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Wessex LMC email update July 2016 - summer bonus edition!

Date sent: Sunday 7 August 2016

Email update for Wessex general practice

 
 

LMC Email - special bonus summer edition!

I am sorry to fill your inbox with another email but I thought that there were quite a few things happening despite entering the holiday season and therefore I thought it was worth sharing this information with you.

How positive do you feel about the future of general practice?

There is no doubt that we have gone through some very difficult times recently and as a result it has become a major challenge to recruit new GPs and retain the older ones.  If you look back at my email updates over the last couple of years this has been a common theme. 

The 64 million dollar question is, what needs to happen to change the fortunes of the most important part of the NHS?

To address the problems several things need to happen:

  1. A recognition that the workload has reach a point that makes the job of a GP unsustainable and action taken to address this. 
  2. The resources needed to support general practice as a % of the NHS budget has fallen to about 7% and needs to be increased to more than 10%.
  3. The model of general practice is not broken, the personal care based around a registered list is as important today as it was in the past but the model needs to transform so that practices are at the centre of the delivery of patient care with other services available to support GPs as part of a wider team, hence the need for general practice to lead the community based care.
  4. The system of funding care does not incentivise the integrated provision of care, it does the opposite and this needs to change to look at the needs of individuals as well as populations.
  5. Resources need to be invested where they have most impact even if that means a care pathway is delivered by more than one provider.
  6. Support must be given for transformation - to do this there needs to be time and resource.
  7. Remember the phrase "high trust, low bureaucracy", we seem to operate in a system that has more red tape and micromanagement than ever, this needs to stop and allow organisations to concentrate on delivering care to their patients.

I am still working as a partner in a practice that I joined nearly 30 years ago, I can honestly say that I still think general practice is a fantastic care and if I had my time again I would make exactly the same career choice. We all know what the problems are, lets work together to deliver a better future, after all, those of us who are closer to the end of our careers will need the next generation to look after us in the future - so we all have a vested interest in the future of British general practice.

This email is largely about the positive things that are happening to support general practice.

 
 

Contents

  1. GP Forward View - myth or reality
  2. The GP resilience programme
  3. ​GP Indemnity costs
  4. Changes to the Hospitals National Standard Contract
  5. MCP Voluntary contract framework
  6. Improving outcomes in cancer
  7. Advice on preventing telephone fraud

 

 

GP Forward View - myth or reality

 

This week NHS England have launched some of their action that has been taken following their early commitments that were detailed in the GPFV. Including funding for the GP resilience programme, meeting the costs of GP Indemnity and the GP development support programme.

For more details follow the link below  Learn more .

There is an event in September in Southampton where the national team from NHS England are going to present the progress that has been made in terms of implementing the GPFV and the plans for the future.

Unfortunately the places are now full, there are places still available in other areas such as London and Bristol.  After the events the LMC will send a summary to all in Wessex.

 

 

The GP Resilience Programme

This programme will invest £40m over the next 4 years with £16m being available this year. The aim is to support practices who are struggling and need help. This is in addition to the "Vulnerable Practice Scheme" that was announced last year.

Support will be provided from a menu of options based on the needs of the practice, and will include local resilience teams or pools of experienced GPs and other practice staff to help with practice management, recruitment issues and capacity.

For more details of the review follow the link below.

Click here to Learn more

 
 

GP Indemnity Costs

The rising costs of Indemnity is one of the reasons that the workforce in general practice is being depleted - recrutment and retention is a key issue. This year additional funding was included in the global sum to cover the increases.  

A new GP indemnity support scheme has been announced by NHS England, will start in 2017-18 and provide a special payment to practices, linked to workload, to offset average indemnity inflation. The scheme will initially run for two years, when it will be reviewed. The first payment, which will be separate from standard contract payments, will be made in April 2017.

For more details of the review follow the link to Learn more .

 
 

Changes to the Hospitals National Standard Contract

The LMC often gets complaints from GPs that a patient has failed to attend an OPD and so the hospital passes the responsibility for follow up back to the GP, or please could the GP refer the patient to another consultant because the hospital are unable to do this, or please could you inform your patient of the investigation that the hospital has undertaken and even worse please could the GP chase up the test and then inform the patient, or OPD letters and discharge summaries arriving 4-6 weeks after the appointment.

Recently the NHS Contract has changed and now there is a requirement on the hospital to change traditional behaviours.  The following changes have been included in this years contract:

  • Stopping hospitals adopting blanket policies under which patients who do not attend an outpatient clinic appointment are automatically discharged back to their GP for re-referral (this wastes an estimated 15 million GP appointments per year).
  • Enabling hospital onward referral to and treatment by another professional within the same provider for a related condition, without the need to refer back to the GP.
  • A requirement for hospitals to notify patients of the results of clinical investigations and treatments in an appropriate and cost-effective manner; for example, telephoning the patient. Therefore GPs should not be inappropriately used to relay to patients results of tests generated by hospital clinicians.
  • Timely clinic letters to GP practices, no later than 14 days after the appointment, and with the hope of electronic transmission within 24 hours in the future.

The GPC has written to all CCGs and the LMC has written to all local hospitals and CCGs to ensure these requirements have been implemented. We hope this will help to reduce the unnecessary work that is frequently "dumped" on general practice.

However, it is clear that despite these contractual changes, GP practices have continued to be burdened by the above bureaucracy, with many CCGs and hospital trusts seemingly unaware of these new requirements. 

As result, the GPC requested that NHS England should write to all CCGs and hospital providers, making these responsibilities clear. NHS England have now written to all CCGs and trusts. This letter should be used as a basis for practices to demand the above requirements, and to notify their LMC where providers breach these contractual terms. You can use the GPC's  template letters in Quality First to reject such inappropriate transferred work.  There are template letters for TPP and EMIS.

 
 

Multi Speciality Community Provider (MCP) 

Voluntary Contract Framework

As I indicated in my recent email this framework has now been published. This would allow groups of practices working together and with other partners to hold a budget based on a population to deliver care in a more integrated way. 

In Wessex there has been a lot of work to try and develop better services for patients including the Vanguards in the Isle of Wight, North Hampshire and Farnham and in Southern Hampshire. There are other areas such as Dorset and Southampton who were not part of the initial Vanguard programme but have joined the process of transformation of services across providers.

Following the announcement at the Conservative Party Conference last year that there would be a new deal for general practice there has been much speculation about what this would include and how much freedom it would give practices.

For the NHS to meet the demands that it faces with an ageing population and more people who have one or more long term conditions, continuing with the over dependency on hospital based care will not only be unaffordable but will also compound the problems faced by community services and general practice.

I have told you before that the NHS needs to build on the strengths of general practice, with the registered list of patients and also, where appropriate, the unique strength of continuity of care that general practice offers, but this is not enough.  There needs to be greater investment, flexibility, and joint working in the community to deliver a balanced model that is sustainable. To achieve this, general practice needs to play a lead role as we account for about 90% of the daily patient contacts.

The Voluntary Contract will be based on a defined population and will require general practice to be at the core of this work. Without the registered list this will have little impact.

The contract will need to be held by a legal entity which could be a Limited Liability Partnership (LLP), a Limited Company, a Community Interest Company (CIC) an NHS Trust or a Foundation Trust. This will be a population based contract with a defined budget giving greater freedom to the providers in terms of the design and delivery of care, breaking down the barriers between general practice and community staff.

Some have said that this contract will mean that practices will have to give up their GMS or PMS contract and therefore is a major threat to the profession. 

I sit on the national advisory committee for the New Voluntary MCP Contract and Hampshire is one of the six pilot sites. I can assure you that those practices who want to retain their GMS or PMS contract will be able to do so. For some, as has happened in Gosport, moving to an employed model where this is in the best interests of the practice, the option will also be available.  

In addition, if a practice does not want to be part of the contract they can remain outside it but will need to accept that services for their patients will be developed at a population level. Clearly if lots of practices opt not to take part in the contract, it will not go to procurement.

To find out more information follow the links below:

LMC webpage for MCP Voluntary contract - click here

You will find the published framework, the BMA's Focus on document responding to the framework.

 
 

Improving outcomes in cancer

The RCGP has launched TWO cancer toolkits to assist GPs in the effective prevention, diagnosis, and treatment of cancer throughout primary care.

The Primary Care Cancer toolkit: 

(http://www.rcgp.org.uk/clinical-and-research/toolkits/primary-care-cancer-toolkit.aspx) provides a collection of key evidence-based resources and guidance relating to cancer prevention, diagnosis and treatment relevant to the primary care setting. The Primary Care Cancer toolkit also contains up-to-date cancer information for patients and carers which you may wish to share with your patients.

The Early Diagnosis of Cancer Significant Event Audit Analysis toolkit:(http://www.rcgp.org.uk/clinical-and-research/toolkits/Early-Diagnosis-of-Cancer-Significant-Event-Analysis-Toolkit.aspx) consists of a wealth of Quality Improvement resources and guidance designed to enable GP practices and CCGs improve outcomes in the early diagnosis of cancer.

In a recent email I was able to give some good news about improved outcomes in cancer. Wessex was the best strategic clinical network (SCN) for early diagnosis and did particularly well for the early diagnosis of colorectal, breast and prostate cancers.

 

 
 

Advice on preventing telephone fraud

GPC has been made aware that telephone systems used by practices may be vulnerable to fraudsters hacking into them and making premium rate calls. In one instance £2500 - £5000 of calls were placed over one weekend.

This is known as PBX/dial-through fraud, which occurs when hackers target Private Branch Exchanges (PBX) from the outside and use them to make a high volume of calls to premium rate or overseas numbers.

The victims are usually small to medium-sized businesses, but the National Fraud Intelligence Bureau has also noticed that a number of schools, charities and medical/dental practices being targeted where fraudsters are taking advantage of flaws in security systems.

This type of fraud is most likely to occur when organisations are most vulnerable i.e. during times when businesses are closed but their telephone systems are not, for example in the early hours of the morning or over a weekend or public holiday.

There are commercial organisations that will install software to prevent this and practices should consider whether this is a cost effective solution. However, a simpler alternative might be to place a block on international calls with the telephone system supplier.

This raises an issue of where, for example, a patient is hospitalised abroad and clinician to clinician communication is required, but the advice of GPC would be to ensure that an alternative mechanism for making and receiving such a call was in place, such as the mobile of one of the practice staff. Any cost to the individual could then be reimbursed.

 

 

Best wishes

Nigel

Dr Nigel Watson MBBS FRCGP
 

 
 

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Updated on 08 August 2016 1056 views