Newsletter December 2002 |
New GP Contract The current timetable for the new GP contract states that the contract will be published and posted on the 10th January 2003. The LMC secretaries and chairmen will be going down to a conference on that day to gain as much information as possible. Shortly afterwards regional meetings will be arranged to allow further broad discussion of the proposed new contract. There will be an open meeting for Glasgow GPs on Thursday 23rd January 2003 at 7.00pm in the Kerrydale Suite, Celtic Football Club. GPs from other parts of the West of Scotland will also be invited. Hopefully as many GPs as possible will be able to attend that meeting as it is at a critical time prior to the subsequent vote. A vote regarding the acceptance or rejection of the contract will take place in February. Obviously the recent rejection by consultants of their proposed new contract has placed an even sharper focus on the need to produce a satisfactory GP contract for possible implementation from the 1st of April 2003. Chronic Disease Management By now you should all be aware of the disease areas which you are able to undertake up to April 2003 and from 2003 to 2004. The ever increasing cost of improving IT in general practices in order to provide CDM has, once again, slowed down the roll-out of clinical activity. This has obviously led to some disappointment in that roll-out of the actual clinical work to patients is being delayed in a number of areas. 48 Hour Access This continues to be a high politically driven priority. As you know we have in the past co-operated with the PCT in addressing this political pressure by carrying out an initial survey on the availability of appointments. There have been many questions raised about the validity or worth of the previous survey and we considered whether it would be worthwhile continuing. However, we have suggested that we will co-operate as it was thought that another survey would be more meaningful in determining how much resource would be required for practices to be able to offer 48 hour access. To this end, we have therefore suggested that the next survey looks at the 3rd available appointment, which is a better measure of true availability. We would also point out that participating in this survey is purely voluntary. However, should you decide to take part, we would ask practices to be painfully honest when replying to this survey as it is an attempt to get a real picture of appointment availability and what we would have to do to provide improved access. We have considered that if this survey continues to fail to provide adequate information, we would suggest a more detailed and 'piloting' approach. Practice Pharmacy Support LHCCs have recently agreed to increasing the resources used to provide pharmacists to come into practices. The Audit Commission report that showed that there was potential for more cost effective prescribing to release funds in primary care, is always brought up whenever we look for funds for primary care. This increased resourcing of pharmacists to address these issues in practices, allows primary care to say that we are doing something about it. Your practice may be offered further pharmacy support or you may ask for it through your LHCC. The National UK LMC Conference This will take place on Thursday 12th and Friday 13th (not an omen we hope!) June 2003 and up to 6 Glasgow delegates will be attending conference. The Scottish conference will be held on 23rd April 2003 in Clydebank at which we hope to have a full complement of 14 delegates. GP Bag Sharps Boxes We are pleased to be able to say that we have worked out a method by which you can obtain sharps boxes which are of a small enough size to fit in your GP bag. With the help of Margaret Johnstone, Principal Pharmacist at the Community Pharmacy, the community pharmacy will stock sharps boxes of the 300 ml size, which proved most popular in a recent poll of forty GPs. Its dimensions are 12 cm by 10 cm by 5 cm. It is suitable for 5 ml syringes and needles but is unfortunately not suitable for vacutainer barrels nor to remove their needles. It can be ordered from the community pharmacy either by adding a request saying "GPs yellow sharps" at the bottom of the child immunisation form. Otherwise please send headed notepaper from your practice to the community pharmacy. Obviously we do not know how many people will request these and the pharmacy will do its best to provide them as soon as possible. If you have requirements for a different size of sharps box, it may be possible to provide other sizes. We have yet to clarify how it is best to dispose of these sharps boxes. However, I will point out that they will fit neatly into the base of a previously unused surgery sharps box. Travel Jags and Fees Dr Levy from Bearsden recently pointed out that some of our advice on asking for fees for travel vaccinations was a bit 'rusty'. His practice manager Mrs Anne Downie, pointed out to us a previous edition from May 2002 of the Glasgow Prescriber from our Prescribing Advisory Team, which provides a succinct and clear advice about this. We hope to provide a link on our web-site to this edition of the Glasgow Prescriber failing that, with the Prescribing Team's permission, a copy of that issue for ease of access. Ambulance Services You will have had the letter from the Scottish Ambulance Service outlining the introduction of the AMPDS System for priority dispatch of 999 ambulances. We would like to point out that this applies only to calls which are made using 999. Obviously this will involve all patients but could also involve the GP or staff when they phone 999 in order to access an immediate response. It is still recommended that you use 999 when you would like an immediate response from the ambulance service, particularly with paramedics. The intention of this is to provide a response to you within 8 minutes. Obviously this level of response is saved for immediately life threatening situations. The ambulance will be dispatched immediately the address and details are given to the ambulance dispatchers. The ambulance dispatcher will then ask some questions, whilst the ambulance is already on its way, so that further information can be provided to the ambulance crew prior to their arrival. The current arrangements for doctors to request other urgent ambulances remains in place. It is very important to tell patients the timescale within which you have requested the ambulance. It is also important to be explicit that should their condition deteriorate, they can dial 999 and their call will be reprioritised accordingly. Negotiations are beginning regarding categories and response times for our GP urgent calls and we will let you know, when and if these are changed. There is a significant increase in resources to ambulance services in order to operate the priority dispatching system. Correct use of the system will hopefully ensure that an appropriate response by the ambulance service is available to all those patients who need it. Parking Permits for GPs If we can remind you that all GPs in Glasgow are entitled to a apply for a Glasgow parking permit, which allows them to park within Glasgow only when undertaking house calls. It does not permit any other parking, including parking while doing surgery. Parking permits are now organised through your LHCC manager, who will liaise with Mr Chris Carron, PCT. We understand that LHCC managers were informed some time ago of the need for them to organise parking permits for district nurses but unfortunately the LHCC managers were not informed of the need to do this for GPs as well. Disclosure Scotland Disclosure Scotland is a Public Private Partnership funded by the Scottish Executive in partnership with British Telecom. It is based at the Scottish Criminal Records Office in Glasgow and serves the whole of Scotland.
Its aim is to provide employers with greater access to the Criminal History System and Police National Computer in order that they make more informed recruitment decisions. Information is reproduced in the form of a Disclosure.
It is worth pointing out that the Disclosure Bureau in Scotland does not have access to overseas systems, List 99 (about teaching staff) and Department of Health Lists maintained by the Home Office. The Disclosure Bureau in Scotland is distinctfrom the Criminal Records Bureau based in Liverpool that attracted press criticism before the start of the English schools' term.
Both offices work to legislation contained in Part V of the Police Act.
Employers need to register to access this service and there are different levels of disclosure available, depending upon circumstances. Basic Disclosure - any member of the general public can apply for one of these and present it to prospective employers. This disclosure contains information on 'unspent' convictions i.e. those convictions that are still 'live'/remain on someone's record.
Standard Disclosure - this is used for certain categories of staff for whom employers can ask excepted questions under the Rehabilitation of Offenders Act (ROA) 1974 i.e. you would not normally be allowed to ask probing questions about someone's criminal record because of the provisions of the ROA but in the cases of jobs where the employee would have regular contact with children or vulnerable adults, you can. This contains both 'unspent' and 'spent' convictions.
Enhanced Disclosure - this is similar to the Standard one described above but is used when the position applied for involves a higher degree of access to children and/or vulnerable adults. This highest level of Disclosure may also contain non-conviction information deemed relevant to be disclosed by the Chief Constable of one of the country's Police Forces.
NHS Scotland employers (i.e. Trusts) are routinely requesting Enhanced Disclosures for all Medical/Dental, Nursing/Midwifery, Allied Health Professional, Psychology, Radiography and Speech Therapy staff. Standard Disclosures are typically being requested for Domestic staff in In-Patient settings, catering staff who handle money and the likes of Ward Clerks. The cost of requesting a Disclosure is currently £13.60 per request.
More information can be found be accessing www.disclosurescotland.co.uk where a frequently asked questions section can be accessed. Also Personnel Professionals in local Trusts should be well versed in Disclosure matters. Serena Barnatt, Divisional Personnel Manager for Primary Care Tel. 0141 211 3993 can be contacted for any enquiries. Pointless Paperwork (or what will they think of next!) A GP recently had a request from a parent who had been asked (by her son's headmaster) to produce a medical letter to state that, because of his medical condition, her son suffered greatly from flatulence and required to pass wind in such a way that it would be audible to the rest of the class! The catering and cleaning contractors at the GRI also made a request for a medical certificate to state that an employee should be exempt from wearing tights in the kitchen. AARGHH!! The same department also requested a less than seven days 'fitness to return to work'. PDSA once again asking a patient to obtain a letter stating he is the home owner and is unfit to attend the PDSA with his dog. As he was however, fit to attend the surgery the letter was declined. BMA Counselling Line The BMA have asked that members are informed that their 24 hour telephone counselling service can be reached on 08459 200 169. Winter Planning Practices will be fully aware of their contractual responsibility to be available for emergency contacts from patients, and that GEMS does not begin to cover this work until 6pm on Tuesday 24th finishing at 7.00am Friday 27th December and from 6pm Tuesday 31st to 7.00am on Friday 3rd January. Practices may wish to consider operating an emergency/urgent appointment system only on the 24th and 31st December in the lead up to the holiday season. We understand that Medic-call will be operating their standard Tuesday afternoon cover for their participating practices on the 24th and 31st of December, if they currently use it, but do not have the capacity to extend this to other practices. Shared Care Protocols The GP Subcommittee is becoming increasingly dismayed at the array of 'shared care' protocols being produced and distributed to Primary Care colleagues. The Committee has agreed to co-operate only on those GP Subcommittee protocols previously agreed with the GP Subcommittee and to advise colleagues not to participate in 'shared care' that has not gained approval from the GP Subcommittee. We hope to shortly have a page on our web-site listing those protocols that have been agree to. Supplementary List for Non-Principals Regulations are now being finalised for the setting up of this list. It will mean that every doctor working in general practice in any capacity, who is not already on the PCT medical list, will have to register. This includes locums, assistants, associates, retainees and registrars, and out of hours deputies. The paperwork and precise regulations should be available by the end of February and doctors in this category will have 3 months in which to register. After that date a doctor not on the register cannot practice. Further information will be sent out nearer the time, but if you employ a doctor on a regular basis or employ locums you will need to be sure that they are on the list. The PCT will hold the local list, but the national list will also be available in electronic from the SHOW website. NHS24 We would like to hear from any colleagues who have experienced any difficulties following the introduction of this new service. Comments can be e-mailed to mary@glasgow-lmc.co.uk Requests for Weekly Prescribing There is now a system in place for pharmacists to assess patients for dosette boxes/weekly dispensing. Anyone (including patients, homehelps, nurses) can ask the pharmacist for an assessment. The pharmacist will be paid an assessment fee and for providing dosette box/weekly dispensing. Dosette boxes/weekly dispensing are not to be used in Residential or Nursing homes. Certain medications are not to be put in dosette boxes (probably including warfarin). The pharmacist will sort this as part of the assessment. It is probably helpful to issue 'weekly dispense' scripts on a monthly basis although this is not compulsory. Nursing Home and Nursery Requests for Permission to Administer Over the Counter Medication We have had a few enquiries about requests from nurseries and nursing homes for written permission to administer OTCM's to patients who may require them at some future date. Answer - just say no! Green Book Waiting Times Apologies for difficulties in accessing this, but it seems that the link now changes on a regular basis. However, it is proposed to e-mail the link to all GPs on a quarterly basis. Seniority Payments and Career Breaks In the past GPs who had attained a certain level of seniority payment and had then left a position as a GP Principal for more than 6 months, had seniority withheld for a variable period of time, known as a 'qualifying period', if they then became a principal again. This unfairness has now been partially rectified. If you are in this position, you can benefit from new regulations which reinstate your seniority payments, backdated to 1st April 2002. In future GPs who leave general practice will not be restricted in this way. Full details are available in the amended SFA para 16. Retainee Fees - Maternity and Sickness As from 12th July this year, practices who employ a GP Retainee can claim the regular sessional fee whilst the retainee is absent:
Full Details are in the amended SFA, para 39. Speaker's Corner We welcome personal letters and opinions for publication in the newsletter, providing of course that they are not illegal or defamatory. Our first guest writer is:- Dr Des Spence,Maryhill Health Centre "Nofreelunch.org contains information that strongly challenges the current relationship between the medical professions and the pharmaceutical industry. It suggests that doctors have a conflict of interest in prescribing because of the gifts and hospitality that they have received. Although this a US based movement the themes are common to the UK. The pharmaceutical promotion is so much part of everyday medical culture that many doctors simple do not see it as a "problem", but it is! We as doctors have significant freedom in drug prescribing and as a consequence there are wide variations between doctors working in the same area over prescribing costs. Individually we spend roughly £150, 000 per GP and nationally these are vast sums of public money. Although doctors frequently deny that pharmaceutical reps affect their prescribing patterns this is not reflected in the research which suggest contact with reps directly affects local prescribing patterns. Also, local experts and influential GPs are often targeted by the pharmaceutical industry to give credibility and access to decision-making groups. On a national basis many sponsored educational meetings are to promote certain diseases and treatments in which the pharmaceutical companies have huge vested interest. In respect to pharmaceutical sponsored research "nofreelunch.org" suggests that this is often biased with ghost-writers over playing benefits and down playing problems. Data is often presented in misleading ways and Numbers Needed to Treatvery infrequently being quoted. They strongly suggest that there maybe extensive conflicts of interest in peer review and in authors of Guidelines. The notion, therefore, that pharmaceutical industries are partners in care is challenged and it is suggested that they should merely be seen as a large multinationals whose sole motivation is profit. The whole interface between doctors and the pharmaceutical industry should , consequently , be seen as very sophisticated marketing exercise with access and influence at it core. Nofreelunch is not about pillorying the medical professions but many doctors and nurses will find the website extremely challenging. We ask doctors to take "the pledge" to where possible accept no promotional material, accept no hospitality or gifts from the pharmaceutical companies. And also, to commit to practice evidenced based medicine and engage in self directed education that is locally based. These may be seen as the ranting of a few zealots but this is a fundamental professional issue and that has not been addressed openly in the past. "Better to light a candle than to curse the darkness". See www.nofreelunch.org Our thanks to Des for his contribution. Articles for future publication can be e-mailed to mary@glasgow-lmc.co.uk Dovedale Counselling Can we also remind you of the counselling service available to Glasgow GPs and their families. Dovedale can help with stress at work, problems at home or difficulties with alcohol or drugs for you or a close family member. They can be contacted on their helpline 24 hours a day, 365 days a year, for a confidential and free counselling service on Freephone 0800 214 307. LMC Offices - Christmas and New Year The LMC office will close at 1.00pm on Tuesday the 24th December and will reopen on Monday 6th January. If anybody requires advice during the holiday period the medical secretaries can be contacted at their surgeries. May we wish all our colleagues a very Merry Xmas and a Prosperous New Year |