Strain on A&E...

Just heard Hunt on Today program, trying very hard to back-pedal and say that it isn't actually GPs' fault that A&E can't cope with the extra 4 million visits per year but the previous governement for allowing us to opt out. And to put that 4 million extra consultations into context, UK GP see 300 million consulations per year. Yes, 2 whole orders of magnitude more...

Well, for one thing, my "part-time" week (read the comments on the Telegraph website) is already 47.5 hours, and that's without the extra I put in. For another, the reason I am tapping away on the computer is two-fold: most important is I'm keeping records so I can remember what happened to you years ago; but the way GP is resourced (NOT how I get paid but how the services in YOUR surgery are funded) means that if I don't tick an increasing number of boxes (many of which will do nothing to improve either your health or well-being), the resources don't come in to pay for the nurses, reception staff, equipment etc.

So rather than blame ME for poor OOH provision, fund the bloody service properly in the first place, rather than engage in a race to the bottom with cheapest wins the tender, set proper standards that must be adhered to. How about a national strategy, given it's the National Health Service? Rather than arms-length "oh that's the fault of local commissioners", who you haven't given the resources to in the first place. And make sure that A&E departments are empowered to tell people to go to the appropriate place rather than have to see and sort them (inadequately, which is not incidentally their fault).

It isn't bloody rocket science.

GPC report 18 April 2013

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

 

18 April 2013

 

The GPC held its meeting on 18 March.

 

This months report will be brief as, for a change, much of the discussion was confidential.

 

Equitable funding, locum superannuation and PMS practices news

Discussions are ongoing. A letter to the profession has been sent by Laurence Buckman on 17 April and its contents are about all I can divulge on how the plans for equitable funding are likely to impact on PMS practices. Discussions about the new obligation on practices to pay locum superannuation are still ongoing but are no further forward at this time.

 

Additionally, there have been discussions about arrangements for collaborative fees and occupational health services for practice staff. But no news.

 

Communications

There will be an announcement shortly on a policy that is to be implemented very soon. You will have to wait for the announcement but expect some of previously aired concerns by LMC members to be addressed. It should also be noted that it will be an ongoing and developing piece of work, with involvement from the profession and patients being encouraged.

 

Premises

Work is continuing on nailing down the details for leases and the like. Legal advice is being taken by both sides in an effort to get an agreed and sensible model. However, it will still be necessary for practices to instruct their own advisors to ensure they will be well served by any lease arrangements.

 

NHS111

I was asked to give an interview to BBC South East Today about NHS111 during this months meeting. Fortunately, I managed to get back to the meeting without missing much about NHS111. In brief, it is still a mess, the tendering process has demonstrably failed, response times are still unacceptable. What we need is a reintegration on the triage service with the face-to-face service. Will it happen? As we already know, there is a political imperative on this. I just hope no one gets hurt.

 

Commissioning update

There was an update on the recently published conflicts of interest guidance from NHS England, the Monitor document on fair playing fields and an oral update on engagement with the process the Labour Party is going through to try and determine its health policies.

 

A motion was proposed and passed in all parts. I reproduce it below:

 

That GPC believes that compulsory practice membership of CCGs with statutory duties as defined by the Health and Social Care Act:

 

1. risks placing GP partners in a position of untenable conflict between their professional obligations to their patients and the statutory obligations of their practices as CCG members;

2. fundamentally changes the role and nature of general practices, and, in view of recent regulatory changes, risks forcing them to be integral agents of state rationing, cost control and privatisation, seriously threatening the trust between GPs and their patients and therefore posing a risk to the very integrity of NHS general practice;

 

3. places significant obstacles in the way of GPs and practices acting in accordance with the recommendations of the Francis report as they will be under inevitable pressure to comply with their CCGs' statutory obligations to stay within budgets and to achieve financially and managerially-driven targets which conflict with the needs of their patients;

 

4. adds to competing pressures on general practice, particularly following the recent contract imposition, and GPC recognises that practices must and will prioritise providing safe essential services to their patients and are therefore very likely to consider limiting their engagement with their CCG and its activities to their contractual obligations;

 

5. leads it to call upon the BMA , local medical committees to robustly support doctors who are placing the interests of their patients as their first concern and who may be unable to comply with obligations placed upon them by the constitution of their CCG where there is evidence that patient safety may be compromised by the requirements of CCG policy.

 

Words mean what words say and I will not embellish them by attempting to interpret the beyond repeating them.

 

I understand there are similar motions going to the Conference of LMCs next month. The next GPC meeting is in June because of this. There will be a report from there as well though.

 

I hope you have found this helpful. As ever, feedback on my report is encouraged.

 

Dr Russell Brown

 

PS It is interesting to see how much more detail is contained in this month's GPC News, which will be on the BMA website soon at tinyurl.com/cuea2rg, as I was under the impression much of the conversation was confidential. Perhaps I should be less discrete...

 

Text of my GPC report 21 March 2013

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
21 March 2013
The GPC held its meeting on 21 March. Much of the agenda and discussions were confidential,
unfortunately. We are now in the new world of CCGs and post-Francis, not that I expect either of
those to make any difference to the direction of travel.
Contract and QOF
Though I cannot report on discussions which took place, details of the imposition and DES
specifications are gradually becoming clearer. It is not pretty and I suspect that at least some
practices will consider carefully whether the new work is affordable. I suppose it may be that
some of the less attractive bits may be possible to do in collaboration with other practices.
Whether that is desirable is for practices to consider. There has already been much comment and
guidance on this so I will not add to it except by pointing to some of it: http://bma.org.uk/practical-support-at-work/contracts/gp-contract-survival-guideThis is a work in progress and will be added
to over time.
The Francis Report
This said nothing terribly unexpected. The BMA welcomed it in the main. I have some concerns
about how it may affect GPs. However, with the rollout of 111 steaming ahead in many places
despite concerns being expressed by many, it appears that HMG and DH are still considering how
to implement some of the suggestions made in the report.
The future of General Practice
Not a GPC piece of work, but a response to a request from the Labour Party to consider how
they should develop their policies on this matter in the future. I can see arguments about being
inside a tent, but I am uncomfortable with this. I am generally cynical about the motives of
politicians.
Commissioning matters
An oral report from the negotiating team generated much discussion and, unusually, a motion
which was passed: "that GPC opposes and calls for the withdrawal of Statutory Instrument
2013/500." This referred to the competition concerns expressed elsewhere. Despite governmental
assurances, I suspect that CCGs will in effect have no choice but to tender services. If we can help
them see how and where they might avoid doing so I am sure they might be inclined to maintain
dialogue.
Premises
Work on premises cost directions is almost complete and there will be a common single set of
documents. The regulations themselves have been signed in to force in the last week. For the first
time there will be a uniform set of guidance notes, available by the end of April. One outstanding
area is the issue of waste of various types but I understand this will be resolved soon. Leases are
coming but still a work in progress.
NHS111 & NHSCB (now NHS England) Single Operating Model
Unfortunately I had to leave the meeting early so Julius will update us on theses items.
The next meeting is on 18 April. As ever, feedback on my report is encouraged.
Dr Russell Brown

GPC report 17 Jan 2013

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

17 January 2013

The GPC held its meeting on 17 January. The day was in two parts, the morning being GPC-proper, the afternoon being devoted to a strategy session with thought-provoking (no, really) external speakers held under Chatham House rules. I expect to be able to share some of the issues raised in the afternoon with you in the months to come but as it is still a work in progress, now is not the time.

Contract negotiations update:
All of the details that can be shared can be found on the BMA website at
BMA.org.uk/working-for-change/negotiating-for-the-profession/general-practitioners-committee/contract-negotiations The BMA are running a survey until 13 February to gauge opinion from the profession. It can be found at http://www.demographix.com/surveys/6VQM-4EGE/72LVTJPV/
I urge you all to complete it before the deadline though it may be sensible to wait until you have attended the Negotiators Roadshow if you are unsure about the extent of the damage that is about to be inflicted on us. This is also true for our constituents and I would ask that you remind them about the survey repeatedly. The negotiators roadshow on Thursday, 31 January has been confirmed. This will be held in the Aurora hotel in Crawley though I am unsure which negotiator is attending. Julius maybe able to advise. This meeting technically covers Surrey and Sussex. As last month, I would encourage all of you to attend and I would ask that you encourage as many of our non-politically minded colleagues to attend as well. For those unable to attend, I understand that the intention is to webcast the Avon meeting which I believe is on 7 February. Either the LMC office or I will forward details of that when we have confirmation.

Public Sector Pensions update:
A useful presentation from Andy Blake, the head of the BMA Pensions department, updated the committee on where we are. The Bill is currently at the Lords Committee stage, about a month ahead of schedule. This implies a degree of "rush". The Government has conceded that the so-called "Henry VIII" clauses, allowing retrospective changes to Primary legislation using Secondary legislation, are inappropriate and has removed them from the Bill. This is good news though of course in a context of a dire inevitability.

GP workforce issues:
A paper was presented for discussion, to advise and inform strategy for dealing with and helping other bodies involved in issues such as workforce planning, a contradiction in terms as no one knows what the NHS will look like in five years, never mind fifteen to twenty. A learning point for me was that the UK has the lowest number of GPs per head of population of any European country. I already knew about the recent report showing we were also the most efficient in Europe. One can't help thinking those two facts must mean something significant.

The next GPC meeting is on Thursday, 21 February and I will be absent as I am on leave that day. Any feedback or questions are welcomed. I have also started publishing these reports at a blog I used to keep at www.thebrownstuff.blogspot.com so that people can get to it easily. I am not using the blog for anything else these days.

Dr Russell Brown.
GPC Rep East and West Sussex

GPC report 20 Dec 2012

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

 

20 December 2012

 

The GPC held its meeting on 20 December. As is often the case there is much that I cannot share with you. However the image below should give you some idea of how I feel the meeting preceded at times.

 

 

 

Contract negotiations update:

You will all have seen the letters sent to the BMA as they have been circulated by Laurence Buckman. Analysis of the imposition documentation is taking place at the tools for modelling the effect on practices is being developed. This should be with us shortly. It is anticipated that there will be another letter in the next couple of weeks from GPC. After this there will be a survey of GPs to gather views on the proposals. This will not be a ballot. I will not repeat the details of the imposition. All of these details can be found on the BMA website at

BMA.org.uk/working-for-change/negotiating-for-the-profession/general-practitioners-committee/contract-negotiations

Given that we are technically in the midst of a consultation about these changes I would encourage all of you to respond to the consultation both individually and through the LMC office. This will enable the BMA to show how much strong feeling there is about this matter. There will be a negotiators roadshow on Thursday, 31 January. This will be held in the Aurora hotel in Crawley. I would encourage all of you to attend and I would ask that you encourage as many of our non-politically minded colleagues to attend as well.

 

 

 

Locum superannuation:

Separately to the contract negotiations the government is suggesting that superannuation payments for locums, which are currently paid by PCOs, will be moved into global sum. This has significant implications the both practices and locums. The BMA will be responding to this consultation in due course.

 

 

Data sharing agreement template for risk stratification:

A template has been developed by the BMA. This will hopefully help practices to ensure that local arrangements for datasharing between practices and third parties adhere to appropriate standards of confidentiality. This template will be sent out in due course.

 

Deprivation:

There was much discussion around the subject of deprivation and workload together with the impact of resource allocation formulae. A motion was passed to the effect that GPC will work with the Department of Health to introduce either a deprivation allowance or other recognition of increased workload in deprived areas. However it should be noted that much of the discussion was around the fact that many health problems may be dealt with by improving resources in other areas such as social services rather than directly in health.

 

CQC registration fees consultation:

The BMA has now responded to the CQCs recent consultation and the response can be found on the CQC section of the BMA website.

 

There was also a session of breakout groups to discuss how best to implement the separation of the positions of Chair and Lead Negotiator within GPC. This is a matter of LMC Conference policy. I started the afternoon thinking that the whole idea is madness. I'm delighted to report that by the end of it I was less convinced it was madness but I'm still unconvinced that it can be made to work. More news when I have it.

 

The next GPC meeting is on Thursday, 17 January.

 

May I wish you all a peaceful and restful Christmas and New Year.

 

Dr Russell Brown.

GPC Rep East and West Sussex

 

GPC report November 2012

I have just come back from a few days leave and was about to write my GPC report when I realised that actually, I have nothing to say this month.  Much of the meeting 10 days ago was either of no interest to grassroots GPs (being matters of process within GPC) or is confidential. 

I was hoping to have more info on the proposed imposition but have none as yet.  It does not, however, look good.

NHS 111 is still a mess and looks to be likely to cost around £2.2million per year more than the current system.

The NHS Mandate/online access business will need to be worked on and Jeremy Hunt already seems to be willing to talk about what is possible and more importantly from our point of view, what is not.

And that's it really.

So there will be no written report this month.

GPC report October 2012

GPC Report

For East and West Sussex LMCs

Dr Russell Brown



18 October 2012



This month was a meeting in two parts. The morning was spent in various subcommittees. I am a member of the Commissioning and Services Development Committee, which has a very wide brief.



Discussion was mainly about the ethically rather dubious incentive schemes being published in a variety of places, Harrow being a particularly harrowing example. These schemes aim to directly financially reward GPs for reducing referrals. This has obvious (I hope) implications. The GMC, when asked for comment, were not terribly helpful. I suspect any GP signing up will be on their own if anything untoward happens as a result of schemes like this. The BMA is intending on making it clear what it considers ethically appropriate. It is conceivable this will exceed what the GMC suggests is acceptable. I must confess to some confusion as to why the GMC is not being more clear in its position.



The other main topic under discussion was performance management of primary care (for which read general practice). The relevant team from the DH have been meeting with a small group of LMC secretaries to discuss how this may work. It should be noted that these are not negotiations, more of a feeling the way forward. The LMC secretaries concerned are being robust in their feedback. Eventually, these meetings may pave the way for negotiations about how to might work in a useful way. In the mean time, I recommend that GPs get in the habit of practicing the following mantra, so it can be recited at appropriate junctures, making any appropriate deletions: "My professional registration is with the GMC. My GMS/PMS contract is with the PCT/LAT. I have a contractual obligation to be a member of a CCG. And that's it. Further queries should be discussed with the LMC." We seem to have very good liaison with local emerging CCGs, so hopefully you will never need to use it. I will let you know if anything changes on that front.



There was a brief discussion on the commissioning of Local Enhanced Services. To reaffirm, unless a single contract is going to exceed £100,000 there is no need to go to tender. There is also no requirement on CCGs to use either the AQP route or competitive tendering. In e context of a LES, the contract size depends on the size of the practice, not on the size of the budget. So a budget of £250,000 does not require tendering if all practices will be taking part in a LES, as the individual contract with each practice will be under the limit.



The afternoon session was the full GPC meeting.



The need for confidentiality was repeated, forcefully.



The GP IT Subcommittee reported that work is ongoing to try and make the transition of GP IT support services as painless as possible. Many of the problems arise from the fact that the amount of funding in many areas is uncertain, so many PCOs are unable to tell the NHSCB with any certainty how much money it needs to budget for these services.



I will now report on other matters, including the current state of negotiations for GMS/QOF for 2013/14, as far as I am able to:

This space is left intentionally blank.

I hope this report is useful. Please feed back any comments if you would like me to present it differently. Additionally, if you have any matters you wish to discuss or that you would like me to raise at GPC, please contact me by email at my email address, which I'm not posting on blogger :)



Dr Russell Brown

GPC and Chair East Sussex LMC