Newsletter February 2007 |
End of Year Meeting This year’s meeting (for GPs, Practice Nurses and Managers) will take place on the evening of Wednesday 28th February in the Carnegie Lecture Theatre, Charles Oakley Building at Glasgow’s Caledonian University. You should all have received the programme and booking slip by now. The venue is close to the motorway and should be easily accessible by all our colleagues. Can you please return your slips ASAP so that we can organise catering to suit. Partnership Agreements Does your practice have an up-to-date, signed partnership agreement? If not, your livelihood may be at risk. Before the nGMS contract came into force, GPs had individual contracts with the health board. In the unfortunate circumstance of a partnership split, the individual GPs retained their personal list of patients, and were entitled to practice separately. The health board would assist practices splitting up in this way to continue to provide services to their patients, and would facilitate in the search for premises, the splitting of computer databases, the reallocation of staff and patient notification. THIS IS NO LONGER THE CASE. The health board now holds a contract with the practice. Whilst this gives us considerable flexibility regarding the appointment of new partners, salaried doctors and other staff, a partnership agreement is vital to enable continuance of the contract if the composition of the partnership alters. If the practice has no written and signed partnership agreement, it is termed a “partnership at will”. This means that if any GP leaves, for whatever reason, including normal retirement, the partnership is dissolved. Consequently the health board contract is null and void. Under nGMS regulations the health board then has the power to award the contract to anyone it sees fit. This could be the remaining doctors in the partnership, but it could also be a private company. This has happened in England on several occasions (and almost happened in Lanarkshire). Please ensure that you have a written, signed up-to-date agreement. BMA Guidance on the drafting of such a document can be found on our webpage www.glasgow-lmc.co.uk in the information section under GP information. At the very least, the agreement should contain provision for continuance of the partnership in the event of the death, retiral or expulsion of a partner. This matter is of such importance that we have asked the BMA lawyer Shanee Baker to come up from London to give us a presentation about partnership agreements. Shanee will be in Glasgow on Thursday 8th March and we have again booked the lecture theatre at the Charles Oakley building in Glasgow Caledonian University. You will receive a specific letter to indicate your interest. Practice managers are also welcome. If you have any specific questions you can also contact any of the medical secretaries. We cannot give detailed legal advice, but we can advise on common pitfalls. Scottish LMC Conference This year’s Scottish LMC Conference will be held on Thursday 26th April at the Beardmore Conference Facility in the Golden Jubilee. Glasgow LMC have been allocated 21 delegate places (all of which have been taken by representatives of all areas across Glasgow and Clyde). If any of our constituents feel very strongly about a particular subject and would like it to be considered by the Committee as a conference motion, could you please email mary@glasgow-lmc.co.uk before Friday 16th March 2007, briefly outlining what you would like debated. Don’t worry, our medical secretaries will convert your suggestion into ‘conference speak’. A sample of topics already raised from members include:-
Sharpsbins Did you know that one litre 'Sharpsbins' are prescribable. However, due to the risk of needlestick injury patients should be advised not to dispose them via their normal household refuse collection. Local authorities will make separate collections of clinical waste on request and patients should contact their local authority to arrange this. Cremation Certificates Just a reminder that your local District Council office is the place to contact for supplies of these. ECS Record and Withdrawal of Patient Consent Following the recent media interest in the proposed ‘national spine’ database, we have had a few queries about its introduction and the possible sharing of patient records with other agencies. A few practices have had patients wanting to restrict all access to their electronic patient records as a result. It should be made clear that the introduction/development of this ‘national spine’ is only proposed for England and there are no plans as yet to have such a system in Scotland. However, you may wish to tell your patient that you will keep their request on file. Because of the media interest in this subject a few patients have also requested that their details are now removed from the ECS database. In these circumstances practices should reassure patients that the only information available via the ECS database is their current medication and any allergies they may have and that this information will only be accessed OOHs by the clinician examining the patient and then only when the patient has given his consent for the information to be accessed. If consent is not given the record will not be accessed. Although SGPC is supportive of the ECS database SGPC also recognise the practice’s and patient’s right not to have their information accessible in the system if they do not wish to do so. However once a record is uploaded it cannot be removed and that, if consent is withdrawn, a ‘flag’ would be put against the record to indicate that all access to it has been denied. Patient Group Directives (PGDs) With the amalgamation of health boards there are now more than eighty PGDs circulating and many of them have now expired (PGDs are meant to be reviewed regularly and there is a review date in each PGD). Hence the reason you may have been recently asked to ‘sign off’ patient immunisation lists (especially child immunisation) by community nurses. There has been a plea for some extra resource to enable the speedy review of these PGDs and also the amalgamation of many that were similar. In the meantime we hope you will be sympathetic to a request to sign off an immunisation list from your community nurse. Depakote (semisodium valproate) Monitoring There is no agreed protocol for monitoring biochemistry or blood for patients commenced on Depokote and such monitoring should continue to be a secondary care function. Adults with Incapacity Act We have had a couple of queries about requests by patients for doctors to complete certificates for the “appointment of welfare or continuing attorneys”. These requests are covered under the Act and allow a competent patient to appoint an attorney to act on their behalf in the event of them becoming incompetent. The certificates can be completed by a doctor, solicitor or advocate and must certify that:
As this certificate may be completed by any doctor or solicitor or advocate the level of fee, payable by the granter, cannot be recommended. However in deciding personal remuneration levels there are many factors to take into account, such as scarcity or resource, length of training, professional skill and experience, as well as the time required to complete the activity. Most doctors condense all of these factors into a professional hourly rate and then base their fees on an estimate of the time taken. Another query concerned countersigning an “Application to intromit with funds”. This relates to the person who is seeking authority to oversee and safeguard the interests of an adult who is incapable. If asked to do this please remember the following:-
Please also note that, as countersigning such an application can be carried out by any member of a prescribed class (e.g. doctors, ministers of religion, teachers, nurses and politicians), as with the previous certificate, a fee cannot be recommended. Certificates, Reports, Certificates Requests for Hep B Status Certificates for Students We have been made aware that students are now approaching their GPs requesting blood tests to determine their Hep B status. Please be advised that, unless there is a good clinical reason for the test, there is no obligation for the GP or practice nurse to carry out this testing or issue a certificate. It may be that there is a note of the patient’s Hep B status already in their record however, if not, this is an occupational health issue and it is up to the student’s university (not the GP) to provide such a testing service. Paternity Leave and Mat B Certificates A practice recently had a request from a patient (male) for a Mat B certificate as his company had stated he had to have this before his paternity leave or pay could be granted. Employees must give their employers a completed self-certificate as evidence of their entitlement to Statutory Paternity Pay. The form is an SC3 and can be found on http://www.hmrc.gov.uk/forms/sc3.pdf This is from the Department of Trade and Industry “Employers can also request a completed self certificate as evidence of entitlement to paternity leave… By providing a completed self certificate, employees will be able to satisfy both the notice and evidence conditions for paternity leave and pay. Employers will not be expected to carry out any further checks”. Please note the sentence “employers will not be expected to carry out any further checks”. Requests for other ‘evidence’ from the GP should therefore be ignored. The LMC would be happy to write to any employer who is unaware of the guidance. Please email mary at mary@glasgow-lmc.co.uk with company details. Prescribing Champix (Varenicline) for Smoking Cessation This drug has only recently been approved by SMC and then only in conjunction with an agreed smoking cessation plan. Champix will come before the Area Drug and Therapeutic Committee which will review the advice from SMC and consider its inclusion in the Greater Glasgow and Clyde formulary. If you require any further information on this new drug please contact the Medicines Management Team on 201 5214. HPV Vaccine Recent media coverage has raised interest in the new vaccine against the HPV virus and its use as a preventative measure against cervical cancer Again, this vaccine is currently non-Formulary. We have had some queries from practices who had been approached by older patients who requested this vaccine. Human papillomavirus (HPV) is one of the most common causes of sexually transmitted infection (STI) in the world. For the vaccine to be fully effective it should therefore be administered before sexual activity commences. If approved, it will be most likely be recommended for use only in the 9-26 age bracket (as in the USA). Controlled Drugs for Sessional GPs A practice asked how sessional GPs got the drugs for their bags and wondered if they had access to their own stock order or was it the responsibility of the host practice (at that time) to supply them for the other practices where the doctor will work over the next year? We then asked the prescribing management team and found out that sessional GPs need to order CDs through a practice they’ve recently trained with or through a practice they work with regularly. The responsibility to keep a CD register lies with the locum once it has been dispensed.
The Home Office also ran a consultation in 2005 which has resulted in tightening of prescribing CDs outside the NHS. We were advised that it is likely that changes will result in due course to the NHS system via a unique identifier for each prescriber. This would allow monitoring and analysis for GPs on the performer’s list. Patient Preference of Practitioner We had a query about paragraph 18, schedule 5 “the practice shall notify the patient of the patient’s right to express a preference to receive services from a particular performer or class of performer, either generally or in relation to any particular condition” Our interpretation of this paragraph is that the patient can ask to see a particular doctor and it should explain in the practice leaflet how a patient can do this. They may also ask to see, for instance, a female or male doctor and you should accommodate this choice if possible. Therefore (in plain English) can we suggest a form of words such as “You can request to see a particular doctor for your appointment and please let the receptionist know your preference when you make your appointment”. Destruction of Controlled Drugs We have now been advised that Strathclyde Police have withdrawn this service. Practices are advised to store out of date drugs securely until alternative arrangements for destruction can be made. Referral to Mental Health Services The LMC has again raised concerns with Mental Health Services that referral guidance being issued to practices appears to indicate that patients cannot access this multi-agency service without consent having being given in the first instance. This guidance is contrary to discussions between the GP Subcommittee and the Head of Mental Health Services in November when it was agreed that duty of care would override consent issues on referral and information sharing. We believe the continued insistence of this requirement would lead to a two tier service with some patients not being seen. It was also pointed out that it was impossible to record a patient’s signature if the referral was sent electronically. Our suggestion (and we thought agreement with the service) was that the service should use anonymised patient data at its initial allocation process with consent then being sought by the professional to whom the patient is allocated. Please let us know if you (or your patient) are experiencing any difficulty accessing the service. Ian@glasgow-lmc Visitors from Overseas Update
QoF Year End Procedures for Clyde Practices You will have already received a letter from Tom Clackson detailing the procedures for the end of the current QoF year. There are some significant differences this year compared to previous arrangements under Argyll & Clyde. Please pay particular notice to the need to provide Tom with Grade A documentation to support claims for QoF achievements. If you are unable to produce this evidence then the Health Board would be entitled to withhold or claim back payments made, so it is vital that you send it in time. Also there are 2 manual adjustments being made to QMAS scores, namely re DM 21 (Retinopathy Screening) and COPD 10 (FEV1 measurements in existing patients). The first QMAS achievement will not include these- you should still approve it if you are happy with everything else. Tom will make a manual adjustment after this and then you will need to go back into QMAS to approve the adjusted score. QoF Points – Mental Health 7 A few practices have been in contact regarding this indicator and queried whether they could still claim the points if they had a protocol in place (all patients who they contacted and invited for a review had made and kept appointments with the practice). The answer is no – before you can claim these points you must have actually had a patient who has not attended for their annual review and who is followed up by the practice team (letter, telephone call) within 14 days of non attendance. Blue Badge Scheme, Renfrewshire Council GPs have been being approached by patients asking for a letter to confirm their disability to allow them to obtain a Blue Badge from Renfrewshire Council. There have apparently been some changes made in the operation of the Blue Badge Scheme locally, but we have been reassured that in most cases, the patient will be able to obtain a badge without the need for either a letter or Blue Badge form. Some patients will be asked for confirmation of their condition from a Health Care worker. This could be from anyone who attends the patient, however if you do wish to write a letter, you can charge a fee for this. The fee should be charged to the Health Board, just as for completing the Blue Badge form under Collaborative Arrangements. Ambulance Booking, Clyde Practices The new arrangements for first appointment Ambulance bookings commenced on 3rd January 2007. There has been a delay in rolling out the SCI Referral screens including the drop-down menus due to some IT related problems, however you should continue to attach the paper copy (or scan of this) to your referrals to allow the Outpatient departments to make the arrangements for Ambulance bookings. While this IT problem is being sorted, please could you indicate in the text of the referral letter that you have attached the details re transport, as it will be easier for staff at Outpatients if this is highlighted. It might save you a phone-call at a later date! We will update you on the timescale re new SCI screens as soon as we have heard anything, however you can now use the SCI referral screen including transport screen if referring to Glasgow hospitals. Ambulance Booking, Other Issues Outpatient Departments Practices being told by outpatient clinics that they know nothing about new arrangements. This is now a process issue and the records managers should be notified via Bill Skelly of any problems you have and the department involved. Bill’s email address is Bill.Skelly@gartnavel.glacomen.scot.nhs.uk Booking for Hospices As far as the SAS is concerned there is no difficulty arranging transport to the hospice. Each hospice will now be contacted individually and appraised of the process they should follow to arrange an ambulance for hospice admissions. Golden Jubilee Just when we thought it was safe to go back into the water!!! It is hoped difficulties arranging ambulance to the Jubilee will be resolved very shortly. X-ray and appointments for Westmark A reminder to practices to send transport information when asking for x-rays and also when asking for wheelchairs from Westmark. At present the documentation for both these services does not include a section regarding transport needs and practices need to attach the information. It is hoped however that both services will in the future, have suitable documentation on SCI Gateway. Return Appointments There is still a problem with return appointments in that the ability to book in advance at the ambulance service has still not been upgraded from three months to twelve months, even though we have been assured many times that this is entirely possible. Ambulances for Social Work As regards social work transfers this needs the remit of the Scottish Ambulance Service to be changed nationally before they become free of charge. Our recommendation that the social worker concerned orders the ambulance therefore still stands. Notice to Patients If you have not already done so it might be useful to put a notice up in the waiting room or at the reception desk informing patients that “as of 1st September 2006 (1st January 2007 for Clyde) the responsibility for arranging transport to outpatient appointment now lies with the outpatient department and not your GP”. You may also like to put a similar statement in your practice leaflet. Please continue to feed in any comments or problems.
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. VAT on Private GP Services Guidance is now available from the BMA on GP Private Services and VAT. This can be found on the fees section of the BMA website: http://www.bma.org.uk/ap.nsf/Content/VATonmedicalservices We would suggest that GP practices who believe their private income would be above the VAT threshold (£61,000) contact their accountants as a matter of urgency. Issue of Med 3 and Med 5 forms This guidance is reproduced with the kind permission of Christine Dewsbury at Wessex LMC. Wessex LMC have been asked about the rules for issuing Med 3 forms in light of a recent report that a GP was suspended by the GMC for not seeing a patient when signing a Med 3. It appears that when a Med 3 has been issued after an initial consultation many GPs will issue subsequent repeat certificates based upon a telephone consultation to avoid ‘wasting’ an appointment slot just for this purpose. However, the issuing of these medical certificates is strictly regulated by law and the official rules are quite clear on the matter. They are set out in DWP - A guide for Registered Medical Practitioners which is available at; http://www.dwp.gov.uk/medical/guides_detailed.asp#IB204 The Social Security (Medical Evidence) Regulations 1976, as amended, set out the format and rules for completion of medical statements of incapacity. Providers of NHS primary medical services are required to issue certificates on the prescribed forms and in accordance with these Regulations. The rules state quite specifically in relation to Med 3s; ‘You must examine the patient on the day, or the day before, you issue this statement (Note: Although a certificate can be issued to a patient's representative, this does not override the necessity of seeing the patient on the day, or the day before, a Med 3 or Med 4 is issued)’ In situations where it is not possible to arrange a face to face consultation the GP may issue a Med 5 if the advice to stay off work is based upon a previous examination. The rules for using a med 5 are also set out clearly in the DWP guide. Practice email address As practices move to NHS Net can we please remind practice managers to send details of their new email addresses to Mary. Employing Foreign Nationals We had a query from a practice who received a large number of applications from foreign nationals for a receptionist post they had advertised. The practice wondered what documentation they should be looking for proof that the applicant is able to work in this country legally. If you find yourself in a similar situation the home office has an employer’s helpline on 0845 010 6677. The helpline will give advice on immigration status and documentation but will not give out personal information from home office records or advise on employment law. The line is open on weekdays from 9am to 5pm. Supplementary Performers List Just a reminder to practices that you can access the GG&C HB supplementary performer’s list via the SHOW website. Whilst in SHOW webpage type www.sml.show.scot.nhs.uk in the address bar to access the list. First time users must register before they can access the information. A password will then be emailed to you. The list will provide details of those GPs who are registered to practice in Greater Glasgow and Clyde. Glasgow Locum Group As you will be aware from last months newsletter, Dr Ian Thompson from the Glasgow Locum Group was co-opted as a "non-principal" representative on the LMC. In the first of a series of notes we hear from the locum group about current issues for sessional GP's. It is now over 2 years since the National Association of Non-Principal GPs underwent a name change to become the National Association of Sessional GPs (http://www.nasgp.org.uk/) to reflect the role that GPs working on a sessional basis either as locums or in longer terms posts are playing in the GP workforce. Nationally this group works to support sessional GPs in all their guises (Locums, salaried GPs, assistants, etc.) producing resources such as the standardised practice induction pack (http://www.nasgp.org.uk/spip/) to allow practices to easily communicate "the 200 essential non-clinical items of information that are specific to the provision of care to their patients." They also produce guidance on consulting room resources (http://www.nasgp.org.uk/handbook/5.htm) as they rightly state locums "can waste a lot of consulting time searching for basic equipment and information." The Glasgow Locum Group would like to make a request to all practices who employ locums to help us to help you by utilising these resources to create an environment to allow locums to provide efficient services to your patients. Consider that within the area covered by the locum group there may be 4 or 5 different laboratory tests forms, not every practice will use the same blood and specimen containers. Practices which provide basic equipment will get far more out of their locums who will spend less clinical time searching for information and equipment. Locally, the Glasgow Locum Group is moving forward with new members, and a revitalised committee including some with experience from outside the west of Scotland. We have a regular diet of well attended monthly educational and business meetings, on the third Thursday of each month, to help maintain our practice and to allow discussion between members about what constitutes a good practice in locum employment. There are a number of small study groups developing from the locum group to help sessional GPs keep themselves up to date. Also the rolling programme of GP appraisal in Scotland includes sessional GPs and locums, many of whom have been appraised in recent months. In future newsletters we hope to provide information on developments (currently in the planning stage), to improve our website (http://www.glasgowlocumgroup.org) for both locum and practice users, and would welcome feedback on this issue to help with our plans to info@glasgowlocumgroup.org. You can also use this address to contact the locum group for other issues. Finally…. Next time you are struggling with tick box medicine, remember there is nothing new under the sun. This letter was written during the Peninsular War. Gentlemen, Whilst marching from Portugal to a position which commands the approach to Madrid and the French forces, my officers have been diligently complying with your requests which have been sent by H.M. ship from London to Lisbon and thence by dispatch to our headquarters. We have enumerated our saddles, bridles, tents and tent poles, and all manner of sundry items for which His Majesty's Government holds me accountable. I have dispatched reports on the character, wit, and spleen of every officer. Each item and every farthing has been accounted for, with two regrettable exceptions for which I beg your indulgence. Unfortunately the sum of one shilling and ninepence remains unaccounted for in one infantry battalion's petty cash and there has been a hideous confusion as to the number of jars of raspberry jam issued to one cavalry regiment during a sandstorm in western Spain. This reprehensible carelessness may be related to the pressure of circumstance, since we are war with France, a fact which may come as a bit of a surprise to you gentlemen in Whitehall. This brings me to my present purpose, which is to request elucidation of my instructions from His Majesty's Government so that I may better understand why I am dragging an army over these barren plains. I construe that perforce it must be one of two alternative duties, as given below. I shall pursue either one with the best of my ability, but I cannot do both: 1. To train an army of uniformed British clerks in Spain for the benefit of the accountants and copy-boys in London or perchance. 2. To see to it that the forces of Napoleon are driven out of Spain. Your most obedient servant, Wellington And from your most obedient servants Alan, Barbara, Elaine, Ian, John, Mary and Murray |