Bulletin 17.02.2010
Last week the government announced that they have identified a security problem with the NHS appraisal toolkit. DoH have released this statement. As a result of this, the toolkit is to be shut down for three weeks, so that the suppliers can modify it to ensure security. There is advice for GPs from the people who run the toolkit at its website and in this FAQ document. Please note that the option given for accessing appraisal documentation when the website is down appears to involve sending and receiving information by registered post.
There are two clear aspects to this problem – data security and the appraisal itself. Taking these in turn:
Data Security
GPC have been unable to ascertain exactly how long the security problem existed for before it was identified yesterday. However, they have no reason to believe that an actual security breach occurred – i.e. that anyone accessed data that they were not authorised to see on any doctor(s) using the toolkit. The government have assured the GPC that steps will be taken to ensure the full security of doctors’ data before the toolkit is re-launched. It is expected that this will take about three weeks.
Appraisal
The shutting down of the toolkit will affect the appraisal of any GP who uses the NHS appraisal toolkit, and whose appraisal is due to take place during the three week period (and possibly after). GPs who are unable to participate in their arranged appraisal due the toolkit being shut down should organise an alternative date for their appraisal. PCTs are being told about this tonight and are being told to be reasonable.
This situation may lead to some GPs being unable to meet the normal deadline for the completion of their appraisal through no fault of their own. The GPC have written formally to the Department to ask them to write to all PCTs, advising them to be flexible in their use of appraisal deadlines for any GPs affected by the problem. They have also asked for any costs incurred by appraisers and appraisees to be met, as well as re-affirming the importance of the security of information uploaded on to the toolkit. They have not asked them to revise the three week shut down period, due to the importance of the security problem being resolved properly.
Pandemic Flu – prescribing antivirals
The DH has sent guidance on the prescribing of antivirals to SHAs, which can be accessed here.
NICE has opened the second of topic suggestion for the 2012/13 Quality and Outcomes Framework (QOF). The online topic suggestion facility allows stakeholders to submit suggestions for new indicators for QOF based on NICE guidance or other NHS Evidence accredited sources. Health professionals, patients, community groups and voluntary organisations are being encouraged to contribute. This phase of topic suggestion is open from Monday 8 February 2010 until Monday 8 March 2010.
The online topic suggestion facility provides a list of evidence-based recommendations drawn from NICE clinical and public health guidance that could provide potential new QOF indicators. This facility will be expanded to provide the opportunity to suggest a wider range of evidence-based sources, accredited through NHS Evidence. When this four-week period closes each suggestion will be reviewed against criteria provided in the submission form and suitable suggestions for the QOF will be presented to the independent advisory committee for consideration. The indicators for the 2012/13 QOF will be the first set to pass through the new NICE process in full, and the topic suggestion represents the first stage of their development. The facility can be accessed here.
The online facility to comment on QOF indicators is continually available on the NICE website and enables people to input into the review of existing indicators, this can be accessed here.
Comments will be used to review existing QOF indicators against criteria including, evidence of unintended consequences, significant changes to the evidence base or changes in current practice. Comments will be fed into a rolling programme of reviews and considered by the independent Primary Care QOF Indicator Advisory Committee. The recommendations of the Advisory Committee will then be fed into negotiations between the NHS Employers and GPC. If you have any queries contact NICE at: qof@nice.org.uk.
The Final Seniority Figures for 2006/07 For England have now been published by the Technical Steering Committee. The figures are £92,140 for England and £82,399 for Wales. Further details are available on the NHS Information Centre’s website.
Within the national cervical screening programme, the responsibility for follow-up vault smears has been shifted from GPs to the gynaecologists who performed the hysterectomy. We want to ensure that GPs are aware of this change, as some women requiring vault smears may not be called for them.
There are two main reasons for this shift:
- it is essentially a post-operative follow-up issue, as if there has been incomplete excision of neoplastic changes, this will require further intervention by the gynaecologist;
- there has been considerable difficulty in performing vault smears (knowing which part of the vault to smear and ensuring that the ‘corners’ of the scar are adequately sampled); this is very difficult to do properly in the primary care setting, so national advice is now that it should be done by colposcopic viewing and sampling, thus ensuring a good valid sampling and greater safety for the patient.
Patients requiring vault smears should not be referred back to the GP for this at any stage; it is the responsibility of the gynaecologist to follow up his/her patient, whether this entails a single vault smear and discharge from screening, or smears every 6/12 months for 9 years or more. The only patients that vault smears are (possibly) required in will be those with vaginal intraepithelial neoplasia (VaIN), who should really be under colposcopic management since vaginal cytology is very unreliable. This move will probably uncover a number of women who have been having unnecessary vault smears, since the evidence relating to their effectiveness has evolved significantly over recent years.
GPs with patients already listed for post-hysterectomy follow-up should be transferring their care to colposcopy/gynae clinics via the referrals process.
For further details see the colposcopy and programme management guidelines for the NHS Cervical Screening Programme.
Look After Your NHS – message from Dr Hamish Meldrum
When we launched Look after our NHS last summer the campaign was targeted primarily at doctors. Today, we have the backing of 80% of doctors for our position on NHS commercialisation and the campaign. With such strong support we are now ready to take our campaign to the public. We believe that, like doctors, they too will be concerned about what is happening to the NHS when they know the facts.
Public information campaign
From the 15th February we’re taking the campaign direct to the public with a leaflet and poster written and designed specifically for a public audience. These will be made available in GP surgery and hospital public areas via Practice Managers and Local Negotiating Committees (LNCs). The leaflet features a simple reply-card which we hope patients will use to tell us their views on NHS commercialisation. The campaign website has also been redesigned to be more public facing, with new content and features. This includes guidance and links to further sources of information should people wish to find out more, either about their local health services or about campaigning. The new site is due to go live Friday 12th February. Of course, it still continues to be an important resource for doctors.
Doctors can still support the campaign
All members in England will receive a pack of campaign materials which includes a new brochure on NHS reforms, a copy of the public poster and a simple questionnaire. These will also be mailed during the week of 15th February. This is a crucial stage of the campaign. To maximise its effectiveness, we need the active support of as many doctors as possible. Please could you:
- Ensure the poster is displayed prominently in public areas and that leaflets are easily available for patients to take away. More copies can be ordered at www.lookafterournhs.org.uk, or by emailing info.lookafterournhs@bma.org.uk
- Be prepared to talk to your patients and staff, when appropriate, about the issues.
- If you’ve not already shared your views and experiences of market reforms with us, please complete the simple questionnaire in your mailing pack; you can also do this online at www.lookafterournhs.org.uk
- Help spread the campaign by putting the web address – www.lookafterournhs.org.uk – and campaign message ‘Stop big business profiting from our NHS’ on all outgoing emails.
These and other ideas can be found at www.lookafterournhs.org.uk If you have any queries, please email Helen Wright on hwright@bma.org.uk.
Thank you for your support. Together, we can help put patients before profits.
Best wishes,
Dr. Hamish Meldrum,
Chairman, BMA Council