Bulletin 22.06.2015

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Bulletin 22.06.2015

Removal of Patients from GP Lists (Violent Patients)
This updated guidance covers the situation where a violent patient needs to be removed from the practice list. In particular it emphasises the responsibility of the practice to ensure a violent patient is removed in accordance with the provisions introduced in 1994 allowing the immediate removal of any patient who has committed an act of violence or caused a doctor to fear for his or her safety, so as to reduce their liability for any further acts of violence committed by the individual on other NHS premises.

Rent Reimbursements and Owner Occupied Premises, GPC Focus On
This guidance gives an explanation of the different types of ‘rent’ reimbursements for GP premises: notional rent (for GP owner-occupiers), borrow costs reimbursement (for GP mortgage holders) and leasehold rent reimbursement (for GPs in rented premises) plus other FAQs about premises costs.

CCG/Practice Agreement for the Provision of GPSoC and GP IT Services
NHS England has published the CCG-practice agreement, which sets out the responsibilities of CCGs in providing GP Systems of Choice (GPSoC) and GP IT services to practices, and each practice’s responsibilities in receipt of these services. Further details and supporting documents are available on the NHS England website. The agreement replaces the previous PCT-practice agreement. Each practice and CCG will need to sign the agreement by 30 September 2015 to ensure the practice’s right to a choice of system is protected, and that the CCG and practice meet their obligations. Where signature is not possible, and a resolution is not reached through CCG escalation to their area team, practices will risk the withdrawal of central funding provisions.

Examinations and Sickness Certificates
It should be noted that GPs are not required to provide sick notes for schoolchildren. When children are absent from school owing to illness, schools may request a letter from a parent or guardian, and this is no different during an exam period. However, children who have missed exams due to illness are frequently told by schools that a note from a doctor is required; but there is no requirement for this to be provided by a GP. Aside from the fact that parents/guardians are responsible for excusing their children from school, GPs cannot provide retrospective sickness certification. When a child suffers from a long-term condition, any certification will be provided by the responsible specialist. The GPC has sought and received confirmation from the Office of the Qualifications and Examinations Regulator that Awarding Organisations make no requirement for pupils to obtain a medical certificate in support of their application for special consideration. Students are asked for information in support of their application, but this may take the form of a statement by the school. The Joint Council for Qualifications has confirmed that as far as they are concerned, if a student was absent from an examination as a result of illness and has the support of the school or centre to be absent, special consideration will be granted on that basis. Awarding organisations do not insist that medical proof is provided.

Carr Hill Formula Review
NHS England has started its work to review the Carr Hill Formula. This will probably be a challenging piece of work which is unlikely to conclude before next year. Any recommended changes from the review would then need to be negotiated with the BMA before being made. The GPC have formally raised their concerns that the review will distract from the real funding problem facing all practices, which is inadequate overall investment in primary care. They have also pointed out the risk of destabilising practices if changes are made to the formula without sufficient additional investment. Nevertheless, the review may be able to use up- to-date information to identify areas in which the current formula is failing some practices. The GPC have urged NHS England to include in the review’s remit the particular needs of practices with atypical patient populations and consideration of an off formula component to cover basic practice running costs.

Update on Supply of BCG Vaccine
Public Health England (PHE) has been notified of a further delay to deliveries from the manufacturer (the Statem Serum Institute) of the BCG vaccine and expect ordering for BCG vaccine to reopen on ImmForm in mid-June. Practices should continue to prioritise remaining local stocks as outlined in Vaccine Update issue 227.

Focus on PMS Review, Transition from PMS to GMS
This week the GPC published a new Focus on PMS reviews and transition from PMS to GMS. As PMS reviews are ongoing in many areas the GPC expect to update this guidance as necessary in response to problems and solutions that arise over the coming year.

Jeremy Hunt, ‘New Deal for GPs’ Speech
Practices may find this DoH transcript of the Secretary of State’s speech in which he announced his ‘new deal for GPs’ useful. Jeremy Hunt set out plans to boost the general practice workforce by 5,000 more GPs and increase investment in surgeries and services. In return he is asking GPs to work towards offering appointments seven days a week. The BMA’s response is as follows:

“The Secretary of State is right to highlight the great strengths of general practice and the need to increase investment to support this vital service that is so valued by patients.

“GPs want and need more time to care for their patients, but at the moment, nine out of 10 GPs feel that excessive workload is damaging the quality of care they can provide patients, and this is having a major demoralising effect on the profession – one that’s pushing more and more doctors toward the exit. At the same time, this pressure cooker environment is putting younger doctors off a career in general practice. The Health Secretary himself recognises the impact of the ‘hamster wheel’ that is the reality of general practice.

“The priority must be to first address this overwhelming workload pressure GPs face, in order to re-establish general practice as a career that is rewarding and appealing – only this will improve GP recruitment and retention. It is vital that government moves beyond rhetoric and brings forward tangible resources and practical solutions to stabilise general practice, and give GP s the time and tools to care holistically for patients. We need urgent action now, not just aspiration for the future.”

“It is positive that the government has listened to our calls to resource and support struggling practices – but this needs to be adequate and available now to for the escalating numbers of practice who are vulnerable.”

Commenting on the health secretary’s pledge on seven-day services, Dr Nagpaul added:

“At a time when even the government recognises that general practice is under resourced and practices struggling with GP vacancies, with some even closing, it is not logistically possible for GP surgeries to be open nationally seven days, without stretching GPs so thinly so as to damage quality. Further, it is crucial that taxpayers money is not diverted from frail elderly patients in greatest need given that pilots of seven-day routine working are increasingly demonstrating a low uptake of routine weekend appointments. The government should focus on supporting practices to provide accessible services during the day and further develop the current 24/7 urgent GP service, so that patients can be confident of getting access to a quality GP service day and night.”

New and Amended Meningococcal Vaccination Programmes for 2015-16
Meningococcal B (Men B) for infants
 – an enhanced service to deliver Meningococcal B vaccination has been agreed. The programme is for three doses of vaccine at 2, 4 and 12 to 13 months. This programme will commence on 1 September 2015 and will run to 31 March 2016. There will be a payment of £7.64 per dose plus £2.12 (to recognise additional workload) with a total fee of £9.76 per dose.

Meningococcal ACWY (MenACWY) – due to a rapid increase in meningococcal group W (MenW) disease in England, JCVI recommended an emergency programme to vaccinate all 14-18 years-olds (school years 10-13) with a quadrivalent MenACWY conjugate vaccine.  This new programme will commence on 1 August 2015, and is a single-dose programme for all patients aged 18 years on 31 August 2015.   There will be a payment of £7.64 per dose plus £2.12 (to recognise additional workload) with a total fee of £9.76 per dose.

Mengingitis C vaccination for University freshers – the Men C University freshers programme, which was due to start on 1 April 2015, has been on hold until the MenACWY vaccine becomes available. The MenACWY vaccination programme will now commence on 1 August 2015, which is when the MenC vaccination programme for freshers will also commence.

The Men C booster will be offered to freshers (first time university or further education students who have received notification via UCAS to obtain MenC vaccination – aged 19-25) not previously vaccinated with MenC since reaching age 10 who self-present at their practice for vaccination. There is a flat fee of £7.64 for one dose.

Further information about all these programmes is available in this table and on the BMA website. The service specifications are available here.

GP Trainees Subcommittee Elections 2015 – 17
The GP Trainees subcommittee are holding elections for the North East region constituency. If you would like to get involved in the work of the subcommittee, and really make a difference to the lives of your fellow GP trainees, please consider standing for election. Candidates do not have to be BMA members. Anyone can stand who is either:
a) on a GP training programme that will not finish before 23 September 2015; or
b) starting a training programme between 26 June 2015 and 1 July 2016.

Successful candidates will be elected to serve for two full sessions; 2015/16 and 2016/17 unless the representative is set to qualify as a GP during the first session, in which case they will only serve for one session. Full details of the election and nomination forms can be found here. Nominations close at 5pm, Friday 17 July 2015. If you have any queries, please don’t hesitate to contact Holly Higgs in the GPC office.

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