Hot Topics March 2010


The Gables Cowley Hill Lane St Helens Merseyside WA10 2AP                       

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MARCH 2010



·                       LOCAL ISSUES






NHS Warrington recently sent a letter to GPs advising that from 1 April 2010 Warrington and Halton Hospitals Trust will only accept orthopaedic referrals via Choose and Book and erroneously stated that it was supported by the LMC.  At no point was this agreed or endorsed by MMLMC.  We would take this opportunity to remind you that the use of Choose and Book is still entirely voluntary.


The LMC is currently undertaking a survey of its constituents concerning this matter.






Due to patients’ requests via Knowsley & St Helens diabetes support groups, the North Mersey Diabetes network, in line with the recent NICE guidance, has reviewed the process for routine lipid testing in diabetes care. The protocol was approved at the 1 March 2010 LMC meeting and will be rolled out shortly.


·                   INFORMATION


·                     RELAUNCH OF MID MERSEY LMC WEBSITE or


Mid Mersey LMC website has been updated. The new look site has improved functionality permitting searches and highlighting newly posted information. We have created sections for the different PCT areas as well as BMA, GMC and DOH information. We plan to place copies of documents such as LESs on the site for your quick reference, soon.  We will endeavour to keep the site up-to-date and hope you will find it a useful resource. If you have any comments or suggestions for the development of the site, please send them to This email address is being protected from spambots. You need JavaScript enabled to view it.


·                   APPRAISAL TOOLKIT


As we speak, the on line Appraisal Toolkit is still not fully operational as security issues continue to be addressed.  We would respectfully remind you that use of this toolkit is not mandatory.  We have asked our 3 PCTs to extend the time period for those GPs whose appraisal is imminent.



Medical Certificates are not required as proof of illness. The letter to GPC from Ofqual reads as follows:


“Awarding Organisations make no requirement for pupils to obtain a medical certificate in support of an application for special consideration. Students are asked for information in support of their application, but this may take the form of a statement by the school. The Joint Council for Qualifications (JCQ) has confirmed that, as far as they are concerned, if a student was absent from an examination as a result of illness and has the support of the school or centre to be absent, special consideration will be granted on that basis. Awarding Organisations do not insist that medical proof is provided.


I am sure that you have considered the likelihood that the misconception stems from the conventional necessity for adults to produce a sick note after long periods of absence from work. In order to address this issue with the schools, we have contacted the Department for Children Schools and Families and requested that they made local authorities aware (via their weekly e-mail) of this message, which they have now done. We have also informed the Joint Council for Qualifications and have posted a notice on our website. In addition, we will pass on this message to the teacher associations and unions.


I hope this response is useful, but I can assure you that the regulations do not ask for medical corroboration in these circumstances and that I do not believe any misconception stems from the awarding organisations”.




The LMC paper, attached at Appendix 1, has been presented to our local PCTs. It can also be accessed on the LMC website,, under “miscellaneous” (item 20).


·                     SUMMARY CARE RECORDS

The BMA is calling for the Government to suspend the nationwide introduction of electronic patient records.

The BMA has written to health minister Mike O’Brien expressing serious concern about the roll-out of the SCR (Summary Care Record).

BMA Council Chairman Hamish Meldrum said: 'The breakneck speed with which this programme is being implemented is of huge concern.  Patients’ right to opt out is crucial, and it is extremely alarming that records are apparently being created without them being aware of it. If the process continues to be rushed, not only will the rights of patients be damaged, but the limited confidence of the public and the medical profession in NHS IT will be further eroded.'

The association has issued guidance to GPs, advising them that they have a crucial role to play in advising patients about their rights, and recommending that opt-out forms be made available in Practices.

Doctors’ leaders have also called for the Government to halt the roll out in areas that have not begun their PIPs (public information programmes).

They also want the inclusion of an opt-out form in patient information packs, and the withdrawal of BMA comment from the NHS Connecting for Health promotional video.

The letter from BMA Council Chairman, Hamish Meldrum, BMA GPs Committee Chair, Laurence Buckman, and BMA working party on NHS IT Chair, Dame Deirdre Hine, says: ‘We are receiving reports from GPs that they feel unprepared and unsupported for the SCR, and in some areas the roll out is taking place without the support and involvement of the Local Medical Committee.

‘This is a direct consequence of the shortened timescale, which involved the announcement of funding in mid-December 2009 and required it to be spent by PCTs on PIPs by the end of March 2010.’

The BMA says it fears that the rushed implementation is affecting patient awareness of the SCR and GPs’ ability to support patients in making informed choices about the storage of their data.

In its Health Informatics Strategy 2010, the BMA working party on NHS IT underlines the need for the best possible protection for data. It adds that investment in IT should build on successful developments such as GP Systems of Choice, which funds primary care clinical IT systems in England.

·                     DDRB REPORT 2010


Please see BMA’s letter to the profession, attached at appendix 2.



The Department is asking everyone who works in Primary Care and NHS and patient groups to take part in a public consultation, to discuss how best to create a system that will give patients a wider and more meaningful choice of GP Practices.

The DH is making improvements to the commissioning and running of out of hours (OOH) services following a review.  DH ministers have asked PCTs to involve GPs more when commissioning OOH services to improve quality. GPs should make sure they are being engaged through, for example, Local Medical Committees, Royal College of General Practitioners standing groups, faculties, clinical executive groups or practice-based commissioning consortia. The plans announced also include developing stronger national minimum standards, the introduction of a new national model contract for OOH services and tighter performance monitoring.


Following the success of the national learning event in December, the DH is working with the National Association of Primary Care and the Royal College of General Practitioners to hold a series of practical and interactive regional events to bring together frontline Practitioners from across Primary Care to explore the vision for clinical leadership and how to use it to drive change. The first three events will be held in NHS West Midlands (11 March), NHS Yorkshire and Humber (18 March) and NHS East of England (25 March). GPs should contact NHS Primary Care Commissioning for more information.


The regulations supporting the new Statement of Fitness for Work – the ‘fit note’ – come into effect on 6 April 2010. GPs can use the note to advise patients whether they can return to work earlier if supported by their employer.  It also replaces the current Med 3 and the Med 5 sickness certification forms.

The change is driven by evidence that working helps to promote recovery and rehabilitation, while unemployment can lead to increased morbidity and poorer physical and mental health.  Detailed guidance for GPs has been produced in partnership with the British Medical Association and the Royal College of General Practitioners. Guidance for patients and employers is also available through the same link.


GPs no longer have to fill in the Department of Work and Pensions’ (DWP’s) IB/ESA 113 form by hand as an interactive electronic version is now available. GPs may be asked to fill in the form if the DWP thinks that the patient may have a severe health conditioner disability, but does not have enough information to be sure. GP Practices are asked to download the form onto their server for future use.


The Advisory Committee on Cervical Screening (ACCS) has produced new guidance for primary care covering the management of young women (aged 20-24) who present with gynaecological symptoms. The guidance has been produced by a multi-disciplinary group, including professionals, patients and the voluntary sector. A covering letter from Ann Keen (Under Secretary of State for Health), Professor Sir Mike Richards (National Cancer Director) and Professor Henry Kitchener (chair of ACCS) has also been published.


·                    IMPROVING THE HEALTH OF THE OVER-40S

GPs and practice teams can do more to help adults aged over 40 improve their health following two new launches. The Change4Life adults campaign is telling adults between 45 and 65 to ‘Swap it, Don’t stop it’. It focuses on six behaviours that people can ‘swap’ into their lives to cut down on portion sizes, get more fibre and their five a day, snack healthily and become more active. The over-40s can also go online and complete the NHS MidLifeCheck, an online questionnaire that covers smoking, healthy eating, alcohol, physical activity and emotional wellbeing. After answering a few multiple-choice questions, users are given advice on how they could improve their health and help in setting goals to make lifestyle changes.


The new tobacco control strategy, called A Smokefree Future, aims to reduce the number of smokers from 21 per cent of the population to just 10 per cent by 2020. It will do this by reducing the number of young people taking up the habit, helping current smokers to quit and protecting families and communities from tobacco-related harm. GPs can help deliver all three by encouraging young patients not to take up smoking and advising any smoking patients of the benefits of quitting: evidence suggests that people are more likely to make a quit attempt if advised by their GP.


A DH campaign to tackle poor public understanding of dementia and its consequences is now under way, and could inspire more people to seek advice from Primary Care services. GPs and practice teams can help these patients by pointing them to the campaign helpline (0300 123 1914), where they can order an information pack, or to the NHS Choices or Alzheimer’s Society websites. The National Clinical Director for Primary Care has written to GPs outlining these details. Guidance on diagnosing dementia is available from NICE.



South London and Maudsley NHS Foundation Trust has teamed up with the Institute of Psychiatry to launch It provides the carers, families and friends of people suffering any form of psychosis with information on the different aspects of treatment and care, and gives the public an opportunity to put questions to pharmacists, psychologists and psychiatrists. GPs are asked to raise awareness of the service.

·                    NEW ‘RED FLAGS’ FOR MENINGITIS

LEG pain and cold hands and feet have emerged as leading ‘red flag’ symptoms in diagnosing children presenting with meningococcal disease in a new study.

Primary Care researchers at the University of Oxford found that both signs are highly predictive of meningococcal disease in children and adolescents. The symptoms can help GPs distinguish children with meningitis from minor febrile illness. The results of the large study into UK general practice will be presented at the Society for Academic Primary Care annual meeting later this month.

Children with leg pain were seven times more like to have meningococcal disease – and children with cold hands and feet were twice as likely – compared to children with minor feverish illness, the study found.

Researchers compared the symptoms of 924 children who presented to 15 Practices in Oxfordshire and Somerset with feverish illnesses with the symptom frequencies recorded from 345 children with meningococcal disease.

Leg pain, cold hand or feet, confusion, photophobia and neck pain or stiffness were all rarely reported by the parents of children with minor febrile illness. All these symptoms were found to be “highly specific for meningococcal disease” but pallor and headache had little diagnostic value.

Dr Tanya Haj-Hassan, a researcher in childhood infections at the University of Oxford, concluded: “The early red flag features of leg pain and cold extremities, as well as classical features of photophobia and neck pain and stiffness, are all highly specific for meningococcal disease.

Confusion also emerged as an important red flag in children with meningococcal disease, and was as sensitive and specific as classic and red flag features. When these symptoms are reported by parents, they should usually prompt an urgent face-to-face assessment with a clinician to exclude meningococcal disease.”



See Appendix 3.


·                    BMA CHARITIES


We would like to draw your attention to two charitable funds which might be of help to you or your colleagues.



The Dain Fund


This Fund helps with the educational costs of Doctors’ children in certain situations.  It assists families who are experiencing an unforeseen financial crisis following an unexpected life event such as involuntary unemployment, family breakdown or the serious illness of one of the parents.  In every case, the family must be in receipt of its maximum entitlement to state benefits.  The Fund can help children who are in the state or private education systems or who are at university.  Only short term help is available for assistance with school fees.


The Earnshaw Bequest


This Fund gives one-off grants for terminal/palliative care to current or retired Doctors and their dependants who are in financial need.  The Trustees are happy to consider applications for grants for the following, although the list is not exhaustive:


-                     Night sitter services

-                     Respite breaks for carers

-                     Holiday break for patient and family

-                     Personal care

-                     Domestic help with shopping cooking, laundry or cleaning


Any queries or to discuss a possible referral, please contact Marian Flint, Clerk to the Trustees, This email address is being protected from spambots. You need JavaScript enabled to view it., or telephone 020 7383 6142.


·                    RELOCATION OF WHISTON A&E


We have been advised that Whiston A&E Department will move into the new hospital site in the early hours of Thursday, 25 March 2010.


In the days before and after, the Trust will be working to maximise discharges and minimise admissions as the move takes place and services come on line.


To help support the move of AED and minimise patient risk/disruption, the hospital will not accept GP admissions from 12 noon, Wednesday, 24 March 2010 to 12 noon, Thursday, 25 March 2010. The Trust will continue to accept 999s but the short relief from GP admissions could provide some real pressure relief immediately before and after the critical moves.









Dr I Camphor

Medical Secretary

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