ࡱ> #` Objbj\.\. >D>DF4R8R8R8h8V9dRJ9l:(:::;H<,<RRRRRRR$ThPWCR?;;??CR::4XRzCzCzC?::RzC?RzCzCRJ'K:9 R/R8@EKAQnR0RcKBRX,ARX<KRXK<<<zC~=l=<<<<<<CRCR"CX<<<<<<R????R8R8 Friday 22 December 2006 M5 Contents Page APMS issues 5 Contract negotiations and the DDRB 1 Disability equality schemes 4 GPC meeting 1 GPC meeting - January 6 GPC regional constituencies 3 GPC secretariat 6 IM&T update 2 Patient charging 4 Patient choice 4 Pensions 3 Report on main negotiating issues 1 Season's greetings 6 Seniority payments following retirement 3 VAT on medical services 5 GPC meeting The GPC met on 21 December 2006 and this newsletter provides a summary of the main items discussed. Report on main negotiating issues Please find attached (appendix 1) the written report from the GPC negotiators submitted to the committee ahead of the meeting and revised in the light of the updates given at the meeting. Contract negotiations and the DDRB Further discussions have taken place with NHS Employers but it has not yet been possible to reach an agreement for 2007/08. The DDRB heard oral evidence on Monday 18 December and GPC now awaits its decision, which should be made within the first few months of 2007. Information Management and Technology (IM&T) update NHS Summary Care Record Lord Warner announced the findings of the Ministerial Taskforce on Monday 18 December. The report suggested a process that involved a compromise between the pure opt-in and opt-out positions. Essentially it recommended an immediate start to the national publicity campaign, which is something the BMA has been calling for for 2-3 years. There will then be local campaigns when the summary care record (SCR) is due to go live in a specific area. At that time, patients will be encouraged to view their summary via HealthSpace, on a print out or directly. There will be a reasonable period (yet to be defined) during which the opt-in position will be the default position. Patients will be encouraged to agree that the summary they have looked at is accurate and consent for this information to be shared via the SCR. After this reasonable period those patients who have not expressed any opinion will be deemed to have given implied consent for sharing a summary, which, in the first instance, will only cover drugs and allergies. However, there are a number of unresolved issues. Firstly the ability of patients to truly prevent an upload to the spine needs to be dealt with. We have made public statements to this effect. It is hoped that the establishment of a new advisory group on the implementation of the SCR, to be chaired by Martin Marshall, Deputy Chief Medical Officer, will address this. Putting in specific codes at this stage may not be the best approach as they can be ignored if the system creators so wish and may not offer patients protection. The workload issues relating to discussions about the upload also have to be addressed. Whilst the BMA is actively pushing for an opt-in process, we are aware that this brings huge additional workload implications. We have said that practices would rather see this than an opt-out process with minimal workload and a breakdown in patient trust in their GP. It should be underlined that only pilots are being proposed at the moment but we are absolutely clear that we have to see this additional work resourced. At the moment the IT DES covers data accreditation, but it does not cover connecting to the spine, or the patient discussions about this. Only practices that have gone through the data accreditation process successfully will be in a position to upload any data at all. Despite Lord Warners statements, nothing has been agreed, and we await the results of the pilots to see how things work in practice. GP2GP Version 1.0 of the GP2GP system (allowing same system patient record transfers between practices using either EMIS LV or INPS Vision 3) is now live in almost 300 practices and rollout will continue in the New Year. Version 1.1, which allows transfers between different systems, is now live in a small number of early adopter INPS Vision 3 practices in Croydon, which will be joined by EMIS LV practices early in 2007. Once testing of the interoperable version is complete in Spring 2007, rollout will commence, and the GP2GP project team will be looking to recruit participating practices from early in the year. Interested practices should liaise with their PCT as the preference is to roll the system out across communities (ie in clusters of practices rather than individual practices) to maximise the benefit from local patient movements. IT DES Accreditation PRIMIS + have recently released a new e-audit tool for GP practices, to support them to achieve accredited data quality standards and ensure their clinical data is fit for sharing in the NHS Care Records Service. Developed specifically by PRIMIS+ on behalf of NHS Connecting for Health (NHS CFH), the tool is designed to support the IM&T DES under the GMS contract. It will also facilitate IM&T adoption within GP practices, will enable paper light practices to benchmark and improve the quality of their clinical data and will support delivery of the National Programme for IT, which is being delivered by NHS CFH. The e-audit, available in the PRIMIS+ CHART software meets a key objective of the IM&T DES and was developed in collaboration with a number of professional organisations, including the GPC, the RCGP and NHS Employers, to ensure the queries to support the accreditation standard are appropriate. Further information can be found on the PRIMIS+ website:  HYPERLINK "http://www.primis.nhs.uk/_" www.primis.nhs.uk PCT funding of IT equipment We are aware that some PCTs are refusing to fund the purchase of IT equipment and upgrades. We would ask to be kept informed when this occurs so that the JGPITC can assist. Details should be sent to  HYPERLINK "mailto:arivett@bma.org.uk___" arivett@bma.org.uk Pensions In the two weeks since Lord Warners announcement of the governments decision to impose a cap on the GP dynamising factor, the GPC has been taking further extensive legal advice and is now finalising the steps it needs to take to challenge the government's decision in the courts. The GPCs lawyer is briefing an expert in judicial review and we hope to have further news in January. It should, however, be noted that the timescales for judicial review are long and, assuming the final advice is not against taking this route, it is very unlikely that there will be a result before the summer. Lawyers have also advised that no consideration of individual legal action against the government will be possible before the actual 04-05 dynamisation figure is announced. The GPC plans to publish a FAQ document setting out its position and answering common questions about the implications of the dynamisation cap. This should be available on the BMAs website by the end of next week. Seniority payments following retirement There has been some discussion about whether a partner is entitled to seniority payments if they return to work part-time as a GP partner after a period of retirement. The GPC can confirm that any provider who has completed at least two years of service as a GP provider will be eligible for seniority payments. Payment will depend on years of service so retirement years will not count towards this. Therefore a GP who returns as a provider following retirement will be eligible for seniority payments provided he/she has at least two years of previous service as a GP provider. Further information is available in the GPC Focus on seniority guidance note FAQs. GPC regional constituencies The GPC considered the LMC regional constituencies for a second time. After initial discussion in October, the representation subcommittee was tasked with ensuring that there was no reduction in overall seats on the GPC and reconsidering the two seats in the South Central region (as they were too large in comparison to all other seats) and the crossing of the SHA border in the East Midlands and Yorkshire and the Humber. After further consultation with the relevant LMCs, three seats have been created in the South Central region and the constituencies in the East Midlands and Yorkshire and Humber have stayed as initially envisaged. With the loss of one regional seat in Scotland, it was decided that this GPC seat should be filled through the LMC Conference. This new seat will only be open to LMC representatives who have never previously sat on GPC, so as to ensure that grass-roots LMC members can access GPC through this route. These changes will go to the LMC Conference and the ARM for approval. Please find attached the list of the final LMC regional constituencies for 2007 (at appendix 2). A further list of regions and LMCs is attached at appendix 6 which enables you to see which member of GPC staff will look after your queries and concerns. Patient choice Members received copies of the recent  HYPERLINK "http://www.sdo.lshtm.ac.uk/" NHS Service Delivery and Organisation Research & Development Programme (SDO) briefing paper Can choice for all improve health for all? The evidence on whether NHS patients can and should become consumers of health care. Although this document is currently unavailable online, a copy can be found at appendix 3. The committee also discussed the consultation paper by the RCGP Choice, contestability and competition in general practice services what does this mean for patients, practitioners and the public? which is available online at the following website address:  HYPERLINK "http://www.rcgp.org.uk/extras/ethicschoice/Contractingoutcollegepaper22Nov.doc" www.rcgp.org.uk/extras/ethicschoice/Contractingoutcollegepaper22Nov.doc. Both documents received the unanimous and overwhelming support of the committee and members expressed their concern over the widening gap between meaningful patient choice and the Governments choice agenda. The GPC will develop a position paper, in collaboration with the RCGP and the BMAs Patient Liaison Group, on patient choice in due course. Disability equality schemes The Disability Discrimination Act (DDA) includes a new general duty on public authorities to eliminate unlawful discrimination against disabled persons and promote equality of opportunity between people with disabilities and other persons. The definition of discrimination has been broadened, and can now include not making a reasonable adjustment to the way the public authority function is carried out. However, it should be noted that: GPs are only public bodies for Freedom of Information Act purposes For the purposes of the Disability Discrimination Act, there is no regulation to say that GP practices need a disability equality scheme The obligation under the Act is on the PCT Like all employers, GP practices should make reasonable moves to comply with the DDA, but this is slightly distinct from having a specific disability equality scheme Patient charging Private practice is still significantly restricted under the GMS contract. The regulations prevent contractors from charging their patients for most services. There are however instances where charges may be made. In the current climate, there is an increasing tendency for private companies to provide services to NHS patients and the BMA as a consequence is receiving a growing number of queries in relation to the topic. The GPC will issue guidance to address these queries and to outline the circumstances when charges to NHS patients are allowed. This will be available in early January 2007. VAT on medical services The European Court of Justice has recently ruled that the UK VAT exemption for medical services is too wide. As a result, some currently exempt health services in the UK will become liable to VAT at the standard rate. Details of the implications of this ruling can be found on the BMA website at:  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/VATonmedicalservices" www.bma.org.uk/ap.nsf/Content/VATonmedicalservices and in appendix 4. APMS issues Monitoring the introduction of APMS providers The GPC is aware that, in some areas, pressure is being put on PCTs to contract with APMS providers or to enter into national tendering arrangements, even in situations where PCTs believe they can introduce acceptable, alternative solutions. The House of Commons Health Select Committee published a report into Independent Sector Treatment Centres (ISTCs) in July 2006. Many of the issues the report raised overlap with the GPCs concerns surrounding APMS providers. A summary of the key findings are listed below and we would like to encourage LMCs, in the areas where APMS does look set to grow, to monitor the situation with specific reference to the issues raised below and to forward any information to the GPC office: Value for money Some ISTC contracts contained financial guarantees whereby they were assured of a certain level of income, irrespective of the number of procedures performed. Clinical quality/good practice Whilst the report found no evidence to prove that standards in ISTCs differed from those in the NHS, it did reveal failings in the quality of data collection. The Healthcare Commission has previously found private providers performance and standards to be no better than the NHS. Provision of training Phase 1 ISTCs did not generally offer training opportunities. The first phase of ISTCs was intended for areas where capacity was most needed. Phase 2 however has extended this provision and ISTCs will be used as part of reconfiguration plans. This could mean that hospitals close and ISTCs undertake the elective procedures in their place. Similarly, APMS was originally aimed at targeting a number of areas reported as being under-doctored but has also now been extended to incorporate any number of areas. Advice on tendering The GPC is currently reviewing its package of guidance and advice available with regard to tendering and bidding for contracts. In the meantime, guidance is currently available on the BMA website, for members only, on bidding for contracts. Whilst this is part of the GPCs wider guidance on APMS, the principles outlined within this section may be applied when tendering for all contracts.  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/apms0406~bidforapms" www.bma.org.uk/ap.nsf/Content/apms0406~bidforapms The GPC is aware that the level of support offered by LMCs to practices on tendering varies throughout the UK. LMCs need to make an individual decision about what advice they give to practices but should be aware that it is important to ensure that all advice offered is unbiased and transparent, ie LMCs should ensure that those they represent are given equal access to the same advice. LMCs should also make sure they are covered by insurance to provide the advice given to safeguard against any future complaint or appeal for compensation about advice. GPs working for APMS contractors APMS has considerable implications for sessional GPs who may be employed, by other GPs or by commercial or voluntary sector organisations, to perform services commissioned through APMS contracts. APMS providers are not obliged to employ salaried GPs under the GMS model terms and conditions of employment using the salaried GP model contract. APMS providers may, therefore, choose not to use the salaried model contract in order to contain staff costs. GPs considering employment by an APMS provider not using the salaried model contract should be aware that their terms and conditions may be less advantageous than those employed by a GMS practice. The GPC recommends that APMS providers use, as a minimum, the terms set out in the salaried model contract. The GPC strongly urges GPs considering employment by an APMS provider to contact the BMA for advice. Guidance for GPs working for APMS providers is also available on the BMA website.  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/apms0406~workapmsprov" www.bma.org.uk/ap.nsf/Content/apms0406~workapmsprov GPC secretariat A copy of our staffing structure to reflect staffing changes is attached at appendix 5. We would be grateful if LMCs would direct all enquires to their liaison officer. A copy of the LMC regional structure is also attached at appendix 6. GPC meeting - January Please note that there will be not be a GPC meeting in January 2007, and therefore we will not be publishing a January edition of GPC News. The next meeting of the GPC will be held on 15 February 2007. Seasons greetings On behalf of the GPC secretariat, we wish you all a joyful and restful Christmas and a happy 2007. The GPC next meets on 15 February 2006, and LMCs are invited to submit items for discussion. You may like to review these, beforehand, with the representatives in your area who serve on the GPC. The closing date for items is 7 February. It would be helpful if items could be emailed to Andrew Young at  HYPERLINK "mailto:ayoung@bma.org.uk" ayoung@bma.org.uk. You may also like to use the GPCs listservers to exchange views and ideas. GPC News GPC News is available via the Internet, via the BMAs web pages:  HYPERLINK http://www.bma.org.uk http://www.bma.org.uk LMCs are reminded that their regional representatives can provide more detailed information about the issues covered in GPC News, and other matters. Other members of the GPC would also be pleased to accept invitations to LMC meetings wherever possible. Their names and addresses are in the GPC Yearbook. The secretariat can also provide a written background brief if required, but it would be helpful to have such requests well in advance of your meetings. Finally, if LMCs require assistance on local issues, they can also contact the BMAs local offices: addresses are on page 3 of the GPCs yearbook. This newsletter has been sent to: Secretaries of LMCs and LMC offices Members of the GPC Members of GP registrars subcommittee Members of the sessional GPs subcommittee       PAGE \* MERGEFORMAT 6 Friday 22 December 2006 M5 Friday 22 December 2006, M5  PAGE \* MERGEFORMAT 7 ,-.;=>T`acdeȸxph`hXXhYOJQJh'sOJQJhcOJQJh1ZOJQJhqZ&OJQJh7xOJQJh9 OJQJh<OJQJhXOJQJh"6OJQJhzOJQJh*1OJQJhGh2`5CJOJQJaJhGh2`CJOJQJaJhGh2`CJOJQJhOJQJh:OJQJhM(h2`OJQJ"-.>e  * P g $a$gd(1  % gdM(  % gdgdG %BNO    ' ) * M O P d f g ȸpcYh:OJQJaJhJhQ \OJQJaJh(1hQ \5CJOJQJaJhM(OJQJhzwOJQJh-fqOJQJh OJQJhUOJQJh]0OJQJhXOJQJhj OJQJhzOJQJh7xOJQJhzEOJQJh"6OJQJh<OJQJh~1OJQJh:OJQJh'sOJQJ " # $ F G    ( ) 6 7 8 l m G H $7$8$H$a$gdw) $$7$8$H$a$gd]*$gd]* $7$8$H$gd]*$a$gd! $7$8$H$a$gd(1$a$gd(1gd(1 $ % a$gd(1 ! 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