Speakers included Dr Malcolm Fox, GPC representative who presented the GPC view, Accountants TFD Dunhams who highlighted the tax advantages of premises investment, Donna Sager, PCT Director of Primary Care and Information who highlighted the pressing premises issues within Stockport, particularly the lack of investment in Health Centres and Ray Goodier, Stockport PCT LIFT Lead who detailed the LIFT application process and highlighted the potential benefits to Stockport.

LIFT is a mechanism for encouraging private sector finance in partnership with the LIFT company to fund the development of new General Practice Premises. LIFT attracts considerable Enabling Funds which can be used to overcome negative equity difficulties when attempting to develop a project and for example move a number of practices into the same new purpose built premises.

During the ensuing debate Mr Richard Popplewell, Chief Executive, Stockport PCT, intimated that funding for premises developments outside LIFT would be severely limited and that LIFT was an excellent opportunity to attract new investment to Stockport.

Many GPs who own their premises expressed concern that selling up and entering the LIFT scheme was passing up an excellent investment opportunity and was effectively reducing GPs remuneration. Furthermore, whilst GPs were assured that LIFT was only one method of developing premises in Stockport, Mr Popplewell’s comments regarding the lack of future identified monies for premises development outside LIFT would lead to a lack of investment in existing premises, an inequitable position effectively coercing GPs to join LIFT.

All parties felt the excellent turnout had facilitated constructive debate enabling many GP concerns to surface. There wass a feeling that LIFT appeared to be a good opportunity to develop Stockport’s run down Health Centres, however to gain wider GP support from the owner occupying GPs many questions regarding future premises investment outside LIFT needed to be answered. Ray Goodier is hoping to look at responding to many of these questions as part of the LIFT application process.

This meeting followed on from the LMC 2001 Premises Questionnaire which attracted a response from 25-30% of Stockport GPs and indicated that 75% of these GPs wished to continue to own the premises from which they practiced. Our 2002 Premises Questionnaire, distributed at the Premises Meeting and to be forwarded to all other GPs in early April, was revised to assess GPs views towards LIFT an attempt to identify any contract in premises opinion across GP age groups and between genders.

Your LMC looks forward to receiving your responses by the end of April.

Whilst rules were applicable from 14 December 2001, guidance for Has and LMCs was also only published in December. Therefore, your LMC has been working closely with the HA to ensure GPs do not miss relevant deadlines.

Current GP principals will be required to submit retrospective declarations regarding previous criminal convictions, cautions etc as well as adverse findings by regulatory bodies. There is no onus on HAs to check declarations except where there is something to declare. GPs will be notified shortly regarding their declaration.

Non-principals, to continue working must apply to be admitted to the new supplementary list of a Health Authority. Non-principals can only be on one the list of one HA at a time,( their host authority for superannuation purposes). Once on a list the non-principal can work anywhere in the country.

Non-principals were advised to apply by 28th February, applications will be processed by HAs by 30th May and non-principals who have applied can continue to work pending completion of processing under transitional rules.

Effectively, the implications for General Practice are that GPs will not be able to employ a non-principal after the 1st April 2002 unless they are on the list of a Health Authority (other than under transitional rules).

At a time when locum GPs are proving increasingly difficult to find this additional bureaucracy will certainly not make life any easier.

However, your LMC will endeavour to work with the newly created Greater Manchester Strategic Health Authority and PCTs to ascertain a list of non-principals and establish a mechanism for ensuring current information is easily accessible to practices.

Twenty years ago we were persuaded by the Health Authority to vacate our own premises on the A6 and move into a new purpose built Health Centre in Heaton Norris. At the time we had some misgivings, but we were told that the building would be the “Jewel in the Health Authority’s Crown” and we would never regret moving.

Since then, less than the barest minimum has been spent on maintaining the fabric of the building and nothing at all on renovations or improvements. During that time the number of staff employed in primary care has increased threefold. Countless letters to the Health Authority have been ignored, or met with evasiveness. With the advent of “Fund Holding” and the iniquitous cost rent schemes, the problem became even more acute, as money was lavished on our “Fund Holding” neighbours—our own premises became shabby and rundown.

We hoped for an improvement under a socialist government—promises were made nationally that extra funds would be available for primary care premises but the responsibility for the care of the health centres was passed between various bureaucratic branches locally, with each denying responsibility, or even ownership of the building.

Three letters to our local M.P. Andrew Bennett, resulted in a few minor cosmetic improvements but the problems caused by twenty years of neglect remain. A meeting with Richard Popplewell, again resulted in half promises but no action. When asked directly how much money was available to spend on health centres, he declined to answer. Surely the “trust” should be about trust and such an evasion is unacceptable. If no monies are to be made available, then please tell those of us who work in health centres that this is the case and we will move elsewhere!

I am pleased to hear that Boots have come up with a scheme where for a handling fee of £3/week payable by the patient (or responsible carer). they will provide weekly monitored systems on monthly prescriptions, No doubt they will also deliver!!!

The Patient’s Attendance Allowance or Disability Living Allowance should be used to help with medicines management.

Boots in Stockport have confirmed they are able to offer this service. and I for one will be directing all further requests for monitored dosage systems to Boots, and putting others on notice that I will cease writing weekly scripts at some time in the future.

The ability of Hospital Medical Staff’s to certify sickness absence following inpatient treatment responsibilities have recently been clarified by Dr N. Jenkins, Medical Policy Adviser, to the Department of Social Security in Whitehall.

This follows continuing problems of patients attending GP practices for sickness certification following in patient treatment.

Hospital staff can certify a patient unfit for work, for as long as they feel it is appropriate, upon discharge, and are normally expected to do so, as well as providing certification for the in-patient period.

The only time hospital staff should not provide prospective cover, is when a patient has had day-case surgery.

The PCT in Stockport has been in existence since April 1st 2002 and has finally appointed all 4 Directors to the PCT, the titles and functions were conceived in July 2001 and comprise Director of Primary Care - Donna Sager; Director of Clinical Services - Judi Smith; Director of Commissioning Sue Alting and Director of Finance Alison Tonge. It appears that the increasing trend of female appointments is apparent in health care management as well as General Practice! Hopefully now all these appointments are in place we can progress and achieve further investment in Primary Care but wait I hear you say, isn’t Gilbert being a trifle naive and optimistic as we now have a drug overspend of £1.9 million, mainly due to all the hard work undertaken by you and your staff in implementing the NSFs in cardiovascular medicine and mental health, by prescribing statins etc and modern higher quality mental health drugs, atypical anti-psychotics and SSRI anti-depressants to name but a few. Unfortunately, short-termism when it comes to finance is still endemic in the NHS and balancing the budget book takes priority over all other issues within the function of the PCT or so it appears to a financially naïve being like myself!

The PCT has been established for 12 months and we have only just appointed a Director of Primary Care and a Director of Finance. Hopefully now these key directors are in place real progress can be made. The Director of Primary Care post is especially important in view of the feeling of PCT empathy for general practice and will “provide practical support to primary care practitioners to modernise and improve services” (quote from job description)

On another tack, the Director or Primary Care post is advertised at a salary of £61,000, this compares with GPs average net remuneration, and is probably more than twice that of the highest paid practice managers of large practices in Stockport. General Practice is now very complex and needs highly qualified managers. To attract them we will have to pay them the going rate. Most practices would give their eyeteeth to be able to offer practice managers posts at 50 or 60 % of the above salary.

This is yet another area the PCT needs to address, why are PCT/HA managers paid more than GP managers when the jobs seem of equal complexity and responsibility?

We have all witnessed the reduction in discounts offered to GPs by flu vaccine manufacturers across the past 2 years. Indeed, our flu purchase consortium has seen the discounts offered drop from 60% to 30% in this period. Perhaps the flu manufactures have seen the IoS fee earned by GPs vaccinating their over 65s and decided they want a piece of it! But of course this is not the full story. In Stockport practices are encouraged to identify and vaccinate under 65s who fall into somewhat ambiguous at risk groups. Indeed this is promoted nationally as Good Practice, and fully supported by our Consultant in Communicable Diseases. Unfortunately, despite being more difficult to identify than our Over 65s, there is no IoS fee offered for vaccinating this patient group. Practices will therefore earn approximately £4 per dose (with the Consortium) or less than £3 per dose (Glaxosmithkline—the cheapest supplier to the NHS) to fund such a vaccination programme. My costing indicate that given a robust At Risk database it still costs at least £5 per dose to run a co-ordinated vaccination programme for this patient group and that’s before allowing for practice overheads or GP time!

Hence, as a result of the decreasing levels of discount offered by manufacturers, those GPs running a co-ordinated under 65 at risk flu campaign are doing so at a personal cost of at least £1 per dose—Why??

GPs have often said they have been working for nothing, now you are actually paying for the privilege!!

There are two issues which have irritated me recently:

1. The moratorium on the use of our hard earned prescribing savings, which involved work by many practices in the completion of designated audits using precious practice staff time at our own expense, until April 1st 2002 because of the total PCT budget overspend of £1.9m. I have taken this issue up with the Chief Executive of the PCT who has promised that these monies will not be held back after April 1st 2002. I advise you all to detail your proposed use of such monies as soon as possible to the PCT’s Director of Primary Care.

2 Social Services and Secondary Care Providers lack of awareness of the LMC guidelines on NOMAD or Dosette prescribing. Despite much hard work by your LMC in promoting these local guidelines, I have an example of a patient who was advised via Social Services that the Disability Living Allowance could be used to fund the NOMAD scheme. The Social Worker, however, after implementing the scheme left the patient with the misconception that I personally was charging the patient for the scheme! Lets hope the recent introduction of a charge by Boots for such dosette or NOMAD schemes, will raise the profile of this issue and that nationally agreed guideline can be agreed.

The Commonwealth Games will be held from 25 July – 4 August 2002. During this period over a million visitors are expected in Greater Manchester. The majority of the sporting venues are within the Manchester City boundary although there are also events at Salford and Bolton. Therefore the following information is mainly for information and outlines the medical services that the Manchester Commonwealth Games organizing committee (M2002) will provide.

The Village Medical Centre will be located in Fallowfield and will be operational from 15 July to 7 August. Diagnostic services will be provided at a local NHS Trust. Other services such as physiotherapy, chiropody and dental services will be provided at the Centre. A pharmacist will be on call for 24 hours advice and there will be a dispensing service at the Centre. There will also be a four-bedded ward for athletes and Games family members who may require overnight observation or isolation.

For spectators, first aid stations will be established at all events by St. John Ambulance. Greater Manchester Ambulance Trust will provide paramedic crew and ambulances at events with an anticipated attendance of 5,000. Crowd doctors will be present where the number of spectators is expected to exceed 2,000.

To put the likely impact of the Commonwealth Games into perspective, the numbers of people traveling to spectator venues at any one time during the period will be less than when several home soccer games take place on a winter Saturday in Greater Manchester. Concerns about visitors suffering the health effects of Manchester night life and putting pressure on hospitals should also be allayed when it is understood that the tens of thousands of university undergraduate students who normally do that every September will be seeking their care in July from hospitals from Thailand to Greece!

Should you require further information please contact Dr Ann Hoskins at Manchester Health Authority.

Last years event attracted approximately 80 revellers who enjoyed the opportunity to socialise with colleagues as well as good food, a disco and Live Entertainment supplied by David Gilbert’s band!

Tickets for this years event are priced at only £32 each and include a Cocktail Reception, Dinner, a Disco and Live Entertainment.

Please contact Paul Stevens or Val Cording at the LMC office on Old Telephone Number if you are intending to go and reserve your table—yes there will be a formal seating plan this year!