Dr David Gilbert
Chairman

Dr Ranjit Gill
LMC Executive Committee

I myself first became a GP in Stockport in November 1985 and in those days relationships with NHS management in Stockport were cordial and this was mainly due to Tony’s communication skills. He was respected by every GP, and this is no exaggeration, for his sound advice, judgement and sense of humour; how times have changed. He was responsible for introducing cardio vascular screening in Stockport in the 1980s, a very early format of our present Quality and Outcome Framework, when preventative medicine and health promotion was still in the Arc . Through his communication skills, partnership disputes and disagreements between partners were often resolved  amicably to the benefit of us GPs and our patients.

After he retired from his post as administrator, he became involved in the development of the Stockport Doctor Co-operative and was responsible for bringing Michaela Buck as manager. As a founding member, I valued his organisational skills and knowledge, whether financial or administrative in the set up of what at the time was a considerably risky venture, we only had the support of under 50% of GPs in Stockport but with his guidance we were able to start  providing a comprehensive out of hours service for the patients of Stockport.

I will miss his personable approach and would like to send my condolences on behalf of Stockport LMC to his widow and family.

Dr David Gilbert - LMC Chairman

1. Practices - The GP Patient survey has been developed as part of the ‘Improved Access Scheme” directed enhanced service (DES). Practices which decide to opt out of the survey, and, therefore the DES, will not receive any payments from the survey as there will be no results to award payment against. The survey will be launched the week commencing 15th January 2007.

Practices intending to opt-out of the DES and Survey should email their practice code number to GPPatientSurvey@dh.gsi.gov.uk by November 8th.

2. Patients - Patients who do not wish to receive a GP Patient Survey questionnaire should:-

 (i) Either email the DoH providing their full name and NHS number to GPPatientSurvey@dh.gsi.gov.uk

 (ii) or inform their practice. The practice should then send the patient’s NHS number and full name to GPPatientSurvey@DH.gsi.gov.uk,

 (iii) or inform their PCT. The PCT can then send the patient’s NHS number and full name to GPPatientSurvey@dh.gsi.gov.uk

Whichever way is used to inform DH, the full names and NHS numbers of patients who do not wish to receive a GP Patient Survey questionnaire are needed at the latest by 8th December 2006.

Your LMC along with others across the country have expressed their real concern that allowing this survey to proceed will permit the Government to manipulate public opinion. One of the additional questions gives the patient the opportunity to respond that they were dissatisfied because their practice was not open early or late enough or not open on a weekend. At no point does it state that such offerings are currently outside the agreed contractual requirements of GPs.

GPC and LMCs across the country are concerned that in the same way that the Government are reneging on an agreement to utilise a survey agreeable to GPC and the DoH, they will look to interfere with the agreed Pensions Dynamisation deal. If this happens then GPs could lose much of the 50% predicted rise in pension gained over 2004 to 2007. The sums involved are much bigger than the loss of the Access money for one year. If the Government wins the Access issue, it will only encourage it on dynamisation.

Withdrawing from the Patient Experience Survey component of the Access DES will of course mean that practices will forfeit any achievement monies under the Access DES. In addition, PCTs may try to clawback monies already received by practices for participation in the DES. There is a further question as to whether practices who have signed the nGMS Standard Contract variations (Sept 2006) could be seen to be in breach of contract for not carrying out a national patient experience survey. Whether PCTs would actually be able recover monies or prove breach of contract has been debated at length particularly as the name of the survey has been changed from a Patient Experience Survey to The GP Patient Survey - Your Doctor, Your Experience, Your Say and has become an opinion rather than an experience survey.

Your LMC Executive Committee will be discussing the issues raised at its next meeting on Thursday 2nd November and will update practices with its view thereafter.   

Utilising the Apollo Software to extract details of patients who had a patient experience encounter across the summer places the onus on the practice to respond to a "Data Processing Agreement" and give their consent for patient data to be used for the survey. Much debate has concentrated on whether allowing patient sensitive data regarding a patient's experience encounter breaches patient confidentiality. There has been no consensus on this particular issue, however, it is clear that should practices have any concerns in this respect they can pass the "Data Processing" responsibility to the PCT by choosing not to allow Apollo to extract the relevant data. In which case the PCT will arrange for a random sample of patients to be selected via the Exeter System. The selected patients may or may not have had a patient experience encounter and will only be asked to respond if they have had such an encounter.

It is your LMC's view that any practices with concerns regarding the confidentiality issues of data extraction via Apollo should choose to have their patients surveyed via the Exeter System. Practices who do not respond to the Apollo Data Processing Agreement will by default have their data extracted via the Exeter System unless they advise the PCT that they wish to withdraw from the Access DES. 

Any practices requiring further information in respect of the specifications for the enhanced services should contact either Janna Rigby at Stockport PCT or Paul Stevens on 07770 616235.

Your LMC's view and advice to practices in this respect is as follows:

1. The PCT should be allowed access if it can access Patient Records via the Apollo Software which anonymises the data viewed.
2. Your LMC is concerned that patients have withheld their consent for their data to be used for this purpose either expressly or by implication (refusing to give their express consent) in past years.
3. Your LMC does not support the opinion of the PCT which allows it to access records on the grounds that the work involved is "disproportionate".
4. Your LMC is agreeable to Stockport PCT writing to a randomly selected sample of a practice's patients seeking their express consent. The practice will nt know the identity of these patients until the day of the QoF visit. Your LMC does not consider the work involved for the PCT in this respect (i.e. writing to 50 - 100 patients per practice) to be disproportionate.

Practices requiring further information should contact Paul Stevens on 07770 616235. 

“In the light of what the GPC considers to be a breach of the original agreement on the Access DES questionnaire, the committee now rejects the DES on the basis that the DES’s integrity has been so discredited.”

In essence GPC states that the Department of Health has renamed the survey “The GP patient survey – your doctor, your experience, your say” and imposed substantial and unacceptable last-minute amendments to the survey by adding two questions which seek patient opinion in relation to the unfunded extension of Practice Opening hours rather than assess patient experience. 

As a result practices need to decide whether they wish to cooperate with a survey that now contains questions which: 

(a)    the GPC did not agree to

(b)    risk raising patient expectations of an extended service that the Government has not demonstrated it can fund

(c)    appear to be biased in their design so as to create negative perceptions of access to GP services

Presently, practices have to decide whether to allow the Apollo System extract patient identifiable data for the survey by 1st November 2006. Your LMC Executive Committee has considered the current position and believes that neither the LMC nor practices have sufficient information regarding the implications of withdrawing from the DES. Therefore, practices should reserve the right to reject participation in the DES once further information becomes available. The only way to achieve this is for practices to take NO ACTION in relation to the Apollo Data Processing Agreement. Practices should not at this stage answer Yes or No and allow the deadline to pass.

17th October 2006 - LMC Golf Challenge - 6th October 2006 - Result Your LMC is delighted to announce the result of the 6th Annual LMC Golf Challenge held on 6th October 2006. The rain in the week leading up to the event almost forced its cancellation as Bramall Park Golf Club was closed. Fortunately, at the last minute we were able to enjoy an afternoon's golf at the nearby Bramhall Golf Club. The event was won by Mark Gallagher who scored an impressive 36 points from the 15 holes counting for the competition. In second place was John Swarbrick from Heaton Moor (27 points), whilst 2004 winner, Rob Beardsall took 3rd prize with 26 points. Full details from the link above.

1. Practices must be clear of the purpose of the survey (Diabetes only)
2. The people handling the information must be subject to confidentiality undertakings if they are not Health Professionals
3. Practices disclosing patient information must keep a record of the reasons for doing so
4. All practices should make it clear in their surgeries through leaflets and posters exactly how patient information is being utilised.
5. If a practice has only a handful of diabetic patients and it is relatively easy to contact those patients to inform them of the disclosure, then they should.
6. Section 60 of the Health and Social Care Act is usually used in drastic or emergency cases but in the light of the interpretation of the DPA, should not be applied here.

The second request is a PCT request for data to be retrieved via MIQUEST and later graphnet to assist the development of a diabetic retinopathy recall system. This is a separate request for information and practice Caldicott Guardians must ensure they are happy to disclose patient sensitive data. Practices could use the guidance provided via the link above to help them in this respect.

Your LMC will be discussing the issues raised by these requests for patient sensitive data at its September Committee meeting and will reports back to practices thereafter.

24th August 2006 - Overseas Visitors - Simple Guide to NHS Entitlement Our colleagues at Wessex LMC have produced the following simple guide to NHS entitlement.

Prescribing Guidance - http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4131465&chk=qsfbI9

"Although it could be argued that there is some breach of confidentiality if people see patients or hear a patient's name in a waiting room of clinics etc, these places are (to all intents and purposes anyway) places that the public can easily access and there is little to stop people from being seen by others when they're waiting, or hearing their names when they register their arrival at the reception desk.  

If there are particular concerns regarding this the practice could set up a system whereby a patient receives a number when they arrive at the surgery that is then called out when it is time for them to see the nurse/doctor."

The ethics department's stance is that confidentiality is an important ethical principal but that it has never been an absolute principle.  There are, for example, three exemptions to it - consent (implied or express), legal and public interest.   Some might argue that using patient names in the waiting room operates on an implied consent basis i.e. patients are aware that this is how their information is used and disclosed.  However, as is the case in both implied and express consent models - if a patient objects to their information being disclosed in this way, his objection should be respected.  

Jan06 & before

Feb06

Mar & Apr 06

May 06