LMC Elections
Elections for half of the Committee will take place in the new year, and further information will be sent to you nearer the time. Please do consider standing for election; we meet once a month, and the meetings cover a huge range of topics of interest to Glasgow GPs. We don’t propose to alter the electoral districts at present, but come the next election, when the Argyll and Clyde changes have bedded in, we may have a different system.
Enhanced Services
The enhanced services that have been agreed this year 2004/05 are as follows:
- NES Drug Misuse
- NES Homeless
- NES IUCD
- NES NPT
- LES Asylum Seekers
- LES Chemotherapy Bloods
- LES CDM: CHD; Diabetes and Stroke & TIA;
- LES Influenza Immunisation for Carers
- LES Implanon
- LES Multiple Sclerosis
- LES Mumps Immunisation
We have had a preliminary meeting with the PCD about next year, and have agreed in principle that these services will carry on. We have no idea if any extra money will be available, so can’t plan for any extra services to be commissioned at present. Please let us know how the provision of enhanced services has gone this year, and any issues that you may wish us to raise with the PCD.
Next year the responsibility for negotiating enhanced services will fall to the new CHSCPs. As the prospect of nine (or maybe more) separate negotiations is not attractive to us or the PCD, we hope to develop a unified negotiating group, to promote city wide consistency.
Near Patient Testing
There appears to have been some confusion as to which patients should be offered this service. Although most patients on DMARDS suffer from rheumatoid arthritis, a significant number will have bowel and skin problems as the reason for their prescription. It is the drug, not the condition, that is being monitored, and so if, say, you had a patient with psoriasis taking Methotrexate, that patient should be monitored according to the Methotrexate protocol. You will of course be paid for patients monitored.
Cancer Guidelines
A new target has been issued by SEHD starting in December 2005. All patients urgently referred because we think they might have cancer, must be seen and have treatment started within 60 days. We fear this may swamp the system, and are working with our secondary care colleagues to help manage the process. Guidance on effective referral is available from www.show.scot.nhs.uk/sehd/cancerinscotland/
There is much enthusiasm for electronic, protocol driven referrals, but unfortunately SCI Gateway is still not sufficiently robust to deal with
this. A good example is the colorectal referral form, now used both
North and South of the river. This is relatively quick and easy to fill in by hand, but the electronic version is much more cumbersome and quite unfriendly to use, especially at the receiving end in the hospital.
In principle, we must of course support the aim for our possible cancer patient to be seen as quickly as possible.
Interpreters
A reminder that interpreting services are available for all patients whose first language is not English. This applies equally to practices with or without asylum seeker patients. The service is available from 0141 341 0019.
It is reckoned to be good practice to offer a qualified interpreter rather than use a family member. For further information contact Linda Davidson on 0141 211 0250. Please be aware that, should an interpreter not be available from the GIS, there will be a cost involved if you opt to use one of the other approved services. Our advice would be to book your interpreter as well in advance as possible.
Argyll & Clyde
The SEHD are currently consulting on how the Argyll and Clyde health board area can be divided between Glasgow and Highland. There are three options:
Option One The Argyll and Bute Council area to be included within the administrative boundary of NHS Highland with the remainder of the NHS Argyll and Clyde area included within the administrative boundary of NHS Greater Glasgow.
Option Two All of the existing Argyll and Bute Council area to go to NHS Highland with the exception of the former Dumbarton District Council area, which includes the west shore of Loch Lomond, Helensburgh, Cardross and the Roseneath Peninsula, with the remainder of the NHS Argyll and Clyde area included within the administrative boundary area of NHS Glasgow.
Option Three As option two, but adding to the NHS Greater Glasgow are the Cowal Peninsula, Dunoon and Bute, Mid Argyll, the Kintyre Peninsula and the islands of Islay, Jura and Gigha.
We think that option one is the most sensible, as it consolidates the urban areas, and also removes the problem of CHSCPs existing across health board boundaries, at least in the South-West and North-West of the city.
We have had discussions with the LMC in Argyll and Clyde, as we shall have to merge our two organisations. We shall then be the largest LMC in Scotland by far; this raises a whole lot of issues about local and national representation which we need to sort out. In the meantime we welcome our colleagues from Paisley, Greenock and Dumbarton and look forward to working with them.
The New Mental Health Act
You will all have received information about this Act, which came into force at the beginning of October. We have already had feedback from GPs being asked to sign part 2 of the new compulsory treatment order (CTO). This replaces the old Section
18.
This form is longer than the old Section 18. It is more difficult to complete. It takes longer.
No fee has yet been agreed for this work, despite our best endeavours nationally and locally. We recommend that you keep a note of any CTO you have signed just in case we get a retrospective payment.
If you fill in a CTO you are liable to be called to attend a mental health tribunal a few days after signing the certificate. There is no agreed fee for this either.
You are not legally obliged to sign the second part of the CTO.
However, if you do, you are legally obliged to go to the tribunal at short notice if summoned. Single-handed GPs, partners in small practices, anyone who would have difficulty getting out of practice commitments should think very carefully before they consent to take part in this process.
Admission to the Brownlee
We have been asked to publicise the following problem that the Brownlee unit has encountered.
“Too many beds in our unit continue to be occupied inappropriately by long stay elderly patients, often admitted with non infectious conditions, such as overflow diarrhoea. Our previous strategy – of referring back to the original on call physician – has not worked. We therefore require a new approach to ensure that we fulfil our core functions of isolation and/or specialist management of patients suffering form important infections referred from throughout Glasgow and elsewhere. We are often unable to accept such referrals because of a lack of available beds. Our intention now is to allocate 5 “elderly care” beds for patients over 80 years of age with suspected infection referred from hospital or the community . We apologise in advance for those patients who we will be unable to accommodate, however this strategy does have the support of our Clinical Director and the Area Control of Infection Committee. Any concerns regarding infection control measures for patients unable to be admitted to the Brownlee Centre, should be raised with the Infection Control Officer (Infection Control Nurse or Consultant Microbiologist). There will be some exceptions to this policy viz. patients over the age of 80 with proven infection with enteropathogens, smear or culture positive tuberculosis, Herpes zoster, or with travel related infections who will be admitted, provided we have a bed.”
Please let us know if this new policy is causing any problems.
Registration
There is still no official central system to enable a patient to be registered with a practice, rather than an individual GP. This is why you are asked to register patients on the old style registration form. You are also asked how a retiring partners’ patients should be allocated. Yes, we know it’s daft….
Over the Counter Medications
We frequently hear that GPs are being asked to sanction in advance the use of OTC medication in care homes and nurseries. We do not recommend that you do this. Please note the official advice of OFSTED regarding children’s medication:-
“You may give children non-prescription medication such as cough preparations, or teething gel but only with the prior written agreement of the parent and only when there is a health reason to do so.
For all non-prescription medicines, parents should give written
consent that specific medication can be administered to their child when required. Written consent should be obtained from parents at the time you start looking after their child and checked at regular intervals so that you take account of any changes, for example where a child can no longer take a certain type of medication or may need additional medication.”
Please note the sensible word “parents”.
Completion of Care Commission Reference Form
It is compulsory for all those applying to the Care Commission for registration to provide care services for children to submit a completed Care Commission medical reference questionnaire with their application. The questionnaire is completed by the applicant’s GP, although it should be noted that completion of this questionnaire is not a contractual requirement (i.e. the questionnaire is not included in the list of prescribed medical certificates set out in the GMS contract regulations and is therefore classed as non-NHS work). In light of this SGPC have agreed that Scottish GPs should determine their own fee for completing the Scottish Care Commission’s Medical Reference Questionnaire.
SGPC has worked with the Care Commission to make the questionnaire as straightforward as possible to complete and a copy of the questionnaire is included with this newsletter. They are aware that some GPs have expressed concerns about having to seek a fee for completion of this questionnaire from patients who may be unemployed or on a low income. Unfortunately, they have been unable to convince the Scottish Executive that central funding should be made available to support this activity. The level of work required to complete the questionnaire may vary significantly depending on each individual case; this was one of the key reasons that SGPC concluded that GPs should set their own fees for this work.
Information on suggested fees for services which can only be provided by a patient’s own GP is available to BMA members on the fees section of the BMA website. BMA fees guidance will be updated in due course to confirm the agreement that in Scotland GPs will set their own fees for completing the medical reference questionnaire.
Disposal of Controlled Drugs
This is a question that comes up a lot. Below is the latest guidance on this issue:-
Following the conclusion of the Shipman trail, the GP Prescribing Subcommittee felt that the medical profession locally should be seen to be pro-active in doing everything possible to prevent any abuse of controlled drugs. Since the Regional Medical Officers were abolished, there has been no regular inspection of GPs Controlled Drugs Registers which you are bound to keep by law. It was therefore decided that this responsibility should be delegated to the Medical Prescribing Adviser for the Primary Care Division. It would be expected that this function might be carried out at routine practice visits. Copies of the Controlled Drugs Register are available from the LMC Office.
There is a need to reassure the public and politicians that we are taking this issue seriously and are making every effort to reduce any potential for abuse as much as possible. It is hoped that you might co-operate with the Medical Prescribing Adviser in carrying out this task.
Destruction of Controlled Drugs
It may be helpful to consider the general legal requirements which are contained in the Royal Pharmaceutical Society of Great Britain
booklet entitled “Medicines, Ethics and Practice – A Guide for Pharmacists” (January 2000).
Practice Held Stock
Any person required by the regulations to keep records of Controlled Drugs, that is Schedule 1 and 2 Drugs, may only destroy them in the presence of a person authorised by the Secretary of State either personally or as a member of a class.
Particulars of the date of destruction and the quantity destroyed must be entered in the register of Controlled Drugs and signed by the authorised person in whose presence the drug is destroyed. The authorised person may take a sample of the drug which is to be destroyed.
The Police Chemist Inspecting Liaison Officer who should be contacted to dispose of practice held stock is Mr Colin Dunk (tel no: 07786 855 379).
Patient Returned Controlled Drugs
A pharmacist or a practitioner may destroy Controlled Drugs returned to him by a patient or a patient’s representative without the presence of an authorised person. Such Controlled Drugs should not be returned to stock. It is good practice to record the returned stock and the date of its destruction on a record book other than the CD register or on separate record sheets. As the quantity of Controlled Drugs being returned can often pose a storage problem, as well as an increased security risk, pharmacists are encouraged to destroy patient returned Controlled Drugs as soon as possible, and not wait for the authorised witness to visit. Pharmacists have a responsibility, within their contractual obligations to the Primary Care Division, to accept such returns for destruction.
Jury Service
GPs may be asked to serve on a jury, but can be excused “as of right” as they are practising physicians. Extract from Jury Form below:-
“Excusal as of Right – Certain persons have a right to be excused from Jury Service on Request.
These are members and officers of both Houses of Parliament, members of the Scottish Parliament, members of the Scottish Executive and Junior Scottish Ministers, members of the European Parliament, members of National Assembly for Wales, the Auditor General for Scotland, full-time serving members of forces, practising members of the medical and similar professions, members of certain religious bodies, ministers of religion etc, persons who have previously attended for service within the last 5 years and persons who have been excused by direction of any court from jury service for a period which has not yet expired.
If you come within this category and wish to be excused from jury service on this occasion you must apply in writing as soon as possible to the Clerk of Court.”
Also on the subject of Jury Service it has been brought to the attention of SGPC that some practices in Scotland have been charging for certificates to establish unfitness for jury service. We have been asked
to remind our practices that these certificates are included in the list of prescribed medical certificates in the GMS contract regulations (Schedule 3) and therefore should not incur a fee.
Your Questions, Our Answers
Q/ “We have a patient who persistently DNAs, on the last occasion a double appointment had been booked – Can we remove the patient from our patient list?”
A/ Before taking this course of action you must first write to the patient and advise them that, in light of the number of missed appointments made, should there be any further defaults you will have no option but to remove them from your patient list. You cannot remove them without issuing a warning first. It might also be wise to include a section in your practice leaflet explaining the consequences of missed appointments and the action the practice will take if the problem becomes intolerable.
Q/ “A patient is making a ‘living will’ and we have been asked to confirm that they were of sound mind at the time of writing it – what would be entailed and should there be a charge?”
>A/ If the patient is well known to you a short certificate of fact at a cost of £11.50 should suffice.
Q/ “We are getting increasing requests from insurance companies to carry out blood tests for the purposes of processing their claims. They are only willing to pay £19.50 for the blood tests – is this reasonable?
A/ The offer of £19.50 for taking bloods seems fair however these should definitely not be processed through NHS labs as if they were a normal specimen. An NHS lab will bill you for the service as it is for an insurance company. Alternatively, there is nothing to prevent you sending the samples to a private lab for processing. The same applies to x-rays requested under these circumstances. Be aware that you need to ensure that the insurance company is aware of the actual cost of the investigation as charged by the private lab (or by the NHS lab; they will tell you the cost if you ask them) and you should obtain written confirmation that they will pay the costs in addition to your fee for taking the blood before you do the work.
Q/ “A solicitor requested information on a child stating that he had been appointed the Curator Ad Litem for the child – do we still need consent before discussing the child’s health record with him?
A/ According to legal advice Curator Ad Litem means that a person legally takes on parental responsibility for the children therefore, you would be allowed to discuss the matter with the solicitor.
Q/ “Recent articles in the medical press suggest that practices must register with the environmental agency before clinical waste is removed. Does this apply to Scotland as well?
A/ No. There are rules about disposal of clinical waste in Scotland but there has been no recent change and there is no requirement in Scotland to register.
Q/ “Is there any guidance on what a practice can do if their list size is growing larger than they can manage? And are there any penalties etc for closing the list?
A/ Closure of practice lists is detailed in clauses 230 to 253 in the New Contract. In short you need to notify the Health Board in writing of your intention to close your list for the stated reason. Within 7 days of receiving your formal request the Board must start formal negotiations with you. These negotiations may be around the services you are providing, and whether by cutting back on those services you could cope with your increased list
size. The negotiation would take no longer than 28 days, and at the end of that time the Board will have to state if they are accepting your list closure. Should they accept it will either be for a stated time; not more than twelve months or until some other thing happens, such as your list size falling below a certain level.
If you fail to reach agreement on closure you can still close your list, by sending a closure notice to the Board. They will then set up an assessment panel to look at your closure. If the assessment panel agrees with you, then your list can close, but if they don't, then your list must remain open, and you cannot restart the process for three months.
Any potential penalties could be withdrawal of enhanced and additional services, as they may feel you could cope with your increased list size if you weren't providing them. There would naturally be a subsequent loss of income.
If any practice is thinking about formally closing their list please give us a call for an informal chat.
Visitors from Overseas
With the advent of the Civil Partnerships Act please note that from 5th December 2005 all same sex couples, married legally in another country will be treated as married in the UK.
Emergency Care Summary
You will be aware that your practice will have been asked for permission to extract this data from your practice system. The Emergency Care Summary will include patient demographics, allergies and adverse reactions, acute prescriptions in the last 30 days, current repeat prescriptions.
Initially the data will only be accessed when the patient gives consent for it to be viewed when attending the Out of Hours Service. The ECS is a very limited step in the use of a central patient clinical record. However, the issues which arise out of it are the same. As you know, some of your colleagues have considered the issues of patient consent, data quality and the responsibilities of practices as a Data Controller in a letter to you all. Many of these issues have been considered in advance but the content and outcome of these discussions are not widely known. We are now in a process of gathering detail on these issues to pass on to you. We have an obligation to care about what happens to information patients give to us in confidence whilst not prejudicing high quality care. So far the existence of the ECS has stimulated debate which will hopefully allow us to get it right. Whilst there is an intention to increase availability of this data to other clinicians (eg Outpatient clinics) no extensions to its use will happen without the agreement of SGPC. You will be informed as to any proposals for change and have an opportunity to assess the reasons for it.
At present, if a patient decides not to consent, you should take a note of this and enter it onto the system (once we are informed of how to do this!). Once a patient chooses to do this, their data (including data taken before this point) is no longer transmitted to the central database.
Please note that your practice should have displayed the recommended poster about this in waiting areas and make a note about this in your practice leaflet.
IT System Choice
A small number of practices (approx.12) have put forward business cases for a change in practice IT systems. At present the agreement is that any change in system will happen only as part of a change to the ‘central server’ model (where the practice’s server is at a remote site rather than in the practice). The central server development is currently clearly behind schedule and is adding to the frustration of those who wish to change their practice software.
Superannuation (not)
Incredibly, we still do not have an agreement on the money to be given to us to pay the employers contribution to superannuation on the new income under nGMS. If we get any news on this we will e-mail you and if it is good news might even set off some fireworks!
Occupational Health and Hep B
We recently e-mailed to practices a copy of the new GPC guidelines on requests for Hep B for occupational health reasons. If you did not receive a copy and would like one please contact Mary at the LMC office.
CHI Numbers
Practices are asked to ensure that CHI Numbers are on all referrals, lab requests, letters to hospitals etc. This reduces errors in patient identification and all hospitals etc are moving to use CHI rather than hospital numbers.
Counselling Services for GPs and their Families
Can we remind colleagues that the Dovedale Counselling
service is a free and confidential service available to GPs
and their immediate families. Dovedale can be contacted
on 0800 214 307 twenty-four hours a day, seven days a week.
Pathways to Work
This is a new initiative from the Department of Works and Pensions and is designed to assist patients approaching their sixth month of unemployment to return to work. The programme offers patients short term work-focused programmes which will educated patients about their condition, emphasised the positive benefits of returning to work and help them to return to work where possible.
Participants will be selected by Jobcentre staff and there will be no need for a referral from a GP. Patients will also have access to a range of health interventions to assist their return to work. GGHB will receive additional, targeted funding to employ personnel who will be responsible for delivering these services to patients.
It is hoped that GPs will feel able to encourage patients to take up an offer for inclusion in this initiative.
And finally….
Q/ Why did the guru refuse Novocaine when he went to his
dentist?
A/ He wanted to transcend dental medication.
Alan McDevitt Barbara West
Ian Mackie Mary Fingland
Elaine McLaren
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