montage

Archived News 2012:
Government has not considered impact on GP practices of proposed changes to the GP contract, warns BMA
Responding to the government’s publication of details about the proposed changes to the GP contract, Dr Laurence Buckman, Chair of the BMA’s GP committee said:
“GPs have been at the forefront of delivering care that keeps pace with technological advances and the changing needs of the population.  The GP contract has always funded GPs for taking steps that directly support and benefit their patients clinically, whether it is managing diabetes, controlling blood pressure or tackling the devastating effects of cardiovascular disease. This has led to thousands of patients benefiting from early diagnosis and treatment that has saved lives.
“Practices are already under huge workload pressures and we have real fears that these proposed changes will result in an even greater load at the same time as forcing through a reduction in core funding.  The government’s proposals may sound attractive on the face of it and some of their suggestions are good, however they have not fully considered the overall impact on practices of all these changes being implemented together. This could make it difficult for some practices to maintain the level of care they currently offer, let alone increase their capacity to meet the demands of these new proposals.  
“We also remain unconvinced about the basis for some of the proposed changes, which include asking GPs to refer patients to certain education programmes which do not exist everywhere in the UK.
 “The BMA will closely analyse the details of these complex proposals. We are open to real dialogue with the government about the impact of these changes as part of its planned consultation.  We hope that ministers intend to engage in a meaningful discussion and that they will listen and act on concerns that are raised, particularly where their proposals are unworkable or will lead to unintended consequences.  We would be extremely disappointed if this consultative process was a rubber stamping exercise for their existing plans.  
 “The unacceptable way the government has handled these negotiations should not set a precedent for future discussions. The agreement reached in Scotland over the future of changes to the GP contract demonstrates how a cooperative and consultative approach can achieve a positive outcome for patients and the NHS.  The UK government needs to follow that example.”
SEE BMA WEBSITE
DH Press Release
Thousands of patients with long-term conditions and dementia could benefit as GP contract proposals are unveiled
THOUSANDS more patients are set to receive potentially life saving care as the Health Secretary, Jeremy Hunt today unveiled the Government’s blueprint for changes to the GP contract.

The proposals will change the way GPs are rewarded for the care they offer. Instead of being rewarded extra for routine office functions like record keeping, GPs will be rewarded for steps which directly support and benefit patients. This includes better control of blood pressure and cholesterol, to prevent heart attacks and stroke and assessing patients at risk from dementia.

Millions of pounds will be switched into improving care for patients and making better use of taxpayers’ money. The proposed changes will see £164 million pounds taken away from rewarding GPs for bureaucratic tick box exercises and re-directed into actions which will directly benefit patients.  

The changes could mean around 1.5 million more patients will get better care in 2013-14. This could reach as high as 3.5 million by 2014-15 and could help doctors go further in spotting early warning signs of illness. It should mean more tests, treatments and medicines for patients with diabetes, hypertension, lung disease, heart failure and arthritis – care that will improve diagnosis, the health of patients and potentially save more lives.

The proposed changes will see GPs rewarded for earlier diagnosis and better care of dementia patients and putting a sharper focus on improving the lives of patients with long-term conditions.

Jeremy Hunt said:

“Getting patients an earlier diagnosis of dementia and supporting those with long term conditions are my main priorities. I want GPs to take the lead in making this happen.

“Standards of care in this country must be world class - and we should  continuously strive to improve. This is why the GP contract must change.

“Our proposals will make sure we support the patients most in need and will help save lives in practices across the country. We believe GPs can and will rise to these new challenges.

“We have listened to, responded to and fully considered alternative proposals put forward by the British Medical Association’s General Practitioners Committee. In the absence of an agreed settlement, it is reasonable to consult on the proposed changes needed to make sure improvements in patient care will follow.”

Standards of care are also being raised, initially in 20 clinical areas – for example relating to stroke or patients with heart disease - meaning more people have to be offered life improving, potentially life saving care. These higher standards will then be rolled out to other clinical areas in 2014 so that even more patients benefit.

The contract will also incorporate the latest expert advice on the areas which will have the greatest impact on patient health. This will include referrals to rehabilitation to allow people with lung disease to improve their health and quality of life as well as improved support for cancer patients and those with depression, arthritis and diabetes.


Update on GP contract situation


Email to all GPs from GPC Chairman
Since I wrote to the profession two weeks ago, the GPC has been busy on your behalf considering the likely implications of the draconian contractual changes the government seems determined to introduce:

  • Implementation of all changes to QOF recommended by NICE, without GPC agreement
  • An increase in all QOF thresholds in line with upper quartile achievement
  • The removal of organisational points with money to be used for entirely new and potentially onerous enhanced services
  • A reduction in some QOF timeframes from 15 to 12 months
  • Dramatic changes to practice funding to reduce the current variability of per patient funding, alongside possible changes to the Carr Hill Formula to give more weight to deprivation
While publicly the government talks about improving care for patients, in reality these proposals have the potential to seriously damage GPs and general practice in its current form, and that could have a negative impact on patients. Do not believe that we have been the barrier to acceptable negotiated changes. The government has disregarded five months of detailed and constructive negotiation between NHS Employers and the GPC. Our overriding concern right now is the huge amount of extra work GPs will have to do if they want to maintain practice funding at current levels. This is not just about pay. You will have read my letter to you as well as perhaps my editorial in the BMJ http://www.bmj.com/content/345/bmj.e7343)and possibly concluded that you can carry on regardless. Sadly, this is unlikely to be true as the workload implications of the changes being threatened will make doing our jobs even more difficult. Given our current lack of capacity, we believe the ultimate result of these changes will be not only the biggest pay cut yet for GP contractors – on top of the very significant real terms pay cut we have already had since 2004 - but further burn out and damaged morale for all GPs. We know that we would love to be able to do more for our patients but that this requires further investment in both premises and staff. As we become increasingly stretched, all practices will be forced to review their priorities to protect core patient care from the encroachment of politically motivated non-clinical initiatives. I realise you will be feeling fed up at the moment and can assure you that we will be working hard to make sure MPs, patients and the public understand how much damage will be inflicted on general practice, and therefore on patient care. You will be getting quite a few pieces of information from me over the next few weeks. As soon as we receive further details from the government we will deliver tools and guidance to help you understand what the changes will mean for your practice. We are also planning roadshows across the country in early 2013 to hear from you.
Laurence Buckman


Huge implications of changes to GP contract, warns BMA
Responding to the announcement from the Department of Health of proposed imposed changes to the GP contract, Dr Laurence Buckman, Chair of the BMA’s GP committee said:
“The implications of the government’s new proposals for general practice are likely to be huge, and we will be examining the consequences of this threatened imposition so that we can fully inform the profession and public as soon as possible. There are serious question marks over whether some of the intended changes are based on sound clinical evidence or are practical or feasible.
“The government is being disingenuous in its presentation of how we have arrived at this point. GPs will be stunned and angered that the government is disregarding five months of detailed negotiations between the BMA and NHS Employers which was in its final stages just a couple of weeks ago. The government must urgently rethink its approach and return to our negotiated settlement that was so close to being concluded.
"The government’s own surveys show that patients consistently recognise their GP’s commitment to their patients.  Doctors have always been at the forefront of driving up standards and we do that by responding to sound evidence, not ill-considered quick fixes.
“Many practices are already stretched to breaking point, which the government appears to be ignoring.  For all practices, the changes will place an enormous strain on GPs at a time when they are struggling under the weight of a wholesale NHS reorganisation, especially the implementation of Clinical Commissioning Groups (CCGs).
“Doctors recognise that we are in tough economic times and the BMA has been committed to achieving a negotiated settlement that delivers genuine improvements for patients while being realistic about what practices can deliver.”
Ends


Department of Health press release

Proposed changes to GP contract to focus on better care for people with long-term conditions

The Government is calling for better care for people with long-term conditions under its proposed changes to the GP contract.
These proposals have been sent to the British Medical Association (BMA) for consideration and include:

  • New measures to improve care for patients with long-term conditions and help prevent unnecessary emergency admissions to hospital.
  • Ensuring that quality rewards for GPs reflect expert advice, from NICE, so that patients receive the very best care in line with the most up-to-date evidence.
  • Stopping additional rewards for organisational tasks like good record-keeping, which should be part of any good health organisation. This money will instead go into rewarding the quality of services that GPs offer patients.
  • Ensuring that more patients benefit from best practice in areas such as keeping blood pressure low and reducing cholesterol levels, especially those in most need or hardest to reach.
Health Secretary, Jeremy Hunt said:
“Putting patients first is our priority and I make no apology for this.
“The GP contract needs to change so that it further improves care for patients.
“Our population is living longer and an increasing number of people have long term conditions. By 2018 those with one or more long term condition is set to rise to 2.9 million. Our proposals will help ensure that we provide the very best care and support possible for those at most risk of life threatening conditions. We want to drive up standards for all and want the contract to reflect the most up-to-date expert guidance and excellent standards of care.
“We want the BMA to work with us on making this happen, but will not back away from making changes that will deliver better care for patients.”
Dr Nicola Smith, Chair of Milton Keynes Clinical Commissioning Group said:
“Achieving continuous improvements in clinical quality must be a dynamic process and the Quality and Outcomes Framework (QOF) is a driver for this. I support the need to regularly review indicators and their thresholds so that they reward improvements in patient care by incentivising the achievement of the highest standards.
“It seems reasonable to me to agree to retire those indicators that are nowadays considered to be standard practice. However, to achieve the desired outcomes it is important to recognise the impact on workload any changes may bring. I am pleased to see that consideration is being given to looking at reducing the demands from some of the lower priority indicators.”
NHS Employers who represent the Department of Health meet with the British Medical Association's General Practitioners Committee to agree changes to the GP contract every year. The Government will continue to invite discussion with the BMA with the hope of reaching an agreement.
Notes to editors:
  • If the Government are unable to reach agreement with the BMA it will move to a period of formal consultation.
  • The proposals put to the BMA include possible new quality improvement schemes for diagnosis and care of people with dementia, care for the most frail or seriously ill patients, patient access to online services, and support to help people with long term conditions better monitor their own health.
Pensions Bill would entrench disparities and give Government sweeping powers for further change, BMA warns
New legislation would entrench disparities across and within public sector pension schemes, with many NHS staff the hardest hit, according to an in-depth analysis published by the BMA today (Friday 12 October 2012).  The BMA is also issuing a parliamentary briefing which highlights the wide-ranging powers the Public Service Pensions Bill – due to have its second reading later this month – would give the Government as it brings all public sector pension schemes under a common legislative framework.
The Bill, published last month, would end final salary schemes for most public sector workers, and increase their Normal Pension Age, linking it to the State Pension Age which is rising to 68. This comes on top of sharp increases in contribution rates, particularly for higher earning NHS staff, some of whom are due to see 14.5% deducted from their pay for their pensions from April 2014.
In a new detailed analysis, the BMA highlights three levels of unfairness – in the overall approach to public sector pension reform, between schemes, and within the NHS pension scheme.  For example:
 
  • The new changes are being pushed through on a large scale and at high speed despite the fact that the Government is estimated to generate £250 billion by 2060 from its switch in the way public sector pension payments are indexed, from the RPI to the CPI
 
  • In implementing the new changes, the Government has ignored the major reforms that were already under way across the public sector, in particular to the NHS pension scheme.  In 2007-08, unions agreed a package of changes which were estimated to deliver £67 billion in savings by 2060
 
  • Despite variations between schemes in stages of reform and funding profiles, the Government has adopted a uniform approach to staff contribution increases, demanding an average 3.2 percentage point increase from all schemes
 
  • There has been a lack of consideration as to whether there are other areas of the public sector where working beyond 65 is inappropriate, as is already considered the case for the police and firefighters, who will keep their Normal Pension Age of 60
 
  • Most doctors will pay significantly more for their pensions than other public sector employees on similar salaries. At the top end of pay scales, doctors will pay almost twice as much in contributions for a similar pension as civil servants or high court judges. The NHS Pension Scheme will also compare unfavourably with the schemes for teachers, local authority staff, police and MPs
 
  • The Government is pushing through a very steep level of tiering of contributions in the NHS scheme, with the highest earners paying disproportionately much more for their pensions than lower paid workers, and receiving less value per £1 of contributions even after taking tax relief on contributions into account. The BMA says this cannot be justified in a career average pension scheme, where the discrepancy between the benefits for higher and lower earners has been removed.
The BMA recommends that the Bill is amended to remove the link between the Normal Pension Age in the NHS and the State Pension Age, so that NHS staff do not have to work beyond the age of 65 to receive a full pension.  While it acknowledges that some tiering is justifiable to reflect the impact of tax relief and the need to encourage the lowest paid NHS staff to take part in the scheme, it calls for a much flatter contribution structure in the NHS scheme.
The BMA’s parliamentary briefing, also published today, draws on the analysis to argue for a more coherent approach to public sector pensions reform.  It points out that, far from securing stability in public service pensions for a generation (as ministers have promised), the Bill would give the Government extremely wide powers to make further, possibly retrospective, changes in the future.
Dr Mark Porter, Chair of BMA Council, said:  
 
“The BMA has always accepted that the NHS pension scheme must offer a fair deal to taxpayers as well as to staff.  At a time when many NHS employees are in the third year of a pay freeze and dealing with the combined effects of major funding pressures and structural reforms, it is more important than ever that the Government should accept the same.
 
“The Government is due to achieve a total of £430 billion of savings over the next 50 years, directly from the impact on public sector workers’ pensions.  To a large degree public service employees are being penalised for an economic crisis not of their making.
 
“But beyond this fundamental unfairness, the changes will also embed unjustifiable discrepancies between and within different public sector schemes.  How can it be right that someone working for the NHS pays twice as much for their pension as a civil servant on the same salary?  And why should higher earning NHS staff pay disproportionately more for their pensions than lower paid staff when they are in a career average scheme?
 
“If the Government is serious about creating a coherent approach to public sector pensions, it needs to tackle this unfairness rather than entrench it.”
 
The BMA is calling on doctors and medical students to raise their concerns about the pension changes and the Bill with their MPs using an online toolkit, also launched by the BMA today.

 Hantavirus Alert Letter from CMO
Clinicians are asked to consider the diagnosis of HPS in all persons presenting with clinically compatible illnesses if they have visited Yosemite National Park between June and  24 August, and to notify their local Health Protection Unit of any persons in whom a diagnosis of HPS is being considered.
Please see further details in the attached letter, which will be sent out to GPs and PCOs later today, and it will also be published on the DH website.
Note that it has also been reported on the Nathnac and BBC websites:
http://www.nathnac.org/travel/news/hanta_usa_280812.htm
http://www.bbc.co.uk/news/uk-19459246

PCT Owned Premises - Open Meeting
The LMCs will be hosting a further meeting for practices located in PCT owned premises to discuss the current situation in terms of lease/service charge arrangements.

See here for further details

NEW GMC GUIDANCE

The GMC has issued new guidance to every doctor in the UK to help them protect children from abuse or neglect. 

Protecting children and young people: the responsibilities of all doctors underlines the duty on doctors to act if they are concerned that a child or young person is at risk.  It provides detailed advice for doctors on information sharing, working in partnership with other agencies, consent for child protection examinations, acting as a witness in court, and where to turn for support.

The guidance will come into effect on 3 September 2012. Doctors will receive a copy in the post but an electronic version can be found at www.gmc-uk.org/childprotection. On our website you will also find:

  • Short guides for GPs – highlighting the sections of the new guidance which are likely to be most those working in primary care
  • Short guides for doctors who treat adult patients – highlighting the sections in the guidance that are most likely to be relevant for doctors whose adult patients may pose a risk to children or young  people
  • Learning materials - including case studies and a flowchart to help doctors decide whether to share information about child protection concerns.

This is one of the most sensitive and complex areas of medical practice. We want doctors to feel confident and supported in raising and acting on concerns about the safety and welfare of children. We very much hope you will find this guidance useful and bring it to the attention of doctors and other health and social care professionals.

Industrial Action 21st June 2012-Advice from the BMA
Dear Sir/Madam
To assist in preparations for BMA industrial action over changes to the pension scheme, we are producing various materials for participating GPs and practices. The first day of action will be
21 June.
We recommend that practices discuss and if possible agree the extent of the service to be provided on the days in question with their PCO.   To begin that process, practices should send a letter of notification to their PCO setting out their intention to participate.  
We have prepared a template letter that practices should complete and forward to the PCO
We are keen to have a comprehensive overview of industrial action participation by practices to help the BMA in decisions about effectiveness and future action.  

Therefore please could you also send a copy of the completed letter to
inbox.gppractice@bma.org.uk 
If you have already notified your PCO of your practice's plans, please email us with your practice's name and address and whether: 
(i) all GPs in the practice are participating in industrial action, or
(ii) some of the GPs in the practice are participating.
 
Finally, LMCs need to know about the level of service on the day, so please also copy the completed letter to your LMC.
Further details, including information on the service to be provided by GPs on the days of action and extensive FAQs, are available at
www.bma.org.uk/nhspensionreform 
Checklist 

 
Complete template letter for your practice
  • Send completed letter to your PCO
  • inbox.gppractice@bma.org.uk 
    Send a copy of the completed letter to us at
  • Send a copy of the completed letter to your LMC
  • Yours sincerely
    Laurence Buckman


    Doctors to take industrial action for first time in almost 40 years
    Doctors will take industrial action for the first time in almost 40 years over major changes to the NHS pension scheme, the BMA confirmed today (Wednesday 30 May, 2012). The first day of action will take place on 21 June 2012 and will see doctors providing all urgent and emergency care, but postponing non-urgent cases.  
    BMA Council made the decision after considering the results of its ballots on industrial action which closed yesterday. Overall, 50 per cent of the 104,544 doctors eligible to vote took part. Across separate ballots covering six branches of practice, a clear majority of: GPs; consultants; junior doctors; staff, associate specialist and speciality doctors, and public health and community health doctors said they were prepared to take part in both industrial action short of a strike and a strike, while a majority of occupational medicine doctors voted against industrial action.
    Although the BMA’s planned action does not constitute a strike as the term is normally understood by the public, the two questions were asked in order to provide maximum legal protection. Doctors will still be at their usual workplaces.
    The government has begun to implement major changes to the NHS pension scheme, despite widespread criticism of its approach from organisations representing health professionals. In 2008, the BMA, other health unions and the government negotiated a major reform of the NHS scheme, which all agreed made it fair and sustainable well into the future.
    The NHS scheme currently delivers a positive cashflow of £2 billion a year to the Treasury, and NHS staff have already accepted responsibility for any future increases in costs due to improved longevity. The latest changes will see doctors paying up to 14.5 per cent of their salaries in pension contributions – twice as much as some other public sector staff on a similar salary in order to receive a similar pension. They will also have to work longer to receive their pension – up to 68 for younger doctors.

    Dr Hamish Meldrum, Chairman of Council at the BMA, said:
    “We are taking this step very reluctantly, and would far prefer to negotiate for a fairer solution.  But this clear mandate for action – on a very high turnout –  reflects just how let down doctors feel by the government’s unwillingness to find a fairer approach to the latest pension changes and its refusal to acknowledge the major reforms of 2008 that made the NHS scheme sustainable in the long term.
    “Non-urgent work will be postponed and, although this will be disruptive to the NHS, doctors will ensure patient safety is protected.  All urgent and emergency care will be provided and we will work closely with managers so that anyone whose care is going to be affected can be given as much notice as possible.  Patients do not need to do anything now.
    “We will also run our own publicity campaign to make sure that members of the public understand what the action will involve and how they can find out what it might mean for them and their families.
    “This is not a step that doctors take lightly – this is the first industrial action doctors have taken since 1975.  We have consistently argued that the Government should reconsider its position, and even at this stage we would much prefer to negotiate a fairer deal than to take action.  We are not seeking preferential treatment but fair treatment.  The government’s wholesale changes to an already reformed NHS pension scheme cannot be justified.”

    GP Commissioning Survey
    It was clear that the majority of frontline GPs, who replied, supported the national BMA’s view on the Health & Social Care Bill, but now that it has been passed we have to move on and try to make CCGs successful and ensure patient care is maintained.
    For the actual results see:
    Newcastle GPs
    North Tyneside GPs
    Tyne and Wear GPs

    Whilst the results demonstrate that the CCGs within our area have been responsive to their individual constituents, it does appear that there is much work to be done about communicating information by the CCGs and also the LMC to our frontline GP colleagues.

    As CCGs develop it is essential that all GPs are aware and have been consulted on the configuration of CCGs, the commissioning support that CCGs need and also the structures of the management of the CCGs themselves. All GPs should be aware of these issues and the potential effects that could arise from the consequences of such developments.

    The LMC hopes to meet the CCG leads on a regular basis to ensure open and transparent processes.

    Changes to practice boundaries from April 2012

    As part of the agreement negotiated between GPC and NHS Employers for 2012/13, changes are being made to regulations from this April to allow practices to create ‘outer boundaries’.
    These changes have been introduced to help improve patient choice of practice and to amend the closed list regulations, but they are unrelated to the piloting of remote registration and consultation. Changes to practice boundary arrangements and the relaxing of the closed list regulations, as described below, are
    permanent and apply across England.

    What changes are being made to practice boundaries?

    The changes being made to regulations regarding practice boundaries really only formalise what many practices already do. From the end of this April, PCTs will be expected to work collaboratively with practices to establish new ‘outer boundary’ areas to help patients who move a short distance outside the current practice boundary to stay with their existing practice.

    Do all practices have to create outer boundaries?

    Where a GP practice already has a large boundary area it may not be appropriate to establish an outer boundary. This is recognised in the new regulations. However we would expect most practices to work with PCTs to specify an outer boundary – in some cases this may only be a matter of a few streets larger than the existing practice boundary.
    Practices’ new outer boundaries will be specified in their GMS contract or PMS agreement and should be advertised in practice leaflets and on websites. The information will also be made available on the NHS Choices website.

    What impact will the new boundaries have on patients?

    Existing patients who move into the outer boundary area of a GP practice and remain registered with that practice will be eligible for the normal range of services, including clinically necessary home visits. Practices will need to bear in mind the feasibility of home visits, and any possible impact on their patient population as a whole, when agreeing their outer boundary


    Guidance will acknowledge that for patients requiring very frequent home visits, it may be in their interests to register with a practice nearer their home rather than remaining with their former practice simply because they live in its outer boundary area.

    The secondary guidance can be found by clicking here here
    LMC Conference Motions(April 2012)
    Every year the LMC has an opportunity to send motions to be debates at the Annual Conference of LMCs which will be held on the 22nd and 23rd May 2012 at Liverpool. Motions are fully debated by LMC representatives from all over the UK and those that are passed set the policy and agenda for the GPC for the year. Our LMC is sending George Rae and Gerard Reissmann, two seasoned reps, to speak to our motions.
    Click
    here for the full set of motions submitted.

    CQC Inspections every two years. (April 2012)

    Practices will start registering later this year for the Care Quality Commission (CQC) but will not be aware of the intention for inspections every two years. Not so long ago it was stated that the CQC would target their inspection visits but that seems to have changed. Click on the link below to see the video interview (by PULSE) of Professor David Haslam, national clinical adviser to the Care Quality Commission.
    http://bcove.me/u92ikbdc