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Somerset LMC weekly Update Friday 25 November 2016

Date sent: Friday 25 November 2016

Sent to all Somerset GPs and Practice Managers          This and previous updates are available here

Chlamydia screening
We are aware of concerns from practices regarding the recent LES Specification for opportunistic Chlamydia screening. The contract has been delayed in getting to practices but is unchanged from previously apart from the payment process. We have clarified the payment process and practices' quarterly figures will be generated by SWISH who will arrange payments without the need for practices to invoice Somerset Partnership NHS Foundation Trust. Because of the delay, practices who are happy to continue to support this valuable service are asked to sign and return their contracts as soon as possible.

Prescribing of Gluten-Free and “Over the Counter” Products - May be more complicated than it seems…
You will be well aware of the CCG decision to make all Gluten-free and some OTC products “non-formulary” from  1st December.  The LMC understands and supports the reasoning behind this: Gluten-free prescribing is outstanding amongst the many anomalies of the NHS prescription system, and is difficult to justify now there is such a wide choice of foodstuffs and gluten-free alternatives to most  wheat flour products are available at a fairly modest premium.  The survival of the NHS requires patients to take more responsibility for their own care,  which should also involve buying inexpensive simple remedies, and the potential £350,000 annual saving from not prescribing GF products in Somerset could be put to many good uses.  GPs are not grocers.

The problem is that prescribing falls within the contract between practices and NHS England to which the CCG is not party, and although the latter has a legitimate interest in the matter as  it picks up the bill,  that is not relevant to the contract itself.  The general  requirement for practices  to  prescribe  falls within Clause 8.1.3 (b)of the GMS contract which says that the management of patients under essential services includes  “ the making available of such treatment….as is necessary and appropriate.”  Clause 14.2.2  goes on to specify that  “a prescriber shall order any drugs, medicines or appliances which are needed for the treatment of any patient who is receiving treatment under the contract by issuing to that patient a prescription”.

Clearly prescribers have a fair amount of discretion in deciding what is “necessary and appropriate”, and it is interesting that  foodstuffs are not actually mentioned in  14.2. However,  the LMC is concerned that  a blanket refusal to prescribe gluten-free or OTC products might put a prescriber at risk of breaching the practice’s GMS contract or PMS agreement.  We have asked the CCG to obtain specific reassurance from  NHS England that this would not be the case if prescribers followed the CCG policy, but this has not so far been forthcoming.

In theory, prescribers could find themselves trapped between  one view that they are required to prescribe, and an opposing one that to do so would make than susceptible to contract action under “Annex 8” which covers excessive prescribing, so until    the whole prescribing position  is sorted out we recommend that practices and prescribers continue to make  individual decisions about patient needs and prescribe accordingly.  Good family medicine is about  making the best decisions for each patient in the context of NHS provision and available  resources, but  sometimes the contract structures we work within are not very helpful with that.

 

Best wishes

Somerset LMC
Crown Medical Centre, Venture Way, Taunton, TA2 8QY

Tel: (01823) 331 428            
Fax: (01823) 338 561     

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