Newsletter July 2004 |
The New Contract We have gone through the contract document to highlight the major differences between the old and the new. No doubt many of you will already have done this exercise but we hope that you will find this summary useful. Paragraphs 32–33 You must offer all new patients (including children) a consultation but there is no fee attached to it, and the format of the consultation is up to you. Paragraphs 36–37 If a patient over 75 asks for a consultation and has not been seen in the previous 12 months you should do this, and the format is up to you. Paragraph 38 You should send a clinical report about any patient treated as a TR or INT to the health board for forwarding to their own GP. Paragraph 39 There is a requirement to have a max/min thermometer on vaccine fridges and to record the readings. Paragraph 42 If you are not providing an enhanced service or an additional service you should co-operate with reasonable requests from the provider of these services for information. We have yet to test the definition of reasonable. Paragraph 68p> Cervical Cytology. This now explicitly states that the woman must have appropriate information about the test, be notified of the result and be followed up appropriately. Paragraph 70 Contraceptive Services. This now includes provision of the morning after pill, advice about terminations and advice and referral for STIs. Conscientious objector must refer to another agency. Paragraphs 71-72 Vaccinations and Immunisations. You should keep a note of consent or refusal of immunisation. This does not necessarily mean a consent form, but it might be helpful. Batch no. and site of administration to be recorded also. Anaphylactic training for administering staff must have been undertaken. See our detailed advice on what immunisations are available on the NHS which is available on our website www.glasgow-lmc.co.uk Paragraphs 73–74 Childhood immunisation. As above. Paragraph 79 Maternity medical services. There is no specific requirement now for a 6 week post natal check. Paragraph 81 Minor surgery (warts). This should include a record of consent. Paragraph 154 If you have opted out of an additional service you should:- Put up a notice. Mention it in your practice leaflet and say how the patient will receive the services. Paragraph 180 When your responsibility for a T.R. has ended, or after 3 months, you should notify the health board in writing about this patient. This is important as there is a calculation in your global sum which is based on an average of the last 5 years of T.R. registration. If you fail to continue to notify T.R.s, you could lose money. Paragraphs 181–184 Refusal to include patients in list or as a T.R. You can refuse a patient, even if your list is open, but this must not be made in a discriminatory way. If you refuse a patient you must give your reasons to the patient in writing and keep a record of all such refusals for potential inspection by the health board. Paragraphs 185-186 Patient Preference. You must give a newly registered patient the option to express a preference for a particular doctor or type of doctor, and must record any such preference. However, you don’t need to comply with this if it is neither reasonable nor possible. Within these constraints it is still possible to operate personal lists if you wish. Paragraphs 192-201 If you wish to remove a patient (other than for violence or change of address) you should first warn the patient that they are in danger of removal, and record this warning. When removed you should write to the patient explaining why they are removed. You should not lay yourself open to accusations of discrimination. You should keep a written record of removals and reasons. Paragraph 213 If a patient moves outwith your practice area, the health board may invoke a procedure asking you and the patient to positively reaffirm that you will continue providing services, otherwise the patient will be removed. Paragraphs 305-311 If you employ a healthcare professional other than a GP you must take up two references and ensure that he/she is registered with the appropriate professional body (a GP must be on the health board’s ‘performer’ list and be GMC registered). There must be an arrangement for the health care professional to update their skills. Paragraph 325 All doctors working in general practice must participate in an appraisal scheme and co-operate (if necessary!) with any assessment under the poorly performing doctors scheme. Paragraphs 327-335 All sub-contracts must be notified to the health board including name and premises of subcontractor. Paragraph 391 The practice leaflet must be reviewed and updated annually. Schedule 3 of the contract shows the required content – which is more extensive than previous requirements. We shall be issuing specific guidance about the practice leaflet. The more comprehensive it is the simpler the model publication for the Freedom of Information Act will be. Paragraph 394 You must answer relevant enquiries relating to prescribing and referrals made by the health board. Prescribing enquiries can only be made by an appropriate healthcare professional, and referral enquiries can only be made by a doctor. Paragraph 399-402 There is to be an annual return to the health board and subsequently an annual review. Details of this are still to be thrashed out. Either party can ask a representative from the GP Subcommittee to attend. Paragraph 403 Other notifications that must be made to the health board are:-
Paragraphs 408-409 You must notify the health board of new or retiring partners. Paragraph 410 You must give details of any death on practice premises (Shipman effect) Paragraph 414 The health board has a right, after reasonable notice to inspect your premises. Either party can request a GP Subcommittee representative to be there. Paragraph 434 You should have a system of clinical governance and a nominated responsible person. Paragraphs 435-438 You must have clinical and public liability insurance. Paragraphs 439-444 You should keep a list of gifts from patients or their families, if the gift is greater than £100. We have not commented specifically on:-
If any practice becomes involved in any of these areas, and you wish advice, please contact us personally and we will do our best. Your Questions Our Answers These are summaries of the various questions you have sent in over the last couple of months. Enhanced Services Q/ “There are other drugs that require monitoring that are not included in the Near Patient Testing list.” A/ We have not yet defined all of the drugs which could be included in the NES. We are continuing discussions on this and hopefully will be able to expand the current NPT list. You may also be interested in the following which Dr Caroline Morrison , Public Health Consultant sent to all acute divisions. “I am sure you are aware that, as well as the new consultant contract, there is a new GP contract called nGMS for short. It has a few interfaces with secondary care services and we have been working through these as best we can. One which needs to be clear in secondary care is around the "Near Patient Testing" National Enhanced service. Each drug which GPs will contract to monitor has to be specified and attracts a payment per patient. The contract has been sent out to GPs to sign or not and so the list of drugs agreed is now fixed. Please note, this list is of drugs which a GP would not expect to prescribe without assessment and recommendation from secondary care. The NES does not cover ALL drugs - solely those which a GP would not expect to prescribe without assessment and recommendation from secondary care. The contract therefore determines that any drug which a secondary care doctor recommends (and which a GP would not expect to prescribe without assessment and recommendation from secondary care) and which requires monitoring, will not be monitored by primary care until a specific agreement has been put in place with GPs to that effect.
The manner in which we should negotiate is through the GMS Work Group - Enhanced Services and Quality & Outcomes Framework, which is currently chaired by Dr John Nugent. That group would ask the relevant expert group to deliver a draft monitoring framework and would then be able to recommend whether or not negotiations about whether the monitoring should be added to the agreed list should go ahead. That negotiation would be between the PCT and the LMC as has already been the case for the existing list. The same applies to changes in the monitoring regime.
Please note that ciclosporin and hydroxychloroquine are not included in the list - the first because it was decided this drug had such complications that a secondary care doctor should be responsible for its monitoring, and the second because blood monitoring was not required.
Possible additional drugs include some psychiatric ones, some rare beasts like epoetin, methylphenidate, flutamide, mycophenolate and probably others we haven't thought about at all. Our thanks to Caroline for all her hard work. Q/ “What happens when a patient on methadone is remanded in prison for 3 months? Normally we would complete a removal form and re-register them on release from prison. If we complete a removal form would we be allowed to take them on again on release from Prison?” A/ If you remove them you have to get permission to take them back on. If they were on methadone in prison we would suggest that this would need to be decided urgently and would suggest phoning Sharon at the GDPS as well as faxing them. The PCD should have a rapid response mechanism for methadone patients in these circumstances. Q/ “Please clarify what the LMC are advising Practices to do with ‘new’ methadone patients from 1st April 2004.” A/ The practice cannot take on (or at least cannot be paid) for any new patients after 1st April without getting permission from GDPS. The PCD have stated they will have alternative arrangements in place to deal with new patients. However our experience to date is that many practices are receiving approval to take on new patients. Please let us know of your experience (e-mail mary@glasgow-lmc.co.uk) Q/ “Should a patient leave the program or be removed for some reason are we allowed to replace them i.e. maintain current numbers in the program but not current patients.” A/ You would need to get authorisation from the PCD to take on anyone new even if your numbers stayed the same. The proposed wording leaves it open for the PCD to approve it, but they may take the patient on themselves in their new service, if available. As the retention rate in Glasgow is of the order of 90%, this would, we think, be a marginal issue. Q/ “No fee has been agreed for annual checks for IUCDs. A/ The PCT did not wish to purchase the annual coil check because Family Planning do not do it and have local guidelines to say it is not necessary. In the presence of this local specialist advice, this means practices do not have to offer it. Superannuation Q/ “How will deductions for superannuation be eventually reconciled?” A/ Your accountants will do the reconciling at the end of the year . They will look at your total income, deduct expenses, deduct private income, reports etc (however reports for the benefits agency counts as NHS income so they should not deduct them). They should also apportion an element of your expenses to your private work and we think you might have to itemise seniority payments separately. We would also suggest that you check if your accountant is a member of the Association of Medical Accountants, as they should have attended the accounting seminars on nGMS. Q/ “Is GP superannuation being held back at the moment or should we be setting something aside to cover?” A/ Superannuation is being deducted at source, but there will be a balancing adjustment once the final profits of the year in question are declared. You may like to put some additional funds aside if you think your adjustment might be high. Also remember that the practice is now liable for the employer and employee element of GPs superann. Q/ “If we are about to employ a new member of staff can we state at the interview that the post will be non superannuable? A/ This is a very tricky situation, especially if there are members of your staff already in the superannuation scheme. Although practice staff do not need to take up the offer of contributing to a personal pension scheme (or joining the superannuation scheme), you might be seen as being discriminatory if you do not offer the same conditions to prospective employees. This could lead to all manner of problems. Our advice is to contact the BMA and speak to an employment adviser who will be happy to go through all the pitfalls with you (before you make any changes to your staff contracts post nGMS). This service is confidential and you (or a practice partner) must be a BMA member to access it. Q/ “Should the GP pay the rise in employers superannuable contribution for practice staff?” A/ The rise in the employer’s rate is paid by the practice and is included in the staff budget element of your GSE for those members of staff who were in the scheme at the end of the qualifying period. If any member of your staff joins the scheme after the 1st April then the practice will have to meet the additional costs as it will not be included in the staff budget. However, if a member of staff leaves who was in the scheme and is replaced by a member who is not, then that funding remains in the staff budget. Quality and Outcomes Q/ “Aspiration utility /Medicine Management 7 – If the practice does not have responsibility for injectable neuroleptic medication (CPN does) are we penalised these four points.” A/ We think if you do not do the work, you can’t get the points. Q/ “Practice Management 4 – should the practice not sterilise any equipment but purchase necessary equipment pre sterilised – can we claim this point?” A/ The PCD will be sending out a recommendation to purchase disposable instruments, there are tough new guidelines on decontamination and sterility, which they will also send out but we really do not recommend you do this. We would suggest that disposable instruments are sterile and therefore do comply with the requirements, so yes we think you should claim this point. It doesn’t say you have to sterilise the instruments yourself, just that you have arrangements. Included with this edition is a list of disposable instrument suppliers. Further copies can be obtained from the LMC office. Q/ “Can you confirm that there is no requirement to send out invites for reviews to patients who are housebound or terminally ill”. A/ You should be able to exception report. Q/ “Do we need to carry out domiciliary visits for housebound CDM diabetic patients?” A/ GPs are not required to do domiciliary visits to housebound patients for the CDM Diabetes Local Enhanced Service. IM&T Q/ “We are about to renew our insurance policy – should we be including our computer equipment in this?” A/ The computer equipment you currently own may be worth insuring as it is part of your assets. However, if you are insuring only to get replacement to carry on your business then the PCD will replace the system and insurance then appears to be of little value. We are in discussion as to the level of replacement but would expect it broadly to be similar to your current system. It is however possible an argument may occur if you previously had 25 PCs for a single-handed practice. However, this all has to happen within an overall IT budget and may restrict other IT provision. Staff Q/ “We were discussing staff salaries and the question of Cost of Living rise, which is normally payable around May annually. What is the situation regarding annual pay increases in terms of the new contract? We can foresee staff, in a health centre especially, being unhappy if colleagues in another practice receive a pay rise and vice versa.” A/ It depends on the contracts that the staff have with the practice. If these contracts specify that their pay will be uplifted as per Whitley Council rates then you would have to do this. If their contracts do not specify this linkage then the practice could technically pay what it liked but as you say, in a health centre situation this might well lead to a bit of unpleasantness! We would strongly advise any practice thinking of making changes to their staff contracts to contact the employment advisers at the BMA before doing so, just to keep yourselves right and avoiding unnecessary disputes with staff. Q/ “Has any progress been made on the subject of payment for replacement partners after June 2003?” A/ It has been agreed that there will be an addition to your GSE if you had a new partner approved and in post by 31st March. So far there is a refusal to pay for any vacancies that were unfilled. This may need to be taken to the dispute procedure. Q/ “We were at a training course recently where someone stood up and stated that reimbursement for GP maternity cover was at the discretion of the health board and that as Glasgow was in a funding crises, they would not be paying for this. Is this correct?” A/ No. Provision for GP long term sickness and maternity is a PCO administered fund and the usual rules apply.
Race Relations Policy You will all have had a letter from the CSA asking you to give details of your race relations policy. Good news – this letter was sent in error. You do not have to reply. Secondary Care Services The LMC has been involved in commenting on various service developments and redesign schemes.
Some of these proposals are clearly designed to cut costs, but we have tried to assist in making these restrictions as clinically driven as possible. The new services will involve – yes you’ve guessed it – yet more special forms. We do try and ensure that they are as simple as possible, but we’re aware that the plethora of hand written forms is frustrating. BMA Model Publication Scheme We shall produce guidance on how to complete this document. It is quite complex, as some of you who have started doing it will know. However, you do not have to have it in place until September. We have yet to establish whether GGHB will host all the practices’ schemes on their website. This is not absolutely necessary; it can be kept as hard copy in the practice. The degree of detail in the document can be kept to a minimum if you have a fairly full practice leaflet to which you can refer. We have been asked about having to declare total practice NHS income, and the possibility that lay people will think that this is just pay for the doctors, when of course practice income also covers all your costs, including staff pay. This was the subject of much debate in England, and we see no reason why you can’t put in an expanded explanatory statement. The figure will need to be your total NHS income in the last verified set of accounts. Remember to exclude any private income. Phlebotomy Training for Practice Staff We have had a few enquiries from practices who wish to train their non clinical staff to take bloods about were they can send staff to be trained. There is a Phlebotomy course available at Stobhill. The training consists of 10 sessions over a two week period totalling 30 hours. The course will cover:- Health and safety. Infection control – this also includes basic items such as changing gloves for taking bloods from different patients. Numerous bloods – the various blood tests that may be requested and why. Labelling – the need to ensure that samples are correctly labelled and the information required on the label. Venipuncture – the various methods of drawing blood. One to one training sessions on the wards – this includes practical experience taking bloods under supervision. Troubleshooting – reasons why it is difficult to obtain bloods and how to deal with it. At the end of the training course the trainees will be able to go back to their practices and safely and confidently take bloods from patients. The course fee is £520. If you are interested please contact Kay Sinclair on 201 3662 after 11:30 am Monday to Friday or telephone 201 3000 and ask for page no 1635. It is important that any staff member undertaking this training has had the Hep B injection. Caledonian University also run venepuncture study days through their Nursing Education Development Unit. The cost of this is £30. Ms Cathy Dickson, is the administrator and she is located in Room A502 at the university. We do not know what the study day fully entails. Practice Nurse Advisor, Greater Glasgow Primary Care Division Gillian Halyburton has now taken up post as Practice Nurse Advisor to the Primary Care Division in Glasgow. Gillian was a Practice Nurse for eleven years in the South of Glasgow and latterly she was the first Diabetes Specialist Nurse to work in Primary Care in Glasgow. Gillian’s principle responsibilities are to provide professional nurse leadership and advice to Practice Nurses throughout the city. There will be an emphasis on professional and practice development which delivers clinically effective services in line with clinical governance and organisational developments. Continuing professional development, clinical support and Practice Nurse education will be high on the agenda. Gillian will support the implementation of the GMS contract, will be associated with workforce planning issues and will provide professional advice on national and local policy. Contact details for Gillian are as follows: Telephone-0141 232 2066 Email-gillian.halyburton@glacomen.scot.nhs.uk Prescribing It has been brought to our attention the costs involved when issuing some 1 OP prescriptions, e.g. you can be charged for 2 litres of calpol if you put 1 OP instead of a specific amount. Please do check what 1 OP actually means. You can get a nasty shock!! Recommending Fees The LMC has in the past recommended fee scales for a variety of non-GMS activities. The Office of Fair Trading (OFT) has taken an increasingly severe view of this, deeming many recommendations to be ‘price fixing’. Consequently, we are very limited in the recommendations that we can make. This is not necessarily the case if a service can only be provided by the patient’s own GP, but we do have to be very careful. In particular, the LMC cannot endorse or publish fees on behalf of any locum group. Please see our website for details. Locums should contract with the practice on an individual basis and you should both agree the fee before the session is done. However, the BMA is still allowed to make an agreement between the themselves and the Association of British Insurers (ABI) regarding insurance reports and examinations. The agreement as from 1st July 2004 is £65 for a report and £71 for an examination. This does not prevent you from setting a higher fee yourself if the case is particularly complex. Smoking Cessation There are two services running parallel to one another which offer the ‘quitter‘ a choice of support and advice. Firstly, there are the Intense Smoking Cessation Groups based in 15 out of the 16 LHCCs. These groups run for an hour per week for 7 weeks and are co-ordinated by 2 trained facilitators. The first 2 weeks are information sessions which address topics such as smoking behaviour, NRT/Zyban, addiction, withdrawal symptoms etc., week 3 is quit week and weeks 4 to 7 are group support sessions. The groups have been very successful and offer both daytime and evening sessions. The smoker referred by their GP tends to be the most successful in breaking the smoking habit. Most patients use NRT, which is accessed via the pharmacy directly and does not come from GP budgets. More information on the LHCC smoking cessation services can be obtained by contacting Smoking Concerns on 0141 201 9825. For those patients who do not like to attend group sessions or perhaps work shifts, there is Starting Fresh a pharmacy based project offering NRT on a one-to-one basis, together with a 5 to 10 minute support session with either the pharmacist or a trained assistant. The list of pharmacies participating in this scheme can be found on our web-page www.glasgow-lmc.co.uk Non nGMS Queries Answered Here are the answers to some recent queries received by the LMC, which may also be of interest to you. Q. “A patient claiming National Insurance Credits because he was incapable of work had been assessed and told he did not meet the threshold of incapacity and was therefore fit to work. The patient was appealing the decision and is requesting sick lines in the meantime. What is the GP’s position on this“? A. If the doctor feels that in his professional opinion the patient is still ill/incapable then he should continue to issue the certificates. However, if his opinion is that they are not then do not give. Q/ “We received correspondence from a firm stating that changes to European legislation means we may now have to charge VAT on medical reports – is this correct?” A/ Private income is now subject to VAT, but only if the total practice income for this work is above the VAT threshold (£58,000). If any practice does earn in excess of this amount they should consult their accountant. Q/ “How do we claim for completing blue badge forms?” A/ As with the old orange badge, send your claim to the health board. Q/ “The rapid access chest pain clinic has asked me to include a referral letter with the referral form. I thought the form replaced the need for a letter.” A/ No referral letter is required. Any requests for such letters should be passed to Dr Caroline Morrison at Dalian House. Q/ “When a hospital is closed to admissions who is responsible for organising an alternative bed for GP referrals?” A/ The hospital. The hospital should have been in contact with neighbouring hospitals and made arrangements for re-routing patients. Certificates, Certificates, Certificates... Just a few more to add to our list. Student Awards Agency for Scotland Asking a GP to provide a letter to confirm that the student’s mother is separated (evidently a letter from DWP did not contain enough information to confirm this). Not part of nGMS (or old) therefore do not need to provide or you can charge a fee for it. Medical Report Prior to Trip to Lourdes A practice contacted the LMC after receiving a request from a doctor to complete a three page report and a form to be returned to the Universal Travel Agency stating that the patient was fit to travel. A number of issues arose from this request.
Our advice was not to complete this form. If the doctor is medically qualified then he (or she) should be able to establish whether or not the patient is able to undertake the journey to Lourdes. NHS Occupational Health Forms Again, not part of nGMS and you do not have to do (or agree a fee). National Statistics Quarterly Capital Expenditure Inquiry A practice received this recently and yes, if you receive one you will have to complete it and return by the date requested. Most of the information requested will be in your audited accounts. Glasgow Housing Association Please do not complete any reports or forms for the Glasgow Housing Association. They have the same arrangement as the old Glasgow City housing department and should not be contacting GPs for reports, letters of support or form filling. Can we remind GPs that they should not be doing reports etc. for any housing association, not just the GHA. Strathclyde Pension Fund Requesting a GP letter to accompany an application to have deferred benefits paid. On receipt they will pass the application and GP letter to their own occupational medical officer who may or may not require to see the patient’s medical records. Totally meaningless do not do. Private Nurseries One or two private nurseries seem to think that because they do not require a full medical report (only an opinion) on a prospective employee and, as they have supplied a letter where the blanks can be filled in together with a stamp addressed envelope, there should be no charge. Not part of nGMS (or old) therefore you do not need to provide but if you do you can charge a fee for it. Declaration of Health BP11 –Health Assessment for Temporary Staffing Compliant with NHS Regional Framework Not compliant with ours. You do not have to complete or if you do agree a fee! Council Tax Exception Forms for the Severely Mentally Handicapped This is one that you are bound to do under regulations. A list of statutory medical certificates can be found on our webpage. You can download it and put it up in your waiting room. Insurance Reports An insurance company recently requested a report from a GP and advised a fee of £15.75 would be paid. We suspect the company may have only looked at the rate for a supplementary report fee however, they happily paid the correct fee once their error had been pointed out to them. Reiki Treatment A GP was asked to complete a consent form for a patient to receive ’Reiki Treatment’. The accompanying note stated that Reiki is a natural holistic therapy and a ’universal life force energy’ which treats the cause and effect of disease. Our advice is not complete or sign as Reiki is probably outwith your (and our) sphere of knowledge. Disability Hearings A number of practices have been in contact about providing reports for solicitors or the citizens advice bureau for clients who are appealing against losing their disability payments. Our advice is that you do not have to provide a report unless you feel your patient’s condition has worsened since you sent your initial report to the tribunal and are happy to do this. It would be an unnecessary duplication of work as the appellant’s team will have access to your original report Backdated Med 5 Sick-lines
A practice was asked by a welfare rights officer to provide backdated Med 5 sick-lines (for a year) in order that patients could claim all the benefits due to them. The patients were lone parents and as such were not required to register as available for work. However, being ‘unfit for work’ is the only criteria used by Income Support to process entitlement to the additional premium being sought by the welfare rights officer. Our advice was that in one case it was appropriate to do so as the patient was well known to the GP, attended the surgery on a very regular basis and the doctor could confirm that the patient did have severe health problems. However, the second patient was not so well known and had little contact with the practice in the previous year. In this case our advice was not to provide. That’s all for now folks but keep them coming!! Waiting List Target Times – Sending Patients to Named Consultant As part of the waiting list target times initiative, Dr Bill Anderson, Clinical Director, North Glasgow Trust has requested that GPs not refer patients to a ‘named’ consultant. Mr Anderson has highlighted that the waiting lists for some consultants were considerable compared to others. It is believed that patient waiting times could be substantially reduced if the hospital department themselves could allocate patients to the consultant with the least patient waiting time. We would suggest that GP colleagues might wish to generically refer patients to a secondary care service unless there is a specific reason to refer to a named doctor. Adults with Incapacity (Scotland) Act 2000 – Medical Treatment Certificates These are now available from the Scottish Executive Health Department and each pad contains 50 certificates. Orders should be sent to the Scottish Executive Health Department, Public Health Division 1-2, Mailpoint 3E (South), St Andrews House, Regent Road, Edinburgh, EH1 3DG Health Council Awards Congratulations to Dr Susan Langridge and her practice staff on their recent award from the Glasgow Health Council. Dr George Barlow M.B.E. Our congratulations also to George on receiving a well deserved M.B.E. in the Queen’s Birthday Honours List. Practice Leaflets Drs Webster and Love, are the first practice (joint) in Glasgow to have their practice leaflet sent to the PCD. PCD Staff Our thanks also to the primary care division staff (especially Kate and Janine) for all their hard work pre and post 1st April. Ian@glasgow-lmc Visitors from Overseas Since the guidance about Visitors from Overseas was released the area that has provoked the most questions relates to former UK residents who emigrated 20 to 30 years ago, generally to Canada or America, and who are now retiring back to the UK. Q/ What are they due? A/ That all depends. If they are in receipt of a UK pension, and: - either more than 10 years continuous residence in the UK at anytime; or more than 10 years continuous service as a UK Crown servant they are due partial exemption from private charges. This means that they are exempt from NHS charges only in respect of “treatment the need for which arose during the visit”. There is also a part of the regulations relating to UK Residents working overseas being exempt from NHS charges if absence from the UK has lasted:
Finally, once an individual has been resident in the UK for one year then they are automatically exempt from NHS charges. Training Training will start again in September and an itinerary will be e-mailed to practices once the training dates have been finalised. On another note, although the full cost of staff computer training is now met by the PCD under nGMS there have been a number of incidents since 1st April where practice staff have cancelled course bookings at extremely short notice; for example telephoning the evening before or on the morning of the course or sometimes not bothering to turn up at all. The courses do cost a lot in administrative and training staff time and financial resource. Cancellations at such short notice (or staff not appearing at all) are very frustrating and inconvenient especially if others could have taken the booking. Given the resource implications it is proposed to address this issue for the new training year and information on a cancellation procedure will be incorporated in the booking form. Please be aware that there may be a financial penalty introduced for cancellations at short notice. E-mail Addresses Could practices managers e-mail mary@glasgow-lmc.co.uk, so that we can update our practice managers e-mail list. Practice Voluntary Levy Could we ask those practices who have not already done so to please complete and return the new practice based voluntary levy mandates. If you have mislaid yours or would like to speak to us about it, please give the office a call. And finally… After a year of difficult and demanding negotiations... “The reasonable man adapts himself to the world, the unreasonable man forces the world to adapt to him. Therefore all progress depends on the unreasonable man..” George Bernard Shaw To all our colleagues have a great summer. Alan McDevitt Barbara West Mary Fingland Ian Mackie Elaine McLaren
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