Hot Topics July 2010
• LOCAL ISSUES
HALTON & ST HELENS
It has come to the LMC’s attention that there are four Practices in Halton & St Helens who, to date, have not signed off their QMAS figures. As colleagues will recall, the date for signing off QMAS data has long since passed and in order for the PCT to agree a final figure for QMAS payments, the LMC urges Practices to sign off their QMAS figures as soon as possible.
• ENHANCED SERVICES UPDATE
A 10% cut will be applied to all LESs (including the Extended Hours LES), and has already been applied to the PBC LES. The minor injuries NES will cease, as will the Quality Improvement Framework (QIF). The PCT will also stop providing disposable surgical equipment. The Consortia have been consulted on these changes.
The following services will continue:
- Anticoagulation, including PBC LES
- Minor surgery
- Extended hours
- QOF plus
- Near patient testing
We understand that there has been some confusion raised in my letter regarding the Diabetic LES being stopped. We have subsequently confirmed with the PCT that the Diabetic LES is to continue in its present format. We apologise for any inconvenience caused.
• FAMILY PLANNING CLINIC IN HAYDOCK
The LMC is given to understand that the Family Planning Clinic was scheduled to close on 13 July 2010. It is our understanding that there is a problem around security provided in the evening and that interim arrangements are being made until a formal solution can be found. The LMC will keep you abreast of any further changes regarding this.
• REFORM OF MATERNITY SERVICES
This LMC understands that there was going to be a massive shake up of the provision of maternity services in Knowsley. Our understanding was that midwives would be withdrawn from Practices where they have traditionally provided excellent services for patients to Community Centres. The LMC raised this as a major point of concern and is given to understand that this roll out has now been stopped until further discussions and negotiations occur between the PBC Groups/LMC/PCT. The LMC will inform you of any changes as they happen.
• WHITE PAPER
The White Paper was launched recently and this represents a significant new reform to the NHS. The NHS has undergone six major reforms in the last 10 years. This new reform promises to bring about savings of £20 Billion but, according to some statistics, will take some £1.7 Billion to implement. It would produce groundbreaking changes in the provision of services, i.e. it will bring commissioning to the heart of General Practice controlled and monitored by GP Consortia. If the proposals set out in the White Paper: Equity and Excellence, are implemented in full, changes will have far reaching and significant consequences for the NHS. The result will be a health care system unique internationally that gives groups of General Practitioners unprecedented control of public funding but will the proposals actually be realised in the way that the Secretary of State hopes?
The White Paper sets out plans for an independent and accountable NHS Commissioning Board, which will calculate Practice level budgets and allocate these directly to GP Consortia by 2013. The Board will also hold Consortia to account for stewardship of NHS resources and health outcomes. The White Paper also states that GP Consortia will receive a management allowance to reflect the costs associated with commissioning. Consortia that perform well will receive extra. It also mentions powerful incentives for GP Consortia for achieving goals set by a new NHS outcomes framework which measure effectiveness of care, safety and patient experience on a range of conditions. The far reaching document also states employers should lead negotiations on new employment contracts. It proposes that all NHS Trusts should become Foundation Trusts.
Handling GP real budgets for commissioning care on behalf of their local communities has real potential to help shift care out of hospitals and reverse the upper trend in avoidable hospital admissions but the scale of the challenge is huge. Previous similar reforms have not motivated enough GPs to manage budgets – to date, GPs have been far more interested in providing Primary Care than buying hospital care.
At present, we do not know how General Practitioners manage their finances or provide value for money.
Potentially, according to the White Paper, £70 Billion of taxpayers’ money will be released to around 8,000 General Practices. GP Consortia will need huge investments in their management if they are to transform themselves.
WHITE PAPER – A GENERAL OVERVIEW
• NHS APPRAISAL TOOLKIT
Please see attached.
• SUMMARY CARE RECORD
The GPC considered the recently published evaluation report of the Summary Care Record (SCR) by UCL and passed the following two resolutions:
That GPC believes that, after consideration of the UCL Report in respect of the Summary Care Record (SCR) in England:
1. The clinical benefits are insufficient to justify continuation at present, particularly at a time when patients are being denied proven clinical services on the grounds of expense;
2. The clinical benefits are insufficient to justify the creation without fully informed explicit consent;
3. The clinical benefits are insufficient to justify GPs consenting to the upload of data on behalf of patients who have not expressed consent;
4. The creation of SCRs in England should be halted until the full review of the model, and other models, has taken place to address cost-effectiveness and the need for informed and explicit consent of patients.
That GPC believes that in view of the risks to patient safety caused by the failures of SCRs to be reliably and consistently updated, access to existing SCRs should be immediately suspended by the government until all patient safety issues have been fully investigated and satisfactorily resolved.
The GPC believes that it is for individual Practices to decide whether they wish to proceed with uploads to the SCR.
• FP69S & SCR UPLOADS
Where Practices participating in SCR uploads have received FP69s from their PCT due to undelivered PIP (Public Information Programme) letters, they should also have been advised to flag the records affected as “not for upload” until processing has been satisfactorily completed.
• GP PATIENT SURVEY
Attached (Appendix 1) is an update from the GPC on the GP Patient Survey. This aims to explain the results process for the 2009/10 survey, directing LMCs and Practices to sources of information and helping to prepare for the release of final survey data for this year. This update applies to England only and the timetable and process will vary in Scotland, Wales and N Ireland. The PE7 and PE8 easements referred to below however do apply to the UK as a whole.
• PATIENT SURVEY AND CALCULATING ELIGIBILITY FOR QOF PE7 AND PE8
The patient survey results have been released and full details can be found online.
PCTs will now use the patient access data in the survey for calculating Practice payments under the QOF. As part of the H1N1 Vaccination DES, those Practices that meet the minimum target for vaccinations will receive a 10 per cent drop in the upper - and 20 per cent in the lower - thresholds in PE7 and PE8.
Practices should be aware that the ImmForm Swine Flu data extraction programme, which has been used to assess uptake levels for the QOF easements, calculates the denominator on the age of the eligible patient population at the date of extraction, rather than the age of the patients at the time of vaccination,
This is likely to have a minor impact on the number of patients in the six months age range because those who were previously not eligible, will now appear as eligible. This is not expected to be a large number and will mainly impact on those Practices that are close to the 50.7 per cent target.
Practices who do not believe that the figures are an accurate reflection of their eligible patient population can, with the agreement of their PCT, perform a manual calculation to work out if they have qualified for the patient experience easements.
Practices can use the data extraction report as a template to perform this calculation. An example of the report and details of the formula to be used, are available in annex 4, page 15 of the H1N1 Vaccination DES guidance, available on the BMA website.
By July 30, the ImmForm programme team will have archived the swine flu vaccination data from October 09 to February 10 to free up storage space on the ImmForm system. This means that the vaccination data for this period will no longer be accessible to the Practice (although it will remain available to the PCT). The March data, which will still be available, is cumulative so includes the uptake figures from October - February. The March data will remain accessible until the end of October 2010 at which point the data will only be accessible via PCTs and SHAs.
In the event that a Practice is disputing their figures, a copy of the extraction reports could be useful, and as such the Practices should save a copy of the report on their internal system to ensure they can access it in the future if necessary.
• CQC REGISTRATION
CQC registration will apply for NHS GPs from April 2012. However, we have had reports of some PCTs telling Practices that, because of CQC, they must fully comply now with the Health and Social Care Act 2008: Code of Practice for the NHS on the prevention and control of healthcare associated infections. There is an ongoing consultation on how the Code of Practice will relate to primary care but at the moment it is guidance only.
• PENSION CONTRIBUTIONS
In 2007, the GPC agreed that for the year 2008/09 there would be a one off arrangement between the Department of Health and BMA that GP tiered contributions would be based on their 2006/07 pensionable pay as declared on their annual end of year 2006/07 certificate regardless of what they actually earned in 2008/09. If there was no 2006/07 certificate available then the 2005/06 certificate was to be used as a yardstick. If there were no certificate or if the GP was newly qualified then the NHSPS regulations stated that the 2008/09 tiered contributions rate would have to be agreed between the PCT and the GP and be based on the GP's estimated 2008/09 income.
However, it is very difficult to project a GP's income because no-one really knows what their Practice profits are going to be or how much they may earn doing other GP work such as out-of-hours or locum work, both of which can increase total pensionable earnings considerably.
If a GP started at a Practice in July 2008 and it turned out that they earned £35k (in total) between July 2008 and March 2009 it is understandable that they may question an 8.5% tier being imposed. With tax relief the real figure is less than 8.5% and in most cases, it is probably not unreasonable for the PCT in July 2008 to believe that a GP may earn more than £35k over the following nine months.
The guidance which was published at the time of the agreement is available on the BMA website.
• GOODWILL AND DISPENSING
A briefing has been drafted to clarify whether GPs can sell goodwill in terms of the dispensing element of their contracts. It is imperative that Practices do not fall foul of the goodwill rules because by doing so, a breach in the regulations could result in a criminal offence. This briefing is available on the BMA website.
• GP EMPLOYMENT LAW COURSES 2010
Managing change, managing performance, managing staff
Keeping track of employment legislation, best practice and other human resource issues can be a real headache. With the best will in the world, you know you cannot be an expert on everything: that is why you have the BMA right behind you to give expert advice and support. However, it is important to understand the principles of employment legislation and practical management of people issues to ensure a good working environment and that you do not find yourselves facing a legal challenge.
The BMA is offering three one-day courses introducing GP Practices to managing change, managing performance and managing staff. Further dates have been added to the programme due to popular demand.
Cost to attend
Registration is open to GP Partners or their Practice Managers and the registration fees are as below:
BMA members: £130.00 including VAT
Non-members: £190.00 including VAT
Priority will be given to BMA members who wish to attend.
For more information on dates and venues and the online booking form please visit the BMA website.
• QMAS 2009/10 ACHIEVEMENT CALCULATION – SEXUAL HEALTH
An issue has been found on QMAS that has resulted in the incorrect achievement calculation for the Sexual Health indicator group.
The Sexual Health indicator (SH1, SH2 and SH3) points remain correct. However, the value ‘national additional service proportion’ used in the calculation is incorrect. This is due to the calculation for Sexual Health using the 2008/09 'national additional service proportion' for 2008/09 (0.38256059619601) rather than the 2009/10 national figure (0.380075702088404). Most practices will receive a small incremental payment, on average £7.82.
15 Practices’ achievement will have decreased due to a further anomaly in the calculation. The relevant PCTs will be contacted individually and these Practices dealt with on a case by case situation.
NHS Connecting for Health and QMAS will be correcting the 2009/10 payments. As Practices and PCTs are currently approving payments for 2009/10 a number of actions have been identified and are detailed below.
If the PCT has approved Practice payment
The approved Practice payment achievement value cannot be altered on QMAS. QMAS will calculate the difference in the achievement and aspiration values and pass this data to Exeter on Monday 12 July 2010. These files will be used to generate a Print Queue entry on each payment agencies NHAIS system. Payment agencies will be advised via a SIS Fax of this release. Variances will be applied as normal non-superannuable Ad-Hocs at Practice level.
If the PCT has not approved the Practice payment
Where the PCT has not yet approved the Practice payment the achievement will be altered on QMAS via an automated adjustment on Saturday 10 July 2010.
This adjustment will reset the Practice’s achievement status and the practice will need to approve the new achievement for payment on QMAS.
If the Practice has not declared achievement
Where the Practice has not approved their payment the achievement will be altered on QMAS via an automated adjustment on Saturday 10 July 2010.
If the Practice has not submitted 2009/10 achievement
QMAS will handle each of these Practices case by case.
Whilst these fixes will resolve the under achievement payments for Practices end of year 2009/10 payment, the sexual health calculation remains incorrect for monthly reports. A strategic fix is being developed that will resolve the monthly reports. Further communications will provide updates on this.
NHS Connecting for Health would like to take this opportunity to apologise for any inconvenience.
MMLMC Med Sec