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Index
1) New Contract Ballot
2) Working for You
3) Your LMC Representatives Are There For You - Please Use Them
4) Letter from the Secretary
5) Snippets
The OFT’s report on the deregulation of pharmacy
Prescribing and referral incentive schemes
The National Complaints system
Questionnaires
Courtesy
Allocations
6)
GPC Slot
7) GP Forum
8) Web SIte Update
9) Your Secretariat Team
If you have not received your ballot paper, contact the Electoral Reform Ballot Services immediately on:
0208 8899 203
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The Contract and associated problems have overshadowed all other medico-political issues. The LMC is trying to keeps its eye on the ball and identify other problems looming which will affect your working lives.
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Your LMC Representatives Are There For You - Please Use Them
They are there to help and advise you and can be contacted with:
- queries;
- topics you would like raised at the LMCs’ county or Local Reference Committee meetings;
- your views.
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By the time you receive this Newsletter you will have received your ballot paper. If you haven’t already voted make sure you arm yourself with as much information as possible. Don’t abstain. Whatever the result a large turnout is essential to let the government know that the result is truly representative of the profession.
The Special Conference of LMCs was a focal point for GPs collectively from across the UK, for the first time, to let the GPC and the negotiating team know their deeply held anxieties around a raft of issues associated with the new contract.
The profession has set its head firmly against Carr-Hill unless it is revised, properly peer reviewed, road-tested and the evidence on which it is based is published. Only in those circumstances will GPs have any chance of regaining faith in the principles, on which the contract framework was founded, which they overwhelmingly supported in the first ballot. Furthermore, the application of any weighted capitation formula must support the infrastructure of practices, and therefore reflect actual list sizes. Conference supported a move to change the balance between global sum and Q and O payments firmly in favour of the former to reinforce this essential shift.
The negative psychological effect of being paid for a smaller list of patients than for which you know you are responsible is so damaging as to be fatal for the current contract. Explanations about redistribution, working to a ”work sensitive” contract which will be sorted out over time simply will not do, and run counter to the expectations that were lifted by the negotiating team before the current debacle.
MPIG is tainted because of its association with Carr-Hill and will only be tolerated in the very short term.
The more the difficulties emerge the closer GPs are examining the original principles of the contract and the more they are questioning them.
The most important direction from the Conference was instruction to the negotiating team to go away and revise the contract on the basis of the concerns raised during the day and report to GPC in six months, or sooner if GPC so decided. There was a caveat that GPC could either revise this timetable or refer to another Special Conference of LMCs if the Committee thought this appropriate.
At that meeting of the GPC the day after the Conference the political reasons for going for an early ballot emerged. The Scottish legislative timetable requires an answer by 23 June for inclusion in their NHS legislation. Devolution is really coming home to roost. Although the impact of devolution is fairly well understood in Scotland, it is taking a long time for fact to dawn that Scottish devolution affects the other UK countries, England in particular, as much as it does Scotland.
The profession wants a UK contract, so the GPC gave the negotiators a further fortnight, until the 29 May, when they must return to a special meeting of the GPC to report progress on further negotiations based on the motions passed at the Special Conference.
On 29 May the GPC accepted that the changes achieved were sufficiently good to move to a Ballot as soon as possible.
The key changes are as follows:
1. Move to registered lists as a basis for payment as from 1 April 2004. This will benefit practices with below average list inflation. The value per patient will reduce from Ł53 to Ł50. C-H still applies.
2. The removal of the financial penalty of 100/150 quality points from MPIG practices. However MPIG practices that don’t achieve 100/150 points in years 1 and 2 will have financial penalty.
3. Disease prevalence data at practice level to be used in calculating payments in the Q and O framework.
4. The Allocation formula will be de-linked from Q and O payments. This applies to all domains.
If the contract is accepted there will be immediate start on the review of C-H allocation formula and the factors to be investigated in that review have been identified.
These changes do not produce any more money, but none was expected. The redistribution is probably fairer and a better basis on which to move forward.
There is no doubt that without the Special Conference these improvements would not have been achieved. It strengthened the arm of the negotiators who have delivered in part. It is imperfect. Is the result good enough for you?
A ”Yes” vote will guarantee the funds go into general practice, you will have signed up to the concept of Carr-Hill with a commitment to its review, OOH will disappear and there will be a natural redistribution of resources with winners and some losers.
A ”No” vote may mean separation of the contractual arrangements across the four countries in the UK. Is this important? It will mean postponement of the OOH deal and may mean the loss of the extra investment in General Practice (as opposed to primary care) in perpetuity. It could also mean the end of the BMA as a national negotiating structure. On the other hand, it could mean that government is forced to rethink the whole contract (caveat: remember the Consultants). However, no Government wishes to be at loggerheads with the whole of the profession and we are in a mid-term. This is a political judgement.
I believe that in the event of a “No” vote Plan B will be published and it is disappointing that the BMA has shrunk from its publication already, taking into account the wishes of the Special Conference.
This Ballot will determine the direction of General Practice for the foreseeable future. It really is in your hands.
So if you haven’t put that little slip in the envelope already, voted on line or by phone, make sure you do so by the time the ballot closes at 10.00 am on 20 June.
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The OFT’s report on the deregulation of pharmacy has been examined by a Select Committee and the government’s response is expected by the end of this session of parliament. There are rumours that lobbying may have produced some “watering down” of the proposals. If the report is endorsed by Government, there maybe commercial opportunities for some GPs worth consideration.
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Prescribing and referral incentive schemes are popping up all over the place. Not all of these have been discussed with LMCs, which of course they should have been. Some of the schemes are acceptable and some are not so. GPs must be careful that notwithstanding the request of the PCT that by co-operating with a scheme they are not in breach of their terms of service and/or their professional and ethical obligations to their patients.
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The National Complaints system is under review. There will undoubtedly be changes. Research shows that both patients and GPs feel the current process is weighted against them. The biggest move will be a transfer of management of complaints to CHAI, which is the successor to CHI. This, as do all changes, will have both good and bad knock on effects.
The three avenues for complaint will remain, Local resolution +/- conciliation, request for an Independent Review and referral to the Ombudsman. The biggest change will be that CHAI will decide whether or not there should be an Independent Review and those conducting such reviews will be more experienced and hopefully better trained.
It isn’t known whether there will be regional offices or how the organisation will be arranged. It is possible that CHAI will be able to refer straight to the Commissioner missing the IRP stage. The regulations covering these changes will be published this year.
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Questionnaires. More and more requests for information are being sort by PCTs and others around a whole range of clinical and non-clinical issues. In most cases there is no contractual obligation to commit your time or that of your staff to completing them. The LMC has written to C/Es asking them to ensure as few requests as possible are made, and those that are will produce data that will be of value and used. Please let the office know what is happening out there as we are often bypassed by PCTs. All this information gathering is at your expense.
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Courtesy. Last year in Berkshire the office had a complaint about GPs being rude on the phone to members of staff in other organisations. It is Buckinghamshire’s turn now. One particular department of a healthcare organisation has complained of staff being bullied and receiving abusive calls from GPs unable to access services for their patients. Such behaviour, borne of frustration almost certainly, if and when it happens does nothing for relationships between GPs and others and the GMC’s guidance is clear that this is professionally unacceptable.
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Allocations. This has long been a contentious issue in both counties perhaps more so in Berkshire where Slough, in particular, has had major problems and has had 1565 allocations in the first quarter of 2003 alone. The TVPCA has been proactive in recognising and dealing with the problem. A working group was set up comprising of representatives from the LMC, PCTs and PALS to look at determining a sound and transparent process for dealing with allocations across the county.
Initially the TVPCA undertook a mapping exercise in Berkshire in order to determine where practices’ boundaries lie. This identified several “black holes” where no practice covered the area and therefore patients have, by necessity, to be allocated. A document entitled “Best practice - Allocating a Patient” has been produced by the TVPCA and distributed to all practices in Berkshire. It demonstrates the transparency of the exercise of allocating patients by the Agency. Basically the Agency enters the patient’s details on their new computer system and a list of the potential available GPs is displayed, this system also shows how may allocations the practice has already accepted and takes into account GPs’ wte, list size and boundaries. The Team Manager makes the final decision in allocating patients taking certain other considerations, where applicable, into account, e.g. non-English speaking patient, patient requiring female GP.
Allocations are a national problem and one, incidentally, that the new GP contract failed to address satisfactorily. They take up an inordinate amount of time for the practice and the Agency alike and are unpalatable for patients.
Whilst it is appreciated that GP workload is an increasingly heavy burden, there is a strong case for practices keeping their lists open. This avoids the allocation process which directly increases the practice workload and stops the domino effect of all practices in a location operating “closed lists”. While the allocations issue is not addressed by Government the current process will continue and patients will be placed on your list whether the list is closed or not.
Meanwhile there is a transparent process in place in Berkshire. If you want to see sight of the document or find out more I suggest you contact Sarah Paulin at Sarah.Paulin@tvpca.nhs.uk
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And finally, the LMC is here to help you. If you are having difficulty with your PCT let us know.
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These views are a personal expression and not necessarily shared by the LMC
I joined the GPC as a campaigner against the 1990 Contract and have spent 14 years working for something better.
I admit I am bitterly disappointed with the current situation. The contract itself has flaws but also offers some advantages such as the removal of OOH. There’s also the prospect of much needed extra funding for general practice. However I think the way that funding is to be distributed is wrong. The Carr-Hill formula is unproven and it is farcical that global sums are so low that 80% of all practices need the MPIG. These arrangements are in my opinion a dog’s breakfast.
With others on the GPC I pressed on your behalf for a total rebuild of the Allocation formula and a redistribution of funding from quality payments into global sums.
We didn’t win these arguments but since the Special LMC Conference there have been some valuable changes. In particular using registered lists as a basis for payment, delinking Carr-Hill from quality payments and the removal of the “fine” of 100 or 150 quality points from MPIG will benefit most practices in Bucks and Berks.
It’s along way off perfect but on May 29 the GPC decided to go to ballot in the interests of getting into the legislative timetable if the contract is accepted thereby preserving UK unity and getting new money into practices in the current year.
In my view neither further delay nor a “NO” vote will get us anything better at this time. I personally have already voted YES -- somewhat grudgingly -- but promise to go on working for improvements.
Eric Rose
GPC Regional Representative for Bucks and Berks
You can contact me via my surgery 01908 393979 or
by e-mail: ericdrose@aol.com
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We are currently looking at setting up a GP Forum/list server, which will be available to all GPs in both counties, to facilitate the electronic exchange of ideas/information/views.
Practices will be e-mailed when work on this project has been completed. Details will also be published on our web site.
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The popularity of our web site continues to grow and it now receives some 1,000 “hits” a month.
We are keen to develop it as a conduit of information for our Constituents.
Please ensure you ask your Practice Managers to visit the site at least once a week to ensure that you are kept abreast of the latest news and information.
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Dr Christopher Tiarks, Medical Secretary
e-mail: christopher.tiarks@bblmc.co.uk
Ms Jane Solomon, Director of Development & Liaison
e-mail: jane.solomon@bblmc.co.uk
Mrs Pauline Green, Administration & Information Manager
e-mail: pauline.green@bblmc.co.uk
Mrs Michelle Walker, Administrative Officer
e-mail: michelle.walker@bblmc.co.uk
Mrs Gillian King, Part-Time Office Assistant
Web Site: www.bblmc.co.uk
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