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Index
1) Letter from the Secretary
2) Retirement of LMC Medical Secretary
3) Bucks Mental Health Care Trust
4) Stoke Madeville Hospital
5) Freedom of Information Act
6) nGMS Snippets
a) PMS
b) IT
c) Quality and Outcomes Payments
d) QUIP
e) Partnership Agreements
f) Seniority Payments
Comment
7) How is your PCT doing
8) How to Say NO... and Mean It
9) CHI Assessments
10) AGMs
11) Forthcoming County LMC Meeting Dates
12) Secretariat News
13) Annual Report
14) Secretariat List Server
15) Your LMC Representatives Are There For You - Please Use Them
16) GPC Regional Representative
17) Your Secretariat Team
Well it’s all not happening! The lack of progress on the implementation of nGMS is disheartening for GMS and PMS Doctors alike. It doesn’t feel right and there is a suspicion that the government is renegotiating through implementation, a privilege denied to the profession. Of course this was the danger of voting on an incomplete package.
The profession believed, however, they had sufficient encouragement and assurances from both our leadership and NHSC to trust that all would be well. Never again I suspect.
Although the continuing lack of adequate communication from the negotiating team as to the current position has a part to play it is difficult to recognize what is happening now as being related to the deal upon which so many people voted. There will be snippets on all the major issues later in the Newsletter. The profession must stiffen the sinews and prepare themselves for some very direct talking with PCTs which, although they may use the situation opportunistically to aid their financial embarrassment, are not really the problem. Don’t shoot the messenger and all that!
It could be argued that the profession had two ballots on the principles of the contract, the second being rather better informed than the first. However, unless there is a demand by the profession to have one further vote on the completed deal, or a call for a second Special Conference, the contract will be implemented on 1 April warts and all.
The new arrangements are introducing huge changes which will alter in perpetuity the nature of UK primary care. Gone will be the traditional holistic, pastoral care and it will be hello to fragmented packages of services. Will we see the HMO model (USA style)? So much for the philosophy.
The role of the LMC is unequivocally to ensure the best deal for its constituent members no matter what the contractual arrangements and this is on which we shall be focusing at the Secretariat.
Now is the time for all Practices to examine their business plan for the short to mid term future. There are important decisions to be made about cash flow, staffing, expenses and how to make the bottom line worth working for. Of course this must be against an ethical background of high clinical standards which match up to the clinical governance programmes of the PCTs.
The big, big change is the Practice based contract which eradicates terms of service and the ability of individuals to walk away from partnerships with their practice lists. This emphasises the importance of Partnership agreements, of which more anon.
The new philosophy is “no contract = no service”. Apart from essential and additional services, if you’re not paid for it you don’t have to do it. It will be difficult to say NO the first time but will become serially easier. This will be difficult for patients at first but history shows that they will adapt.
I shall be putting any hot news on the website (www.bblmc.co.uk) and good luck.
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2) Retirement of LMC Medical Secretary
The Secretariat of Berkshire & Buckinghamshire
Local Medical Committees
FULL TIME MEDICAL SECRETARY
Applications are invited from registered Medical Practitioners to replace Dr Christopher Tiarks, who retires at the end of June 2004. The successful candidate will have wide experience in general practice, understanding of current NHS legislation and knowledge and experience of LMC work.
Based in Marlow, the Secretariat relates to 10 PCTs and serves 850 GP Principals and potentially 220 Non-Principals.
Starting salary circa £90k with benefits. 6 weeks holiday per year.
For an Information Pack, or to arrange a visit to the Secretariat, contact:
Mrs Pauline Green, Administration & Information Manager, Berks & Bucks LMCs, Mere
House, Dedmere Road, Marlow, Bucks, SL7 1PB.
Tel: 01628 475727 Fax: 01628 481173
Email: pauline.green@bblmc.co.uk
For an informal discussion about the post please contact Dr Tiarks on the above number.
Closing Date: Friday, 28 November 2003
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3) Bucks Mental Health Care Trust
Several people sent examples in about the care to patients and problems with the Trust which I was able to take to the CHI review. Also, I have had the opportunity of meeting with the Interim Chief Executive, Jill Cox, who is grappling with many complex issues, of which recruitment is only one.
Everyone is aware that all is not right yet and GPs, especially in South Bucks where the problems seem to be greatest, are concerned that change will not take place.
It is essential that hard evidence of problems is forwarded to the Interim Chief Executive for action, general complaint will not do.
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In the Vale of Aylesbury many GPs are exercised by either the poor quality, or lack of information, about their patients in the form of discharge letters, or letters from out patients.
Again, general whinge will not help. Hard evidence is needed for the PCT to take action.
Any problems with photocopies and/or relevant dates should be sent with a covering letter to Jane McVey, the clinical governance lead at the Vale of Aylesbury PCT.
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This now applies to all practices
Have you submitted your protocol?
Model schemes are available on the website.
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John Hutton has sent guidance to all PMS Practices. The main points are as follows:
- In the future, any growth associated with a PMS application, which will not have to be in any particular wave but would be by negotiation with PCTs, will have to be provided out of the unified budget. NO more central growth funding.
- That permanence will be enshrined in the legislation currently going through Parliament but that it is virtually in place already.
- That flexibility to move between PMS & GMS will remain.
- That PMS Practices will currently keep their growth money.
- That growth retention will be reviewed if a PMS Practice elected to revert to GMS.
- That PMS Practices will be entitled to new payments to mirror GMS, ie quality and outcomes preparations payment, quality information payments (DES) opt out to OOHs and application for all Enhanced Services.
- That future PMS applications will not necessarily have to provide essential and additional services.
- That some PMS applications could include the commissioning of services.
- That there can be some flexibility of quality and outcomes payment moulded to local needs.
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Considerable anxieties remain over IT. The current situation is that the £17million to be made available to PCTs in England is to be increased to £20million (this is a third of what was originally intended).
This money should be devolved to PCTs shortly and is to cover:
- 100% reimbursement of maintenance payments
- essential minor upgrades to hardware.
No definition of an essential minor upgrade has yet been disseminated. The profession’s interpretation is that it should be any modification or upgrade to a system to ensure that it can fulfil the function for which it is designed.
After 1 April, when PCTs take over 100% responsibility for IT, it is unsure how each PCT will introduce a rolling programme subject to previous stocktake. It is also unclear what the service specification level will be. It is still believed that contractors will be given a choice of three service providers, although there will be pressure from PCTs to narrow this down to one.
Any Practice that needs upgrades now to fulfil the new contract, or is running a system which could be unsafe, must ask for confirmation in writing from the PCT what its intentions are to fulfil the spirit of the undertaking given by Government.
Some Practices may find themselves in the difficult situation of having to take a commercial decision to upgrade without guarantees from the PCT to reimburse. If, however, they have in writing a refusal this may be able to be used against the PCT when the legislation is absolutely clear.
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The preparation payment of £9k approximately (abated for real list size rather than notional list size) should have been paid by now. The delay of payment has just been a further irritant in the apparently shambolic implementation phase of nGMS.
It is important that you maximize your payments from the Q and O framework and information is slowly being released. Note that Smoking status, BP measurement, flu immunization status and note summarisation are major players and appear in several indicators.
The Organisational domain is well worth attention and it should be relatively easy to gain lots of points here although, of course, it is the clinical domain where the majority of points are to be had.
Many practices intend to aspire to 1050 points in year one. In this way they will get 350 points up front to help cash flow and are very unlikely to achieve less than 350 when the outcomes are monitored.
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This special Directed Enhanced Service, designed to run for two years, continues to cause difficulties. Yet another indication of the shifting sands of implementation.
This payment, put at between £1-5k per average practice, is apparently to be paid according to need. Who decides need?
This is an area where conflict between practice and PCT will easily arise. The LMC will be there to help you argue your case if you feel unjustly treated. PCTs will see this as an opportunity not to release money, a stance that must be vigorously resisted.
The latest intelligence seems to be unsure whether this is already in the unified budget Enhanced Services floor, or whether there is funding still to come.
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The rapidly approaching new contract should focus the minds of all GPs on their partnership agreements.
Alas, I spend much of my time trying to assist doctors who are in dispute when they have no agreement. This process is both exhausting and costly. In most cases the majority of the problems would have been avoided if an agreement had been in place.
The importance of having a robust agreement after 01/04/04 is even greater.
Most agreements are for the joint and several lives of the partners. That is to say that if a partner leaves the remaining partners are bound by the terms of that agreement. However, should a new partner join, the partnership immediately becomes a partnership at will unless a new agreement is signed and engrossed, or a suitable amendment made to the old agreement.
Under the current rules, as GPs are individually in contract with the PCT in the event of a partnership split they may retain the right to provide services to their own patients in new circumstances. This right automatically disappears on 01/04/04. Just as terms of service disappear, so do individual patient lists as it will be a practice based contract.
In these circumstances, if one partner dissolves the partnership the contractual rights of all the partners are dissolved and, therefore, the contract no longer exists. PCTs will have the discretion whether to provide or not temporary or permanent contracts to the disputing parties. A proper agreement will make provision for how a dispute will be handled and what rights accrue to whom.
Taking into account the often complex arrangements over property ownership the jeopardies are huge.
The legislation, including the regulations, will probably not be in place before the middle of January. After that the BMA will issue guidance on what amendments will be needed to make your agreement watertight for the new arrangements. If you haven’t already got an agreement put your thinking caps on now - IT CAN HAPPEN TO YOU! You wouldn’t think of not insuring your house or car, this is equally important.
The office can advise on partnership agreements before the definitive advice about nGMS is published.
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03/04 is a hybrid year with the old ”wte” qualifying status but with all reckonable NHS service applying. This year's figures in the blue book may be enhanced by 2.6%. This applies to this year only.
04/05 onwards the new rules apply. All reckonable NHS service continues (including PRHO posts) but, as the terms of service will have disappeared, wte will not apply. Payment will be related to individual superannuable income compared to the average. This information will, of course, not be immediately available because the last factor will need to be trawled nationally from practice accounts.
There is a delay in payment of this year’s seniority because of alleged difficulties with the Exeter system. This year’s seniority increase is included in the 3.225% pay rise.
The total rise for 03/04 is worked out to be 9.225%. To include:
Basic rise 3.225%
Q and O preparation 3.6%
Flu Imm fees 1.2%
QUIP 1.2%.
Make of that what you will.
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It is clearly the relatively small issues that are going to be the major irritants. IT payments, QUIP, late payment of senility money and lack of clarity around Enhanced Services, not to mention the fading image of the preferred provider status. The whole is much greater than the sum of the parts.
Buckinghamshire LMC passed the following Motion in September, which was submitted to the GPC:
That the LMC has no confidence in the implementation process of GMS and has
grave concerns with regard to the lack of clarity and progress and will review the payment of the GPC Levy at its next meting in the light of developments.
It will be revisiting it again at its next meeting.
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The Secretariat is trying to attend all the nGMS Implementation Groups across the two counties in order to ensure full understanding from all parties of the main issues. Some PCTs are much better than others in keeping the office informed of their latest decisions and information being sent out to constituent practices.
It is very important that we have information at an early stage if things are’t going well.
Please let us know about anything going on in your patch which you feel is very good or very bad.
The earlier we deal with problems the more likely there will be a better outcome.
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8) How to Say NO... and Mean It
Many of you will have read this interesting document.
Clearly joint practice negotiations in any PCT area are stronger than each practice trying to arrange its own deals, which also disadvantages small practices.
There is a clear ability for a divide and rule philosophy to develop in PCT land. No matter how they protest that they are only interested in partnership and equity, their bottom line is their bottom line! They are being performance managed and, in their turn, will performance manage you.
I shall be writing to Practices shortly to ask them if they wish the LMC to be involved in their local negotiations with regard to Enhanced Services.
If you continue to provide services for which you are not paid after 1 April, your PCT and your patients may love you but you will be selling yourself, and ultimately your colleagues, short (yet again?).
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CHI is performing a Clinical Governance Review on RBAT in the New Year.
As LMC Secretary I am invited to give evidence.
If you have anything you wish me to raise, positive or negative, please let me know by January 13th at the latest.
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Once again the two counties have held their AGMs.
Dr Andrew Dearden had a lively reception at Berks and gave an entertaining and very useful nGMS resume. In particular, he stressed the importance of doctors not doing work for which they were not being paid. Times are changing and we must take control of workload. There is information on the web site about this.
Dr George Rae, Chairman of the Representative Body of the BMA, spoke to Bucks GPs and outlined the problems facing the Association and the challenges it had met with the parallel contract negotiations for GPs and Consultants.
The evaluation for both meetings was very positive. As usual, the turnout was not good. However, it is well understood that meeting fatigue, and the pressures of practise, make these sorts of occasions not of the highest priority.
It is a shame, however, as the meetings give a platform where I, as Secretary, can publicly acknowledge all the hard work put in by the staff over the year on your behalf. They are a great team.
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11) Forthcoming County LMC Meeting Dates
Berkshire:
16 December 2003
17 February 2004
20 April 2004
08 June 2004
21 September 2004
07 December 2004
Buckinghamshire:
16 January 2004
02 April 2004
04 June 2004
10 September 2004
12 November 2004
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CHRISTMAS & NEW YEAR ARRANGEMENTS
The Secretariat Office will close at 4.00 pm on 24 December 2003
From 29 - 31 December 2003 it will be manned from 9.00 am - 1.00 pm
Normal opening hours (8.30 am - 5.00 pm) will resume on 02 January 2004
Dr Tiarks can be reached on his mobile in case of emergencies: 07710 761 312
WARMEST WISHES TO YOU ALL FOR
THE FESTIVE SEASON AND NEW YEAR
FROM ALL THE TEAM
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This year the Secretariat is publishing an Annual Report which will, hopefully, be sent to you before Christmas.
You should have received it with the papers for the AGMs, or that was the original idea. However, not all the contributors managed to produce their copy by the deadline.
We will try and do better next year!!
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160+ GPs and Practice Managers have now signed up to our List Server, established to facilitate the exchange of information, views and ideas, across the two counties.
If you would like to join them, you can do so via our web site, or by emailing your preferred email address to:
Our web site averages 1000+ hits a month. Why not have a look.
www.bblmc.co.uk
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15) 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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16) GPC Regional Representative
Dr Eric Rose is the GPC Regional Representative for both counties.Â
You can contact him by telephone on 01908 393979
or by email at: ericdrose@aol.com
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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
e-mail: gillian.king@bblmc.co.uk
Web Site: www.bblmc.co.uk
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