No sooner have we settled into our Primary Care Groups than the agenda moves forward again, discussing the establishment of one or more Primary Care Trusts within Stockport.

Your LMC is keen to ensure you are not swamped by the reams of guidance landing daily on your desks.

Your LMC is keen to ensure you are not swamped by the reams of guidance landing daily on your desks.

Therefore, to assist the informing process, this edition of your newsletter carries a centre page feature summarising the national debate and local progress to date.

The LMC (the voice of general practice) is represented on the group. Other Stakeholders of the group include the Health Authority (formally responsible for the consultation process), the 3 PCGs, the Stockport Trust, staff representation from the Trust, the voluntary sector, the Community Health Council and Social Services.

A smaller working group formed from this large group is to develop the formal consultation document. If formal consultation occurs for the establishment of one or more PCTs , it has to be for a minimum of 3 months, possibly in July, August and September. Your LMC will be represented on the relevant groups developing the PCG consultation document.

The LMC will then also organise meetings for ALL GPs to discuss the issues involved and a formal vote to provide a clear voice for general practice in the process. We also hope to ensure that the voice of Stockport General Practice is heard. After all we are the key point of contact for most patients when illness strikes, and we control or influence 90% of all healthcare expenditure. Also relevant is the fact that we are the only professional group who personally own much of the infrastructure (premises and equipment) that is used to provide primary care.

You may remember receiving a couple of documents recently entitled Becoming a Primary Care Trust (October 1999) and Primary care Trusts; Implications for General Practice (January 2000) published by the General Practitioners Committee (GPC) of the BMA. Copies of both are available from the LMC office.

The first document (4 pages) was full of questions (but no answers) on the way forward. It is worth referring to when pondering the future.

The second document (18 pages) is a more detailed look at the longer term implications of Primary Care Trusts.

Conscious that time is precious your LMC has highlighted these two documents amongst the plethora of papers written on this subject as worthy of reading.

Clearly it’s vital that we GPs speak up not only to bemoan any burdens we bear in delivering high quality general practice in Stockport, but also to clearly articulate what we want general practice to be in the future.

Please fax, e mail or write to us and let us know what you want from any PCT(s) that are formed-is it better premises, training for new or extra skills, extra staff or extra services in your practice. Perhaps it’s simply more time to do core general practice or more pay?

Improve the health of the community

Develop primary and community health services

Commission secondary care services

A level 4 PCT will bring together commissioning and primary care development with the provision of community health services. They will be able to commission and provide services, run community hospitals and community health services, employ staff and own property. The precise range of community services provided will depend on local circumstances and the views expressed during the consultation process.

The PCT will be managed by a PCT board, comprising:

Chair (appointed by the Secretary of State)

5 lay members (appointed by the Secretary of State and open to local authority elected members)

Chief executive (appointed by chair and lay members with some professional input)

Finance Director (appointed by chair chief executive and lay members)

3 professional members drawn from the executive (clinical governance director 1 GP 1 nurse)

It can be seen that the Board will be largely political appointees and care must be exercised to ensure its culture does not become too bureaucratic. It will be important to ensure the culture evident within General Practice is adopted by PCTs.

The PCT board with the help of the executive will do the detailed thinking (does this mean make the decisions?) on priorities, service policies and investment plans. Decisions on how to take this forward will be delegated to the PCT executive.

The PCT executive will be the engine room of the PCT and is where the detailed work of the PCT will be done or initiated. It will consist of

Chief executive

Finance director

Up to 7 GPs

2 nurses

a public health/health promotion professional

a Social Service officer

One of the trust executive members will be elected chair of the group.

The executive will be working under the direction of a board, which will consist of political appointees. The implementation of any decisions made will be by the executive, thus any unpopular rationing decisions can be blamed by the public on the professionals and not the Treasury.

A note for your diary. The LMC Annual General Meeting will be held on Tuesday 27th June 2000, at Pinewood House commencing 8.00 pm. Light refreshments will be available from 7.30 pm.

Please do make every effort to attend. Items to be received include Last Year’s accounts, a proposed amendment to the LMC Constitution and your LMC’s proposals for ensuring all Stockport practitioners are in a position to make informed decisions throughout the forthcoming PCT consultation period.

A list of preferred drugs for cardiovascular diseases has been published by Stockport West PCG .

The aim is to encourage the use of a shared list of drugs across general practice and hospital colleagues, so helping both reduce costs, encourage the use of evidence based medicine and help co-ordination between hospital doctors and GPs when dealing with patients. The soon to be implemented provision of 28 days discharge medication for patients will help and assist drug stock management on wards.

The full list can be found by following this link. [Cardiovascular Formulary]. GPs are free to use the chosen list (which is subject to 6 monthly review) for “new” patients from now on. It is NOT proposed that patients currently established on other drugs not within the list, should be actively changed, unless for example, patients are having their medication reviewed anyway.

Following the Government announcement that there will be a National Flu Campaign entitling all over 65s to a free flu vaccination, your LMC is pleased to confirm that an Incentive Scheme targeting the over 65s has been agreed in principle by the Health Authority, PCGs and LMC.

Your responses to the 1999 Flu Campaign Audit have proven invaluable in informing the process for the new scheme.

The proposed scheme will provide an Item of Service Payment to all practices vaccinating in excess of 46% of their over 65s.

As can be seen from the Flu Audit Results, this means all practices currently achieving the Stockport Average will qualify for an incentive payment under the scheme.

Furthermore, the amount received per patient will increase once a practice achieves 55%, 60% and 70% of their target group.

Practices who do not reach the 46% target will not qualify for an incentive payment.

This scheme will provide an excellent incentivised opportunity for Practices to make a real difference alleviating Winter Bed Pressures.

As a word of caution, experience gained from those practices currently vaccinating in excess of 65% of their over 65s indicates that practices should commence planning their Flu Campaign at the beginning of the Summer!

It is likely that this scheme supplemented by the proposed Government Promotion will substantially increase flu vaccination uptake within practices and consequently supplies required. Solvay Healthcare, the LMC Purchasing Consortium Suppliers, are fully aware of both the National and local initiatives

The biggest public health programme in Britain for many decades was recently launched to improve the provision of healthcare for patients who either have, or are at high risk of getting, coronary artery disease.

The framework calls for the co-ordinated and concerted implementation of evidence based care for these patients. General practice will be central in ensuring that patients are offered comprehensive and co-ordinated care. This requires real resources, for example training for all staff (including GPs), equipment, IT and time (what are we going to stop doing to deliver the care that patients clearly deserve?).

The LMC will be advise the PCGs and Health Authority that Primary Care Investment Plans in the future will need to recognise the realities of general practice, and the effect of chronic under-investment. Practices should be identifying what costs will be associated with fulfilling the requirements of the NSF, so that they can engage in constructive and informed negotiation with their PCG for resources.

If you need advice or help in identifying costs, or negotiating with your PCG, please let the LMC office know.

Attached with your newsletter is a detailed list of the LMC’s functions. No excuses now for knowing what the LMC does!

In line with national BMA recommendations Stockport LMC’s constitution requires amendment (dare we say modernisation!) to reflect modern general practice. All GPs will in due course receive a draft document to pass comment on.

Detailed within the newsletter is a list of your local LMC representatives. The present distribution provides each of the current Primary Care Groups with 6 LMC representatives.

It is proposed that your LMC Constitution be amended to formalise this arrangement.

Please feel free to contact any member of the Executive Committee or board to discuss issues pertinent to either your practice or General Practice as a whole.

Your local representatives will be assisting in the Primary Care Trust Informing & Consultation process.

Following on from the success of the Flu Purchase Consortium, your LMC has secured an excellent Pneumococcal purchasing arrangement with Wyeth Vaccines securing a 35% discount and 120 days credit.

Since practices order pneumococcal on an ad-hoc arrangement throughout the year, practices are not required to sign up for a specific quantity only an intention to purchase. Your contact is Joyce Brown on 07770 832691.

Your LMC is currently discussing a consortium approach to purchasing Zoladex / Prostap, Travel Vaccines along with Stationary, Clinical Consumables and Practice Equipment.

With this in mind if any practices are currently looking to purchase either vaccine fridges, examination lamps or couches, please call Paul Stevens on 07770 616235.

The final agreed protocol has been circulated. Your LMC would like to remind its constituents that the provision of weekly scripts for monitored dosage systems is goodwill on the part of GPs and not part of our terms of service. It is not required in nursing homes and it is not GPs responsibility to provide this service for rest homes. This valuable service should on the whole be available to those patients who you wish to maintain in the community who through physical or mental incapacity are unable to manage their medication, and have no carer (friend relative or paid) who is able to do it for them.

Our advice is that all requests are personally approved by the GP.

With the Chief Medical Officer’s recent (controversial) consultation paper “Supporting doctors, protecting patients” emphasising the difficulties that we face in general practice, relating to our own health and that of our staff we have begun to look, with the Health Authority, at the potential to develop an occupational health scheme for GPs and their staff. As part of the scheme we would like to pursue the idea of a GP (perhaps employed by the Health Authority) to provide locum cover for sickness or sabbatical study leave.

If any of you have an interest in the subject and would like to share you thoughts please contact us at the office.

If you have a practice web page and would like a free hypertext link from your Stockport LMC web page please let us know!

Send your web page URL to Paul Stevens on info@stockport-lmc.org.uk.

Let others see your creativity!

The Government after re-organisations, pleading, threatening, & persuasion has finally decided to throw large amounts of money at the NHS in an attempt to make it work (£19.4 billion over 4 years).

I personally (KW) will be amazed if more than a few crumbs end up in General Practice. It will almost certainly be swallowed up in the black hole of secondary care. The Trusts have armies of managers with expertise in making bids for resources and erudite Consultants at the leading edge of medicine who are adept at shroud waving. We in General Practice deal with 90% of illness and are too busy to put together decent bids for additional resources (most are done at lunch time on the back of used envelopes) and too sensible to shroud wave.

All research evidence suggests that for a cost effective and efficient health service it is essential to have a strong well-funded primary care sector.

We in general practice need

1. Professional degree class managers at practice level who can enable the clinicians to effectively and efficiently perform the tasks they are trained for. These managers must be properly remunerated and additional funds should be made available.

2. Premises of a high standard, which should be comfortable to work in and a pleasure for patients to visit. Experience shows that if the premises are owned and maintained by NHS organisations, they tend not to be properly maintained (health centres).

3. IT&M together with training to enable clinicians to perform their clinical duties optimally, and not used as a management tool for control purposes.

4 Incentives for effective and efficient practice. At the moment there are few quality incentives for practice. In fact there often seems to be a perverse incentive to do as little as possible to keep costs down.

Many GPs have expressed an interest in an LMC Golf Tournament. Naturally, it would prove very difficult to organise a one day event. However, it may be possible to organise either a knockout or league style event with participants arranging matches with opponents at mutually convenient times.

Anyone interested should complete the tear off slip attached and return to Paul Stevens.

Including preferred playing days, Golf Club and Handicap details will assist assessment of viability.

Discussions are currently underway with our equivalent body within the Acute Trust to resurrect the popular LMC Annual Dinner.

A number GPs and Consultants have expressed great interest in such an event. Should it be feasible to organise this year we would probably be looking at an October date.

In order to further assess numbers please either complete the tear off slip enclosed or email us if you would be interested in participating.

Following the Bristol Inquiry and the Shipman Case the public confidence in the medical profession has been tarnished.

The Government has set out in its White Paper, Supporting Doctors—Protecting Patients, a proposed framework for dealing with poor clinical performance. The message is clear be pro-active not reactive. Therefore dealing with performance issues at an early stage of development before they become a GMC referral.

Your LMC in conjunction with Stockport Health Authority and post graduate tutor, Dr John Adams, have formulated a panel whose function is to investigate and advise those small number of GPs, estimated to be 3-5 per Health Authority according to DoH statistics whose performance is a cause for concern. It is imperative that this procedure is objective and is not criticised for being a witch hunt.

There have been 3 meetings of the panel to date, and the panel is formulating criteria for referral to it. For further information please contact David Gilbert or Ranjit Gill at the LMC Office.

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