Newsletter July 2003

Dr Alastair Short

All members of the Committee wish to express their sense of shock and loss at the death of Alastair in a climbing accident.

He was a good colleague, mentor and friend, liked and trusted by all who knew him. We are sure you will join with us in sending our heartfelt condolences to his family.

New Contract Result.

79.4% said 'yes' out of a 70% turnout. Obviously it is good news to get such a strong mandate to proceed now with the new contract. At this point there remains a lot of continuing work to clarify many of the issues involved in the new contract and the transition phase between GMS1 and GMS2. The LMC will continue to offer support in this transition phase and will provide further information during the remainder of the year. Thank you all for your input to the debate so far. We welcome any further comments or queries about the new contract and will do our best to get answers for you. We recommend that you maximise your GMS income this year, as we are not sure which time period will be used to calculate MPIG.

Provision of Medical Reports to Support Applications for Central Heating Etc.

We were recently asked to examine the practice of local authorities asking patients for verification of their medical details when applying for council grants for central heating etc. We believe that all patients should have warm, dry houses with suitable amenities and that local authorities should believe what their clients tell them about their health. If they require 'verification' of medical details then they should do it themselves. We would therefore strongly suggest that you no longer provide these certificates and a supporting document to hand to patients is now available on our website.

STD Health Adviser

Health Advisers have now been employed by the Sandyford Initiative. All the health advisers employed have a nursing background, an accredited counselling certificate and have to abide by a code of ethics produced by the Society of Sexual Health Advisers. Following a positive chlamydia report, the health adviser will contact your practice to offer support and advice. They will not contact the patient, unless the practice asks them to do so. The practice can decline to have further contact from the health adviser should they so wish.

Nursing Homes PMS

In those areas where a GMS practice has subcontracted to take on nursing home work, there has been a significant transfer of patients onto the new system funded by PMS.

However, the PMS practice with employed doctors who will look after the remainder of nursing homes has been somewhat slow to get off the ground. The PCT continue to advertise for salaried doctors to take this forward, if you know of anyone who is interested please contact Dr Jean Hannah tel no: 0141 427 8297.

SIGN Meetings

The following meetings are being planned and the LMC will fund up to two doctors to attend on a first come, first served basis. The meetings will be taking place at the Royal College of Physicians of Edinburgh. Please e-mail interest to mary@glasgow-lmc.co.uk

Breast Cancer - Tuesday 2nd September

Continence - Tuesday 16th September

Epilepsy in Children - Wednesday 1st October

Bipolar Disorder - Friday 14th November

Lung Cancer - Monday 24th November

Bladder Cancer - Tuesday 16th December

Dementia - Monday 2nd February 2004

We would appreciate a short report from any GP who does attend any of these meetings.

Pointless Paperwork

Mr Trevor Jones (Chief Executive NHS Scotland), has written to all higher and further education institutions informing them that such institutions cannot ask GPs to provide letters, without being prepared to pay a fee. He also pointed out that anybody requesting certificates from students should clearly state to the student whether they would reimburse any fee.

Fees for Mental Welfare Commission Reports

SGPC and the Mental Welfare Commission have had recent discussions and indeed, have a difference of opinion as to whether a fee is payable to GPs providing medical reports to the Mental Welfare Commission. The Mental Welfare Commission has wide reaching powers to summon people to give evidence, and the giving of evidence will be treated in the same manner as giving evidence in court. In view of this disagreement, it is for individual GPs to decide whether to decline to supply a report (and possibly be summoned to give evidence to an inquiry) or else to supply a report with no fee.

In cases where a patient has died and records have been returned to the health board, the Mental Welfare Commission no longer has the power to require the production of medical records from the practice.

Chronic Disease Management

Obviously the 'yes' vote for the new GMS contract has significant implications for Glasgow's Local CDM Scheme. Considerable work is currently being undertaken and will continue to be done over the summer to make sure these programmes can be interlinked with the new GP contract. However, we would welcome your view on the Glasgow CDM programme, in light of the new GMS contract implementation.

Practice Nurse Association

The LMC and the PCT now have regular meetings with the Practice Nurse Association to deal with issues in relation to development of practice nursing. In particular, we are seeking the development of an 'introduction to practice nursing course' which would enable more nurses to transfer into primary care nursing. Recently the Practice Nurse Association was involved in the decision to alter the awarding of discretionary points for practice nurses, so that each nurse was able to achieve a single point above the top of the 'G' grade when appropriate, rather than have to go through a panel, which may allow them up to three discretionary points. This change will be incorporated into staff budgets where appropriate.

Staff Budgets

The vote on the new contract has delayed the PCT receiving information on its current year budget for staff, computing and premises. As you know practices have previously been given their whole budget for practice staffing, and it is hoped that there may be some additional funds for staffing in the current financial year. However, you will first of all have to ensure that any increase in staff funding this year will be reflected in your MPIG next year, so that you do not lose out in the future.

Cervical Cytology

You may have heard that Glasgow is moving to a liquid based cytology system. The laboratory at Glasgow Royal Infirmary will be the first to introduce this new system and a proportion of practices in that area will be offered training around July and August. It is possible that the introduction of the new system may initially create a small backlog of reporting as the staff are trained in the new system. A training CD-ROM will be available for users.

We are also still waiting for the roll-out of the national call/recall systems, which will supersede both practice and health board current arrangements. In the meantime, we would encourage you to consider moving to the GGHBs centralised call/recall system. This will save considerable staff time and effort. Statistics show that there is no difference in smear uptake between practices who operate their own systems and those who use the board's system, so it makes sense to relieve your staff of this chore. This health board system will meet all of your requirements under Cervical Cytology in the new GMS contract. If you want to transfer, please contact Mrs Elizabeth Rennie, tel no: 0141 211 0641.

Dovedale Counselling

Glasgow GPs and their family members can access counselling services, 24 hours a day by phoning the number given below. This arrangement includes all GP Registrars and Locums working in the GGHB area. The service is funded by the PCT, but is entirely separate from it and completely confidential. Problems with work, relationships, drugs and alcohol can be discussed and a GP can receive 6 counselling sessions in any one year. There is a choice of male and female counsellors, and it is possible to go outside Glasgow to receive help if you wish. Tel No: 0800 214 307

Research and Ethics Committees in Greater Glasgow

There are 4 vacancies for GP representatives on Glasgow's Research and Ethics Committees. Expenses will be paid by the Health Board.

This is interesting and challenging work, and there is also a requirement for each committee to have a GP member. However prospective members should be aware that there is considerable paperwork and reading involved prior to each meeting, and the time for preparation work is not as yet funded. If you are interested please e-mail mary@glasgow-lmc.co.uk and she will pass your details on.

Supplementary Lists for Non Principals

All non principals now should have applied to join the supplementary lists, and can only work as locums in the Glasgow area if they are on this list by 31st August 2003. Any non-principal who has not yet applied to join the supplementary list should do so rapidly in order that they can continue to work in primary care. It is also true that any principal in Glasgow, who wishes to work in another health board area, may well have to apply to join the supplementary list in that health board area. It is only necessary to join the supplementary list in one area in Scotland and then inform them which other areas you wish also to be registered for. Information on joining the supplementary list can be obtained from Kate McGloan at the PCT, tel no: 0141 211 3760.

We have been involved in altering the information form for references for non-principals as we felt it was too labour intensive, and hopefully the shortened form is now being used widely.

Shared Care Protocols

We have had fairly long discussions about the nature of shared care protocols in Glasgow. It is the opinion of the committee that it often more appropriate for hospitals to set up repeat prescribing systems, than to prepare complex shared care protocols for drugs which we are unlikely to see frequently in general practice. However, we are having further discussions on this issue and will provide further information in the near future.

Pneumonococcal Vaccines

We have had many enquiries from practices wondering whether they should order Pneumonococcal vaccine in view of the NHS intended immunisation programme for this year. Negotiations are currently ongoing for a payment for pneumococcal immunisation. This has been delayed both by the new contract and also by our request that practitioners, who have already immunised patients, receive a backdated fee for this. We hope agreement will be reached soon. In the meantime you may wish order the vaccine as apparently it takes some time to manufacture.

IT Update

As you know the new contract means that PCTs will take over the full costs of providing IT in the future. There are some fairly big changes occurring in IT in primary care at the current time, some of which are in tune with the future provision of IT by the PCT. It is clear that the PCT IT department were struggling to have a decision making process in place, which involved GPs and which GPs would find acceptable. We have therefore been putting in a lot of work to improve this situation. We are also involved in an attempt to improve the communication between the PCT IT department and GPs in general. The principles of this communication are that; practices are provided with simple information about what may appear different, but that more detailed technical information will be available to those who wish it.

There have now been 700 workstations installed in GP practices as part of the CDM IT rollout and this will continue throughout the year. As a result of recent Scottish Executive money, some new 'high tech' practice servers have also been installed to practices with particularly challenging needs. This new hardware represents a significant improvement, but practices need to be aware that due to the software problems this does not necessarily lead to a very high level of response on your workstations. What it does mean hopefully is that CDSS will run for practices. Most practices that have had CDSS installed will realise that it does slow down GPASS opening files compared with not having CDSS installed. However, it is important that the response time is quick enough not to be too irritating.

Hopefully our current level of IT hardware will suffice for the new contract software. The CDM CDSS screen will also incorporate the relevant parts of the new GMS contract (GMS II). We are very grateful to those GPs who have helped by reporting problems with the new systems.

IT Maintenance

The sharp eyed amongst you will have noticed that, now that the vote for the new contract is 'yes', IT maintenance and Minor Upgrades back to April 2003, should now be 100% reimbursable. However, as the PCT has not yet had its normal budget for this year, this is not yet entirely clear. Nevertheless, it would be unwise to book any future maintenance contracts beyond the end of March 2004. We would also strongly advise that you look at the small print in any contracts you have at the moment.

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 guest writer is Dr Richard Wilson, Locum

"As a medical student and throughout my career as a medical practitioner, I have always been taught the dangers of polypharmacy and been aware of the debilitating effect of it on patients, both physically and mentally.

Since my return from Africa I have been working all over Scotland as a locum GP. I am simply stunned by the amount of medication patients are now expected to comply with, not to treat disease, but to reduce risk. Risk of what? Death? That is a risk that is irreducible. To delay death then. And by taking all these pills how long do we on average delay death by? A few days, a few weeks? Life expectancy here now far exceeds the three score years and ten, not as a result of multiple medications but as a result of social change. Are we really committed now to try and extend it chemically as well, and at what cost? I saw a man last week in his sixties. He takes 28 tablets every morning. He was crying as he told me it took him ten minutes just to open the bottles.

Now, of course my views are influenced by my time in Tanzania, where life expectancy is perhaps forty and a child dies every five minutes. A place where death can be delayed years and years by a spoon , some sugar and salt

with clean water. But that doesn't benefit the pharmaceutical industry. And let us be clear, this new polypharmacy has been led by the hospitals but driven by the drug companies. The agenda is not life quality but profit, all covered by the new mantras of evidence based risk reduction. And soon you will all find out if your pay will be determined by your adherence to this philosophy. Good luck to you, but I don't want any part of it."

Many thanks to Richard for his contribution. If you would like to reply, or have a subject you would like to highlight please submit to mary@glasgow-lmc.co.uk

Mercury Sphygmomanometers

Mr John Henderson, Medical Technical Officer, Department of Medical Physics and Bioengineering at the Southern General Hospital, tel no: 0141 201 1895/6, will calibrate Aneroid, Mercury and Electronic Sphygmomanometers for a cost of £40 per hour plus 17% employers costs and mileage. In addition, he will check fridge temperatures/thermometers and adult and baby scales. Mr Henderson will also take mercury sphygmomanometers that are in good working order, which are sent to be used in clinics and hospitals in Ghana. This arrangement has come about through the work of Mr Martyn Webster, Plastic Surgeon at Canniesburn who visits Ghana several times a year to help out in a plastic surgery unit.

Nursery Requests for OTC Medication

Ofsted guidance clearly states that non-prescription medication can be administered in day-care with the written prior consent of parents. If you are asked by a parent to provide a prescription or letter stating it is ok for a nursery to administer such medication, please do not provide them. We are aware that some nurseries ask parents to obtain a prescription, but the GPC Prescribing Subcommittee hope that GPs will remain firm on this issue and not comply with unnecessary requests. It is for parents and the nursery to resolve this issue and should not involve general practice.

Duration Certificates - Release of Information to Life Assurance Companies after Death

Doctors will be familiar with the situation where a life assurance company writes to them asking for information or a report about a patient after they have died. These requests are what is known as 'duration' or 'interval' certificates. For many years, it was BMA policy that such certificates should not be issued on the basis that the assurance company should have asked for the information while the patient was alive and able to give informed consent.

More recently, the BMA's Medical Ethics Committee modified that advice in the light of the Access to Health Records Act (1990). They now consider it acceptable for a doctor to release information to an assurance company, provided the patient consented, when the original contract was signed, to disclosure of information after his or her death. However, only information about the patient up to the date of the signed consent should be disclosure, i.e. the consent is not prospective. Also, any information which is so sensitive that the doctor believes the patient would have wished it to remain confidential should not be disclosed. Where the patient gave no indication prior to his or her death as to whether information should be disclosed from their medical records, the doctor may find themselves in a difficult situation. They may feel it is necessary to disclose information, at the prompting of next of kin, in order for them to be able to claim on a life assurance policy. Often the next of kin is in a 'no-win' situation as the assurance company will not pay up in the absence of further information which will either confirm or refute any suggestion that the patient had a pre-existing which would invalidate the policy.

In some cases, however, the patient may have, during their lifetime, indicated that details of their medical history should not be divulged after their death and, in these circumstances, the doctor should not disclose the information unless ordered to do so by a court. If this is recorded in the notes, it will override any apparent consent which may have been given to the assurance company at the time of the proposal. GPs are advised to check very carefully whether or not the person has indicated a desire for information not to be disclosed and discuss this with the next of kin. Should GPs have any particular concerns, in any case, outside the normal agreed procedures, they are advised to take advice from the LMC in the first instance.

Reproduced with the kind permission of Nottinghamshire LMC

HIV, STIs and Insurers

The British Medial Association and Association of British Insurers have recently issued new guidance on what information GPs can provide to insurers about HIV and sexually transmitted infections (STIs). For some time, the disclosure of information to third parties, particularly insurance firms, has been seen as a deterrent to people seeking advice and testing for HIV and other STIs. The new guidance states that there is no reason to disclose "information about an isolated incident of an STI that has no long-term health implications, or even multiple episodes of non-serious STIs" Similarly, "insurance companies should not ask whether an applicant has taken an HIV, Hepatitis B or Hepatitis C test, had counselling in connection with such a test, or received a negative test result. Doctors should not reveal this information when writing reports and insurance companies will not expect this information to be provided" Insurers may only ask whether someone has had a positive test result, or receiving treatment for HIV/AIDS or Hepatitis B or C.

Fit to Join the Army

A GP had a few requests to supply letters stating that patient does not have any ailments that would stop them from joining the army. We have investigated and discovered that such letters 'only muddy the water' and if the army require an additional report they will make a request themselves and pay a fee for doing so. The army suspect that these requests may have come from people whose applications were 'declined'.

Name and Shame

Practices in Townhead Health Centre had recently received a lot of requests from a Glasgow Social Work hostel, for a GP's letter to state that a healthy diet was required by their resident(s). Evidently, Glasgow's direct catering department cannot provide any 'healthy' foods unless a GP says so. This has something to do with financial constraints on their budget apparently. We wonder what category of resident does not require a healthy diet. Any suggestions? Perhaps if asked, you might like to drop a letter to your local hostel stating that all their residents require a healthy diet.

Finally….

Fitness to Work Certificate

A GP was asked by a patient, who was going to Australia for a year , for a certificate to state he could not go cherry picking whilst he was there because of his asthma.

Can you beat this? Please let us know.

Barbara West

Elaine McLaren

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