Seasons greetings to all readers!

To help somebody celebrate this year we will present a bottle of champagne to the winner of our special Christmas Competition.

The competition is open to all Stockport GPs.

To win simply solve the two brainteasers on page 2 of our newsletter and the two new brainteasers on our website.

Recognising that all members will bring different skills to the table, if you can answer yes to some of these questions and can demonstrate your ability you are well on your way to satisfying the competencies laid out in the PCT Executive Committee Member appointment guidance.

With Stockport’s proposed PCT due to go live from 1st April 2001 (subject to Secretary of State approval) timescales will be tight for the appointment of GPs to the Executive Committee. Therefore we need to identify potential GPs to fill the proposed 7 GP Executive Committee positions as soon as possible.

The exact role for a GP member has not yet been identified although roles will probably include management of the prescribing budget, commissioning, clinical governance, information technology and primary care development.

Your LMC is keen to identify potential candidates so that appropriate training can be provided in preparation for the selection process.

Tentative training days have been scheduled for mid January 2001 and it is essential that any GP considering applying participates in the training to be provided.

The Health Authority will fully fund time out of practice to enable GPs to dedicate their time for training purposes.

Your LMC would like to hear from any GP as soon as possible who has an interest in being involved either as an Executive Committee Member, or in any other way such as a Member of a Sub-Committee.

To recap the current maximum charge to include postage, paper, staff and GP time is £50. This however, drops to £10 in October 2001.

When we allow for GP time in the costing, it is unlikely that the current £50 maximum fee is sufficient to recover costs let alone the reduction to £10.

Whilst we can not ignore the Act, a possible defence for practices within the legislation may well be the “disproportionate effort” clause.

In the forthcoming months your LMC will be looking at ways in which Stockport and hopefully Greater Manchester Practices can agree a collective approach to discussions with the Law Society in this respect. We will keep you informed.

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

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

To encompass this change Stockport LMC is currently reviewing its constitution and has established links with the reformed Greater Manchester Locum Group (GMLG).

GMLG is an affiliated branch of the National Association of non-principals, representing and providing advice to non-principals in the Greater Manchester area. A monthly list of affiliated locums is available free of charge to all practices in Greater Manchester via Stockport LMC on Old Telephone Number.

In conjunction with Manchester LMC, your LMC will provide a comprehensive up to date Locum List combining details from the Manchester Locum Register and the GMLG list. Our aim is to include GMC registration details along with Defence Union status and referees. Naturally, it will take some time to collate this information, however in the meantime your LMC will continue to circulate the GMLG list. Practices should therefore undertake their own check to ensure any locum satisfies necessary criteria.

It appears practices are not aware that the exercise is being undertaken and that the households receiving the questionnaires are not made fully aware of the purpose of the exercise. Furthermore the reason given to practices for removal from the practice list via the link system is an obscure “other”.

Consequently, patient records have been returned to the Health Authority, although it is quite clear in many cases the patient will still believe they are registered with the practice. This exercise will clearly be putting patients lives at risk. Your LMC has therefore requested that:

1. All Stockport Practices are made aware of the exercise and that details of any patients deleted from practice lists to date are advised to practices to permit the opportunity to recover the position.

2. The letter to households encourages any previous occupants (sons or daughters) who have not advised their GP of their change of address to do so.

3. Practices are in future advised under separate cover and given at least a three month period to contact the patient to identify their new address prior to deletion from the list.

We have received positive feedback to our concerns and await a formal response. We will keep you informed.

Seen recently in the Health Service Journal:

.............fascinating news from a cyber survey by NetDoctor. It found that over half of men 'would have no problem at all with their partner checking their testicles'. One in five 'wouldn't mind if their partner asked first'. Ever since I tried to make spontaneous lump-checking a pastime in our house, the 'better-half' has kept his pyjama bottoms securely fastened. The survey also asked how men would feel if advised by their doctor to check themselves during an unrelated consultation. The vast majority (72%) would welcome it, and would 'probably follow the advice in private'. I would hope so........rummaging in public is a high risk activity and can be easily misconstrued!

Exactly 100 votes were received in time for the Official LMC Stockport PCT Ballot. This represented a turnout of almost 60% of Stockport GPs. With all votes counted by hand and 85% voting in favour of forming a Single Level Primary Care Trust effective from 1st April 2001 there has been no call for a recount in our election!

In addition to voting in favour of the PCT, 94% of voting GPs were in favour of an executive committee comprising 7 GPs. Furthermore the table below suggests that GPs would prefer a devolved management structure down to probably a locality level. Interestingly, over 50% of those voting would like parts of the management and financial structure devolved to practice level.

All comments made on the voting papers were anonymously forwarded to the PCT Development Committee who now await Secretary of State approval for the PCT following a successful recent presentation to the Regional Authority. Watch our web site for further news.

Follow this link for result.

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In addition your LMC commenced compensation discussions with Solvay through their Chief Executive, Dr John Peter. Solvay have apologised unreservedly for any problems caused to patients and those who care for them by the delays in delivering their product this year. For information the delays were caused by two factors, firstly the two new strains of A virus recommended by the WHO this year proved troublesome and slow to grow and secondly the failure of an industrial autoclave late in the production cycle which took two weeks to replace.

Many practices will recently have received a compensation cheque directly from Solvay valued at 10% of their confirmed order value at 1st October 2000. In addition Solvay agreed a further compensation amount to be paid directly to buying groups (consortiums) in respect of the additional time, effort and resources required assisting practices throughout the period. Further information regarding the distribution of these additional monies will be advised in due course.

Follow this link to our Flu Consortium Index

Despite the difficulties encountered this year many practices have confirmed their desire for the consortium purchase of flu vaccines to continue for next year.

The strengths of the consortium approach are clear not only can we negotiate a very low purchase price which even non consortium practices will benefit from when negotiating independently. But also when faced with adversity the consortium is able to negotiate additional supplies from alternative suppliers and co-ordinate practices for priority deliveries.

In addition the collective purchasing power of the consortium was the main motivator in securing the recent compensation payments for practices, both the 10% to all practices and the additional sum payable to purchasing groups.

Naturally the Consortium must learn the lessons of this year. If there is to be a repeat incentive scheme for practices in 2001 increasing demand, then the Consortium must look at new ways to guarantee supply and delivery schedules.

Moving away from a sole supplier contract has been suggested and this will be considered. Unfortunately multiple suppliers would not necessarily have prevented this year’s difficulties. Granted, depending on how arranged (split supplier for all practices versus alternate supplier across practices) it could possibly have reduced the impact on practices but we would not have been able to source the shortfall from other suppliers as they had already sold out. Indeed it could have actually exasperated the problem, since at least virtually all practices in Stockport were experiencing similar problems and a consistent message could be conveyed by way of the local media campaign.

We will write out to all practices in early January 2001 to take matters forward. Naturally any comments or suggestions as to how we can improve the process will be gratefully received.

Follow this link for latest Flu Consortium News

Following a call to our office from a practice, your LMC wondered how many practices were aware of the implications of the Fire Precautions (Workplace) Regulations 1997 effective from December 1999.

Under the legislation employers are now responsible for fire safety and must carry out a full fire risk assessment, even if the practice is covered by a Fire Certificate. In addition most employers with 5 or more employees (i.e. virtually all General Practices) are required by Law to document the Fire Risk Assessment.

For further information and guidance on completing such an assessment practices can contact Bob Jordan, Operational Services Manager at the Health Authority on 0161 419 4962. Alternatively, practices may wish to contact their Fire Alarm Contractors who may be able to assist (albeit at a cost). Practices covered by Chubb Fire can obtain Chubb Fire’s Practical Guide to Fire Risk Assessment by contacting Charlie on 0845 606 6222 (Cost £110).

Has the World gone Mad - is a GP worth only 55% of a PCT Chief Executive ?

A few nights, ago after having worked from 8.30am to 11.20pm, I was idly flicking through the HSJ and drinking a very large, very dry martinini* whilst trying to wind down after dealing with an epidemic of combustible infants during my co op session. My attention was drawn to the adverts for chief executive of PCTs. My god I thought the salary scale in Stockport will be up to £90,000! This compares very favourably with our intended net of £54,220. No doubt the person appointed to the position will have a degree, postgraduate diplomas, and years of experience in the NHS. But so do GPs! I don't expect the potential Chief Executive will have done out of hours on call. But they will be responsible for a budget of mega bucks. Hold on though, I mused, GPs are responsible for decisions, which if wrong, can (and sometimes do) mean that people die, and they are rightly accountable both in the civil courts and to the GMC.

After sober (or not too sober) reflection I agreed that the salary of the PCT CE was correct and therefore, it was GPs who are grossly underpaid and undervalued. Maybe our intended net should be linked with that of a NHS manger with similar educational attainments (and responsibility?), ie the Chief Executive of a large PCT. Any thoughts?

*Take 4 measures of Gordons gin, and one measure of extra dry vermouth, shake with ice in a cocktail shaker, pour into a chilled traditional cocktail glass add two olives, sit back and enjoy.

The Advisory Council on the Misuse of Drugs (ACMD) recently published the report “Reducing drug-related deaths”. ACMD considers there to be an unacceptably high and avoidable number of drugs related deaths resulting from drug misuse. The report calls for a co-ordinated and integrated initiative at national and local levels. Amongst the recommendations are: (1) Improving Data and Research (2) Better Public Awareness (3) Methadone & Prescribing The report suggests supervised consumption for at least 6 months with Health Authorities monitoring the quality of methadone prescribing and doctors being licensed to prescribe according to their expertise. (4) Reducing Injecting (5) Improved Training & Audit (6) Social Inclusion.

Opinion is split regarding supervised methadone consumption which whilst reducing deaths through diversion may lead to dropping out from treatment since it is unpopular with patients. This appears to be at odds with the “maximising retention saves lives” maxim prevalent in numerous studies. 6 months supervision is also greater than the envisaged clinical guidelines and would increase pressure on pharmacies and drug units. It is further interesting to note that our Health Authority is looking to pilot a supervised consumption programme in Stockport in the early New Year. Your comments and views would be gratefully received.

Earlier this year the Secretary of State announced a review of GP out of hours. The report has just been published and amongst its principal recommendations are a single point of telephone access via NHS Direct (NHSD), more out of hours primary care centres, greater use of nurse triage and improved electronic information exchange.

In addition quality standards are to be incorporated into service level agreements between NHSD and GP OOH providers, and between GPs and these providers. HAs will accredit and monitor OOH providers whilst PCTs will monitor compliance with service level providers. PCTs will also administer funding—the OOH Quality Fund. Night visit fees will be abolished and absorbed by the OOH Quality Fund. Implementation is expected by 2004.

Whilst in Stockport, our co-operative already meets many of the standards, the big question surrounds GPs undertaking their own OOH. Will they be able to meet the new standards. The answer is almost certainly “no” which means all GPs will need to sign up with an OOH that can.

Your LMC website is about to be updated with further information. Do continue to let us have details of your recommended tradesmen as well as any other information you would like to see on the net.

Hits have now reached 800, and I am aware following a request for information about our flu consortium that even Pulse have reached our site!

This month of course we are running our Website and Newsletter Competition to win a very nice bottle of champagne. You will need to answer the brainteasers from both the Newsletter and the Web site to win. Turn back to the front page for further information.

Approximately 14—18 GPs were disappointed as Stockport LMC’s inaugural Annual Golf Challenge was postponed following this Autumn’s heavy rainfall. Heaton Moor Golf Course kindly agreed to carry our deposit forward to 2001 and a date in March or April 2001 now looks favourite for staging the event. More information will follow.

Much discussion regarding proposed venue, type of function and date has been had with our Consultant Colleagues since our last newsletter which provisionally suggested a formal dinner in February 2001.

Preference was expressed for a summer event and Mottram Hall has subsequently been booked for Saturday 2nd June 2001.

Further information will be sent to all GPs in the New Year.

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