Hot Topics March 2009

Hot Topics
06 May, 2009

N.B. 1 COPY PER PRACTICE – PLEASE SHOW TO ALL DOCTORS
MID MERSEY LOCAL MEDICAL COMMITTEE
The Gables Cowley Hill Lane St Helens Merseyside WA10 2AP
Tel: 01744 28588 Fax: 01744 453689 e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

HOT TOPICS
NO.1 – 2009/10

INFORMATION

• NEW COMPLAINTS PROCEDURE

The new complaints procedure started on 1 April 2009. From this date onwards, if any complainants are not satisfied with the way a local NHS body or Practice has dealt with their complaint, they can ask the Parliamentary and Health Service Ombudsman to look into it.

The main differences between the old and new complaint procedure are:

1. Oral complaints made to the Practice do not have to be dealt with under the legislation if they are resolved to the patient’s satisfaction by the end of the next working day.

2. Practices must acknowledge receipt of a complaint within three days (via telephone is acceptable).

3. The Complaints Manager does not have to be a Practice employee and can perform this role for more than one Practice in the vicinity.

The GPC will be producing a FAQ document shortly.

• GPC GUIDANCE ON REFERRAL LETTERS FROM ACUTE TRUSTS TO GP PRACTICES IN ENGLAND

The GPC has been informed of many occurrences across England where Acute Trusts have been sending all referral information/correspondence to senior partners, rather than the referring GP. Changes to Acute Trusts’ computer software in some parts of the country have resulted in all referral communications being sent solely to senior partners. The issue has been raised with Connecting for Health and the GPC has written guidance for Practices on referral letters from Acute Trusts to GP Practices in England. This guidance is attached in Appendix 1.

• MENTAL CAPACITY ACT 2005 - DEPRIVATION OF LIBERTY SAFEGUARDS

The aim of the deprivation of liberty safeguards is to provide legal protection for those vulnerable adults who are not detained under the Mental Health Act 1983, but are nevertheless restricted in their freedom owing to their inability to consent to care or accept treatment. The deprivation of liberty safeguards came into effect from 1 April 2009 and covers mentally incapacitated adults in hospitals as well as those in Care Homes registered under the Care Standards Act 2000. More details are available on the Department of Health website.
Doctors are eligible to undertake a mental health assessment as part of these procedures provided they are three years post-registration and they must have undertaken the deprivation of liberty safeguards Mental Health Assessors training programme made available by the Royal College of Psychiatrists. This is now available online, free of charge, to all NHS funded Doctors in England. Doctors can register online.

This work is not part of essential services for GPs; the Department of Health is unwilling to agree to a national fee for this work and the BMA’s Professional Fees Committee advises Doctors only to undertake this work if they have agreed the level and payment arrangements for the work in advance. Responsibility for payment lies with the PCT or local Social Services Authority according to whether the person is in hospital or a registered Home at the time of the assessment. However, in some areas, PCTs and LSSAs may have made joint local arrangements. For further information please contact askbma.

• STAMP DUTY LAND TAX (SDLT) GUIDANCE

The GPC has published general guidance on Stamp Duty Land Tax (SDLT) as it applies to GPs. SDLT is payable on transactions relating to UK land and buildings and although not all transactions involving GPs will be liable for SDLT, it is likely to affect an increasing number of Practices in the future, due to the increasing number of Practices occupying leasehold premises and the varying nature of the property market. Note that this guidance is not a substitute for individually tailored professional accountancy and tax advice and that GPs should always seek such professional advice when considering a transaction that may be subject to SDLT.

The guidance can be accessed at:

http://www.bma.org.uk/employmentandcontracts/
tax/stamptaxSDLT0309.jsp

• CLINICAL DES FOR GMS CONTRACT 2008/09: GUIDANCE AND AUDIT REQUIREMENTS

The guidance and audit requirements for the 2008/09 clinical DESs have been released. This is an update to the guidance released last year detailing the audit requirements and Read codes. Please note that a change has been made to the heart failure indicator which means that patients who are stable on a non-licensed beta blocker do not have to have their medication changed, and this will still count towards achievement of the DES. The guidance can be accessed at:

http://www.bma.org.uk/employmentandcontracts/
independentcontractors/enhancedservices/ClinicalDES0809.jsp

GPC have stated numerous times before that the delays associated with the proper implementation of these DESs are unacceptable. The Negotiators have told this to NHSE and are working on ensuring that the money set aside for the DESs is not lost.

• QOF CONSULTATION

The Government has responded to the QOF consultation. The response confirms that from 1 April 2009, the National Institute of Clinical Excellence (NICE) will oversee the annual process of reviewing the clinical indicators included in QOF. To see the response, (sit down before you click on this) please visit this website:

http://www.dh.gov.uk/en/Consultations/index.htm
• HALTON & ST HELENS PMS CONTRACTS

The PCT is currently undertaking a piece of work to update PMS contracts to incorporate the standard variation notices that have been issued since the contract was first introduced and to ensure a standard format is used for each Practice. This document has been circulated to all Practices. The LMC is satisfied that this activity is an administrative exercise and is happy to endorse the process. Please could you respond to the PCT by Friday, 1 May 2009 with any questions you may have on the proposed contract.

• FAIRER FUNDING FOR GP PRACTICES

A letter by Ben Dyson, Director of Primary Care, Commissioning and System Management Directorate, from the Department of Health, dated 3 April 2009, pointed to the Government’s commitment to reduce reliance on Minimum Practice Income Guarantee (MPIG) payments and phase in changes to the prevalence adjustment for Quality & Outcomes Framework (QOF) payments to reflect recorded prevalence of long term conditions.

The gross GMS contract payments are to be increased by an average of 2.29% in order to allow an average increase in GMS Practitioners’ net income of 1.5% after allowing for movement in their expenses. The Government has accepted all the DDRB’s recommendations.

Under the formula agreed with the GPC, this 2.29% increase will be differentially applied as follows:

1. Every GMS Practice will receive a national minimum uplift of 0.7% to their Global Sum Equivalent.

2. In order to reduce reliance on MPIG, the formula gives a proportionately higher increase in underlying global sum payments (i.e. the price per weighted patient before any correction factor is applied to achieve a Practice’s protected income levels). Insofar as this exceeds the minimum 0.7% uplift, this leads to a corresponding reduction in correction payments. The accumulative effect of these changes is that the price per weighted patient used in the Global Sum calculation will increase from £56.20p in 2008/09 to £63.21 in 2009/10 (an increase of 12.5%). The value of Quality & Outcome Frameworks points will increase by 1.75% from £124.60p in 2008/09 to £126.77p in 2009/10.

3. There will also be an increase of 1.74% in Enhanced Services payments.

The effect of these changes is to redistribute resources more equitably between GMS Practices to reflect relative needs using the Carr-Hill weighted capitation formula. The changes to the QOF prevalence formula have a further effect in distributing QOF payments more equitably.

Implications for PMS Practices

The Department of Health is committed to ensuring an equitable approach for PMS and other local Primary Medical Care contracts. While the PMS and APMS contracting arrangements provide PCTs with flexibility in commissioning services, PCTs need to be able to demonstrate that funding decisions between all Primary Medical Care Contractors are fair and equitable and represent value for money.

Given the differential effects of DDRB awards on GMS Practices, PCTs will wish to consider the implications for PMS Practices on a case by case basis, with specific reference to the contractual agreement the PCT has with these Practices. It is our understanding the PMS Practices will receive an uplift of 0.7% in core contract payments.

• TWO WEEK REFERRALS USING CHOOSE & BOOK SYSTEM – WARRINGTON

It was brought to the LMC’s attention at the last meeting that there was some concern about using the 2 week rule referral through the Choose & Book system. After discussions with Jim Britt, No Delays & Choose & Book Programme Manager, I can inform you that Warrington and Halton Hospitals use a system called Meditec which is not MP fit and therefore Choose & Book is not compatible with this system. However, a half way house which seems to be working reasonably well has been set up. GPs still have a choice of which system they want to use. They can still fax 2 week referrals to the designated service or, alternatively, they can use Choose & Book to refer the patient to the appropriate service provider. The patient should be given a telephone number which they can ring the following day and make an appointment. The beauty of doing this is said to be fast, reliable (when it works) and Practices will be able to see this on their Practice Activity List on their computer.

• KINGS FUND – QUALITY OF GENERAL PRACTICE ENQUIRY

The Kings Fund is launching an 18 month investigation into the quality of General Practice. The investigation will search for ways to define the quality of General Practice and will include more than a dozen pieces of research and topics including access, public health and management of long term conditions. It will be overseen by an expert panel including the Royal College of GPs’ Chairman, Professor Steve Field, and NHS Alliance Chairman, Dr Michael Dixon.

• HALTON & ST HELENS PRESCRIBING BUDGET FOR 2009/10

The prescribing budget was presented at the April 2009 Local Medical Committee meeting. The Committee were assured that the methodology in setting the 2009/10 prescribing budget was the same as that in 2008/09.

The Director of Finance gave a commitment to keep the budget level for prescribing the same for 2009/10 as 2008/09. This was in recognition that where PBC Consortia had made planned saving on their prescribing budget in 2008/09, these should be available to invest in prescribing or other service developments in 2009/10. Further details can be obtained from your PBC Consortia.

Dr I Camphor
Medical Secretary



Appendix 1

REFERRAL LETTERS FROM ACUTE TRUSTS TO GP PRACTICES IN ENGLAND


The GPC has received a series of complaints in recent months from GPs and LMCs concerning the procedures adopted by acute trusts when dealing with referrals letters from GPs. The most common complaint is that trusts address all referral correspondence to the senior partner of a practice, rather then the referring GP.

This policy impedes administration within practices and can, potentially, compromise clinical safety. In addition, it would appear to run counter to the government’s policy of improving services and putting patients first.

The Department of Health’s guidance below is explicit:

Hospital letters to referring clinicians.

This is to remind relevant provider trusts and agencies of recommendations endorsed by the Department of Health, NHS Connecting for Health and the General Medical Council in respect of addressing return letters to GP Practices and referring Clinicians.

It is currently viewed as 'best practice' for hospital and provider organisations to ensure that internal systems address return correspondence to the referring clinician. This will ensure patient safety, patient choice and continuity of care, together with the recognition of custom and practice in Primary Care to appropriately process incoming communications with maximum efficiency and safety .

Further information can be found in the Data Set Change Notice DSC 3/2008, issued by the Information Standards Board for Health & Social Care, at the URL below. Please see the annex to this guidance for specific details.

www.connectingforhealth.nhs.uk/dscn/dscn-2008/data-set-change-1/dscn03-2008.pdf

In addition, legal advice received by the GPC indicates that if a hospital deliberately writes only to a senior partner who may not be involved in a patient's care, this will result in making the patient's personal data available to someone who is not entitled to see it in a manner that the patient will not have expected, or consented to. This would constitute unfair processing under the terms of the Data Protection Act. In the event that a trust does not comply with requests to address letters to the referring GP, practices should formally complain in writing to the trust’s CEO and Medical Director with copies to the CEO of their PCO. If there is still no appropriate response, practices should consider making a complaint to the Information Commissioner.




ANNEX

DSC 3/2008, General Practice and General Medical Practitioner (GMP) - changes resulting from the introduction of the General Medical Services (GMS) Contract.

Page 18, Paragraph 2.1

General Medical Practitioner (Specified)

It is a mandatory requirement that this data item is available to be recorded, if required, so as to maintain the above GMC position and continuity of patient care. By definition, General Medical Practitioner (Specified) is restricted to a member of the General Medical Practice Code (Patient Registration).

The guidance for completion of the data item “General Medical Practitioner (Specified)”, if required to be completed for local processing, is as follows:

4. Where a patient is referred to secondary services by an identifiable GMP from within the Registered GP Practice then that GMP should be recorded as General Medical Practitioner (Specified) appropriate for the current patient contact event

5. Otherwise, if the patient - or the patient's representative – offers the name of an identifiable GMP then that GMP should be recorded as the General Medical Practitioner (Specified) appropriate for the current patient contact event

6. If neither of the above points applies, and a named GMP is required (ie for downstream systems), then the General Medical Practitioner (Specified) can be derived by a standardised algorithm until such time as the patient can offer a named GMP.

A suggested standardised algorithm is as follows:

I. The referring GP (as above).

II. The GP nominated by the patient (as above).

III. The GP previously nominated as “Registered” in a local system, provided that the GP is still at the General Medical Practice Code (Patient Registration).

IV. The GP nominated as the pooled list holder, if applicable, and recorded by local agreement between primary and secondary care.

V. The lead GP in the Practice (available from NACS).

VI. Any GP in the Practice (available from NACS and SDS)

The above algorithm is provided for guidance only and system suppliers should agree with their system users the best way to implement this to fit with local business needs. Please note that, as stated in the exclusions section, the use of this data item does not affect in any way the data elements, definitions and requirements currently in place to record GMP Referrer.

March 2009

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