If you want to know how Technology will revolutionise the NHS the IT4U Exhibition is for you. Amongst the exhibits will be Web Based Results Reporting, the Ward Discharges Project, General Practice Intranets and Internet Appointment Booking, Pharmacy links and the European Computer Driving License.

The event is high profile with Professor Bellingham, Chairman of the NHS Information Authority giving the Key Note speech.

Feel free to drop in during the day (PGEA accreditation has been sought). Exhibitors will include Stockport Acute NHS Trust, British Telecom, Primary Care Training, North Area College, Compaq (provisional) Pharmacists and General Practitioners.

Professor Bellingham is well aware of the good progress being made in Stockport having presented first prize in the Healthcare IT Effectiveness Awards to the Acute Trust for their Mail Storm Project and he will present a summary of the work being carried out nationally and comment on the progress to date in Stockport.

The Mail Storm Project effectively organises clinical correspondence across specialties within the Acute Trust allowing access to all relevant information regarding a patient across the Trust at the press of a button. Subsequently, the Acute Trust have been continuing their work, particularly web-based developments including electronic referrals and discharge letters.

The IT4U promises to be a day to remember—come along and see how today's technology will shape tomorrow’s practice.

The survey will provide essential evidence to the GPC for this year’s DDRB and will certainly inform the negotiations for a new NHS GP contract.

It is appreciated that the survey is some 12 pages long but please remember this is the chance for every GP to make his or her voice heard and to influence negotiations.

Please do take the time to complete and return the survey by 3rd October (a pre-paid envelope is included), of course GPs are severely time pressured at the moment, but that cannot change without the help of all GPs— it is your future!!

Now that the scheme is operational your LMC would welcome any feedback from practices who have used the scheme to date regarding ease of access & response timescales etc.

Furthermore, your LMC would encourage practices to make full use of the scheme. It has taken a long time to establish—we certainly do not want to lose any of the monies put aside for the scheme as a result of under-utilisation!

At the same time, it has been agreed that we will establish new LMC Constituencies to link with the anticipated internal boundaries of our PCT. We believe these boundaries or neighbourhoods will be closely aligned to the eight Local Authority areas and your LMC boundaries will merge these to form the following four constituencies:

Stockport North (Heatons & Tame Valley) 41 GPs

Stockport West (Bramhall & Cheadle) 51 GPs

Stockport East (Marple, Bredbury & Romiley) 30 GPs

Stockport Central (Heathbank, Stepping Hill & Hazel Grove) 44 GPs.

Each constituency will have between 4 and 6 members representing their interests.

At this stage therefore we are looking for any GPs who may wish to stand for election to express their interest so that we may include them on the voting papers.

Any GP considering putting their name forward who wishes to discuss the nature of the role and / or the commitment required should contact either Ranjit Gill, Keith Wells or David Gilbert. Each will only be too keen to encourage new members on board!

Remember it is your LMC and we rely upon your assistance identifying issues and concerns so that your Committee can represent you effectively.

Your LMC has been advised that Stockport Health Authority has calculated fee advances in a manner which is not in accordance with the Statement of Fees & Allowances or in line with neighbouring Health Authorities. The July advance was calculated using the method laid down in the S.F.A. resulting in the lower advance. Following discussion, and on highlighting the potential cash flow implications for practices it was agreed that the Authority will revert to the old method of calculating advances until January 2002. Advances in August were calculated to include any shortage suffered in July.

The calculation detailed in paragraph 76 of the S.F.A. will be used from January 2002 and includes a proportion of Basic Practice Allowance and additions, Capitation Fees, Seniority, PGEA and Child Health Surveillance.

All practices should have received a letter detailing the recalculations for August along with details of the monthly advance of fees they can expect in non quarter end months from January 2002. The advance figure will then normally remain constant throughout the year unless there is a significant change within the partnership.

Whilst this change does not affect the amount of money you will receive it does affect the timing of the receipts and the mid sized Stockport practice’s cash flow will be £3,000 light during the first two months of each quarter. Some practices will be affected by as much as £6,000—£10,000 per quarter.

The cash flow implication could be exacerbated for those practices who pay partners taxation from the practice account as the first month of the change is January 2002, when the first instalment of tax for the year fall due for payment.

It is therefore advisable that practices calculate the potential shortfall for their practice and assess the impact on the practice bank account. An initial assessment can be undertaken by reviewing historic bank statements, deducting the calculated shortfall from the end of day balance and ensuring the practice account remains either in credit or within its agreed overdraft facility. Naturally practices should undertake a more detailed analysis should their practice be undergoing significant change such as partnership change or substantial capital expenditure.

Practices will need to make any necessary provision with their banks by January!

Should practices require any further guidance please do not hesitate to contact Paul Stevens at the LMC office.

It seems that the Executive Committee of the PCT is now to be known as the Professional Executive Committee with the unfortunate acronym PEC.

The Library is based on the first floor of Pinewood House and can be accessed via the stairs or lift. The Library offers resources and services to support training, education and clinical practice across the Stockport Health community and for staff and students of Manchester University. Offering:

Books – covering all aspects of healthcare. Books can be borrowed for periods of 3 weeks or 7 days depending on demand. These can be renewed by visiting, phoning or e-mailing the Library, unless the book has been reserved (just remember to renew or you will be fined for late return of books). Books out on loan can be reserved and you will be informed when they are ready to collect. You must have your library card with you to borrow a book.

Journals – we subscribe to 150 titles. Journals are for reference only and cannot be taken out of the library. Details of journal holdings can be found on the intranet site.

Videos – an extensive collection of management videos. Videos can be viewed in the Library and are also available for loan to departments.

Computers – both in the library and the adjacent computer room. The computer room is sometimes closed for training so please phone in advance to check.

Photocopying – there is a small charge for photocopying and all copying must be done within the Copyright Act

Databases - The Library has access to a range of databases via Aditus, the North West health knowledge portal. These include: Amed, BNI Plus, CINAHL, Embase, HMIC, Medline & PsycInfo. In addition the Library also offers access to Topley On-line & RPS E-PIC and the Cochrane Library. For more details pick up the databases guide from the Library or check on our Extranet site. The site includes details of services offered and a range of links to useful sources. It can be found under Stockport NHS, Education, Library.

Document delivery: the library has links to healthcare libraries across the North West and can order journal articles from these libraries for you. If not held regionally journals can be ordered via the British Library or John Rylands University Library. There is a charge for this service.

Training: training can be provided on a one to one basis or for small groups. Training can cover searching databases and searching the internet.

To use the Library’s services you must register with us. You will need to complete a registration form and for security purposes will be asked for id.

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For 2001 GPs will receive an Item of Service payment of £6.55 per dose plus the administration fee for each over 65 vaccinated as well as, of course, any difference between discounted purchase price and the NHS price. GPs will also receive the administration fee for any other patients vaccinated.

The GPC has stated that if a patient under 65 and at risk presents for vaccination they should be, but there is no obligation for practices to keep morbidity registers and spend time and money chasing these patients unless local funding is secured.

The PCT has been approached in this respect and a scheme proposed. Unsurprisingly despite the CMO’s recommendation that all under 65s at risk should be vaccinated, our PCT has declined to provide the resources claiming lack of money. Bearing in mind each emergency admission apparently costs £2,000, a scheme costing £60,000 would only need to prevent 30 admissions across the winter to be cost effective!

Presumably, we are expected to vaccinate these particular patients for free!! I may be a little sceptical but I fear the PCT may not be the GP friendly organisation we all hoped for, this decision does nothing to alleviate my concerns.

All practices should by now have agreed delivery dates for their flu vaccine. Remember that Solvay have stated vaccines will be delivered during “a week ending” and therefore practices should not book clinics until the week after.

Both Solvay and Wyeth are reported to be on target for scheduled deliveries this year.

Stocks of vaccines for practices who may wish to target at-risk under 65s are low with Wyeth now completely out of stock, my understanding is only Solvay have a limited availability of vaccines for an October delivery.

Just to share a few thoughts on Stockport HIMP. This inches thick document thumped onto desks recently.

I stared at it with sinking disbelief at the enormity of its wasted effort. What a pile of bureaucratic nonsense!! Obviously it is intended that its lists and action plans would be implemented by those poor sods at the end of the line. Yet it comes with no indication of matter relevant to the recipient. The consequence of this is that recipients must read the entire document in order to identify stuff they need to implement!

Do they really think this is going to happen? Do they really care? Or is the production of the document a means in itself? If there is anyone out there who cares can someone please advise them that most of the 'poor sods' who can actually make these intended improvements to service delivery are too busy seeing patients etc to read this piece of long winded irrelevance

We have been a third wave PMS practice for 4 months; I personally have found it a very liberating experience. We are not now concerned with chasing every last IOS and can concentrate on quality.

The practice has already identified areas for improvement and these are being addressed. We applied for “growth” for a nurse practitioner and as there are not the nurse practitioners out there to employ have commenced the training of one of our practice nurses who has taken on this role. This process has been very enlightening in itself. An experienced practice nurse has a huge amount of experience, facilitating simple diagnosis and treatment has opened my eyes to the great possibilities of skill mixing. Already there is nurse triage and a nurse surgery (with GP support). This has enabled us to improve our access so every one is happy. The patients can get appointments, the nurses are using and developing their skills, the doctors are less harassed and the management and reception staff feel that they are not now acting as a barrier between doctors and patients.

We have yet to agree monitoring but hopefully we will be able to agree a simple monitoring process with the PCT, which will be attainable by future waves of PMS practices.

One frustration is that the Primary Care Development Committee of the HA did not share our vision of the development of general practice and chose to fund extra ECG services and additional minor surgery in secondary care and rejected our bid to perform them in the practice. We strongly feel that this was mistaken and will continue to agitate for their funding in primary care.

All things considered entering a PMS contract has been a positive experience for the practice freeing us from the inflexible* “John Wayne“ (a GP’s got to do what a GP’s got to do) GMS contract. However we do not regard our present contract as cast in stone and will continue to negotiate with the PCT to increase resources so we can provide the services our patients deserve in our practice.

Least I sound too upbeat about PMS, I recognise that the real agenda is to get more work of a higher standard for the same money. GPs do deserve more money for the same work (as we all agree we are underpaid and overworked). This is where the negotiations must begin, practices should go into PMS, only when they are ready, with their eyes open for the many potential pitfalls and not just because someone thinks it’s a good idea .

I would like to take this opportunity thank General Practitioners for their understanding and co-operation over the last few months during a difficult time within the FHS Contractor Payments section.

Since January this year Lorraine Hesford (Payments Manager) has been away due to long term ill health. Our best wishes go to Lorraine. Carole Slack, Lorraine's deputy left in May to take up a new post in Manchester Health Authority.

At this point our resources were severely stretched and it was becoming difficult to hit deadlines for some payments.

Our fortunes have recovered now we have been able to secure Alison Utting on a six month secondment from Bury and Rochdale to cover for Lorraine and in late August Caroline Cadman joined us from West Pennine Health Authority as Deputy Payments Manager. The section now has a full team in place and normal service has been restored. Once again many thanks for your patience during a difficult time.

As things stand with effect from October 24th practices undertaking the arduous task of photocopying patient records to facilitate for example a personal injury claim (a non NHS activity) will only be able to charge a fee of £10 to solicitors.

At a time when morale in General Practice is at an all time low, at a time when patients are being promised access to a GP of their choice within 48 hours, at a time when General Practice is attempting to implement National Service Frameworks with minimal resources, practices will effectively have to use NHS resources to subsidise the copying of notes for a private legal claim.

This is an extraordinary waste of NHS monies and the opportunity to offset the costs of the photocopier, paper and staff costs against the private sector.

Practices could of course send the records direct to the solicitors for them to copy. This could jeopardise patient care and potentially lead to the loss of the notes. Whilst solicitors will state that they handle numerous legal documents, the reproduction of legal documents will typically only delay a case, medical records cannot realistically be reproduced. Furthermore, sending records provides difficulties to GPs wishing to remove non-relevant information.

Of course this is not a problem that has just arisen, representations have been made locally to MPs and nationally by the GPC to Government across the past TWO years. Typically to date no resolution has been reached.

We have been promised a revised fee structure by the end of this month, however it is probably appropriate for practices to consider contingency arrangements should this be delayed.

Since October and the flu vaccination campaign is always a particularly busy period for General Practice, and since practices have up to 40 days in which to provide access to medical records, practices could delay responding to any requests received on or after 24th October by the full 40 days. This will allow a further 6 weeks in which time it is hoped a revised fee structure will have been agreed.

We will of course keep you advised of developments.

This summer I travelled to the Indonesian island of Sulawesi (for those of you without GCSE geography it is the funny shaped island next to Borneo). We travelled to a small town called Mamasa, which is in the mountains of central Sulawesi 70 kilometres along what can loosely be described as a road. It is very remote, unspoilt and beautiful.

One morning we managed to lose ourselves. The locals are very helpful and anxious to practice English. The Questions asked are “where you from? how many children do you have? and what do you do?”. It seemed that we had stumbled into the back of the local hospital/clinic and when I said I was a Doctor the chap we were speaking to dragged us into the clinic to meet his doctor.

The doctor gave us a tour of his very primitive establishment. There was a young man in one room with a large wound on his leg, which had been neatly sutured. In another room was another young man who seemed to have an acute abdomen, and was being managed conservatively (by benign neglect). A woman was lying on a stretcher looking a little unhappy but not too poorly. When I asked what was wrong with her I was told, “post partum rupture”. I sincerely hope she only had a perineal tear and not a ruptured uterus, as I don’t think she would have survived that in Mamasa. The last patient I was shown was a very cahexic man with a drip running. His family had brought him in that day from one of the villages. He had TB, which I was told was a great problem. Although the doctor had the drugs to treat TB the villagers only take the drugs till they feel better then return to their farms. We were told he died the next day.

The NHS with all its faults perhaps does not seem so bad after all!

You may know that David Gilbert and I are members of the PCT’s Executive Committee (PEC). In these early days the PCT is developing its internal structures to enable it to develop the mechanisms to make Primary Care better.

David Gilbert has expressed his interest in being involved in Clinical Governance and “Out-of-hours” service provision, whilst I have expressed an interest in participating in the commissioning of secondary care services as well as the interface between primary and secondary care, so called shared care and intermediate care.

A process known nationally as a “Strategic Outline Case” (SOC -more abbreviations-maddening isn’t it! ) to invest large sums of money in the total Stockport NHS community is being developed for initial submission to Ministers around April 2002.

If the whole process is successful new investment could begin to flow into Stockport around 2004/5.

Don’t hold your breath, but it’s possible in the medium term things may actually get (a little) better! I will attempt to keep you up to speed with General Practice related PCT developments through the forum of this newsletter.

Most Stockport Practices have participated in the very well presented PCT Access Workshops.

Practices have realised that they can benefit from some of the work undertaken by the practices who have to date been involved in the Stockport General Practice Collaborative, spearheaded by Jack Sharp.

Many of the ideas will be used as part of practice’s action plan and objective setting to realise the second tranche of Investing in Primary Care monies.

Not wishing to dampen the enthusiasm of practices and certainly not wanting to discourage investment in Primary Care we would urge practices to be realistic when setting their objectives.

Yes the monies are welcome but they are NOT sufficient to rectify the demand issues currently prevalent within the NHS. We should of course utilise these monies wisely but we must remember to calculate the full cost of any initiatives established and ensure this cost does not exceed the first tranche of monies now received by practices.

When calculating full cost we must include GP time and staffing whether that is new staff or additional hours for existing and covering staff at 100% (any less diminishes practice income) plus add on costs - NHS Pension Scheme employer’s costs (7% from April 2001), Employer’s National Insurance Contributions (say 9.2% including employers rebate) as well as an element for relief (say 11.5% which allows for 5 weeks holiday and 1 week sickness absence). Remember also to make allowance for the enhanced rates of pay you may need to pay to staff working extended hours

Furthermore practices should ensure they include any additional cleaning costs. Practices should also fully consider additional heat & lighting costs as well as other administrative costs such as stationery.

General Practice is keen to improve access to its services but there is no slack in the system, unless fully resourced the implementation of new ideas and schemes will mean stopping another activity.

Over the next few months, increasing volumes of information will be sent to GPs, and your LMC and the GPC will need to canvass members’ opinions. The GPC Discussion Forum (www.bma.org.uk/gpc.nsf) is potentially a very useful way to get discussions underway on a national basis. Please use the discussion forum to let colleagues around the country, and the GPC, know your views, the more information we can share and the better.

GPs should contact Ruth Holland at the GPC if they have any queries about the forum, or send us an e-mail via the site. In addition, the GPC Principal Executive Officers (June Taylor for the North West) are always glad to hear from GPs on an informal as well as formal basis if you have any points to make, or questions to ask—go on give it a try!

This question came up recently and strangely enough it was very difficult to ascertain what the rules actually are. On consulting the Red Book, NHS regulations and talking to Margaret Watkiss and the medical advisor the rules are that the HA can allocate a patient to a practice if no practice will accept them. However the practice have the right to immediately ask for their removal. This process takes 8 days. There is a “gentleman’s agreement” in Stockport that practices will keep an allocated patient for 3 months. Who agreed this and when seems to be lost in the mists of time. The allocation can take place if the patient lives in the practices defined area. Thus a practice that says their practice area is the whole of Stockport could theoretically have a patient allocated from anywhere in Stockport. If a practice has a more tightly defined area say ½ mile radius of the surgery the allocation can only take place if the patient lives within this area. This does not prevent the practice accepting patients outside this area.

Stockport LMC is pleased to announce a pneumococcal consortium purchasing arrangement with Aventis Pasteur MSD.

The terms and conditions for Pneumovax® II in a prefilled syringe include:

25% Discount – Purchase Price £7.50 plus VAT – NHS Price £10.00 plus VAT

All practices supplied and invoiced directly.

Up to 120 days credit (payment due by 31^st December 2001).

Free Delivery if order value over £100 (i.e. 12 Units).

Stockport LMC has been informed that Aventis Pasteur MSD has a strong supply position. However, as always at this time of year, it is prudent to order early to ensure deliveries can be made in time for your clinics.

Practices wishing to place an order should contact their local Aventis Pasteur MSD representative, Rebecca Cabrejas on 07976 543372.