Hot Topics No 3

Hot Topics 

The Gables Cowley Hill Lane St Helens Merseyside WA10 2AP
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NO.3 – 2009/10



A meeting has been held between the GPC, the Medical Defence Union (MDU) and the Medical Protection Society (MPS) to clarify whether GPs working in any primary care role, in their usual place of work or in a position to which they have been transferred, would continue to receive full protection of the above Medical Defence Unions (MDOs) and the MDDUS. The MDOs appreciate that the extra demands on GP services as a result of pandemic flu may impact upon the ability of GPs to carry out work to non-pandemic standards and acknowledge that during the pandemic, GPs may have to provide care to very ill patients in the community who would have been admitted to hospital under normal conditions.

GPs transferred to non-primary care roles will be subject to NHSLA indemnity. In such situations, GPs should be provided with written evidence by their contracting body confirming that they have been commissioned to provide services on its behalf. GPs must also continue to remain members of their ordinary MDO.

It will be the responsibility of the employers of retired GPs to provide them with indemnity cover. It is planned that PCOs will employ retired GPs in roles supporting currently working GPs, and that they will therefore be covered under NHSLA indemnity. For this reason, it is strongly advised that individual GPs do not employ retired GPs themselves, as they will be liable for provision of their indemnity.

The MDOs have provided guidance on their websites confirming the above arrangements:

• Guidance on the MDU website.
• Guidance on the MPS website.
• Guidance on the MDDUS website.

The GPC is seeking a written statement from the DH supporting the imposition of NHSLA indemnity for GPs working outside of primary care settings and for retired GPs employed by PCOs.


The Department of Health (DH) has started distributing special antiviral vouchers to PCTs which will be used to prescribe the antivirals Tamiflu and Relenza free of charge. The DH is proposing to amend the GMS regulations accordingly, on which the GPC currently is seeking clarification.


Earlier this week, the BMA spoke to both BA and Virgin about the provision of fitness to fly notes.
GPs will not be asked to provide fitness to fly notes.

They have made their staff aware of the swine flu situation and have given them broad instructions on how to spot possible symptoms. This is standard practice - they issued similar guidance during the SARs incident. If their staff have concerns, they can refer the passenger to their on site medical service – Medlink – who will then assess, in co-operation with the patient, their fitness to fly. If they are not regarded as fit, they won't be allowed to fly and will be asked to ring the NHS flu line or go on line to the symptom checker and then follow the normal advice for people who suspect they have swine flu.

Virgin and BA are not saying that fit notes will need to be issued for all patients and they do not believe that a passenger's GP needs to be involved at any stage of this process.


The process used by General Practitioners to document their advice on fitness for work to patients with a health condition and the forms they use have remained largely unchanged since the foundation of the NHS. The DWP is currently consulting on proposed changes to this process. The draft regulations apply to England, Scotland and Wales.

To read the consultation document please visit the DWP website.

The DWP is welcoming responses from anyone with an interest.


The British Association for Adoption & Fostering (BAAF) has launched a new campaign which is aimed at health care professionals. The campaign is called Somebody Else’s Child and is concerned with private fostering. This is an arrangement for 28 day or more, which is when children are cared for by someone other than a close relative. By law, parents and carers must notify their local authority before entering into these arrangements, but sadly many don’t.

There are an estimated 10,000 children living in private fostering arrangements in England and Wales, but last year only just over 1,500 notifications made with local Authorities. While most of these children will be safe, others may be at risk of abuse and neglect at the hands of their private foster carers. Without Social Services intervention, this could go on for years.

Although the legal responsibility lies with the parent and the carer, the campaign is urging anyone who works with children to play their part. If you know of a child living with someone who isn’t a direct relative, for 28 days or more, then please don’t ignore it. You should either speak to the child’s carer, if appropriate, or inform your local Social Services. Keeping children safe is the responsibility of the whole community.

For more information visit the campaign website.


The LMC has received two dozen CD-ROMs regarding Practice Based Commissioning and the Improving Access to Psychological Therapies programme to be distributed to Practices on a first come first served basis. Please contact the LMC office if you wish to receive a copy.

The Department of Health has provided this CD-ROM, which contains a number of documents about how the IAPT programme works, as well as a business case for those interested in commissioning the service. The disk contains useful information about how to use practice based commissioning to maximise the potential benefit of the IAPT programme and strong evidence of the effectiveness of the service in treating people with long term conditions and medically unexplained symptoms, as well as in treating the common mental health conditions of depression and anxiety disorders. The involvement of General Practitioners is central to the development of the new services. For further information, please go to the IAPT website or contact the Primary Care Lead, Dr Alan Cohen.


Due to a misunderstanding, the LMC were mistakenly informed that the BMA Advisory Service (EAS) are providing a service drawing up Partnership Contracts for a one off fee of £200 and this was duly reported in issue No 2 of Hot Topics.

The EAS have now clarified the situation and the correct price is £1500 plus VAT.
Some GP clinical systems include functionality that allows a GP to restrict access to elements of patients’ electronic health records to different levels of user within the Practice. This functionality is not consistent across systems and any data that is hidden is likely to be revealed when the patient record is transferred to another GP clinical system. This can happen when a patient’s record is transferred to another Practice via traditional paper record transfer or GP2GP or following a data migration to another GP clinical system in the Practice.
GPs are therefore advised to inform patients, who want elements of their electronic health record to be kept confidential, that the information is not likely to remain hidden when the record is transferred to another system, either electronically or via paper transfer.
It has become apparent that there are some serious problems with the results of this year’s patient survey, in particular because they seemed to be based on small response rates. The GPC debated this and is very concerned that problems similar to those in Scotland have been reported in England and in the other nations. Some Practices may have their results and therefore some QOF points and a significant amount of funding determined by a very small proportion of their total Practice population. It is quite possible that Practices will receive a good response rate to the survey as a whole, but low levels of response to one or both of the key access questions. It seems that this is a particular problem with the PE8 questions on advanced booking.
Following discussions between the GPC and the Department of Health and NHS Employers to seek to resolve this issue, The DoH has issued further guidance to PCTs regarding the QOF patient experience indicators. The important paragraph reads:
We have clarified in previous guidance that there remains provision for PCTs to make discretionary local payments where this is beneficial to the delivery of services and there is an absence of a survey result or where the result is very low for an individual Practice and the PCT can reasonably be assured by other evidence that achieved survey results may be ‘unduly skewed’ from the limited response an individual Practice received. In these circumstances, PCTs will need to be satisfied that

The survey result is substantially lower and different than that of previous years, and

The Practice can provide clear evidence that they routinely provide arrangements that consistently offer 48 hour and advanced booking access, backed up by evidence from patient participation groups or local surveys. This evidence must be clear and auditable to demonstrate that decisions reached are fair and justified.
The Practices concerned should by now have submitted an appeal to their PCTs who are convening panels to decide the outcome of these appeals. The appeal period is from 1 July 2009 for 6 weeks in which GPs and Practices can appeal in Halton and St Helens and we understand that a similar policy is being developed in Warrington.
In order to be eligible to lodge an appeal, Practices must meet both of the following criteria:-
1. The confidence interval for PE7 and/or PE8 must be greater than 7 percent and;

2. The survey result for 2008/09 is substantially lower and different than that of previous years. Compared to 2007/08 and 2006/07, has the % achievement against the survey reduced by equal to or greater than 10%?

The GPC is getting reports from all across the country that GPs are authorising the use of oseltamivir solution for adults and children who are not able to swallow capsules.
The advice is that GPs should be advising the emptying of the appropriate strength capsules onto something palatable and NOT prescribing the solution.
Oseltamivir Solution must be limited for use in children under 1.
This is causing an unprecedented demand for the solution and if we continue to use this strategy, we will run out of solution for babies under 1.
Can we please get the message across to everyone urgently that the solution should ONLY be used for kids under 1.
Children or adults who are not able to swallow capsules are asked to empty the contents of the capsules.
PCTs have been provided with templates for labels and these clearly state that the contents of the capsules can be emptied into a sweet, sugary solution.


There are training budgets available for all Practices in Halton and St Helens. We would advise GPs/Practice Managers to ensure they use their budget within the year.

Dr I Camphor
Medical Secretary

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