Duty of Care for Hospital Test Results and Drugs Recommended from Outpatient Clinics
The joint GPC and Consultant Committee statement on hospital test results has been updated as follows:

Duty of care regarding communication of investigation results

We are aware that in some areas, some hospital doctors have been instructing GPs to find out the test results which the hospital had ordered.

Both the General Practitioner Committee and the Consultants Committee of the BMA agree this practice is potentially unsafe, and that the ultimate responsibility for ensuring that results are acted upon, rests with the person requesting the test.

That responsibility can only be delegated to someone else if they accept by prior agreement.

Handover of responsibility has to be a joint consensual decision between hospital team and GP. If the GP hasn’t accepted that role, the person requesting the test must retain responsibility.

This advice is in line with both National Patient Safety Agency guidance and the Ionising Radiation (Medical Exposure) Regulations

The following statement on Duty of Care regarding drugs recommended from out-patient clinics has also been issued:

Duty of care regarding drugs recommended from outpatients
Communication of prescribing recommendations from out-patient clinics to patients and their GPs is a complex area where patient safety can be compromised. Policies with regard to this should include the following general principles:

• Drugs required for urgent administration should be prescribed by the hospital doctor, and if appropriate dispensed by the hospital.
• Responsibility for the provision of a prescription for non-urgent medications should be determined and agreed locally, but must recognise that delegation of responsibility for prescribing from hospital to GP can only take place with the explicit agreement of the GP concerned.
• All communications should be in writing with the responsible doctor identified.
• Where communications are sent via the patient, there should be clear instructions to the patient regarding the time scale for completion of the prescription, and this should be in addition to and not instead of a formal communication.
• The doctor recommending a prescription should ensure that the prescription is appropriate, including carrying out any tests required to ensure safety.
• The doctor recommending a prescription should provide counselling for the patient about important side effects and precautions, including any need for ongoing monitoring, which if needed should be agreed between primary and secondary care clinicians.
• Recommendations should be in line with any agreed local formularies. Individual judgements should be made about the desirability of recommending a particular drug as opposed to a therapeutic class.
• Where a GP feels that a prescription recommendation is inappropriate, the secondary care clinician should be informed.
• Notwithstanding any of the above, all prescribers must be aware that the ultimate responsibility for the prescription lies with the prescribing doctor and cannot be delegated.

NHS England Notification Required for Changes in Service Delivery/New Models of Care
Some practices are developing innovative solutions/ways of working in response to resource pressures to assist in managing capacity and workload. This includes looking at new models of care similar to those outlined in the Five Year Forward View. There is no desire to stifle this innovation BUT we remind all practices/organisations of the contractual requirements surrounding service provision. It is essential that everyone involves NHS England at an early stage, when appropriate, so they can advise as to whether contract variations or new contracts may be required. We have been made aware of some practices who have fallen foul of this requirement and have developed well worked plans only to find they cannot implement these without NHS England approval.

MDO Fees for OOHs, Extended Hours and Working at Scale/Treating the Patients of Others
It is important you inform your defence organisation about any working at scale, collaborative working/looking after another practices’ patients and CCG work as well as all out of hours and extended hours work. Put simply, ensure they are aware of your full work commitment to ensure you have appropriate cover. Many GPs are now shopping around for the best value cover, when doing this please be very careful about the terms and conditions to ensure you are covered for past events and anything that may arise post retirement etc. as well as you current full work commitment.

As you will be aware, there has recently been an increase for defence organisation membership. This has been raised nationally and the GPC are collating comments from practices with regard to increases. Please send any examples to janice.foster@nhs.net.

Workforce Minimum Data Set
GPC has updated this guidance on the Workforce Minimum Data Set (WMDS). GPC are aware that alternative guidance was provided to some practices. This guidance stated that although practices were required to submit the data, pressure could be exerted on NHS England and the HSCIC to prevent them from processing the data. It was recommended that practices encourage their staff to submit a notification under Section 10 of the Data Protection Act (DPA) to the HSCIC, lodging their objection to the use of their information, and asking the HSCIC to confirm they would comply with this objection and not process the data. This advice had been provided following communication with the Information Commissioner’s Office (ICO). The legal department has sought to clarify the position for practices, through further independent legal advice and correspondence with the ICO and HSCIC. Each has confirmed that data subjects do not have the right to issue a Section 10 notice under the DPA when the processing of data is being conducted pursuant to a legal obligation, as is the case with the WMDS. The legal advice also confirmed that practices could be in breach of their contractual obligations if they fail to comply with a legal requirement to provide data under direction of the Health and Social Care Act. We therefore recommend that practices continue to follow the guidance issued by GPC. The deadline for the initial data collection was 7 June and we understand the next collection of data will take place in November 2015. As mentioned in the GPC guidance, we remain concerned about the burden placed on practices in completing this collection and GPC will continue to take up feedback from practices with the HSCIC. Please note that the HSCIC confirmed that they received a large number of Section 10 notices following the alternative advice provided to practices. They are in the process of responding to these applications to clarify the situation.

New Accessible Information Standard
The Accessible Information Standard will be implemented on 31 July 2016 and aims to provide people who have a disability, impairment or sensory loss with information that they can easily read or understand. This means informing organisations how to make sure people get information in different formats, for example in large print, Braille or via a British Sign Language (BSL) interpreter. All organisations that provide NHS or adult social care are required to follow the new standard, including NHS Trusts and Foundation Trusts, and GP practices. As part of the accessible information standard, these organisations must do five things:

• Ask people if they have any information or communication needs, and find out how to meet their needs. Record those needs clearly and in a set way.
• Highlight or ‘flag’ the person’s file or notes so it is clear that they have information or communication needs and how those needs should be met.
• Share information about people’s information and communication needs with other providers of NHS and adult social care, when they have consent or permission to do so.
• Take steps to ensure that people receive information which they can access and understand, and receive communication support if they need it.

Further details are available here.

GMC Duty of Candour
The GMC have released this joint guidance with the NMC on duty of candour which sets out the standards expected of all doctors, nurses and midwives practising in the UK. It also aims to help patients understand what to expect from healthcare professionals. The GMC can deliver sessions on duty of candour. If you would be interested in attending a session please email janice.foster@nhs.net and we can liaise with the GMC to try and organise this.

Community Pharmacy Pilot
NHS England launched a new £15m three year pilot to fund, recruit and employ clinical pharmacists in GP practices. This pilot is part of the GP workforce 10 point plan, Building the Workforce – the New Deal for General Practice, and is the result of close collaborative working between NHS England, Health Education England, the GPC, the Royal College of General Practitioners and the Royal Pharmaceutical Society.

GPC has been heavily involved in the design of this pilot and sees this as another step in the right direction towards reducing workload pressures and improving recruitment. This scheme is of course by no means the answer, but is part of a series of initiatives that they hope will ensure struggling practices get the sustained resources they need to safely manage their workload. The pilot will be comprehensively evaluated by an independent academic institution and NHS England plans to invest at least £350,000 in this evaluation process. Further information about the pilot is available via the BMA website.

The deadline for applications is Thursday 17th September and a decision will be taken on successful bids around mid-October.

The pilot will be funded for three years with an expectation that practices will continue with the role into year four and beyond. NHS England will provide practices with match funding of 60% in the first year, 40% in the second year and 20% in the third year. It is anticipated that in the region of 250 clinical pharmacists will be involved over this period. The focus will be on areas of greatest need where GPs are under significant pressure, and the pilot should build on the success of those GP practices already employing pharmacists in patient-facing roles. Practices working collaboratively, multi-site practices or GP networks / federations that are interested in offering patients different approaches to accessing care will be able to bid for funding from today. The pilot proposal has two grades of clinical pharmacist working together:

• experienced clinical pharmacists who will be prescribers or working towards to prescribing qualifications and who will begin to see patients immediately, whilst developing additional skills such as leadership and change management;
• less experienced clinical pharmacists will be employed as part of the same development programme, working with and mentored by the experienced pharmacists, developing their clinical skills in the context of general practice with the intention of taking on prescribing responsibilities in the course of the programme.

Innovation Funding
The Health Foundation is looking for projects to improve health care delivery and/or the way people manage their own health care. Each team will receive up to £75,000 of funding, over 15 months, to support the implementation and evaluation of their health care innovation project. The deadline for applications is 12 noon, 4 August 2015. Further information available here.

GMC Consultations on Generic Professional Capabilities, Credentialing and Publication & Disclosure
The GMC are currently running three consultations covering:

• Generic professional capabilities (joint consultation with the Academy of Medical Royal Colleges) – a new approach to making sure that all postgraduate courses for doctors cover common areas such as leadership and communication. This consultation is open until 22 September 2015. Further information and details on how to respond here.
• Credentialing – a new system to recognise competence and expertise in areas of medicine not covered by current specialties. This consultation is open until 4 October 2015. Further information and details on how to respond here.
• Publication and disclosure – changes to the information they publish about a doctor’s fitness to practise. This consultation is open until 23 September 2015. Further information and details on how to respond here.