Newsletter May 08 |
Welcome to our Spring/Summer 2008 Newsletter. A lot has happened over the last few months and the coming months will also be as challenging for the profession both locally and nationally. We seem to be in constant conflict with both Scottish and UK governments, and are struggling to maintain constructive dialogue with our Health Board. We really value your support and information. We hope our regular email communications to our constituents have been of use and our thanks to your practice managers who kindly forward the emails on our behalf. However, if you would prefer any emails from the LMC to be sent directly to you could you please email mary.fingland@glasgow-lmc.co.uk with your contact details. You have also been circulated with the contact details for your local LMC representatives however if you would like another copy please contact Mary at the LMC Office. Following elections for the GP Subcommittee and LMC this year your new Committee is as follows:- Chairman: Area: Constituency: Paul Ryan - Royston - (E) Vice-Chair: Maureen Smith - Port Glasgow - (C) Treasurer: Richard Groden - Tollcross - (E) Medical Secretaries: Barbara West - Drumchapel - (W) Alan McDevitt - Clydebank - (W) John Ip - Paisley - (C) Murray Macpherson - Erskine - (C) Executive Members: Colin Brown - Glenburn - (C) Douglas Colville - Rutherglen - (SE) Jim O’Neil - Carntyne - (E) Peter Wiggins - Castlemilk - (SE) Alastair Taylor - Bearsden - (W) Main Committee: Donald Blackwood - Govan - (SW) Georgina Brown - Springburn - (N) Malcolm Brown - Pollokshaws - (SW) Peter Cawston - Drumchapel - (W) Brian Clegg - Clydebank - (W) William Doak - Pollok - (SW) Mark Fawcett - Cessnock - (SW) Norrie Gaw - Woodside - (N) Stephen Goldberg - Pollokshaws - (SE) Ian Gordon - Bishopbriggs - (N) Gary Hamilton - Clarkston - (SE) Michael Haughney - Newton Mearns - (SE) Robert Jamieson - Bridgeton - (E) Derek Logan - Dumbarton - (C) Gerry Lynas - Bridgeton - (E) Neil Mackay - Alexandria - (C) Jim Mackenzie - Maryhill - (N) Chris McHugh - Townhead - (E) Keith McIntyre - Cambuslang - (SE) Kathryn McLachlan - Alexandria - (C) John McLauchlan - Kirkintilloch - (N) Robert Mair - Paisley Rd West - (SW) Patricia Moultrie - Sessional GPs Anne Mullin - Govan - (SW) Michael Mutch - Port Glasgow - (C) John Nugent - Drumchapel - (W) Nigel Pexton - Clarkston - (SE) Alex Potter - Clydebank - (W) Arun Rai - Clydebank - (W) Iain Robertson - Cambuslang - (SE) Petra Sambale - Possilpark - (N) Ian Struthers - Cardonald - (SW) Andrew Townsley - Easterhouse - (E) James Ward - Greenock - (C) Raymund White - Bishopbriggs - (N) Our thanks to retiring members Drs Barry Adams-Strump, Jane Connelly, David Gaffney, Stephen Goldberg, Susan Langridge and Stewart McCormick for all their hard work on behalf of the GP Subcommittee and LMC. Special tribute was paid by members to Dr Adams-Strump, a previous Chairman of the Committee and the longest serving member for Glasgow (28 years) and Dr McCormick, previous Chairman of Argyll & Clyde and also the longest serving member for that area. We looked through the minutes of the 1980 meeting of the LMC, the first one attended by Barry, and evidently Doctors were unhappy that an amendment to their terms and conditions would see them providing short-term certificates free of charge to employees claiming sick payments from their employers. This amendment was being made and enforced under a new government strategy without consultation with the profession. Déjà vu Our thanks to Dr Barbara West who steps down in July as our (very hard working) GPC representative in London this year and our congratulations to Dr Alan McDevitt for being elected her successor. He has a hard act to follow but we are sure he will prove to be more than able for the task! Pay Rise – What pay rise? You will no doubt be upset at the pay review body report which seems to suggest we got a pay rise but which would actually mean a pay cut if you have an MPIG (which is almost everyone). The BMA is challenging the Review Body report in how it suggests the ‘pay rise’ should be delivered as it may breach the GMS contract agreement. Scottish LMC Conference Glasgow and Clyde were well represented at the April 2008 SLMC conference. Delegates heard speeches by Laurence Buckman, Chairman of GPC and Dean Marshall, Chairman of SGPC. Dean spoke of his disappointment in an SNP government which could have shown great leadership instead of following the lead of Gordon Brown. He was concerned that the final version of the Scottish Extended Hours DES would not address patients’ perceptions of the ‘extended’ GP service or the raised patient expectations by politicians, which clearly could not be met. He commented on the anger of Scottish GPs at the DDRB pay award and voiced concern that the UK government seemed to be picking apart the nGMS contract and moving it away from clinically proven outcomes, which had worked very well and improved patient care, towards outcomes to meet the latest political whim. He spoke of governments that did not seem aware (or no longer cared) about the disastrous consequences of their actions on the NHS. In his speech to conference Laurence Buckman highlighted the difficulties caused to the UK government by the DDRB report and delegates heard the UK government was now reviewing the recommendations especially with regard to the MPIG, as what was proposed could cause legal difficulties for the government. Conference heard that Hamish Meldrum, in his capacity as Chairman of BMA Council, had already written to the Secretary of State outlining the BMA’s concerns at the legality of the DDRB recommendations with regard to the GP pay award and Hamish was currently awaiting a response from the DOH on those concerns. Dr Buckman then turned to the negative media spin against GPs and how GPs, through their local press and patient groups, could stage a fight back. He urged more GPs to contact their local newspapers, MPs and MSPs to counteract the negativity in the media. This strategy was already raising local awareness and in some cases a public backlash, on threats to local primary care services in England. Dr Buckman referred to the recent BMA Extended Hours poll and GP calls for an ‘option C’. He reminded delegates there could not have been an ‘option C’ as to reject ‘option A’ would have seen ‘option B’ imposed on General Practice. An impossible position for GPs to find themselves in. Delegates heard the additional questions in the poll had allowed GPs to let the UK government and the public know exactly how the profession felt about the government’s handling of the NHS and in particular Primary Care, the jewel of the NHS crown. In the question and answer session that followed both speeches, Dr Peter Holden, GPC negotiator in response to a question on Extended Hours asked GPs to please look to the ’bottom’ not ’top’ line when deciding whether to provide Extended Hours. He asked delegates to take into account the cost of providing a safe and secure service for both doctors and patients especially with regard to health and safety legislation. It was suggested the government was gambling the DES would be a ’loss’ leader for GPs with practices feeling obliged to do it because a neighbouring practice might (or was). Delegates heard in England the alternative to GPs providing the service would be PCOs being directed by government to commission the private sector to provide the ‘service‘. Dr Buckman then spoke to conference about future QoF changes and how GPC were stressing any proposed QoF changes would need to be evidence based. Delegates were reminded that QoF had been designed to grow and develop and not remain static. Dr Buckman told delegates GPs should also use their Practice Accreditation to counter claims of ‘rubbish’ GPs and highlight to patients and the local media how well they, as a practice, have done in achieving and retaining it. Conference heard the Patient Experience Survey Board (responsible for overseeing the new survey) would be made up of representatives from the health departments, GPC and employers. The questions in the survey would be constructed and market tested by an approved research company before being sent out nationally. However, delegates were also told that whilst the patient survey in Scotland this year would probably be the same as in England, from next year Price Waterhouse Cooper would be responsible for producing patient surveys for all NHS areas in Scotland and their surveys would be the ones used in Scotland from 2009. Most of the motions put forward by Glasgow LMC and chosen to be debated by delegates, were passed by conference. Given time constraints not every motion listed in the conference agenda is debated however those that are debated and passed, form the basis of policy talks and negotiations with the Scottish Government Health Department (SGHD) for the coming year. As well as motions passed on all aspects of Extended Hours, Enhanced Services in general, safeguarding the MPIG, and repelling any further erosion of the nGMS contract, SGPC will hopefully also be discussing the Vaccinations and Immunisation schedule and how it needs to be reviewed and amended with clear guidance issued on what is actually covered by the NHS. Hopefully such a review will finally ease the pressures of GPs being coerced into providing patients with non NHS immunisations for occupational health or travel abroad. However, do not hold your breath!! Staff safety was also debated and John Ip, whilst welcoming the inclusion of GPs and community nurses in the Emergency Workers Act, called on the Scottish Government to extend the Act further to include GP staff. Our delegates also deplored the erosion of the Primary Care Team and called for better communications between CH(C)Ps and General Practice and an end to ‘top down‘ management. Problems with SCCRS and SCI were also debated as was the need for GPs to retain the ‘right of choice’ on IT systems for their practices. Health Visitor Review and the Proposed Replacement DES and LES The LMC has entered into a formal dispute process with the Board on the proposal to charge practices 35% of the funding from the current immunisation DES for the services of health visitors. Our advice to practices is not to agree to any changes to the current set-up until the dispute process has been finalised and a decision reached. We will keep you posted but in the meantime would be grateful to catch sight of any historical documentation practices may have in this regard. Antenatal Services There has been a review of antenatal services (Glasgow City only) and it has been proposed that there is a reduction in the number of midwife clinics. The proposal is to streamline the number of clinics down from 150 to 78 per week with 2-3 ‘spokes’ in each CH(C)P. The change should mean that there would then be seven day access to triage and day care service of the Early Pregnancy Assessment Service. This might mean you would no longer have a midwife come to your practice but that she would see your patients at another venue. Patients could directly self refer to the midwife and would have a named midwife. Consultant led clinics in the community would cease. These changes are significant and the LMC has expressed concerns about the proposed changes. Please make sure that you are involved with local discussions on this in your CH(C)P. For your information, there are 10-20 home births each year in Glasgow. Extended Hours DES Like you we were very disappointed that the Scottish Government decided to follow England’s lead on the imposed Extended Hours DES and not that of their Northern Irish or Welsh counterparts who had taken a more pragmatic view and commissioned services relevant to the needs of their individual communities. From your queries we produced and circulated our question and answer list, which we hoped you found useful. As ever our advice is to look at all the costs involved in providing this DES (which is voluntary not compulsory in spite of what some people think) before coming to a decision. We are aware that some practices in Health Board premises might also incur additional charges for board employed staff to open and man the premises outwith normal hours and some practices have already been advised of these additional charges. We are also aware some GPs are thinking of providing this service on their own with no reception or other staff in attendance to try and keep costs down. Whilst you may feel secure catching up with paperwork in your consulting room after your surgery has locked up for the day, working on your own when the surgery is open for patients (albeit booked appointments) is an entirely different scenario, and we would strongly recommend you have a least one other person in attendance for security and the safety of you and your patients. We would also strongly urge that you take into account the views of your staff on this issue. They may not be happy (like you) at having to work earlier in the morning, until later in the evening or on a Saturday morning. Can we also remind practices to check their insurance policies will cover any new opening hours, we would not like your policies to be made null and void because your insurer was not advised of any changes to the surgery opening hours. We would also remind you that IT support will not be available after 6pm, and any problems with your IT Systems cannot be dealt with until the next day. We would also reiterate that the most a practice would lose should it decide not to opt into the Extended Hours DES, is the Access DES money it received last year. There still seems to be some confusion about this. The old Access DES ended on 31st March 2008. Once again we remind practices that whilst they can move a daytime surgery to concur with an Extended Hours surgery for safety reasons, only the Extended Hours surgery will count towards the DES. Evidently a recent article by one of the medical press journals when commenting on the differences between the Scottish and English DESs, has given some GPs the wrong impression on this issue. In addition practices should note that they are not required under the DES to book any extended hours appointments backwards e.g. from last to first. IM&T Update There have been a number of developments in IM&T as you will see from the following items Managed Server Pilot (remember that!) You may remember that there was a push to transfer practice data to a central server. The pilot for this has not gone well and will now come to an end. Those practices who had changed to this will now be migrated back to a practice based server. This only affects one practice in GG&CHB but we thought we should let you know as the central server plan had caused anxiety in the past. IPACC Process There is a new e-Health strategy being produced for both Glasgow and Scotland. There appears to be a sensible focus on the need for GP system replacement to be the main focus of this process. We will keep you informed. IT Service Our IT maintenance helpdesks suffered a sudden drop in performance when the SERVO helpdesk was combined with a larger helpdesk in England (part of the parent company). We have had apologies about this from SERVO and assurances about the changes they have made to fix these problems. Can we remind you that the local IT team no longer has a helpdesk, all of your calls need to go through SERVO. If you do have problems with the IT support, please let us know. Clyde IT Helpdesk The running of the IT Helpdesk in Clyde has been transferred to Servo. Servo are the company who are contracted to provide all IT support to practices in Glasgow and it is hoped that practices in Clyde will see an improvement in IT support with the help of Servo fronting the Helpdesk. The local IT teams in Clyde will still remain to provide help and support to practices. SCI Store At long last, all of Glasgow & Clyde practices have access to SCI Store for laboratory results. All clinicians need to have the link to SCI Store on their desktops and have a login name and password to access the service. Practices should contact the Helpdesk or their local SCI Store contact for assistance. SCI Gateway Referral There have been discussions at the LMC and AMC about the content of Gateway referrals. The SCI Gateway referral contains past medical history extracted from your patient record according to pre-set protocols. Its content depends on the content of your patient summary and the priorities you have set. Sometimes, particularly where the ‘high’ priority is set for many entries, the amount of information sent can be excessive. If this is the case with your system it is important that you edit the history before sending. In addition, some entries could be inappropriate to send with some referrals e.g. sexual abuse history with a cardiology referral. As a first step a guidance document will be sent out by the Board and we would support this document. SCCRS We have discovered that, should the laboratory enter an incorrect result into a patient record and then corrects it within 24 hours, the practice will not see the amended result in their patient list, only the incorrect one. We feel this is highly worrying and may have medico-legal issues should an abnormal result not be acted upon in time. However, we have been advised that the SCCRS patient letter should have the correct result. We have been told the problems with dissolving labels and leaking pots have now been resolved. Please let us know if you still have any difficulties. We have also heard that laboratories are becoming much more stringent in refusing a smear if it has not been submitted electronically. Can you please let us know of any instances where a sample has been refused. Enhanced Services CDM Enhanced Services have not yet been completely agreed as it was decided to wait until year end achievement figures were available for 2007/08. It is proposed to use these figures to resolve difficulties on the level of attainment required to trigger payment for 2008/09. It had been agreed the payment levels would be based on what was doable and feasible as shown from the previous year’s results. CDM Training There will be over thirty training events on offer and it is a requirement of the LES programme that primary care support staff should keep up to date on training. Drug Misuse NES Please be aware that the specification now also includes provision for the prescribing of Suboxone as well as Methadone, if started by the addiction services. Glasgow Anticoagulation Service (GAS) At a recent meeting with GAS, LMC members were given a guarantee by GAS that all GPs will receive six monthly reports about their patients on warfarin. This followed concerns raised by the LMC with regards to communications between GAS and GPs. In addition, GAS has given a commitment that it will work towards having all INR results available on SCI Store. Anticoagulant Service in Clyde The proposal to roll out GAS in the Clyde area is currently on hold due to funding issues. Therefore the existing Anticoagulant NES in Clyde will continue. The LMC had carried out a poll to seek the views of practices about this service change. The feedback was mixed in terms of support but with a large number of practices expressing concern about the loss of Enhanced Service funding. HPV Immunisation Programme The National Immunisation Programme for HPV (Human Papilloma Virus) will begin in Scotland in September 2008. This will be a school-based programme targeting girls aged between 12 and 13. GPs will be involved in the catch-up programme from April 2009 and this will target girls aged 18 or under at September 2008. The details of the catch-up programme such as funding arrangements, timing and phasing are still to be finalised. GP Pensions – Judicial Review In a landmark judgement, the BMA has won its case against the UK Government’s action in reneging on its decision on how GP pensions would be calculated from the years 2004-06. In a Judicial Review, High Court Judge Mr Justice Mitting has decided that the government behaved unlawfully, when the Secretary for State for Health retrospectively introduced a limit on the amount retiring GPs could receive in their NHS pensions. The government has decided not to appeal the ruling. This is good news for all GPs but especially good for those who retired recently as they should now get the pension they expected when they planned their retirement. Seniority Payment Practitioners who might be adversely affected in their seniority payments by the requirement to earn two thirds of the average superannuable income can now ask for a review. If any GP is working full time in a low earning practice who feels that he or she has been disadvantaged, they can now initiate such a review by writing to their NHS Board. However a problem has now emerged regarding GPs who retire part way through a financial year and then earn less than two thirds of average superannuable income during that year. PSD is clawing back seniority in these circumstances, and the practice is faced with the difficult problem of asking a retired partner for money. The BMA considers this to be a completely unjustified use of the regulations and is in discussions with the Health Department about this. Partnership Agreements We unashamedly remind you once again to ensure your practice agreement exists (!) and is up to date. If problems occur later in your partnership we might well be tempted to say ‘we told you so!’. BMA Law Services now offer a comprehensive practice agreement service and will also review your current agreement to ensure you have kept up to date with legislation. BMA Support to Practices We have been advised that the BMA would not consider supporting a practice when it was proceeding with disciplinary action against a member of staff, if the BMA had not been involved in the disciplinary process from the beginning. It appears their main concern is around practices who may have behaved completely inappropriately, had not taken advice and then sought for the BMA to get themselves out of a difficulty of the practice’s making. Members should therefore be warned to consider taking advice at an early stage in a disciplinary matter. Provision of Medical Records by NHS to Courts It has been agreed that the NHS will no longer routinely provide the Crown with the original medical records of patients who are still alive for use in criminal proceedings. Instead, suitably authenticated copy medical records will be provided in the first instance in all cases unless the patient is deceased. However, the Crown has reserved the right to request the originals where, for example, the writing is difficult to read, there are concerns that the records are not complete or because of the particular significance which may attach to the use of different coloured inks. Local liaison is encouraged to resolve such issues, which may be of critical importance in terms of disclosure obligations, preparation for trial and evidence to be led at the trial. As there is no ongoing clinical need for the NHS to retain the original medical records in cases which have resulted in a fatality, the original records will continue to be provided to the Crown.
Confidential Waste – DIY! In a previous newsletter we suggested that you could obtain this service through the Health Board Contract but unfortunately this is not the case. Clinical Waste Contracts The Board now has a contract for all of Glasgow and Clyde and all practices should move to this at the end of their current contract. DO NOT sign any new contracts for this but speak to Primary Care support or you might not be reimbursed. If you have signed a contract please read the small print to ensure you have not signed a long term contract. If you have signed such a contract you should contact Primary Care Support. If you have a problem with your contract please also let us know. Pandemic Flu The BMA GPs committee and NHS Employers have reached an agreement that GP practices would not be disadvantaged if they needed to suspend some or all routine work to care for pandemic flu victims. GPC chair Laurence Buckman said the agreement provided ‘necessary stability’. Under the deal, GP practices’ income would be the same as the previous year’s earnings, plus any agreed uplift. It would begin when a pandemic was declared in the UK and would be reviewed every three months. Significant Event Analysis (SEAs) – Anonymisation Practices are asked each year to submit SEAs to Tom Clackson’s office as part of their Grade A evidence for QoF. It is important to remember that these documents should not contain any patient identifiable information, and we would remind practices to ensure that they are appropriately anonymised prior to being submitted. This should also apply, where possible, to doctors and members of staff mentioned in the SEA. Tom has previously ensured that any identifiable information was removed from SEAs submitted in the past, however he will now return documents to the practice to ensure that they are properly anonymised. To avoid having to submit documents twice we would ask that you make sure to remove names, etc prior to sending in the first instance. We are aware of concerns about SEAs being forwarded to CH(C)Ps. We discussed this at a recent meeting and could find no reason why properly anonymised SEAs should not be used for educational purposes by Clinical Directors. Once an SEA has been submitted in compliance with our nGMS contract, it then becomes a public record. Security of GP Premises Following two violent incidents against Glasgow GPs in the past year, the Board released £400k to fund security upgrades to GP premises outwith Health Centres. This was welcomed by the LMC and we are pleased that all the funding has now been allocated to practices. New Southside Hospital LMC members attending the Area Medical Committee were given a presentation on the proposed New Southside Hospital which will house a new adult hospital, new children’s hospital and a new lab building. It is anticipated that there will be 1109 adults beds (completion date 2014) and 240 children’s beds (completion date 2013). LMC Benevolent Fund The LMC has taken the decision to wind up the Benevolent fund and to distribute the funds equally to the Cameron Fund and to The Royal Medical Benevolent Fund. The Glasgow LMC Benevolent Fund was established over 60 years ago to help GPs and their families in crisis or in times of need. Over recent years we have had little call on the funds and LMC members agree that the money will be better managed in the hands of these larger charities. Certificates, Reports, Certificates MRSA Testing We are aware that some practices have been asked to carry out MRSA testing on patients about to enter hospital. This is not part of our GMS contract and such testing and follow up treatment should be carried out by secondary care. We have also been made aware of Glasgow Caledonian’s Radiology Department advising its students who are being sent on an exchange visit to Malta University, to attend their GP for a range of tests and a certificate to state they are free from MRSA or have been immunised against a range of diseases including Rubella and Hep B. We have written to the University and advised them that this service is not available in General Practice and is an occupational health issue that should be dealt with by the university authorities. Hep B for Students
Despite our best efforts practices are still having prospective students being advised to attend their GP for Hep B testing and immunisation. The Dental School, Glasgow Caledonian and Glasgow University have all been written to in the last few months and asked to change their advice as this service is not available on the NHS. Can we also remind practices that the Board had in the past also written to practices stating that this was an occupational health issue that should be dealt with by the universities. Please also refer to the GPC guidance on Hep B for Occupational Purposes (copy can be found on the information page of our website). Student Loans Company A constituent has been in contact to let us know that the Students Loans Company had requested a medical report on one of its clients. The company subsequently told the GP that it did not, as a matter of company policy, pay for medical reports. As provision of such reports is not part of your GMS commitment and is a private service, we suggest that you get agreement in writing that your invoice charge will be met. If the company continues with its policy of non payment for reports, our advice to all GPs is to politely decline the request. DWP and Proof of Address A patient approached a practice and asked if they could provide proof of address for the patient for the local DWP office. The practice contacted the office in question and was advised that the office will accept the patient’s own medical card as proof. There was no need to contact the practice for a letter. IVF Bloods and Screening Tests for Private Patients We have written to the relevant clinic and explained (again) that it is not appropriate to ask GPs to provide blood and other tests for patients undergoing private IVF treatment. There is a sample letter for patients which you can download from the information page on our website www.glasgow-lmc.co.uk, on this issue. A constituent also received a letter from the clinic which stated “..the patients who attend our unit are not advised to go to their GP for screening..” The clinic does advise patients to bring copies of test results that may have already been carried out but evidently informs patients that any tests required by the clinic should be provided by the unit and the unit does not ask the GP or NHS to carry out tests on its behalf. Once again, if you are asked to undertake testing or bloods for private clinics can you please advise patients these are not available under the NHS. We would also refer colleagues to the CMO communication SEHD/CMO(2007)3 , which further clarifies the situation. Mental Health Services Integrated Care Pathway – Physical Health Check From a previous newsletter, however it seems you are still receiving these! A practice received an invitation from the homeless mental health team to attend an integrated care pathway meeting for a patient. They were also asked to complete an annual physical health check form (two pages complete with diagram of the human body). The practice wondered whether it was obliged to complete the form. Our advice was that under nGMS the practice have their own requirements for health checks and this was sufficient. It was therefore not necessary to complete the form which, incidentally, had not been seen or approved by the LMC (still hasn’t). South Lanarkshire Council and Change of Heating on Medical Grounds - Supporting Letter We thought this had been resolved a long, long time ago. However, a practice recently received a request to provide a supporting letter to confirm why the patient needed a change of heating. We have once again written to South Lanarkshire Council and reminded them that this service is not available under GMS, and also enclosed a copy of the ‘Reducing GP Paperwork’ which was issued by the Scottish Government to all Health Boards and Local Authorities in November 2007. A copy of this document can also be found on our webpage. Movement Alarm System for Epileptic Patients A practice recently contacted us as they had been asked to support an application to a charity which supplied Epilepsy Movement Alarms as part of their service. Our advice was not to provide a supporting statement as the GP had no knowledge of the device or what it actually did (although they had been supplied with manufacturer’s instructions for the product). We were also concerned that the charity had included the following statement in their letter to the patient’s guardian “...does not accept any responsibility for the quality of the alarm system which you receive or any instructions regarding its use. Nor does the trust pay for any servicing or repair costs…it is for you, with the help of your health professionals, to decide if the alarm system is suitable for you..”. We felt, given the wording, should the equipment fail or be used improperly, the GP who supported the application could possibly be held liable for supporting its use. Gardening Certificates Just a reminder you can find a leaflet for patients on the information page of our website. Blood and Urine Monitoring for Diet Clinics There are a number of online ’weight management clinics’ offering all sorts of diets however, please be aware that many of them advise their clients to go along to the GP or more often the practice nurse for blood tests and monitoring before, during and after the selected diet. One extremely thoughtful clinic (which uses a very low calorie diet) wanted the practice nurse to complete a form stating that he/she had agreed to weigh the patient and monitor the ketones in the patient’s urine. The ‘clinic’ also suggested the patient should be prepared have ten minute appointments every four weeks with their GP as evidently this was needed for the company to comply with their insurance requirements. We would strongly advise practices not to get involved in this work and would suggest patients who do wish to tackle a weight problem are referred to the Board’s NHS weight management clinics for help and support. Oral Consent and Medical Reports We have had a number of calls regarding a well known bank asking for medical reports to be provided and that the patient had given oral consent to this. However, can we remind colleagues that medical records are also covered by the Data Protection Act which does require written consent before data can be passed to a third party. GP Trainers Dr Bill Doak has been nominated as the GPC Trainers Network representative for the West of Scotland. This is part of work to form a GP trainers database to allow GPC and SGPC to communicate with Trainers as they work to address concerns about funding and workload. GP Counselling Services A reminder that this service is available to all GPs (and their immediate families) on the performers list in GG&CHB (note that Clyde GPs are now covered). We also point out that all sessional doctors and trainees can use the service. The counselling is available for any issue that concerns you not just those related to your work. It is confidential and the Board and the LMC only know how many people use it. Dovedale Counselling can be contacted on: 0800 214 307. Intrathecal Drug Delivery Service (Pain Control) We welcome the introduction of this service which will allow this method of pain control to patients in their own homes. It will involve fewer that 20 patients each year. The service will be initiated by Palliative care teams and managed by specialist Palliative care nurses (reloading etc) in conjunction with the District nurses providing general palliative care. Palliative Care consultants will be available 24hrs a day to deal with any medical issues arising.
MAPPA You might not have heard of this process so we thought we would explain. MAPPA stands for Multi-Agency Public Protection Arrangements – a set of arrangements established by police, probation and the prison service in your area (known as the Responsible Authority) to assess and manage the risk posed by sexual and violent offenders.
The principles that govern MAPPA are:
Problems have arisen where practices are advised (or sometimes not advised!) of a level of risk from a patient registered with them. Due to the limited information it can be difficult for the practice to react appropriately to protect their staff whilst providing service to the patient. In the first instance, we recommend you contact the Medical Director of your CHP who should help with your response. The process still requires to be improved to allow you to respond to the risk notice appropriately. Most of these patients will have been registered with your practice before their prison sentence but will now have a risk assessment. Community Optometrists and Direct Referral to Secondary Care The Scottish Government sent a letter to all general medical practitioners regarding new arrangements altering the scope of general ophthalmic services. In this letter it was stated that optometrists would now have the ability to refer their patients directly to secondary care when they thought it was appropriate. However, GPs are still getting requests from optometrists to refer patients onto hospital. Investigation of this problem reveals that the mechanism for optometrists to directly refer to secondary care has not yet been clarified. As the optometrists do not have access to the patient’s CHI number and medical history, routine referrals are still being sent to the GP for forwarding on. We welcome the ability of our optometry colleagues to refer directly to the ophthalmology departments in local hospitals and it is very disappointing to find out that this cannot, in fact, be done. The Scottish Government hopes to resolve these issues and is working towards a solution. These arrangements are however already operational in Clyde. Social Work Case Conferences We have had a few queries about GP attendance at social work case conferences. GPs have no contractual obligation to attend social work case conferences. Therefore a fee would be entirely appropriate if a Local Authority social work department wish the GP to attend to assist them. With regards to provision of a report, we would consider that, if a GP had information which could give concern about child protection then they would be obliged to passing on these concerns to the relevant authorities. On these occasions we do not think that a fee is appropriate or necessary. This brings us to the subject of collaborative arrangements and we would remind practices that set fees for such arrangements are no longer applicable. Unfortunately it appears as if each practice has to negotiate its fees separately with the organisation requesting the work. In addition practices would be able to opt out of providing any of this work should they wish to do so. Practices should give three months notice that they intend to set their own fees for such work. Beware nothing for nothing!! We have been advised that a constituent was invited to update their information on a medical directory run by NovaChannel AG, a Swiss based company. The GP then received a rather large invoice for the inclusion of their details in the NovaChannel database. If you are asked to provide your details for any online ‘directory’ please, please look at the (very) small print. This company is being investigated by the Swiss authorities and there is advice on the Swiss embassy webpage on how to extricate yourself from its clutches. Prescribing for Patients Travelling Abroad A patient who was leaving the country for six months asked their practice to provide a prescription for six months supply of their medication and the practice wondered whether they could provide this. We checked with the prescribing team and as prescriptions are normally issued for two possibly three months supply (although in case of contraceptive pill six months), after this period of time the patient would be deemed to be no longer under the care of the NHS and would be expected to register with a doctor in the country they are visiting for any repeat medication. However, discretion could be used in the case of a patient who was visiting a country where it was known there was a poor provision of health services. Phlebotomy Training If anyone is interested in phlebotomy training for their staff the person to contact is Mary McRobert on 211 2064. GP Subcommittee Minutes Please note these are now available on our webpage. and Finally… To bring a smile Three aspiring psychiatrists were attending their first class on emotional extremes. "Just to establish some parameters," said the professor, to the student from Arkansas, "What is the opposite of joy?" "Sadness," said the student. "And the opposite of depression?" he asked of the young lady from Oklahoma. "Elation," she said. "And you sir," he said to the young man from Texas, "How about the opposite of woe?"
The Texan replied, "Sir, I believe that would be giddy up." Have a great summer, Alan, Barbara, Elaine, Ian, John, Mary and Murray
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