The GPC has now launched revised guidance to help guide doctors’ practices through registration with the regulatory body.

The GPC launched a CQC toolkit in 2011 amidst concerns from GPs about the burdensome nature of the registration process.  Since then registration has been delayed by a year to April 2013 and changes have been made to the process itself. 

The new guidance takes these changes into account.  It is intended to help GPs decide if they are compliant with the CQC’s essential standards and provides an easy explanation of the process and what happens once they are registered.

GPC chairman Dr Laurence Buckman: ‘The GPC has been helping the CQC for the last year, looking at how to improve the registration process for GPs and how to ensure that both it and the subsequent monitoring of compliance are proportionate.

‘We’ve produced this guidance to help GPs and practice managers through the process, trying to make it as straightforward as possible, however we believe all practices should already be able to fulfil and demonstrate the essential standards through the work they currently do.” 

You can read the guidance http://www.bma.org.uk/employmentandcontracts/independent_contractors/cqcreg.jsp

17 MAY 2012

The latest twice-yearly Lloyds TSB Healthcare Confidence Index shows that the short term confidence of GPs – recorded as negative in first survey published in October 2011 – has fallen, and doctors envisage a very different post-Lansley landscape shaped by consolidation and the possible closure of the smallest practices.

Once again, the outlook of GPs was the least positive of the three primary healthcare providers researched, followed by pharmacists and then dentists, whose previously positive score showed the biggest fall in confidence.

The findings are based on a combined ‘Confidence Index’ drawn from responses to a number of questions, canvassing primary healthcare providers opinions on overall business confidence and outlook for the future profitability of their businesses.

Where any figure greater than zero represents a positive outlook and figures below indicate a negative one (the maximum value achievable is plus 100 and minimum value achievable is minus 100), GPs registered minus 62, an overall shift of minus 1 to an even less confident position.

This compared to minus 42 for pharmacists – an eight point uplift – and a 12 point fall of minus 38 for dentists, indicating that GPs are still by far the most uncertain about the proposed NHS reforms, a quandary recently reflected by criticism of the health and social care bill from both the Royal College of General Practitioners and the Royal College of Surgeons.

GPs’ collective long term confidence (looking ahead over the next five years) remains static at minus 81 since the last survey.

Ian Crompton, head of healthcare banking services for Lloyds TSB Commercial, unveiled some of the findings of the survey at AISMA’s conference last week.

He said: ‘GPs were feeling so negative in our first survey published in October 2011, that we hoped a degree of regulatory clarity might lead to a more positive outlook for 2012. It hasn’t arrived and every indication is that the confidence of GPs is unlikely to improve until they can see a final outcome.

‘GP responses to the second Confidence Index are quite definitive in expecting significant change. For instance, 89 per cent are expecting more practice mergers and 73 per cent expect the demise of the ‘single handed’ GP practice by 2017.

‘Even though practices this small have been in decline in recent years, that still represents around 14.5 per cent or 1,203* of UK practices, which GPs do not think will be here in five years.’

Other report findings include:

• 52 per cent of GPs are confident in the future of healthcare provision to patients in the UK, yet 60 per cent expect NHS services to reduce to some degree over the next five years

• 91 per cent of GPs are expecting their financial pressures to increase over the next five years and 73 per cent expect a reduction in profits

• 37 per cent of GPs believe a move to commissioning groups is a good thing, while 51 per cent do not and 12 per cent are unsure

• 77 per cent of GPs expect to still be working to an NHS contract in ten years time, an increase from 59 per cent in 2011

• 50 per cent of GPs would like to be involved in premises ownership, yet only 19 per cent are expecting to have to move premises within the next five years

Despite the low levels of confidence reflected by the index findings, 51 per cent of GPs indicated that they would like to own their own premises at some point in the future.

Mr Crompton added: ‘GPs are clearly resigned to change but are still divided in their opinion of whether it will ultimately improve or hinder how they work.

‘Just over a third of GPs believe commissioning groups will be a good thing, yet that structural change underpins the reforms.                                   

‘“Partners in every size of practice have financial decisions to take and the Healthcare Confidence Index suggests that many are waiting for a clearer picture of a revamped NHS before they make them. 

‘“GPs who are taking decisions now and preparing for reforms with mergers, new premises and investment, may well be the ones who do feel most confident about change and are best placed to deliver when it arrives.’                                                  

To view the full Lloyds TSB Commercial Healthcare Confidence Index please visit www.lloydstsb.com/healthcare and to take part in the next Healthcare Confidence Index visit www.healthcareconfidenceindex.co.uk

16 MAY 2012

Dr Andrew Dearden, BMA treasurer, told the AISMA conference that some doctors were just waking up to the extent of the changes. He said one consultant was shocked to find himself paying £250 a month more when he received his April pay.

But the BMA at the weekend said a consultant earning £120,000 would pay £1,450 a month in pension contributions in April 2014, compared with £850 before the changes – making them £360 worse off in net monthly pay.

‘Those on £60,000 will be paying almost double what they paid in pre-April 2012 contributions when the reforms tighten their grip in 2014’, it warned in a message to members.

The BMA pension ballot runs from today (Monday 14 May) until Tuesday 29 May 2012.

Leaders are hoping for a strong turnout – but on past evidence of doctors’ called to vote only a small proportion register their opinion.

Members have been told it is vital to vote as the profession has reached ‘a critical moment’.

14 MAY 2012

As part of the Queen’s Speech, the Government announced its intention to introduce a Public Service Pensions Bill which is its approach to bringing about major changes to public sector pension schemes, including the NHS Pension Scheme.

These include raising the normal pension age for NHS staff. This comes on top of steep increases in contribution rates.

Dr Alan Robertson, Chair of the BMA’s Pension Committee, said: ‘The BMA is gravely concerned that ministers are still intent on pushing ahead with their unnecessary and unfair changes to the NHS pension scheme.

‘Doctors and other NHS staff agreed substantial changes to their pension scheme in 2008 to make it sustainable for the future.

This included an acceptance of increases in contributions and a rise in the normal pension age.

Staff also agreed to take on responsibility for further increases needed to cover cost increases, such as those created by people living longer.

‘The Government now wants to scrap this agreement, even though the scheme currently delivers £2 billion to the Treasury each year’.

He claimed there was anger amongst hard working doctors about the way they had been treated. Dr Robertson said the Government must think again and re-open negotiations with the BMA to find a fair solution.

The BMA will be balloting eligible members on industrial action over the changes to the NHS Pension Scheme between 14 and 29 May 2012.

10 May 2012

Dr John Milne said the figures would need to be looked at carefully and understood to ensure that the cases of intentional fraud were distinguished from cases where a course of treatment had been staged for legitimate reasons.

He said: ‘It cannot be assumed that treatment that has been planned in a phased way, or had to be restarted during what was intended to be a single course, is fraudulent; that simply isn’t the case. There are clinical factors that can explain both scenarios.

‘A number of issues have arisen with the workings of NHS dentistry since the introduction of flawed contractual arrangements in 2006. Those arrangements have proved unpopular with patients and dentists alike. A new contract is now being piloted. The BDA supports this development, which it hopes will address the many problems the current contract has created.’

Dr Milne said where deliberate fraud did happen it was indefensible and the BDA fully supported the counter-fraud activities undertaken by the NHS to detect and eradicate any such activity.

8 MAY 2012

The report describes the findings of a loss analysis exercise to measure the prevalence of suspected fraud in contractor claims within NHS dental services England. This work is based upon a random sample of 5000 FP17 dental activity reports for completed treatments drawn by NHS Dental services. All claims were submitted for payment during March 2010.

The Department of Health said: ‘This report concludes that the estimated loss to suspected contractor fraud during 2009‐10 was £73.188m based upon an assessment of resolved treatment queries, with a potential for a further £5.31m of loss in unresolved queries.

‘It is estimated that during this period almost 1 million inappropriate claims (FP17s) were submitted for payment. With revised contract arrangements not expected to be in place until April 2014 these findings indicate that, without intervention, there is an identified risk that a further £146.38m could be lost to fraud whilst the existing dental contract remains in place’.

The type of suspected contractor fraud was distributed as follows – patient did not receive the level of treatment on the FP17 (50%), split course of treatment (27%), patient did not visit dentist (12%), patient did not exist (10%) and patient paid for treatment but was marked as exempt on the FP17

The GPC, RCGP and the NMC have come together to inform doctor employers that nurses cannot legally practice in the UK unless they are registered with the Council.

With almost 60,000 GPs registered in the UK, the joint initiative aims to raise awareness about their responsibility as employers to regularly check the registration status and qualifications of nurses.

GP practices which do not perform the required checks, may find themselves facing contract sanctions, and nurses may be liable for prosecution for claiming to be registered when they are not.

The NMC’s free employer confirmation service makes it easy for GPs to check a nurse’s current registration status and details of any conditions of practice, cautions or suspensions issued as a result of fitness to practise proceedings.

GPC chairman Dr Laurence Buckman said: ‘GPs will recognise the importance of making sure the qualifications of all their practice staff are properly checked before they are appointed. If they weren’t aware of the NMC’s free confirmation service already we would recommend they use it as it’s a valuable resource.”
GPs can get details about the NMC’s employer confirmation service, or register as an employer, at www.nmc-uk.org/employer-confirmations or by calling 020 7333 9333.

2 MAY 2012

The findings are set to reignite the debate over health tourism, and follow cases where GPs have been under pressure to register foreign nationals not entitled to secondary care.

Where foreign nationals are not eligible for NHS care, they, their insurers or their country of origin will be approached for payment.

Acute trusts across England were approached under the Freedom of Information Act to ask how much they were owed for the treatment of foreign nationals who were not entitled to free NHS care.

A total of 35 acute trusts replied and were able to provide figures, and their average unpaid debt for the provision of care to foreign nationals was £230,000. If that figure is extrapolated across all 168 trusts in England, it puts the total owed the NHS by foreign nationals at £40m.

St George’s Healthcare Trust had the largest outstanding debts, totalling £2m from £3.55m invoiced to foreign nationals for health treatment from April 2009. Barnet and Chase Farm was next, with £488,000 outstanding from invoices worth £934,000.

The most inefficient trust in collecting money was Royal Wolverhampton, which collected only 24% of the £419,000 owed, followed by Newcastle-upon-Tyne, which collected 36%.

Other hospitals admitted to writing off fees. Northampton General said it wrote off £140,000, despite only having been reimbursed £87,300 to date. St George’s wrote off more than £95,000, while University Hospitals Coventry and Warwick, and Royal Wolverhampton wrote off £79,000 and £41,000 respectively.

A spokesperson for St George’s said: ‘A high percentage of our patients require life-saving trauma, neuroscience, cardiovascular or paediatric care. We’re working hard to improve the way we record overseas patients and the debt recovery rate.’

Dr Richard Vautrey, deputy chair of the BMA’s GP committee, said: ‘Hospital trusts must put in place arrangements that ensure people cannot exploit the system. However, we need to be careful that we are not putting barriers in place that prevent people from getting access to healthcare. It can be quite challenging. It is too simplistic to call it health tourism. The reality is a lot more complex.’

Richard Hoey, editor of Pulse, said: ‘The amount of unpaid debt is likely to at least in part reflect the degree of confusion across the NHS about which foreign nationals are eligible to free NHS care, and which are not.

‘GPs are in theory allowed to exercise discretion about whether to register foreign nationals who are not eligible for hospital care, but in practice they are sometimes put under pressure to take them on.

‘Where NHS hospitals give care to patients they know are not entitled to it for free, they have a responsibility to taxpayers in the UK to chase payment promptly after treatment.’

2 MAY 2012

Company chief executive Graham Pink said its partnership was ‘a fantastic example’ of what can be achieved by the public and private sectors working in partnership together.

He explained: ‘Each of our developments serve areas which have poor health outcomes and which have seen very little investment over recent years, so they really are making a huge difference to local communities that use them.’
 
The company, which specialises in the delivery of modern, innovative health and community facilities, was originally formed as part of the NHS Local Improvement Finance Trust (LIFT), a major Government initiative designed to stimulate investment in local primary and social care facilities, and reduce health inequalities. 

Structured as a Public Private Partnership (PPP), with the private sector holding a 60% shareholding and the public sector owning the remaining 40%, the company holds the franchise for the NHS Local Improvement Finance Trust (LIFT) for the Liverpool and Sefton areas.

LSHP is also currently building a major new Neighbourhood Health Centre in Liverpool’s largest regeneration zone situated on Edge Lane in Kensington.
 
The company said its structure is one of a Public Private Partnership (PPP), with the private sector holding a 60% shareholding and the public sector the remaining 40%. Its shareholders include Community Health Partnerships, Liverpool PCT and Sefton PCT.

2 MAY 2012

Responding to a GMC report ‘Investigating the prevalence and causes of prescribing errors in general practice’, RPS President Martin Astbury said: ‘Prescribing errors are common but the number of mistakes could be reduced by up to 50 per cent if GPs introduced an in-house pharmacist-led support scheme.’

‘Recently published research provides conclusive evidence that collaboration between pharmacists and GPs makes care safer’ .The NHS spends around £8.82 billion on medicines prescribed mainly by GPs in England each year. We must do more to maximise the benefits of that investment. We are calling for every GP practice to have a pharmacist on the premises dedicated to patient safety’.

He said patients who move in and out of hospital and other settings are at high risk of medication errors as the right information about medicines is often not transferred with them.

The Society has published new best practice guidelines on patient transfer which if implemented would reduce risk and harm to patients.

It claimed the public could be confident that pharmacists and GPs were already working collaboratively to make sure the use of powerful prescription medicines is safe and effective.

Mr Astbury said every prescription for every patient is clinically screened by community pharmacists to ensure the dose and strength is correct for the person being treated.

‘In addition, pharmacists are now spending more time with patients when they are prescribed new medicines for blood pressure, asthma, and diabetes, sitting down with patients in a private consultation area and making sure there is a full understanding of these medicines.’

His comments came following a GMC report today which found 1 in 20 GP prescriptions contain an error.

Researchers looking at a sample of GP practices in England found that where there were errors, most were classed as mild or moderate, but around one in every 550 prescription items was judged to contain a serious error.

The most common errors were missing information on dosage, prescribing an incorrect dosage, and failing to ensure that patients got necessary monitoring through blood tests.

Researchers say improvements can be made to reduce the error rate.

The research recommends a greater role for pharmacists in supporting GPs, better use of computer systems and extra emphasis on prescribing in GP training.

GPC chair Prof Sir Peter Rubin said: ‘GPs are typically very busy, so we have to ensure they can give prescribing the priority it needs. Using effective computer systems to ensure potential errors are flagged and patients are monitored correctly is a very important way to minimise errors.

‘Doctors and patients could also benefit from greater involvement from pharmacists in supporting prescribing and monitoring. We will be leading discussions with relevant organisations, including the RCGP and the CQC, and the Chief Pharmacist in the Department of Health, to ensure that our findings are translated into actions that help protect patients.’

Prof Tony Avery, of the University of Nottingham’s medical school, who led the research, said: ‘Few prescriptions were associated with significant risks to patients but it’s important that we do everything we can to avoid all errors. GPs must ensure they have ongoing training in prescribing, and practices should ensure they have safe and effective systems in place for repeat prescribing and monitoring.

‘I’d also encourage doctors to share their experiences of prescribing issues both informally within their practices, and also formally where appropriate through local or national reporting systems. Prescribing is a skill, and it is one that all doctors should take time to develop and keep up-to-date.’

2 MAY 2012