Newsletter December 2006 |
Glasgow & Clyde Appointments to SGPC Glasgow and Clyde are represented at SGPC by Drs Colin Brown, Douglas Colville, John Ip, Mustafa Kapasi, Alan McDevitt, Paul Ryan, Barbara West and Peter Wiggins.
SGPC Committee Elections Drs Douglas Colville and Alan McDevitt were elected to the SGPC Executive Committee. Dr Colville was also elected to the Scottish Council. Dr Colin Brown will represent Glasgow & Clyde on the Information and Management & Technology Team and Drs Alan McDevitt and Barbara West were elected to the Statutes and Regulations Team. Dr Dean Marshall, Lothian LMC is the new SGPC Chairman with Drs Andrew Buist (Tayside) and Stuart Scott (Grampian) acting as Joint Deputy Chairmen. Our special thanks to Dr Barry Adams-Strump who stepped down from SGPC as a Glasgow representative this year, for all his hard work on behalf of Glasgow practices. Joint Inspection of Children’s Services and Inspection of Social Work Service (Scotland) Act 2006 Dr David Love at the Scottish (and subsequently UK) conference outlined GP concerns at the introduction in Scotland of the Joint Inspection of Children’s Services and Inspection of Social Work Services (Scotland) Act 2006. This act will allow members of the ‘Joint Inspection Teams’ to access child health records without their (or their guardians) knowledge or consent. Any GP practice declining such access under this new Act will be liable to prosecution. Many GPs are unaware of this new act and its ramifications, however the Scottish LMC conference passed a motion calling for the Scottish Executive to require all Joint Inspection Teams to obtain explicit consent before requesting access to child records. Given the lack of awareness of the new Act (and its introduction) delegates also called for Executive to detail the requirements of the act to members of the public and health professionals through a national advertising campaign. There was real concern that the act may deter young people from seeking healthcare or advice when they most need it. IT GP Systems Showcase Many thanks to those practices who attended the IT GP Software Systems events in June. For those of you who are interested the results of the evaluations can be found on our website www.glasgow-lmc.co.uk Practices who applied for a system change last year are now undergoing conversion to their approved systems. The IT Committee had hoped to invite business cases for further change in the near future, however the publishing of the Deloitte report on GP computing has made future plans a bit uncertain. We hope to get further information to you once the process is clear. Workforce Planning Survey Once again our thanks to all those practices who returned the recent workforce planning questionnaire. The information provided will prove invaluable for future national and regional workforce planning and, most importantly. Glasgow LMC has now been asked to help other LMCs conduct the roll out of the survey nationally. Ian Mackie, who had been relentlessly chivvying you and your practice manager to complete the form, now has a whole new constituency of practices to help. Can we also assure practices that the information supplied to the LMC was presented to the Board at a CHCP/CHP level only and could not be traced back to individual practices. Mental Health Act All practices should have by now received the claim forms for completing part 2 of the CTO. Claims can be backdated to 1st October 2005, when the new act came into force. Claims should be sent to the local Psychiatric Records department. The department will validate the claim and forward it to the Practitioner Services Department at Clifton House for payment. Psychiatric Records Departments are located in Stobhill, Parkhead, Gartnavel Royal, Southern General and Leverndale hospitals. Claim forms can be obtained from mental health wards and community mental health centres. Can we once again remind practices that you will receive an invitation (at short notice) to attend the accompanying tribunal however attendance is voluntary. The tribunal does have the power to compel you to attend but only after they have applied for and received a court citation and this will only be done in very rare circumstances if they feel the GP has a particular point of view or particular expertise that they need to hear. Such a compulsory attendance would also be funded. Practices looking for information or forms for CTOs can find them on http://www.scotland.gov.uk/Topics/Health/health/mental-health/mhlaw/forms Disclosure Checks for Staff The Board’s HR Department will carry out disclosure checks on behalf of practices for a fee of £20. However, if a more advanced disclosure is required this will be more expensive. Please contact Noelle Norman on 0141 211 3610. Travel Clinics Can we please remind practices that as this is work that ANY registered practitioner can do and to satisfy Office of Fair Trading rulings, travel clinic fees should be negotiable in each individual practice and not set as area wide charges. Collaborative Arrangements As with the article above the Office of Fair Trading now views collaborative arrangements as being anti-competitive. As a result any collaborative arrangements previously in place are now null and void. Unfortunately you will have to negotiate a fee to complete reports/forms etc. which would have been covered under the old arrangements. We would also strongly suggest that you agree a fee before carrying out the work. Car Break-in and Theft of Medical Bag A Glasgow GP recently had his car broken into and his medical bag stolen. His insurer refused to pay out for replacing the bag as it was seen as ‘work’ related. If you find yourself in a similar situation can we suggest you check your practice insurance as, in this case, the GP was covered through the practice. Interpreter Services Can we please advise practices that if an interpreter is unavailable you should get an authorisation code from interpreter services before contacting either of the alternative providers. If you have any difficulty getting an authorisation code please let us know. Expected Death and Moving the Body A GP recently attended an expected death at home where the patient had died in his kitchen. The GP, helped by a family member, moved the body to a bedroom. The doctor was then informed that the ambulance crew who attended following the patient’s death had told the family that they were unable to move the body until the doctor had been. However, ambulance guidelines do allow crew members to move a body in the case of an expected death. It was thought that the crew involved were possibly new and unaware that a body could be moved in these circumstances.
Increased Utility Charges in Health Centres There has been no change to the mechanism of calculating the charges but the increase on the heating and lighting portion of the standard charges is proportionate to the real increases in the cost of these utilities. Evidently the increase was based on the current level of charges (to practices) which are not the true cost therefore Health Centre practices still do not have to meet the full impact of these changes in utility costs. We therefore now recommend that practice pay these increased charges as they are being applied. Clozapine Monitoring This should not be carried out in general practice but undertaken by the outpatient clinic who prescribe. Certificates, Reports, Certificates
Insurance Companies and Targeted Reports The BMA's Professional Fees Committee (PFC) had been informed by the Association of British Insurers of their intention to introduce targeted reports and are aware that the reports are being piloted. PFC have received a number of queries recently, indicating that they are now in wider use. The BMA has not supported the introduction of these targeted reports, and therefore there is no fee agreement with the ABI. Whilst the BMA-ABI agreement remains in place for the GP and supplementary reports, PFC would suggest that doctors charge at their own rate for undertaking targeted reports however there is no obligation on the doctor to undertake the work. Our advice therefore is that on receipt of such a request to contact the insurance company and agree a fee before completing and returning the forms. Companies (that we know of so far) requesting this new type of report are Scottish Equitable and Legal & General. On a more positive note, the BMA and the ABI have now agreed a five year deal regarding fees for medical reports. The fee for completion of a GP report will be as follows: 1 September 2006 – Increases from £70.50 to £74.70 1 April 2007 – Increases from £74.70 to £79.20 1 April 2008 – Increases from £79.20 to £84.00 1 April 2009 – Increases from £84.00 to £89.00 1 April 2010 – Increases from £89.00 to £94.30 Glasgow City Council Forms
Shotgun Licences We recently had a query from a GP about giving an opinion as to whether a patient was suitable to hold a shotgun licence or not. Once again the GP does not have to do this. Certificate of Fitness The following is Defence Union advice received by Lothian LMC in connection with practice queries on completing fitness to join a gym, to travel, pantomime certificates etc. The Defence Union advised Lothian that "it was not acceptable for a doctor to give a guarantee that the individual was fit - however if the patient suffered from a condition to which a particular form of exercise would be detrimental, then the patient should be advised" We would suggest that if you wish to provide certificates in such circumstances, you make a simple statement such as “I know of no medical reason why patient x should not do activity y, based on the information currently available to me” Patients could have undiagnosed silent cardiac condition, for instance, that might only be uncovered by sending all patients for comprehensive cardiac investigations, clearly not feasible or appropriate. Our thanks to Lothian LMC for sharing this information with us. Letter for Taking Medication Abroad It seems practices are getting a number of requests from patients whose insurance companies want GP letters to stating what drugs they are taking and that they require to take their medication abroad. Firstly the patient would have to ascertain from the travel agent/foreign office or the relevant embassy what drugs are permissible in the country of destination, as the rules in any one country vary and are often interpreted differently. Controlled drugs may also require an export licence (see BNF). Any letters or forms completed would be private work and would be chargeable. The patient would also have to decide what they need (export licence) as we cannot guarantee that any letter the GP could provide would be sufficient. Often patients on insulin are advised to get a letter confirming they need it especially if carried in hand luggage. However, the only reason we can think of that would explain why insurance companies would need actual drug lists is to identify prior illnesses. Patients can also get a print out of their computer medical record for £10 under data protection and this might be a way for them to pass on their own information. Housing Letters As you know we believe patients should be able to state their medical history and should not be required to seek a GP letter to gain housing points on medical grounds. We have also written on your behalf to numerous housing associations over the last few years stating that GPs will not routinely give out letters to support housing applications. In many instances we have discovered it is the patient himself who believes getting a ‘doctor’s letter’ will help his application. Can we once again remind colleagues not to write such letters and suggest that you might like to print off and retain in your reception area our leaflet on why GPs will not provide such letters. The leaflet can be found on our information page on www.glasgow-lmc.co.uk, also on the same page you will find a leaflet for gardening certificates. Department of Work and Pension A practice has recently been approached by a patient requesting a letter (stating that the patient had back problems) to support a DWP grant application for a new mattress. As far as we are aware grant applications do not require a GP letter of support. Less than Seven Days Sick Certificates We had a couple of queries from practices who had patients requesting medical certificates for their employers for less than seven days illness. Evidently it was in their staff contracts that any absence for more than three days had to be accompanied by a doctor’s certificate. You do not need to do this. The following form of words can be found on our webpage www.glasgow-lmc.co.uk. “Employers asking for a doctor's statement for the first seven days of an employee's sickness are referred to the "Statutory Sick Pay Manual for Employers" - National Insurance Contributions Series CA30, Paragraph 28, which states "…you (the employer) cannot ask for a doctor's statement for the first seven days of a spell of sickness". The purpose of this regulation is to avoid the necessity for employees with minor, self-limiting illness or injury to use surgery appointments for the sole purpose of obtaining a medical certificate. We do not, therefore, issue certificates in these circumstances. If employers have reason to inquire about a spell of sickness, they are advised to write to the doctor, including written permission from the employee concerned, when a report may be issued. A charge will be made for such a report“. Practices might also like to visit the www.managingabsence.org.uk website were “Managing Short-term Sickness” leaflets can be downloaded for employers. There is also a link to this site on our website’s links page. Fitness to Practice for Dental Staff The General Dental Council (GDC) recently issued a ruling that not only newly qualified dentists but also their staff, required complicated occupational health assessments and a range of investigations, and they had told these patients to attend their GPs to get this done. Needless to say this was without consulting the BMA! The dentists and their staff need to get this certificate, but it is not part of GMS and you are entitled to charge for it. All laboratory tests and X-rays are also private and you need to clarify the charges of your local hospital before you start. You could of course not do this work and refer the patient to an occupational health service or other private provider. Should you decide to do this the patient is entitled to ask for a copy of his/her record under the Data Protection Act. Can we also remind colleagues to carefully read what is being asked of them as this is a very detailed examination and report. Failure to complete correctly might cause problems if something adverse occurs in future years. As a result (we think) of discussion with the BMA, the regulations have now been modified in respect of practice staff. From Friday 10 November 2006 dental care professionals (DCPs) registering with the General Dental Council (GDC) will be able to ask either their employing or supervising dentist or a doctor to sign their health certificate. Dental technicians and dental nurses who do not work in a clinical environment will need to make a self-declaration about their health and confirm they do not have any clinical contact with patients. Revised guidance on the process, including the requirement for applicants to provide information about their health, is being introduced. The changes that come into effect from the 10th November are: • Dental technicians and dental nurses who do not work in a clinical environment will not need to provide a health certificate signed by their doctor . • dental nurses who work in a clinical environment (i.e. the majority of dental nurses) and dental hygienists, dental therapists, clinical dental technicians and orthodontic therapists can now have their health certificate completed by either an employing or supervising dentist or a doctor. The DCP will need to have worked in the practice for at least 12 months and provide evidence of their original immunisation certificates for a dentist to sign their health certificate The new GDC guidance is available on the information page on our website. Medical Reports for Citizens Advice Bureau Practices are continually being asked to complete reports, provide comment or send copies of patient records to CAB personnel for a variety of reasons and usually with a request for the GP to consider a “waiver of fee” or “minimum fee” for the work they have been asked to undertake. We have always advised GPs that such work is not part of their contractual obligations and GPs can, and should, either refuse to do or charge a realistic fee for such work. Whilst understanding that there may be occasions when a GP wishes to assist a patient who may have exceptional circumstances, we have been asked to highlight that by complying with requests for medical reports/information for little or no fee undermines the principle of reducing workload and bureaucracy in general practice. If every GP politely declines such requests both private companies and public bodies may be encouraged to look again at their administrative policies and drastically reduce the need for “a doctor’s letter”. Ordering of Ambulances After a long hard struggle, we now have agreement that hospitals will in future be responsible for ordering ambulances for out patient attendance. All new referral letters as from September 4th this year should contain details of the type of transport required (if any) from the patient, and that should end your involvement in the matter. There will be patients who were referred prior to September 4th, who may contact you to arrange an ambulance, but obviously these requests will soon come to an end. We are aware that there are teething problems to this transfer, and that some nooks and crannies of the hospital system will not be as efficient as others. We rely on you to point out any discrepancies and will try and tackle them. We have already been made aware of problems regarding transport to the Golden Jubilee Hospital, and hopefully this has now been sorted. Could we also remind you that referrals for X-rays or wheelchair assessments will need to be accompanied by appropriate information on transport requirement. The problem regarding self referral patients is more difficult to cope with. However there is a pilot project going on in Lothian in which all patients contact the transport service directly to make arrangements, thus removing GPs and hospitals from the loop. We hope that this will ultimately be rolled out to the rest of the country, but in the meantime we hope you will agree that the new system is an improvement. This agreement is for Glasgow practices. We are now happy to announce that Clyde practices will also be relieved of the responsibility for ordering ambulances from January 1st. More Ambulance Problems As from 13th October, the Scottish Ambulance Service (SAS) have firmed up their position regarding ’social work’ transfers i.e. to and from care homes. The person who orders the ambulance will be invoiced. Social workers can and should order ambulances. If you feel you must help them with this (although we don’t recommend it) get the name and address of the social worker and ensure the bill goes to their department. Unscheduled Vaccine Reports There is only a four week gap between vaccinations. Most practices send unscheduled forms (and indeed the SIRS forms) via the black bag. This can take two weeks to reach the SIRS team, by which time the next call/recall has already been scheduled., given the potential for error. SIRS request that all these forms be sent to them by First Class Post. Euro Business Guide You may get an email with a request to complete and return the form in order to include your company details in the Euro Business Guide. Please do not complete and return. Via the (very) small print you would be held liable for a three year contract and a hefty bill. This is company is related to the European Business Guide which has caused a lot of grief for unsuspecting recipients across Europe. Zero Tolerance We recently had a request for information on aggression management training and are pleased to report that the Southern General’s Aggression Management Services Team are still run training courses. Although these courses are primarily designed for ward staff there are two that would be suitable for practice staff.
For further details or to book a place on either of these courses please contact Aggression Management Services on 201 1976. Clyde Practices - Arrangements for Dealing With Violent Patients Could we remind all Clyde practices that the Enhanced Service for Violent Patients is still operating, and that the arrangements for referral to this scheme are as follows. If a violent incident occurs, practices should contact the police to obtain an incident number, and should then contact practitioner services to register the patient. This should automatically allow the patient to be picked up by the scheme and allocated to one of the three practices providing the service. An incident can be reported to the police even if the patient has left the premises, or even a few days retrospectively if appropriate. Once a patient has been referred to the scheme, the practice will no longer have responsibility for him, and the patient will receive provision of medical service via the Enhanced Service practice only, until such time as they are stepped down from the scheme. Carers and Medication Help We thought we should draw your attention to the following regarding housebound patients receiving help with their medication. If a patient is competent and requests help from their carer to open medication blister packs or difficult bottle tops, then help would be given. However if a patient is not competent then a carer cannot help without being trained to do so. The outcome of this policy is that, unless trained, social work carers should not help with the administration of medication. This now means that patients will miss taking vital medication unless a district nurse (or GP) is present. Overseeing the administration of medication in the home is not part of a GP’s basic duties and would be impossible for GPs to do. The same applies to district nurses. We also wondered if the decision for carers not to be allowed to assist with medication administration unless trained, was evidence based and whether such patients, if assistance could not be given by their carers, should be actually be cared for in a nursing home rather than community setting. Court Witness and Fees If you have been asked to appear in court as a witness we would advise that you agree fee arrangements before you agree to attend. Recently a GP had a court appearance cancelled a few days before they were due to appear. The lawyer then refused to meet locum costs stating that the GP should have been able to cancel his locum within the timescale given. Evidently, he was not aware that most locums require a seven day cancellation. Advice on court fees can be found on www.bma.org.uk/ap.nsf/Content/medicolegalscot LMC Training Courses Cancellation Fee Can we advise practices that the charges for cancellation of IT training courses (less than 3 working days) have been increased to £45 per full day and £22.50 per half day. Ian@Glasgow-lmc Visitors from Overseas We have been getting a number of enquiries about this recently, and I would like to take this opportunity to refresh some of the information on the guidance, and also update information where there have been changes in the Law, or situations which have provided clear(er) guidance on given issues. EEA Residents rights to NHS Treatment With the enlargement of the EEA in 2004 the rights of EEA residents to treatment on the NHS changed. From September 2004 lawful residents of EEA countries became entitled to treatment for existing conditions and illnesses as well as illness that had occurred since they had arrived in the UK. This changed from the previous position where they had only been entitled to NHS treatment for illnesses which had occurred since they arrived in the UK. Lawful Residents in the UK are those defined in the guidance, e.g. UK citizens, EEA Nationals, students, etc. What is a dependant? A couple of situations have produced clarification on what a dependant is. Two British females have arrived back from abroad married to men from countries where there is no reciprocal agreement with Britain. These men have entered Britain on visitor’s visas. Although they could be seen as dependants, they will have no right to NHS treatment for the duration of the Visitor’s visa, and will only have a right to NHS treatment if they are successful in upgrading their Visitor’s visa to a Resident’s visa when it expires, or if their visa is extended beyond a year. If their only claim to NHS services is that they are married to British Citizen, they only have the right to those services if they have a permanent right to stay here. However if they are granted the right to stay beyond a year, then after the first year they gain entitlement to NHS Treatment. LMC Advice Leaflet We produced an updated two page “Visitors to the United Kingdom” leaflet, available in the Information page on our Website, at the end of 2004 detailing these changes. If your leaflet does not have the Category 2 countries split between EEA and non-EEA countries, or the part above about dependants, please go to the site and download the up to date leaflet. Other recent changes detailed in the leaflet are: -
HC1 Form We were contacted by a Practice looking for advice. An Indian student, over 19 years of age, on a two year full time course, had come to register. He produced an HC1 form as proof of his entitlement. Unsure of what the form was for the Practice phoned the number on the form, and were told by “Help with Health costs” that the student should complete the form, send it to Newcastle who will means test him, and the practice will then be told what level of assistance the student is entitled to get towards his NHS care. They were concerned that this was another thing to consider when dealing with overseas visitors. I contacted “Help with Health costs” and learned that the HC1 form is to do with reimbursement of Prescription Charges. This means that the Practice can treat the overseas visitor based on the current guidance, and if the student is entitled he/she can get their prescription costs reimbursed. Further Help Go to our website at www.glasgow-lmc.co.uk and on the “Information” page you will find a link “Guidance on nGMS services for Visitors from Overseas”, which you can download and print off. If it would help you to have the guidance explained to you, and to be able to discuss its details, I am happy to come out and speak to a group, 8 plus, about this. It takes; depending on how many questions you have, up to an hour. Further down on the Information page you will find a copy of the slides I use when presenting this. As ever we are happy to take your enquiries at the LMC office. Retirement for Superannuation Purposes – Single Handed GP A GP in partnership can retire for superannuation purposes, cease all clinical work for 24 hours, and then, with the agreement of his partners, return to the practice providing he does not work for more than 16 hours a week in the following month. The GP does not have to come off the performer’s list, and the practice’s contract with the health board is not affected. We had hoped that the new regulations would also permit single handed GPs to continue with their health board contracts, but a recent clarification by the Scottish Executive has made it plain that this is not possible. Although the GP can stay on the performer’s list, he must give up his NHS contract. We have discussed this issue with the practitioner support team, and have clarified that although the single hander must give up his contract for 24 hours, there is no bar on the health board immediately re-contracting with him, should it so wish. However it is not obliged to do so. Any GP considering retiring in such circumstances should contact us for advice. We are sorry that our single handed colleagues still face this potential inequity. Non Principal Representative Co-opted to GP Sub/LMC Dr Ian Thompson has been co-opted onto the GP Subcommittee and LMC as a representative for non principals. Dr Thompson is an ex member of BMA Scotland and UK JDC negotiating teams and a current member of BMA Scottish Council and is actively involved with the Glasgow Locum Group. We look forward to having him on board. Anticoagulation and Patients who DNA A few practices had been in contact about patients who DNA at the GAS service and wondered how they should now be managed. Following talks with Dr Caroline Morrison we would advise practices that the following should occur. The GAS service will notify practices when a patient has DNA’d. The GP is advised to consider ceasing prescribing warfarin for that patient as it would be unsafe to continue to prescribe the medication if monitoring has not been carried out. A letter should be sent to the patient stating why the prescription was being stopped. Patients could then be referred back to the hospital clinic for their warfarin to be restarted if they decide to continue or restart. Hepatitis B Vaccination for Students We welcomed the letter from Mr Nic Zappia, Head of Primary Care Support, GG&C HB to Glasgow GPs in which he confirmed that GP practices were not obliged to carry out Hepatitis B vaccination for students and that responsibility for this lay with the educator or employer. Please do not do but refer back to the educator or employer. Chronic Kidney Disease (CKD) This new area of QoF work has raised a lot of issues about the considerable clinical problems it has uncovered. There are numerous guidelines and recommendations flying about on how to treat such patients. We should point out that the QoF recommends identifying these patients, seeking to treat their blood pressure appropriately and the use of ACE inhibitor if appropriate. This represents a considerable advance for previously undiagnosed CKD sufferers. Any further monitoring or investigation is up to you but we have no agreement on funding for any more comprehensive care of these patients. Testing for Patients Attending Private IVF Clinics We have been made aware that practices are still being asked to perform blood testing for patients undergoing private treatment at the Nuffield Hospital. Such tests should not be carried out in general practice as the practice would be liable for any laboratory costs associated with the testing. GPs should be advised to notify patients that they would be liable for laboratory costs and that these costs should be established before bloods were taken. We hope to shortly produce a letter that you can give to your patients explaining why you cannot provide this service on the NHS. On the subject of carrying out monitoring/testing for patients attending secondary care clinics, our advice to practices is not to do unless it falls under the NPT LES. A number of practices have also been in touch about requests to flush PIC lines for patients who are mobile enough to attend a clinic. To carry out this work would take around 30 minutes and the practice nurse would need to be suitably trained before she could do it. Our advice is that there is no funding for this, involves a substantial workload and should be carried out by either the district nurse service or the hospital clinic. Date for the Diary Glasgow Caledonian University on the evening of Wednesday 28th February for our annual “year end” meeting. All GPs, practice managers and practice nurses will be invited. The newly formed Docman Users Group will also be presenting on the night. Counselling Services for GPs and their Families Can we remind colleagues that the Dovedale Counselling service is a free and confidential service available to GPs and their immediate families. Dovedale can be contacted on 0800 214 307 twenty-four hours a day, seven days a week. Christmas and New Year Holidays Please note that the LMC office will be closed from noon on the 22nd December and will reopen on Wednesday 3rd January. If any of our colleagues requires urgent advice or assistance during this time could they please contact the medical secretaries at their respective practices. Finally... We wish you all a very Merry Christmas and a Prosperous and Happy New Year. Alan, Barbara, Elaine, Ian, John, Mary and Murray
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