GPC News November 2014
Link to PDF: GPC News November 2014
GPC meeting
The GPC held its meeting on Thursday 20 November and this newsletter provides a summary of the
main items discussed.
Five Year Forward View
The 'NHS Five Year Forward View' was published on 23 October. The full report can be accessed on
the NHS England website and you can read the BMA's public and media response in the BMA press
release on the BMA website.
Much of the content of 'NHS Five Year Forward View' appears to herald a step in the right direction
for general practice, with the strategy document emphasising a new focus on many of the areas that
the BMA has been working on, particularly in the 'Your GP Cares' campaign and in our document,
'Developing General Practice Today', accessible on the BMA website. The 'Forward View' also
includes far-reaching proposals for new models of care, which will require careful consideration, and
a full response is being prepared.
Co-commissioning
On 10 November NHS England published its Next steps towards primary care co-commissioning
report [available on the NHS England website]. The report provides information on the scope of cocommissioning
arrangements that CCGs can apply to take on board from April 2015. These three
models described in the report are:
(1) greater involvement in primary care commissioning,
(2) joint commissioning (with area team), and
(3) delegated commissioning.
Amongst the many changes outlined in the report, a number are of great concern to the GPC. These
include the proposal to extend the following powers to CCGs who take on board delegated
commissioning:
• newly designed enhanced services (local enhanced services (LES) and directed enhanced
services (DES));
• design of local incentive schemes as an alternative to the Quality and Outcomes Framework
(QOF);
• the ability to establish new GP practices in an area;
• approving practice mergers; and
• making decisions on 'discretionary' payments (eg returner/retainer schemes).
The changes described in the Next steps report are of relevance to all LMCs and all GP practices. As
CCG members, all practices should be aware of the upcoming changes to primary care
commissioning and should be actively engaging with their CCG on this agenda.
Extensive consideration was given to this topic at the GPC meeting and consideration is being given
to the next steps. We will update GPs and LMCs shortly.
Care Quality Commission
The GPC remains concerned about a number of issues that have arisen following the introduction of
the CQC's new inspection regime in October. In particular we will be seeking clarity on patient
confidentiality, the naming and shaming of GPs and their practices in CQC press releases, the
introduction of ratings for practices and the use of 'intelligent monitoring' to band practices prior to
inspection.
The particular concern about intelligent monitoring was prompted by the announcement that the
CQC would be, for the first time, publishing information on every general practice in England as a
way of deciding which surgeries it will inspect and on what it will focus.
This so called 'intelligent monitoring' of general practices is made up of 38 indicators, including:
- Quality and Outcomes Framework
- GP patient survey
- electronic prescribing analysis and costs
- hospital episode statistics
- information centre indicator portal
- NHS comparators.
In theory it will allow the CQC to prioritise its inspections under the new regime, which began last
month.
The GPC strongly opposed the publication of the data, as the CQC can only judge the quality of care
within a service once it has carried out an inspection. We made strong representations prior to
publication and as a result, a health warning was included when the data appeared on the CQC
website.
We made it clear in the extensive media coverage that it attracted that GP practices are trying hard
to continue to deliver high quality care to their patients despite increased workload pressure that is
not being matched by the necessary increase in GPs or funding. This task is only made harder with
the CQC's focus on targets. The publication of 38 more targets by which practices will be judged just
adds to the growing burden and bureaucracy on practices, and could further undermine
hardworking GPs' morale.
This data was published with no context about GP practices before inspections and it is likely to
confuse and mislead patients. It will not give an accurate picture of how GP services are operating.
The information does not take into account the differing circumstances in which GP practices
operate, including levels of deprivation in the community to which they deliver care or the state of
their facilities.
Updated guidance on the new inspection regime is currently being drafted and will be on the BMA
website shortly.
NHS Property Services Lease: update for all LMCs and practices
It has come to GPC's attention that NHS Property Services (NHSPS) is circulating a lease that is being
framed a 'standard lease' which it is saying has the backing of the BMA. Although the GPC has had
a number of discussions with NHSPS about developing a standard lease, the GPC has not agreed to
standard lease nor endorsed one.
The GPC advises all practices in NHSPS properties that they should under no circumstances sign any
current standard lease or other document from NHSPS without receiving full legal advice in order
to understand the consequences of signing the lease. To help explain some of the risks of the lease,
The GPC has partnered with BMA Law to put together a short guidance note about leases. This note
was sent to all LMCs, for distribution to practices in their area, and will be published on the website
shortly.
The note provides an outline of the headline issues and key provisions arising from the draft lease. It
covers:
• break clauses
• rent reviews
• relocation
• repairing obligations
• sharing occupation
• alterations
• security of tenure.
Our advice to all practices if they are asked to sign or agree a lease would be that they inform GPC
and seek independent legal advice on the document.
The GPC is seeking clarification with NHSPS on the exact nature of this document and the scope of
its intended use. To that end, we will be meeting the Chief Executive of NHSPS in early December.
GP Systems of Choice – contracts signed for Lot 2 services
The Health and Social Care Information Centre (HSCIC) has announced that agreements have now
been signed with 30 suppliers to enter into the new GP Systems of Choice (GPSoC) framework, to
provide Additional GP IT Services (Lot 2). This will enable practices and CCGs to procure additional
software, hardware and professional services, complementary to those available under Lot 1.
A link to the HSCIC's bulletin is available on the HSCIC website and a summary of the products and
services each supplier intends to provide is available on the HSCIC website.
The HSCIC will now work with suppliers on a Lot 2 online catalogue detailing their service offerings.
This will be published in December 2014 and will be accompanied by 'how to buy' guidance to
support local organisations in ordering services. Services will be funded by the local organisations and
ordered through a Call Off Agreement. This will allow ordering parties to negotiate some of the
contract terms relating to delivery of the Lot 2 services, such as service management and
implementation provisions. Further information is available in the HSCIC bulletin.
Extension to enhanced service for MenC Freshers vaccination programme
The enhanced service for the MenC Freshers vaccination programme is extended until March 2015
due to reported outbreaks. Area teams will be informing all practices of the extension
shortly. Participating practices can continue to vaccinate patients. Practices who have not signed up
must be offered the opportunity to do so. More information can be found online.
Seasonal influenza vaccinations for patients with learning disabilities
Area teams and NHS England have received a number of queries from area teams and practices to
clarify the position on flu vaccinations for patients with a learning disability. Although this cohort is
included in the service specification under the category for ‘neurological conditions’, the line ‘using
clinical judgement’ has been causing some confusion. As such, NHS England intends to send out a
bulletin to clarify this. GP practices should be aware of information material to support the drive to
offer vaccinations to people with learning disabilities.
The materials (linked below) provide information for parents of children with learning disabilities,
adults with learning disabilities and Headteachers of Special Schools on the reasons for being
vaccinated against flu. Practices and providers can use this information to encourage more people
with learning disabilities to be vaccinated.
• https://nhsengland.sharepoint.com/TeamCentre/Operations/PublishedDocuments/Adult%
20flu.pdf
• https://nhsengland.sharepoint.com/TeamCentre/Operations/PublishedDocuments/Childre
n%20and%20young%20people%20flu%20information%20sheet.pdf
• https://nhsengland.sharepoint.com/TeamCentre/Operations/PublishedDocuments/Head%
20teacher%20letter.pdf
• https://nhsengland.sharepoint.com/TeamCentre/Operations/PublishedDocuments/Parent
%20letter.pdf
• https://nhsengland.sharepoint.com/TeamCentre/Operations/PublishedDocuments/Social
%20care%20provider%20letter.pdf
Sessional GPs e-newsletter and revalidation survey
The first edition of the sessional GPs e-newsletter was sent out last week, and will from now on be
distributed on a monthly basis.
The first newsletter focuses on the implications of the 15/16 GP contract agreement for sessional
GPs, a survey on sessional GP experiences of appraisal and revalidation and some guidance on the
relationship between sessional GPs and LMCs.
The newsletter is available on the BMA website. It has been sent out to sessional GPs on the BMA's
membership database but to ensure that it gets to as many sessional GPs (and indeed GPs as a
whole) as possible, we would encourage LMCs to distribute the link as widely as possible. Using the
e-newsletter format it is also possible to highlight easily different sections of the newsletter via social
media.
We would also encourage LMCs to distribute the link to the revalidation survey, available here
online, so that as many sessional GPs as possible give us their views on their experiences of
revalidation and appraisal.
Armed Forces Covenant
We have been asked by NHS England to draw attention to the commitments of the Armed Forces
Covenant that came into effect through the Armed Forces Act 2011 and NHS England has passed on
the following information.
The Armed Forces Covenant is regarded as the ‘contract’ between the population of the UK, the
Government and all those who serve or have served in the UK armed forces and their families. The
Covenant notes that the armed forces fulfil a responsibility on behalf of the population and the
Government, sacrificing some civilian freedoms, facing danger and, sometimes, suffering serious
injury or death as a result of their duty. Families also play a vital role in supporting the operational
effectiveness of the armed forces. In return, the Covenant states that the whole nation has a moral
obligation to the members of the armed forces together with their families.
Those who serve in the armed forces, whether regular or reserve, those who have served in the past,
and their families, should face no disadvantage compared to other citizens in the provision of public
and commercial services. Special consideration is appropriate in some cases, especially for those who
have given most such as the injured and the bereaved.
Veterans should receive priority treatment where it relates to a condition which results from their
service in the armed forces, subject to clinical need.
Those injured in service, whether physically or mentally, should be cared for in a way which reflects
the nation’s moral obligation to them whilst respecting the individual’s wishes. For those with
concerns about their mental health, where symptoms may not present for some time after leaving
service, the ambition is that they should be able to access services with health professionals who
have an understanding of armed forces culture.
For GPs, asking, READ coding and recording if patients have served in the armed forces, or are part
of the wider armed forces community (family, reservist, etc.) will help their patients get better access
to the full breadth of NHS services; including some that are specifically focussed on this cohort (e.g.
the Reserves Medical Assessment Programme). It may give access to specific veteran-focused funding
(eg prosthetics or mental health) and further charitable services (eg mental health).
This knowledge will also enable GPs to access their prior medical records; a précis of which should be
provided by the new veteran on leaving their respective service and registering with an NHS GP. The
registration and recording helps the referral process, as well as the commissioning and planning of
appropriate services.
Further information is also available via NHS Choices.
For clinical commissioning groups, the main responsibility is for the healthcare of the veteran
population and non-mobilised reservists, and potentially for the families of those serving. In some
parts of the country, where there are higher levels of veterans, CCGs have a lead GP for this area of
work and find this a useful contribution to enabling the commissioning process. All CCGs are urged
to ask themselves the question about the care for veterans, and particularly to help with ensuring
that GPs are aware of the potential to access some of these bespoke services.
LMCs – change of details
If there are any changes to LMC personnel, addresses and other contact details, please can you email
Karen Day with the changes at kday@bma.org.uk.
Royal Medical Benevolent Fund
In the original PDF find (appendix 1) details of the Royal Medical Benevolent Fund Christmas appeal.
