Primary Care Incentive Schemes
A number of primary care incentive schemes that reward arbitrary reductions in clinical activity without evidence that this is in the best clinical interests of individual patients are being developed throughout the country. There are also schemes with little or no restriction on the reward given to practices, for example, the stipulation that the money should be reinvested in patient services. The GPC and the BMA Ethics Department have significant concerns about the professional and ethical implications of these schemes. In particular, the schemes may breach paragraph 74 of Good Medical Practice (GMP):

“You must act in your patients’ best interests when making referrals and when providing or arranging treatment or care. You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients. You must not offer such inducements to colleagues.”

The BMA asked the GMC for its view of these incentive schemes. The GMC is clear that, in general, incentive schemes should specify that payments arising from the scheme should be used for improving patient services and not for the financial benefit of individual doctors. The BMA urges any doctor making decisions about commissioning or participating in an incentive scheme to consider the schemes carefully. Any GP with concerns about a proposed incentive scheme should seek advice from their LMC. Doctors should, where possible, review the evidence base for the schemes and satisfy themselves that, in participating, they will not be compromising patient care.

Crucell Flu Vaccines Update
Crucell has now sent this letter to its customers confirming that they are withholding all their deliveries of the Viroflu/ Inflexal flu vaccine.

Zostavax Vaccine Update
The Department of Health has confirmed that if a GP makes a judgment that vaccination against shingles would be clinically indicated and beneficial for an individual patient, Zostavax can be prescribed on the NHS. The DH is also planning to make a statement about the possible introduction of a shingles vaccination programme for those people aged 70-79 years, as recommended by the JCVI. Their position on this issue has also been published in this edition of ‘Vaccine update‘.

Stamp Duty Land Tax
The GPC is currently seeking specialist advice on the subject of Stamp Duty Land Tax (SDLT), a tax on land transactions that, in the context of general practice, is liable on any lease of a GP practice or acquisition of freehold. The issue is complicated and further advice will be forthcoming once representatives of GPC have met with the Department for Health and received legal advice. In the meantime, GPs who are about to acquire land for a new practice, enter a new lease, or whose leases are up for renewal, are urged to seek advice from a specialist property lawyer. Please note that if your practice has a Licence to Occupy then there is no SDLT liability.

Door Entry Codes & the Patient Demographic Service
Practices are reminded that confidential door entry codes must be recorded correctly in patient electronic records. Practices are sometimes provided with four-digit codes by their patients to allow them access to a door entry system, or to a box containing a key for the patient’s front door. Last year, Connecting for Health wrote to practices to alert them that door code details were being stored incorrectly in the address, telephone number or name fields of patient records, which were subsequently uploaded to the Patient Demographic Service. This creates a serious security risk with, for example, the codes being included as part of the address on letters sent to patients. Practices should instead add the information to the patient record using Read Code 915L ‘Patient door access via key code’, and then record the code using free text.

GP IT
From April 2013, the NHS Commissioning Board (NHSCB) will be accountable for the delivery of primary care IT, with funding and responsibility for hardware, practice networks and support services (including training) being delegated to CCGs (i.e. the services PCTs currently provide). CCGs as commissioners will need to own a locality informatics strategy. The Local Service Provider contract and GP Systems of Choice programme will continue to be managed and funded at a national level. Work is underway with PCTs to determine the current level of spending on GP IT before decisions on the funding to be devolved to CCGs in 2013-14 are finalised.

The NHS CB has provided the following update on arrangements for GP IT systems:

The following information is in support of the information released in issue 20 of the CCG bulletin. Primary care trusts (PCTs) have led on the provision and support of GP IT systems and therefore the safe transfer into the new commissioning system is highly important to ensure that GPs continue to have a choice of quality solutions which meet local needs. The future operating arrangements for GP IT, to apply from 1 April 2013, are due to be published in the autumn. GP IT services comprise of IT support services for GP practices as set out in GMS and PMS contracts (plus APMS contracts that specifically include these IT services) plus implementation and support for all appropriate nationally mandated systems. They also include discretionary, locally determined IT support services. The NHS Commissioning Board (NHS CB) will be accountable for these services. The NHS CB will continue to set overall direction, standards, strategy and budgets, such as the GPSoC contract and maintaining national infrastructure. Clinical commissioning groups (CCGs) are best placed to plan the use of IT systems to support service delivery and service change to enable better patient care across local health communities. The NHS CB will therefore discharge its operational responsibilities for GP IT services by arranging for CCGs to provide these services locally on its behalf and by devolving associated funding to CCGs. IT support for other primary care contractors will be incorporated into the NHS CB’s operating arrangements. The proposal is that the NHS CB, through its local area teams, will be the registration authority for all primary care contractors (administration of access to clinical and business systems) and will be responsible for clinical safety and assurance (adherence to dataset change notices). We anticipate that local area teams will arrange for commissioning support units or other IT providers to provide these services.

If you have any questions about these future arrangements please contact ccgdevelopment@nhs.net.