Dear All

The worst scenario of a Christmas/New Year surge in demand didn’t happen, and the Government and NHS breathed a sigh of relief, although David Baxter has advised that we can use Relenza because the threshold for incidence rates has been breached—great!

The intensity of work in general practice seems to increase nevertheless, even without a flu epidemic. NSFs for CHD, Mental Health and soon for diabetes and elderly care will place more and more demands on our time as GPs.

I’ve just read the Health Circular on Intermediate Care (www.doh.uk/coin.htm) it’s not an exciting life being your Chairman! There is no mention of who will be responsible for patients receiving Intermediate Care, so you can assume that the buck will stop with us. Sadly the circular has lots to say about the usual “joint working” and “input from nurses, care managers and a range of allied health professionals” but nothing about who will carry the can.

The Commission for Health Improvement (CHIMP as it should be known perhaps, or CHI as our leaders would have it) now has a legal right to make us jump through more hoops, as if we didn’t have enough to do.

General practice as an organisation is becoming ever more complex, and the “Red Book” doesn’t really offer appropriate funding. We need enhancements, not only for extra staff, but for us GPs as well. After all we are a “human resource” too aren’t we?

So what can you do?

Stick together as a profession locally and nationally. Especially now, given the public and media image that we seem to have acquired. Certainly we need to be accountable, open and share decision making with patients and seek informed consent etc. However professional unity is our greatest strength, and only by learning from each other’s best practice can we really change our working lives and redeem our image.

We also need to make a crystal clear case for more money. Your LMC regularly makes the case for better investment in your practices, and in you, for work outside General Medical Services, such as increased access outside contracted hours.

Each practice should now be considering what extra funds it will need for staff, IT and premises from April 2001, and be ready to bid not only within the terms of the “Red Book” but also for “Modernisation funds” (the new mantra).

Please do use the knowledge of your LMC members and Officers to ensure your bid is appropriately detailed so that it is more likely to be successful. We are here to help!

The closing date for receipt of tenders from the manufacturers is Friday 9th March 2001. Details of the successful tenders will be announced as soon as possible thereafter, and will be available first on our website—www.stockport-lmc.org.uk

Approximately 50% of practices have expressed the desire to use more than one supplier for 2001, whilst others have indicated that they would prefer to go with the supplier tendering the best deal. It is the intention of the consortium to accommodate both groups of practices by accepting two tenders, the first which will be offered to the single supplier practices for 100% of their order, and in a proportion (to be decided) to the multiple supplier practices. The second successful supplier would make up the order of the multiple supplier practices.

All practices who have previously taken part in the consortium have received an invitation to take part this year, although the consortium is of course open to all practices who are members of their Local Medical Committee.

To date almost 100,000 vaccines have been provisionally ordered.

It is not too late for practices to place an order with the consortium. Practices should contact Paul Stevens at the LMC office for further details

Peter takes up his new post, necessitated by the increasing numbers of Primary Care Trusts being formed within Greater Manchester at the beginning of February. We wish him well.

It has also been announced that Mrs. Jan Hewitt, currently Deputy Chief Executive and Director of Performance and IT will take over at the top in an Acting Chief Executive capacity. We look forward to working alongside Jan in her new role during these exciting changing times.

At present due to the establishment of a Stockport PCT no decisions have been taken regarding the roles Jan will vacate.

Your LMC Officers can be contacted by email at the following addresses:

Dr Ranjit Gill ranjitgill50@hotmail.com

All email addresses are avilable by hypertext link from our Website—www.stockport-lmc.org.uk.

Your GPC representative is Dr Malcolm Fox.

For your further information, your LMC Officers are detailed below by PCG.

Follow this link to find your LMC Officers detailed by PCG.

For information the answers to the four Brainteasers featured in December’s Newsletter and on our Web site were:

Head over heels in Love

Splitting Headache

Back Seat Driver

No Excuse For It

Due to space constraints there will be no Brainteasers in this edition but will reappear in our next edition

With effect from 1st March 2001, Practices will be able to purchase both one month and three month UK Zoladex from Farillon under specially negotiated terms

In order to guarantee supply and price, Stockport LMC has decided to go with UK Zoladex and not parallel imported product.

To purchase Zoladex through the consortium please initially contact Paul Stevens at the LMC office or alternatively look on our website.

Your LMC is pleased to announce the introduction of an Occupational Health Scheme for General Practitioners, Practice Nurses and staff. A working party comprising GPs, Practice Nurses, the Health Authority / PCG and your LMC have been collaborating to produce a scheme which could be introduced at the Launch of Stockport’s Primary Care Trust, thereby ensuring equity of access to an Occupational Health Service for General Practice, Health Authority and the incoming former Community Trust staff.

The scheme is being introduced a full year ahead of a National Requirement for General Practice Occupational Health Schemes, and Dr Malcolm Fox, our GPC representative has commended Stockport LMC on this achievement.

It is anticipated, subject to proof reading and printing timescales that full details of the scheme will be sent to practices during April 2001. Included within the scheme, for example are pre-employment examinations for GPs, Practice Nurses and Staff joining a practice, sickness absence referrals, immunisation reviews (eg HepB), medical retirement assessments as well as self referrals by GPs and employees for work related problems. In addition the Occupational Health manual will provide contact details regarding general and stress counselling and interventions for substance abuse and psychotic illness.

There will be no cost to General Practice for accessing the scheme; any subsequent referrals necessitated would be covered within standard NHS commissioning or private insurance arrangements.

Many practices have called the LMC office chasing up the monies promised by Dr David Baxter as part of the Flu 2000 campaign.

The delay in payment has occurred for two reasons, firstly it appears that the papers forwarded by Dr Baxter to the Health Authority’s Finance Department were initially mislaid and secondly, upon discovery there was no clear indication of the amount to be paid to each practice.

Your LMC can confirm that payments will now be made to practices during the first two weeks of March 2001.

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Subsequently, Professor Sam Moore, a Stockport resident who is currently chairman of Central Manchester Healthcare NHS Trust has been appointed Chairman of the PCT. Professor Moore will clearly bring good experience of secondary care to the Trust. Naturally, your LMC will be aiming to assist bringing Professor Moore up to speed with Primary Care issues as soon as possible.

The next steps include the appointment to the Chief Executive post (which has now been advertised nationally). In addition the potential 13 GP candidates for the Executive Committee are presently undergoing their pre-selection training. Should all candidates come through the selection process successfully, it is probable that a formal election will be the best method of ensuring all Stockport GPs have their say in determining how our Primary Care Trust will be run. The selection process will be organised in conjunction with your LMC and we will obviously keep you all informed.

Earlier this week, Dr Susan Glicher, Joint—Chair West Stockport PCG said “I was very pleased the PCT received the go-ahead and our Chairman’s NHS experience will certainly benefit the development of the PCT. Naturally I am now anxious for the Chief Executive and Executive Committee appointments to be made as soon as possible.” Dr Glicher also extended an invitation to any GP to contact her (0161 419 4041) should they wish to discuss any aspect of the PCT development.

Follow this link to our PCT Latest Page

You will have received and may even have read, a letter from Judith Smith and Jon Simpson about the COPD service. This arose after a meeting where chestiness of one sort or another, was identified as a cause of admission to hospital in winter.

It transpired that Jon had a plan, but he not been able to put it into action. Of course, once he had Brinnington on his side he had no problems!

The plan is a pilot until April but we hope it will be permanent. Two nurses (Karen & Linda) have been seconded to the scheme. They assess all patients admitted with chest problems and identify those with exacerbations of moderate COPD who are suitable, potentially, for early discharge and home care. They do not take on asthmatics (the FEV1/FVC ratio must be <= 70%), those with acidosis, hypercapnia, significant hypoxia, confusion or other significant illness (e.g. heart failure). There is a firm protocol, which is available if you wish to see it.

We hope that this is the beginning of a much wider chest service, that a register of people with COPD will be built and that the quiet, summer months will allow us to move to a pulmonary rehabilitation service. We also hope that the expertise will cascade down to community nurses and that exacerbations of COPD will be better controlled by, for example, vigorous anti-smoking propaganda, encouragement of exercise, early intervention and so on. Eventually it may be possible for the patients and GPs to have direct access to the service (like the diabetic service) and more involvement in the cases of those who are very ill (too ill to be included) but who are improved on discharge and may benefit from life-style advice.

For now it is a pilot. Small beginnings, big ambitions. Ring me (430 4002) if you want to know more.

Many practices may well use Recorded Delivery to send copies of Patient Records to solicitors etc. Unfortunately recorded delivery provides a maximum of only £28 compensation should the Post Office lose or damage your package. This of course would not cover the staff costs involved in sending a replacement copy.

As a result a number of practices are now sending such packages by Special Delivery with the first level Consequential Loss option. To send a typical set of patient notes (500g > weight > 100g) would cost £3.80 plus £1.20 consequential loss insurance. This can provide for compensation (up to £1,000) for documents sent which have no actual market value but which would result in additional cost to the sender if lost.

Since practices are able to charge postage in addition to the maximum £50 fee, the additional postal cost will be borne by the party requesting the copies. The practice however will have the peace of mind of knowing that should the item be lost or damaged in the post they will be entitled to sufficient compensation to cover redoing the work.

For further information contact the Post Office on 0845 7 950 950.

The GPC has given the following advice:

We have had a number of queries from Practices regarding Stakeholder pensions and whether practices are exempt from the need to provide access to a stakeholder pension.

Your LMC has taken advice from the NHS Pensions Agency in this respect and has been informed that “the existence of the NHS Pension Scheme means that you already have a pension scheme provided by the employer and, consequently there is no need for the employer to set up a stakeholder pension”

There is a grey area surrounding members who have retired, taken their pension and come back to work, However, it is hoped this will be removed before the October 2001 deadline. Practices with employees in this situation should contact the NHS Pensions Agency (01253 774413) for further advice.

Recent reports in the Medical Comics suggest that this Government is suggesting the item of service fees payable for over 75s flu vaccinations was a double payment for work already undertaken by GPs. Therefore, it is reported that these monies will effectively form part of next year’s pay award hence reducing the 2001 pay award for GPs to approximately 1.5%.

Naturally the GPC is appalled by this proposal and has requested GPs to voice their discontent via their Local Medical Committees. Stockport LMC is therefore seeking motions for the Annual Conference of Local Medical Committees to ensure a strong mandate can be given to our negotiating committee, the GPC, for the forthcoming year.

Your LMC proposes to share proposed motions with its constituents through both our Newsletter and the LMC Website to ensure Stockport GP opinion is fully reflected in the motions we send to Conference. Any GP wishing to propose a motion to Conference should submit it either in writing or by email to the LMC office by 6th April 2001. Conference motions can make a big difference.

The current “Access funds” should therefore be used to provide extra non-GP services such as the provision of facilities for hearing or visually impaired patients, or Nurse triage. Such extra services will be reimbursed at 100%. Practices should remember to allow for the “on-costs” of national insurance and pension contributions. Your LMC can provide guidance on this.

Should GPs wish to provide a surgery session at different hours to their current Red Book contractual commitment, they should firstly seek to alter hours of availability, by writing to Margaret Watkiss at the Health Authority.

The need to provide GMS services, in a secure environment, to patients who have a history of adopting threatening or vexatious behaviour towards GPs and their staff has resulted in the establishment of a Local Development Scheme for Stockport. Working alongside the Health Authority your LMC is pleased to announce that the first phase of the scheme will be operational from April 2001.

Initially, one practice (maximum 10 patients at anyone time) has been identified as the recipient of the first patients removed from a practice list as a result of violent or vexatious behaviour towards a GP or his/her staff. Security issues at the practice have been addressed and recommendations are now being implemented. Since the extent of patients of this nature can not be clearly identified from current statistics a fairly tight definition of violent / vexatious will need to be operational. It is hoped that further practices will be recruited, preferably one in each PCG area, as time passes and demand dictates.

Full details of the scheme will be sent to all practices in the very near future .

Your LMC website has just passed another milestone! Over 1000 hits!

In addition to Medical Practices, Health Authorities and pharmaceutical companies we have also been visited by a number of companies who provide locum service to practices. Indeed, one is interested in advertising on our web-site. Discussions will commence shortly.

In the meantime please continue to send in your recommended tradesmen and other ideas for the site.

As previously advised Mottram Hall has been booked for Saturday 2nd June 2001 for the this joint event.

Further information will be sent to all GPs by the end of March.

Your LMC also hopes to announce an end of April date for the postponed Annual Golf Challenge in the very near future.

Paul Stevens will automatically contact all the players who expressed an interest in playing last time.

Any other interested players should call Paul at the LMC office on Old Telephone Number

Please send comments, articles or information to Paul Stevens at the LMC office or by Email to info@stockport-lmc.org.uk.