Newsletters
View All Newsletters- Latest Newsletters:
- October 2009
Download this newsletter as a PDF file...
NEWSLETTER
Download this newsletter as a PDF file...
October 2009
COVENTRY LMC LTD
NEWSLETTER
_________________________________________________________
WELCOME To the October 2009 Coventry LMC Newsletter.
This is the first newsletter which we have been published online. For this edition we have included it on the website and will also be posting hard copies to practices.
Shortly we will only publish the newsletter online so it is important that all GPs (whether partners, salaried or sessional) and Practice Managers are registered users of the LMC website (www.covlmc.co.uk). All practices have been contacted about this and invitations to join sent to all GPs and Practice Managers. If you have not signed up already then please contact Maggie Edwards at the LMC Office either via email (maggie.edwards@uhcw.nhs.uk) or phone the office (024 7696 8785) and leave email address details and Maggie will ensure that you are sent an invitation.
As you can see the LMC continues to be involved in a wide range of issues. Should you have any queries please contact the LMC office. Should you have any articles you wish to be included in the next newsletter then please email them to Maggie at the LMC office.
TERTIARY REFERRALS
There is much unhappiness and confusion amongst GPs around what can be referred from one consultant/speciality to another.
A policy was drawn up by the LMC,PCT and UHCW NHS Trust to clarify and to try to put a stop to the large number of money-spinning, unnecessary cross-referral at UHCW. More than 50% of new patients seen in Neurology, for example, had been referred by other consultants.
The following can be referred:
· As Part of an agreed pathway e.g. cancer patients to oncology
· Complex or urgent patients, e.g. life threatening conditions or suspected cancers. The former should include referral to chest pain clinic.
· As part of the management of the condition for which the original referral was made, eg thyroid disease to surgery of radiotherapy by endocrinologist.
All others will be referred by to GP for assessment with a view to referral onward if this is deemed appropriate.
OOH AND EXPECTED DEATH
There have been several cases recently when an expected death has occurred and relatives telephone OOH. All these calls are first taken by the Ambulance Service. This has resulted in blue lights flashing and the arrival of the Police. This is clearly inappropriate and discussions are afoot to clarify the situation.
In the interim it is good practise for Practices to notify the OOH services and ambulance services of the details of patients expected to die, so the process can be as dignified and stress free for relatives as possible.
Please try to put in place protocols for doing this.
NHS CHOICES
There has been much concern around NHS Choices enabling the public to post comments about Practices and GPs on its pages. The GPC has given its approval to this. At the recent GPCWM "Nuts and Bolts" meeting we questioned Laurence Buckman (GPC Chair) about this. He assured us that all postings will be scrutinised and "moderated" by an external, independent company before being posted on the site, thereby protecting practices against vexatious comments. We await with bated breath!
RETIRING SINGLE-HANDED GPs
At the "Nuts and Bolts" meeting the importance of practice succession was again stressed. Single handed GMS and PMS GPs who are approaching retirement should take on bona fide partners to avoid their practices being awarded to APMS groups. The PCTs are very keen to develop APMS as it is a means of performance-managing practices through short term contracts. The mushrooming of APMS will gradually erode General Practice as an Independent Contractor Business to all our detriment.
SALARIED GPs
The LMC Secretary and a salaried GP representative of the LMC attended a BMA sponsored course on Salaried Doctors in General Practice.
The course was poorly attended considering it is a subject of great importance. Most issues were around lack of watertight contracts and concerns about salaried GPs being taken advantage of.
Salaried GPs are reminded that if they are employed by GMS Practices they must have been given a valid contract. PMS Salaried GPs should have a contract, this is deemed Best practise, but this is not enforceable by PCTs. They should have a formal Terms of Employment agreement which stipulates, hours, benefits etc. This is a standard legal requirement.
There is a move for Salaried GPs to be aligned to a different representative body to the BMA. The BMA represents all GPs regardless of their employment status and has a track record of acting for both parties in inter-GP disputes. There is no reason to suspect that it would act in the interest of employing GPs rather than Salaried GPs.
The LMC has 2 designated seats for salaried or sessional GPs. The current elected members are Harj Chaggar and Steve Richards. Please contact them if you have issues (email Dr Harj Chaggar at dochsc@hotmail.com and Dr Steven Richards at snowman@doctors.org.uk ). The BMA runs a variety of courses for salaried and sessional GPs. If you are interested then look on the BMA website or contact Maggie at the LMC office who will let you have the details.
SIGNIFICANT EVENT ANALYSIS AT PRIMARY / SECONDARY CARE INTERFACE
Some time ago we established a pathway for dealing with problems emanating from secondary care. This was through the Best Practice team at the PCT. This fell by the wayside during PCT re-configuration.
We are trying to re-establish a clearly defined pathway. It is important that the PCT is informed of any significant events so that trends can be identified and corrective action taken.
It is, of course, still appropriate for problems to be dealt with by direct contact with UHCW if this is thought best. However, it is important that these instances are collated.
EQUITABLE ACCESS TO PRIMARY CARE ( EAPC /AKA DARZI CENTRES)
We have requested details of the cost per patient per year as agreed in the contract for these services from the PCT. We are told that divulging this information would be “anti-competitive” as procurement processes are still being carried out in the West Midlands SHA. We have been assured that we will be given the information by the end of the year. We are discussing the matter with the BMA.
QOF VISITS
The PCT has set up a sub-group to review QoF visits. The group includes several GPs some of whom are QoF assessors. There will be a more intensive training programme for Assessors to try to prevent individual prejudices being an issue. We are trying to sort out the issue of patient consent for access to their notes for the purpose of assessing summaries.
LES/DESs
There has been a real glut of these recently. These are, of course, optional.
The PCT has the power to engage other providers to offer services not taken up by practices. There is a danger that this will play into the hands of APMS.
The PCT is obliged to consult with the LMC but does not have to have the LMC’s approval before offering LESs. We are going to use a traffic light system to let Practices know the LMC’s view of individual LESs
- Red: The LMC Officers have not been consulted or are opposed to the LES
- Amber: The LMC has been consulted but has reservations about the Specifications or the Remuneration.
- Green: The specification and remuneration has been agreed by the LMC
Each Practice has to decide whether it wants to participate in the LES .
NB: SMOKING CESSATION LES
The LMC was consulted on this. We felt the remuneration did not compensate for the work involved and that too much of the payment was dependent on patients stopping smoking which we felt made GPs hostages to fortune.
DE-REGISTRATION OF PATIENTS
In light of events reported in the Press it is important that Practices are fully aware of their obligations when de-registering patients.
- Patients moving out of Practice area: The Practice should inform the PCT that the patient has moved outside the Practice area. This area has to have been agreed between the Practice and the PCT. The PCT will then inform the patient and give guidance on re-registering. Practices do not have to inform the patient directly
- Patients not moving but being removed for other reasons: The Practice MUST give the patient written warning and provide the reason. The patient has the right to appeal. The Practice should then let the patient know that the de-registration has taken place and inform the PCT. De-registration does not take place until 8 days after the PCT is informed, the Practice remains responsible for the patients’ care in that time. Patients cannot be removed on ground of race, religion, ethnicity, degree of difficulty or cost etc.
- Patients being Actively Treated: Patients who are being seen more often than weekly cannot be de-registered until that course of treatment has been completed or they have actually registered with another Practice
- Immediate de-registration: In cases of violence or perceived threat to GPs or Practice staff a patient can be removed immediately. For this to happen the police must be informed and a “crime” number obtained. The PCT must be informed.
If the Government’s plan to do away with Practice areas comes to fruition all this will have to be revisited.
DEALING WITH THE PRESS
Dealing with the Press is fraught with potential dangers. If a Practice should be asked to comment on an issue it is important to understand what is being asked and to consult your defence body. The LMC and BMA can give guidance (all the LMC officers have attended BMA training on this). The PCT can also be of help through their Communications department.
SALARIED DOCTOR CONTRACT
We have recently received reports of cases in the City where salaried Doctors have been working without a contract and have found their position compromised when they need sick leave or maternity leave.
GMS There are severe consequences for a GMS Practice which does not offer at least the Model Contract (available from the BMA and on their website) to a new Salaried GP, with the ultimate sanction being the withdrawal by the PCO of the GMS Provider Contract. It is vitally important that GMS Practices take note of this. This contract should include Maternity Leave, Sick Leave and Protected Learning Time.
PMS and APMS It is not obligatory for PMS and APMS employers to offer the Model Salaried GP contract. The GPC recommends that allsalaried GPs are offered the Model contract at least, regardless of their employers contract with the PCO.
PMS and APMS salaried GPs should seek to ensure that they receive at least the minimum, particularly in recognition of continuous service.
NB: there may not be a requirement for PMS and APMS Practices to offer their salaried Doctors a contract but there is a legal requirement to have a “statement of employment” which lays down the terms and conditions of the employment. This must include details of sick leave and maternity leave. PMS and APMS Practices that have not offered their salaried Doctors a “statement of employment” are leaving themselves open to legal redress. Full details can be obtained from the Department of Business Enterprise & Regulatory Reform.
PARTNERSHIP SPLITS
In the event of a Partnership split the PCO is obliged to put the resulting Practices out to tender which means going through the “Procurement and Tendering” process which is lengthy, complicated and costly. The resultant Practices would not be entitled to MPIG, there is currently no new Growth Money, so the only game in town is APMS which involves short term contracts, which seems to be what the powers that be want.
MATERNITY LEAVE
The PCT has accepted the DoH’s recommendation that locum payments are based on £1500/week pro-rata. This does however remain discretionary.
PATERNITY LEAVE
The PCT has just agreed that Paternity Leave locum costs will be reimbursed. Provided:
- The paternity leave is for more than one week and not more than 2 weeks
- The GP is entitled to Paternity leave by Statute, Partnership Agreement or contract of employment
- The locum must not be a partner or shareholder in the Practice (we are still working on clarification of this)
- The Practice is not claiming another payment for locum cover in respect of the GP on paternity leave.
The PCT is offering £978.91/week pro rata. We feel that the payment should be equitable with maternity payments and are raising this with the PCT.
SWINE FLU
You will have all seen the arrangements for H1N1 vaccination.
These are available on the LMC website, along with explanations around the agreement met by the GPC and the NHS employers.
Practices will be expected to vaccinate their own “Front Line” staff without reimbursement. District Nurses will be vaccinated by PCT’s Occupational health. District Nurses will be expected to vaccinate all housebound patients regardless of whether the patient is being case managed or not. Practices will not be charged for this.
The GPC advises that all Front Line staff are vaccinated. This does however remain a matter of personal choice, however.
FLU-ESCALATION PLANNING
A sub-committee is being established to monitor and manage this. It will have LMC Membership. The aim is to make sure that Practices are helped to deal with Pandemic Flu and will not be financially penalised if QoF work etc is affected.
The DoH guidance on this applies to GMS but the PCT has undertaken to ensure that PMS and APMS Practices are treated equitably.
COVENTRY LOCAL MEDICAL COMMITTEE
CHAIRMAN: Dr Manoj Pai
VICE-CHAIRMAN: Dr Madeleine Wells
SECRETARY: Dr Jamie Mapherson
COMMITTEE MEMBERS –PRINCIPALS
Dr B Bodalia, Dr S Bogahalanda, Dr J V Chandra Mohan, Dr T De Souza,Dr H Dosanjh, Dr A Ezzat,
Dr A Feltbower, Dr M Gold, Dr M Hill, Dr G Ingrams,
Dr M Jayaratnam, Dr R Lal-Sarin, Dr I Macdonald,
Dr D Mistry, Dr P O'Brien, Dr R Rhodes, Dr I Saeed,
Dr C Taggart, Dr P Whidborne
COMMITTEE MEMBERS – SESSIONAL /SALARIED
Dr H Chaggar and Dr S Richards
CO-OPTED MEMBER
Dr S Chaggar
REPRESENTATIVES
UHCW Rep: Mr R Kennedy
Coventry PCT Rep: Dr P Baker
Registrars Rep: Dr N Wiratunga and Dr J Foster
Ophthalmology Rep: Dr R Kumar
EXECUTIVE OFFICER
Maggie Edwards
Clinical SciencesBuilding
UniversityHospital
Clifford Bridge Road
Coventry
CV2 2DX
Ph: 02476 96 8785
email: maggie.edwards@uhce.nhs.uk
WEBSITE