Monday, December 24, 2012

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

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.



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


Tuesday, November 27, 2012

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.

Monday, October 22, 2012

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

Friday, September 21, 2012

GPC report September 2012

GPC Report

For East and West Sussex LMCs

Dr Russell Brown


20 September 2012


This month's meeting took place in BMA House in London again, as the Olympic season is over. The day started with a rather uninteresting 10 minute GPDF AGM and I will not subject you to further information on that.


There was discussion around the recent Dispatches program which effectively blew the whistle on the way DWP assessments are being undertaken by ATOS. A letter will be sent to the DWP asking what they are going to do about. Additionally, a meeting between Laurence Buckman, Mark Porter and the Minister has been organised for October to discuss the matter.


The matter of NHS Pledge cards was discussed briefly. I understand this will be considered by BMA Council next week. The intention of the cards, as I understand it, is to enable GPs to reassure patients that they are supporting the NHS by only referring them to NHS hospitals. Personally I am uncertain that this is something that is sensible for the BMA to commit to given the huge local variations in service availability and quality. I would be reluctant to commit to a scheme of this nature if I knew a local private or AQP provider would be a better choice for the patient sat in front of me for example. GPC's position is that we are neutral on the matter until we have more details to consider.


Pension matters have been quiet over the summer. I understand however they are to be discussed at BMA Council next week. The Public Service Pensions Bill was published on 13 September and as you know it's purpose is to address the claimed unsustainability of Public Sector Pensions. The BMA strongly believes that the scope of these changes is unfair and will adversely impact staff in the NHS Pension Scheme for reasons we have discussed before. The BMA is working on several strands of work. Firstly, the BMA is involved with the Working Longer Review, looking at the impact on health workers; secondly work with the other health unions to look at the principles of the relative contributions; lastly using the publishing of the Bill as an opportunity to lobby Parliamentarians and make them aware of our concerns.


Reports from various of the subcommittees were received. There seems to be an issue in the Kent, Surrey and Sussex Deanery area where GP Trainees who require further training are only being offered part time positions, apparently so as to avoid the prospect of a waiting list (and no work). Funding seems to be the issue. Many of the individual doctors concerned are vulnerable for one reason or another and seem to be unrepresented by anyone but GPC so far. The GP Trainee subcommittee is watching the situation. Of interest to some practices in the federation will be the fact that CSC, the provider of iSoft Synergy and Premier GP IT systems will not be supporting them after October 2013, necessitating a change of system for those practices. This will be managed carefully to avoid problems with QOF data degradation.


In better news, there has been movement on Revalidation: GP remediation will be funded in certain circumstances by NHSCBA from central funds, namely where the training needs to take place away from the normal place of work. However, I heard nothing about locums and am concerned that most GPs in need of remedial training will have it in their practices and so am unclear how this will be funded. Criteria for deciding on eligibility for this will be discussed and decided with the BMA in due course, but I have no idea how long that will take or what will happen in the mean time. Some colleagues may have seen stories in the press about the BMA agreeing that Revalidation can go ahead. That isn't quite right but the BMA has agreed that its seven principles have been met sufficiently to allow the process to move forward, though there are still many outstanding issues which need to be addressed.


The authorisation process for CCGs moves on in unstoppable fashion. We are fortunate locally that there is LMC involvement in developing our Constitutions. In some areas there are reports of CCG Boards behaving quite irresponsibly which doesn't bode well for their longevity I would think.


Finally, the juggernaut of NHS 111 similarly moves on. There are still many problems which the project board seems to find difficult to comprehend. Many of these are manifestly patient safety issues. The dispositions need much work. Pilot areas are feeding information back to GPC. The ScHARR report into the performance of the pilot schemes is inexplicably still unpublished, having been in the hands of the Ministry for some time.


I hope this report is useful. Please feed back any comments if you would like me to present it differently.


Dr Russell Brown

GPC and Chair East Sussex LMC


Tuesday, August 14, 2012

GPC report July 2012

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
20 July 2012
The first meeting of this session of GPC took place, unusually, in Edinburgh, due to the Olympics dominating hotels and BMA House this month.  The city is lovely to visit, though I didn’t get to see much of it due to a pre-meeting meeting of the Commissioning and Services Development Sub-committee.  Although if I’m honest, that last was my own fault, as it was I who suggested meeting beforehand rather than after, as I had a plane to catch.
The first thing to report is the election of the GPC negotiating team: five candidates stood for four positions.  As has been widely reported in the medical comics, those elected were Richard Vautrey, Peter Holden, Chaand Nagpaul and Dean Marshal.  Beth McCarron-Nash was not.  This caused some consternation amongst some of those attending the meeting.  I suspect the result is at least in part down to the vagaries of the single transferrable vote system used.  However, the end result is that the negotiating team is perhaps less demographically representative than GPC as a whole, which is less demographically representative than the profession as a whole.  Richard Vautrey was also made Deputy Chair.
After the elections were held, discussion moved to the progress of negotiations with NHS Employers .  Unfortunately much that was discussed is confidential and I am under threat of death by suffocation if I reveal any details of the debate.  Nevertheless, I am prepared to tell you that the proposed changes to LES arrangements are at the very pinnacle of the mountain of issues the negotiating team intend to address.  There are numerous issues around this which we can discuss in committee if you wish.  Additionally, Julius has already written to colleagues about the contractual status of CCG constitutions, or rather their lack, and a physical signing may not be necessary, nor may 100% uptake.  However, much is uncertain as there are currently no regulations or guidance to assist anyone.  The Health and Social Care Bill (HSCB) of course mandates in clause 28 that all practices in England must be a member of a CCG from April 2013.  With regard to NHS 111, problems continue to be raised with the project board and the official report on the pilots will apparently be published later this month.
We had an opportunity to be addressed by our new Chairman of Council, Dr Mark Porter, an anaesthetist, though this should not be held against him. As you may be able to imagine, his main topic was that of pensions and industrial action.  I am sure you are aware that BMA Council decided, narrowly, to not pursue further industrial action.  He made several points about this, most of which has already been reported in the press but which can be summarised briefly as:
  • No other unions will be taking further action and Labour will apparently not be opposing the Public Sector Pensions Bill;
  • The only escalation which could be reasonably planned would be a full strike and it is unlikely the majority of members would engage with that;
  • The DH and in particular the Treasury are determined not to make any concessions.  However, we took IA to get them to talk to us.  We have now been offered the chance to be involved in the review of the impacts the changes may have, the “Working longer” Review, and other Trades Unions are keen to have us there.   So we are talking.  Just not negotiating.  We could not be a member of that group if we were to take further IA. Being part of it allows at least the potential for influence and mitigation.
Dr Porter made the point that this is not the end.  There will be a campaign to make it clear to all what our position is.  It is perhaps arguable that we should have done that already.  However, regardless of how one feels about the IA taken already, a further escalation is likely to divide the profession and perhaps damage both the profession and our Trade Union permanently.  Having said that, it was obvious, reading between the lines, that there are many differing view points, both on and off Council.  But I probably didn’t need to tell you that.
There was some discussion about how to deal with Premises issues especially how to achieve improvement in funding arrangements.  I note this to advise that this is the case, but this is one of the issues I may not currently discuss in detail.  I can report that the Northern Ireland model is of considerable interest.
Revalidation was discussed again.  There are still many issues unresolved, especially how remediation is to be funded and how certain groups of colleagues such as freelance locums will be able to engage with the process.  However, I am not certain that much will be resolved before the Secretary of State for Health signs the process off as ready and fit for purpose.  The situation on the ground does not seem to be the same as that which is being discussed in the meetings reported to us at GPC.  No doubt it will all come out in the wash.  I just hope the rinse cycle doesn’t damage any of us in the process.
Finally there was further discussion about the non-Commissioning bits of the HSCB.  There is actually little to report.  A summary of most of it could be “meetings are continuing”.  There are some IT developments, in that the DH hopes, by 2015, to have achieved four things, that patients will be able to book GP appointments and request repeat prescriptions, which is achievable, given that many practices already offer this; access to patient records may not be as it is fraught with governance difficulties; e-consultations will for most patients not be their main method of communication with their GP I suspect, but it appears the focus groups the DH uses think it is a good idea.   Who knows, for some, patients and doctors, it may even be workable and secure.
I hope this report is useful.  Given it is my first, any feedback offered will be considered carefully.

Dr Russell Brown
GPC and Chair East Sussex LMC

Friday, April 27, 2012

Yet another phoenix (or possibly not)

I have just been elected to GPC, this time to the regional seat of East and West Sussex.  Given blogging seems to have deserted me (!), I shall, perhaps use this blog to provide reports for my constituents from now on, roughly monthly.

As my 3 year term begins in July, it may well be from then that reports appear.