Email update from Carole Cusack, Lisa Harding (Directors of Primary Care) & Michelle Lombardi (Assistant Director of Primary Care) - Jan 2015
Date sent: Friday 30 January 2015
PM NEWSLETTER - January 2015
This is the first in the series of our LMC email newsletters for 2015 and includes the usual myriad of information, which we hope will be of help to you.
Premises: Cost Rent Reimbursement
As many of you will know, the Area Teams are concentrating on clearing the back-log of outstanding rent review disputes and have advised that once this has been completed, they will be looking at those practices in receipt of Cost Rent reimbursement to ensure this is being reimbursed at the right level.
Given that mortgage rates have reduced quite drastically over the past few years, some practices have re-negotiated their rate but have failed to advise the Area Team that this has taken place. Please be aware that, under the Premises Costs Directions 2013, practices can only claim rent reimbursement at the same rate they are paying as otherwise this could be seen to be a breach of the Directions.
We are aware of a couple of cases recently where practices were unaware that they should inform the Area Team and as a consequence have had to pay back the amount that has been overpaid. If you would like further information or help with this please contact us.
NHS England has finally released the premises funding information for the next 4 years which consists of £250 million per annum split down as £75 million capital and £125 million revenue. No one knows what happens after the 4 years is up! We are aware that the timescale for plans for the first tranche is exceptionally tight (16th February 2015) and it is likely that only submissions already made and worked up will achieve any funding in 2015/16. However, it is still worth putting your plans together and getting the bids in as they will be considered for next years pot and so on.
Improvement Grant funding is also still available but this has to be applied for via the local Area Teams and this is for smaller projects which the Area Team will fund up to 66% with practices funding the remainder.
Finally, Wessex, alongside Thames Valley has been chosen as a pilot site to explore the Premises Costs Directions minimum standards - more information will be available in due course but basically, this should give practices the evidence required of their premises being fit for purpose or needing investment.
CQC - GP Appraisals
The LMC has been made aware that some of the lead inspectors are asking to see dates and evidence of appraisals for everyone in a practice. Having taken this up with CQC, we can confirm that they are not entitled to see GP appraisals as these are between the GP and their appraiser but it would be helpful to have the appraisal dates listed for all GPs and staff.
CQC - How to be an outstanding practice
CQC has announced that they have given two practices an outstanding rating, the links below will take you to both outstanding practices CQC reports if you want to see how its done!:
Irlam Medical Practce 2: http://www.cqc.org.uk/sites/default/files/new_reports/AAAA3213.pdf
Salford Health Matters Ecles: http://www.cqc.org.uk/sites/default/files/new_reports/AAAA3126.pdf
Personally, we think all of our practices are outstanding!
CQC - Provider Group Registration
In our last email we included an item on CQC registration of provider companies.
The LMC asked the CQC to comment on our article and the following is their response in respect of actual registration when submitting a bid but before being awarded a contract:
The Health and Social Care Act 2008 only requires registration where regulated activity is provided. Companies bidding for contracts will often need to apply for registration before they know whether they have been successful. CQC may ask for confirmation from applicants that they WILL provide regulated activity (e.g. that they have been awarded a contract to do so) before they grant registration. CQC cannot register Companies that will not provide regulated activity (i.e. those that are unsuccessful). Companies can, in these circumstances, withdraw their applications. “
In summary, they have softened their stance and applications can be submitted and either followed through or withdrawn once the outcome of the bid is known.
As you will be aware, the Department of Health has decided that NHS mail is too costly and have decided to terminate it. The GPC has objected to this as it is seen as a retrograde step and, as a result, although NHS mail faxing will terminate at the end of March 2015, SMS messaging will continue to be available until September 2015. However, the GPC is working with DH on a new procurement programme so we hope this will be resolved during 2015.
The clinical system suppliers do offer an SMS texting service details of which are below: - contact system suppliers
Vision inps: http://www.inps4.co.uk/vision/partners/pcm
TPP systm one: Offers a free messaging service via NHS net
Although not yet open for bookings, the LMC will be holding another of its IT Conferences in May and this will be an opportunity to explore this issue further with the clinical system suppliers aswell as a possible national resolution.
Job Section - Professionals Available to Work
The LMC is pleased to announce that we have included a new facility on our website called ‘ Professionals Available to Work’ . This has been specifically designed to allow Locum GPs, Nurses and Practice Managers to add their availability to work details on our website. There is also an "other" option whereby those who fall outside of the aforementioned job titles can also upload their respective details.
Given the personal details being displayed, in order to view and have access to the “Professionals available to work” section, yourself and other users will need to be logged into the Wessex LMC website (using their myLMC login) and linked to Wessex LMCs, otherwise they will only see the Practice Vacancies page.
We would like to remind practices that Wessex LMCs cannot be seen to endorse adverts for vacancies/locum availability included on the website and the responsibility for conducting relevant checks on staff members remains with Practices.
In line with this, as you are no doubt aware, the PPSA serving Hampshire practices only (Dorset and Wiltshire are already with SBS) has been closed with all services transferred to Reading. This has left a number of highly skilled and experienced staff being made redundant today.
They have therefore been invited to upload their information to the 'other' section of 'professionals looking for work' jobs page on the LMC website and we highly recommend that, if you're looking for staff, you consider the staff from the PPSA, who all have extensive NHS experience and are bound be an asset to your practice. You can find their CVs and other information on our jobs page: https://www.wessexlmcs.com/jobsectionprofessionalsavailabletoworkuserguide
Workforce Minimum Data Set
The GPC has taken legal advice on the very detailed and personal information being requested by HSCIC which includes sickness records for all staff and the reasons for any sickness, their NI numbers etc which is thought to be very intrusive.
BMA lawyers advised that section 259 of the Health and Social Care Act overrides section 10 of the Data Protection Act and as such practices have no choice but to supply the data and staff cannot object.
However, LMC Law, the LMCs legal advisers disagreed with this and don't believe that the DPA can be overridden by the H &SC Act. Given this situation, LMC Law have now approached the Information Commissioners Office (ICO) for their view which is still awaited.
As soon as an update is received from the ICO we will circulate this to practices.
Friends & Family Test
CQRS :You will have received a task within CQRS to sign up to a data extraction for the Friends & Family Test, practices will need to sign up to this and the following guidance outlines the collection process via CQRS:
Unfortunately, as it stands, this is a manual entry!
Survey of services : Please note that patients should be asked to comment on any of the services you provide for them and not just GMS services. Rather than make this too complicated, it may be wise to ask on the template or other media which service the patient has received eg GP consultation, minor surgery, diabetic nurse care etc before asking the mandatory question.
Out of Area Registration Update
Following on from our previous update around the out of area registration scheme, we are receiving an increasing number of queries relating to this.
As previously stated, there are 2 elements to this scheme which are separate however they run in parallel with each other. These are as follows:
- Out of area registrations – this element is where the practice can choose to register a patient as ‘out of the area’ with no home visiting obligation. The GMS contract has been amended to enable you to do this, you therefore will not be asked to opt in for this service. It is also worth noting that even though it is in the GMS contract it is up to the practice whether they wish to register patients as ‘out of the area’
- In hours urgent primary medical care enhanced service – This is an enhanced service and you will have received a request from your Local Area Team to ask if you wish to provide urgent care & a home visiting service to patients who have an out of area registration. This you need to opt in or out of providing. This will be for patients registered as an out of area patient who require urgent care when at home and live within your practice boundary.
The GPC has stated that it is important that practices must not register any patient under these new arrangements (out of area registration) until they are certain that a safe and adequate service is available if patients are too ill to travel to the practice. GPs have a professional responsibility to ensure this is the case.
The Area Team, working with CCGs are currently identifying the practices who would like to provide the in hours urgent primary medical care enhanced service, this is to ensure there is an adequate service for out of area registered patients to access. Whilst undertaking this the Area Team is also looking at contingency plans if practices do not wish to provide this enhanced service. Therefore you may also have received an email asking if you would like to undertake this enhanced service outside of your boundary. Again this is up to the practice whether you would be interested in providing this and discussions are taking place as to the funding for this service.
A summary of the national guidance, which we included in our last update, can be accessed by clicking on the following link:
Following on from this a flow chart has been created that takes you through a suggested registration process for an out of area patient which can be accessed on the link below: Flow Chart - Patient Registration Process
Please also see links below for an out of area patient registration form and a treatment form for the In Hours Urgent Medical Care DES that has been produced by Ian Wright, Practice Manager at Ringwood Medical Centre. Ian is happy for you to adapt and use if you wish.
Retired QOF Indicators
We received the following statement from the GPC which is self-explanatory:
GPC has heard a number of understandable concerns regarding recent communications from the Health and Social Care Information Centre (HSCIC) about retired QOF indicators for 2014/15. Practices have been informed that support for these indicators has now been added to the Calculating Quality Reporting Service (CQRS) and automated data will be collected by the General Practice Extraction Service (GPES) from February 2015. To receive automated data for this service from February, practices were asked to participate in CQRS by 23 January 2015.
In accompanying information, HSCIC suggests that “it is a requirement for general practices to ensure they continue to provide the services linked to these indicators”. This statement is incorrect and is not what was agreed by GPC, NHS Employers and NHS England in the 2014/15 contract negotiations.
Concerns have been raised by LMCs and practices about the recording and achievement of retired QOF indicators. Following the wholly inappropriate and flawed use of coded data by the Care Quality Commission as part of its “intelligent monitoring” risk assessment, practices are understandably anxious about how data that is extracted will be used.
The GPC’s position is that the decision to retire and amend these indicators was intended to reduce bureaucracy and to allow practices to focus on the needs of patients. These indicators were successfully removed during negotiations as being clinically inappropriate and unhelpful to practices. As such, there is no expectation that practices should continue to focus on achieving these targets, and GPs should instead continue to use professional judgment to treat patients in accordance with best clinical practice guidelines. It is for clinicians to decide how they record clinical consultations and what codes, if any, to use. Practice funding is no longer linked to meeting these indictors and so it is a matter for practices to decide whether to respond to CQRS extraction requests. Practice payments under the contract will not be affected by agreeing to the extraction.
GPC anticipates a large fall in the recording of many of the retired codes, particularly those that were previously imposed, as practices now work more appropriately, and therefore believes that allowing retired codes to be extracted could help to demonstrate how inappropriate it was to impose contract changes in the first place.
The European Medical Directory
We have been notified of yet another scam but the GPC has become involved with this one.
A number of GPs have in the past completed and signed a Med1web form from NovaChannel AG under the misapprehension that the form offered a free listings service in the European Medical Directory (TEMDI). However, in the small print there was a clause enabling NovaChannel AG to charge for this service, and some GPs have or are being pursued for payment. Whilst GPs may decide to ignore the requests for payment by the company, there is always the risk that the individual will be obligated under commercial contract law to render the amounts claimed in full plus interest. NovaChannel AG was a Swiss registered company, and its practices were investigated by the Swiss Office of Fair Trading in 2008. GPC previously wrote to the Swiss Embassy and issued advice to practices based on their response. However, NovaChannel AG has now ceased trading from Switzerland, and it has been brought to our attention that payment for the Med1web forms is now being pursued by United Directories Lda (a Portuguese company). GPC subsequently wrote to the Portuguese Embassy for their views, who undertook to inform the appropriate Portuguese authorities on the matter.
We are aware that some doctors have received letters from United Lda notifying them that their files have been reviewed and that, because they are not independent doctors, their particulars have been deleted from the directory and that the contract is null and void. We therefore advise all NHS GPs who unwittingly signed up to the Med1web form to contact United Directories Lda asking for their details to the removed from its directory and for any contract to be terminated. The address is: United Directories, Lda, PO Box 1571, 1056-001 Lisbon, Portugal or email: firstname.lastname@example.org.
This does mean that anyone signing the form without reading the small print is considered to have entered into a legally binding contract. The decision must rest with the individual or practice as to whether to take the risk of not paying the charge. We accept that the company in question may be relying on the fact that people do not read the small print, and equally, it appears to be the case that they do not begin proceedings for non-payment. However, the BMA cannot advise members to act in any particular way. This is unlikely to have affected large numbers of doctors, but we are aware of instances where United Directories Lda have accepted that NHS doctors who did sign Med1web forms can consider their contracts annulled. If you are a doctor practising within the NHS and receive a letter of demand from Med1web, you should reply noting that you are NHS registered and asking for the contract to be annulled. If attempting to have contracts annulled by following the above process, it would be helpful if members then notified the BMA of the outcome. Should United Directories Lda aggressively pursue payments, GPC can notify the Portuguese Embassy. They have offered to pass on specific details to the Portuguese authorities, and GPC can continue to lobby on behalf of members for as long as this problem persists.
Practices in Crisis
The LMC is increasingly being approached by practices who cannot recruit, have workload or partnership issue etc. We are very happy to provide support in a variety of ways but please do not wait until the crisis is at the point when the partners are consdering handing back the contract - the earlier we become involved, the better. Thank you.
Audit of potentially avoidable appointments and reducing bureaucracy (England only)
NHS England has commissioned two pieces of work from the Primary Care Foundation, working with NHS Alliance, to look at ways in which practice workload might be reduced. The GPC is supportive of this initiative, which ties in closely with our recent publication Quality First: Managing Workload to Deliver Safe Patient Care.
The Primary Care Foundation has developed an audit tool to collect information on shaping demand to reduce avoidable appointments. Notwithstanding that GPs are already overloaded with paperwork, we would request that you encourage as many GPs as possible to take a little time to engage in this work, as we are confident it will help to demonstrate the excessive pressures facing general practice. The results will also be an important lever to achieve system and commissioning changes to reduce inappropriate demand and workload. If three or more members of a practice complete this audit, the Primary Care Foundation will prepare a report for the practice, comparing results.
Practice managers are also invited to respond to the survey on reducing bureaucracy
You can find out more about both the audit tool and survey here: www.primarycarefoundation.co.uk/audit-tool.html
Finally, if you would like to share any best practice tips with your colleagues, please do not hesitate to let us know and we look forward to seeing many of you at the Practice Managers Conferences on 10th and 26th February 2015.
Carole, Lisa and Michelle
Directors and Assistant Director of Primary Care
30 January 2015