Director of Primary Care Email Update - December 2013
Date sent: Friday 6 December 2013
This is the sixth in the series of LMC e-mails newsletters for 2013 and again includes a myriad information which we hope will be of help to you.
Before you begin to read, make a cup of tea, sit down and then pass this first article to each of your partners to read:
When it comes to primary care who would argue that the volume, range and complexity of tasks have all increased with the shift of work from secondary care? And that many are working long hours, probably unsustainable in the long term? Or that many feel unsupported by colleagues who appear to be insensitive to their problems, partners who seem to lack insight, and understanding, and who do not provide clear leadership, leading to a feeling of isolation? There is no competition about who is more stressed but these are just some of the issues expressed by practice managers.
When it comes to the stresses of work Practice Managers often complain about doctors who expect the rights of partners but without the attendant responsibilities: those who act more like employees. Paradoxically this may well be an unexpected consequence of phenomena like wider part time working, greater emphasis on work-life balance, importance of child care arrangements and GP training no longer involving prolonged out of hours experience; all changes in modern practice applauded by many brought up in the “old school.” Many PMs, in contrast, still carry huge burdens but are not partners in the business. Indeed, we hear that requests for help are often refused owing to lack of funding or the shortage of suitable staff with the right skills. Divisions within partnerships are also cited as adding problems for managers ,as is having to deal with stress in GPs. Everyone has their head down dealing with the clinical work, assuming that somehow everything will just carry on. Requests for clinical input are refused: “Just get on with it!” Too many GPs are too busy to help and support their managers.
The LMC has been shocked by the number of calls it has received from PMs and the numbers taking sick leave or even resigning. The lack of support and sense of isolation can even mean that PMs feel unable to attend PM groups and other meetings where assistance for some of these problems can be found: one example being collaborative working to achieve CQC inspection requirements. Why reinvent the wheel? Other examples of good practice are appointing deputy PMs and appointing an executive partner with protected time to work with the manager — but these require investment.
But, none of this applies to your practice...or does it? Stress in PMs appears invisible to many partners. Support is available through the LMC office and via the PM supporter scheme but mutual support at an early stage is much more important. The LMC asks partners, when did you last sit down with your PM (perhaps having first made time or her/him a cup of tea) and, rather than talking about how stressed and busy you are, asked how things are for them? The survival of your practice may depend upon it.
We make no apologies for including this article (first published in the Somerset LMC newsletter) as it applies to the majority of practices. We will continue to advise and support you whilst also trying to reduce the burdens placed on you by the Area Teams, Public Health and CCG’s where appropriate.
Visits are taking place on an almost daily basis now with the vast majority of practices having few or no issues raised and certainly nothing major. Patterns emerging are that recruitment and staffing are included at virtually every inspection as is infection control. It would also appear that practices which have completed the CQC Provider Compliance Toolkit start their visits with a more positive attitude from the inspector.
Organ and blood donor forms
We have been asked whether practices should be or continue to be uploading information to Open Exeter and can confirm that the information is transmitted to the United Kingdom Transplant Support Services Authority (UK TSSA) and the National Blood Donor Service respectively and should therefore continue.
We have been asked by the GPC to remind practices of the short shelf life of Fluenz as follows:
‘Fluenz® has a shorter shelf life (18 weeks) than other influenza vaccines and some of this will have passed by the time the vaccine has been supplied to you. The expiry date on the nasal spray applicator should always be checked before use. Vaccine has been ordered to cover the period over which historically the flu vaccine has been used, extending from September to mid-December. All the Fluenz® will have expired by 16th January 2014. In the light of this it will be important to ensure that efforts are made to vaccinate children before the Christmas holidays.’
We would urge practices to continue their efforts for inviting children aged 2-3 years to be vaccinated, as set out in the service specification.
For further information about the seasonal flu programme, please see the vaccinations and immunisation pages on the BMA website.
Flu vaccinations for front line care workers
The branch manager of CareUK Kent has sent a letter with a reference to the NHS Choices website to individual professional carers to 'present this letter to your GP to confirm that you are currently employed by Care UK as a front line social care worker and therefore eligible for a free flu' jab'. Said manager blamed a directive from head office who Kent LMC have asked to consider rapidly rescinding this and have pointed out that the reference quoted states that flu jabs for front line health and social care workers is the employers responsibility.
Care UK is a big outfit so we could expect quite a few mis-informed professional carers turning up at surgery doors!
Flu vaccine purchase – 2014/15
Influenza deals from the Buying Group for 2014 Please see the attachment (also available on the Wessex LMC and the Buying Groups website) giving details of the LMC Buying Group flu deals for next year. If you are not a member of the buying group ( which is free and there is no obligation to use it) but wish to join please send an email to email@example.com when we will add you to the group and request a welcome pack for you from the buying group which is administered from Nottinghamshire LMC.
Focus on Vaccinations
The GPC Focus on vaccines and immunisations guidance has now been updated following the many recent changes to the vaccinations programme.
This document explains the various payment mechanisms available, and the new sections include information about shingles, pertussis, childhood flu, rotavirus and meningitis C vaccinations. It is also available on the LMC website.
SBS Remittance Advices
The issue of SBS remittance advices and NHAIS statements has been raised at the Area Team meetings with NHS England and has now been considered at the national working group. This group have confirmed the following:
- NHAIS trialled new software from the 24th October and this has now been released nationally. Everyone is now using the new statements.
- The Open Exeter update is tested and will be rolled out nationally by the end of Nov
- A user guide for the new remittance advice is being developed for GPs which will be communicated via NHAIS and area teams
- CCGs/CSUs are being sent a reminder regarding payment date deadlines
A practice has recently been fined under copyright laws for using images obtained from the NHS Choices website which they assumed to be free. There is an NHS library of images as well as some free images on various company website such as iStock but always check before using no matter where they come from (including Wessex LMCs website!)
A simplified version of the call summaries sent to practices following an NHS111 call will be rolled out by the end of the year. The new design has been agreed and IT specialists are working on changes to the software prior to implementation.
Contrary to popular belief, patients may still complain to their practice who can use their in-house process to resolve. However, should the complainant remain dissatisfied, the next step is to the NHS ombudsman and not NHS England (the area team). A patient may make their initial complaint direct to the Area Team which is dealt with by a central complaints team via 0300 311 2233 or by email to England.firstname.lastname@example.org Where the complaints team are unable to resolve the issue it may be passed to a practice for investigation and comment. Please note that where you are asked to provide a written response this will be copied, in full, to the patient.
It would appear that some confusion has arisen over the need to provide an alternative pension provider to the NHS one for some staff and the following should clarify this:
- where the NHS pension is the default pension for a practice then all eligible staff should be enrolled in this
- eligible staff cannot insist on an alternative pension just because they don't want to pay 5% or more of their earnings towards their pension
- eligible staff include all those between the age of 22 and state pensionable age earning a minimum of £8,105pa in 2012/13 or £9,440pa in 2013/14.
NB (the NHS pension scheme (NHSPS) caters for staff from age 16 - 75)
The Government Actuary’s Department (GAD) has estimated that 10 per cent of retirees from NHS employment are re-employed each year and excluded from NHSPS. This is likely to be the largest group of employees with restricted membership to NHSPS and therefore requiring access to an alternative scheme.
Locum staff and those on temporary contracts are classed as workers and therefore need to be assessed for eligibility status as follows:
- an employee or
- someone who has a contract to perform work or services personally, that is not undertaking the work as part of their own business
Workers already in receipt of a pension must be offered an alternative provider but can then opt out.
Preparing for automatic enrolment
The following steps are designed to help prepare for automatic enrolment:
Having attended a CQRS training event in London with colleagues from other LMCs I can confirm the following:
- CQRS is unlikely to work in full until June/July 2014
Until that time:
- all entries should be made manually
- the Area Team can see the manual entries and therefore should be able to pay from those
- the information is available in real time so payment delays should not occur
We are, however, aware that some Area Teams are concerned about the accuracy of manual entries and have devised an electronic template for practices to make their claims on. We are, therefore, discussing this apparent dual entry requirement with the Area Teams.
The following services should be on CQRS now and manual entries made:
The following DES’s will be offered via CQRS later this financial year:
- On line Access
Quirks of CQRS:
- The data submission screen is set to 2008/9 – you must amend this to 2013/14
- You will need to select each enhanced service separately to enter your data – again, you MUST set the achievement date to the end of the month (if you fail to do this CQRS will accept the data but you will not get paid!)
We have fed back on a variety of issues including the above and also asked a number of questions about how ‘intelligent’ CQRS will be with regard to recognising read codes for extraction once a person has left the practice or moves out of a given cohort before the payment deadline.
Please let us know what else we can do to assist you.
Further to the recent announcement by NHS England with regard to their national awareness raising plans for care.data, please see the attached fair processing guidance for practices. The guidance has been produced by NHS England and the HSCIC, with ICO, GPC and RCGP input, and sets out the responsibilities of practices in meeting their fair processing obligations under the DPA. You will find the Fair processing guidance on our website.
The Health and Social Care Information Centre (HSCIC) does not pass Online Appointment Booking or Repeat Prescription Data to NHS choices directly. The data are collected on a quarterly basis as a PHF10 return from the software providers which is then processed and published on the HSCIC Indicator Portal in the GP Outcome Framework section by the end of the following calendar month. NHS Choices then uploads data to their site. So, any data collected for the period 1 January - 31 March would finish being processed by 20 May and published by the end of June update to the HSCIC indicator portal ready for NHS Choices to upload. NHS Choices is working to enhance the edit function of their site to allow practices to update this information directly in the same way as for other details shown there. If you have experienced any major delays please contact your software supplier in the first instance to ensure the correct information was included in the PHF10 return to HSCIC.
A number of practices have recently applied to the Area Teams to close their lists but in many cases have failed to provide an action plan showing what the current issue is which has led to the request and how the practice is working to resolve this over the next few months. The Area Teams will not approve closure in these circumstances and practices are advised that 'being overwhelmed and needing some breathing space' will not suffice as, tragically, this applies to almost all practices in the current climate. If you are in a position like this and wish to discuss your options please contact the LMC for advice.
Court of Protection Visitors
Thank you to Norman Boyes, PM at the Swan surgery in Hampshire for the following information:
A Court of Protection visitor requested computer access to records:
- I asked for his credentials and the Court Order.
- He supplied both and I could see the Court Order was out of date.
- I checked his credentials with the Office of the Public Guardian (Telephone =0121-631-6916) – He was pukka.
- I also raised the issue with the public Guardian, of the out of date Court Order, the unusual request to access computer records directly, and how that created both a data protection issue and a resource one for us (we would have to stand over him) and that we would require a fee of £75 for doing so.
- I informed the COP visitor I was seeking clarification from the Public Guardian’s office and he was a bit miffed – he stated ‘I normally use a terminal and someone just logs me on to their account’ – never had an issue before – ALERT!
- The outcome from the Public Guardian’s Office (which took over a week) was that the information being sought was not actually required and the request was withdrawn.
- It appears some Practices may have been allowing access to medical records on their computer systems under essentially ‘false accounts’ – i.e. there is no audit trail of the person who is actually accessing the records;
- Always check credentials and read the Court Order carefully;
- This is chargeable work – agree a fee at the outset for legitimate requests.
We have been advised that the Area Teams have submitted their prioritisation plans for premises developments to NHS England and that no further schemes will be considered before April 2014. However, this should not prevent practices from submitting plans but please do not invest or agree anything until you have approached the Area Team for approval. Plans which include partnership working including mergers with other practices, joint projects with local authorities and other stakeholders are more likely to gain approval in the future.
Child Care Vouchers
You may be looking for a way to support staff (including salaried GP’s) which is both cost effective and easy to manage. Child care vouchers are a voluntary government scheme which allows staff to sacrifice a percentage of their salary in return for child care vouchers. The recipient receives tax relief on their contribution and the employer receives a lower NI bill. There are a number of schemes available which are all very similar. See the following link for more information: http://www.hmrc.gov.uk/calcs/ccin.htm
Jennie Dock, one of our PM representatives on the Hampshire and Isle of Wight LMC, has alerted us to a possible scam. Jennie received a very badly photocopied sheet, purportedly from the CCG finance department requesting individual partners’ details including email addresses and bank details in order to pay for services! Upon checking with the CCG no such request had been made and nor would it! You have been warned!
As you will be aware, the LMC is holding a number of roadshows around the area during December and January to explain some of the new contract issues and clarify in more detail the changes from April 2014. We do not therefore propose to include much more at this stage but will ensure that once the Regulations are in place we keep you updated and interpret what’s required.
Finally, we wish you all a very Happy Christmas and a peaceful New Year!
Carole and Lisa
Directors of Primary Care
6 December 2013