LMC Email update July 2017
Date sent: Sunday 2 July 2017
Email sent by Wessex LMCs, on 2nd July, 2017
I sent you an email update a week or so ago but one or two issues have come to my attenntion that I thought were worth sharing with you.
1. Sharing information with the Police (part 2) - advice from MDO and the Information Governance Alliance
2. Who represenents GPs locally? - fairly obvious, the LMC, but some CCGs and hospitals are confused - this I hope will clarify the issue for them.
3. Should Practices opt to be NHS Bodies or non NHS Bodies?
4. GP Registrar Timetable - this is an example from the East Midlands which might be helpful.
5. Cancer - early detection and improved survival - this will be a focus of attention following the refresh of the Five Year Forward View
6. What GPs need to know about the introduction of primary HPV testing in cervical screening
7. Another Cyber Attack - a 2nd attack happened last week - are you prepared as a practice?
1. Sharing information with the Police
This is obviously a very live topic of debate with the various acts of terrorism that have occurred recently in addition to the tragic fire that happened in London.
The MDU has recently produced some useful guidance - click here .
I have attached the Information Governance Alliance's helpful document called "Disclosure of personal information to the Police"
2. Who represents GPs locally?
Some CCGs and hospitals are confused and think that GPs working for CCGs are there to represent GPs. They have an important role to play but they are not representative of GPs. To help clarify matter the LMC has produce the document below.
The Role of the LMC
As we are all aware the NHS is facing some of the most significant challenges it has seen since its inception in the 1940s this is not only in terms of financial problems but is also related to capacity, workload and recruitment and retention. At a time when general practice is unable to recruit younger GPs and retain older ones there is a need as defined in the Five Year Forward View (5YFV) to invest more in community services and general practice and remove the barriers between providers. This means replacing choice and competition with partnership working.
In Wessex we are already seeing a sea change in attitude towards general practice and a wish to work more closely with general practice. But few outside general practice seem to understand the independent contractor status and practices working as small businesses.
The NHS needs to be less reliant on hospital based services, and this means that there needs to be an out of hospital service that is delivered at scale and to make this effective it needs to be embedded in general practice.
The Sustainability and Transformation Plans (STPs) have brought together commissioners, Public Health, the Local Authority and providers (which includes general practice) to try and ensure the local system covered by the STP footprint works together effectively and efficiently. One question that repeatedly gets raised is who represents general practice both locally and nationally? The LMC thought it would be helpful to clarify this matter.
The LMC is the only body that has a statutory duty to represent GPs at a local level. This statutory duty was first enshrined in law in 1911 and has been included in the various NHS Acts over the recent past and is included in the Health and Social Care Act. The LMC has a constitution that ensures it is representative of GPs and this was produced and updated regularly following consultation with GPs and NHS England. In every area of the country there is a local representative committee called a Local Medical Committee whereby GPs are nominated by their peers and elections to these roles take place regularly (normally every 2 – 4 years). The committee also ensures there is a balance in terms of representation (contractual status and other factors).
Whilst recognised by statute and having statutory functions, unlike CCGs, LMCs are NOT themselves statutory bodies, they are independent; it is this unique status as independent representative bodies recognised by statute that allows them to be so effective in standing up for and supporting their GPs. They are accountable to the GPs they represent, unlike CCGs who are answerable to their NHS England and the Department of Health leaving LMCs free to speak up on behalf of GPs, practices and their patients when others cannot.
The Health and Social Care Act reinforces the requirement for NHS Bodies to consult with the LMC on issues that relate to general practice. It is important to understand that the LMC is not a trade union and cannot act as such this is the role of the British Medical Association (BMA).
The LMC would therefore consider itself the voice of general practice at a local level. We work for and support individual GPs. Practices and also the wider professional voice of general practice.
The current confusion occurs when people consider the role of the Clinical Commissioning Groups (CCGs), federations or GP provider companies, the Royal College of General Practice (RCGP) and the General Practitioners Committee of the BMA.
CCGs were constituted as clinically led commissioning organisation whereby all local practices were members of the CCG. This would normally mean either practices or individual GPs elect their peers to sit on the Board of the CCG. Their role is to provide their expertise in order to better commission services to the population and this should not be confused with the role of the LMC who represent GPs as providers.
It is therefore incorrect when some GPs who work for CCGs say they represent GPs, they do not, the CCGs have member practices not GPs as members
GP federation (or GP provider companies) these organisations are becoming more important especially in terms of providing services at scale and they can represent their member practices in terms of provision of services that lie outside essential services, additional services, local contracts (practice level) and QoF. If the provider company is speaking on behalf of practices they must ensure they have a mandate to undertake this role.
The Royal College of General Practice – is the national membership body that is focused on quality and training and is committed to improving patient care, clinical standards and GP training.
The General Practitioners Committee is part of the BMA and is the only body that represents all GPs (even those who are not members of the BMA). It remains the voice of general practice at a national level.
The LMCs work with the GPC and ensure that there is close liaison between the national and local representation for general practice.
3. Should Practices be NHS Bodies or non NHS Bodies?
Practice have the choice in their GMS or PMS Contract to be an NHS Body or a non NHS Body. But what does this mean?
If you are an NHS Body and have a contractual dispute with the NHS you have no choice but to use NHS Resolution (formally known as the NHS Litigation Authority or NHS LA). If you are a non NHS Body you have the choice to use NHS Resolution or use the Civil Courts.
The LMC's advice is that practice should choose to be non NHS Bodies unless the current situation changes and it becomes more advantageous to be an NHS Body.
4. GP Registrar Timetable
See attached Excel document which is a worked sample timetable developed in another area that has been signed off by a Trust in the East Midland as compliant
5. Cancer - early detection and improved survival
Cancer survival rates are at a record high, with an estimated 7,000+ more people surviving cancer after NHS treatment compared with three years earlier, and with more people accessing cancer testing, funding for new, effective drug treatments and diagnostics, and continued action to reduce smoking.
But despite this improved survival the UK lags behind other counties in terms of survival. One of the keys to improved survival is earlier detection.
One in three people will get cancer in their lifetime and due to the country’s ageing population and increasing numbers being referred for testing, it is essential that the NHS expands diagnostic capacity.
The review of the Five Year Forward View earlier this year listed 4 key priorities for the NHS this year:
- General Practice
- Mental Health
- Acute and Emergency Care
The commitment is that within two years, over 5,000 more people a year will survive cancer, delivered by better prevention, earlier diagnosis and innovative new treatments for cancer.
So what does this mean for GPs? This is my personal view.
Earlier detection will inevitably mean that GPs must have better access to diagnostic tests such as Ultrasound, CT Scans and MRI Scan. There needs to be clear pathways for access but in 2017 it seems beyond belief that in some areas GPs have difficulty in organising simple tests such as an USS. Access is needed where currently it is not available and also quicker access is needed where cancer is a possibility.
The 2WW were an excellent idea and have resulted in patients accessing care and having a potential cancer diagnosed at an earlier stage. But not all patients fit into nice boxes and we need a clinic that can see patients where you suspect there might be a cancer but the symptoms and signs are rather non specific.
Finally to improve the quality of care of patients who have cancer we do need to improve the quality of communication.
All the Oncologist I have met have been really committed to their patients, kind, caring and considerate but communication with the patients GP - well, can I say the could do better! They do not seem to realise that the patients will also come and see us when they are going through their treatment - so it is important that we are aware of current issues.
What I am looking for is not complex, I just want simple information:
Name of cancer, the stage, whether it has metastisised or not, is treatment being offered and if so is this chemotherapy, DXT or surgery and is this curative or palliative. Then what is the plan for follow up. Are there any specific issues as GPs we should be aware of for example complication from the cancer or treatment?
it would be helpful to know the 1 and 5 year survival and where the individual sits in terms of the Oncologist's expectation but I can see this would be difficult to do and may cause significant problems with individual patients.
6. What GPs need to know about the introduction of primary HPV testing in cervical screening
Cervical screening saves an estimated 5,000 lives a year by detecting abnormalities of the cervix early and referring women for effective treatment.
The NHS offers cervical screening to all eligible women aged 25 to 49 every 3 years and to those aged 50 to 64 every 5 years.
Human papillomavirus (HPV) is a common virus transmitted through sexual contact. High risk sub-types of HPV (HR-HPV) are linked to the development of abnormal cells and can cause cervical cancer. HPV is a necessary cause of invasive cervical cancer.
Evidence shows HPV testing is a better way of identifying women at risk of cervical cancer than the cytology (smear) test that examines cells under a microscope.
Last year, after reviewing the evidence, the UK National Screening Committee recommended that the HPV test should replace cytology as the first (primary) test in cervical screening. This will be a major change for the NHS Cervical Screening Programme.
Nurses and doctors carry out cervical screening in primary care. So it’s important that those of us working in primary care understand the reasons for the change and the implications of it.
To read more about this - click here
7. Another Cyber Attack
You will have seen the news about the latest ransomware. Providing everyone has updated their protection since the WannaCry virus there should not be a problem.
Here is the official advice from the NHS’s Cybersecurity division.
Every practice ought to have one or two people with different e-mail accounts that are registered with CareCERT to receive e-mails. You can sign up to receive bulletins and alerts by sending an e-mail to email@example.com with this text in the subject box
“Sign me up to the security threat bulletin and emergency updates”.
Then type an explanatory note in the message box. You do not have to have an NHS mail address to receive them.
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)
Attached file: Copy of Example Registrar Timetable(2).xlsx
Attached file: Disclosure of Personal Information to the Police.pdf