Bulletin 28.02.2012

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Bulletin 28.02.2012

Clinical DES Guidance 2012/13
This Clinical DES Guidance outlines the requirements for 12/13 including details on the alcohol and learning disabilities DESs which will continue until 31 March 2013 and the osteoporosis DES will no longer be available from 1 April 2012.

Commissioning – Key Questions for ALL GPs to Consider and Key Issues for CCGs
This summary briefly outlines the key issues for CCGs and all GPs to consider as clinical commissioning groups develop and seek authorisation. Additionally, to help empower GPs the GPC has produced these key questions and urges you to ask these questions of your CCG and LMC. GPC Chairman, Dr Laurence Buckman, has circulated this message:

Dear colleagues,

The Health and Social Care Bill purports to develop a commissioning structure that is clinician-led and locally focussed. This aspiration is looking ever more difficult to achieve due to the increasingly complex and confused legislation and the rushed implementation of the reforms.

If the Bill becomes an Act, GPs and practices will be the constituent bodies of clinical commissioning groups (CCGs), and will play an important role in holding them to account. The General Practitioners Committee (GPC) is concerned that due to the fast pace of developments, many GPs are not aware of the decisions being made on their behalf, or which will impact on them and their practice in the future.

To help empower GPs and practices we would urge you to ask these questions of your CCG and local medical committee (LMC).

Yours sincerely
Dr Laurence Buckman
Chairman, BMA General Practitioners Committee

Cervical Cytology Good Practice
Following the recent letter from Barbara Hakin regarding mandatory cervical cytology training, we would still advise practices to make sure that anyone conducting smears are cognisant of the latest guidance on good practice e.g. the need for the cervix to be visualised for a smear .

084 Telephone Numbers Compliance with Regulations
DH has published this further guidance on the use of 084 numbers in the NHS. For clarity, the DH position has not changed and the regulations remain the same. Consequently, the legal advice the GPC has obtained also remains the same. The issue revolves around the word ‘reasonable’ within the regulations. All the suggestions about termination or varying the terms of the contract are always going to be based on ‘reasonable steps’. Any practice would have a very strong arguable case to say that, albeit all ‘reasonable steps’ had been taken to try and cancel the contract or vary it, to do so would mean the practice would be subject to a financial penalty. The regulations do not say the practice must cancel or vary the existing contract. If this were to be the case, ‘reasonable steps’ would be replaced with ‘best endeavours’. Subsequently, it would not be possible to argue that the acceptance of a financial penalty is reasonable. If practices ensure they have correspondence from their telephony provider on record stating that they will be financially penalised if they vary or cancel the contract, this should be enough to satisfy that ‘reasonable steps’ had been taken. All practices will be expected to become fully compliant with regulations once their existing contracts are up for renewal or they wish to contract with a different provider. At this point, practices will be expected to ensure they contract with a provider who is compliant with regulations. Practices are advised to obtain a copy of the statement of compliance with NHS regulations from their telephony provider when entering into new or renewing contract arrangements.

CQC Registration – Joint GPC/CQC Statement
The GPC and CQC have agreed the following statement about CQC registration:

Under the Health and Social Care Act 2008, all providers of primary medical services will be required to be registered with the CQC by 1 April 2013. The process leading to registration will begin in July 2012. As part of registration, practices will have to tell the Care Quality Commission (CQC) whether they are meeting the essential standards of quality and safety, which are derived from regulations governing the CQC’s work.

The essential standards are based on legislation and cannot be altered. However, the British Medical Association’s General Practitioners Committee (GPC) and CQC are currently discussing how the standards will apply to primary care providers. Work carried out by the CQC, during the delay to the registration of most providers of primary care, has focused on the need to be proportionate and appropriate, reducing bureaucracy to a minimum. The CQC and the GPC have been working together to achieve this and to ensure that the registration requirements are understood across the primary care sector.

To that end, the CQC is working with stakeholders to improve the logistics of its registration process. This is partly taking place through the CQC’s Stakeholder Advisory Group, on which the GPC is represented.

Discussions are also taking place between the CQC and GPC about how compliance will be demonstrated and monitored following registration. The CQC is working to ensure that the compliance monitoring process is proportionate and appropriate. As part of this, the CQC will be carrying out a pilot in the summer, to test how its model of compliance monitoring will work in primary care.

There is no need for practices to purchase expensive software or consultancy services in order to register with the CQC. Most practices delivering good quality care will already be meeting the majority, if not all, of the essential standards.

The GPC and CQC will continue to issue updates in the coming months, including further detailed guidance on registration.

Important Reminder – Nurse Registration
We would like to remind you of the importance of ensuring sure periodic checks of registrations take place as we have been made aware of a small number of cases where qualified nurses failed to keep up their registration. It is an offence to work as a nurse without the required registration in place and practices will have to deal with any consequences should this occur. The NMC website has 2 separate means of checking registration, a simple pin number check that is open to the public and an employers check. It is important that practices register as employers and undertake the enhanced employers check as this gives additional information including the employment history of the nurse.

Locum Payment Form Error
We have been made aware of an error in the letter to locums provided by NEFHSA with regard to payments. This error has been highlighted to NEFHSA to be rectified. The letter states “Each month you should send to me the completed forms and a cheque made out to the PCT of whom you are listed with on the Medical performers List. They should reach me no later than 7 days into the following month after the month the work relates to, i.e. forms for work done in April should reach me no later than 7th May”. To avoid any confusion, the rules have not changed and the correct rules are that the money should reach the pensions dept no later than 7 days into the following month after the month in which the payment is received.

NHS 111
This document clarifies the GPC view, supportive but with implementation/procurement concerns, with regard to NHS 111. The GPC supports the principle of developing an easily accessible national telephone number for patients who have urgent health problems, as proposed by the new NHS 111 system which has recently been piloted but are extremely concerned that the new NHS 111 service is being rolled out without full, truly independent and thorough evaluation of pilots and without adequate input from local clinicians. A comprehensive NHS 111 service is currently expected from April 2013. The GPC has written to the Secretary of State for Health, calling on the Government to slow procurement of NHS 111 services to allow for proper evaluation of the pilots, and to adopt a flexible deadline for full implementation of the service to ensure that fledgling clinical commissioning groups can become fully established and ready to drive local procurement decisions at a pace that will ensure that the right decisions are reached.

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