Changes to Practice Boundaries
As part of the agreement negotiated between GPC and NHS Employers for 2012/13, changes are being made to regulations from this April to allow practices to create ‘outer boundaries’. These changes have been introduced to help improve patient choice of practice and to amend the closed list regulations, but they are unrelated to the piloting of remote registration and consultation. Changes to practice boundary arrangements and the relaxing of the closed list regulations, as described here, are permanent and apply across England.

Cervical Screening Training Update
The GPC would like to remind practices of their responsibilities as both providers and employers who have a duty to ensure that staff are up-to-date. It is recognised that existing training packages may not meet the needs of all, and practices may wish to explore different modes of training delivery e.g. via cascade training or on-line tools. In a recent meeting, officials from GPC, Department of Health and NHS Cervical Screening Programme discussed the ongoing update training requirements for health professionals performing tests for cervical screening in line with the principles for training set out in Barbara Hakin’s letter of 15th December 2011 and agreed that:

• sample takers need to be fully competent and appropriately trained in sample taking and cognisant of the latest developments;

• the GMS contract places a responsibility on practices both as providers and employers to be satisfied this is the case;

• the NHS Cervical Screening Programme supports practices both as a provider and employer through its training and update programme;

• individual training needs will differ between practices and between health professionals and clinical governance systems should be in place to identify the training needs of all clinicians involved in the screening programme (nurses and GPs).

We would also recommend that practices familiarise themselves with the primary care guideline on unusual bleeding in young women.

Business Continuity Plans
With an imminent fuel strike expected we would like to remind all practice of the need to ensure they have an up to date business continuity plan and give thought to how a fuel strike could impact on daily work e.g. home visits, difficulty for staff attending work. It may be worth dusting off buddying arrangements that were put in place for flu.

BMA Guidance on Firearms Licensing
The current letters being sent from the Police to GPs to enquire whether there is any medical information that might have a bearing on the individual’s suitability to hold a firearm is causing concern for GPs. The BMA and Association of Chief Police Officers (ACPO) are looking for a longer and more enduring solution, however owing to the current legislation governing firearms licensing it is anticipated that this will take longer than expected. In the interim, the BMA has agreed that the letters will continue to be sent out to doctors. Doctors are reminded that they are under no obligation to respond to these letters, but should they decide not to, doctors should inform the police as it will otherwise be assumed that there is nothing relevant on the medical record. Where doctors are happy to respond to these letters, consent to the disclosure of any information should be sought as the letter does not currently indicate that consent has been given. If the patient does not consent to disclosure, this should ordinarily be respected, although the police must be informed to that effect. If, however, the doctor believes that the patient presents an immediate risk of serious harm to themselves or others, information should be disclosed even in the face of an explicit refusal. Although the current letter from the police states that it does not have to be retained, the BMA has been advised doctors can record the request for information in the medical record and indicate what action, if any, they have undertaken. The BMA are seeking to change the wording of the letter to reflect the position. There is no nationally agreed fee for this work. It is the BMA’s view that the Police should pay for any work. Serious concerns about a person’s suitability will always take precedent over payment.

NICE Infection Control Guidelines
NICE has published clinical guidelines for Infection control.  These are available at the NICE website. The consultation comments and responses can also be found  here. 

Reminder, Changes to HPV Vaccinations
From September 2012 the HPV vaccine supplied as part of the HPV immunisation programme will change from Cervarix to Gardasil. Until that time Cervarix should continue to be used, with the aim of completing all courses by April 2013. A small supply of Cervarix will be available to order after September 2012 for outstanding courses, but please note that quantities of this vaccine will be capped. For further guidance, please refer to this letter from the Department of Health Director of Immunisation which includes some helpful FAQs.  

GPC Message, CCG Constitutions
As CCGs focus attention on authorisation, many are drawing up constitutions. The NHS Commissioning Board has published a model constitution and the GPC will be providing short guidance on this soon.  The existing GPC constitution guidance  outlines key elements of a constitution that GPs should check are included. It is vital that the CCG constitution has the support of member practices and that the constitution outlines how the CCG will engage with the LMC. One final point – we have seen some draft constitutions that outline how practices can be ‘expelled’ from CCGs. This makes no sense – the legislation states that every practice must be a member of a CCG, and furthermore that CCGs should cover a coherent geographical area (i.e. no gaps!). Therefore, unless a practice is located precisely on the boundary between two CCGs there is no option for a practice to be ‘removed from a CCG’ as this would compromise coherent geographical coverage.