workload in the Avoiding Unplanned Admissions DES and the withdrawal of the Alcohol and Patient Participation DESs. Improvements have been made around cover for maternity/paternity/adoption leave and there will also be a requirement for all patients to have a named GP in future. I will pull together a 1 – 2 page summary sheet for ease.

The changes to the contract will not in themselves solve the workforce crisis or address the exceptional strain affecting general practice. In order to tackle these wider issues, the GPC wrote to and met the Secretary of State of Health in July to propose a set of urgent measures designed to relieve the pressure on GP practices.

GP Electronic Annual Practice Declaration
NHS England wrote to all practices (23 September email) to inform them that the 2014/15 GP electronic Annual Practice Declaration (eDec) will be open for submissions over a five week period from Monday 6 October to Friday 7 November 2014. The letter included a set of FAQs. All GP practices are required to submit their eDec electronically through the primary care website
. This year they have been able to pre-populate 76% of the eDec with responses provided from last year’s eDec submission – including the catchment area and any updates which practices have since made to it when in the GPOS module. The remainder are new questions which relate to recent changes to the GP contract. You need to check pre-populated responses, amending these where necessary, and also respond to the new questions in order to submit your eDEC. An updated GP practice eDEC user manual has been published on the website. A link to this can be found on the website’s introduction to eDEC web page. If you have any questions about the declaration please contact the Area Team or email Janice.foster@tees.nhs.uk. I will offer any assistance I can for completion of these return but we hope that the process should be a little more simple this year as the system is bedded in and the difficulty associated with the area maps has been removed.

Safeguarding and 111
JCUH will commence forwarding a letter to GP practices following an A&E DNA of a child following referral from 111. This letter is for information only but it is hoped that it will be useful if GPs are noticing the emergence of a pattern of behaviour that could indicate safeguarding concerns. There have been a number of discussions in the 111 Clinical Governance Group with regard to concerns stemming from A&E DNAs and the potential that this could form part of a wider pattern of behaviour pertinent to that patient and indicate a potential safeguarding concern. 111 has no process for identifying where a young/vulnerable patient has been advised to attend A&E and DNAs. To try and mitigate this risk JCUH has put an internal system in place where they check a child DNA against their safeguarding register. This is beyond their responsibilities but they are equally concerned about potential risks to patients. Being aware that this internal process does not capture those who have not yet appeared on the register but a pattern of behaviour may be emerging, they will now send a letter to GP practices, for information only, to ensure that there is a full picture of any DNA/safeguarding patterns. This is a short term solution until a national/contractual solution is developed. If you have any questions about this please contact Janice.foster@tees.nhs.uk.

Urgent Primary Medical Care Services for Out of Area Patients when at Home
You are strongly advised that you should not currently register any patients under the new regulation. Further to the announcement that it would not be practical to allow GP practices to proceed to register patients who live out of area without home visiting duties until 5 January 2015 concerns remain about this scheme due to the reference in the Regulations. NHS England takes the view that as the regulations, at the point of registration, require GP practices to determine whether it is clinically appropriate or practical to accept an application for inclusion in their list of patients without access to home visits etc (as set out in 26B of the GMS Regs), there is no basis on which to amend the regulations at this time. Until services for patients that register out of area are in place nationally, the criteria to set aside home visits cannot be met. Although the Regulations remain in place, a practice should only register patients without home visits knowing that they have sought and obtained assurance themselves from the Area Team that such arrangements were in place for individual patients. The GPC and LMC view is that it would neither be clinically appropriate nor practical to register patients without home visits whilst there is no assurance that arrangements for their care outside of the practice area are in place, even though the regulations now technically allow it. Practices are therefore strongly advised that they should not currently register any patients under the new regulation.

GPSoC/Choice of GP Clinical System
There are instances of CCGs (elsewhere in the country) exerting undue pressure on practices to choose a particular clinical IT system. You are reminded that the GP Systems of Choice (GPSoC) framework and GMS contractual arrangement entitles you to a guaranteed choice of clinical system from a range of accredited options. Also, CCGs are responsible for providing you with equivalent levels of support following the exercise of your choice.

If you have any questions about your rights under GPSoC please contact Janice.foster@tees.nhs.uk.

GP Clinical IT System, Deed Of Undertaking for Data Processing
A Deed of Undertaking for Data Processing has been signed by each general practice system supplier and published by the Health and Social Care Information Centre (HSCIC). It is a generic agreement covering all data processing undertaken by suppliers on behalf of practices and clarifies the relationship between practices and system suppliers. General practices as data controllers are responsible for the data held within their GP clinical system, and for any decisions relating to accessing or processing these data. System suppliers have been commissioned to process data held on practice systems on behalf of practices. The document has been agreed in
principle by the Joint GP IT Committee of the BMA and RCGP (JGPITC), as well as the Information Commissioner’s Office, with input from the Medical Defence Organisations.

CQC Guidance, Emergency Drugs
You may find it helpful to be aware of this CQC Guidance covering Emergency Drugs for GP Practices.

Roles & Responsibilities of GPs in Supporting Pupils at School with Medical Conditions
The Department for Education has issued new statutory guidance and non-statutory advice on the roles and responsibilities of GPs in supporting pupils at school with medical conditions, which replaces previous guidance on managing medicines in schools and early years settings published in March 2005. This new guidance came into force 1 September 2014.

Its aim is to ensure that all children with medical conditions, in terms of both physical and mental health, are properly supported in school so that they can play a full and active role in school life, remain healthy and achieve their academic potential.

NICE Guidelines, Publication of the ‘Manual’
The new manual for developing NICE guidelines was published on 1 October 2014 and will be used in future to develop all NICE guidelines, including clinical, medicines practice, safe staffing, public health and social care topics. The manual will be implemented from 1 January 2015 for all guidelines that start from this date. Topics that are in the final stages will continue to be developed to their current processes and methods until completion. Other topics already in development will undergo a planned transition to the new manual, and NICE will be in contact with registered stakeholders regarding the implementation schedule for these topics.

Seasonal Flu, Communication with Practice Nurses and Fluenz Tetra Cap Lifted
The latest edition of Vaccine Update explains that the temporary cap on the orders for Fluenz Tetra, the nasal spray vaccine for children aged two to under 18 years, has been lifted as of Monday 6 October. Please ensure that all Practice Nurses are signed up tot an read on a regular basis the information that is circulated both nationally and locally with regard to vaccine updates. If your nurse is not registered for local updates please contact susan.kirkham@nhs.net

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Business Rules for Unplanned Admissions Enhanced Service
Business rules for the Avoiding Unplanned Admissions (AUA) Enhanced Service have now been published.

Out of Area Registration Scheme Paused
All practices will have received a letter from the Area Team notifying them that the Out of Area Registration Scheme has been delayed. If you have not received this letter please email Janice.foster@tees.nhs.uk and I will forward a copy to you. It is now proposed to commence January 2015 rather than 1 October 2014. NHS England are still working through the details as to how the scheme will work and as soon as we have further information we will forward this to practices to enable you to make an informed decision as to whether you wish to participate.

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CQC Guidance Notes
Nigel Sparrow, CQC's Senior National GP Advisor, has drafted a number of guidance notes aimed at tackling some of the common myths about CQC inspections of GP and out-of-hours services. The guidance notes covering clinical audit, curtains, carpets and hand washing may prove helpful in preparing for the new round of CQC inspections.

Prescription Direction Guidance
The GPC recently met with the Pharmaceutical Service Negotiating Committee (PSNC) and Pharmacy Voice to discuss issues in relation to prescription direction and would like to remind practices about the joint guidance. Prescription direction occurs where a patient is being directed by their GP practice to a certain pharmacy to have their prescription dispensed, or where practices have preferential arrangements for certain pharmacies, these would be seen as a breach of good practice.

Fluenz Tetra Restricted Orders
Please note the temporary restriction for orders of Fluenz® Tetra - at present orders are restricted to 50 doses (5 packs) per practice per week.  Further details available here.

Vaccine Update Newsletter
We would like to remind practices that they can subscribe, free of charge, to Public Health England's 'Vaccine Update' newsletter. This is published monthly and contains useful updates on the latest developments in vaccines, and vaccination policies and procedures in England. The September issue
- to subscribe just click on the link within the newsletter itself.

Update from RCGP on Resources to Support Doctors in Appraisal and Revalidation
The RCGP has recently developed a number of new revalidation resources and updated some of its existing resources. These include Version 9 of the RCGP Guide to the Revalidation of General Practitioners (the ‘Guide’), a number of mini-guides (‘toolkits’) designed to augment the Guide, an updated version of The Principles of GP Appraisal for Revalidation - originally published in 2008, and a revision to the Revalidation e-learning module. Version 9 of the Guide clarifies aspects of revalidation, including: variations in process between the four countries of the UK, the function of ‘suitable persons’ and the patient and colleague feedback process. Additionally the Review of Practice section has been significantly developed. The RCGP Revalidation Toolkits look in greater detail at the following elements of revalidation:

• Colleague and Patient Feedback
• Personal Development Plans
• Significant Event Analysis
• Complaints
• Quality Improvement
• Impact Credits.

The above resources are accessible via the RCGP’s Revalidation Guidance for GPs and CPD Credits and appraisal, and signposted from the newly launched Clarity & RCGP Appraisal Toolkit for GPs. The RCGP can answer revalidation queries at revalidation@rcgp.org.uk.

Prescribing Unlicensed Medicines
The GMC has confirmed that under European law, it is unlawful to prescribe an unlicensed or off-license medication in preference to a licensed one on the grounds of cost. Prescribers should ensure that when prescribing such a medication they are content that there are clinical rather than financial reasons for the prescribing decision. Where unlicensed or off-license medicines appear in an agreed patient pathway their position must be determined purely by their clinical properties, and licensed medicines should on no account be changed to unlicensed ones for financial reasons.

GP Earning & Expenses Enquiry Report 12/13 and Investment in general Practice 09/10 to 13/14
The Health and Social Care Information Group has published the GP Earnings and Expenses Enquiry Report 2012/13
along with Investment in general practice 2009/10 to 2013/14. This commentary summarises some of the key information on the EEQ and the Investment report. The main figure used in the EEQ report is now that of the average of combined GPs (contractor and salaried), rather than that for contractor GPs which has been the case formerly. The mean income before tax for combined GPs (contractor and salaried) in the UK in 2012/13 was £92,900 for those GPs working in either a GMS or PMS (GPMS) practice (compared to £94,200 in 2011/12, a decrease of 1.4% which is statistically significant). The median income before tax for combined GPs in the UK in 2012/13 was £89,300 compared to £91,200 in 2011/12, a decrease of 2.0%.

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CQC Myth Busters
CQC's National GP Advisor, Nigel Sparrow, has been drafting some 'mythbusters' guidance for GP practices which you may find helpful in preparing for the new round of CQC inspections.

Local Dialling Codes
From 1 October 2014 it is important that patients add the area dialling code (01642, 01287, 01429 – apologies if I have missed any!) as appropriate before calling a local number. The charge will remain the same but, if they forget to do this they will get a free recorded message and will need to hang up and dial again which may cause them inconvenience and delay. Additionally, you may wish to alert patients that they will also need to check other equipment such as personal and home alarms – particularly if they rely on telehealth services e.g. carelines or pendants.  You may also wish to check any numbers you have stored within your systems have the appropriate dialling code stored.

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Prescription of Drugs Regulations Amendments 2014
Schedule 2 of the Prescription of Drugs Regulations has been amended as follows
2. In Schedule 2 to the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004(b) (drugs, medicines and other substances that may be ordered only in certain circumstances), in column 1 of the table (drugs), in the entry relating to drugs for the treatment of erectile dysfunction —

(a) omit “Apomorphine Hydrochloride”, “Moxisylyte Hydrochloride”, “Sildenafil” and “Thymoxamine Hydrochloride”; and
(b) after—
(i) “Alprostadil” insert “Avanafil”, and
(ii) “Vardenafil” insert “Viagra”

GPC Guidance - Ebola Virus
A Cascade alert was issued on 1 August via area teams concerning patients presenting with a positive travel history to Ebola Virus areas within the previous 21 days. There is a complex viral hemorrhagic fever risk assessment algorithm which suggests that practices should carry out complex investigations. This is a simplified version of the algorithm, explaining which steps practices would need to follow in case of a potential Ebola case presenting at the practice.

CQC Guidance Significant Event Analysis
You may find it helpful to be aware of this CQC guidance on
Significant Event Analysis.

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CQC Guidance on Agreed Principles for Defibrillators, Oxygen and Oximeters
You may find it helpful to be aware of this guidance CQC has issued to its inspectors ahead of inspections.

Pertussis Vaccine Recommendation
The service specification for the pertussis vaccination programme currently recommends the vaccine to be used as Repevax. From 1 July 2014, practices should be using Boostrix-IPV instead of Repevax. Practices have been made aware of this via the Vaccine Update, on the ImmForm website and also through pop ups on ImmForm. Practices have been able to order the replacement vaccines via ImmForm since 1 June 2014. Any remaining stocks of Repevax should be used for the pre-school booster programme as it is the same vaccine.

Free Data Protection Workshops from ICO
The Information Commissioner’s Office (ICO) is holding a series of free data protection workshops, designed to help small to medium sized organisations from a range of sectors learn about their obligations when handling personal information. The workshops are aimed at staff who may have limited practical experience, but are working for organisations that process personal data. The sessions will provide a basic overview of the Data Protection Act, data controller responsibilities and practical advice from the ICO, using case studies and interactive exercises. The workshops are run by experienced ICO auditors and there is no charge for the event (except for individual lunch and travel costs) and the ‘local’ workshop is held in York on 1 October 2014.

BMA Committee Visitors Scheme
The BMA recently launched the Committee Visitors Scheme - an initiative aimed at encouraging grassroots members of the Association to participate in the Committee process, particularly women. They have had an encouraging number of participants to the scheme so far, and there are still a number of seats available for the 2014-15 session. The Chair of BMA Council Mark Porter published a blog on the BMA website supporting the initiative for its desire to break down barriers to medico-politics. You will find more information on the Committee Visitors Scheme.

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PIP Codes
Chemist and Druggist (C&D) believe practices are using PIP codes without a valid licence and have been sending final demands insisting on payment. However, the GPC, the Dispensing Doctors Association (DDA) and NHS England believe that because practices order through a wholesaler, who in many cases have an end user license, they should not be charged again for this licence and all agree that practices should not pay any invoices they receive from C&D demanding payment for the PIP licence. NHS England is monitoring the situation and if you encounter any problems, contact the GPC on info.gpc@bma.org.uk so they follow this up.

CQC Guidance on DBS Checks
You may find it helpful to be aware of this guidance CQC has issued to its inspectors ahead of inspections.

Indemnity Arrangements
New legislation resulted in a change in indemnity arrangement as if 16 July. Historically there was no requirement for private practitioners to have indemnity but this is now a requirement for all healthcare professionals.  At the same time the NMC has required all nurses to be indemnified prior to obtaining or maintaining registration. Please ensure your indemnity arrangements, and those of your staff, are up to date. The Health Care & Associated Professions (Indemnity Arrangements) Order 2014 {SI 2014 No 1887}.

Dementia Extract
This additional information on the forthcoming dementia extract follows on from an email that practices received from the HSCIC in the week of 21 July.

Pharmaceutical Needs Assessment
This survey is being distributed to help inform each Health and Wellbeing Board in the Tees Valley as they prepare to publish a new
Pharmaceutical Needs Assessment (PNA) in the spring of 2015. Please provide your view via www.surveymonkey.com/s/pharmacy_stakeholder_yourviews before the closing date of 10 August 2014. PNAs describe the pharmaceutical services in a given area and how they meet the needs of the local population. They should identify current and possible future gaps in provision and what might be required to fill those gaps. NHS England (Durham, Darlington Tees Area Team) uses the PNA when making decisions on the commissioning of pharmaceutical services in our HWB areas, including applications to open new pharmacies. The PNA also provides a resource and steer for other local commissioners (e.g., CCGs and Local Authorities) when planning or reviewing local pathways or processes that involve, or impact, pharmaceutical services.

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LMC Conference Report 2014
The Report from the LMC Annual Conference 2014 is now available.

Spine 2 Transition 22 – 25 August
An upgrade to the NHS Spine service is scheduled on 22-25 August. The majority of GP practices will not be impacted by the transition, but weekend users of services such as Choose & Book, the EPS, General Practice Extraction Service, GP2GP and the SCR are advised to read the transition documents available here. The Spine 2 mailbox can also be contacted with any queries.

The NHS Spine provides the infrastructure that delivers access for GP practices to the Personal Demographics Service (PDS), and enables Smartcard logon and functionality. The Spine also controls the messaging between key applications, such as Electronic Prescription Service (EPS), Summary Care Record (SCR) and Demographics. The Health and Social Care Information Centre (HSCIC) will be moving Spine from BT to a new platform called Spine 2, which has been developed and will be managed by the HSCIC.

GMC Guidance – Better Care for Older People
The GMC has launched a new online resource to help doctors challenge the stereotypes associated with older people and tackle the most common concerns older people have about their care. Resources include guidance, case studies, tips, tools and signposts for discussion with colleagues and to share with patients. To keep this content current and relevant and to respond to any new issues that arise, these resources will be continually updated and reviewed, with regular e-updates about these, to doctors and other subscribers - subscribe to updates here.

Local Health Profiles
Public Health England has published the 2014 local health profiles.The profiles present a picture of health in each local area in a format that’s easy to use. This valuable tool helps local government and health services to understand their communities’ needs, so they can improve people’s health and reduce health inequalities.

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Technical Guidance 2014/15 Contract
The guidance on the technical requirements for the GMS contract for 2014-15, has been updated to include sections on shingles and avoiding unplanned admissions. One new Read code has also been added to the dementia section following the HSCIC review of the April Read code release.

Vaccinations and Immunisations Programme Guidance and Audit Requirements
The final version of the of the supporting guidance for the 2014-15, vaccination and immunisation programmes includes the detail for the shingles routine and catch-up vaccination programmes and the childhood seasonal influenza and seasonal influenza and pneumococcal vaccination programmes.

Focus on Vaccinations and Immunisations Update
The Focus on vaccines and immunisations guidance has now been updated following the changes to the regulations on 1 April 2014. This now includes information and links to documents in the devolved nations, and also changes to the new vaccination programmes hepatitis B for newborn babies at risk and meningitis C for freshers.

Carers and Annual Flu Vaccination Programme
The annual Flu Plan for 2014-15 has recently been published and as in previous years, carers (defined as ‘people who are in receipt of a carer’s allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill’) are one of the groups of people who can request a free flu vaccination. The Flu Plan suggests that ‘consideration should also be given to the vaccination of household contacts of immunocompromised individuals, specifically individuals who expect to share living accommodation on most days over the winter and therefore for whom continuing close contact is unavoidable’ potentially broadening the scope of previous programmes where only the ‘main carer’ would be eligible. However, as this is not clearly defined, practices should use reasonable clinical grounds and discretion about to whom to give it, in order to be eligible for payment.

Pharmacy Direction Schemes
Following reports in the press about a number of schemes that appear to encourage or have the potential to be associated with prescription direction, the GPC, Pharmaceutical Services Negotiating Committee (PSNC) and Pharmacy Voice have written to the Department of Health and NHS England to highlight concerns. Such schemes could also have an impact on rent abatement under the Premises Costs Directions. We know that a number of practices have been approached recently and we would like to remind them not to tie themselves into any long-term and inappropriate arrangements. We would suggest that practices report to GPC (info.gpc@bma.org.uk) any concerns about similar arrangements between practices and pharmacies which incorporate an element of prescription direction. We would also like to remind practices about the joint guidance to practices and pharmacies on prescription direction which was published last autumn. A copy of the aforementioned letter is also available on this page.

QOF Business Rules v29
The HSCIC has published v29.0 of the QOF business rules.

Learning Disabilities, Rotavirus and Dementia Enhanced Service Business Rules v4
The HSCIC has published v4.0 of the learning disabilities, rotavirus and dementia enhanced service business rules

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Unplanned Admissions Enhanced Service
A revised version of the joint guidance on the unplanned admissions enhanced service has now been published, along with NHS England's service specification. The guidance now makes it clear that:

A GPC “step by step” guide, which is being updated to reflect the above changes, is intended to minimise the administrative processes involved with the enhanced service, provide practical examples about how practices can meet the requirements and provide optional templates for practices to use to minimise bureaucracy for reporting purposes.

HPV Vaccination Programme Schedule Changing from 3 to 2 doses
From September this year, the number of doses of HPV vaccine that girls aged 12 to 13 years should receive, is being reduced from three to two. The two doses should be given at least six and not more than 24 months apart, but, for planning purposes, Public Health England is recommending an interval of twelve months between doses. Local needs, however, should be taken into consideration when planning the programme, so that any girls who may have missed out on their vaccinations can be accommodated. Also girls who have received two HPV vaccine doses under the 2013/14 programme should still receive their third dose, to complete their course. For full details of the change to the programme, see this letter from Public Health England, the Department of Health and NHS England

Shingles (catch-up) Service Specification
NHS England have published the enhanced service specification for the Shingles (catch-up) vaccination programme.

Interest on Late Payments
The GPC has sought legal advice on whether practices can charge interest on late payment from the Area Team and sue through the small claims court (assuming it has not elected to become an NHS body) for cases of non-payment. The advice confirmed that this course of action is open to practices and 'The Late Payment of Commercial Debts (Interest) Act 1998' should apply too (as the GMS Contract does not appear to have contracted out of this). This allows for interest at the rate of 8% above base rate, plus a fixed sum and reasonable costs of recovering the debt.

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CQRS Guide for 14/15 Enhanced Services
CQRS has now been updated to support the following services (14/15) as of 4 June 2014:

This now allows practices to participate and provide achievement data for the services via the CQRS system. For the monthly programmes that began in April 2014 (MMR, Meningitis C and Hepatitis B), practices will need to enter the first three months of data into CQRS. These services will be manual entry on CQRS for the duration of the financial year. Guides on these enhanced services on CQRS can be found here. For further information on CQRS, the service desk can be contacted via email: cqrsservicedesk@gdi.com.

Change to the Misuse of Drugs Act 1971
The Home Office Circular 008/2014: A change to the Misuse of Drugs Act 1971 – Control of NBOMes, Benzofurans, Lisdexamphetamine, Tramadol, Zopiclone, Zaleplon and Reclassification of Ketamine came into force on Tuesday 10 June. Please see below for the changes to the control of Tranadol and Zioiclone:

The Misuse of Drugs Act 1971 (Ketamine etc.) (Amendment) Order 2014 inserts tramadol as a Class C drug in paragraph 1(a) under Part III of Schedule 2 to the 1971 Act. Tramadol is inserted into Schedule 3 to the 2001 Regulations, with the effect that it is subject to regulations 14 (documentation), 15 (prescription writing), 16 (supply on prescription), 18 (marking of containers), 22, 23 and 24 (record-keeping and preservation of registers), 26 (furnishing of information) and 27 (destruction of the drugs only in presence of an authorised person) of the 2001 Regulations. Tramadol is also being inserted into Schedule 1 to the Misuse of Drugs (Safe Custody) Regulations 1973, which means it is exempted from the safe custody requirements.

Zopiclone and Zaleplon
The Misuse of Drugs Act 1971 (Ketamine Etc.) (Amendment) Order 2014 inserts zopiclone and zaleplon as Class C drugs in paragraph 1(a) under Part III of Schedule 2 to the 1971 Act. Zopiclone and zaleplon are also inserted into Part 1 of Schedule 4 to the 2001 Regulations, with the effect that they are subject to regulations 22 and 23 (record-keeping and preservation of registers), 26 (furnishing of information) and 27 (destruction of the drugs only in presence of an authorised person) of the 2001 Regulations.

New GPC Online Community for Practice Networks, Alliances and Federations
The BMA recently launched a new online initiative, called Networks-L, which will provide a digital space for GPs with an interest in practice networks, federations or alliances to share learning, best practice and insights about these new working arrangements. The forum is one of GPC’s first steps toward offering greater support for practices looking at new models of working. The GPC has also produced this guidance
about collaborative GP alliances and federations. Networks-L is best suited to those GPs, especially group leaders, whose practices are already federated or in a network or alliance, or those whose practice is exploring new models of working. Networks-L was developed following a GPC survey which revealed that GP practices are looking for more support and information about new models of collaborative working. To join Networks-L email Karen Day at kday@bma.org.uk.

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LMC Annual Conference Resolutions (including GPC Chair Opening Address)
The resolutions of the LMC Annual Conference 2014 reflect the challenges and pressures practices face whilst also looking forward, with a renewed self-belief in our fundamental role in keeping the NHS afloat and a spirit of collective determination to fight for a secure future for GPs and our patients. In his first speech as GPC Chair, Chaand Nagpaul highlighted the parlous state of general practice: how it is facing workload, workforce and premises crises, with morale at an all-time low. He warned that ministers ignore this at their peril, since destabilising general practice will have dramatic adverse repercussions on the wider NHS and put forward to government a clear programme of action, arguing that investing in general practice is the indisputable solution to achieving a sustainable NHS.

Your GP Cares Campaign Film
Your GP Cares was officially launched at the LMC Conference and we encourage you to find out more and what you can do in your practice to support the campaign.

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GP Health, Occupational Health service Available to GPs
Recognising that the occupational health service provided through GP Health is a valuable service and particularly vital at this time of increased pressure in which GPs find themselves, Cleveland LMC GP Members voted unanimously to make a donation to GP Health to enable them to continue to provide support to GPs in Tees. This donation has been made from the existing levy, which all practices pay, and will incur no extra cost to practices or their GPs. Please be aware that this service is only available GPs in Tees. Please view the Useful Links page for further details. This service has always been well received and is designed for you. Please do not hesitate to contact GP Health if you feel you need their support - it is completely confidential, anonymous and free of charge.

GP Trainees Work Pattern Data Collection
As part of the negotiations (scheduled to conclude October 2014) for a new contract for all doctors in training,
GP Trainees received, from their deanery, a data collection spread sheet and a letter including instructions on how to complete the spread sheet. The collection asks for trainees to record the hours they have worked for a two week period beginning on June 2nd as well as their OOH work for 12 months. It is essential that as many GP trainees as possible take part in the collection to ensure that there is accurate information for negotiations – please encourage your trainee GPs to take part. GP trainees do not currently have a formally negotiated national contract; rather, the terms and conditions in the GP trainee framework contract have been produced by the GPC in conjunction with COGPED, and are designed to reflect NHS directions. It is proposed that a new nationally agreed contract would include GP trainees.
An important aspect of the negotiation process will be to model pay arrangements for the new contract. In order to do this, the negotiating parties need to improve understanding of the hours of work and working patterns undertaken by all doctors in training. 

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Public Health Services Contract through Local Authorities – sign up reminder
Public Health Shared Services would like to thank all practices that have returned their signed Section A of the Public Health contract. Once the contracts are signed and authorised by the Local Authority, all practices will receive a copy of the signed agreement. For all those practices that are yet to return a contract, could you please do so as soon as possible or notify Philip Ray that you do not wish to provide the services. If you have any queries please contact Philip Ray on 01642 745288 or email Philip.ray@nhs.net.

2014/15 Seasonal Flu Tripartite Letter
The tripartite seasonal flu letter and flu plan have been published.   

Childhood Flu Service Specification 14/15
The updated childhood flu vaccinations service specification for 14/15 commences 1 September 2014 and will be offered to practices by NHS England no later than 20 June 2014.

BMA ‘Your GP Cares’ Campaign
Your active support of this campaign is absolutely vital to its success. Can we please ask you to do the following today:

This campaign will aim to increase awareness amongst the public, patients, government and policymakers of the intense pressure faced by general practice caused by escalating demand, and fuelled by demographic change of an older population with complex needs, coupled with the shift of care out of hospitals. It also highlights the impoverished infrastructure of general practice with regards to workforce and premises, and of a service where demand simply outstrips capacity. It will promote solutions, and fundamentally the long overdue need for sustained investment. The campaign will be a prolonged programme of activity, leading up to the next general election. It will also enable GP practices to publicise the campaign to and involve their patients, through materials to be used in GP surgeries, which will be made available in the near future - there are two posters that you can download from the website and start using straight away if you so wish.

Locum Cover Reimbursements for Working with NICE
NICE has increased the reimbursement rate for GP locum cover for those involved in work on behalf of NICE. These reimbursements are available for principle and salaried GPs working in a practice and are payable where a practice incurs costs in order to release a GP to attend a NICE committee meeting. Self-employed locums are also now able to be reimbursed at eth same rates. Full details available on the NICE website.
This guidance on Non-Staff Travel Subsistence and General Expenses Policy and Procedures
has been updated to include the above changes. 

EU Healthy Aging Questionnaire
The EU has released 2 linked questionnaires relating to healthy aging. The survey for doctors aims to assess their awareness on functional performance (capacity), decline and frailty relating to ageing and possibilities to prevent/delay the onset of these issues and/or mitigate their consequences. The survey for patients aims to assess the awareness, opinion and attitude of the population aged over 60 regarding healthy and active ageing. If you are willing to assist with this survey please contact Paul Laffin (BMA’s EU Policy Manager) via email: plaffin@bma.org.uk.

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Avoiding Unplanned Admissions DES - GPC Guidance and Readcodes
The GPC have published a guide to implementing the unplanned admissions enhanced service. This should minimise the administrative processes involved, while supporting you to achieve the requirements of the enhanced service by complementing your care for the frail patients already likely to be under ongoing management.
In addition, the practical examples for practices document provides further guidance and examples of how practices can meet these requirements. There are also optional templates for ongoing internal practice use, to minimise bureaucracy for reporting purposes. The read codes for this DES have also been published.

Hep B Read codes
The Read codes for the hep B vaccination programme have been published. The technical requirements document will be updated to reflect the read codes; however, this may not be ready for re-publication for a couple of weeks or so.

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GP Trainers Urgently Required
If General Practice is going to cope with everything that is being asked of it, we urgently need to increase our training capacity. Please take a moment to look at this flyer and consider becoming a trainer (if you are not one already) or host more trainees (if you already are!).

North East Sessional GP Group
NESG - North East sessional GP group is a non-profit support group for sessional GPs which has been around for about 15 years. It currently has around 300 members. It aims to provide peer support for sessional GPs and also to improve access to information about educational and job opportunities. It also offers the facility for practices (and trusts) to advertise vacancies (locum/salaried and partnership) for free. Practices can post their vacancy on their website. In the last 3 months, for example, 75 vacancies have been posted on our website (250 in the last 8 months).

The group was originally created by and for locums but now has a wide range of sessional GPs including retainers, salaried doctors, GPs with academic or teaching interests etc. It has been recognised by both GMC in its case studies for revalidation and in the RCGP latest guide for Revalidation. Regular NESG members' meetings occur on the same evening (7pm), and preceding, the deanery sessional GP educational programme (8pm) - on the 1st Tuesday of each month (except for January) at the Freeman Hospital Newcastle. If you would like further details please contact NESG Chair Paula Wright.

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QOF & CPI Issues – Response from NHS England
The QOF re-calculation highlighted last week is expected to result in approximately a 1.95% increase in QOF 13/14 achievement on CQRS for most GP practices. Further information about the re-calculation of QOF 2013/14 achievement and declaring achievement can be found in these FAQs. NHS England has also responded to some of the queries in relation to this as outlined below:

Why is the index list size taken as it stood on 01 January 2013, when the year in question is 1 April 2013 to 31 March 2014?  Basing the actual national average practice list size on that at the start of the last quarter before the financial year in question ensures there is transparency going into the financial year.

On the whole, it appears that list sizes are increasing - why is the current list size not taken into account? Contractors current list size is reflected in the CPI calculation which is the sum of Contractors Registered Population (generally that at the start of the final quarter in the financial year) divided by the actual national average list size as above.

CPI allows QOF payments to reflect comparative list size.

Is the PMS QOF deduction also incorrectly based on the January 2014 CPI figure? The letter from NHS England to area teams sent on 4 April uses the average list size which is applicable for 2014/15, but the calculation is for the 2013/14 QOF. NHS England has provided the following briefing in response:

14/15 QOF Point Value
During the QOF negotiations for 14/15, the GPC negotiating team highlighted the issue that the QOF point value needed to increase comparatively along with any increase in the national practice list size to NHS England. Although there was a 16% rise in the value of QOF points for 13/14, GPC pointed out that this would be an ongoing problem every year if QOF was not adjusted accordingly every year. It was argued that due to the 16% increase in QOF point value, this change was meant to be cost-neutral. It clearly has not been, so GPC are continuing to put pressure on NHS England to sort it out.

Technical Requirements Guidance for 14/15 Contract
This Guidance on the technical requirements and this guidance and audit requirements document for the GMS contract for 2014/15, includes information on clinical enhanced services, named GPs for patients over 75, and vaccinations and immunisation.

Guidance on PMS Reviews & Equitable Funding for PMS Practices
As part of the 2013-14 contract imposition, the government in England planned far-reaching changes to practice funding. From 1st April 2014, the wide variation in core funding per patient between practices will begin to reduce. This may have a profound effect on practice income. Practices with above average levels of funding generally receive either large correction factor payments (as a result of the Minimum Practice Income Guarantee (MPIG) negotiated at the time of the new general medical services (GMS) contract) or above average personal medical services (PMS) funding. NHS England’s guidance puts the amount of ‘premium’ expenditure, (identified as the amount by which PMS expenditure exceeds the equivalent items of GMS expenditure) at £325m, which will reduce to £235m over the seven years to 2021-22 as GMS correction factor funding is phased out and global sum funding increases. The guidance states that Area Teams should invest the premium funding according to the following criteria:

Area Teams will complete these reviews over a two year period starting in April 2014. NHS England has suggested that GP practices can expect LMCs to be engaged in the local review process. GPC guidance on PMS reviews and equitable funding for PMS practices is available along with NHS England’s letter to Area Teams and accompanying presentation.

CLMC has been contacted by a number of practices with a view to reinstating the PMS Group which represented practices during the PCT PMS review process. Once we have further details on how the Area Team will be progressing with the PMS Review locally we will contact practices to consider the best way to ensure PMS Practice views in Tees are represented.

Care.data Phased Roll Out
A six-month extension to the start of data collections from GP systems under the care.data initiative was announced in February. Representatives from the GPC and BMA have met regularly with NHS England to discuss the actions to be taken between now and the autumn.

The GPC is also represented on the recently established independent care.data advisory group. The purpose of the group is to make recommendations to the care.data programme board to help ensure the benefits of the programme are understood and articulated, as well as the risks, and that these risks are appropriately mitigated. NHS England has issued a letter to stakeholders, which confirms that care.data will now proceed in the autumn with a phased roll out of the GP data extraction process. This will involve a cohort of between 100 and 500 GP practices to trial, test, evaluate and refine the collection process ahead of a national roll out. Further information on how the phased roll out will be implemented will be available soon.

Steps are also being taken to make changes to the law that will further increase protections around confidentiality and ensure greater transparency around the release of data by the Health and Social Care Information Centre (HSCIC). The HSCIC will provide additional assurances over the safety of data collected, stored and shared, including the option of accessing data from a controlled environment, sometimes referred to as a ‘data-lab’ or ‘fume-cupboard’, for use by organisations requesting data. NHS England will be taking further action to ensure that patients have a clearer understanding of the care.data programme and will be working with stakeholders to produce additional supporting materials, such as a template letter for patients, as well as simplifying the opt-out process.

NHS England is keen to hear your views so that they can improve and build confidence in the programme. They will be engaging with GPs and patient groups through local and regional engagement events and they also welcome individual comments, which can be emailed to: england.cdo@nhs.net. We recommend you feedback your concerns and suggestions.

NHS Property Services Guide for Customers & Tenants
New guidance for tenants has been launched by NHSPS.

Bulletin 221

Unplanned Admissions DES, Updated Guidance

Revised guidance on the unplanned admissions enhanced service clarifies that:

The changes are made on pages 7 and 15 of the guidance. Practices signing up to this voluntary service should read the guidance and ensure that any requirements from their CCGs beyond the enhanced service are met with additional resources. The GPC have made it clear to government that reducing unplanned admissions is not in the direct control of GPs and requires the whole system to play its part, from community services to urgent and social care. This enhanced service is part of a wider programme of care for vulnerable older people, and NHS England expects CCGs to give practices an additional £5 per head to support them in managing such patients, as specified in the Everyone Counts planning guidance (paragraphs 36 and 37).

QOF Recalculation of Achievement

This newsletter from HSCIC has been sent out to practices in relation to the re-calculation of their QOF achievement.

QOF Business Rules v28
Version 28 of the QOF Business Rules have now been published on the HSCIC website.

Vaccinations & Immunisations Guidance 14/15
Guidance on a number of changes to the vaccination and immunisation programmes has now been published along with a summary table. Note that guidance or service specifications are still outstanding for some of the vaccinations; these will be added as soon as they are finalised. In short - the changes refer to:

New vaccination programmes commencing 1 April 2014
Hepatitis B for new born babies at risk (SFE) - guidance published.
MenC vaccination booster for freshers (ES) - guidance and service specification published.

Existing vaccination programmes continuing from 1 April 2014
- for patients over 16 who self present at practices (this was an enhanced service in 2013, but has now moved to the SFE, so no new service specification will be published).
Pertussis for pregnant women (Temporary ES) - service specification 2014 has been published.
Rotavirus (SFE) - guidance published.

Existing vaccination programmes continuing after August 2014
Seasonal influenza for at-risk patients (DES/ES) - widened so that it mirrors the at-risk groups set out in the Green Book to include pregnant women, but excluding 2-4 year olds - guidance and service specification to be published in June 2014.
Childhood seasonal influenza (ES) - this has been extended to include children aged 4, so that the new cohort is children aged 2-4 - guidance and service specification to be published June 2014.
Pneumococcal (DES) - There is an addition to programme to include the cohort as indicated within the Green Book – i.e. those aged under 65 in the at-risk groups - guidance and service specification to be published June 2014.
Shingles (routine cohort patients aged 70, SFE; Catch up programme (patients aged 78-79, ES) - Guidance and service spec to be published soon.
Men C for freshers (England)
Full details were included in the CLMC bulletin dated 010414

Increase in Prescription Charges April 14
The Department of Health (England) has announced that prescription charges in England will increase from £7.85 to £8.05 for each medicine or appliance dispensed as from 1 April 2014. The charge is also intended to increase by 20p to £8.25 in the following year.

Controlled Drugs and Repeat Prescriptions
Though we have not heard any reports locally, some CCGs in the country are telling GPs they cannot put Controlled Drugs on repeat prescriptions, which is incorrect. There appears to be some confusion generated by only reading the first sentence of a paragraph in the NPC’s Guide to the management of controlled drugs in primary care (12/09) on page 53 it says:
It is clear under the current legislation that repeat prescribing of CDs in Schedule 2 and 3 is not permitted. However, management systems which allow the patient to receive a prescription (hand signed by a practitioner) without a consultation is not subject to legislation, but is a clinical decision made on a case by case basis. It is good practice that patients should be reviewed before prescribing Schedule 2 and 3 CDs.

The repeat prescribing systems within practices are not the definition to which the regulations refer - the CCGs are confusing repeat prescribing within a clinical context (i.e. as every GP would understand it) with a “repeatable prescription” which is defined in the Pharmaceutical Services Regulations. They are correct in so far as Schedule 2 or 3 drugs cannot be prescribed on such a form but there is no restriction whatsoever on what may or may not be contained within the patient’s practice based medication repeat list.

Amendment to Generic Medicine Reimbursement Prices: April 2014
NHS England has reduced generic medicine reimbursement prices (Category M) from April 2014 by £10 million per month, equivalent to £120 million in a full year – view NHS E letter here. The Drug Tariff will be amended from April 2014 to reflect this change.

MRCGP Exam Costs
You may have been contacted by the RCGP regarding tax relief on AKT and CSA examination fees paid since 2009. This will translate into a significant tax saving. Please see the dedicated RCGP web page for more information about this issue.

GP Retainer Scheme North East
Health Education North East (previously the Northern Deanery) would like to raise awareness locally about the GP Retainer Scheme  they run. This is an opportunity for practices (funded) as well as for GPs wishing to retain a part-time clinical commitment.

CCGs 1 Year On, GPC Surveys
April marked the first anniversary of the Health and Social Care Act and CCGs. The GPC are carrying out a short survey  to assess GPs' views and experiences of CCGs, and are interested in the perspectives of all GPs, from sessional doctors to partners, CCG clinical leads and board members. It should only take a couple of minutes to fill out and the results will help inform GPC policy. The BMA has also marked this anniversary by launching a campaign to repeal the act, highlighting the damaging effects of imposed competition and tendering, and pressing the need for policymakers to prioritise integration over competition. You can read about the launch event in Westminster and provide your views/experiences of working under the Act via email to info.gpc@bma.org.uk  or by posting on the BMA forum.

Bulletin 220

Men C for Freshers
This tripartite letter  has been sent to practices regarding the new Men C for freshers. In short, this is a booster offered to freshers (aged 17-25) not previously vaccinated with Men C since reaching age 10, and who self-present to the practice (they will be notified via UCAS). It will commence 1 April 2014 and run until 31 October 2014. There are no call and recall requirements, the vaccine will be centrally supplied, and there will be a payment of £7.64 per dose The letter is available on the PHE website. The GPC are drafting joint guidance and a service specification, both of which are in the process of being finalised and will be published on their website shortly. Note that there are quite a few updates in relation to vaccinations and immunisations, so there will be several updates to the GPC vaccs & imms web pages in the coming weeks

Reminder, Contract Changes and Ready Reckoner for Financial Impact
The GPC has published guidance  on the contract changes coming into effect 1 April 2014 and a ready reckoner  to assist in calculating the financial impact of the changes. We strongly recommend you look at this, if you have not done so already, to fully understand the impact the changes will have on your practice. The GPC is also preparing a checklist for practices in England on actions they should take from April. This is awaiting some last-minute detail from NHS Employers and NHS England but we will share it as soon as possible. We are also still waiting the information/specification surrounding the new DES – again this is still awaiting information from NHS England (national team) before our Area Team can discuss this with us. We will share as soon as possible.

Bulletin 219

We have been made aware of an email scam targeting practices throughout the country. The email purports to be from HMRC and advises you can reclaim overpaid tax returns. I am sorry to say that there is no money waiting for you via this email and advice from HMRC is that they would not usually send such. Just hit delete! 

GP Trainee Framework Contract

The GP trainee framework contract has been updated by the GPC and COGPED to bring it in line with current legislation and terminology. The changes to the framework are not the result of a negotiation and are in no way connected to the ongoing negotiations for a new contract for all doctors in training. We recommend that the framework is used for all GP trainees.


Federated Flexiplan No. 1 Pension Scheme
This industry-wide occupational pension scheme covers workers in the health and education sectors and was set up in 1966. The scheme is currently being wound up, having closed to future accrual on 1 February 2010, with a deficit of approximately £20 million. The GPC would like to hear from any practices that are members of the scheme that may have been affected by increasing cost liabilities as a result of the deficit. Please contact info.gpc@bma.org.uk  to share your experiences.

Bulletin 218

IMPORTANT, Scam Targeting Patients
We have been made aware of a particularly malicious scam that is targeting patients throughout the country (we have also had local reports). The scam involves sending emails to patients advising them that following recent blood tests the results show they may have cancer. The email mentions NICE and has attachments and links for reports. As you can imagine this is incredibly distressing for patients and, as one colleague has phrased it, an all time low for scammers. It is currently unknown as to how they have accessed email addresses and it could be purely coincidental that some of the patients have recently had blood tests BUT we recommend you alert patients to this. NICE is aware of this issue and have posted a note on their website to advise patients they are investigating this issue and not to open emails. Further updates will be posted on the NICE website and via twitter: @NICEComms.

CQRS, GP Practice Checklist for QOF 13/14 Year End
HSCIC has released an email bulletin providing a step-by-step detailed checklist advising practices what they need to do and when for QOF 2013/14 year-end. We recommend that practices view this checklist on line as updates will be made on a weekly basis. A step by step guide on entering achievement data manually for the 17 indicators and how to declare QOF achievement in CQRS will also be made available here together with a number of FAQs. If you require any more information please contact the HSCIC service desk via email: enquiries@hscic.gov.uk

Alcohol Related Risk Reduction Scheme 2013/14

Practices will need to manually enter data into CQRS for the Alcohol Related Risk Reduction Scheme 2013/14. HSCIC are aware that previous guidance stated that practices would not be required to manually enter data for this Enhanced Service and, to support practices, a guide on how to enter data for the Alcohol Related Risk Reduction Scheme 2013/14 has been made available.

QOF Guidance 14/15
The QOF guidance for 2014-15 has now been published and includes a summary table at the end of the document which highlights all the changes made.

DDRB Report
The DDRB report has now been published and the main GP-related recommendations are:

MPIG Changes, Ready Reckoner for GMS Practice
One of the most common calls we are currently receiving in eth LMC office is with regard to the MPIG changes and how practices can calculate the impact on their finances. NHS England has produced a ready reckoner for practices to use as a rough guide to estimate how their funding will change in 2014-2015, both as a result of the phasing out of MPIG and the negotiated changes to the GP contract for 2014/15. We strongly recommend that practices also read the GPC guidance. If, as a response to these changes, you have concerns about your practice and your ability to provide services, please contact the LMC office (Janice.foster@tees.nhs.uk).

Reminder, Music Licensing
GPC has been contacted by PPL, which is a music licensing company that works on behalf of performers and record companies (most of them small businesses or sole traders) to license, amongst other activities, the playing in public of recorded music. PPL issues licences to many medical practices and surgeries for the playing of background music within their premises. PPL’s role stems from the legal requirement that the permission of the copyright owner must be obtained before a sound recording can lawfully be played in public, by virtue of the Copyright, Designs and Patents Act 1988.
You may wish to view their website for more information, including an explanation of the difference between PPL and PRS for Music.

Bulletin 217

QOF Framework 2013/14
The Health and Social Care Information Centre (HSCIC) sent an email bulletin to practices last week on the QOF for the 2013/14 financial year. A step-by-step guide for practices will be issued in March by the HSCIC. We recommend that practices read last week’s bulletin, which explains how the General Practice Extraction Services (GPES) will operate for the QOF extraction. The bulletin also explains how practices should prepare for and participate in the QOF using the Calculating Quality Reporting Service (CQRS).The GPC has emphasised to NHS England and the HSCIC the need for the necessary functionality and training to be in place so that practices can effectively use the CQRS with minimised disruption. In the event that data is not available via GPES for all practices by the end of March, the HSCIC has provided some detail on their contingency plan – this is also set out in the bulletin with further information to follow. Please also see the HSCIC's FAQs.

DEP001, QOF Business Rules
Following a query regarding the QOF business rules of DEP001, where a practice had found that their performance on this indicator dropped following the upgrade by EMIS to v27.1 of the business rules, the GPC have had the following advice from the HSCIC:

‘Originally indicator DEP001 was developed to follow the guidance which requires that the diagnosis of depression and the bio-psychosocial assessment (BPA) codes are recorded on the same date to meet the requirements for this indicator and that a patient would only have one BPA recorded for each new episode of depression. The BPA code was a new code in April 2013, however it was found that some practices were recording the code again following diagnosis (as well as at diagnosis), which was a use that HSCIC hadn’t anticipated. It has since been brought to HSCIC's attention that a patient may have more than one BPA recorded in a given QOF year. This has been discussed with QOF stakeholders and as the numbers of patients affected was expected to be small any change to the indicator was to be implemented in 2014/15, however this indicator will now be retired on 1 April 2014.

HSCIC have considered whether a change can be made to the business rules at this stage, however this is not possible as there will be an impact on GPES as all the suppliers would need to go through re-certification.

If practices feel that they have been unfairly disadvantaged for 2013/14 QOF they are advised to negotiate with their area team. Where a patient newly diagnosed with depression in the current QOF year, has received more than one BPA in the current QOF year the area team would need evidence that at least one BPA had been recorded on the same day as the depression diagnosis.’

Alternatively, practices could delete the second offending code, and re-enter it as free text to preserve the integrity of their record.

Workplace Pensions
Neither the GPDF nor GPC provides financial advice to individual GPs; however they would like to draw to GPs’ attention to areas of change in legislation which may have an impact on GPs and/or their practices. Workplace pensions place responsibilities on employers including GPs, both as practices and individuals (e.g. for nannies), to provide a pension.

The GPDF and GPC urge you to begin by taking independent financial advice in so far as Auto-Enrolment is likely to impact you personally and/or your practice. Planning is the key.

The BMA, NHS Confederation and Pension Regulator all provide very helpful further information.

Final Seniority Figures 2010/11
The Final Seniority Factors for England and Wales for 2010/11 have been published today by the Health and Social Care Information Centre, following agreement by the Technical Steering Committee. The figures are £94,080 for England and £82,237 for Wales. Further details and the report explaining the calculations may be viewed on the HSCIC website.

Bulletin 216

£5 Per Head Funding for Practices to Improve Care for Vulnerable Older Adults
NHS England's recent planning guidance, Everyone Counts, recognises the need for practices to be given additional resources to provide improved quality of care for patients over the age of 75, over and above the avoiding unplanned admissions enhanced service that will be coming into effect in April. CCGs are expected to fund practices at around £5 pounds per head of practice population. For more information see page 14 (Part 1, paragraphs 36 and 37) in this NHS guidance. The LMC has contacted the CCGs to request information on just how this funding will reach practices locally.

Funding Redistribution for GMS Practices
You will be aware that from April 1, there will be funding changes for GMS practices as the phasing out of MPIG over a seven-year period commences. There will be redistribution of the correction factor across all GMS practices, with each ending with an equivalent weighted £ per head funding in seven years. This will mean that about half of GMS practices will lose funding, while the other half will gain. We are not aware of any Tees practices that fall into the ’98 outlier’ category but we are concerned about the impact on service provision and practice viability for those who will lose significant sums of money. If you feel you will be significantly adversely affected please contact the LMC (Janice.foster@tees.nhs.uk) so we can work with our Area Team to try and manage the impact. We have a meeting with the Area Team on 21 March where we will discuss this as well as discussing the local approach they are looking to take with regard to the PMS practice funding review.

NHSE Consultation: Framework for Managing Performer Concerns
NHS England has begun a formal consultation on its framework for managing performer concerns. The documents have been published and will be open for four weeks, closing midnight on Thursday 20th March. The framework incorporates the policy and high level procedures that together detail NHS England’s responsibility for holding and maintaining performers lists in respect of primary medical, dental and ophthalmic performers as detailed in the National Health Service (Performers Lists) (England) Regulations 2013. The framework aims to support Area Teams in managing their responsibility for performers seeking to join the relevant list and to support the few performers that may fall below expected standards once on the list. NHSE expects to publish the framework, annexes and a range of further guidance in April/May 2014. GPC will be preparing a submission to the consultation on behalf of the BMA, but if you would like to contribute as an individual GP, you can do so by contacting Kate Rogers, Responding to Concerns Project Manager, via kate.rogers2@nhs.net.

Bulletin 215

Care.data Roll Out Delay
NHS England has this week announced a six month delay in the roll-out of care.data following follows concerns, particularly on the grounds that the public awareness campaign has not worked, with many patients still unaware of care.data and their right to object to the extraction of data from their medical record. GPs will welcome that NHS England has allowed more time to ensure that patients are made fully aware of the implications of care.data, how their information is stored and used, and their right to object. The BMA continues to support the use of anonymised data to improve and plan NHS services, but will be seeking further assurances from NHS England around the scheme, working closely with
them to ensure that the public is properly informed and that safeguards are in place before uploads begin in the autumn. GPs should continue to enter the objection code(s) to patient records where requested by their patients.

Named GP for Over 75s Guidance
The GPC have published guidance on the requirement for a named GP for patients aged 75 and over, which has been agreed as part of the GP contract changes beginning from April 2014. The guidance includes information on the responsibilities of the named GP and how practices should decide on the identity of each patient's named GP.

Changes to Pension Arrangements for GP Locum Appraisers and Salaried GPs
The NHSPA (NHS Pensions Authority) has stated that all the practice income of salaried GPs will now be pensionable. Practice-based overtime is not currently pensionable for salaried GPs - for example, if they work a Saturday morning that income is not pensionable if it is outside their contracted hours. Now all practice income can be pensioned, even if it takes salaried GPs over their working time hours. The NHSPA has also announced changes that mean freelance GPs who carry out appraisals can now choose to pension that income. Until now, only salaried and partner GPs appraising other doctors could do so. This move comes after continued lobbying of NHS England by the GPC sessional GPs subcommittee. GP locum forms A&B will be updated by the NHSPA in the coming weeks to reflect this change, which comes into effect from 1 April 2014.

Updated Enhanced Services Guidance 13/14
The enhanced services guidance for 2013/14 has been updated following the October 2013 read codes release.

Information Governances Toolkit – 31 March Deadline
Version 11 of the Information Governance Toolkit for general practice went live in June 2013 and the deadline for final submission is 31 March 2014. The toolkit encompasses 13 requirements against which general practice should self assess. The Health and Social Care Information Centre (HSCIC) states that completion of the toolkit is necessary in order for practices to ensure that their HSCIC services, such as the N3 connection, continue to be provided. This is because every practice receiving these services needs to sign up annually to an Information Governance Statement of Compliance and the only way this can be signed or submitted is through the IG Toolkit online assessment. 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. A link to the toolkit is available here. We recommend that practices submit their 2013/14 self assessments by the deadline.

Potential Scam, IT Systems
We have been made aware of a potential scam involving someone claiming to work for a technical support department on behalf of BT, Virgin media and other telephone and broad band providers contacting practices via telephone. The caller stated that they were being alerted by the central server that the person answering the phone had a number of viruses on their computer that could be effecting the speed of their machine and that if they switched on their PC the caller would talk them through how to clean these viruses from it. When challenged and informed that there is a central IT department or when informed that this was a GP practice the caller hung up. The caller ID in one case was 1010101010. Some practices have had this call on every phone line they have into the practice! This has been reported to IT to create awareness but please be extra vigilant if you receive such a call.

Kings Fund Report, Commissioning & Funding General Practice
The King's Fund has published a new report entitled ‘Commissioning and Funding General Practice: Making the Case for Family Care Networks’. The report argues for increased collaborative working between GPs and increased funding for practices to meet the demands on primary care, but within a new contractual framework. Dr Chaand Nagpaul, GPC Chair, has made this response to the report.

Chronic Kidney Disease Care Audit
We are sharing this information on behalf of the BMJ:
National CKD Audit commissioned by HQIP, delivered by BMJ and partners. Practices participating in the audit will be able to easily identify and manage patients with CKD using free tools to optimise coding of patients, improve quality of care, and comply with NICE guidelines; without adding to their current workload. BMJ encourage all GP practices to participate. Read more: http://informatica.bmj.com/ckd

Bulletin 214

Value Based Clinical Commissioning Policy
Public Health Shared Services have shared this revised Value Based Clinical Commissioning Policy for the Individual Funding Requests (IFR) in the North East and Cumbria. This joint policy has been adopted by South Tees CCG and Hartlepool and Stockton CCG and has been operational since January 2014. The IFR process is led by NECS. Public health has been supporting the review of the policy as part of the public health core offer to CCGs.

BMA Collaborative Working Survey
Nationally, there has been significant interest recently in GP practices working as part of formal or informal networks or federations to maximise productivity, cost efficiencies and meet future challenges. At the same time, GPs have rightly expressed that such collaborative models must retain the essential values of general practice, as well as giving opportunities to all categories of GPs. Models have already been established in some areas, discussions are emerging in others, while many practices have not felt the need to consider collaborative working yet. In light of this, the GPC would like all GPs to fill in this survey so they can establish the current landscape. The survey should take no more than two or three minutes to complete and your responses will inform the GPC on how best to support practices and GPs wishing to work in groups. The GPC have also produced guidance on forming alliances for GPs and practices, which includes illustrative case studies and details the practical considerations and first steps you will need to take. This resource is intended for England, but its contents can be applied across the UK. Further guidance on sharing practice staff is also available.

Message from GPC Sessional GP Chair
As we face one of the biggest periods of change to affect general practice, national and local representation of sessional GPs has never been more important - and the BMA's sessional GPs subcommittee, which I chair, is actively working on your behalf.

We have seen the formation of clinical commissioning groups, and now practices are looking to form federations or work in collaborative ways. If we want to take control of our future, it is essential that sessional GPs engage with these changes. Representation of sessional GPs at local medical committee (LMC) level (across the country) remains limited, yet involvement in your LMC is one of the most important ways for sessional GPs to understand and influence what happens at a local level. Now is the time to stake your claim and secure your future in a general practice that upholds the standards and principles that we value as GPs.
To stay up to date with these changes, which directly affect you, I urge you to visit the sessional GPs subcommittee webpage, which includes information about local sessional GP groups and links to individual BMA sessional GP support.
Best wishes,
Vicky Weeks
Chair, GPC Sessional GPs Subcommittee Chair

Bulletin 213

PMS Equitable Funding and Reviews
NHS England has published guidance and an accompanying presentation for its local area teams on equitable funding arrangements and reviews for PMS practices. £325m of "premium" PMS expenditure has been identified by NHS England as the amount by which PMS expenditure exceeds the equivalent items of GMS expenditure. The premium will reduce to £235m over the seven years to 2021/22 as GMS correction factor funding is phased out and global sum funding increases. Area teams will have two years from April 2014 to review their local PMS contracts, with the pace of change on the redeployment of funding following the reviews being left to local judgement. They will invest the premium funding in GP services according to criteria set by NHS England, which are that the investment should:

The guidance gives area teams discretion about how the funding should be invested within these criteria. The GPC’s position is that the premium expenditure should have been redistributed to core GP funding, providing greater certainty for practices and allowing them to invest for the future with greater confidence, for example by employing long-term staff and taking on new partners. In largely leaving decisions about the process and timescales to area teams, the guidance will create further uncertainty for practices and potentially create further inequity between practices in different areas. This position has been made clear to NHS England.

Partnership Changes (LLPs)
The government intends to make significant changes to the taxation of partnerships and partners therein from 6 April 2014. The draft Finance Bill 2014 was published on 10 December 2013 and contained further detail on the proposals. Under current legislation, all partners in an LLP (known as ‘members’) are regarded as self-employed for tax and national insurance contribution (NIC) purposes. The GPC has obtained this advice from a leading firm of tax experts.

Scam Warning
We have been made aware of a potential scam targeting patients in the area. A patient received a call from someone, falsely, saying they were her surgery and advising that they were now able to supply all medication direct without going to the chemist or the surgery. They proceeded to ask what medication the patient was taking in order to update records and then asking for bank details so the patient could pay the delivery fee. This incident was reported to the police and the call was traced to a mailbox number.

Bulletin 212

Care.data, NHS England Information about Leaflet Drop
NHS England have circulated this information (with link to attached document titled NHSE message to all practices about leaflet drop 24.1.14) to all practices. You may find you are unable to view the animation they are promoting on the NHS England website, but you should be able to view the same video on NHS Choices.  

Bulletin 211

Care.data, Important Information
Throughout January 2014, every household in England will receive a leaflet from NHS England about information and data sharing, which will support practices with their public awareness raising activities. The leaflet describes 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. Our area is will be one of the first to receive this leaflet which will include the telephone number of a dedicated patient information line that came into operation on 6 January. BMA and patient representatives have been involved in the wording of the leaflet. GP practices should also have received an email communication shortly before the household leaflet drop. This includes 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. Background information and existing guidance are available on the BMA and NHS England websites.

GP Workforce, Flu Vaccination Data Collection
Public Health are currently requesting practices provide data with regard to the number of GP practice staff who have received the flu vaccination. It would be deemed that practices should provide this information as this request would fall under the ‘reasonable request for data’ as covered in the flu DES as well as falling under information required in line with the tripartite letter. Practices are required to submit the data using ImmForm and we understand that the information required is brief and far less onerous than the patient data you submit. The next data collection window is open from Monday 3 February to Tuesday 11 February and submissions should be made by selecting the ‘Healthcare Worker GP Collection Tool’ on ImmForm. Public Health are happy to support and/or talk through any practice who is having difficulties with this submission – telephone 0113 825 1600 and ask to speak to the immunisation coordinator. We would encourage practices to complete the submission of the data within the 7 day window to ensure contractual compliance. Please contact Janice.foster@tees.nhs.uk if you have any further questions.

Special Patient Notes (SPNs)
CLMC would like to remind practices of the importance of utilising special patient notes. Where there are special instructions, complex medical needs or agreed care plans in place, SPNs are the sole reliable method that Out of Hours providers and 111 can utilise to ensure that patient, and in hour GP, wishes and requirements are followed efficiently and effectively. SPNs can assist in ensuring continuity of appropriate care and safety and may assist in reducing emergency admissions. Sharing key information minimises any misinterpretation of circumstances or a misunderstanding of a patient’s condition/situation and empowers the out of hours GP to manage the patients in a manner consistent with the in-hours care. It is particularly important now 111 manage calls as it will assist the telephone assessment process for your patients. Common examples where SPNs are of particular use include information regarding violent patients, drug seeking behaviour, advanced care plans (e.g. not for admission), palliative care plans, vulnerable adults and safeguarding issues.

British National Formulary (BNF)
NICE is now only going to fund a single edition of BNF per year for practices even though the formulary will be published twice yearly. Bearing in mind that the CQC may expect practices to use an up-to-date formulary it may be prudent for doctors to familiarise themselves with the online BNF.

BMA 2014 Research Grant
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 210

Compliance Aids and Change of Medication
For safety reasons it is important that practices issue complete new prescriptions for all medication within compliance aids/blister packs/medipacks, even if the original prescription is only partially changed e.g. only 1 medication in 10 is to be changed in order for a complete new compliance aid be issued. We appreciate that this may result in a lot of wastage but, without a complete new script, there is risk of human error in removing the correct medication and the pharmacy will not be aware of the conditions under which the medication has been stored so there would be safety concerns for the pharmacist in accepting and reissuing medication that has already left the premises. This guidance was issued by the PSNC (with BMA input) and provides more information if required.

Guidance for the Implementation of Repeat Dispensing
This joint guidance for the implementation of repeat dispensing was produced by the BMA, PSNC and NHS Employers and explains briefly but clearly what repeat dispensing is, how suitable patients might be identified and the potential benefits.