September 2001 Newsletter

Report from Jane Solomon

Since joining the LMC in June, I have managed to meet with PCO Chief Executives and Chairs of the Executive Boards. The intention of these meetings was to raise awareness of the role of the LMC and, at the same time, to examine ways in which the LMC and PCOs could work together for their mutual benefit.

The reception I received has been very positive. Some PCOs clearly were unaware of their statutory obligations to consult with the LMC but all were anxious to engage in a closer working relationship which will ultimately be of great benefit to the constituent GPs.

The information regarding the distribution of Investing in Primary Care funds clearly demonstrated the individual approach of PCOs to engaging GPs. Notably only one PCG, Chiltern and South Bucks, made their payment through the use of Local Development Schemes (Section 36) which makes the payment superannuable for GPs. Others made their constituent GPs jump through huge fiery hoops to achieve the money, which at the end of the day was a pretty derisory amount. There were instances, however, of PCOs actually taking a more mature approach to awarding the money outright on the agreed understanding that practices would meet certain quality requirements within an agreed timeframe.

Now the flu season is upon us and the LMC has been active in promoting the remuneration of GPs for vaccinating the 'at risk' group in the under 65 age group. So far there is little hard news to report, Berkshire PCOs are considering a scheme, Bracknell PCG appears to be leading the way on this. Buckinghamshire PCOs are also considering schemes and I will be reporting back on the web site as soon as we get confirmation.

I see my role as one of raising the awareness of the role of the LMC both to Primary Care Organisations and also to the GP constituents and their practices, many of whom have had little dealings with the LMC in the past. I am, therefore, anxious to make the acquaintance of as many GP practices as possible and to understand the issues which they are experiencing and which the LMC can assist them with.

My background has been in primary care since the 1970s from Practice Manager to Assistant Director of Primary Care in Inner City Nottingham. I am also a Kings Fund assessor and an RCGP facilitator for the Quality in Practice Award. There are many issues where I can be of assistance to GP practices from writing a business plan to facilitating 'away days' and would be happy to help in any area of practice development.

I can be contacted at the LMC at any time or by e-mail at jane.solomon@bblmc.co.uk

I look forward to hearing from you.

Sponsorship

The Secretariat are delighted that Bayer PLC recently agreed to become joint sponsors of our Newsletters.

Our grateful thanks go to Bayer, and our continuing thanks to Lloyds TSB Bank, for their support.

Letter From the Secretary

I hope you all have had a chance to get away from the challenges of General Practice over the summer and have managed to recharge your batteries.

Although Parliament is in recess until October much has been going on with pieces of information trickling through. Several documents of importance have emerged from the DoH, which perhaps give a flavour of things to come. Two in particular are important. Shifting the balance of Power, http://www.doh.gov.uk/shiftingthebalance/execsum.htm that is largely about the new Strategic Health Authorities that are mainly going to deal with performance management. The second defines the new Body that is going to oversee the activity of all Professional Regulatory Bodies including the GMC. Self-regulation for the medical profession is by no means yet assured.

The new body, which was heralded in the NHS Plan, is to be called the Council for the Regulation of Healthcare Professionals. The Council, which will be accountable to Parliament, will potentially have wide powers to oversee and regulate the regulators. It is also suggested that the Council will have a sovereign role over Education, Training and Development. The web site for the whole document in pdf format can be located at http://www.doh.gov.uk/modernisingregulation/index.htm.

The office has commentaries on both documents should you wish a copy.

The negotiations around the GMS contract continue and you will all have received a copy of the questionnaire of all GPs about the future. Interestingly enough this survey may well have sprung from the one this office carried out last year as our GPC members (Drs E Rose and J Reggler) took the idea forward strongly in Committee. It is important to achieve a good response as the moment is now with a Bill being published in the autumn. I am trying to meet with as many of our MPs as possible before Parliament returns to brief them on the concerns of the profession.

The national appraisal of the Complaints Procedures has just been published. The results do not read well as far as the profession is concerned showing that the public finds the procedures slow, biased, stressful and on the whole unhelpful. This applies to both local procedures and Independent Review Panels. The reporters make a whole raft of recommendations, which, along with the Kennedy Report, are bound to bring about changes. The political emphasis continues to be on a patient centred service and the politicians will find the report just up their street. PCOs will have responsibility for complaints monitoring with quarterly returns, there will be standards set for procedures within house and Patients’ organisations will have access to Practices to see whether any recommendations resulting from a complaint have been satisfactorily instituted. Local resolution and Independent Reviews come in for the same amount of criticism.

My experience of IRPs is that the Panels are very variable and depend on the attitude of the Chairman. It is clear from the report that the recommendations favour giving the IRPs more teeth with formal power to call witnesses and take outside evidence and the power to enforce their Recommendations, again with scrutiny from statutory Patients’ groups. The report favours a single ‘regional’ body to run IRPs and puts emphasis on training for Convenors, Chairmen and Lay Members. This is welcome. The whole process is to be performance managed at supra PCT level either by a special authority or the SHA. Finally it is proposed that there should be a NSF for complaints management. Should all the recommendations be implemented there will have to be a change in procedures so that all parties to the complaint can challenge evidence given by witnesses. Any other course could lead to contravention of section 6 of the Human Rights Act.

As I mentioned earlier, Strategic Health Authorities are just round the corner (01.04.02) and it looks as though there will be 29 in all. The variation of size of SHAs across England will be considerable. Bucks/Berks/Oxford seems to be the local configuration, following the consultation, and will be one of the larger ones. Chief Executives will be appointed by November in all probability and will start to shadow activities. Performance management is to be the main remit. Shifting the balance of power spells out the transfer of FHS functions from Health Authorities to PCOs. This requires primary legislation and until that is on the statute book Health Authorities will continue to have the responsibility. It seems likely that such legislation will not be in place before October 2002. Health Authorities will disappear on 31/03/02 so it looks as though some hybrid arrangement will have to exist in the interim with SHAs (as they have the word ‘Health Authority’) taking responsibility.

Local Medical Committees have statutory representative functions in the 1977 and 1999 Health Acts for all GPs relating to Health Authorities. Until the wording of the draft legislation, expected in the autumn, is published it is unclear what LMCs will mean in future. Assuming the current configuration of one LMC per Health Authority is not altered that will translate into one LMC per SHA bringing with it implications for the three county LMCs. The Secretariat has made an approach to Oxford LMC to explore if there is a need for a closer relationship until such time as things become clearer. I hope to be able to update you further next month.

Finally please make a note of the date of your AGM in your diary (see page 4). This year we have Dr Bogle for Berks and Dr Chisholm for Bucks.

With best wishes.

• Partnership Agreements

As the culture in General Practice changes so Practitioners need to adjust to deal with a much more flexible workforce. Whereas a generation ago doctors tended to look at a partnership as a life time commitment that no longer holds true today. The workforce before long will be made up of more women than men whose professional path generally requires more flexibility to fit in with the sometimes-conflicting demands of a career and raising a family.

All doctors no longer see their professional vocation as sovereign so part-time working and career breaks are becoming the norm.

For a partnership to succeed it must fulfil two criteria:

• A fair distribution of the work
• A fair distribution of the profits.

More and more I am coming across partnership disputes, many of which could have been avoided if a proper partnership deed was in place. Often an agreement is not signed before a new partner joins or a partnership relies upon an old agreement which is null and void because of partnership changes, resulting in a partnership at will. Putting a sound legal foundation to your working environment although costly is one of the steps to a happy working life. Resolving a dispute using the lawyers will be far more costly than investing the money in putting a proper agreement in place before any partnership changes. Particularly now that property is so expensive it is essential to be explicit about the arrangements and obligations of the partnership to outgoing and incoming partners and their obligations to the partnership.

How will you cope with sickness absence of a partner, particularly with the current recruitment and retention problems? Of course it is impossible to foresee all difficulties but most disputes are avoidable or at least their solution can be catered for through a robust agreement.

For all parties concerned the clever thing to do is to make sure the agreement is signed before the partnership change starts. Probationary periods can be written in satisfactorily to a partnership deed.

The office can advise on Partnership agreements and has addresses of several firms specialising in medical partnership law.

• LMC Sub-Committees & Performance

Both counties have now agreed that they should form local Sub-Committees to relate to the PCOs. Subject to satisfactory negotiations with the PCOs the new system will start by the end of this year. Bucks agreed the format on 7 September and Berks will be considering the final points on September 18th.

Both counties are busy considering performance indicators and how poor performance will be managed after 1 April next year. Currently there are GP Support Panels in both counties. It looks as though the ‘Centre for Primary Care’ being launched shortly in Berkshire may have a pivotal role in performance issues in the future. The mechanisms are not yet clear in Bucks though initiatives are being taken to ensure that the expertise, of key personnel that have been active thus far, is not lost.

The office will try and keep you informed of new developments as they emerge.

• Flu Vaccinations

There are different schemes being considered for the remuneration of flu vaccination for the under 65 at risk groups in the following PCOs:

• Bracknell
• Slough
• Chiltern/South Bucks
• Wycombe.
   
• Caveat Emptor

Don’t forget when employing a doctor to ensure they are not subject to performance investigation by the GMC and are not on a sex offender’s register.

Always get a signed declaration to that effect.

BERKSHIRE NEWS

• Flu Campaign

The Public Health Service Laboratory is looking for a few practices in Berkshire to be ‘spotter’ practices for flu. It involves taking swabs of the first five cases of clinically diagnosed flu (by protocol). A fee of £400 is payable for the season. For more information please contact Dr Abid at the Health Authority.

BUCKINGHAMSHIRE NEWS

• Dr Satya Murthy

Congratulations to Satya Murthy on his election to the Chair of the Professional Executive Committee of Milton Keynes PCT.

• 999 Ambulance Calls

The LMC discussed the rare situations when a GP may call a 999 ambulance for a collapsed patient for whom they are providing essential immediate care. The Ambulance Service is required to ask a number of questions, which may prove time consuming and therefore life threatening to the patient. The Ambulance Service has to account to the DoH for calls where all the information is not collected.

The LMC advises their Constituents in these situations simply to say they are administering essential care and will not continue the ‘phone call and replace the receiver.

GPC Slot

(These views are a personal expression and not necessarily shared by the LMC)

In early September the 41,000 GPs in the UK received a copy of the GPC’s national survey of general practitioners’ opinion.

This is an extremely important event in the development of general practice over the next few years. The GPC and its negotiators will use the results to help them present demands for a new contract to the Department of Health, through the NHS Confederation which is negotiating on the government’s behalf.

The new contract must be sensitive to workload. It will need to ensure proper demand management so that patients are made to use the limited resources of the NHS more appropriately. The contract must allow GPs and their patients to have more time together in the consultation. Too many GPs now feel unable to provide the high quality service that they know they could give their patients if only consultations were longer. GPs are also increasingly worried that they will make errors of judgement that would not happen if enough time was available when seeing patients. The new contract must address this.

Finally, the new contract must be attractive to young doctors who are deciding which specialty to follow and it must be attractive to older GPs. More and more are planning for early retirement to escape from the NHS. Recruitment and retention must improved dramatically.

The national survey of GP opinion gives every GP the chance to be heard. If your copy is under a pile of other papers on your desk or on the floor, fish it out. Fill it in. Send it off. We are all so busy now that it is too easy to dismiss a 54 question survey as mere bumph. This one matters.

Any GPs who have not received the questionnaire can contact Electoral Reform Services by telephoning 020 8889 9203, faxing ERS on 020 8365 8587, e-mailing enquiries@electoralreform.co.uk, or writing to Independence House, 33 Clarendon Road, London, N8 0NW

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
 

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 LMC meetings
• your views.

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
[please contact the Office for passwords].

DON’T FORGET THE ANNUAL GENERAL MEETINGS!!

Buckinghamshire LMC: 17 October, 2001
7.30 pm, Floyd Auditorium,
Stoke Mandeville Hospital,
Aylesbury.

Guest Speaker: Dr John Chisholm

Berkshire LMC: 06 November 2001
7.30 pm, Postgraduate Centre, Royal Berkshire Hospital, Reading.
 

Guest Speaker: Dr Ian Bogle.

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