ࡱ>  @ EdbjbjFF ;,,)\BBBV$$$86%&LVQZ&'"4'4'4'(((PPPPPPP$URcWPB1((11P4'4'PL6661V84'B4'P61P66I*B0K4'N& @GQ$s3H0JP=QHQDJ3X43X(0KVV0K3XBK(*6,|.(((PPVV$u6VVNEGOTIATORS REPORT FOR GPC NEWS - February 2007 GMS contract negotiations and DDRB Update There has been no further progress in agreeing a negotiated uplift to the contract for 2007-08. Following NHS Employers and Department of Healths submission of evidence to the DDRB, the GPC wrote to the DDRB again to correct several fundamental inaccuracies in the both the Departments and Employers evidence. In particular we have questioned the figures they have quoted for GP net income, the expenses to earnings ratio and the GIG, as well as objecting to their narrow definition of efficiencies. It is anticipated that the DDRB will submit its report to the government in mid-February, though how soon it will be published following that remains to be seen. QOF Review The QOF Review process is now open to new submissions of evidence. Please see the following link -  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/NHScallqof" http://www.bma.org.uk/ap.nsf/Content/NHScallqof Any GP who would like to submit evidence to the QOF review process should do so following that link. The closing date for submissions is 28th February. Letter to the profession The GPC Chairman wrote a letter to the profession in light of the constant barrage of criticism the profession has faced. This letter is intended to tell the profession what the GPC, together with the BMA, is doing and will continue to do, both to promote the values of UK general practice and to protect and defend us from these many threats. Accompanying this letter was a fact sheet to help LMCs and GPs respond to the criticisms and misinformation surrounding the work that GPs do. Despite all the negative press we know that the vast majority of the public retains confidence in their GP and their practice and will trust them to tell the truth. The GPC would encourage individual GPs and LMCs to make contact with their local media and local politicians to promote the work that they do and to ensure that they put them in possession of the real facts. NHS Employers also sent a briefing and statement to all PCTs. The briefing bears some resemblance to the value of general practice fact sheet, though the detail is a little different. We advise LMCs to refer to information in the GPC fact sheet if PCTs wish to discuss the points raised in the NHSE briefing. Putting Politics into Practice - lobbying your MP The BMAs Parliamentary Unit is keen to encourage GPs and LMCs to contact their local Westminster MPs (and their devolved equivalents) to discuss primary care. Keeping MPs, AMs and MSPs informed about how the health service is working for their constituents can ensure their speeches in Parliament - and comments to the media - are well informed. You can also ensure that they understand the topical issue of the GP contract and GPs pay. MPs, AMs and MSPs can help GPs and LMCs in a number of different ways including tabling parliamentary questions to obtain information from the departments of health, and meeting or writing to Ministers and PCO/NHS Trust chief executives. How the BMAs UK Parliamentary Unit can help The Parliamentary Unit can help GPs and LMCs identify opportunities to work with their MPs including: Helping to arrange meeting with MPs in the constituency, LMC premises or the House of Commons Regular contact - telephone calls, letters, briefing papers on local health issues. Briefing MPs before debates in the House of Commons Arranging for MPs to visit local GP surgeries The BMAs Parliamentary Unit has helped the following LMCs establish a constructive relationship with their MPs: Surrey and Sussex, Bedfordshire and Hertfordshire, Warwickshire, Salford and Trafford, Coventry and North West Lancashire. The Parliamentary Unit can also provide additional advice, MPs profiles and contact details for MPs. If you would like to meet your MP, or for further information on how you can work with local MPs, please contact Susan Solanki, Parliamentary Liaison Officer at  HYPERLINK "mailto:ssolanki@bma.org.uk_" ssolanki@bma.org.uk. GPs can also get in contact with their BMA local divisions, many of which have close links with their MPs, AMs ad MSPs. Alternatively, you may want to use a new web resource, which was created to help GPs and LMCs lobby MPs more effectively. The website contains helpful tips on lobbying as well as briefing papers on a wide range of topical issues. You can also email your MP within minutes from the site:  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/Puttingpoliticsintopractice_" http://www.bma.org.uk/ap.nsf/Content/Puttingpoliticsintopractice The BMA has public affairs teams working in the devolved nations. Each of these can offer you advice and support on how you can raise issues with members of the Scottish Parliament or Welsh and Northern Ireland Assemblies. Please contact: Scotland: Gail Grant, Senior Public Affairs Officer at ggrant@bma.org.uk Wales: John Jenkins, Public Affairs Officer at jjenkins@bma.org.uk Northern Ireland: Ivor Whitten, Assembly and Research Officer at  HYPERLINK "mailto:iwhitten@bma.org.uk" iwhitten@bma.org.uk Referral management and CATS centres There has been another wave of reports of GPs being instructed that they must refer all outpatient referrals in certain specialties to the local Clinical, Assessment and Treatment Schemes (CATS) centre. As a general policy, this is unacceptable. The only possible mitigating factors that might make it not so would be if this was a policy that had been agreed by all parties after discussion between GPs (involving the LMC) and their consultant colleagues and if exceptions were allowed where the GP and/or the patient felt that this service was inappropriate in the particular case. Even then, there are wider issues to consider. There is a particularly large scheme being proposed in the north west of England, involving Manchester and Cumbria and Lancashire. There appear to be mixed views, to say the least, amongst health professionals about the need, the desirability and many of the practical issues surrounding such schemes in particular, issues around choice of referral and the impact on existing services. In response, the BMA announced that plans for privately run CATS centres in England could jeopardise NHS finances, threaten medical posts, and create potential conflicts of interest. There are also concerns that the award of an ICATS (Integrated Clinical Assessment and Treatment Services) contract for Greater Manchester to a private provider could result in job losses in the NHS. These proposals could have a huge impact on the way the NHS operates, on the availability of services, and on patients relationships with their doctors and, additionally, the sending of all referrals to the private sector, regardless of the patients wishes, runs totally contrary to the principle of patient choice. Concern about the consultation process in Cumbria and Lancashire was also raised. The GPC has been involved in discussions with our consultant colleagues and the BMA locally has been liaising with local doctors about the introduction of the scheme. The BMA is anxious to ensure that important principles are taken into account but equally anxious that any discussions and decisions occurring locally are not adversely affected. Further details of the BMA`position and activity on this are available on the BMA website. The GPC needs to be kept updated on developments of this nature across the country as it seems increasingly likely that this is just the thin end of a, potentially, very thick wedge. Therefore we would be grateful if LMCs could keep us updated regarding developments relating to either referral management centres, CATS centres or ICATS so the GPC can review its guidance and policy accordingly. Patient Experience Surveys To clarify a few points of confusion about the DES-related patient experience surveys, there are now two different surveys that will be used. The first is to measure component 2 of the Access DES and this is the survey which will be sent directly to patients for them to return directly to IPSOS Mori. Practices participating in this survey will be using either the Apollo or the Exeter system for data extraction. The final version of the survey which will be used is being prepared by IPSOS Mori and will be available shortly. Whilst the GPC still objects to the inclusion of the additional questions that were not part of the original agreement, and believes therefore that the access DES is discredited, we have maintained our involvement with the board that has been finalising the survey. The GPCs position on the patient experience survey, and the additional questions that will be inserted, can be found in the Focus on the Patient Experience Survey available on the BMA website:  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/FocusonPES" http://www.bma.org.uk/ap.nsf/Content/FocusonPES The second survey will measure the choice component of the Choice & Booking DES, as detailed below. Choice and Booking DES i) A letter has been sent from Richard Armstrong, Head of Primary Care Contracting, at the DH informing practices questionnaires will be sent to all practices to hand out to all patients who are given a first consultant referral between 16 Jan and 30 March 2007. Due to technical reasons, the Choice component of the survey could not be delivered as originally planned as part of the patient experience survey. This is because it is not possible for the choice question to be answered from a list of patients derived from an individual practice computer as not all referred patients would have been eligible for the survey. Therefore other options for measuring this were considered by the PES board. It was agreed that the best method to allow the choice component of the choice and booking DES to be measured would be an in-practice survey of all relevant patients. The methodology for administering this will involve practices handing the questionnaire to patients once they have been referred. This can be at the end of the consultation. Questionnaires (pre-addressed and with pre-paid postage) can then be posted back directly to Ipsos MORI for analysis. A payment mechanism for practices for administering this survey has been agreed. Formal details have not yet been announced but this is intended to comprise 2.8p per registered patient provided that completed surveys have been received from at least 1.5% of a practices list size. ii) Component 2 of the Choice and Booking DES was designed to utilise the Choose and Book system for referring patients to first consultant outpatient appointments. It is to be measured via converted Unique Booking Reference Numbers (UBRNs) made using the following mechanisms; in the GP surgery, by the appointments line, through the internet, by local booking services or via Indirectly Bookable Services (IBS). To achieve the aspiration payment practices needed to provide their PCT with a written statement to demonstrate their commitment to utilising the Choose and Book system. The other 50% of component 2 will be dependent on the percentage of Choose and Book referrals made between the beginning of September 2006 and the end of February 2007. The GPC is aware that many practices in many areas are suffering from frequent failures of the C&B system and collapses of the N3 network connections and that, therefore, not all practices will hit the C&B target for the DES. If, by the end of 2006/07, a practice cannot implement a programme due to circumstances outside its control, practices will be guaranteed a pro-rata payment for the work they had completed. This includes system failure or the inability to access the system due to national problems. Practices in this situation should raise this issue with their PCT. Additionally, failure of the Choose & Book system should not affect the aspiration payment if a commitment to use the system has been demonstrated. The Department of Health have produced some FAQs on the Choice and Booking DES available here:  HYPERLINK "http://www.dh.gov.uk/PolicyAndGuidance/PatientChoice/Choice/ChoiceArticle/fs/en?CONTENT_ID=4142066&chk=1uByDc" http://www.dh.gov.uk/PolicyAndGuidance/PatientChoice/Choice/ChoiceArticle/fs/en?CONTENT_ID=4142066&chk=1uByDc iii) The issue of whether acute trusts or PCOs can insist on referrals being made solely though Choose and Book has arisen again. The message to LMCs is the same as previously: although GPs have a contractual requirement to refer, they should retain the ability to refer in the format of their choosing. Choose and Book is voluntary, and considering the continuing technical problems with the system, to compel all practices to use C&B without the option of a paper default seems not only unreasonable but potentially impractical and even dangerous. The GPC is seeking further legal advice on this in order to determine whether commissioners or indeed the providers are within their legal right to insist on a particular referral process. The risk of providers doing this is that they lose business as choice may mean that referrals go elsewhere. The GPC would encourage LMCs to put pressure on PCOs and insist that when they are commissioning a service, referral via Choose and Book is not made obligatory. Where PCOs are insisting on Choose and Book, we recommend clarifying what the commissioned arrangements are and what the legal basis is for their insistence that practices refer using Choose and Book. Enhanced services floor expenditure To help inform negotiations and discussions with the Technical Steering Committee, the GPC would like to ask LMCs to contact us with information about their PCOs total enhanced services spend for 2005/06, or for the last financial year available. The GPC is aware that there appears, in some areas, to be a discrepancy between the figures submitted by PCOs and what we believe has actually been spent. We are also aware that some LMCs are in dispute with PCOs about enhanced services spending and we would be grateful if you would inform us if this is the case when you submit the figures. What we are primarily interested in however is the level of enhanced services expenditure that PCOs have reported to LMCs for 2005/06. Please send responses by Wednesday 21 February to Muna Yahaya at  HYPERLINK "mailto:myahaya@bma.org.uk_" myahaya@bma.org.uk, making it clear to which PCO and year the figures relate. Use of Non-Geographical (084) Telephone Numbers to contact NHS Services. A letter was sent from Lord Warner to PCT Chief Executives on 19 December 2006 detailing the Governments plans for the use of telephone numbers in primary care. This letter indicates that PCTs should consider moving practices away from using 084 numbers, charged at national rates, to a new 03 number, charged at local rates. The GPC was not consulted on this issue and is concerned the content of the letter. Whilst the GPC fully supports the view that practices should not seek to make significant financial gains from their telephone systems, there is no evidence to suggest that using an 084 number allows practices to do this. In fact, many practice using 084 numbers are often able to deal with their calls more efficiently and quickly, therefore costing patients less overall. Furthermore, we are aware that there are many other NHS services (NHS Direct for one) that are not using local rate numbers. This was raised with NHS Employers, and Barbara Hakins response stated that: the timing for introducing these improved arrangements for patients into individual practices is a matter to be decided between individual practices and their PCTs and bearing in mind any existing proposals for switching or a previous decision that has already led to a switch. There is no requirement to switch over. Control of Entry Regulations Anne Galbraith, ex chair of the Prescription Pricing Authority, has been asked to manage an inquiry into the control of entry for pharmaceutical services regulations, to be completed by the end of March, about the best way forward. Alongside this inquiry there will be a stakeholder consultation. It is not that long since the rules were changed following the  HYPERLINK "http://www.oft.gov.uk/Consumer/" Office of Fair Trading's investigation into the same issue. Whilst the GPC is happy to cooperate with a further inquiry, our views have not changed in that we believe that a total free-for-all would not be in the best interests of stability of pharmaceutical services to patients and, in particular, not in the best interests of dispensing doctors. Moreover, there is some evidence that some of the more recent changes, including "100-hour pharmacies" have not fulfilled their promise. Both the GPC and Dispensing Doctors Association will be involved in this inquiry. Flu Pandemic Planning There have been a variety of meetings and discussions about planning for a flu pandemic. The GPC is still not satisfied with either the amount or timeliness of information that has gone to practices or of planning at PCO level. We are trying to address these issues as a matter of urgency and hope to have further news shortly. Implementation of VAT on medical services HM Revenue and Customs have formally announced that implementation of the VAT ruling on medical services (Dr DAmbrumenil judgment) will take effect from 1 May 2007, subject to House of Commons approval. Therefore, medical practitioners registered on a statutory professional register whose taxable income (including VAT) exceeds the VAT registration threshold (currently 61,000) will need to register for VAT. Similarly medical practitioners who are already VAT registered, for example as a result of dispensing changes which took effect on 1 April 2006, will also need to ensure that they account for VAT on any affected services from 1 May 2007. There will be no compulsory back-dating of VAT registration before the implementation date. Further details of the announcement and general information on the ruling can be found on the fees section of the BMA website:  HYPERLINK "http://www.bma.org.uk/ap.nsf/Content/VATonmedicalservices_" http://www.bma.org.uk/ap.nsf/Content/VATonmedicalservices The GPC is aware there have been a number of queries and questions raised following this announcement and the further two paragraphs below should clarify some of these. The shortened guidance above has been drafted to ensure that the details are very clear and should be helpful in answering most queries. Definition of 'taxable income' VAT is the national system of turnover tax that has been in effect across the European Union since April 1973. This is an indirect tax on turnover and will now be collected on a wide range of services that were previously considered as exempt in terms of VAT. The guidance issued by HMRC yesterday (see link from doctors fee section of the BMA web site) explains in more detail. It is important to remember that primary heath care provided through either the NHS or the private sector will remain VAT free. When the term taxable income was used in the HMRC public notice and guidance issued yesterday this relates to VAT and not income tax. Income tax is levied on the income of all UK resident individuals or those living abroad in receipt of income from a UK source. Definition of private income There has been a further query asking if this work is classified as private income. Although this term is sometimes used to classify contract for services or non-NHS income within general practice accounts, there is the potential of confusion with private practice work. As noted above primary health care services provided through the private sector are not subject to VAT. The HMRC information refers to the term medical services but practices are advised to read the guidance provided and take advice from a qualified medical accountant to establish which professional fee services will be subject to VAT. DLA and AA report fees rise The Department for Work and Pensions has agreed to an increase in fees paid to GPs for the completion of factual reports for disability living allowance and attendance allowance and has confirmed that a new fee of 33.50 will be effective from 1 January 2007. The BMAs Professional Fees Committee would be grateful if LMCs would share this information with their constituents. Dividend income pensionable in the NHS pension scheme We have recently found out that, as more and more GP practices were becoming limited companies, the Department of Health has decided, with effect from April 2006 that any NHS profits that are drawn down as dividends would be pensionable (previously they were not). There seems to have been a bit of a communication breakdown as the Pensions Agency was only informed of this by the Department of Health recently. This decision may have far-reaching implications for GPs who may have wished to change the status of their practice to a limited company but who have not done so because of the presumed non-pensionability of their dividends. We are still awaiting the precise details and facts of the situation and will issue guidance for the profession once these are known. The Pensions Agency has said it will highlight the message when the 2006/06 technical newsletter is issued. HMRC guidance on recording employers pension contributions on self-assessment tax returns The HMRC would like all GPs and their accountants to be aware of the following when filling out their self-assessment tax returns. The HMRCs view of the correct accounting and tax treatment of GP contributions is that returns should be submitted stating gross income, including employers pension contributions. The 14% employers contribution should also be stated separately so that it can be claimed against tax. Doing tax returns in this way will ensure uniformity across the country but will make no difference to GPs tax burden if they were previously recording their income net of the employers contributions. In instances where another method has already been used for the 05-06 accounts, HMRC would ask that the self-assessment forms are resubmitted in the correct format. Further guidance can be found on the HMRCs website at:  HYPERLINK "http://www.hmrc.gov.uk/pensionschemes/esca9.htm#2_" www.hmrc.gov.uk/pensionschemes/esca9.htm#2 Pension Agency Delays GPs who have retired have reported delays in the Pension Agency recalculating their pension following the confirmation of the final dynamising factor of 12.9% for 2003/04. The Pensions Agency has confirmed that interest will be calculated and paid in line with Regulation T8 that outlines the provisions for payment of interest on late payments of benefits. We have received assurances from the Pensions Agency that, in order to increase operational efficiencies, work has already started on designing enhancements to the automated practitioner processing systems. They are now looking to further enhance these for the specific purpose of processing the practitioner sub awards backlog as quickly as possible, including incorporating the appropriate interest payment automatically calculated from when the member's benefits first became due. This is in recognition of the delay and loss of timely payment. It is their intention to take some weeks out now to design and develop such a system that will enable them to complete the exercise sooner. 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