Newsletter November 2003 |
Not only the New GP Contract News We are very aware that interest and the need to impart information on the New GMS Contract is all dominating at the moment so please remember to look out for our new regular faxed updates to practices. However, we also know that there are still the everyday practice problems and queries to address as well and for the remainder of this newsletter there will be no mention (other than this) of the New GMS Contract. Louise@glasgow-lmc As you will no doubt be aware, our Louise has taken up a new post within the Primary Care Trust and is now based at Clutha House in the South-side. We wish her well in her new role as Information Services Support Manager and are sure that she will bring to this post the same dedication, drive and determination we have come to admire at the LMC. Louise is in the process of recruiting her mentoring team and has already started to contact practices to see if they wish some help in preparing for the implementation of the N** ******** in April (sorry we did say we would not mention again in this newsletter). Louise can now be contacted on 0141 427 8310 or e-mail Louise.McTaggart@glacomen.scot.nhs.uk Ian@glasgow-lmc Mr Ian Mackie will be taking up post in the LMC on 1st December 2003. Ian is currently a practice manager and will already be known to some practice staff through his other role as an accredited GPASS trainer. Ian will be available to advise and assist GPs and their practice staff on everyday matters and will be maintaining the LMC’s (and Louise’s) excellent record of identifying and delivering appropriate training for GPs and their staff. We look forward to having him on board. Mercury Sphygmomanometers If you use mercury sphygmomanometers on a regular basis in your practice do you also have a mercury spillage kit to contain any spillage? Kits can be obtained from the community pharmacy at Leverndale, and it is recommended that keep one in the practice as part of your health and safety policy. As we reported in our July newsletter Mr John Henderson, Medical Technical Officer, Department of Medical Physics and Bioengineering at the Southern General Hospital will gladly take any mercury sphygmomanometers that are in good working order. Mr Henderson can be contacted on 201 1895/1896. Mr Henderson will also provide a sphygmomanometer calibration service at a very reasonable cost. If, however, you need to dispose of mercury sphygs that are defunct then shanks.waste solutions provide an approved service for the uplift and disposal of mercury sphygs at their Polmadie site. Approximate costs are:- 1. £5.00 per mercury sphyg 2. £8.00 for the supply of 25L containers (each) 3. £50.00 per hour for transport. 4. Supply of consignment note £28.00 We would suggest that if there are a number of practices based at the same site, they may wish to pool resources and organise a batch of sphygs to be uplifted in one go, which would be cheaper as there would only be one transport cost and one consignment note. Shank.waste solutions can be contacted on 0141 420 3993. OTC Medications Practices are still being asked to prescribe/certify that it is ok for nursery staff to administer over the counter medication to children in some nursery schools. Please do not prescribe or write such certificates for OTC medication as they are not necessary. Interdisciplinary Response and Intervention Service (IRIS) The IRIS service started in April 2002 and provides supported discharge and appropriate admission avoidance. Patients are included from A&E, Orthopaedics (particularly trauma), elderly care wards, acute medical and surgical receiving, who require short-term intervention providing care and rehabilitation in the period following discharge. GPs in the West have had access to the GP Rapid Response element of the service for a number of years and additional resourcing in March 2003 has allowed the ‘roll out’ of this service to the North and East of the NGT catchment area. IRIS would like to encourage GPs in the North and East to use this service. GPs can contact the team to request assessment of older people at home who have had a ‘crises event’ requiring intensive health and social intervention but no need for inpatient medical care. GPs retain medical responsibility for patients included in the service, however, each team has close links with a Lead Geriatrician. Patients who will be included in the service must have a need for short term intervention only, as IRIS input from Nurses, Physiotherapists, Occupational Therapists, Rehabilitation Assistants and Pharmacists last for around 4 weeks. The service operates from the Western Infirmary, Glasgow Royal Infirmary and Stobhill Hospital between the hours of 08:00 to 18:00 hours, 365 days of the year. The latest referral accepted from GPs on a daily basis is 15:00 hours. To contact the IRIS Teams to make a referral:- IRIS Western Infirmary Telephone: 0141 211 6354 Radio Page: 0765 917 3271 IRIS Glasgow Royal Infirmary Telephone: 0141 211 1284 Radio Page: 0762 360 4644 IRIS Stobhill Hospital Telephone: 0141 201 3210 Radio Page: 0762 360 2202 Certificates, Certificates, Certificates.. Here is a selection of the new and not so new! Pantomime Certificates It is that time of the year again (although shows/plays/TV appearances last the whole year through) and we have had some queries recently about certifying children fit to perform. Unfortunately, the law states that councils have to be given a certificate to allow children to take part in certain performances. They are unable to bypass this requirement. It seems that a statement has to be made that the child is fit to take part in performances for which a licence is requested and that his/her health will not suffer by reason of taking part in such a performance. We would like to remind our colleagues that provision of these certificates are not part of your GMS and that you do not have to provide them. We have suggested to various organisations that they may wish to employ a GP on a sessional basis to examine and provide certificates for the child performers in their companies. A few organisations have pointed out their charitable status. However, we have suggested in this case that perhaps one of their children may have a parent or guardian who is a GP and would be willing to provide this service for free. If you do wish to provide such a certificate we suggest you charge according to the level of service you give. A full private examination and report with certificate £120, this appointment would take approximately 45 minutes we suspect. Alternatively, you may choose to offer a 10 minute appointment with a letter and certificate at the same level as the fitness to attend school examination, for a fee of £29.70. Weight Watchers Form This one is easy – do not do! However, if you choose to you would be entitled to charge a fee commensurate with the amount of time and effort you put into completing it. One Plus One Plus is an organisation that provides help and support to one parent families. They request medical references under the 1989 Children Act, for potential employees. One plus will pay a fee for completion of the reference form if you choose to do it. Riding for the Disabled Some practices have been approached to certify a disabledpatient as being fit to ride a horse. Our advice would be not to provide such a certificate as the finer details of horse-riding are probably not in our sphere of expertise. Richmond Fellowship Scotland The Richmond Fellowship are requesting GPs to complete a risk assessment form on prospective clients. This is not part of GMS and our advice is not to complete this form unless you agree a fee prior to sending. However, please be aware that some of the information requested in this form would not necessarily be known to a GP. Medical Information for Homeless Housing Applicants – West Dunbartonshire Counci Our thanks to Mr Bill Clark, Head of Strategy at the Department of Social Work and Housing Services at West Dunbartonshire Council, for his very prompt response to our concerns about providing medical information to his department. We are very pleased to report that the Homeless Persons Staff at West Dunbartonshire Council will no longerrequest information from their clients GPs regarding their client’s medical problems. As an alternative they are exploring avenues with their own Independent Medical Officer to assist them in considering applications for homelessness where the client has medical difficulties. Policy on Intimate Examination Practices received a document from the PCT on Intimate Examination Policy. This document was issued as a guide only (much of which already occurs in practice) and it is up to individual practices to formulate their own intimate examination policy. Data Protection Act - Verification of Claim There still appears to be a lot of confusion over whether inserting a paragraph in your practice leaflet informing patients that their records are held on a database and may be accessed by another agency to verify payment claims, would be adequate for consent purposes. Practices should be aware that there is an abundance of information available to them on this subject (try the BMA website for one) and that they should use the information they feel is best suited to their needs. Shared Care Protocols Could we once again highlight that no agreement had been reached on many of the 'shared care' protocols currently in circulation. We have also recently been told that there are no additional resources in the current primary care budget for prescribing shared care, and that colleagues should be advised not to participate in shared care because of this. There have been a number of concerns raised about the prescribing of Ritalin in primary care and you should note that the GP Subcommittee have not agreed a protocol for this. Some of the concerns raised include GPs not being told when their patient has DNA’d at Yorkhill, which could mean that routine monitoring has not taken place and the GP may be prescribing inappropriately as a result. There is also concern that there is no ’exit’ strategy for children who have reached their teens or adulthood or information on who is responsible for their continued care. GPs and their secondary care colleagues should also be aware that GPs have full legal responsibility for the drugs they prescribe. It is unfair to request GPs to repeat prescribe rare, unusual or high risk drugs started in secondary care, especially if the drugs are not licensed for primary care use and the patient has a condition that requires specialist input and monitoring. Pneumococcal Immunisation
SGPC is actively seeking a retrospective payment for those practices who had started immunising in advance of the campaign and who will not receive payment for earlier immunisations. Alternatively, you may wish to agree a ‘data collection’ fee of £6.80 for each of the patients you had previously immunised before you enter their immunisation details on the sheet provided. Can we also remind you that influenza vaccine for the at risk under 65s should be ordered through your stock order. X-Ray Reporting at Stobhill Hospital A number of GPs had been in contact about the unacceptable delays in receiving reports following their patients having an X-ray at Stobhill. This matter has been raised at the Area Medical Committee and we will advise you of the outcome. DEXA Services The Direct Access DEXA service is considering initiating a routine follow-up recall system for patients and will be happy to extend this service to GP practices. Oral Cancer Awareness Campaign A major advertising campaign is underway to make the public more aware of mouth lesions. As a result more patients may present to GPs and dentists for referral to specialists. Patients you may want to refer will be seen at the Dental Hospital in the North, by the Facio-maxillary Team in the South and at the GRI for head and neck. A further campaign to highlight colorectal cancer is also planned to follow on from the oral cancer campaign. Reduction in the numbers of GP Registrars There is great concern about the reduction in the number of GP Registrars in the West of Scotland. The current GP Registrar quota for Scotland is 250 however, for many years 280 to 290 GP registrars were employed because of an underspend in secondary care. This funding is no longer available. In February 2004 there will be 260 GP Registrars allotted for Scotland and by August 2004 this will drop to 250 GP Registrars. The quota for the West of Scotland of 116 is dropping to 100 with Glasgow's quota of 50 dropping to 45. In Dr Colin Hunter's assessment, Scotland needs 300 GP Registrar posts per annum for replacement purposes and to fit in returnees. If Scotland does not get this amount of GP Registrars it will shortly go into deficit. It is also important to realise that this funding helped GP returnees. Colleagues are asked if they would write to their MSPs and the Health Department at the Scottish Executive to highlight this crisis. Adults With Incapacity Act – Some Frequently Asked Questions Q. A private nursing home has requested an assessment of a patient in their care under paragraph 5 to allow their nurses to administer medication, can I charge them? A. Unfortunately no. This is one of the anomalies of the Act as, if they had been independent practitioners you could charge a fee, but as they are not you cannot. However, if they are looking for an assessment under any other part of the act, for example to manage someone’s finances, you can. SGPC is also lobbying the Scottish Executive to allow nurses to carry out these assessments for AWIA certification. GPs should also remember that such assessments should be carried out at a time convenient to you and you should make the home aware that there is no reason to cease administering medication whilst awaiting the assessment. We would also remind you that the patient still has the choice to refuse medication whether or not a certificate of incapacity has been given. Q. Is a fee payable for providing certificates to community dentists to undertake treatment on a patient with incapacity? A. Yes. Claims for payments under section 47 of part 5 of AWIA should be submitted to the CSA at Clifton House. Q. The partner of a patient left a form at reception for me to complete to state that their partner was incapable of managing their own financial affairs. They left a message that they would ‘collect’ it at the end of the week. A. Firstly, You cannot just sign this and pass it on, no matter how well you may know the patient‘scircumstances. You must carry out an examination of the patient and sign and date the document on the same day. There is also a fee payable for this by the person requesting the assessment. What you must also remember is that sometimes you may decide that, yes, a patient is capable (and a fee will still be due). Hypertension Project A pat on the back to all Glasgow practices who participate in this project. As some of you may know, Dr Caroline Morrison produced a paper on the results of Glasgow’s hypertension project and also spoke about the project at a medical conference in Vienna. Both were very well received and showed that Glasgow GPs and their staff, have turned conventional thinking on hypertension identification and management on its head. Well done, it isnice to have something positive reported about Glasgow’s health care for a change. Now to this year’s campaign. The CD-ROM with the programme to extract the information has been sent to practices. Unfortunately, we have a small typo in the accompanying instructions. So to all those who have yet to run this years extraction, don’t panic when version 2.3 appears instead of version 3, version 2.3 is correct. Click on view practice statistics and you should see the three tabs, follow the instructions and extract the data. If your practice has not yet reached the target, remember you have until 31st December to complete the programme. Remember: Congratulations to Helen Robertson, Dr Rogerson and Partners for being the 1st practice to return their statistics this year. Dr Isobel Cullen’s practice were second and our commiseration to Mr John McIldowie, Dr Lawrie and partners who came in third and was just pipped to the post this year after being first last year. Occupational Health and Hep ‘B’ We have had a few queries from practices whose patients are requesting Hep ‘B’ vaccinations. If they are an NHS patient, you cannot charge for Hep ‘B’ vaccination. However, if the patient indicates it is for occupational health reasons, then it is perfectly reasonable to suggest that their employer should refer them to their own occupational health service for this. BMA/Law Society Consent Form In July a joint BMA/Law Society consent form was launched in response to concerns by GPs that the consent they received from solicitors was frequently inadequate. The new form, available at Form is intended to ensure that doctors can rely on the consent obtained in the knowledge that patients are aware of the extent of disclosure they are authorising. It is not obligatory for solicitors to use this form but it is good practice for them to do so and there are clear advantages for both solicitors and doctors having an agreed form. As with any new form there are some teething problems that will need to be addressed when it is reviewed. Some GPs have expressed concern, for example, that the form does not request payment before the information is provided to the solicitor and this will be discussed with the Law Society when the form is revised. Some GPs have also expressed concern that the form does not give the option of providing only partial access to the records. In the past the BMA has advised, from an ethical perspective, that the a report should be offered instead of access to the records and that access should be limited to those parts of the record that are relevant to the episode in question. Developments in practice, and in case law, however, mean that this is no longer appropriate advice. Court rules allow the person against whom the claim is made to seek disclosure of any documents which may impact on the case.
In most cases the defendant will seek access to the whole record, primarily to assess whether there is anything in the records to indicate that an existing disorder could have contributed to the injury for which the claim is being made. Given that the full medical record is likely to be sought by the defendant, the solicitor acting on behalf of the patient needs to see the whole record in order to advise the client about the chance of a successful outcome – failure to do so could be considered negligent. The option of agreeing to only partial disclosure is not, therefore, open to patients in most cases and they will need to decide whether to either agree to full disclosure or not pursue their claim. The form is designed to ensure that patients fully understand the implications of giving consent before they give it. This will be discussed with the patient in advance of information being sought from the GP. Whilst the doctor may wish to point out to a particular patient, that the request will involve the disclosure of very sensitive information, it is ultimately for the patient him or herself to decide whether to agree to disclosure and, if not, to discuss this with the solicitor. The GP’s role is to ensure that valid consent has been obtained before disclosing the information. Although solicitors will be encouraged to use the form, GPs may continue to receive some requests for information with the consent in a different format. The situation regarding such requests has not changed. Provided the doctor is satisfied that the consent is valid, information must be provided under the terms of the Data Protection Act. (courtesy of GPC News 17th Oct 2003) A Word of Warning Please, please look at the small print before signing contracts. If you have been approached to change suppliers for waste disposal we would advise that you check the minimum length of the contract and the cancellation clauses of your current and proposed supplier. Also be aware that changing suppliers would lose you preferential rates currently enjoyed under local health board arrangements. You would not be able to rejoin at these rates. And finally…. GP Subcommittee and LMC Elections Are you interested in becoming a member of the committee of the largest and one of the most proactive LMCs in the UK? As you know, every two years half of the GP Subcommittee and LMC elected members retire. Elections will take place in February 2004 for members to serve on the committees from April 2004 to March 2008. Retiring members can be nominated by their peers to continue on the committee and any GP members who were co-opted or have filled a temporary vacancy are also eligible to stand for re-election at this time. Notification of the election timetable will be issued to GPs in January. Alan McDevitt Barbara West Mary Fingland Elaine McLaren
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