Friday, March 21, 2014

GPC report 20 March 2014

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

20 March 2014

The GPC held its latest meeting today. 

Negotiation report
As usual, much of this part of the meeting was confidential.  
Contract 2014-15 Under sustained pressure from our negotiators, guidance on the contract changes for the next financial year should be out soon, after various last minute changes were rejected.  Likewise, guidance for the Unplanned Admission avoidance DES has been delayed as certain changes were proposed and rejected.  I understand the guidance will reflect the agreed position of some months ago. The GPC guidance documents have been ready for some time but need to be published after the "official" joint guidance documents that are published. Jeremy Hunt has said that there will be £5 per patient made available to further support the work around the Unplanned admissions DES.  However, it is likely that this money already resides within CCG budgets, albeit unbadged. LMCs will need to work with CCGs to ensure practices can access this money for their patients' benefit. Locally, I suspect there will be positive, proactive discussions.  Nationally, the picture is distinctly patchy. 
DDRB announcement We will be getting a 0.28% uplift, which is supposed to deliver a 1% rise in income for GPs. This figure has been arrived at because expenses have apparently fallen, a situation I do not recognise.  What this means is that the system for calculating expenses is flawed.  We are pressing for a review of the process to ensure the formulaic approach reflects reality in future.  The negotiating team are continuing to press hard on this.
MPIG/PMS reviews This is still chaotic, we continue to express dismay and anger that it is not sorted out.  There is a ready reckoner produced by NHS England to help practices get some idea how they will be affected.  I am not sure how accurate it is given the assumptions it makes.  However, my own non-MPIG practice would appear, on the face of it, to LOSE £6k per year, which seems odd.  NHS England persists with the fiction of local resolution of the PMS review process, given they are locally negotiated contracts, albeit with a de facto national "solution" to the differential funding “problem” between PMS and GMS practices.  Work is ongoing to ensure the £235M identified as NOT being mappable to additional work remains within General Practice.
Premises Work is ongoing, with discussions with health ministers.  They are aware their wishes for service changes will not work without some kind of premises strategy. Expect news at some point before the next general election...

Structure and function of GPC
Changes to nomenclature and processes were debated.  An attempt was mounted at the outset to have all the suggestions adopted en mass, facilitating an early lunch.  Sadly, my suggestion fell on deaf ears and lunch took place two hours later.

Care.data
After last month's discussion with Tim Kelsey, Tony Calland, the chair of the BMA's Ethics Committee, presented further information on care.data and it's implications.  There was a broad-ranging and lengthy debate.  The delay on extractions provides an opportunity to influence how this works.  It should be allowed to work, as it is potentially a valuable research tool.  Negotiations about potential changes are ongoing.

ICM perceptions survey
HPERU presented a summary of th results of a BMA perceptions survey, covering public perceptions of the NHS and GPs in particular,  As usual, we do well.

The latest edition of GPC news will be on the BMA website at https://communities.bma.org.uk/the_practice/default.aspx soon.  I suggest bookmarking the URL as in future GPC news will be published there, often on a more frequent basis than in the past.

The next meeting is to be held on 17 April 2014.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  Feel free to email me if you would like to comment or ask me anything.  Comments can also be posted on my blog where this report will also be posted at www.thebrownstuff.blogspot.com


Dr Russell Brown

Friday, February 28, 2014

GPC report 20 Feb 2014

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

20 February 2014

The GPC held its first meeting of the year today. 

The meeting in January was an "extra" with external speakers to help stimulate debate and thus assist with strategy formation for the longer term. Held under Chatham House rules, there is little to report directly, but it was useful in my view.

This month's meeting was back to the usual format, though was shortened by subcommittee meetings in the afternoon.  The official GPC News 10 appears not to be on the BMA website as yet.  I will see if I can upload a copy to the blog entry for this report so constituents can see it if they wish. (Available here )

Negotiation report
Work continues on the implementation of the contract agreement for 2014/15.  Though confidential in the main, I was interested to note that negotiations and discussions are not following the traditional format.  I will say more on that if and when able but it is likely to be a positive step forward.  Guidance notes will be published in due course on the contract changes and  enhanced services.  The King's Fund published a paper called "Commissioning and funding general practice". It is an interesting perspective and I suggest you at least glance at it.  It can be found here

Future of general practice 
A motion was passed at the September meeting directing the negotiators and GPDF to work towards establishing a view of the the opinion of the profession. Work is ongoing and colleagues should expect a survey in due course, of all GPs.  It is likely to be a lengthy and detailed survey.  I have no more details at present.

Care.data
Tim Kelsey and two of his team visited GPC to answer questions.  This occurred the day before the announced pause and the week before the grilling by the Health Select Committee in Parliament. Colleagues will no doubt have seen the email from Chaand Nagpaul on is matter, so I will bore a you no further.  GPC is however continuing to apply significant and persistent pressure.

Funding redistribution
Area teams have two years to undertake reviews of PMS practices, with NHS England telling them that matters need to be sorted out locally. It is a right mess.  There are 35 practices I the LMC area (including Surrey) who will be affected by this.  As well as this, the MPIG transition process by NHS England has identified 98 practices who are outliers, using an arbitrary cut off of £3/patient/year.  I am very concerned that there will be other practices in Sussex who are not technically outliers who will nevertheless find it extremely difficult. Please contact the LMC office if you are concerned about the impact this may have on your practice. 

The afternoon session was taken up with subcommittee meetings.  Colleagues may recall I am the Deputy Chair of the Commissioning and Services Development subcommittee.  Much of this meeting was taken up with discussions based around the King's Fund document mentioned above.  Together with members of the negotiating team and Simon Poole, the Chairman of CSD, I will be meeting to further develop matters in a couple of weeks time.  Additionally Simon and I will be attended a meeting at the King's Fund on behalf of GPC/CSD on this matter.  We will endeavour to ensure your interests are represented, given all the other non-elected and non-representative "stakeholders" who tend to be at these things.

The next meeting is to be held on 20 March 2014.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful. 

Dr Russell Brown

Friday, December 20, 2013

GPC report 19 Dec 2013

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

19 December 2013

The GPC held its last meeting of the year today.  

A packed audience witnessed a gripping debate about the minutiae of the Standing Orders at the opening of the meeting.  I was particularly impressed by one members prolific use of commas, parentheses and indeed subclauses, not only within one sentence but in one breath.  Remarkable. 

Thankfully, the meeting then moved to subjects of more relevance to my constituents.  After the contract announcement of last month, where Julius Parker wrote from the LMC office, there was a report as to how work is progressing on the implementation of the changes.  Much work remains to do.  Of particular interest to PMS practices is the news that NHS England has written to Area Teams to inform them that they should pay PMS practices for locum superannuation costs, backdated to April.  It is unfortunate that NHS England has taken nine months to discover that what we were telling them all along, namely that no PMS practice already had this money in their baseline budgets, was correct. With regard to the Equitable funding arrangements that were part of the current year's contract imposition, there may be news imminently on how is is to work for PMS practices.  It should be noted that vigorous discussions are still on going.

The reprehensible and one might say irresponsible media management of CQC last week will no doubt have filled you all with disgust, as it did me.  Apparently a stern letter is to be sent to Prof Steve Field with a meeting afterwards, by both Chaand Nagpaul and Mark Porter.  There was much disappointment and criticism of the lack of an open letter to Prof Field.  It appears that some in the BMA felt it needed tweaking, until such time as it was no longer appropriate to send an open letter.  The Chairman was left in no doubt as to the feelings if the committee on the unacceptable delays to a letter.  Nevertheless, it is being made clear to CQC that such incompetent press releases are not acceptable in future.

A presentation on the work of the BMA's EU policy Manager was given, explaining why it is important for the BMA to lobby in Brussels.  Essentially this is so that we can influence the drafting of EU law, which has a direct bearing on UK law.  After that, we heard about a European professional card, initially designed to be used by mountain guides, plumbers and similar professionals.  There are moves to have it used across the EU by GPs, though training and experience is not equivalent across the EU.  This is being resisted.  Finally, there are moves afoot to get General Practice in the UK, Italy and Austria recognised as a speciality, as it is in much of the rest of the EU.  This requires a ⅔ majority vote in the European Parliament and so will remain a work in progress for some time to come I suspect.

The tariff concept to fund general practice training was discussed.  There are moves afoot to pilot a change in funding arrangements for both undergraduate and postgraduate training.  Various meetings are taking place and reality is being described to those whose plans include charging practices to train.  I predict wholesale withdrawal if that ever happens...

Breakout groups were held during the day to discuss the effectiveness and way of working of GPC, including a discussion of the continuing appropriateness of the negotiating body in its current form.  I suspect there will be changes, but not soon.  When definite plans are made, I will report back.
The next meeting is to be held on 16 January 2014.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  Feel free to email me on drbrown1970@gmail.com if you would like to comment or ask me anything.  Comments can also be posted on my blog where this report will also be posted at www.thebrownstuff.blogspot.com

And so, finally, I wish you all a Merry Christmas and a prosperous New Year.

Dr Russell Brown

Thursday, October 24, 2013

CSD and GPC reports from 17 October 2013

Sorry for the lateness, I was hoping to have more news on negotiations by now.  Documents replicated below.


CSD Report
For East and West Sussex LMCs
Dr Russell Brown

17 October 2013


The subcommittees of GPC meet three times a year and each have their own email listserver to facilitate discussions.  I was recently elected by the committee to be its Deputy Chair, another step on my progress to a life peerage*.  Information about the roles and functions of the various subcommittees can be found on the new and improved GPC pages of the BMA website at www.bma.org.uk/gpc.

After considering the committee's business plan, based in large part on relevant Motions from both LMC Conference and BMA ARM, we briefly discussed BMA guidance on Ethical Procurement.

Subsequently we began to discuss new models of service provision.  GPC guidance on collaboration and federation will be coming out soon.  It is a good paper.  However, we agreed that it should be one part of a toolkit and that practices wold need more information on other elements of survival as well.  This is a work in progress but one we hope to prioritise. There are already models in use in various parts of the country, including Birmingham and Hertfordshire.  It is my view that practices will to consider the future with some urgency and begin to plan now for 3-5 years time.

We were joined by Chaand Nagpaul mid morning and discussion turned to the state or negotiations.  I have written as much as I am able in my GPC report on this matter.  The morning's discussions in CSD helped inform the discussion at GPC in the afternoon.

The next meeting is to be held on 14 November.  If LMC members or other constituent GPs would like to raise matters for discussion, please contact me or the LMC office.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  Feel free to email me if you would like to comment or ask me anything.  Comments can also be posted on my blog where this report will also be posted at www.thebrownstuff.blogspot.com

Dr Russell Brown

*For the absence of doubt, this is a joke.



GPC Report
For East and West Sussex LMCs
Dr Russell Brown

17 October 2013

The GPC held its meeting on 17 October.   This months meeting was in two parts, with the morning being devoted to subcommittee meetings.  Of the three GPC members in the federation of SSLMCs, Julius Parker is the Deputy Chair of Contracts and Regulations, Richard Van Mallaerts is on Clinical and Prescribing and I am Deputy Chair of Commissioning and Service Development. Each of us will be writing short, separate reports on our subcommittee meetings which will be circulated by the office in due course to all the LMCs in the federation.

The afternoon session was dominated by discussions about the state and progress of the negotiating process.  As ever, faces were grim, as we are faced by a government who seem to not wish to understand General Practice and how vital and efficient we are.  Negotiations are at a delicate stage and there may be more news next week that I can share.  At present, GPC is engaged in discussion to help formulate a plan at the suggestion of Jeremy Hunt to both help him and protect us.  Whether anything positive will come of it remains to be seen. If agreement can be reached there is potential for gains on both sides.  If agreement cannot be reached, the government have form on how they behave.

An update on Comms revealed a significant improvement to the GP part of the BMA website with a presentation by the web development team.  You will note the absence of my customary "h" from the words "BMA website".  It is still a work in progress and search for example needs more development but colleagues can view the "new" site at www.bma.org.uk/GPC. It certainly seems more easy to find relevant information.  A comms group is in existence in electronic form and this is being formalised to try and get communications to be more proactive.  With any luck, we will soon be in a position of leading news rather than reacting days after everyone else.  BMA processes are often glacial in their progress and this work is an effort to make GPC specifically more responsive to events.  A separate update on media work (related to but separate from the comms work) was postponed until November after the afternoon was interrupted by a fire alarm for the best part of an hour.  An investigation into whether Mr Hunt has cameras in the BMA Council chamber is underway, as the timing was interesting.

An update on the ethnicity bias in the CSA was given.  Colleagues will have seen reports of the issue in the national media, with a defensive RCGP and GMC.  A judicial review of the processes is underway.

The next meeting is to be held on 14 November.  If LMC members or other constituent GPs would like to raise matters for discussion, please contact me or the LMC office.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  Feel free to email me if you would like to comment or ask me anything.  Comments can also be posted on my blog where this report will also be posted at www.thebrownstuff.blogspot.com

Dr Russell Brown

Wednesday, September 25, 2013

GPC report 19 September 2013


GPC Report
For East and West Sussex LMCs
Dr Russell Brown

19 September 2013

The GPC held its meeting on 19 September. The official summary of the meeting is contained within GPC News 2, which can be found at http://tinyurl.com/pl9wyww (points to a pdf).  This month’s version is only 8 pages long.  It includes information not discussed at the meeting which it may be helpful for the profession and LMCs to be aware of.  This month’s report is very short as much time was spent discussing and developing the negotiating position.

Prior to the meeting, the results of elections to the various subcommittees were released to committee members by email.  Of the GPC reps from our LMC Confederation, Julius Parker was elected to the Contracts and Regulation Sub-committee (and indeed was elected as that group’s Deputy Chairman), Richard Van Mellaerts was elected to the Clinical and Prescribing Sub-committee and I was elected to the Commissioning and Services Development Sub-committee.  I am waiting to see whether CSD considers me the best candidate (of two) to act as Deputy Chair.

After a short meeting to elect 3 new directors for the General Practitioners Defence Fund, often erroneously labelled as the GPC war chest, the meeting proper began with a confidential report from the negotiating team.  Negotiations are beginning and it is hoped that a co-operative and communicative approach will be employed by NHS Employers.  At this stage it would be inappropriate for me to publish any details of the negotiations but I can say that the GPC is actively considering options and approaches. 

Colleagues have probably seen details of the Contract Imposition Survey undertaken by GPC after the profession was emailed by Chaand Nagpaul.  The results were disappointingly predictable but also tremendously helpful in bolstering the position of our negotiating team.  In brief, we are overworked and have little or no capacity to do more, coupled with an expectation of diminishing resources.

The NHS England Call to action, a bid to “improve” General Practice, focuses on encouraging local discussions and feedback.  I feel this is telling and am concerned by an apparent wish to see swingeing changes and introduce more competition into an area of the NHS which is efficient and well regarded.  The consultation closes on 10 November and details can be found at http://www.england.nhs.uk/ourwork/com-dev/igp-cta/  I would encourage you to consider responding.

The matter of the poor pass rate of the CSA by international medical graduates was discussed, following a leaked draft version of a report for the GMC made its way round the internet.  When it is eventually published, the Trainees Sub-committee will be taking the lead for GPC.

The next meeting is to be held on 17 October.  If LMC members or other constituent GPs would like to raise matters for discussion, please contact me or the LMC office.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  

Dr Russell Brown

Monday, July 22, 2013

GPC Report 18 July 2013

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

18 July 2013

The GPC held its meeting on 18 July. 

An exciting morning was had, with elections for a new Chairman (Chaand Nagpaul) and for three negotiator posts (Richard Vautrey, Beth McCarron-Nash and Peter Holden). With the election of Charlotte Jones to the position of Chair of GPC Wales, our negotiating body is 25% female.  There is significant challenge ahead.  All were elected on the promise of change. We will see but in my view we have a good team to move forward with.

Negotiations may start soon, with some clarity developing as the mandate of NHSE matures.  There is little I can report as yet as far as negotiations are concerned but there have been meetings about some of the many problems encountered in the new world of the NHS, such as payment irregularities, money for appraisals and IT.  NHSE have apparently gone away to consider how to resolve the issues.  I am not expecting rapid resolution on a national level.

By the time I publish this report, a position paper on Out of Hours provision will be in the public domain.  I have asked the LMC office to send a copy with this report. No doubt it will be somewhere on the BMA website. Good luck finding it. 

UEMO, the European Union of medical organisations, wishes to see general practice (or Family Medicine as it is called in some countries) recognised across Europe as a speciality in it's own right. As you might expect, GPC supports this and will try and facilitate the process. 

There has been further work on the Future of General Practice.  A document should be forthcoming soon, likely in the form of a position statement.  More when I have it.

There was discussion around the recently reported consultations about eligibility for access to NHS services for immigrant populations of one sort or another.  The consultation documents make suggestions which are unworkable and LMC conference policy is that we will NOT become de facto agents for the Borders Agency.  Many of the suggestions are not only unworkable but would cost more than they would save (given reliable figures suggest that this costs the NHS about £6M per year, not the £200M Hunt has been spouting) and are probably unethical and contravene Human Rights legislation to boot.  Still, makes for a good soundbite. 

Monitor are examining General Practice, overtly asking where current commissioning arrangements work against the interests of patients, which is double-speak for "how can we introduce competition?"  This is a very worrying piece of work and will be responded to robustly by the BMA. GPC has been the main player in composing the response which will be published soon.  

A presentation by the Association of Medical Research Charities went on rather, as they are keen to enthuse GPs and get them engaged in research.  Which is all very well, but when we are all overloaded already and they failed to address the issue of how is that time funded, I am not sure there is an easy answer.  The obvious solution is to invest more in General Practice, perhaps by generating an extra 22,000 whole-time equivalent GPs, so we can resource to time needed to engage. There was no disagreement with the position that research is important but no obvious, realistic way forward.  The matter will be examined by the Clinical and Prescribing subcommittee in due course.

The subcommittees will be elected electronically in the next month or so.  I am standing again for the Commissioning and Service Development Subcommittee. Fingers crossed, eight spaces, a least a dozen candidates....

For further news, colleagues can access the most recent GPC News on the BMA website.  For some reason it is under "About the BMA" rather than clearly signposted.  A direct link to this month's offering is at http://tinyurl.com/m2d7dnw.  It may interest you to know that there is a work stream on improving communications going on within GPC separate from BMA. Watch this space...

I hope you have found this report useful.  Please feedback so that I can ensure my reports are useful. 

Dr Russell Brown

Monday, June 24, 2013

GPC report 20 June 2013


GPC Report
For East and West Sussex LMCs
Dr Russell Brown

20 June2013

The GPC held its meeting on 20 June.  Given my previous reports seem to have been superseded fairly rapidly by GPC News, rather than be indiscreet, I have waited until this month’s edition is available.  It is lengthy, and though I avoided somnolence for the majority of the session, it contains much that I have no recollection of discussing during the meeting.  Of course, it is also an opportunity for the GPC Secretariat to publish information which has arisen since the previous GPC meeting for LMCs.  It is available for downloading, should you wish to read it, at the bottom of the page here: http://tinyurl.com/cuea2rg

The morning session was devoted to various subcommittee meetings.  I currently sit on the Commissioning and Services Development subcommittee, which has a wide remit.  Various matters were considered, including some draft BMA responses to consultations Monitor are running and consideration of those motions from LMC Conference which would fall under the remit of the subcommittee.  Of particular interest to me was a report about a roundtable event held by GPC to engage with GPs who are board members of their Clinical Commissioning Groups.  As a forum for sharing of ideas between those running our CCGs and those representing us as providers, this seems to be a Good Thing.  More events are planned and I would encourage colleagues with such Commissioning roles to consider engaging in the future.

After a brief lunch, the main meeting started.  Laurence Buckman was Chairing his final meeting.  He advised he will be returning to full-time practice, but will remain as an ex-officio member of the GPC for the next year.  After a long discussion about electoral processes, it became clear that, should the standing orders which state how elections take place need changing, it would have to be after the elections coming up next month!

Negotiations
There are currently no negotiations taking place regarding next year.  As yet, NHS Employers have not been given a mandate by the Department of Health to negotiate on its behalf.  Hopefully this will change soon and thus allowing some kind of discussion to begin.

Future of General Practice
A major item discussed was the Future of General Practice.  Work and discussions are ongoing to develop a vision of what we may wish to see in the future.  It is too early to report any details, but any thoughts you may have would be welcomed.

OOH
A lengthy and detailed debate on the thorny issue of Out Of Hours care was had.  This followed a lengthy and detailed debate on the GPC listserver.  I contributed to both, emphasising the wishes expressed both in the local survey so many of you were kind enough to complete (512 of you in the end) and by LMC Conference.  Consideration is being given to what will happen next.  This does not imply navel-gazing.  I suspect I will have news for you quite soon but at the moment this is genuinely one of those occasions when I have no wish to potentially compromise our negotiating position, especially given the ongoing pressure on services in-hours.

Monitor
The Monitor consultations were discussed again in the afternoon.  Regarding walk-in centres, it is important to consider that the review is about the CLOSURE of some or all of them and NOT the procurement.  The procurement was a politically-driven centralist process.  My own view is that the closing of centres should be considered according to local circumstances - there never was a one-size-fits-all solution to the “problem” (that wasn’t, in many areas) and it would be unwise to follow the same blanket approach to closure.
A brief update on appraisal and revalidation was delivered.  Particularly invidious is the policy of ceasing payments to locum GPs for their appraisals.  It is illogical to inflict this on locums as a group, given the time for preparation and the appraisal itself means time not working and thus loss of income.

Comms
The issue of communications was discussed.  There is already some patient facing information on the pressures facing General Practice at changingnhs.com.  Discussions and work are ongoing as to next steps in a comms strategy.

Standing Orders for GPC mandate that the meeting cannot run past 1800, which is when we finished.  I then managed a new personal best, getting from the Council Chamber in BMA House to a train at Victoria inside of 16 minutes.  Sharp elbows.

This was the last meeting of the current session.  Next month’s meeting will see the election of a new Chairman and several negotiators, as well as elections to the subcommittees again, including elections of Chairmen of five of the subcommittees.  I am aware of several candidates for the negotiators’ election already.  I suspect there will be a fierce contest.

I hope you have found this report useful.  Please feedback so that I can ensure my reports are useful.

Dr Russell Brown