What is New & Interesting on the Devon LMC Site

Information is normally on here for a couple of months after which it is moved to the Info&Guidance Page
If you are looking for something specific please use the search facility above

Hot Topics Colour Coding

 Purple Pages  

December  06  - LMC Newsletter

PEAT @ Devon LMC 

GPC Link

Trouble with PDFs

 

DOH Link

or DH Link
 Devon Voice 
Access & Register Here

Yellow = Local issue

Blue = National Issue

White = General Info

Green – High Priority

Updated Areas-  Salaried GPs Page -  PBC - Practice Based Commissioning - GPC & BMA

List of LMC Meeting Dates - SEE

The web site has been getting bigger. Therefore, to simplify the site and to speed up load times, I have moved some
issues onto their own dedicated pages – if you experience problems please let me know!!

nGMSData Protection Act (DPA) - Sessional & Freelance GPs -  GP Appraisal - Hep B

SI 2004 No. 291 “The NHS (GMS Contracts) Regs 2004- Quality and Outcomes Framework - Criminal Record Bureau (CRB) checks on GPs

School of Health and Related Research (ScHARR) Report – “Leading Medical Consensus – Local Medical Committee in the 21st Century”

Looking for Work in Devon?

Why not visit the Adverts Page for a wide range of posts and opportunities.  We have vacancies for GPs, Practice Nurses, 
Practice Managers and General Admin Staff - If you are interested in Sessional or Freelance work, then have a look at the Locum Page

Please note all GPC guidance’s have a BMA copyright.  The content, layout, design, data and graphics contained in this document are protected by UK and international copyright laws. You are not permitted to adapt, alter or create a derivative work from any of the material contained in the document or to use any of the material for any purpose other than for your personal non-commercial use.

 

Please note a new web site is currently being developed this site will continue to be supported.

If you experience any problem with content please contact admin@devonlmc.org

Information for GPs about the decision by the Secretary of State for Health to cap pension dynamising factors - Jan 2007

Most GPs will now be aware that the Secretary of State has announced her intention to limit the dynamising factor (DF), used to uprate GPs’ pensionable earnings for the period 2003-2006. She has declared that the figure will be set at 48% and, additionally, that this increase will be spread over a five-year period (2003-2008) instead of the 3 years (2003-2006) that GPs have earned the income and paid the equivalent contributions for their pensions. Local Copy   5 Feb 07

Guidance for medical practitioners undertaking work under the collaborative arrangements (including family planning and sessional work)

The rates for work under the collaborative arrangements have until 2006/07 been set by the Doctors’ and Dentists’ Review Body (DDRB) and issued via an NHS circular.  In its 2006 Report, however the DDRB did not recommend collaborative arrangement fees for 2006/07 and it seems unlikely that it will do so in the future; the Government has accepted the DDRB report in its entirety, although there was a staging of pay awards for consultants.  The DDRB has recommended doctors set their own fees for work done under the collaborative arrangements and this position has not been opposed by the Government.  The Professional Fees Committee has drafted this guidance as a result of the DDRBs recommendation and seeks to clarify doctors’ fee arrangements, superannuation and obligations under the collaborative arrangements, as well as the situation on family planning and sessional work.  This guidance provides a more detailed update to the interim guidance produced for the profession in June 2006. Local Copy   5 Feb 07

GPC Guidance – Charges to NHS Patients – Jan 2007

Private practice is still significantly restricted under the GMS contract.  GMS regulation 24, subsection 2, as set out at appendix 1, prevents contractors from charging their patients for most services. 

 

There are however instances, as set out in this guidance, where charges may be made. Schedule 5 of the National Health Service (General Medical Services Contracts) Regulations 2004 lists the strictly limited circumstances in which GPs may charge fees for providing treatment to their NHS patients. These provisions are listed in appendix 2.  In addition to the circumstances which apply to all doctors, Schedule 5, regulation 24 sets out that dispensing doctors may charge a fee for the supply of drugs which are either restricted or prohibited from being ordered on an NHS prescription, to NHS patients.

 

In the current climate, there is an increasing tendency for private companies to provide services to NHS patients and the BMA as a consequence is receiving a growing number of queries in relation to the topic. This guidance seeks to address those and to outline the circumstances when it is allowed for charges to be made to NHS patients. Local Copy   5 Feb 07

BMA Professional Fees Committee - Guidance for negotiating fees for Locum services in General Practice

In the past the BMA published a range of ‘suggested fees’ for locums, but in 1999 the Office of Fair Trading (OFT) advised that publication of these fees was anti-competitive in the context of the Competition Act 1998. As a result the fee guidance, which had been published as Fee Guidance Schedule (FGS) 12, Fees for GP Non-principals, was withdrawn and guidance issued to BMA staff that no advice could be given to members on suggested fees for sessional GPs.

QOF Implementation: Business Rules

The business rules on this site are for use with the revised QOF which came into operation on 1 April 2006.  This is the officially published version and should be used for all matters relating to the technical requirements for correctly recording QOF information on the new, revised and unchanged indicators. Version 9 of the QOF business rules/read codes is now available at the following address:

http://tinyurl.com/n9yto   or www.primarycarecontracting.nhs.uk/145.php   5 Feb 07

Implementation of VAT on medical services – 30 Jan 2007

Please see below from the Professional Fees Committee of the BMA.

HM Revenue and Customs formally announced that implementation of the VAT ruling on medical services (Dr D’Ambrumenil judgment) will take effect from 1 May 2007, subject to House of Commons approval.

Therefore, medical practitioners registered on a statutory professional register whose taxable income (including VAT) exceeds the VAT registration threshold (currently £61,000) will need to register for VAT. Similarly medical practitioners who are already VAT registered, for example as a result of dispensing changes which took effect on 1 April 2006, will also need to ensure that they account for VAT on any affected services from 1 May 2007. There will be no compulsory back-dating of VAT registration before the implementation date.


Further details of the announcement and general information on the ruling can be found on the fees section of the BMA website:

 http://www.bma.org.uk/ap.nsf/Content/VATonmedicalservices or http://tinyurl.com/2ggdlc

HMRC have given the medical profession three months notice to prepare for implementation on 1 May 2007. See - http://tinyurl.com/hyfwa

LMC advice – if you think you are going to be or might be liable be please discuss with your accountant ASAP   5 Feb 07

 

Revised GPC Guidance - Focus on… the Patient Experience Survey (PES) - posted 8 Dec

October 2006 (updated December 2006)

This guidance note has been produced by the BMA’s General Practitioners Committee (GPC) to help GPs and Local Medical Committees (LMCs) understand the development of the Patient Experience Survey (PES) that was introduced as part of the 2006/07 GMS contract review in England only to measure achievement of the Access DES. This guidance note should be read in conjunction with the contract guidance ‘Revisions to the GMS contract 2006/7 – delivering investment in general practice’ available on the BMA website and the ‘Focus on access’ guidance note  PDF Copy

New Devon LMC Guidance on… - posted 8 Dec

“Physiotherapy Clinical Policy for Sickness Certification of Patients with Musculoskeletal Problems”

The lead physiotherapists from Devon PCT, Northern Devon Healthcare Trust, South Devon Healthcare Trust and Torbay Care Trust have been working together to produce a definitive guidance on the above process.

 

The main aim was to ensure that patients who are having their simple musculoskeletal problems managed by the Physiotherapy service are:

  • Signed off work in a timely manner by their Physiotherapist. 
  • Not having to return to their GP just to obtain a sickness certificate.
  • Signed back to work at earliest possible opportunity.

 

Training for the physiotherapists began on the 1st December 2006 and should be rolled out to all areas shortly.  Please note Plymouth Teaching Primary Care Trust was involved in the process but opted to conduct a small pilot, hopefully the policy will come on stream for the whole county early next year.  PDF Copy

 

The General Practice Physical Activity Questionnaire (GPPAQ) - posted 8 Dec

DH - The General Practice Physical Activity Questionnaire is intended for use in adults (16 - 74) years in routine general practice to provide a simple, 4-level Physical Activity Index (PAI) reflecting an individual's current physical activity. The index can be cross-referred to Read codes for physical activity and can be used to help inform the decision as to when interventions to increase physical activity might be appropriate. http://tinyurl.com/ydwa7p

New PBC Guidance from the Department of Health for 2007-08 - posted 8 Dec

The DH has produced 2 useful updates on PBC, the GPC is currently reviewing the publications and they will be commenting on the guidance shortly.

  • PBC: Practical Implementation (DH - 34 Pages)PDF Copy
  • PBC: Practical Implementation - what does this mean for practices? (NAPC, NHS Alliance, Improvement Foundation - 3 Pages) – PDF Copy

DH Briefing Paper - Access to Health Care - posted 8 Dec

Can choice for all improve health for all? The evidence on whether NHS patients can and should become consumers of health care

This briefing paper outlines the main findings of a review to assess the extent and nature of the evidence available on patient choice and its impact on equity, efficiency and quality within the NHS. It was commissioned in 2004 by the NHS Service Delivery and Organisation (SDO) Research and Development Programme and carried out by researchers at Manchester and Cardiff Universities. PDF Copy

Devon LMC was interested to see that one of the main findings was "There is no evidence that giving patients greater choice will, in itself, improve the quality of health care.  Some studies suggest that increasing choice may result in deterioration in the quality and cost-effectiveness of services.

Fit to Lead - a review of the Primary Care Trust - posted 8 Dec

The DH has launched a consultation document called 'Fit to Lead' which is a review of the Primary Care Trust Professional Executive Committee. PDF Copy

BMA Professional Fees Committee guidance on the completion of health reference forms for prospective registrants with the General Dental Council - November 2006 - posted 8 Dec

The General Dental Council (GDC) has introduced a requirement that states all prospective registrants for clinical practice must have a health reference form completed by a doctor, or in some circumstances a supervising dentist. All dental professionals applying for registration or restoration with the GDC must provide certain information about their health. This applies to dentists as well as dental care professionals (DCPs) including dental hygienists, dental therapists, dental nurses, dental technicians, clinical dental technicians and orthodontic therapists. PDF Copy

 

GPC Focus on….  Excessive Prescribing

Annex 8 of the Revisions to the GMS Contract 2006-07 ‘Excessive or inappropriate prescribing: guidance for health professionals on prescribing NHS medicines’ is a document aimed at helping LMCs and PCOs encourage appropriate and cost-effective prescribing. 

The GPC is aware of cases where PCOs and LMCs seem to be taking a different view on what is excessive prescribing, and in some cases PCOs are making financial threats to practices.  The GPC have suggestions on how best to understand issues around excessive prescribing in practice, and what is or is not possible within the regulations – PDF

URGENT Focus on….the Patient Experience Survey (PES) - October 2006

To help GPs and Local Medical Committees (LMCs) understand the development of the Patient Experience Survey (PES) that was introduced as part of the 2006/07 GMS contract review in England only to measure achievement of the Access DES - PDF

This is a very hot topic and is being discussed on Devon Voice

Register now for more detail!!!!

GPC Guidance - On Exception Reporting

Exception reporting was introduced into the Quality and Outcomes Framework (QOF) in order to allow practices to pursue the quality improvement agenda and not be penalised, where, for example, patients do not attend for review, or where a medication cannot be prescribed due to a contraindication or side-effect.

It has become clear that a variety of interpretations and applications of the nationally defined exception reporting criteria are possible. NHS Employers and the BMA agreed to issue further guidance regarding what constitutes good practice in exception reporting (see Revisions to the GMS Contract 2006/07, paragraph 1.23). This guidance is designed to provide additional clarity in order to help maintain a consistent approach to exception reporting by practices, PCOs and QOF assessors. - PDF

http://www.bma.org.uk/ap.nsf/Content/exceptreportingoct06

GP Registrars e-bulletin, October 2006

Welcome to the third issue of the GP registrars e-bulletin, in which we aim to bring you news of some of the major issues facing registrars today, as well as an update of the ongoing activities of the GP registrars subcommittee. - PDF

 

A CAUTIONARY TALE FROM CORNWALL

Budock Hospital and the Cornwall NHS Learning Disability Service

Dr Jane Richards - Portfolio Representative Devon LMC on Devon Adult Protection Committee

GPC Guidance - GP Returners - October 2006  - posted 4 Oct

Intro - In order to work as NHS GP in the UK, a doctor needs to be on the GMC’s new GP register, and be on a PCO’s Performers List in the country where they are working or intend to work.

 

Up until earlier this year funding was available in England for the GP returners’ scheme.  This was an excellent mechanism for encouraging qualified GPs (particularly those who had taken a career break for family reasons) back to work.  It provided a funded placement for the returning doctor normally for six months on a full-time basis or 12 months part-time in a practice experienced in offering support and training.  It also represented very good value for money to the NHS.  Unfortunately, the funding for the GP returners’ scheme has been withdrawn by the English Department of Health, although some deaneries have retained local sources of funding for returners’ schemes.  The BMA has made numerous representations about the withdrawal of the funding to the Health Department, including a meeting with Lord Warner, Health Minister.  We are also seeking to publicise the advantages of the scheme. – Full PDF copy of Guidance

GPC Guidance for GPs - Primary Medical Services Contracts: Advertising and Appeal  - posted 26 Sept

Dear LMC

There is considerable variation in practice regarding the advertisement of primary medical services contracts. This paper discusses requirements for advertising and outlines appeal mechanisms for parties that feel the tendering process has been unfair or obscure. GPC would like to be kept informed both of any problems that cannot be resolved locally and of examples of successful resolution of issues that could be used as examples of good practice.

Regards - Karen Day - GPC secretariatPDF Copy

GMS dispensing quality payment scheme SFE Amendment  - posted 26 Sept

Dispensing Quality Payment Scheme 10% becomes 7.5% this year only!

Dear LMC,
Please find attached the SFE amendment for the Dispensing Quality Payment Scheme, which comes into force today.
Details of the scheme have been available to practices since July and can be accessed on the BMA website http://www.bma.org.uk/ap.nsf/Content...sescheme010806


Section 4.1 - Review with patients of compliance and concordance with use of medicines
This section (page 6 of the specification) of the Dispensing Quality Payments Scheme stipulates that there shall be:
“A face-to-face review with patients (and, where appropriate, their carers) of compliance and concordance should be carried out and recorded in the patient’s medical record at least once every 12 months for at least 10% of the contractor’s dispensing patients. The practice should agree with their PCT the types of patients that should be targeted for the review as part of their undertaking to carry out the services specified.”


The GPC has secured agreement from the NHS Employers and Department of Health that, for this financial year only, the 10% check referred to above will be scaled back by 25%, to 7.5%. This is in recognition of the fact that details of the scheme only became available to practices in July and has been written into the SFE Directions. PDF Copy

Rural Proofing the new GMS Contract   - posted 26 Sept

Institute of Rural Health - A report funded by the General Practitioners’ Defence Fund

This report examines the new GMS contract from the rural perspective. Primary care is an essential part of health service delivery and in rural and remote parts of the UK it is the mainstay of health care provision (Cox, 1995). Certainly in the past (and to a large extent at present), there has been a tendency to take a ‘one size fits all’ approach to the development of policy and an assumption that services and policies developed on the basis of evidence from urban areas will be readily applied in rural areas. There is increasing recognition that this is not the case and organisations such as the Institute of Rural Health are helping to build the evidence base on rural health issues to inform the development of rurally sensitive policy and practice. – PDF Copy

 

(GPC)  Issues regarding sending attachments to GP records in electronic form  - posted 5 Sept

This is advice from the Joint GP IT Committee (JGPITC) of the General Practitioners Committee (GPC) of the BMA and the Royal College of General Practitioners (RCGP).

This document is not designed to be a definitive guide regarding the electronic transfer of documents relating to the GP held patient record, but merely to list the areas that need to be considered. It is limited to the transfer of electronic documents (not the core record) between practices, or from practice to PCT, where the documents are not also being sent in hard copy.  - Link

(GPC & DOH) ‘Health reform in England: update and commissioning framework’:
GPC Summary/Analysis of new policy developments in relation to PBC
 - posted 5 Sept

The Department of Health published ‘Health reform in England: update and commissioning framework’ on 13 July 2006, The commissioning framework provides an update about health reform and focuses on commissioning NHS services, in particular hospital services.  It builds upon ‘Health reform in England: update and next steps’, published in December 2005.  In terms of practice based commissioning (PBC), it sets out to build upon and add clarity to Department of Health guidance issued earlier this year, ‘PBC: achieving universal coverage’ (January 2006).

This commissioning framework is split into two parts; the main document and an annex, which contains the bulk of information relevant to LMCs and GP practices.  This GPC analysis seeks to highlight the new and/or important developments in policy that will be relevant to GPs/LMCs. 

  • GPC Guidance - Link
  • DOH Extract - A framework to strengthen Practice Based Commissioning - Link

NHS Pensions Newsletter – NHS Pension Benefits & Retirement (TN 14/2006) 

This letter contains important clarification about NHS Pension benefits and the rules regarding qualifying for retirement benefits. Following a number of recent enquiries, discussions have been held with the Department of Health who have confirmed that the underlying requirement of the NHS Pension Scheme Regulations is that all Scheme members must demonstrate a clear intention to retire from the NHS before NHS pension benefits are awarded. - Link - External

(GPC) Identifying services that should not be provided by GPs under primary medical services
(GMS, PMS, APMS or PCTMS)

GPs should not be asked to accept overall clinical responsibility for patients in secondary care institutions or for those in any setting where the clinical needs of the patient fall outside the normal skills of GPs. 

On several occasions in the past, the GPC has been made aware of GPs being asked to provide services to patients residing in institutions or homes where the type of services expected do not fall under the responsibility of primary care.  At the margins between secondary and primary care, most typically in various types of long-stay psychiatric institutions, it is sometimes difficult to define in any absolute sense where responsibility for patient care lies.  This is not in patients’ best interests.

Care for patients in intermediate care can also present problems of poorly-defined professional remits.  This problem is salient in the light of the trend to discharge relatively high-dependency patients from hospitals to other institutions.  Although GPs often provide vitally important care for patients in intermediate settings, the care these patients need will sometimes go beyond that which most GPs are trained, or contracted, to provide.

With this in mind, this short guidance document has been put together to help doctors decide whether or not the patients they are treating in institutions and residential homes fall under standard primary medical services contracts.  - Link

(GPC) Guidance on the implications of the new age discrimination legislation  - posted 5 Sept

The Employment Equality (Age) Regulations are due to come into force from October 2006.  The regulations are complex, cover all areas of employment and apply to both ‘workers’ and partners.  They will make it unlawful to discriminate against any person on the grounds of their actual or perceived age.  Employers need to ensure that they make themselves fully aware of all the relevant provisions.  - Link

 

Dispensary Services Quality Scheme - posted 9 August

 

Dispensary Services Quality Scheme – Guidance

As part of the changes to the arrangements for dispensing doctors for April 2006, agreed as part of the GMS changes in 2006/07, a Dispensary Services Quality Scheme has been developed.  The specification for this Scheme, which rewards practices for providing high quality services to their dispensing patients, is available on the BMA and NHS Employers website - PDF

·         Appendix A – Dispensing staff competencies - PDF

·         Specification of Requirements for Receiving Dispensary Services Quality Payments - PDF

GPC backs new GP Practice Workload Survey - posted 9 August

Family doctors and health teams at around 4,000 GP Practices across the UK are being encouraged to take part in a groundbreaking survey which will give them the opportunity to document the way their practice works. – download PDF

Professional Education and Training

PEAT at Devon LMC

dedicated page - NewsletterPEAT Questionnaire

Update of LMC Secretariat Database

The LMC is updating their database at present and although we receive details from the PCTs this is not always up-to-date. 

Enclosed with this newsletter is a “Practice Contact Details” form which it would be appreciated if the practice manager could complete and return to this office by the end of June. 

The form is also posted on the LMC website - this can be faxed, emailed or posted to Lynn Stubbings: lynn@devonlmc.org

Electronic Copy of Document – Doc   updated  12 July

 

 

Good Doctors, Safer Patients: Proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients

A report by the Chief Medical Officer

This report aims to create a new approach to promoting and assuring good medical practice and protecting patients from bad practice.  The Chief Medical Officer was asked to undertake this broad review of medical regulation, following Dame Janet Smith’s inquiry into the circumstances surrounding the murders committed by Hyde GP, Dr Harold Shipman. The CMO’s report, Good doctors, safer patients, advises Ministers on measures to strengthen the arrangements in place for the protection of patients. The report contains 44 detailed recommendations. Proposed changes include devolving some of the powers of the GMC to a local level, changing its structure and function, and creating a new framework for revalidation. The Secretary of State for Health has welcomed the publication of Good doctors, safer patients and has launched a period of consultation.