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LMC Update - April 2015

Date sent: Thursday 2 April 2015

We have now entered a period before a general election where the Government is not allowed to announce any new initiatives that could be advantageous to candidates in the election, this period is called purdah. So we will now have about 4 weeks of relative peace, free of initiatives but full of promises about how each party will propose to improve the care to patients.

Funding of the NHS is going to be a critical issue in the next Parliament.

Whatever the outcome of the general election the years of under funding in general practice and the community must be addressed. If the politicians or the NHS fail to act the consequences will be inevitable.

A 1.16% increase in the global sum will not deliver sufficient additional resource to address this under investment.

On a more positive note over the last couple of weeks, 3 areas in Wessex have be successful in their bid for Vanguard Status from Southern Hampshire (Gosport, Petersfield and SW New Forest), the Isle of Wight and North Hampshire and Farnham  and this will attract new resources to develop new models of care.

In addition, the 2nd Wave of the Prime Minister's Challenge Fund was announce this week with successful bids from Southampton. Swindon and the New Forest.

Although this will not benefit everyone initially , I would hope it is the start in terms of new ways of providing care that will benefit patients and all GPs.  These initiatives must start to address the workload, recruitment and retention and demand that is having such an adverse effect currently.

Contents:

1. New Models of Care

2. Doctors and Dentists Review Body Report, GMS guidance and Statement of Financial Entitlement

3. Important information regarding NeisVac-C vaccine, Boostrix IPV injection and Fluenz Tetra nasal spray suspension Influenza vaccine

4. QoF guidance

5. Generic prescribing of pregabalin

6. The National CKD Audit – England and Wales

7. Medical information and insurance – Subject Access Requests

8. Sessional GPs e-newsletter

9. FOCUS ON GP CONTRACT PAYMENTS 2015/16

10. GPC guidance notes

1. New Models of Care

If you have read my regular emails you will have be aware of the Five Year Forward view  (FYFV) this document was published by NHS England. 

Primary Care is largely funded on a capitation basis whereas hospitals are funded based on activity. 

Over the last 10 years this has lead to a significant increase in consultants, as increased activity has and attracted new funding, whereas general practice has experienced a rise in workload that has not been matched with resources.

Although the current model of care are seen to deliver high quality care, it is now clear to many that the model of general practice, community based care and hospital care is not sustainable without significant increases in funding (which most would agree is unlikely to happen).

This proposed two new “Models of Care” in the FYFV,  that are expected to help meet the demands that the NHS faces and help to address the over dependence on hospital based care, expand the out of hospital care and ensure the sustainability of general practice. 

The two “Models of Care” are Multi-specialty Community Provider (MCP) and the Primary and Community Acute Care Systems (PACs).

Recently 269 bids were submitted to NHS England to become pilot or Vanguard Sites.  These were short listed to 69, of whom 29 were selected.

In Wessex there were 3 successful bids:

Each of these areas have much in common but are exploring different  solutions, below are brief details of what is being proposed.

Isle of Wight

Patient population: 140,000 and 17 GP practices.

The Vanguard application team known as ‘My Life, a Full Life’ is a partnership consisting of Isle of Wight CCG, Isle of Wight NHS Trust, Isle of Wight Council and the GP collaborative "One Wight Health".

Their aim is to develop person-centred, coordinated health and social care services for the island and should support better outcomes for people, working with local communities to build capacity and resilience of people, families and carers.

This will be achieved through a greater use of digital technology coordinated through a single point of access. It will include patient-led monitoring and will be supported by primary care led integrated locally based services, delivering care out of hospital right across the Island.

This will mean a patient with multiple long term conditions, such as diabetes, will be supported to manage their condition so it enables them to live the life they want to lead. This will include monitoring their condition and working with their GP practice to ensure they receive out of hospital care and are able to remain at work.

 

North Hampshire and Farnham

Patient population: 220,000 

The Vanguard is made up of providers and commissioners of health and social care  in North East Hampshire and Farnham and  will focus on the development of an integrated health, social care and wellbeing system which will put the person at the centre of their care.

NHS and social care services will share resources and skills to support people to stay healthy and well at home.

Care will be provided by local multi-disciplinary teams working together, across physical and mental health services and in partnership with the voluntary sector to provide a personalised service.

The Vanguard will support people with respiratory and cardiac problems and people who have fallen.  For example, a patient with a long term respiratory condition, waiting for many long assessments to be completed by different parts of the health and care system will, in the future, have a single assessment, together with their family and carers, to help them stay healthy and well.

 

Southern Hampshire

Patient population: 220,000 and 27 practices

General Practice and Southern Health NHS Foundation Trust is working in partnership with 16 local NHS, local government and voluntary sector organisations to develop their Vanguard Multi specialty Community Provider across Southern Hampshire.

The Multi specialty Community Provider aims to improve the health, well-being and independence of people living in Southern Hampshire by delivering higher quality, more accessible and more sustainable out-of-hospital care.

It will serve a population of nearly one million, with the initial focus on launching three rapid implementer local sites covering South West New Forest, Gosport and East Hampshire.

These sites cover a rural area with an aging demographic (South West New Forest), an urban population with high levels of deprivation and significant pressure on local GPs (Gosport) and an aging population in a semi-rural area with difficult transport links (East Hampshire).

The Multi specialty Community Provider will support people to take a more active role in self-managing their care and offer access to improved care when needed.

The aim is to develop new models of care for: The proposed work will explore sustainable general practice and help reduce practice workload.

We will share more details as they become available.

 

2.  Doctors and Dentists Review Body Report, GMS guidance and SFE

Last week the Government in England accepted the Doctors’ and Dentists’ Review Body (DDRB) recommendation that GPs should receive a 1% increase in net income.

An overall contractual uplift of 1.16% has been calculated using the DDRB’s formula to deliver this net increase. The new global sum figure will be confirmed very soon when the new SFE and GMS guidance documents are published. For this year only, the value of global sum will increase again in October to reflect seniority recycling.

3. Important information regarding NeisVac-C vaccine, Boostrix IPV injection and Fluenz Tetra nasal spray suspension Influenza vaccine

NHSBSA Prescription Services is making practices aware that where vaccines have been centrally procured for the practice through Public Health England, they should not make a claim under personal administration arrangements to the NHSBSA on form FP34P/D Appendix or FP10.

NHSBSA Prescription Services has identified an increase in FP34P/D Appendix forms and FP10 forms claiming payment for Fluenz Tetra nasal spray suspension Influenza vaccine, NeisVac-C vaccine and Boostrix IPV injection where practices have later verified these have been centrally procured via a vaccine ordering facility, such as ImmForm. Practices must not submit payment claims for vaccines or injections obtained in this way to the NHSBSA.

An FP34P/D appendix or FP10 form should only be submitted for payment to cover the ‘dispensing’ of the vaccine for personal administration where the vaccine has been purchased by the practice.

Practices who have incorrectly submitted centrally procured vaccines to NHSBSA Prescription Services should contact

nhsbsa.repricingrequest@nhs.net.

 

4. QoF guidance

The QOF guidance for 2015-16, applicable from 1 April 2015, has now been published on the NHS Employers website.

A link to the guidance has also been published on the BMA website QOF guidance pages.

 

5. Generic prescribing of pregabalin

A generic version of pregabalin (Lyrica) is shortly to become available, but it only has a license for use in epilepsy and general anxiety disorder with the manufacturer’s patent on use for pain control continuing.

The manufacturers have indicated their intention to enforce their patent through the courts, and anyone supplying generic pregabalin for pain control might be open to litigation.

While this primarily affects dispensing doctors, others might be troubled by pharmacists seeking to confirm the indications for generic prescriptions.

The GPC would therefore advise doctors to prescribe Lyrica by brand when used for its pain control indication for the time being.

This advice is available on the BMA website prescribing page.

NHS England has also published guidance which has been cascaded to practices.

 

6. The National CKD Audit – England and Wales

Detection of chronic kidney disease (CKD) in primary care allows identification of people at higher risk of developing ‘end stage’ kidney disease, acute kidney injury and cardiovascular disease. There is an important balance between the identification and management of risk and a prudent approach to minimise over-medicalisation.

To inform our understanding and encourage better identification and management, NHS England and the Welsh Government have jointly funded a National CKD clinical audit. The audit has been commissioned by the Health Quality Improvement Partnership and is being undertaken by BMJ Informatica.

The aim of the audit is to improve the identification and treatment for patients with CKD. One of the key features of the audit is the serial collection of data on kidney function over time, which will help practices to identify patients with CKD and optimise the care provided to those patients already on the CKD register.

The audit will run automatically so requires no extra work once it is installed. Practices are encouraged to participate so that their data can contribute to the national picture of CKD care. The software also includes an optional Quality Improvement (QI) tool for practices, providing in-consultation computer prompts and lists of patients who potentially need recoding.

The Clinical Review Group for the audit is chaired by Dr Kathryn Griffith, the RCGP Clinical Champion for CKD. The free CKD Audit is available to GP practices who are current BMJ Informatica customers. It will soon be made available to all practices through the new GP Systems of Choice (GPSoC) framework.

Interested in taking part? Please visit the website and follow the instructions to sign up!

Website: www.ckdaudit.org.uk

Email: nationalckdaudit@bmj.com

 

7. Medical information and insurance – Subject Access Requests

The BMA’s joint guidance with the Association of British Insurers (ABI) on the use of medical information for insurance purposes has been withdrawn and is under review. The BMA is aware that some insurance companies are now requesting full medical records (via a Subject Access Request – SAR) rather than asking for a report from the applicant’s GP, as previously agreed with the ABI.

In the GPC’s view, requesting the full medical record for any patient is excessive and potentially in breach of the third data protection principle under the Data Protection Act 1998 (DPA) which states that personal data shall be "adequate, relevant and not excessive" in relation to the purpose for which it is processed.

Under the DPA, patients are entitled to copies of their full medical record. We are awaiting guidance from the Information Commissioners Office (ICO) regarding the BMA’s concerns about the use of SARs. Until this guidance is received, the BMA would recommend that a letter is sent to any patients requesting their medical records via a SAR.

The letter can be found on the BMA website but the text is below

 

Wording for letter in response to request for SAR.

Dear [PATIENT]

I am writing to you as your insurance company has requested access to your full medical record. You will already be aware of this as you have agreed for the insurance company to make a Subject Access Request – as enclosed. I understand that you have signed a form of consent, however, we need to be satisfied that you have provided specific and informed consent for your full medical records to be shared with the insurance company. This is because your records may include extremely sensitive information which you may not expect to be shared or may not need to be shared as part of your application for insurance or the assessment of any claim. 

I also want to let you know that our representative body (The British Medical Association) has questioned whether the law allows insurance companies to use Subject Access Requests to obtain confidential and sensitive personal data. Where insurance companies are requesting a copy of your full medical records, we believe that this puts us (as a GP Practice) at risk of breaching the Data Protection Act 1998 (DPA). The DPA states that only data which is sufficient for the purpose for which it is required should be disclosed and sensitive personal data which is not relevant or excessive in relation to this purpose should not be disclosed.

Therefore, until further guidance is obtained from the Information Commissioners Office (ICO) regarding the use of Subject Access Requests by insurance companies, we are in a difficult position. As the guardian of your medical record we are responsible for ensuring only necessary and relevant information held on your record is shared with an insurance company, however we also have a duty to comply with a subject access request made by you as a patient and do not want to cause any delays to your application.

We are therefore giving you a choice. We can provide you with a copy of your full medical records under a Subject Access Request. This would not be considered as excessive as we are providing the information to you, not the insurance company. It is then entirely your decision whether you give your medical records to the insurance company in full or not

Alternatively, you can ask your insurer to request a GP report from the practice which will only cover information in your record that is relevant to your application. Medical reports also exclude some information, in line with agreement reached with the insurance industry, such as genetic test results and certain information about sexually transmitted infections.

Please therefore let us know if you would like a copy of your full medical records under a subject access request or whether you plan to ask your insurer to seek a medical report.

We have let the Association of British Insurers (ABI) and insurance companies know that we are offering patients this choice. If your insurance company expresses concern about this please ask them to contact the ABI.

Yours faithfully

 

 

8. Sessional GPs e-newsletter

The March edition of the sessional GP e-newsletter was sent out yesterday and is available here is available on the BMA website.

The major feature this month is the new and updated appraisal and revalidation guidance for sessional GPs. It also features news and information aimed at supporting sessional GPs as well as blogs from

The e-newsletter has been sent out to all the sessional GPs on the BMA's membership database but to ensure that it gets to as many sessional GPs I have included the link. it is also possible to easily highlight different sections of the newsletter via social media if you use Twitter, etc.

 

9. FOCUS ON GP CONTRACT PAYMENTS 2015/16

Payments to GP contractors will change from 1 April 2015 to reflect negotiated contract changes and the Government’s acceptance of the Doctors and Dentists Review Body recommendation for contractor GPs.

See the attached document for details.

 

10. GPC guidance notes

Since the beginning of the year, the following guidance has been issued by the GPC and is available on the BMA website:

 

CQC guidance on registration and inspection

Co-commissioning guidance – information for GP providers

Co-commissioning guidance – conflicts of interest

Focus on Fitness to Work guidance

Guidance and FAQs on out of areas registrations

Guidance on applying for premises transformation funds

How to declare GP earnings guidance paper

How to deliver new contract IT requirements

Legal framework for practice networks

Quality first: Managing workload to deliver safe patient care

More detailed and practical how-to guidance to help practices prepare for CQC visits etc

New care models – Vanguard sites

Sessional GP Appraisal and Revalidation Survey and Guidance

 

Best wishes

Nigel

Dr Nigel Watson

Chief Executive

Wessex LMCs

Churchill House, 122-124 Hursley Rd

Chandler's Ford, Eastleigh

Hants. SO53 1JB (Registered Office)

Tel: 02380253874

Mobile: 07825173326

www.wessexlmcs.com

 

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