GPs are under no obligation to provide PMA reports and insurance companies wishing access to medical information about clients can do so with written consent using the Data Protection Act 1998, where the maximum charge that can be made is £50.

The BMA’s guidance on fees for services can be used to charge appropriately for the provision of PMA reports, with the current rate being £132 per hour.

The BMA conference in July 2001 passed a resolution that it is appropriate and ethical to obtain fees for private reports before submitting them. This is worth remembering and quoting when preparing private reports.

Insurers can be told that a PMA report is ready for submission, and should be told how long the preparation time was, and an invoice sent for the appropriate charge.

Practices that have implemented these charges have seen an increase in income actually reflecting the workload involved.

Click here to find details of your LMC members following the recent election.

After many years of service to your Local Medical Committee, Dr Mather from Cheadle Hulme Health Centre decided to stand down at the last election. The Executive Committee would like to extend its thanks on behalf of Stockport GPs to Dr Mather for his valued service.

The guidance reviews current trends and models of premises provision, summarising the risks and benefits to GPs of the various models and concludes that GPs should continue to have the option of investing in their premises although some may find other models more suited to their needs.

Your LMC has produced a summary of the guidance which will be copied to all practices during December, however a full copy of the GPC Guidance (35 pages) is available on request from your LMC office.

The GPC has been made aware that Doctor Online has written to all LMCs stating:

The GPC confirms that they had been contacted by the company and, having looked at their product, thought it might be of use to some GPs. The GPC are however surprised at the strength of their statement and would like to make it clear to GPs and LMCs that the GPC has never made this claim. It should not be taken as an endorsement of Doctor Online by the General Practitioners Committee.

Your LMC was keen to ensure the additional work involved caring for asylum seekers was recognised over and above standard capitation rates. The scheme is intended to provide an annual fee of £120 for each asylum seeker taken on by the practice (after 1 year the patient would revert to normal capitation), £60 for the first quarter and £20 for each of the next 3 quarters. In addition the designated practices will be able to utilise interpreting services to assist in the care of the patients.

If you are currently providing care for asylum seekers make sure your practice signs up for the scheme and therefore claims the monies it is entitled to.

In the last newsletter from Clinical Governance it seems that this body wants practices to provide chaperones as part of a risk management strategy. I don’t know about other practices but in mine we have difficulty having enough staff to answer the telephones!! Whilst staff are chaperoning they obviously cannot be performing other tasks such as repeat scripts, filing, making appointments answering telephones arranging ambulances etc. We have to comply with access targets NSFs and now clinical governance wishes us to provide chaperones, it is just not possible unless staff funding is increased to take this into account.

If the NHS decides that chaperones are necessary, perhaps some decision and guidance could be given on who needs chaperoning. Should male and female Doctors be chaperoned? What examinations need chaperones? Above knees? above thighs? Chests? Do you ask for a chaperone if examining feet or ears? (some strange people are very turned on by feet and ears!). Do we appoint professional chaperones (who will have studied at postgraduate level for 2 years and have a Dip. Chap.)? The whole thing becomes ridiculous.

Either we need to tell patients that when they consult with a problem they must expect to be examined, and if the examination is potentially intimate or embarrassing they could ask for a friend or relative to accompany them. Or we are properly resourced in General Practice to provide a chaperone service.

Welcome to the first edition of the The PECtator, a report on the life of a Primary Executive Committee member otherwise known as the PEC. Before I proceed I need to swear in PCT language, SHIP! STAMP! COG! LOG! HIMP! LIS! PAF! SAFF!; I won’t bore you all in explaining what these acronyms stand for but it was my first observation as a new member that everyone within the Health Authority and Primary Care Trust (PCT) talk to each other in such acronyms supposedly to enhance communications! I will therefore refer to the Primary Executive Committee as the PEC. We have been meeting as a committee on a fortnightly basis since the end of May 2001 and comprise 7 GPs, 2 nurses, 1 social services rep, a Lay Member, a pharmacist, Director of Finance, a paramedical services manager, Director of Public Health and the Chief Executive, totaling 16.

We are responsible for a total budget for healthcare within Stockport of £212m and have a dual role of commissioning services from Stockport Acute Trust and other Trusts within the region and the provision of Primary Care services, district nursing, health visiting and community physiotherapy being examples. Within this budget are also monies of £35m for Primary Care drug prescribing and £5.5m for General Medical Services (GMS). GMS is the budget used to pay our staff and computer reimbursements within our practices. The total budget the PCT is responsible for, is a reflection of central government’s intention for 75% of the total NHS budget to be apportioned to PCTs.

In future issues of The PECtator I hope to demonstrate projects the PCT has ratified which hopefully will improve the quality and access of services we offer to our patients, the cynics amongst you will surely say, I've heard it all before!

The noises, which are coming out of, the PCT at the moment don’t sound too good for General Practice. The PCT is heading for a £1.6 million overspend on the Drug Budget and we are told that money will be very tight for the foreseeable future. Apparently the Chief Executive will have to balance the books or his head will roll. It seems any extra resources coming from the government will be used to bail out secondary care overspends and to support keeping waiting lists down. If we are lucky a few health Centres may be tarted up and there may be a little tinkering round the edges with community mental health services, but we cannot expect any real developments or injections of money for staff, premises or computers.

It is interesting to note from the Stockport Metro that Stepping Hill is to be almost completely rebuilt over the next 10 years at a cost of £170 million. This amazes me, as I cannot remember a time when Stepping Hill did not look like a building site! I naively thought that it actually had been rebuilt during the last 10 years when workers in grubby denim jeans displaying their gluteal clefts populated the site. The danger is that secondary care will suck in all available resources for years to come by increasing revenue costs and we in General Practice will as usual be left with the crumbs to practice fag end medicine.

Pressure needs to be kept up on the professional members of the PCT so investment can be made in General Practice to enable us to provide the services our patients deserve.

I have two issues which are irritating me this month, working at the coal face of General Practice:

Firstly referrals to the old age psychiatry led memory clinic. Why are GPs being asked to undertake investigations on patients who have already been referred to secondary care prior to them being commenced on the centrally acting cholinesterase inhibitors, such as donezipril? An ECG, CXR and routine blood parameters involve not only extra resources within General Practice but also cause unnecessary travel and inconvenience for this group of patients and their carers. I am not aware of any shared care arrangements with respect to investigations on this vulnerable group of patients.

Secondly, requests by Community Drug Team workers to prescribe buprenorphine or subutex for our substance abuse patients. I see no difference in workload or risk in prescribing a schedule 3 listed drug like subutex compared with methadone. Our LMC is endeavouring to set up a Local Development Scheme for substance abuse patients where GPs will be remunerated for the care of this high risk group of patients.

To help train the assessment teams, consisting of a GP, a Practice Nurse, a Practice Manager and a CHC member, to undertake assessments of practices where performance is being assessed, the assessing teams need to do a few “dry runs” to practice their skills & techniques.

The exercise may be useful to your practice in understanding how some elements of performance are assessed, and may give a useful insight to your practice team also about the local process and maybe even areas for development within your team.

It will probably involve around a 2-hour time commitment from a GP from your practice, along with the Practice Manager, Practice Nurse and a Receptionist. Locum costs will be met.

If your practice is interested in volunteering, please let the LMC office know-contact numbers on the front page.

You can’t have missed the pressure on GPs to embrace new technology and to become ‘paperless’. The new General Practice will have all information available instantly at its fingertips, creating a seamless management of patients and their conditions. Sounds great? Stockport PCT certainly thinks so and has provided money (£1 per patient) to help oil the wheels of change. There is however a very worrying aspect to IT Nirvana. All this infrastructure costs money, it costs money to purchase, to maintain and to replace, and may well mean that Stockport GPs will end up with less than average net pay.

For example recently a nameless practice had to replace a server because its old server was full and was unable to process any more patient data. So a new server was purchased, but the new server needed a higher spec. to enable it to process the new (EMIS) GV software at the speed needed to conduct a consultation within 10 minutes, etc, etc.

The cost of the new server plus necessary ‘gizmos’ was a staggering £9K. This was for a server that the practice didn’t want and had never needed in the past. The practice is now holding its breath hoping that all the PCs won’t also need replacing.

Such a rapid increase in GP expenses cannot immediately be reflected back into national calculations. Add to this that Stockport may well be moving at a quicker pace than that nationally and it doesn’t take much to realise that we may be working ourselves towards a pay cut.

Do turkeys and Christmas spring to mind?