Friday, June 20, 2014

GPC report 19 June 2014

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

19 June 2014

The GPC held its latest meeting today.   The latest official GPC news can be found at the BMA Communities web site.  The meeting this time was in two parts, with GPC proper held in the morning session and subcommittee meetings in the afternoon.

Negotiation report
There is much going on in the background, developing and assisting idea formation within the DH.  As usual, much is confidential.  However, PMS reviews guidance and a checklist for LMCs has been published.  The LMC in our area has already had extensive experience in assisting practices during the review process.  I would recommend practices affected by reviews approach the LMC office at the earliest stages.  A letter has ben sent to once again ask what support the outlying practices affected by the phasing out of MPIG has yet to be replied to.  I am not aware of any outliers in our area but of more concern is those practices outside of the 98 identified by NHSE as outliers, as many other practices are going to find the situation uncomfortable if not ruinous.  Again, please contact the LMC office as early as you can if you have any concerns about your practice.  Care.data was not a big feature of the agenda today, a welcome break.  Pilots are however to be held later this year, involving 100-500 practices, to look at the mechanism for data extraction.  There is no date set for the national roll out of the scheme.  A GPC CCG involvement survey has taken place, the results of which will be published soon.  I hope it will make some CCGs around the country take note.  The local Somerset QOF replacement scheme was discussed at length.  It is causing much consternation and concern.  Though practices will not be performance managed, they will still need to do the work (and so will be collecting the data anyway).  I am concerned that this is a short term view which will have implications for a nationally negotiated contract in future.  NHSE has been clear that this is a one off pilot and we are pressing to ensure that a proper and full evaluation takes place, given the DH’s past definition of the word “pilot” in various other schemes.

Communications
The “Your GP cares” campaign was launched at LMC Conference.  Although separate, the RCGP have also launched a campaign and the two organisations are now, finally, collaborating on the development of both and planning to work much more closely in the future.  Given the different nuances of the two bodies, this can only be a good thing.  Practices should expect to receive patient materials from the comms team very soon.  I would encourage all practices to engage with the campaign.  As a part of the campaign, there is an e-petition at http://epetitions.direct.gov.uk/petitions/65093.  I urge you to read it and sign it and share it with your professional and personal networks such as patient groups and friends on Facebook or Twitter.  It has already drawn almost 5000 people to sign it in its first few weeks.  It’s closing date is next year, just before the General Election.  Additionally, an early day motion, sponsored by several past health ministers including Frank Dobson is being placed before the Commons.  Please consider emailing your GP, which can be done easily by clicking on the following link and following the prompts.  It takes about 2 minutes and could have a real impact.  The link is http://bma.org.uk/working-for-change/your-gp-cares/email-your-local-politician

Recruitment and the future
Figures soon to be published have revealed an absolutely dire situation in GP training, with many places north of London desperately short of candidate for training places.  Worse, HEE is shifting funding around and planning on spending money meant to train GPs on other projects, given they have been unable to fill places.  The only solution is to make General Practice a more attractive carer choice and that is in the gift of others, which of course is where the negotiations we go through each year come in.

The next meeting is to be held on 17 July 2014, but I will be on annual leave that week.  There will be an election for the negotiating Executive team taking place.  I will be voting by proxy,, an arrangement which allows a more democratic process.  Until recently, on those actually present at the relevant meeting could vote.  There is a hiatus in August so expect my next report in September.

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

Dr Russell Brown


Wednesday, April 23, 2014

GPC Report 17 April 2014

GPC Report
For East and West Sussex LMCs
Dr Russell Brown

17 April 2014

The GPC held its latest meeting today.   The latest official GPC news can be found at the BMA Communities web site.

Collaborative fees: In some areas of the country, there have been issues with getting these fees paid.  I am not aware of any particular issues in Sussex, but if there are any, please let the LMC office know.  It has been acknowledged this is an NHS responsibility and the system that existed for payments prior to the changes last year should still be functional.

Negotiation report
As ever, much of this is confidential, but as discretion is my watchword, I can reveal that we appear to have someone in a position of influence who wants to see lots of money come into primary care (which as you may recall includes general practice).  Treasury however is apparently concerned that hospital waiting times will go up, which demonstrates nicely the difficulties we have in perception of the problem and potential solutions to it within the NHS, as well as the apparent mismatch in viewpoints, not to mention priorities, in different places in Government..
Contract implementation
Admission avoidance DES read codes should be available by the end of April.  I am unclear which April but I assume the aim is this year.  Hopefully, there will very soon be some short and snappy GPC guidance on implementation to compliment the official joint guidance.
Transforming Primary Care, aka the £5 per head.  
A document sent out by NHS England has made it clear that this money should be used to support the work of practices.  Local plans are developing and I anticipate the usual proactive and productive discussions will take place between the LMC and CCGs in the two Sussexes.
Prime Minister’s Challenge Fund
The eagle-eyed amongst you will have seen that Brighton and Hove have bid successfully for some of this money.  I heard that all these schemes will be independently evaluated in due course.
QOF 13-14 payments
There was an error in calculating the achievement scores of some practices, who will have been contacted by HSCIC already.  It is not yet clear, however, whether PMS deductions have been similarly affected.
QOF 14-15
There is an issue affecting the value of the average QOF point as the average list size changes.  This is being actively addressed by the negotiating team as it has a small but significant effect on funding for General Practice and will continue to do so in future if not sorted.
PMS reviews
Guidance for LMCs will be issued shortly.  In my personal view, PMS practices might be sensible to ask the LMC for assistance at an early stage as there is unlikely to be anything other than a single model approach, perhaps even on a national basis, adopted for these locally negotiated contracts. GPC is prevented from negotiating directly on matters relating to PMS contracts.

Care.data
There was yet another presentation on this.  There is now an independent advisory group, which has an interesting combination of members.  I am not sure if the membership is currently in the public domain.  However, this is highly likely to be discussed at length at LMC Conference, where GPC policy on the matter will be set.

Communications
I may actually have news I can share on something which may actually be quite promising soon.  As things stand, I can’t/haven’t.

Recruitment and the future
An excellent paper was presented by some younger members of the committee, which is included as an attachment to this report.  Please, read it, forward it on, give feedback and encourage others to do so to, either to me or to the GPC secretariat.


The next meeting is to be held on 19 June 2014, as the annual Conference of Local Medical Committees, the annual “policy setting” conference, is taking place on 23/24 May in York.  I hope to be tweeting/updating from there as we go along (@drbrown1970), broadband and batteries allowing.  

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, 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