EMail Alerts - Buckinghamshire
LMC to MK practices: Unresourced handover of work to primary care
(06/12/11)
I recently
had cause to confront the employers of Oxfordshire district nurses (see my attached email below).
The Chair of Milton Keynes LMC (Julian Bradley) has asked me to circulate that email
The escalating workload handover to practices from secondary care trusts and district nursing teams (leg ulcers, lymphoedema, MRSA swabbing/treatment, VTE prophylaxis) has become a big issue across the ThamesValley.
LMC plans to ensure resources follow any shift in activity
Paul Roblin
CEO of BBOLMC
From: Julian Bradley [mailto:julian@bulldog.clara.co.uk]
To: MK Practice Nurse
Sent: 05 December 2011 11:49
Subject: Re: FW: Development of a LES for leg ulcer care
After some years it seems this issue is now moving nearer the top of the priority list, and while a favourable outcome is far from guaranteed there are now some clear national and local supportive statements.
Real change is almost always the result of work by many people and this is a good example. I quote below from a very recent email sent out by Paul Roblin to all Thames Valley LMC reps, which as you can see makes the points that I have also made
What has been striking has been the widespread support from across several counties.This is another reminder that we should not give up, should not give in, but try to do what is right even if it takes years.
Paul's final sentence is particularly important for all to know.
I will ask him to forward his advice to all MK GPs
Paul Roblin EMail:
Oxfordshire LMC email to Oxfordshire Health
"I do think we need to sort out leg ulcer care.
My view is that district nurses are responsible for
the nursing needs of patients in the community and this includes both the housebound and the ambulant.
GPs are not obliged by contract to have practices nurses but established practice is that they do.
Our GPC negotiators believe this is for tasks that a GP could do under the contract but which he chooses to delegate to his practice nurse (employees). Leg ulcer dressing is not included within this classification and remains an enhanced service type activity currently funded out of MPIG (see below)
Under the pre 2004 contract (Red Book) practice nurses were funded under staff reimbursement and expenditure on them in Oxfordshire was relatively high.
In 2004 (the new GP contract) this funding stream was vaguely translated into MPIG correction factor but this is being eroded nationally with the intention of abolishing it altogether.
Whilst I believe leg ulcer care should take place in the community, practices are no longer resourced to do so and I will be seeking to negotiate a LES with commissioners (as has already occurred in other areas).
In the meantime LMC advice will be resist any hand back of leg ulcer care by district nurses to practices"
From Dr Phil Hammond (19/10/10)
Hello BBO LMC
I'm a GP working in Bristol and member of Avon LMC. My comedy tour comes to High Wycombe on November 17 (reduced rates for NHS staff) and I wondered if you might circulate the details to anyone who might be interested.
Many thanks and best wishes
Dr Phil Hammond
High WycombeTown Hall
Wednesday November 17, 7.30 PM
Tickets £14 online (£10 NHS staff/ concessions)
01494 512 000, http://tinyurl.com/25szzf3
If you only see one doctor this year, make it Dr Phil
Phil Hammond is a GP, writer, broadcaster and possibly the only comedian to have appeared at a public inquiry. He is Private Eye’s medical correspondent and has appeared on Have I Got News for You, The News Quiz, The Now Show, The One Show and Countdown. He is rude about everything (politicians, doctors, death, drugs, sex, himself) but in a funny way. Free swabs and fit notes for all.
“One of the most entertainingly subversive people on the planet” The Guardian
”Sceptical, irreverent, very funny and like a mighty gush of fresh air in a field that’s bedevilled with cover ups and cloaked in a vow of silence” Time Out
“Generates dozens of laughs and more ire than any amount of tentative taboo-breaching” The Financial Times
“In the long and brilliant tradition of comedy doctors” Sunday Times
View Dr Phil's tour dates, books, DVDs and Private Eye columns at www.drphilhammond.com
Vacancy on South Bucks Local Reference Committee (14/05/10)
Dear All
Self nominations are invited to fill
a vacancy on Buckinghamshire Local Medical Committee’s South Bucks LRC/PCT Liaison Sub-Committee.
This will provide an exciting opportunity for a GP to become involved in local developments and help make the PCT aware of grass root opinion.
Please send expressions of interest and/or requests for further details to:
paul.roblin@bbolmc.co.uk
Best wishes
Pauline
Pauline Green
Administration & Information Manager
Berks, Bucks & Oxon LMCs
Vacancy on Milton Keynes Local Reference Committee (14/05/10)
Dear All
Self nominations are invited to fill
a vacancy on Buckinghamshire Local Medical Committee’s Milton Keynes LRC/PCT Liaison Sub-Committee.
This will provide an exciting opportunity for a GP to become involved in local developments and help make the PCT aware of grass root opinion.
Please send expressions of interest and/or requests for further details to:
paul.roblin@bbolmc.co.uk
Best wishes
Pauline
Pauline Green
Administration & Information Manager
Berks, Bucks & Oxon LMCs
Invitation to Travel Health Update (29/04/10)
There are still a few places left - please see the attached invitation to a travel Health Update sponsored by Novartis Vaccines and Diagnostics Limited
Travel Health Update including Focus on New Developments in Meningitis Vaccines
Date: Thursday 13th May 2010
Time: Session 1: 2.00pm - 4.00pm or Session 2: 6.30pm - 8.30pm
Venue: HolidayInn, Milton Keynes East, London Road, NewportPagnell, MK16 0JA
(01908 613688 )
Speaker: Jane Chiodini MSc RGN RM FFTM RCPS (Glasg)
To confirm your free place at one of these meetings, or should you have any queries, please email melanie.allen@novartis.com or telephone 07900 828964, by Monday 10th May 2010 together with your contact details (please note, space will be allocated on a first come, first served basis
Invitation to Travel Health Update (20/04/10)
Please see the attached invitation to a travel Health Update sponsored by Novartis Vaccines and Diagnostics Limited
Travel Health Update including Focus on New Developments in Meningitis Vaccines
Date: Thursday 13th May 2010
Time: Session 1: 2.00pm - 4.00pm or Session 2: 6.30pm - 8.30pm
Venue: HolidayInn, Milton Keynes East, London Road, NewportPagnell, MK16 0JA
(01908 613688 )
Speaker: Jane Chiodini MSc RGN RM FFTM RCPS (Glasg)
To confirm your free place at one of these meetings, or should you have any queries, please email melanie.allen@novartis.com or telephone 07900 828964, by Monday 10th May 2010 together with your contact details (please note, space will be allocated on a first come, first served basis
MK Health (13/03/10)
I have just been faxed the letter sent by Jeannie Ablett to senior partners on 6.4.10 (attached)
I was not copied into the original mailing
Various bits concern me.
The third paragraph offers Health MK services on âœsounding out ideas with GPs and staff then offering a single response to external bodies.
The last paragraph seeks views on HealthMK representing the business interests of practices
Is Health MK trying to take over the role of LMC in Milton Keynes?
Please remember Health MK is funded out of the PCT unified budget, and will be expected to comply with PCT policies even when these run counter to the interests of practices. LMC is independent of the PCT and is solely concerned with representing levy payers.
Please remember this when responding to the Health MK letter
Paul Roblin
CEO of BBOLMC
Wycombe Hospital - Childrens Day Unit (CDU) Closing time
(04/03/10)
Please see guidance below from Dr Rastogi on use of WycombeHospital - Childrens Day Unit (CDU)
Paul Roblin
CEO of BBOLMC
Dear Dr Roblin
The Wycombe Childrens’ Day Unit(CDU)as you know is open
Monday to Friday except bank holidays.There has been a change in the CDU closing time wef 8thMarch 2010 .It will now
close at 9pm (instead of 10pm) because we have considerable long term sickness affecting the paediatric nursing staff.We will be happy toreceive referrals till 7pm assuming the child arrives in the unit by 7.30pm.
There has been no other change in service provision
The opening hours for the CDU wef 8th March 2010 are 9.30am to 9pmMon - Fri (last referral 7pm).
I should be grateful if you could please circulate this toall the local GP’s.
Many thanks
Kind regards
GC Rastogi
Consultant Paediatrician and SDU Lead
Buckinghamshire Hospitals NHS trust
Wycombe Hospital - Paediatric Services post reconfiguration
(17/02/10)
To Bucks GPs
I have been asked to make practices aware that there are still some Paediatric services available at WycombeHospital, and not every child needs to go to StokeMandevilleHospital.
Please see what Dr Rastogi has written belowÂ
Paul Roblin
CEO of BBOLMC
Dear Dr Roblin
Thank you for your telephone call. I wish to update you about the residual paediatric services remaining at Wycombe Hospital following the transfer of inpatient Children’s services to SMH as I am not sure if our local GP’s have enough information about them.
It has come to my attention that some children who could be managed and observed for a few hours and sent home are being referred to SMH as GPs are not aware of the existence of the day unit at Wycombe.
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The Children’s day unit (CDU) is staffed by a Consultant paediatrician, SpR and SHO. They can be contacted through the switch board. It is open Monday to Friday( excluding bank holidays) , from 9.30am to 10pm. We are happy to receive referrals till 7.30pmassuming the child arrives in the unit by 8pm .Two hours are needed to tidy things up and transfer children to SMH if they need overnight stay. We are happy to see acutely ill children with a variety of problems for assessment, investigation and  treatment and follow up if needed. There are facilities for short stay including isolation if needed such as a child with D & V or chicken pox.Children who need overnight stay can be transferred across to Stoke .
The day unit is located in the former ward 7 and is also called WACU or CDU.
Direct line 01494 425506
Children with the following problems such as -
Respiratory:
Chest infection/Pneumonia
Bronchiolitis
Acute exacerbation of Asthma/wheezing
Croup
Gastroenterology
D &V
Bloody diarrhea
Vomiting ? cause
Newly diagnosed diabetic
ITP
Henoch Schonlein Purpura
Febrile children and children who have had a febrile fit
Suspected UTI
Skin infection/ infected eczema/impetigo
Periorbital Cellulitis
can be referred to the Day unit at Wycombe. (This is not an exhaustive list!)
If any clarification is needed, the SpR or consultant will be able to advise where best to send the child
All children who are ill enough to need an ambulance to bring them to hospital should go direct to SMH as should those with a surgical or orthopaedic problem.
I should be grateful if you would share this information with your colleagues.
Many thanks for your help.
Best wishes
GC
New LMC reps required for Milton Keynes (05/01/10)
Please circulate this amongst all your doctors, whether partners or not.
Using the agreed ratio of one LMC rep per 40K patients, Milton Keynes LMC should have 6 representatives.
The current LMC reps for Milton Keynes are Abdul Suleman, Lakshman Rao, Ron Carter and Julian Bradley (recently elected as Chair), so we are 2 short of full complement.
Because of illness and other absence, the last liaison meeting with the PCT (October 2009) was attended only by Paul Roblin and Julian Bradley.
With the recession, the NHS has entered a period of financial constriction.
All PCTs will looking for cuts both in primary care and the services we need to help patients. LMC has therefore never been more important in its role of defending general practice.
Please consider whether you can contribute to MK LMC and put yourself forward as an LMC rep.
If you are unsure and need more information please contact us
Dr Paul Roblin Julian Bradley
CEO BBOLMC Chair MK LMC
NCAS seeking extra Medical Assessors (17/11/09)
Bucks LMC has been sent the attached letter which is summarised below
NCAS (National Clinical Assessment Service) is seeking extra GP assessors, particularly those with experience of single or small practices, OOH and inner city practice
Candidates must offer 15d/year
The application deadline is 20.1.10
Shortlisted candidates will be invited to a 3 day training workshop on 17-10 March 2010, which will include assessment and selection at the end.
Contact details Vicky.voller@ncas.npsa.nhs.uk
Tel: 0207062 1630
How to refer in low and high risk TIAs in Bucks (23/10/09)
Bucks PCT has asked LMC to help with improving the clinical care of TIA
It seems that despite several mailings, some GPs are still referring high risk cases by post or fax and not sending the patient in immediately.
Please see the two attachments to this email:
TIA Letter
TIA Referral Form
They include the referral form (showing how to calculate the ABCD2 score), the care pathway and the fax numbers that will be needed.
The back of the referral form shows:
1 How to classify someone as low or high risk
2.The arrangements for admitting patients and faxing both rapid and slower referrals
The PCT has asked that:
1.High risk patients be sent to A+E within 24h
2.Low risk patients should be seen in Stroke Out patients within one week
For those who have not encountered the ABCD2 score before details are shown below
Your help in improving TIA care would be appreciated
Dr Paul Roblin
CEO BBOLMC
07799116597 or 01628 475727
SurgeryPods (14/10/09)
I have been asked to let you know about SurgeryPod (see attached leaflet and extract below)
This comprises kit and software for patients to self assess themselves in the surgery and is useful for:
- Measuring blood pressure objectively before making a decision as to whether to treat or not
- Monitoring those with chronic stable hypertension who need little intervention
- Allowing those who want basic cardiovascular screening to administer this themselves
- Using self administered questionnaires to measure and monitor anxiety and depression
SurgeryPods are installed and connected directly to the local practice management system
All fields are Read-coded, so the information can be stored immediately, for example, in EMIS, SystmOne (in Sept 09) or Vision.
Installation requirements include a small table and screen in the waiting area, and 13A & data sockets.
Standard protocols include new patient check, standard check, blood pressure, BMI, alcohol (including FAST/AUDIT) and PHQ9/HADS/GAD7; these are amended as QOF requirements change.
Standard peripherals are simple sphygmomanometer and scales - many customers though prefer an arm-in “sphyg” and a few like the laser height-measuring device too.
Dr Paul Roblin
CEO BBOLMC
07799116597 or 01628 475727
Bucks PCT letter re Housebound patients on Warfarin (08/10/09)
Since my first email earlier today, some of you have contacted LMC to say you have not seen the letter of 18.9.09.
I therefore attach what was sent out to senior partners by Geoff Payne’s PA
I have asked the PCT to look at why this has occurred. It is possible their address listing (snail or email) is incomplete
Dr Paul Roblin
CEO BBOLMC
07799116597 or 01628 475727
LMC letter to all Bucks Practices re cessation of district nurse domiciliary phlebotomy (08/10/09)
To all Bucks PCT practices
I am writing to you to describe the circumstances behind the unilateral Bucks PCT decision to decommission a district nurse phlebotomy service for housebound patients not already on their caseload.
The decision contrasts with all the other four Thames Valley PCTs, which accept that some domiciliary phlebotomy should be performed by non-practice staff and have appropriate services in place. LMC and PCT are agreed that this task does not need a district nurse and a HCA is appropriate, but this option has not been discussed with LMC or presumably considered within the PCT
The new policy was not what was agreed with me as LMC CEO. In two meetings before you received the PCT letter of 18.9.09, I had offered to encourage those practices appearing to overuse the service to rein in their demand and to encourage GPs to take blood when visiting for clinical assessment wherever possible. These offers were accepted but never followed up by the PCT, and soon made redundant by the PCT letter.
My view is that this action is inconsistent with the PCT seeking GP help in limiting activity and cost in secondary care to manage its budgetary difficulties, an initiative I supported. If GPs are to do more long term follow up in the community, the domiciliary venesection workload will become a problem.
The PCT seems content to give this workload to practices without resources. The assumption seems to have been made that domiciliary phlebotomy is part of essential services, ignoring the customary division of workload within primary care teams upon which the national pricing of the GP contract was based
LMC has pointed out the difficulty some GPs face in having their specimen transport van attend the practice before visiting can be reasonably done and the workload of housebound INR monitoring. The latter is outside essential services and not universally covered by an anticoagulant LES.
Concentrating solely on seeking financial balance, those driving PCT policy cannot ignore the damage they are causing to PCT relationships with practices and the disruption of successful primary care teams.
I urge practices to assess how cessation will affect them and let the PCT know of predicted difficulties. If you believe as I do that unavoidable second trips to a patient solely to take blood are not the responsibility of GPs then please say so.
It would also be helpful if you could tell me when your specimen transport van normally visits your practice, so I can demonstrate the difficulties GPs have in taking blood at the time of clinical assessment at home
I hope LMC and PCT can reach a compromise. Your input will be important in achieving this end.
Paul Roblin
CEO of BBOLMC
Roblin comment on Referrals allocations letter from Bucks PCT
(04/09/09)
Letter to practices from Bucks PCT and Collaborative Leads dated 1/9/09
(Text of comments from Paul Roblin also attached)
I saw the attached two page letter and attachments for the first time today, and felt that it needed some explaining.
Even with the knowledge obtained from my recent attendance at the Healthy Bucks Leaders Group, I found it a difficult read, so I presume many practices would have been in a similar position.
The two page letter explains the budgetary difficulty of Bucks PCT and its plans to ensure OPD referral activity is made affordable.
Initially, I found the table labelled “Attachment One” a little confusing, so below is my understanding.
Bucks PCT total annual funding allows them to calculate the total number of OPD referrals affordable in 2009/10. Subtracting the total made so far gives a residual total for the number of referrals Bucks practices can make before 31.3.10 without the PCT going over budget.
For the months September to December, the PCT has allocated these remaining referrals to each practice using two methods:
- Recent Usage (RU)
Usually known as historic share - Fair Share (FS)
Using the âœDOH modelâ formula, so presumably something like Carr-Hill.
Those whose RU < FS may be efficient referrers, or have significant numbers of private referrals.
Those whose RU > FS may be inefficient referrers or be unfairly treated by the DOH (FS) formula.
All figures may be wrong if the hospital data used to calculate them is inaccurate or incomplete.Â
I know nothing about the DOH fair shares formula. I presume, that like the Carr-Hill formula, it uses practices’ patient characteristics such as age and social class, to manipulate your real list size (up or down).
Using fair shares allocations always raises questions about whether the formula is right or fair.
Using historic shares tends to perpetuate previous habits (both good and bad) and doesn’t incentivise behaviour change.
The PCT intends to provide practices with rapid monthly feedback on referral numbers, so that all can check how close they are to exceeding either of the allocations (paragraph 5).
The PCT asks:
- those practices exceeding their allocations to look at why this might be so (paragraph 7)
- each practice to record every out patient referral (NHS and private) on a supplied template (paragraph 8 and Attachment Three) and email the completed table to its PBC collaborative, together with any referral analysis (paragraph 11)
- practices to monitor their monthly referrals against the RU allocation and take action if a 5% overshoot seems likely
eg check referrers are complying with referral criteria (paragraph 9). - each practice to record every out patient referral (NHS and private) on a supplied template (paragraph 8 and Attachment Three) and email the completed table to its PBC collaborative, together with any referral analysis (paragraph 11)
Where a 10% overshoot seems likely PBC help will follow (paragraph 9).
The PCT intends to benchmark each practice against others as in the histogram in Attachment Two (paragraph 12).
Please let me know your views.
Paul Roblin
CEO of BBOLMC
AGM - Milton Keynes PCT (24/08/09)
Please would you be so kind as to forward this invitation flyer to all LMC members. Also please feel free to forward to any other groups you may be involved with that may wish to attend this years event which is being held at BletchleyPark.
Also attached is a booking form should any council/community groups wish to showcase and have a stand at this years event.
Many thanks for your support.
Regards
Allison Carlton
Communications & Engagement Manager
NHS Milton Keynes
Hillingdon Independent GP Group (HIGP) support group for sessional GPs (20/11/08)
To All Berks & Bucks Practices
Please could you circulate the information below to any sessional GPs working in your practice?
Many thanks.
Michelle
Berks, Bucks & Oxon LMCs
From: Sashi Shashikanth [mailto:Sashi.Shashikanth@gp-E86620.nhs.uk]
Sent: 16 November 2008 18:30
To:pauline.green@bbolmc.co.uk
Subject: article for circulation
Dear Pauline,
We have members from your region as well since we are bordering with your area. I will be grateful if you could kindly send this to bucks and berks GPs . These are difficult times for
sessional GP and we would like to be supportive as much as possible . Please note â“ we are NOT the plc hawks , we are front line GPs who care for the next generation . This group is entirely run by volunteers.
Sashi www.londongp.org.uk
Article below
Hillingdon Independent GP Group (HIGP) is a mutual support group for sessional GPs. It
was established in 2002 and is run entirely on a voluntary basis by GPs. This dynamic group, free to members, provides continuous professional development and informal
mentoring for sessional GPs. Networking and information-sharing are strong features of HIGP, and help combat isolation as well as keep members up to date. In the absence of a
formal method of information-sharing, sessional GPs get all notifications from PCT, clinical tutors and GPC cascaded to them via the group's active hillingdonigp e-forum which also provides medico-political updates.
Monthly educational meetings, always well attended, offer PDP certificates. The 69-member strong group also organises regular sponsored away-days. The well-run group
has been frequently complimented by the deanery and the GPC for its organisational skills and its inclusiveness. It has attracted GPs from surrounding PCTs, which in turn has
helped practices in the region to get high quality sessional GPs. The group maintains its association with The National Association of Sessional GPs, and its members have been
elected to local LMCs. With upcoming revalidation, sessional GPs will find membership with such an educational group even more useful to prove they are up to date with
professional development. The group relies on funding from pharmaceutical industry and the deanery for its activities. Committee members who meet regularly write proposals and tenders for funding from the deanery.
Apart from being a useful educational resource ,the group's website www.hillingdongp.org.uk has been helping the local practices to find GP locums and
salaried GPs, absolutely free of charge. As soon as practices place their advert on the website, an instant email is generated to all members. The practices usually fill their
vacancies within 30 minutes and this service has been a resounding success in Hillingdon and surrounding PCTs. The website has eliminated the need for locum agencies, with a
significant savings cost to both practices and sessional GPs.
Sashi Shashikanth
Web editor /e-forum moderator
The LMC in Milton Keynes (23/10/08)
Hello Everyone,
I thought I would write to let you know about the LMC (Local Medical Committee) in Milton Keynes. Many of you are aware of us but I am also aware that some people think we have been disbanded and are not active.
I have chaired the LRC (Local Reference Committee ie local branch of Bucks LMC) for the past year or so and will be attending a planning day next month where we will discuss the future of the LMC in Berks, Bucks, and Oxfordshire. We feel that Milton Keynes is often quite different to these Counties and that the local meetings should have more weight and influence than the County meetings (which we also attend every 2 months).
As you all pay subscriptions to the LMC, I would welcome your views on how you would like to see the LMC working for you over the next few years. At the moment we meet every 2 months, with members of the PCT to discuss problems, new ventures, contract details like DESs and LESs etc. We have the option of using the subscription money as we see fit and have suggested that one use could be to have a part-time local deputy for Paul Roblin (CEO of Bucks,Berks and Oxon LMC) who could spend more time in MK. Paul works very hard to cover all of the PCT areas but is based in Marlow, so obviously cannot attend every MK meeting which can leave us at a disadvantage. Other ideas would be very helpful, and I can then present these at the planning meeting on 25th Nov.
Finally, we do have a spare seat on the LMC in Milton Keynes at the moment - we meet at MK Village Practice every 2 months and in Aylesbury for the County meeting in between - always on Friday afternoons. An honorarium and mileage is paid for attendance. I would love to hear from you if you feel you could join us and help shape general practice in Milton Keynes in the years to come.
Regards, Sian
Dr Sian Whyte
Chair of MK LRC
Milton Keynes Village Practice
Griffith Gate, Middleton
Milton Keynes, MK10 9BQ
Tel: 01908 393808
LMC view on Warfarin prescribing letter from Anne-Marie O'Hea (04/07/08)
TO ALL BUCKS PRACTICES - PLEASE CIRCULATE
A problem has arisen this week over a letter from Anne-Marie O'Hea (Stoke Mandeville Anticoagulation Consultant)
This was sent to practices but not the LMC.
I gather it announces the fact that patients attending the SMH clinic will not be prescribed Warfarin from 1.8.08.
It seem that the policy change was decided by a steering group with no GP or PCT involvement
Under the new GP contract, Warfarin prescribing is covered by the Anticoagulation NES which is voluntary for practices.
The unilateral decision by SMH has not taken this fact into consideration, so that no
provision has been made for patients of those practices that have not signed up for the NES.
LMC has raised the problem with Bucks Hospital Trust, Dr O’Hea herself and the PCT.
Our view is that until we are all agreed on how all patients can be accommodated and any workload transfer resourced, the change should be put on hold
Please let me know your views and whether you have any problems
Paul Roblin
Chief Executive Berks, Bucks and Oxon LMC
07799116597
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