Hot Topics No 7

Hot Topics 07
02 February, 2010

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.

NO.7 – 2009/10



The agreement for the 2010/11 GP contract in England will mean relative stability for family Doctors.

The agreement will see a continuation of the Extended Hours Access DES (Directed Enhanced Service) and clinical DESs designed to improve care for patients with learning disabilities, osteoporosis and problems with alcohol misuse.

The ethnicity DES, which rewards Practices for recording a patient’s ethnicity and first language, will also continue under the new contract.

GP Practices will need to tell PCTs whether they want to continue or take up the Extended Hours Access DES, which was introduced in 2008/09.

The four clinical DESs will be based on the existing 2009/10 thresholds for achievement.

The Department of Health is drafting guidance on extended hours and NHSE is expected to publish an updated version of the clinical DES guidance shortly.



The LMC have recently been made aware that from 1 February 2010, Orthopaedic Referrals can only be made via Choose & Book to Warrington OCATS. The LMC have raised the possible implications of this with the PCT and have asked for a robust, alternative pathway should the Choose & Book computer system not work. The LMC have been given assurances that Warrington PCT will be looking into this. The LMC will keep you informed of any further developments.


The LMC understands that the CVD LES which is being widely used in neighbouring PCTs to screen patients for potential risk of cardiovascular disease is not going to be rolled out as a formal LES in Warrington. Our understanding is that one Practice and an Equitable Access Practice will be piloting a much abridged form of this screening in their Practices. The LMC has voiced its concern regarding workload issues and implications on referral and prescribing patterns. These discussions are ongoing and we will keep you updated of the outcome.


The LMC have formally met with Warrington PCT to discuss the recent survey that it undertook on behalf of GPs regarding the state of Health Visitors in Primary Care.
We would like to thank you for your co-operation in this survey which highlighted some very important issues and concerns. These were shared with the PCT who have promised to take our concerns and issues on board and, indeed, we are given to understand that they are trying to implement policies which would help improve health visiting in Warrington. If you continue to have concerns regarding health visiting, please feel free to contact Joan at the LMC office on 01744 28588 or e-mail This email address is being protected from spambots. You need JavaScript enabled to view it.



The LMC in its recent meeting with the PCT discussed the recent highly successful survey of General Practice regarding issues with Health Visitors. The LMC found the PCT to be helpful and supportive regarding concerns raised by GPs. Our understanding is that Mike Ore has drawn up an action list which, we understand, will be distributed to Primary Care subject to formal approval by the LMC. The initial draft document looks comprehensive and we believe supportive of Primary Care.


It has come to the LMC’s attention that GPs are experiencing some problems when admitting young female patients under surgery. Our understanding is that this is being dealt with through appropriate channels. Should any of you encounter any further problems with surgical admissions, please feel free to contact Joan at the LMC office on 01744 28588 or e-mail This email address is being protected from spambots. You need JavaScript enabled to view it.



The LMC understands that the under 5s Swine Flu LES is working well and the uptake has been above average. The LMC would like to thank GPs, Nurses and Staff for their help and co-operation.



GPC has worked with NHSE over several months to try to create an emergency SFE (eSFE) in case the flu pandemic becomes severe enough to necessitate a suspension of normal workload. The prospect of introducing an eSFE designed for income protection has always had a range of drawbacks and operational difficulties; for example Practices would not have improvements in DESs or QOF reflected in their payments under an eSFE and neighbouring Practices would almost certainly need to move to an eSFE together regardless of how they experience the pandemic.

Progress on creating an eSFE for 2009/10 has now stalled because of legal and political obstacles which cannot currently be overcome in a mutually acceptable way. Most of these problems are unique to 2009/10 and would be surmountable in future years.

We believe the best course of action now is to focus on constructing an eSFE that could be used from 2010/11 onwards if necessary. We appreciate that there have been pockets of real difficulty across the UK this year during the pandemic but we hope that our decision to put on hold this work now will be understood in the context of the currently mild pandemic. In the unlikely event that the pandemic suddenly worsens before April 2010, we believe we have done enough work on the eSFE to date to resurrect it rapidly.

The licence for Pandemrix has now been amended to allow one dose (0.25ml) in children. Patients who are immunocompetent and who have already received one dose of the vaccine do not need a second dose even if this has already been scheduled. Immunocompromised individuals should still receive a second dose as scheduled. Read more about this in the letter by Professor Salisbury.


The second edition of the joint GPC/RCGP/DH pandemic influenza guidance for GP Practices, specific to swine flu (H1N1), was published last week. The original guidance, published in January 2009, was designed to help General Practice plan for the possibility of having to work during a severe pandemic, such as avian flu. The updated guidance has been reviewed to take into account this year’s swine flu outbreak and the guidance relating to it that has been published. The guidance is available on the BMA website.


The DH has published revised versions of the Pandemic H1N1 2009 influenza; Clinical management guidelines for adults and children. The change is in paragraph 5 on page 9, which has been extended to define what 'high dose' means in the context of this document.

The DH has also updated the Pandemic H1N1 2009 influenza: Clinical management guidelines for pregnancy. There are two changes: a footnote has been added to paragraph 5 on page 17 reflecting the different requirements of the abortion legislation in England and Northern Ireland; they have also added a new paragraph 5 on page 19 to deal with the outcome of the ORACLE study which implicated co-amoxiclav with necrotising enterocolitis in preterm rupture of membranes.


In October 2009, we were notified that some local Registrars of Death were requesting unnecessary information from GP Practices because of a misunderstanding about the implications of the new GMC licence to practise - for example, Practices were asked to supply the names of GPs who were licensed to sign Death Certificates, together with their GMC registration, their GMC licensing number and details of their qualifications allowing them to sign the forms.

We took this up with the GMC licensing team. As a result, the GMC has clarified the situation with the General Registrar Office as well as updating its FAQ website advice.

We can confirm that there will be no GMC licence number and there will be no further qualifications required of a GP to sign a Death Certificate. With the introduction of the licence to practise in November 2009, Registrars need to check that the Doctor signing a Death Certificate is licensed with the GMC at the time of signing the form. There should not be a need to supply information to the Registrar prior to completing the form (particularly as the information could be out of date if supplied in advance). However, it would be helpful to Registrars if GPs could include their GMC number on Death Certificates so that it is easier for the Registrars to do the necessary checks.


Version 16 of the Business Rules has now been published and is available on the NHS PCC website.

Please note that for the QOF CVD PP1 indicator (Cardiovascular disease - primary prevention 1), the Business Rules have been amended to exclude patients under 35 years of age from indicator PP1. The age range for this indicator is now set as 30-74 years. Patients outside this age range should still be individually assessed and their risks reduced, although risk equations do not apply and thresholds for reductions are not currently available. PP2 applies to all age groups, as do the blood pressure control indicators in the hypertension set.


GPC members discussed the RCGP's CPD guide, which is available on the RCGP website. The committee will be feeding back to the RCGP to emphasise the need for greater flexibility in the scheme in catering for the learning styles of individual GPs, and to highlight concerns around the concept of ‘impact’ for locum and out-of-hours GPs.


The Care Quality Commission (QC) is currently consulting on the registration fees to be charged to NHS trusts. We will be responding that no fee should be payable by NHS bodies or those providing NHS services (eg GP Practices). While this consultation does not directly refer to GP Practices, the CQC aims to consult later on charges to GP Practices. We are therefore using our response as an opportunity to state that NHS GP Practices should not be charged a registration fee.


In the past many GPs signed up to a Med1web form from NovaChannel AG under the misapprehension that the form offered a free listings service. However, in the small print there was a clause that this service was chargeable, and many GPs are now being pursued for payment for signing up to the form.

NovaChannel AG was a Swiss registered Company, and its practices were being investigated by the Swiss Office of Fair Trading. We previously wrote to the Swiss Embassy and issued advice to Practices based on their response. However, NovaChannel AG has now ceased trading from Switzerland, and we had heard that payment for the Med1web forms was now being pursued by United Lda (a Portuguese Company). We have therefore also written to the Portuguese Embassy for their views. However, in the meantime, we are aware of one Doctor who has recently received a letter from United Lda notifying him that they had reviewed his file and that, because he is not an independent Doctor, they have deleted his particulars from the directory and that the contract is null and void. We therefore advise all NHS GPs who unwittingly signed up to the Med1web form to contact United Lda asking for their details to the removed from its directory and for any contract to be terminated. United Lda's address is: PO Box 1571, 1056-001 Lisbon, Portugal or email: This email address is being protected from spambots. You need JavaScript enabled to view it..


The National Pharmacy Association (NPA) and The Centre for Pharmacy Postgraduate Education (CPPE) have launched a package of workshop material, 'Communicating Locally', designed to help GPs, trainee GPs and community pharmacists to improve how they communicate with their pharmacist or GP colleagues. The Clinical and Prescribing subcommittee of the GPC was involved in the development of these resources, which aim to help attendees to become more confident when communicating with other members of the healthcare team in discussions relating to patient-centred care.

The resources are available to anyone who wishes to use them. It is envisaged that workshops will be initiated by PCTs (with a GP and pharmacist appointed as joint facilitators) or run jointly by Local Medical Committees and Local Pharmaceutical Committees.

The resource is available from and


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.

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 see the BMA website.

Dr I Camphor
Medical Secretary

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