Bulletin 24.07.2012

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Bulletin 24.07.2012

Focus on Hep B Immunisations
This Focus on Hepatitis B Immunisations aims to clarify the circumstances where charges can be made and where active attempts to encourage hepatitis B immunisation ought to be made. Note that the occupational health section replaces and updates the former guidance Hepatitis B vaccination for employees at risk.

General Practice Extraction Services (GPES)
GPES is a new service, delivered by the Health and Social Care Information Centre (HSCIC). From April 2013, GPES will make data available from GP clinical systems with the intention of improving the health and wellbeing of patients in England and the first request will be the data required for QOF 2013/14. It is important that you are aware of GPES because each GP practice will be asked to consider whether to participate in the service.

From January 2013, HSCIC will be asking all GP practices about their preferences for participation in GPES data requests. For effectively anonymised data requests, you can either choose to automatically opt in to all requests, or alternatively make a decision on a case by case basis upon receiving details of each request. For identifiable data requests, you will NOT be able to make a general choice to opt in to all requests but will be asked to opt in to each individual request. The GPES software is being designed to minimise the workload for GP practice staff. Extractions of data will be undertaken by your GP system supplier and sent on to HSCIC. The data will be held in a secure environment and then sent to the customer in the required format. The data held in the HSCIC secure environment will then be destroyed.

GPs are rightly cautious about the information they hold on behalf of their patients – the BMA believe GPES strikes the right balance between patients individual rights to privacy and the need to share for the greater good.

The BMA has been involved in advising on GPES from the outset, particularly in relation to information governance and ensuring that the confidentiality of patient data is protected. This included agreeing GPES information governance (IG) principles which recognise the role of GPs as data controllers. One fundamental IG principle is that general practices, as data controllers, decide whether data should be extracted. Another is that anonymised data will be extracted wherever possible. Identifiable data can only be extracted if there is a legal basis, for example with explicit patient consent or approval by the Ethics and Confidentiality Committee (ECC) of the National Information Governance Board. New Read codes have been developed to allow patients to opt out of appropriate identifiable data extracts. Customers of GPES must be approved by the DH and/or the NHS Commissioning Board. The GPES Independent Advisory Group (GPES IAG), which includes BMA representation, considers each data extract request ensuring GPES IG principles are met and there are sufficient benefits for patients.

Further information on GPES will be provided shortly, but you may wish to access the current GPES information, including the GPES IG principles agreed with the GPC, on the HSCIC website.

Flu Immunisation Programme – Patient Leaflets

The DH has clarified that they do not intend to fund any distribution of communication media for the flu immunisation programme and that the patient leaflet that is available on the DH website is for practices to use should they wish to. Given the view that we do not believe GPs should be expected to print such leaflets at their own expense we would advise GPs not print such leaflets as there is no funding available for doing so.

Management of Adult Diabetes Service in NHS
At the end of May, the National Audit Office (NAO) published this report on the management of adult diabetes services which highlighted the differences in reported achievement between QOF and the National Diabetes Audit (NDA). NICE has subsequently been asked by the Department of Health to consider the issues raised in the report and have initiated a review of DM13 which is the QOF indicator for micro-albuminuria. The GPC had several concerns with the recommendations set out in the report, in particular Recommendation b.

Recommendation b.

Payment mechanisms currently available to GPs are failing to ensure sustained improvements in outcomes for people with diabetes. The current system of incentives needs to be reviewed and renegotiated to improve outcomes for people with diabetes in accordance with clinical practice recommended by the Framework and, more recently, by NICE. GPs should only be paid for diabetes care if they ensure all nine care processes are delivered to people with diabetes. The threshold at which GPs are remunerated for achievement of treatment standards should also be reviewed and increased at regular intervals.

The GPC disagrees with both parts of this recommendation. The suggestion that GPs should only be paid for diabetes care if they ensure all nine processes are delivered would have unintended consequences where patients did not wish to engage in some checks or continue to attend. They also believe that payment thresholds are outside NICE’s remit and have, therefore, written to Professor Sir Bruce Keogh, NHS Medical Director, to highlight their concerns over this report.

Vaccine Update June 2012
The Department of Health published this vaccine update for June, which contains useful information on: HPV immunisation programme – change of supply from Cervarix to Gardasil from 1 September 2012; Flu vaccination uptake reports for Winter 2011/12; Deliveries of vaccines during Olympic and Paralympic games; and Process of ordering of vaccines through ImmForm.

Reimbursement of GP Trainee Travel Expenses
GP trainees who use their cars to conduct home visits during their placements are entitled to claim mileage expenses. The journey to and from work (up to 10 miles in each direction) can also be claimed, but only if a home visit is made that day. Travel expenses can be reimbursed for deanery-organised educational events or programmed teaching, but this does not seem to apply to all deanery areas. Training practices and trainees are advised to check this with their deanery.

Trainees are either able to claim this allowance through the training practice, which in turn claims reimbursement from the regional Deanery, or directly though the PCT. The training practice is expected to signpost the trainee to the correct person at the PCT if necessary.

The rates at which trainees can claim are set nationally by the Directions to Strategic Health Authorities Concerning GP Registrars and the amounts they can claim vary according to the cc of their car – up to a rate of 58.3p per mile for certain cars. This is over the rate permitted for the purposes of tax (45p per mile) and so any amount above the 45p per mile rate is seen as a benefit and should be taxed as such.

This means that the employer (practice) should then either complete a P11D form  for the Inland Revenue detailing any of this and any tax owing will be taken out of the trainees National Insurance contributions the following year; or, some practices may have pay roll software that can do the tax calculations for them as they go along. Trainees and practices should ensure that they keep a record of any mileage claims for up to six years for tax purposes. The BMA is working with NHS Employers to see if the GP Registrar directions can be changed to come in line to reflect taxable allowances.

Locum GP Handbook (BMA members only)
The BMA GP locum handbook has now been published for the benefit for BMA members and provides useful advice on a range of issues to consider when working as a locum GP. The handbook includes specific sections on starting out as a locum GP, as well as others sections on setting up a business and agreeing contracts for services with different employers. It will also be a useful guide for practices that engage locums.  The official launch of the handbook will take place at Sessional GPs: Redefining Success, a one day conference to be held at BMA House on Thursday 11 October 2012. Attendees will be the first to receive hard copies of the handbook.

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