LMC Update June 2017 - part 2
Date sent: Monday 26 June 2017
Email sent by Wessex LMCs,
Normally at this time of year the focus for the LMC moves from new contract changes, year end problems, negotiations related to new enhanced services but this year it seems to be very different. There is far more focus on support for individuals and practices. In addition there is much discussion with hospitals and community providers who want to engage with general practice in a ways that we have rarely seen before.
We are in a period of great change and the recent general election will not change that. It was hugely significant that the Queen's Speech last week did not include anything about the NHS. This, in my view. does not mean that change is not going to take place but it does mean that it will be driven within the current regulations rather than expecting primary legislation.
So lots going on and hence the number of emails that the LMC is send to you, I hope these are helpful.
Learning Disabilities - more information for practices
In my last email I reported the outcomes of a very positive LMC Conference that was focused on Learning Disabilities.
The aim of the conference was to raise the profile of this important area and to try and significantly increase the uptake of the LD Annual Health Checks from an average of 44% to over 80%.
This has not only been shown to be of significant benefit to the individual and their carers and/or family but is also helpful for practices in terms of the quality of care provided and to incentivise this the practice will receive £140 for each annual review you undertake which makes it cost effective to provide this service.
There were a number of resources made available by the Hampshire Learning Disability teams who partnered the LMC in organising and delivering the conference. As some of you found out, the links to some documents in my last email did not work. We have reviewed our website and repaired those links. In addition I have attached some additional resources to this email. We are going to add all these documents to our website in the next week or so.
To find these resources go the our website - www.wessexlmcs.com and search for learning disabilities.
If your practice does not offer these annual reviews CCGs will be looking for alternative providers, which would be a shame as I believe the best people to deliver this service is the practice where these individuals are registered. If you practice does not provide the service it would be helpful if you could let me know what help you would need to be able to offer the service.
Police Requests for Medical Reports
The BMA professional fees committee has received new legal advice regarding medical note requests received from the police, which are detailed below.
There is clear guidance regarding the obligations that GPs have with respect to copying and/or release of the GP record. For your reference, these circumstances are:
- If the police do not have a court order or warrant they may request voluntary disclosure of a patient’s health records under section 29 of the Data Protection Act 1998.
- However, while health professionals have the power to disclose the records to the police where section 29 applies, there is no obligation to do so.
- In such cases health professionals remain bound by the long-established common law duty of confidentiality and may only disclose information where the patient has given consent, or there is an overriding public interest. They may also be required to defend their decision to disclose before the GMC which is a statutory tribunal.
- Disclosures in the public interest based on common law are made where disclosure is essential to prevent a serious threat to public health, national security, the life of the individual or a third party, or to prevent or detect serious crime. This includes crimes such as murder, manslaughter, rape, treason, kidnapping and abuse of children or other vulnerable people. Serious harm to the security of the state or to public order and serious fraud will also fall into this category.
Your practice is entitled to a fee for producing the notes for the police.
There is no set fee for producing these notes, as they are not considered a subject access request that you may receive from a patient. Therefore the practice is able to set its own fee.
In order for you to proceed with the police request, please find attached a pro forma that we recommend you complete and send to the police authority. We recommend that you obtain each of the following:
- Provide written patient consent to release of their records OR provide written confirmation as to the nature of the serious crime allegedly committed by the patient and an explanation as to why the patient’s records, or other information requested, are considered necessary for the specific purpose you are pursuing. You will require one of these in order to fulfill your responsibilities as the Caldicott Guardian.
- Confirmation in writing that the fee of £xx will be paid within 28 days of the police receiving the record. This fee is due to the disproportionate effort placed on an already overburdened GP practice to provide these notes which recognises the need to support the police in their investigation of a crime, where appropriate to do so.
- Written confirmation from a senior police officer – ranked Superintendent or above – that he or she considers that the crime being investigated is a serious crime in line with the examples provided above.
Once you are in receipt of both of these at the practice, and have checked the appropriateness of release of the records, you should respond to the police authority as soon as possible.
Alternatively, should it be appropriate for the police to view the record (based on their answer to requirement 1 above), then there is the option for them to view the record in the practice in the presence of a practice staff member. In this situation there is no fee chargeable.
There is no set fee for providing records in this manner. Therefore it is the responsibility of individual practices to set their own fee for this work. When completing the attached pro forma you must enter the fee you choose to charge.
It is vital that the police agree in writing to pay the fee, otherwise you will not be able to claim for the service. If the police authority do not agree to pay the GP can decide whether they would like to provide the service free of charge, or not at all.
Please note that if the police authorities have a court order or warrant for disclosure of the records, you may be required to comply with the request even where a fee has not been paid or agreed. This will depend on a number of factors, including the terms of the court order or warrant.
GPs should, in all cases where there is no patient consent, consider whether the benefits to an individual or to society of disclosing the records outweigh both the public and the patient’s interest in keeping the information confidential before agreeing to disclose the records.
If you have any further queries about this please contact: firstname.lastname@example.org.
Attached is a profoma letter your practice may wish to use.
Ongoing CHP and NHSPS premises issues
The GPC's advice to practices is as follows:
In respect of lease negotiations, it is vital that you do not sign any lease or Heads of Terms (including those purporting to be based on the national template GP lease negotiated between the BMA and NHSPS) unless and until you fully understand and are comfortable with your potential liabilities. To this regard appropriate due diligence as to your potential liabilities should be carried out.
Such arrangements should only be entered into where you are entirely satisfied that when the transitional period ends that you are not inadvertently left having to meet increased costs without the benefit of increased funding. In the view of the BMA, transitional arrangements should be avoided. More permanent solutions which align a practices’ funding to their costs are needed.
In respect of current charges, practices should only make payments to both the extent that they are both satisfied as to the legal basis upon which they are payable and their accuracy.
Focus on funding from the GPFV
The GPC have recently updated the GPFV funding and support guide (see attached) and the GPC's GPFV hub page to reflect changes to some of the 2017 timelines for implementation.
It is vital that this funding which has been promised to us reaches the practices which need it. Your LMC has this as one of our top priorities.
Locum GP and salaried GP handbooks
The locum GP handbook provides advice and guidance on all aspects of locum work, including on starting out as a locum, setting up as a business and establishing a contract for services with a provider. The handbook also provides advice to practices on recruiting locums.
The BMA salaried GPs handbook is a resource for salaried GPs and GP employers. It explains the legal entitlements of salaried GPs as employees, helps to ensure that salaried GPs are aware of their statutory and contractual rights, and outlines the effect of the various provisions of the model salaried GP contract. It includes sections on maternity leave and redundancy, and information on many other areas such as salary, hours of work, sick leave and employment protection.
There is an e-learning module on the eLFH website on Death certification - to access this you will need a password - click here for the website.
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)
Attached file: Focus-on-General-Practice-Forward-View-May-2016.pdf
Attached file: Pro forma for practices June 2017.docx
Attached file: GP Access needs letter Final June 2017.pdf
Attached file: Hospital Passport SHFT ADULT April 2017_.dotx.docx
Attached file: Annual Health Check Invitation Letter Example.docx
Attached file: CS41976 Health Facilitator A5 leaflet.v12.pdf
Attached file: SH01274 GP Choking poster v4.pdf