2015/16 Contract
Negotiations with NHS Employers for the 2015/16 GP contract have concluded and an agreement has been reached. The changes provide some much-needed breathing space for practices, through further reductions in bureaucracy; with a decrease in workload in the Avoiding Unplanned Admissions DES and the withdrawal of the Alcohol and Patient Participation DESs. Improvements have been made around cover for maternity/paternity/adoption leave and there will also be a requirement for all patients to have a named GP in future. I will pull together a 1 – 2 page summary sheet for ease.

The changes to the contract will not in themselves solve the workforce crisis or address the exceptional strain affecting general practice. In order to tackle these wider issues, the GPC wrote to and met the Secretary of State of Health in July to propose a set of urgent measures designed to relieve the pressure on GP practices.

GP Electronic Annual Practice Declaration
NHS England wrote to all practices (23 September email) to inform them that the 2014/15 GP electronic Annual Practice Declaration (eDec) will be open for submissions over a five week period from Monday 6 October to Friday 7 November 2014. The letter included a set of FAQs. All GP practices are required to submit their eDec electronically through the primary care website. This year they have been able to pre-populate 76% of the eDec with responses provided from last year’s eDec submission – including the catchment area and any updates which practices have since made to it when in the GPOS module. The remainder are new questions which relate to recent changes to the GP contract. You need to check pre-populated responses, amending these where necessary, and also respond to the new questions in order to submit your eDEC. An updated GP practice eDEC user manual has been published on the website. A link to this can be found on the website’s introduction to eDEC web page. If you have any questions about the declaration please contact the Area Team or email Janice.foster@tees.nhs.uk. I will offer any assistance I can for completion of these return but we hope that the process should be a little more simple this year as the system is bedded in and the difficulty associated with the area maps has been removed.

Safeguarding and 111
JCUH will commence forwarding a letter to GP practices following an A&E DNA of a child following referral from 111. This letter is for information only but it is hoped that it will be useful if GPs are noticing the emergence of a pattern of behaviour that could indicate safeguarding concerns. There have been a number of discussions in the 111 Clinical Governance Group with regard to concerns stemming from A&E DNAs and the potential that this could form part of a wider pattern of behaviour pertinent to that patient and indicate a potential safeguarding concern. 111 has no process for identifying where a young/vulnerable patient has been advised to attend A&E and DNAs. To try and mitigate this risk JCUH has put an internal system in place where they check a child DNA against their safeguarding register. This is beyond their responsibilities but they are equally concerned about potential risks to patients. Being aware that this internal process does not capture those who have not yet appeared on the register but a pattern of behaviour may be emerging, they will now send a letter to GP practices, for information only, to ensure that there is a full picture of any DNA/safeguarding patterns. This is a short term solution until a national/contractual solution is developed. If you have any questions about this please contact Janice.foster@tees.nhs.uk.

Urgent Primary Medical Care Services for Out of Area Patients when at Home
You are strongly advised that you should not currently register any patients under the new regulation. Further to the announcement that it would not be practical to allow GP practices to proceed to register patients who live out of area without home visiting duties until 5 January 2015 concerns remain about this scheme due to the reference in the Regulations. NHS England takes the view that as the regulations, at the point of registration, require GP practices to determine whether it is clinically appropriate or practical to accept an application for inclusion in their list of patients without access to home visits etc (as set out in 26B of the GMS Regs), there is no basis on which to amend the regulations at this time. Until services for patients that register out of area are in place nationally, the criteria to set aside home visits cannot be met. Although the Regulations remain in place, a practice should only register patients without home visits knowing that they have sought and obtained assurance themselves from the Area Team that such arrangements were in place for individual patients. The GPC and LMC view is that it would neither be clinically appropriate nor practical to register patients without home visits whilst there is no assurance that arrangements for their care outside of the practice area are in place, even though the regulations now technically allow it. Practices are therefore strongly advised that they should not currently register any patients under the new regulation.

GPSoC/Choice of GP Clinical System
There are instances of CCGs (elsewhere in the country) exerting undue pressure on practices to choose a particular clinical IT system. You are reminded that the GP Systems of Choice (GPSoC) framework and GMS contractual arrangement entitles you to a guaranteed choice of clinical system from a range of accredited options. Also, CCGs are responsible for providing you with equivalent levels of support following the exercise of your choice.

If you have any questions about your rights under GPSoC please contact Janice.foster@tees.nhs.uk.

GP Clinical IT System, Deed Of Undertaking for Data Processing
A Deed of Undertaking for Data Processing has been signed by each general practice system supplier and published by the Health and Social Care Information Centre (HSCIC). It is a generic agreement covering all data processing undertaken by suppliers on behalf of practices and clarifies the relationship between practices and system suppliers. General practices as data controllers are responsible for the data held within their GP clinical system, and for any decisions relating to accessing or processing these data. System suppliers have been commissioned to process data held on practice systems on behalf of practices. The document has been agreed in principle by the Joint GP IT Committee of the BMA and RCGP (JGPITC), as well as the Information Commissioner’s Office, with input from the Medical Defence Organisations.

CQC Guidance, Emergency Drugs
You may find it helpful to be aware of this CQC Guidance covering Emergency Drugs for GP Practices.

Roles & Responsibilities of GPs in Supporting Pupils at School with Medical Conditions
The Department for Education has issued new statutory guidance and non-statutory advice on the roles and responsibilities of GPs in supporting pupils at school with medical conditions, which replaces previous guidance on managing medicines in schools and early years settings published in March 2005. This new guidance came into force 1 September 2014.

Its aim is to ensure that all children with medical conditions, in terms of both physical and mental health, are properly supported in school so that they can play a full and active role in school life, remain healthy and achieve their academic potential.

NICE Guidelines, Publication of the ‘Manual’
The new manual for developing NICE guidelines was published on 1 October 2014 and will be used in future to develop all NICE guidelines, including clinical, medicines practice, safe staffing, public health and social care topics. The manual will be implemented from 1 January 2015 for all guidelines that start from this date. Topics that are in the final stages will continue to be developed to their current processes and methods until completion. Other topics already in development will undergo a planned transition to the new manual, and NICE will be in contact with registered stakeholders regarding the implementation schedule for these topics.

Seasonal Flu, Communication with Practice Nurses and Fluenz Tetra Cap Lifted
The latest edition of Vaccine Update explains that the temporary cap on the orders for Fluenz Tetra, the nasal spray vaccine for children aged two to under 18 years, has been lifted as of Monday 6 October. Please ensure that all Practice Nurses are signed up tot an read on a regular basis the information that is circulated both nationally and locally with regard to vaccine updates. If your nurse is not registered for local updates please contact susan.kirkham@nhs.net.