Hot topics No 5

Hot topics

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.5 – 2009/10

• LOCAL ISSUES

KNOWSLEY

• SEXUAL HEALTH LES

Please look carefully at the terms of the new Sexual Health LES. The long term contraception section has not been uplifted for inflation. The Chlamydia screening section contains a complicated table suggesting remuneration could go up to £15 per patient or drop from the current £10 per patient to as low as £2 per patient. The performance of other Practices determines the rate of remuneration. Also, there is a requirement to sign up to the “You’re Welcome” accreditation, an onerous process which is not remunerated.

It is up to individual Practices to decide whether they wish to sign up to this LES.

• HOME TO SCHOOL TRANSPORT

Following recent discussions between the LMC and the PCT, a letter from the PCT is imminent. It will explain that GPs will no longer be required to give an opinion, just state facts.

• SWINE FLU LES

The Swine Flu LES was agreed in principle by the LMC, however, due to the urgency of getting this out to GP Practices, it was agreed that the LMC Executive would agree the detail of the LES prior to its being sent out to Practices.

HALTON & ST HELENS

LOCAL ENHANCED SERVICES

• QOF PLUS SCHEME LES

The LMC noted with disappointment that this LES had been rolled out to Practices prior to it being presented to the LMC. An appropriate letter has been sent to the PCT indicating that, in future, LESs should be presented to the LMC prior to circulation to GP Practices.

• CARERS LES

This was approved by the LMC.

• HEALTH CHECK LES

This LES was discussed by the LMC, however, as there were some issues around patient confidentiality, it was deferred to the next LMC meeting.

• GRAPHNET

The LMC IT Sub-Committee is working with the PCT to develop a system to permit a summary of the GP records, with appropriate disclaimers, being available to our hospital colleagues (and, in due course, vice versa). Practices will need to sign the Graphnet agreements to facilitate this. The LMC IT Sub-Committee will be looking with the PCT at what information would be reasonable to be made available. This is work in progress. We will keep you informed as further information comes to hand.

• PRACTICE REVIEWS

The PCT have informed us that many of the Practices have now returned their workbooks. We would like to encourage those who have not returned their workbooks to do so at the earliest opportunity. If you are having problems completing the workbook, please contact Lisa Barcroft-Lee and her team at the PCT who will be only too willing to help.


WARRINGTON

LOCAL ENHANCED SERVICES

• CHLAMYDIA LES

As with all LESs in Warrington, there is no more money on offer. Therefore, it is up to GPs to decide whether to participate or not.

• SMOKING LES

The PCT have confirmed that they will buy the CO2 monitors.

• CDR INTELL

The PCT have indicated that there will not be a LES for this.

• OTHER ISSUES

• THE CAMERON FUND

The Cameron Fund is the only medical charity which provides help and support solely to General Practitioners and their dependants.
It aims to meet needs that vary considerably from the elderly in Nursing Homes to young, chronically sick Doctors and their families and those suffering from unexpected and unpredictable problems such as relationship breakdown or financial difficulties following the actions of professional regulatory bodies.

Anyone who knows of someone experiencing difficulties, hardship or distress is urged to draw attention to the Cameron Fund’s existence or alternatively to contact Jane Cope, the Services Manager on:

E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
Tel: 020 7388 0796
Address: Tavistock House North, Tavistock Square, London, WC1H 9HR

• TRAVAX

Halton & St Helens PCT pays for a subscription for all GPs and Practice Nurses to access a travel medicine database called Travax.

http://www.travax.nhs.uk
User name: homas81072 Password: 413-703

• DEATH IN SERVICE BENEFITS FOR LOCUM GPS

The Department of Health recently wrote to PCTs with guidance on how locum GPs should be protected for death in service benefits during the flu pandemic. GPC representatives have been informed that PCTs would have to find the necessary funding to enact this guidance. The GPC will be urging the Department of Health to ensure that this occurs, and will suggest that further guidance is issued to PCTs on appropriate locum agreements.

• SEALING ELECTRONIC RECORDS AND GP2GP TRANSFER

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 are hidden are 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.

• DVLA - CONSENT FOR THE RELEASE OF RELEVANT MEDICAL INFORMATION FOR PATIENTS

On Monday, 17 August 2009, new rules called Consent by Assurance were implemented by the DVLA relating to the release of relevant medical information for patients applying for driving licences.

The BMA has given agreement that the DVLA no longer needs to provide the patient’s written consent for access to the relevant parts of their records for the purposes of being granted a driving licence. The documents in Appendix 1 explain the new rules to GPs and to driving licence applicants.

This agreement might generate concerns amongst GPs about patient confidentiality. The GMC website has a frequently asked questions supplement to their confidentiality guidance and one query advises that doctors should:

“Obtain, or have seen, written consent to the disclosure from the patient or a person properly authorised to act on the patient’s behalf. You may, however, accept written assurances from an officer of a government department that the patient’s written consent has been given.”

The BMA has taken legal advice about a system of accepting such assurances from a government department, and received written assurances from the DVLA, in the form of a written legal indemnity.

• INTRODUCING THE LICENCE TO PRACTISE IN 2009

The GMC is introducing the licence to practise on 16 November 2009. From this date any Doctor wishing to practise medicine in the UK will, by law, need to hold both registration and a licence to practise.

More information about licensing is available on the GMC’s website and if you have any questions about licensing, please email This email address is being protected from spambots. You need JavaScript enabled to view it..

• ABOLITION OF PRACTICE BOUNDARIES

Although there have been no details following Andy Burham's proposal to abolish practice boundaries, the GPC and the task-orientated subcommittees are considering the concept in detail so that the committee is in a position to respond effectively should the Department of Health seek to pursue this idea.

• REPLACEMENT FOR QMAS - QUALITY MANAGEMENT ANALYSIS SYSTEM

The Department of Health and NHS Connecting for Health are currently considering replacing the Quality Management Analysis System (QMAS) with a more flexible calculating and reporting system. DH and CfH are looking to extend the payments supported beyond QOF to the following:

• the Quality and Outcomes Framework (the national QOF)
• quality indicators recommended by NICE that are not negotiated into the national QOF
• most directed enhanced services (DES)
• local enhanced services (LES) that work in the same way as the other payments that are
supported by the new system.

DH and CfH are asking for the views of frontline staff, such as practising GPs, practice managers and PCT staff. The results of the consultation will be reviewed by representative groups such as the GPC and the RCGP.

To participate in the survey, which is running during October, go to the Connecting for Health website.



• SWINE FLU

The GPC is in the process of signing off SFE amendments, Directions and guidance related to the vaccinations DES. It will also be publishing its own FAQ document in the near future. We hope these documents will be finalised before the vaccination campaign begins in earnest. In the mean time, we recommend that GPs go ahead and start vaccinating once they have received the first delivery of vaccines.

Vaccination by district nurses and definition of housebound:

Following reports from LMCs that some PCTs are claiming that district nurses (DNs) will only be immunising swine flu vaccine to housebound patients already on their case load list and that GPs would not get paid for this, Ian Dalton (National Director of Flu Resilience) has acknowledged that there has been some local misunderstanding about this issue, and that GPs will definitely receive payments for vaccinations done by DNs. It is for GPs to decide who is on the housebound list and DNs will be responsible for administering the vaccination to all patients on that list.

GPs will be paid £5.25 for every H1N1 vaccination given to clinically at-risk patients on their registered list, regardless of who administers it. District nurses will not be allowed to charge GPs for their time.

There has been some debate about the definition of housebound. This will be clarified in the Directions and guidance, but housebound patients are those to whom a contractor would normally offer home visits as the only practical means of enabling a face to face consultation.
In the meantime please see Ian Dalton’s letter dated 22 October attached at Appendix 2.

Final details of these issues will be in the vaccination DES.

H1N1 vaccination for locums:

Locum GPs are frontline health workers but are unlikely to be offered H1N1 vaccination by occupational health services. We suggest that in the first instance they contact the practice with whom they are registered and request they are included in the list of patients to be vaccinated. The practice will not receive a fee for vaccinating locum GPs and no charge should be made to the locum for this service.
Alternatively locums may wish to ask a practice in which they are working to be vaccinated if supplies are available. Similarly the practice will not receive a fee for vaccinating a locum and no charge should be made to the locum for the service.
The medical defence organisations have confirmed that GPs are covered to vaccinate individuals who are not registered with them. It is important to ensure that when a locum is vaccinated by a practice they are not registered with, their registered GP is informed.
GPC encourages practices to provide this service to locum colleagues to ensure they are able to access H1N1 v
H1N1 vaccinations administered by GP staff vaccination.
The DH has confirmed that, as with other vaccinations delivered in general practice, GPs can delegate responsibility to carry out the H1N1 vaccinations to any appropriately trained person [including practice nurses and healthcare assistants (HCAs)]. The GP takes overall responsibility for the procedure as a prescriber.
As long as the GP is content with the health professional’s competence to vaccinate and has a written practice protocol in place, they can delegate responsibility for the procedure to them - they are acting as the GP’s agents/employees and the GP carries the medico-legal responsibility.
Patient group directives (PGDs) are not required when a practice is treating its own registered patients, however many practices find it useful to use PGDs as a protocol for their nurses to perform certain procedures. PGDs are necessary only when a non-prescriber is performing the procedure and there is no individual with prescribing authority taking overall responsibility for the procedure.
The DH is planning to publish PGD and patient specific directions (PSD) templates on their website shortly.
H1N1 vaccinations and Hajj pilgrims
The Saudi Embassy advises that ‘Incoming travellers for Hajj from all countries must provide a valid certificate of vaccination at least 2 weeks old against Swine flu (H1N1) A before acquiring a Hajj Visa, if it is universally available'. As this is not currently the case, with only the at-risk groups and health care professionals being vaccinated, it is our understanding that Hajj pilgrims will not be asked for a certificate of vaccination, but may be screened for high temperature on arrival. Further advice about this is available on the Saudi Embassy and RCGP websites, and this issue has also been sent to GP flu operations group (GP FLOG) for further clarification.
• Saudi Embassy website.
• RCGP advice online.











Appendix 1

IN PROFESSIONAL CONFIDENCE Driver and Vehicle Licensing Agency
Drivers Medical Group
Swansea SA99 1TU
Phone: 0870 241 1875 Fax: 0845 850 0095
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Website: www.direct.gov.uk/driverhealth
Driver No:
Our Reference:
Date:

Dear Dr xxxxxxxxxx
RE: Xxxxxxxxxxxxxxxxxxxxxx DOB: xxxxxxxxxxxxxxxxx
ADDRESS: Xxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Please fill in the enclosed medical questionnaire and return it in the envelope provided. The medical condition of # has been declared.

There is no need for you to see your patient to fill in the questionnaire as this can be done from their notes. If this questionnaire does not allow you to give sufficient details, please also send any relevant hospital notes or a letter providing the information.

The BMA has given agreement that DVLA no longer need to provide the patients written consent. Therefore, as an officer of the Government I offer my assurance that your patient has provided the department with their consent to disclosure of this information, sight of which is available on request.

To avoid delays, if you are unable to return the questionnaire for any reason, within the next 21 days, could you let us know either by phone, fax or e-mail.
We will pay £39.00 when we get the questionnaire and invoice. If you are VAT registered we will pay the fee plus VAT at the standard rate on receipt of a VAT invoice which should be sent with the filled in questionnaire.

Please note that your patient can request copies of any medical documents which are held at DVLA unless is specified in writing that releasing this information could cause serious harm to your patient.

Your patient may be entitled to drive whilst we are awaiting your reply and this might have an impact on road safety.
Rev Aug 09
Yours sincerely,


IN PROFESSIONAL CONFIDENCE Driver and Vehicle Licensing Agency
Drivers Medical Group
Swansea SA99 1TU
Phone: 0870 600 0301 Fax: 0845 850 0095
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Website: www.direct.gov.uk/driverhealth
Driver No:
Our Reference:
Date:

Dear Dr xxxxxxxxxxx

I refer to our previous request for information about the above patient's medical condition relevant to their fitness to drive.

You have requested sight of the patient's written consent for the disclosure of this information, a copy of which is now enclosed together with a copy of our original request.

A prompt reply would be appreciated so that the licence can be processed quickly. I therefore enclose a pre-paid envelope.
Rev Aug 09

Yours sincerely,
xxxxxxxxxxxxxxxxxxxxxxx









APPENDIX 2




TO:
All SHA Flu Lead Directors

CC:
Laurence Buckman Richmond House
79 Whitehall
London
SW1A 2NS
020 7210 4850
This email address is being protected from spambots. You need JavaScript enabled to view it.

22 October 2009
Dear Colleague,

Vaccinating Housebound patients

I wanted to take the opportunity to clarify the arrangements for vaccinating housebound patients,

Under the agreement with the BMA's General Practitioners Committee on the
swine flu (H1N1) vaccination programme district nurses will vaccinate all
housebound patients, in line with seasonal flu vaccination arrangements.

A housebound patient is defined as a patient to whom the practice normally
offers home visits as this is the only practical means of enabling the
patient a face to face consultation with a general practitioner.

If a patient is in a care home and is registered with a GP practice that
would normally visit the patient in the care home then that patient is
included in the practice's list of housebound patients.

Practices can claim £5.25 for each dose of vaccine administered to
housebound patients who are both on their registered list and fall into one
of the priority groups defined by the Joint Committee on Vaccinations and
Immunisations (JCVI).

I should be grateful if you could ensure that your PCTs and other colleagues are made aware of this immediately, as I am aware that some PCTs have suggested that they would refuse payments to GPs in these circumstances, and that is clearly something we need to prevent happening.

I am also copying this letter to the BMA.

Yours sincerely,

Ian Dalton
National Director of NHS Flu Resilience
Department of Health



Dr Ivan Camphor
Mrs Joan Wick

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