Furthermore, it is possible and somewhat ironic that current PMS GPs may be the key floating voters in the New GMS Contract Decision. With approximately 30% of GPs now involved in PMS schemes, the New Contract must be attractive enough to entice PMS GPs to exercise their return ticket to GMS or this 30% will vote against the contract.

Current GPC timescales indicate the costed contract will be released on 10th January 2003 with a Greater Manchester Presentation Roadshow on Wednesday 15th January 2003 at the Reebok Stadium, near Bolton. The ballot to be completed by March and if a yes vote 80% implementation from April 2003.

The GPC negotiators were in a bullish mood verging on arrogance at the recent LMC Secretaries Conference. Let’s hope the Contract offered justifies their smugness.

Your LMC will be producing a Special New Contract Interim Newsletter ahead of the Open LMC Meeting on Tuesday 21st January 2003 at Pinewood House. This meeting will give Stockport GPs an opportunity to discuss the New Contract with their colleagues. Put both dates in your diary now!

Once again your LMC is dismayed that our PCT failed to fund a co-ordinated programme for vaccinating our Under 65 at risk patients. This despite neighbouring PCTs such as Rochdale and West Pennine having agreed an incentive programme.

Your LMC has calculated that the costs of organising a coordinated programme for vaccinating this group of patients exceed the monies reimbursable to practices by purchasing discounted flu vaccine. Many practices have therefore decided to vaccinate Under 65 at risks on an opportunistic basis only, until the PCT is able to provide appropriate funding to support a coordinated campaign.

Practices will be well into this year’s flu vaccination programme and I guess from the lack of telephone calls to me that deliveries etc from our two consortium suppliers have gone well this year! Both Wyeth & Solvay still have additional supplies available should practices wish to increase their order.

As for next year tender papers will issued to all prospective suppliers by the end of November with a consortium price announced early in the new year. Papers will be sent out to all practices inviting them to participate in mid January.

Your LMC has been contacted by a number of concerned GPs regarding the current state of Psychiatry Services in Stockport.

It is clear that although Stockport PCT have commissioned and are therefore paying Stockport Acute Trust for the provision of a psychiatry service the current service is being provided without the backup of Consultant Psychiatrists.

General Practice has once again been asked to provide the escape valve for secondary care problems. GPs are now being asked to take on the ongoing care of patients they neither have the time nor expertise to manage.

Your LMC believes it is essential that GPs only undertake the work they are trained and paid to provide under GMS. Click here for a model letter, which you may wish to adapt and send to Mrs Sue Alting, Director of Commissioning, Stockport PCT to state your position.

Should any GPs have any queries in respect of this letter please do not hesitate to contact one of your LMC members or Paul Stevens on Old Telephone Number.

The subsidy of up to £20 per full time week in childcare or £4 per day was only offered to PCT Staff and not to General Practice Staff.

Apparently, some 50-75 full time places were available for PCT employees.

At a time when Practices are probably under greatest pressure due to the flu season surely it was not beyond the comprehension of our PCT (remember we are all part of the same NHS family now!) to make these monies available where they were most at need!

Stockport PCT has been operational for 18 months but have there been any tangible improvements to the services for Stockport patients? Many of you will, I’m sure think not. Increased problems in admitting emergency patients to Stepping Hill, a lack of additional resources to undertake NSF work on cardio-vascular, mental health, & care of the elderly, along with a totally deficient adult and child psychiatry service. The PCT complain that this is a very difficult period due to the £6m overspend projected for 2002/03, hence there are no monies to invest in primary care or to commission extra services from secondary care. Understandably this response reduces morale and de-motivates health care workers who are in daily contact with patients in General Practice. What’s happened to the present government’s aim of providing PCTs with new powers to change and hopefully improve the delivery of health care to its local population…?

The PCT will obviously ask for more money from central government stating that they are unable to provide improvements without more money, but I and several other members of the PEC believe other avenues need to be explored. Of Stockport’s £230m budget over £150m commissions secondary care but are we receiving value for money? Inpatient Psychiatry and neurology out patient services??.

A regional comparison shows Stepping Hill to be an expensive provider of certain services such as orthopaedic and ophthalmic operations. This differential should change with the introduction of standard tariffs for many operations from April 2003 but it is vital that the PCT commissions for all secondary care services more shrewdly in the future especially as it has been alleged that Stockport NHS Trust has overcharged the PCT and the previous Health Authority over £2m. So how do we commission more effectively? Direct access for NMR scanning for undiagnosed headaches, more in house physiotherapy to reduce orthopaedic referrals, realistic financial incentives to undertake spirometry and ECGs to manage more respiratory and cardio-vascular disease in Practice etc. What is vital is that monies which would have been directed into secondary care for such services are now directed into primary care.

Much debate will ensue over the forthcoming months and it is likely to pitch the PCT against Stockport Acute Trust leaving Central Government to look on with derision.

GPC recently reported on increasing difficulties regarding ambulances originally tasked to GP requests for urgent admissions being repeatedly diverted to respond to often trivial 999 calls. GPs are increasingly being asked by the ambulance service for “a little more time” beyond the agreed time frame to complete the task.

This of course shifts the patient management responsibility back to the GP and before agreeing to the request the GP should reassess the patient. Such practice is wasteful of GP time and NHS resources duplicating work and detrimental to the care of the patient.

GPs should be aware that agreeing to an extension of the time target they are not only taking on the medico-legal burden, but also allowing the ambulance service to start the clock again, as the calls will not appear in statistics as a failure to comply with DoH targets.

To combat this increasing problem GPC encourages GPs to (i) Decline the request for extension except in the most unusual circumstances and ONLY when they can reassess the patient. (ii) If necessary upgrade call to 999 (iii) Keep a record of original call time, “in hospital time” and job number (iv) Consider whether a full paramedic crew or a technician crewed vehicle is most appropriate (v) Refer complaints to the ambulance service (vi) refute the view that a GP assessed patient should be a lower priority than other ambulance calls (vii) refute the view that the GP can stay with the patient until an ambulance arrives.

To ensure your LMC can keep GPC informed of local difficulties please advise us either by phone or email of any problems encountered

We have all witnessed the reduction in discounts offered to GPs by flu vaccine manufacturers across the past 2 years. Indeed, our flu purchase consortium has seen the discounts offered drop from 60% to 30% in this period. Perhaps the flu manufactures have seen the IoS fee earned by GPs vaccinating their over 65s and decided they want a piece of it! But of course this is not the full story. In Stockport practices are encouraged to identify and vaccinate under 65s who fall into somewhat ambiguous at risk groups. Indeed this is promoted nationally as Good Practice, and fully supported by our Consultant in Communicable Diseases. Unfortunately, despite being more difficult to identify than our Over 65s, there is no IoS fee offered for vaccinating this patient group. Practices will therefore earn approximately £4 per dose (with the Consortium) or less than £3 per dose (Glaxosmithkline—the cheapest supplier to the NHS) to fund such a vaccination programme. My costing indicate that given a robust At Risk database it still costs at least £5 per dose to run a co-ordinated vaccination programme for this patient group and that’s before allowing for practice overheads or GP time!

Hence, as a result of the decreasing levels of discount offered by manufacturers, those GPs running a co-ordinated under 65 at risk flu campaign are doing so at a personal cost of at least £1 per dose—Why??

GPs have often said they have been working for nothing, now you are actually paying for the privilege!!

My first gripe this month concerns the PCTs proposal to change the format of GP appointment to its Professional Executive Committee (PEC). At present there are 7 GP members of the PEC who are elected democratically by the GPs of Stockport.

The management of the present PCT have proposed to reduce this number to 4 and appoint the other 3 themselves. This strikes of cronyism and is a retrograde step in this apparent era of transparency and supposedly greater opportunity for clinicians to influence the provision of health care services. It will mean the PCT will listen more to what it wants to listen to and not to reality. Whilst I am told we are powerless to stop this proposal, your LMC has already indicated its opposition. Please contact your LMC by email or letter with your views on this matter.

The second gripe I have concerns the receipt of prescribing incentive monies which are rightly ours and the bureaucratic hoops we have to go through to procure the monies from the PCT when we have already stated the purpose in writing for their use. Of course for audit purposes I am happy to provide appropriate documentation confirming expenditure but why should we send three estimates to the PCT for the work to be carried out in our surgeries using our monies. GPs, unlike healthcare organisations are not exactly renown for frittering away monies on white elephant schemes! I speak from experience after spending at least 2 hours of my time in correspondence with the PCT in order to release monies to enhance security at our surgery.

Stockport PCT were advised across the summer that their LIFT (Local Implementation Finance Trust) application had failed. Naturally, this is a disappointment as it means much needed resources to develop our dilapidated Health Centres and other Surgery premises will now not be forthcoming.

Our PCT still however have an obligation to produce a Premises Strategy by the end of this year and have therefore commissioned a firm of surveyors, Property Tectonics, to undertake a Condition Survey to obtain information regarding the building condition, statutory compliance and disability access. The report will include layout plans, photographs and costings.

Your LMC has sought guidance from the GPC regarding any potential obligations which could arise following such surveys.

Following the success of the LMC & Consultants Summer Ball this year, next year’s event is scheduled to take place on Saturday May 17th 2003 at The Belfry Hotel, Handforth, Wilmslow. Please make sure you have entered this date in your diary!!

Further information regarding tickets etc will be made available early in the new year, in the meantime if anybody has any suggestions as to how we may improve the event please contact Paul Stevens at the LMC Office—Old Telephone Number.