Director of Primary Care Email Update - April 2014
Date sent: Thursday 17 April 2014
This is the second in the series of LMC e-mails newsletters for 2014 and again includes a myriad of information which we hope will be of help to you.
Avoiding Unplanned Admissions
Revised guidance now available via the following link: Unplanned Admissions Enhanced Service
Following pressure from GPC, the revised guidance clarifies that:
- Care plans for patients initially added to the case management register have to be in place by the end of September 2014, not June 2014 as was originally specified. This recognises the difficulty with producing care plans for these patients for the end of June and ensures consistency with the payment structure in place for the enhanced service.
- Patients initially added to the case management register have to be informed of their named accountable GP and care co-ordinator by the end of July 2014, not June 2014 as was originally specified. The July deadline for the named accountable GP applies only to patients added to the register who are under the age of 75, as patients aged 75 and over will have been informed of their named GP by the end of June (existing patients) or within 21 days of registration (new patients), as per the requirements of the GMS and PMS regulations for a named GP aged 75 and over.
The changes are made on pages 7 and 15 of the guidance.
Other contract enhanced services changes can also be found here.
Following a very confusing end of year GPC has issued clarification regarding QOF and CPI:
Why is the index list size taken as it stood on 01.01.2013, when the year in question is 1.4.2013 - 31.3.2014?
Basing the actual national average practice list size on that at the start of the last quarter before the financial year in question ensures there is transparency going into the financial year.
On the whole, it appears that list sizes are increasing - why is the current list size not
Taken into account?
Contractors current list size is reflected in the CPI calculation which is the sum of Contractors Registered Population (generally that at the start of the final quarter in the financial year) divided by the actual national average list size as above.
CPI allows QOF payments to reflect comparative list size.
Is the PMS deduction also incorrectly based on the January 2014 CPI figure? We've had a number of queries about the letter sent to area teams regarding the PMS adjustment for QOF achievement payments. The letter uses the average list size which is applicable for 2014/15, but the calculation is for the 2013/14 QOF. This is the same problem with the more general CQRS calculation error. The 7084 figure used in the calculation in the third paragraph on page two looks incorrect. Could NHS England please provide a clear briefing summarising how they have calculated the figures?
- The QOF PMS Points Deduction was set in 2004 as £13,050 for average PMS practice – that was a practice with a list size of 5,891 (the average in 2004). £2.22 is the deduction calculated as the price per patient when you divide the above price by the then average list size (£13,050/5891)
- The worked example in the letter has used an incorrect CPI figure, but it is just that a worked example, to demonstrate that the current CQRS calculation will undervalues the QOF PMS Points Deduction.
- The national average practice list size for use in CPI to calculate 2013/14 QOF achievement is being corrected to 1st January 2013, which is 6911, which is in line with the SFE. So to run the worked example again, a practice of 6,200 patients should have its deduction calculated as 6200/5891 x 13050 = £13,735 but CQRS will calculate as 13050 x 6200/6911 = £11,707. So CQRS remains to undervalue the deduction that needs to be made and in this example by £2,028.
- Another way of looking at is CQRS will calculate the deduction at £1.89 price per patient (£130505/6911) which is a difference of £0.33 price per patient (£2.22-£1.89). Using £0.33 might be a simpler basis to calculate the adjustment required.
Hopefully, despite the CQRS debacle you have all managed to complete your year-end QOF and other claims but, as is becoming more and more prevalent, there is no time to relax as you have to have signed up to the majority of local contracts with the CCG and Public Health by 30 April 2014.
Named GP for the Over 75’s
It has been suggested that a template letter be made available regarding notification to the over 75’s of their named GP. Please feel free to use the template below as a basis:-
Dear (insert patient name)
Our practice now assigns a named GP to all patients aged 75 years and older to oversee your care. Your named GP is (insert named GP).
The responsibilities of the named GP will be to:
- Take the lead responsibility for ensuring that all appropriate services required by you from the GP practice are provided.
- Where required, use their professional judgement, to work with relevant health and social care professionals to deliver a care package that meets your needs.
- Ensure your physical and psychological needs are recognised and responded to by the relevant clinicians in the practice
- Ensure you have access to a health check if requested.
- These responsibilities will be carried out within the opening hours of the surgery and do not change the way patients currently access care outside of these hours.
What this will mean for you as a patient:
You are unlikely to see any notable change in the way care is delivered to you by our practice, just a formalisation of our current process.
You must continue to book appointments with the practice in the same way. If you require an appointment with a GP urgently and are unable to book it with your ‘named GP’ please book in with another available doctor at the practice.
Nurse appointments will be booked in the usual way.
Please note that, although our GPs work alongside other Health and Social Care Professionals to deliver your care needs, your named GP will not be responsible for the care provided by any agency other than [insert Practice Name].
If you have any queries please contact (insert contact details), who would be happy to discuss these with you.
Read code 67DJ patient notified of named GP
With thanks to Emma Bentley of Poole Town surgery who has discovered a read code for this of 67DJ – patient notified of named GP, not released as yet via EMIS but on its way. No doubt all system suppliers will be providing relevant read codes very soon.
Patient ID for Registration Purposes
Any ID taken for the purposes of validating a registration request should be recorded but not actually scanned into the patients record as it does not form part of their actual medical record of treatment.
The DPA also says that information should only be held for the period necessary and, once the ID is validated, it is no longer required.
We believe that making a note which states you have checked the ID and what that ID was is sufficient.
Therefore, it follows that once the record is sent to another practice any ID information should be removed.
Despite years of urging GP’s to ensure they have up to date and appropriate partnership agreements in place we are still coming across many practices where they remain a Partnership at Will. The professional medical solicitors we work with keep stressing the importance of this and you would be doing your partners a great service by reminding them to ensure they have an agreement in place and that it is up to date and signed by all partners. We have a list of solicitors specialising in this work should you require it and they are also happy to attend Practice Manager forums to explain their concerns in more detail should you wish to invite them.
Counter Signing Passports
Following the refusal of a Post Office counter assistant to accept a GP’s signature on a patient’s application for a passport the LMC have had a series of emails culmination in the following response:
The current Her Majesty’s Passport Office policy not to include doctors in the recommended list of countersignatories has been in place for six years and was introduced to support the Government initiative of reducing non-medical work for doctors. Furthermore, any countersignatory must be able to fulfil the criteria of having personal knowledge of the applicant. It became apparent to Her Majesty’s Passport Office that some doctors were countersigning applications for patients without being able to conclusively state that the information provided on the application form was correct.
Her Majesty’s Passport Office do not recommend using a doctor to countersign passport application forms, therefore, our published literature does not contain information regarding the capacity in which a doctor must know the applicant.
Whilst Her Majesty’s Passport Office accepts that a doctor may be asked to countersign passport applications in their capacity as a professional person or as a person of standing in the community, if a doctor patient relationship is specified it may be necessary to write to the doctor asking them to confirm the identity of the applicant. As this process must be undertaken in writing, by post, it can take a number of days to complete.
We are sorry if you find this reply disappointing but trust that this has clarified the position of Her Majesty’s Passport Office on this matter.
It would appear that patients are better known on a personal basis by their pharmacist or chiropodist who do appear on the HMPO list of acceptable professionals!
It wouldn’t be right not to include at least one article about CQC in these newsletters would it?
As many of you will be aware CQC launched a consultation in January aiming to clarify how the current 28 Outcomes in the Essential Standards of Quality and Safety will be replaced by the new 11 Fundamental Standards and supporting conditions.
Professor Steve Field, the Chief Inspector of general Practice, has given several interviews outlining the changes expected from April this year and either he or his soon to be appointed deputy will be speaking at the Wessex LMCs annual conference on 8th October 2014.
the inspection team will change radically to include:
- a CQC inspector
- a GP
- a Practice Nurse or Practice Manager
- a trainee GP
- and possibly, a member of the public with “particular experience of using GP services”
The outcomes areas that are currently in use will be replaced and the focus will shift to five key areas for providers to demonstrate:
Is it safe?
People are protected from physical, psychological or emotional harm and this area will focus on cleanliness, medicines management, safeguarding and incident monitoring
Is it effective?
People’s needs are met and their care is in line with nationally recognised guidelines and relevant NICE standards. The focus will be on people receiving the right diagnosis, care of people with long term conditions, effective referral processes and involvement in decision making
Is it caring?
People are treated with compassion, respect and dignity and that care is tailored to their needs in line with RCN 6Cs approach
Is it responsive?
Care and treatment is delivered at the right time, without excessive delay and that people are listened to in a way that responds to their needs and concerns. This area will focus on access, responding to the needs of your local population, record keeping and patient engagement and feedback
Is it well led?
There is effective leadership, governance and clinical involvement at all levels and an open and fair culture that listens to people’s views. This area takes into account training and supervisions and coordination with other providers
Eleven Fundamental Standards of Care from the CQC:-
- Person-centred care. The care and treatment of service users must reflect their needs
- and preferences.
- Dignity and respect. Service users must be treated with dignity and respect.
- Need for consent.
- Safe and appropriate care and treatment. All care and treatment provided to service users must be appropriate and safe.
- Safeguarding service users from abuse. Service users must not be subject to abuse.
- Meeting nutritional needs. The nutritional needs of service users must be met.
- Cleanliness, safety and suitability of premises and equipment
- Receiving and acting upon complaints
- Good governance
- Fit and proper persons employed
CQC will begin testing the new approach from this April (including the Dorset CCG area as one of the pilot areas) and will evaluate their findings in the summer before the new process and regulations are formally adopted in October.
The aim is for every practice to have been inspected and rated by April 2016
The 11 Fundamental standards don’t really change the basic principles that have been in the previous essential standards but the challenge for practices will be to provide evidence across the 5 Key questions and not just in relation to each individual supporting condition.
The message to practices is to continue the work started on getting the whole team involved and committed as the emphasis of the visit will continue to be on what actually happens to the patients and how they are dealt with by the team.
I (Carole) will be attending a consultation event in May as well as having smaller LMC group meetings with CQC and will keep you up to date with developments
In the meantime, a few visits are ongoing and below is a set of questions posed to patients at one recent visit which you (and your PPG) may find of interest:
- How long have you been using the surgery? Do you use both surgeries? Can you use both surgeries?
- How long have you waited in the surgery today for your appointment? How easy was it to get an appointment? Did you ring today? When you rang where there lots of appointments available to you or did you have to wait a long time to get the appointment?
- Were you happy with your consultation today? Did the doctor clearly explain his diagnosis? If he prescribed any medicine, did he clearly explain how it should be taken and what the side effects were?
- Did the GP refer you to have any further tests. Or refer to a specialist?
- What out-of-hours service is available? Have you used it? Was it effective?
- Do you find the staff (all) caring and responsive to your needs?
- Are you on repeat prescriptions? If so, how often do they review your repeat prescriptions?
- When you have had tests – have they communicated the results back to you in a timely way?
- Have there been any patient surveys? Is there any other way in which your opinion about the service provided at this practice has been sought? Have you b3een asked to suggest improvements?
- Do you know how to complain? Have you ever complained? Did it make a difference?
- Are there any ways in which you can feedback anonymously?
- Are you happy with the cleanliness of the surgery, toilets, waiting room?
- Did staff wash their hands and wear gloves before providing treatment to you?
- Are the staff clean? Uniforms clean?
- Are you confident with receptionist maintaining confidentiality?
- Is there a chaperone service?
Certification - Continuing Care
More and more GPs are being asked to provide Continuing Care Reports. A GP is required to always act in the patient's best interests, and this information should only be provided with the patient's consent.
It is not obligatory to provide any report if it is:
- Not part of the essential services as detailed in the new Contract (therefore not included in the Global Sum)
- Not included in the Schedule 4 List of Prescribed Certificates under nGMS regulations
Where a simple statement of fact regarding major diagnoses and current medication is requested in order to assist a placement decision, we would confirm this falls within essential services and no fee should be charged i.e. for Palliative Care or to provide confirmation that will enable a clinical practitioner to make an individual decision about treatment or support concerning any patient.
We have developed a Continuing Care Assessment Form between the LMC and NHS Hampshire's Director of Continuing Care. We think this form could be used across Wessex and would encourage you to use it when you receive requests. Alternatively, a print out of current medications, diagnoses etc can be provided.
From time to time, reports are requested for retrospective reviews but in the majority of cases this is done via the PCSE/SBS as the patient is deceased.
New Partner Checklist and Retiring Partner Checklist
Our thanks go to Christina Cleworth at The Adam Practice in Poole for sharing her very comprehensive ‘New Partner Checklist’ with us. We have also added the checklist to our Website and you can download it here.
Given the very real problems we know many practices are experiencing in recruiting GPs and nurses, we’d also like to suggest that you are as flexible as you can be when recruiting. For instance, often GPs do not work full time at a practice – many have competing work or family commitments which mean that they cannot work a full complement of sessions. So, it may be worth offering flexible working, a partnership or salaried work and negotiating terms.
Remember that the LMC also has a jobs page on the website and this is free of charge. We know by looking at the hits we receive that it’s a popular page and is accessed by people working both in and outside Wessex. If you would like to advertise on our website, it’s very straightforward – just email the details to firstname.lastname@example.org
Christina has also shared her ‘Retiring Partner Checklist’ with us and we’ve added this to the website too, download it here.
Transforming Primary Care
Here is a link to a little bit of light reading for you over Easter:
Transforming Primary Care
... and finally, just to let you know, we continue to be aware of your stresses and this is now recognised nationally, see this link
Have a lovely relaxing Easter.
Carole and Lisa
Directors of Primary Care
17 April 2014