The Primary Care Trust Consultation period for Stockport formally commenced on 1st August 2000.

To assist our constituents in making an informed choice your LMC has arranged a series of two meeting to discuss the proposal.

The first meeting will take place at the Pinewood centre on Tuesday 26th September 2000 at 7.30pm. Speakers from the Health Authority and our Primary Care Groups will present their proposals and answer any immediate questions from the floor.

The second meeting to take place on Thursday 12th October 2000, again at Pinewood House (7.30pm), will provide an opportunity for General Practitioners and their staff, alone, to debate the Primary Care Trust issue.

A formal sealed envelope vote will be taken after the October meeting. GPs will be able to vote either at the meeting or within 7 days thereof.

Please do make every effort to attend both of these meetings, we need to know how you wish to be represented—this is your opportunity to inform us.

The Government and Stockport are keen to vaccinate 70% of their over 65 population. A tall order considering only 43% of this age group were vaccinated last year.

Recognising this your LMC has negotiated a further payment to practices who order sufficient vaccine to vaccinate 70% of their over 65s.

Payments to cover additional nurse led flu clinics of between £150 and £500 will now also be made to qualifying practices. Payment will be scaled on an over 65s capitation basis.

This of course will be additional to the £6.45 Item of Service payment practices will receive for vaccinating each of their over 65s against flu this winter. This fee, payable regardless of the number of over 65s you vaccinate is of course further supplemented by the profit of over £5.30 per dose practices purchasing through the LMC Consortium will earn.

Practices should by now have decided upon their practice based flu campaign and it is hoped that the additional nurse monies will encourage practices to run either Saturday morning or early evening clinics as well as co-ordinate visits to patients in local homes.

It is anticipated that the Item of Service payment will need to be claimed manually, thus stressing the importance of good recording systems. In addition all practices will be asked to complete a regular simple audit (probably fortnightly) to monitor progress.

This audit will serve a dual role as the campaign progresses hopefully identifying those practices with surplus vaccines and those requiring extra. It is planned that the LMC Consortium will act as a clearing house for such practices.

The main changes can be summarised as follows:

The Act now permits access to all Manual Health Records (ie those before 1st Nov 1991)

The maximum fee chargeable by a practice for copying notes is set at £50. (including Access, Photocopying and Postage.

To cover circumstances where the fee of £50 (£10 Access plus 35p per sheet plus postage) will not fully cover the costs involved in undertaking the work, we are aware that many practices are charging a flat rate fee of £50 to solicitors in all circumstances.

In addition many practices ensure they have received payment prior to undertaking the work.

For further information, a link to formal GPC guidance can be found on our website, www.stockport-lmc.org.uk.

Your LMC Officers can be contacted by email at the addresses detailed wiithin this website.

Your GPC representative is Dr Malcolm Fox.

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

GPC guidance states that there must be an adequate mechanism in place whereby the result of the examination is reported to the GP.

It has therefore been agreed that midwives will make their records of examinations available to practices for photocopying to ensure relevant information can be entered in the patient notes. GPs will then be able to claim for the visits undertaken.

A joint letter from Alison Ramsey, Head of Midwifery, the Health Authority and the LMC will be sent to practices detailing the arrangements.

My practice has concluded that this is an illogical way to help patients stop smoking and is typical of a Health Authority who think that GPs cannot be trusted to use new and effective medications in a responsible manner. Their reason for promoting this policy is to prevent their large prescribing overspend rising any further, and thus is one of finance not quality. They seem to think that drug overspends are a result of the prescribing of expensive drugs, this is a fallacy, it is a result of poor housekeeping.

The data sheet for Zyban states that it should only be used in well-motivated individuals for a maximum of two months. This is hardly going to bankrupt the PCG drug budget. By referring patients to the Trust’s Smoking Cessation Clinic the HA is effectively doubling the cost as the HA will have to provide extra funds to finance these clinics, money which could be more effectively be spent in primary care. There has been no consideration of the opportunity costs to the patient, presumably a waiting list will develop and when they eventually get to the clinic it will need a half day off work instead of a twenty minute appointment at the local surgery.

Our practice has had a nurse led smoking prevention policy for some years using NRT and we will incorporate the use of Zyban into this. I was under the impression that the government’s policy was to move care and resources into primary care; our HA seems to be reversing this.

During these changing times it is essential that your LMC remains proactive; participating and being representative in PCT, Local Development Scheme, Personal Medical Services discussions to name but a few.

Unfortunately this increasing need for representation is placing a strain on LMC finances. To counter this, although approval was given at the LMC AGM to enforce the Statutory Levy, your LMC would prefer to maintain the voluntary status of the levy. Therefore, with effect from 1^st October 2000 the voluntary levy will be increased from its present 0.875% to 1.1% of superannuable income. Assuming a superannuable income of £50,000 for a full time GP, the increase equates to less than £30 per quarter per GP.

In addition your LMC will continue to offer financial benefits to its members through consortium purchasing, indeed the additional discount secured on the purchase of 100 flu vaccines is sufficient to fully cover the increased levy.

Announced last month the Government’s 10 year plan promises the most radical changes to General Practice in over 50 years. It is true the NHS will benefit from the welcomed cash boost, but why has the scale and speed of the proposed reforms left GPs and Consultants concerned?

The Government, despite limited time for evaluation, appears particularly keen to speed up the move to providing services under PMS (Personal Medical Services) with a target of one third of all GPs practising under PMS contracts by 2002. The intention is that PMS will offer GPs greater flexibility, although replacing independent contractors with salaried GPs could lead to manpower shortages.

Indeed potential manpower shortages are a key concern in respect of the NHS Plan, which plans to offer patients the ability to see GPs within 48 hours, encourages GPs to develop specialist services within a primary care setting along with promoting the salaried GP option through PMS. It is pertinent to note that prominent GP leaders believe achievement of these goals will require substantially greater than the 2000 additional GPs (is this 2000 wte?) the NHS Plan optimistically proposes to deliver by 2005.

Perhaps it is true to say that the old style GMS Red Book contract has become increasingly bureaucratic, and that PMS offers the opportunity to break loose from GMS shackles. However, to protect GPs interests and to ensure the profession is fully valued, it is important that any move towards locally agreed contracts is done with the full backing of the profession and that a local contract is reflective of a nationally agreed contracting blueprint.

Please forward any comments you may have in respect of the NHS Plan to Dr Malcolm Fox, our GPC representative on 01260 252677.

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Because they are cost effective, well trained, responsive to local needs in innovative and flexible ways and provide holistic care that is well received by patients.

Chronic disease, and more recently acute care, is very successfully managed by Practice Nurses in General Practice and the availability of IT, enabling multi-professional record keeping of individuals and families, affords comprehensive assessments and treatment.

The cost associated with large numbers of patients attending hospital and community clinics for routine care means that only those with specialised needs or complications can be catered for. But what about enabling self care, empowerment and monitoring of the many people with asthma, diabetes, coronary heart disease, sexual health needs and much, much more?

If care can be given in General Practice then it should be, because it is far cheaper and more user friendly. To achieve this money needs to follow patients from secondary care into General Practice and Practice Nurses need to retain their professional freedom, authority, responsibility and be free from the rein of bureaucracy that is so stifling to nursing practice.

If they are to continue to provide the cost-effective care that patients need and want, Practice Nurses must guard against bureaucratic restriction in the transition from PCG to PCT by ensuring they remain employed in General Practice.

The Trust’s Anticoagulant Service is overloaded and there has been an attempt to move these patients into Primary Care without any resources following.

Your LMC have informed the Trust that such a shift of Secondary Care Activity to Primary Care can not even be considered before suitable resources are attached to the proposal.

In the meantime a meeting between the PCGs and the Trust has been convened in an attempt to manage the current problem.

Your LMC advises GPs that they are under no obligation to take on this additional work.

Many GPs are once again receiving requests for letters of support for patients appealing against decisions to withhold Incapacity Benefit, Attendance or Disability Living Allowance.

Your LMC’s consistent advice to GPs is that they are under no obligation to provide any such letters.

LMC Officers, along with Dr Bostock met with both Welfare Rights and the Citizens Advice Bureau to agree a way forward earlier this year. A pilot programme of Welfare Rights Officers working part time in a couple of practices to promote joint working was agreed in an attempt to avoid some of the problems of the past.

This has not happened yet, and the LMC would like to hear from any practices interested in such a pilot.

We are pleased to advise that a working group comprising your LMC, the HA, Dr Donald Menzies, Stockport NHS Trust Occupational Health and Practice Nurse representation has been established to discuss the development of an Occupational Health Scheme for General Practice.

Dr David Gilbert has suggested an Occupational Health Scheme should comprise:

COSHH (Control of Substances Hazardous to Health) assessments

VDU and Ergonomic assessments of the workplace

Hepatitis B immunisation status review

Needle Stick Injury Protocol

Pre-Employment medicals for Primary Care Health Workers and GPs

Sickness Absence Referrals, repetitive short term to exclude a medical cause, or long term when advice can be given to the GP as an employer or as a stipulation within the partnership agreement

Obviously this service will vary in cost depending on which members of the Primary Health Care Team are to be included, initially there is only £40,000 pa to provide a service for the whole of Stockport.

Your LMC is currently consulting with GPs to determine the shape and, in the early years, the initial focus of the Occupational Health Scheme. A questionnaire has been sent to all GPs for return to the LMC by Friday 16^th September.

Conscious of Health & Safety regulations and the impending Flu Vaccination Season your LMC has recently put together a bulk buy of vaccine fridges and examination lamps.

Twelve Stockport Practices have combined to buy approximately one dozen fridges and ten examination lamps saving up to £170 per item on catalogue prices.

Please let me know by telephone or email (stevens@which.net) if you are looking to purchase any item of equipment in the near future, chances are other practices within the areas may also be looking to buy a similar item and bulk purchasing secures greater discounts!!

The General Chiropractic Council has a statutory register which was opened on 14th June 1999.

With effect from 14th June 2001, it will be a criminal offence for anyone in the UK to claim to be a chiropractor if that person is not registered with the GCC.

Your LMC and GP colleagues recently met with the Stockport Coroner to discuss the increasing number of methadone overdose related deaths in Stockport.

The Coroner’s opinion is that all methadone prescribing should be done on the Blue FP10 MDA Forms (available from the HA on request) thus enabling chemists to dispense on a daily basis. Prescriptions should be marked “Dispense Sunday’s amount on Saturday” and similarly to cover bank holidays.

The BMA and LMC position is that substance misuse management is not part of GPs NHS core service. Separate resources are needed to properly fund training, staffing and management.

With this in mind and the Coroner’s comments perhaps it would be prudent for Practitioners to carefully review their involvement in methadone prescribing.

We are seeking the views of practitioners on this matter as we hope to engage in discussions with PCGs and the HA concerning suitable support arrangements for practitioners who wish to participate in substance misuse management

The GPC strongly advises GPs not to supply a drug that has been handed in by another patient. To do so the GP would need to be certain of the identity, security and quality of the drug as well identify the manufacturer to avoid liability for a defective product.

The GP would also need to be satisfied that he/she is aware of any product recall issued, that there is no possibility that the drug has been tampered with, that the drug has been stored appropriately, that the patient pack contains the correct information leaflet and that the drug has a product license.

For these reasons the GPC recommends the destruction of drugs handed in by patients.

Latest statistics show it is not just practices accessing our web site!

I am aware that people from Astra—Zeneca, Wyeth and other pharmaceutical companies have accessed our site.

Many of the companies have been keen to keep up to date with our latest Consortium Offerings whilst others have been keen to see whether their product is on the Stockport Cardiovascular formulary available from the site.

Also currently available from our site are direct links to the Stockport PCT Consultation Document as well as the NHS Plan. Keep on Surfing!!

I am pleased to advise details of our first annual Golf Challenge to be held at Heaton Moor Golf Club on Friday October 13th 2000.

The Challenge Competition will tee off from 1.30pm. Rules and format will be advised in due course. Soup and Sandwiches will be available from 12.30pm. An evening meal will be provided along with the presentation of prizes.

The competition is open to all Stockport GPs, for further information and to confirm your entry please call Paul Stevens at the LMC Office or on 07770 616235.

LMC Annual Dinner

Further to our last Newsletter and following discussion with our equivalent Hospital Doctors body, we have agreed to arrange a joint dinner event.

To give everyone a social event to look forward to after Christmas, it is proposed that the dinner will take place on Saturday 3rd February 2001 at the Stanneylands Hotel.

Further details will follow in due course, however in the meantime do keep this date free in your diary.

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