OCTOBER/NOVEMBER 2001 NEWSLETTER
Letter From The Secretary
Dear Colleague
The thrust of government policy, strengthening public accountability, continues. The profession accepts unreservedly that accountability to those who use and pay for the NHS is appropriate and a useful tool, in conjunction with clinical governance, in raising standards.
The Department has recently published a paper entitled "Involving Patients and the Public in Healthcare - a discussion document". This spells out what bodies will replace Community Health Councils, how the public will be involved in overseeing standards and how they will be supported with complaints when the system lets them down.
As usual the layers increase, as do the "bodies" with acronyms to match.
Every Trust will have a Patient's Forum in addition to a Patient's Advocacy Liaison Service (PALS) and access to an Independent Complaints Advisory Service (ICAS). The local authority will set up an Overview Scrutiny Committee (OCS) of local councillors, which will have a statutory right to call NHS Chief Execs to account twice a year and refer contested service changes to the Secretary of State. The OSC will monitor all NHS services including primary care. All NHS bodies (this will include PMS practices that have applied for NHS Body status) will be required to publish details in a patient prospectus of how they have involved service users and their local community.
All premises providing services under the NHS, including general practices, will be subject to inspection by Patient's Forums.
Whatever the implications of Strategic Health Authorities that emerge when the legislation is published it is clear that good liaison between the profession and PCOs is essential. There are still many statutory functions that the LMC must fulfil and many others where a strong local voice is and will be needed. The PCOs need to be kept on their toes and the profession must put itself in a position to give speedy responses and foresee difficulties.
The Secretariat is busy setting up Local LMCs to relate to PCOs and the evidence is that since autonomy is being devolved to a local level there is much to do. Jane Solomon and I have to keep our eyes on 10 balls instead of the two previously! We have already this month come across two examples where PCOs have been acting inappropriately when considering the distribution of funds (details inside). This makes the case for a strong, local, democratically elected representative structure in which the local practices have confidence.
We will be holding short meetings in each PCO area, to which all practices will be invited, to explain the new structures and their remit. When we are visiting your patch please come along. The meetings will be local, at lunchtime, with sponsorship and hopefully some PGEA. Details of the first meetings are advertised elsewhere in this Newsletter.
It is becoming increasingly difficult to track GMS discretionary funds and we need to be ever watchful for potential sleight of hand by the PCOs. It is now widely realised that there will be large prescribing overspends throughout the UK. Our two counties will be no exception. PCOs will be looking across their whole budget to deal with this. They will regard any unused monies as fair game and there is already evidence that some PCOs are planning to use GMS underspends for this purpose without consultation. I am writing to Chief Executives to remind them of their statutory obligation to consult with the LMC. The comics are suggesting that Prescribing incentives will also be swallowed up. Jane Solomon elsewhere in this Newsletter gives details of other risks to Primary Care Development money.
Please be watchful and let the office know about any threats to GMS infrastructure funds. Also, quiz your GP colleagues on the Professional Executive Committees who will be party to decisions around these matters that they recommend to PCO Boards.
Report From Jane Solomon
Is Primary Care Losing Out Again?
The LMC was informed indirectly that £3.7 million had been transferred into supporting deferred discharges in Berkshire. This left the PCTs with insufficient funds to invest in any innovation or primary care development in General Practice. The PCTs have a statutory obligation to consult with LMCs regarding the use of discretionary GMS money all of whom conveniently forgot this obligation and the LMC was told of the move only after the money was committed.
Whilst it is recognised that PCTs have a political imperative to meet Modernisation Targets, this should not be at the expense of development in primary care. Nor can the profession be expected to swallow this bitter pill as money sees its way to shoring up, yet again, the problems in the secondary sector.
Many GP practices had been asked to submit Business Plans and a great deal of effort had been put into this only to be told there was insufficient funding to meet the cost of these plans. This makes a mockery of the incessant demands on practices to feed the PCT information beast only to be disregarded when practice development plans are submitted.
Berkshire is not the only area to be affected in this way, in Buckinghamshire the Aylesbury PCT has used GMC discretionary money to shore up the prescribing overspend again without consultation with the LMC.
The LMC cannot be aware of all that goes on in the 10 PCTs and that is one of the main reasons behind reconfiguring the LMC. The formation of LMCs, which are coterminous with PCTs, will make them more sensitive to local issues. However we do need feedback from you, the constituent members and indeed your practice managers, to inform us of irregularities occurring particularly in relation to investment or lack of it in the localities.
GP Meetings to introduce the new style Local Medical Committees
Following on from the above article, I am pleased to be able to tell you that we have set up meetings in 4 PCT areas to consult with local GPs about the shape and future of LMCs in your area. We would like at least one GP representative from each practice to attend. PGEA has been awarded and lunch will be provided. All meetings will begin at 12.30 pm, lunch will be available from 12 noon onwards. Practice Managers are welcome to attend.
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We look forward to meeting you.
Access to Medical Records Under the Data Protection Act 1998
The LMC has been informed by the Chairman of the Professional Fees Committee that the Lord Chancellor's Department announced on 27 September 2001 the maximum fee for providing access and copies under the Data Protection Act 1998 would remain at £50.00.
Additionally, the proposal to introduce a fixed sliding scale of charges has been abandoned for the time being, thus GPs can determine for themselves what constitutes a 'reasonable charge' for providing copies of the records requested.
The Professional Fees Committee have also received a commitment from the NHSE to discuss other aspects of the problem, including the impact of these demands on GPs' workload and patient care, and are about to begin discussions with the legal profession to see if ways can be found to limit this work.
We will keep you informed of developments.
Practice Nursing - Discussion Paper by the GPC's Practice Nursing Working Group
Your attention is drawn to the above document, which is available from the Secretariat Office, on request, or via the GPC's website at:
http://web.bma.org.uk/gpc.nsf
Practice Staff
Your staff are your most valuable asset. Please remember that you have responsibilities as an employer. Many GPs comply with the ever-exacting responsibilities of being an employer but alas some don't. The government is putting great store on HR issues and it is essential that you make sure that the contracts you offer your staff are appropriate with the necessary grievance procedures and disciplinary procedures attached.
Check that you comply with all employment legislation and don't forget that if your are a NHS body as a PMS Practice that you are bound by Human Rights Legislation. If you are in receipt of reimbursement from public funds for your staff via the PCT/G they have a legitimate interest in the terms and conditions of employment you offer. In large partnerships one partner should hold responsibility on behalf of the partnership for HR issues, which will be no doubt be delegated to the Practice Manager.
The NHS Plan refers to government policy "Improving Working Lives" Paragraphs 5.14 - 5.21 which you should read along with the government's HR policy in the document "Working together" which can be accessed at the following internet address. This applies to all organisations providing NHS services including General Practices and is essential reading.
http://www.open.gov.uk.doh/newnhs/hrstrat.htm
BERKSHIRE NEWS
Prescription Pads
The TVPCA has reminded us of the responsibility of practices to return all prescriptions for GPs that have either moved within Berkshire or hung up their stethoscopes. It is illegal to use a prescription after a GP has left the list. The LMC supports the suggestion that GPs should return all such prescription pads to the TVPCA for shredding with a note of the initial serial number of each pad. The Practice should keep a record of all such returns. Don't forget to store your prescriptions and certificates securely.
Violent Patients
If you remove a patient from your list because of violence to you or your staff please notify the TVPCA so that any new Practice to which the patient is allocated may be notified. Hopefully when a structure is in place for dealing with violent patients according to HSC 2000/001 these patients will be on a register.
BUCKINGHAMSHIRE NEWS
Appointment of GPs to Trust PECs
The LMC was consulted by the PCOs in the South of the county about the process of appointment of GPs to the Professional Executive Committee (PEC) of the Trusts when they come into being on the 1 April 2002. The question was asked whether the process should be by selection or election, or a combination of the two.
There was a lengthy debate and following a vote of 13:2 the Committee decided to recommend selection, with input from the LMC. The reasoning was that any electoral process might imply a representative function for the members of the PEC. GPs sitting on a PEC cannot fulfil a representative function as they are there for their competencies and expertise to take difficult executive decisions, which may well run counter to the wishes of other GPs in their area. Furthermore, their accountability must be to the Board and can never be to the GPs on their patch.
Certification on Discharge
The old chestnut about hospitals not issuing patients with sickness certificates after discharge has reappeared. Stoke Mandeville has been complained about in particular. The LMC has written to the Chief Exec and Director of Nursing pointing out their statutory duty to provide adequate certification to patients on discharge, which is not fulfilled by covering not a minute longer than the in patient stay.
If you are having problems with this issue please let the office know.
Children's Act
The difficulty around medical certificates of medical fitness for childminding has been brought to the attention of the LMC once more. Provision of this evidence and signing of certificates is not part of GMS and should command a professional fee. This had been a national bone of contention.
The LMC has written to the Director of Social Services in Milton Keynes from whence the complaint arose.
Is this a problem where you work? Are your reasonable fees for completing these forms being met, or do you not bother to charge a fee?
Please let the office know.
Under the Children's Act GPs as employers will have a statutory obligation to ensure those people working in the Practice are not a danger to children.
Treatment of Foreigners
The question of which foreign visitors not to treat on the NHS was raised at the last LMC meeting. The rules are clearly laid out in HSC 1999/018.
You may register anybody as a temporary resident in which case he or she will be entitled to NHS treatment in Primary Care. In this case you may not charge a fee for any service.
Only visitors from the EEA in possession of form E128 are entitled to free NHS treatment as if they were a UK resident
People in possession of Form E112 are entitled to specialist treatment e.g. dialysis or oxygen free of charge. Such patients should make arrangements for their treatment before arrival.
You are obliged to provide emergency or immediately necessary treatment to any person on the NHS. You have to be the judge of what is necessary or emergency.
All other people you may treat on a private basis and are encouraged to do so. When referring patients to secondary care whether you are providing treatment on the NHS or not you must warn them that they may be charged for their secondary care treatment.
If you have not got the NHS Circular in your surgery, then you can download it from the website:
http://www.open.gov.uk/doh/coinh.htm
GMC
The GMC has just published a consultation document on the Structure, Constitution and Governance of the GMC. This has not been circulated to all doctors but is available on the GMC website:
www.gmc.uk.org
The GMC has asked for comments by 15th November. The office will send in comments. You may either email the GMC direct or send contributions to the office which will forward your comments.
GPC Slot
These views are a personal expression and not necessarily shared by the LMC
At the GPC meeting on 18 October GPC members heard a presentation by Mike Farrar, the chairman of the NHS Confederation's team for negotiating with the GPC negotiators on the new GP contract.
His presentation made it clear that Mr Farrar knows the problems facing general practice and the pressures under which we all work. He obviously recognises that relentlessly increasing workload is the single most important issue for most GPs. He knows that the plethora of politically-influenced directives being spewed out by the government have demoralised general practitioners still further. He appears to believe that improvements to the contract are likely to cost money. Those GPs to whom I have spoken who work in his area (the North East) say that he is pro-GP and fair.
However, just because the chairman of the NHS Confederation negotiating team is a reasonable individual does not mean that the battle over the new contract has been won now or will be won in the future.
Apart from the issues of pay and working conditions we must guard carefully against the new contract bringing further reductions in the power of GPs within the NHS. The NHS Confederation is negotiating on behalf of the government. We can expect to see the government pressing for more political control of general practice rather than what we need, which is less political control.
We should expect the government to aim for greater corporate control of GPs as well, with a consequent reduction in our ability to act as advocates for our patients. The government hates the freedom that GPs have, as independent contractors, to criticise poor performance within the NHS. In Buckinghamshire, senior NHS managers were told by ministers to "Shut your GPs up" when we went public over the closure of a local hospital to GP admissions and the national press carried the story. The managers' inability to do so will be something for the government to rectify through the new contract if they possibly can.
One of the greatest dangers lurks under the banner of "local flexibility". Both the GPC and the government want to see this but for different reasons. The GPC wants LMCs and PCTs to be able to introduce schemes in their local areas which will address problems peculiar to them. This makes sense. But it is also a threat. The government would dearly love to have a contract with a great deal of local flexibility as they know that this will reduce the ability of a united profession to influence the future development of the contract and GP remuneration. The government would be delighted if the contract in Berkshire and Buckinghamshire started to look very different from the contract in East Anglia and in the South West. Central negotiations by the GPC would become increasingly meaningless. GPs may be critical of the GPC's ability to negotiate with the government - with good reason on occasion - but if in the future it is just LMCs battling it out with central government or their local representatives at the Strategic Health Authority or the PCT the situation will be much worse. When you negotiate with government the other side always has the option of saying "OK, we'll find more money". When you negotiate locally, the other side can only say "There is no more money - this is all we have been given".
When the proposed new contract is published for consideration by the profession we must all scrutinise it very carefully, asking whilst we read it "How will the government try to screw GPs with this in the future?" Because they will.
Contact your GPC representative about any general practice matter that you want raised there:
Dr Jonathan Reggler
The Doctors' House
Victoria Road
Marlow SL7 1DN
Work: 01628 484666
Fax: 01628 891206
Home: 01494 529839 Mobile: 07855 370970
Email: Jonathan.Reggler@ukgateway.net
The Future of GP Practice Premises - Guidance For GPs
This excellent Guidance was distributed to each practice in the county at the request of Bucks LMC. Should any Berks practices wish a copy, however, they can contact the Secretariat Office, or access the document via the GPC website at:
http://web.bma.org.uk/gpc.nsf
YOUR SECRETARIAT TEAM
Dr Christopher Tiarks, Medical Secretary
Ms Jane Solomon, Director of Development & Liaison
Mrs Pauline Green, Administration & Information Manager
Miss Linda Butler, Secretary
Email addresses:
christopher.tiarks@bblmc.co.uk
jane.solomon@bblmc.co.uk
pauline.green@bblmc.co.uk
linda.butler@bblmc.co.uk
Web site:
www.bblmc.co.uk
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