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  • 1. 17 – 23 JULY 2006 TH RD A DIGEST OF PROFESSIONAL NEWS, GUIDANCE AND POLICY FOR PRIMARY CARE CLICK HERE TO ACCESS RCGP ONLINE RESOURCES FOR MEMBERSSeven Days 1 17th – 23rd July 2006
  • 2. CONTENTSPROFESSIONAL NEWS: CMO Review: RCGP Consultation, Summary and Comments; First Statistics 2 on Doctors’ Performance Concerns; GPs Warned to Get Licenses for Waiting Room Music. GUIDANCE: Updated VAT Guidance for GPs; Medical Secretaries Access to NHS Care Records Service; GMS Guidance 2006/07 (England).CLINICAL NEWS: Audit of MS Services; Mental Health Patient Safety Incidents. 3 GUIDANCE: Black Cohosh Linked to Liver Disorders.ENGLAND ANNOUNCEMENTS: RCGP Joins Electronic Records Taskforce; OOH National 4 Requirements Clarified by RCGP/DH; NHS Charges Report: Prescriptions and Fees for DNAs; Review of Allergy Services; Prescription Costs Fall for First Time Since 1976; Tariffs to Shift Services into Primary Care. PARLIAMENTARY NEWS: Consultation on Smoke-Free Legislation; HER2 Testing Now Widely Available.WALES ANNOUNCEMENTS: Watchdog Confirms Fall in Waiting Times; Annual Health Statistics 6 Published; Better Healthcare Premises. PARLIAMENTARY NEWS: Smoking Ban Consultation Launched.SCOTLAND ANNOUNCEMENTS: BMA GP Partnership Guidance for Scotland; Heart Operation 7 Survival Rates Published.NORTHERN IRELAND ANNOUNCEMENTS: Implementing NICE Guidance; Consultation on Medical 7 Regulation. PROFESSIONAL NEWS: CMO Review: RCGP Consultation, Summary and Comments Consultation and Summary: On Friday 14 July, the Chief Medical Officer (CMO) for England Sir Liam Donaldson published his report, Good Doctors, Safer Patients, which sets out his proposals to strengthen the system for assuring and improving the performance of doctors. It responds primarily to the recommendations of the Fifth Report of the Shipman Inquiry, which examined the role of the GMC and the broader arrangements for medical regulation. From 31 July to 1 September the RCGP will consult with Members, Fellows and Faculties to inform a considered and structured response by the College to the proposals – ahead of the 10 November closure of the CMO’s consultation. Via a dedicated webpage the RCGP will ask the membership to respond to specific questions regarding the recommendations, especially about the role of the College. In anticipation of the consultation, the RCGP has prepared a summary of the report to allow Members to synthesise the conclusions of the CMO, and the rationale behind them. Good Doctors, Safer Patients (RCGP Summary Paper: 11 Pages) Comments: Responding to the “first proper review of medical regulation for over 30 years”, Professor Mayur Lakhani, Chairman of the RCGP, said: “We are pleased the report acknowledges that the majority of doctors provide good quality care for patients and emphasises the need for clearer standards of professional practice. The College has always advocated the need for stronger patient and public involvement in healthcare”. Professor Lakhani also acknowledged the concerns that GPs will have with regards to workload, commenting that: “The emphasis must be on support, education and professional development and we will be working closely with our colleagues on the GPC to ensure a workable and supportive programme to assist all GPs in securing re- licensure and re-certification. “ Seven Days 2 17th – 23rd July 2006
  • 3. RCGP Response to CMO Report (Press Release)In its response to the report, the GMC has welcomed the proposal that revalidation can now proceed based onstrengthened local systems including appraisal; but advises that changes to fitness to practise procedures need tobe closely tested for regulatory impact and cost. It disagrees with proposals regarding shifting the responsibilityfor medical education, arguing that these activities must remain linked to the core GMC functions of registrationand revalidation.GMC Response to CMO Report (Press Release)First Statistics on Doctors’ Performance ConcernsThe National Clinical Assessment Service (NCAS) has published a report - Analysis of the First Four YearsReferral Data – profiling the 1,772 cases where NCAS was approached for help in dealing with performanceconcerns about UK doctors or dentists between 1 April 2001 and 31 March 2005. The document examinesreferral patterns within the medical workforce, and suggests that concerns about practitioners’ behaviour are atleast as common as concerns about clinical capability. The data was used in the CMO’s review of medicalregulation as part of a wider discussion about the incidence of performance concerns amongst doctors. The mainfindings are:  Doctor referrals from England are currently around 620 a year - 250 a year from the GP sector and 370 from secondary care. Referral rates from career grades are approximately equal between sectors.  The rate of referral to NCAS increases with age and rises steeply after 60 amongst GPs, but not for secondary care practitioners.  Referral rates are lower for women than men in both sectors.  In the GP sector, white practitioners account for 51% of referrals, but there is no national workforce comparator. NCAS has proposed introduction of ethnicity monitoring in primary care to fill this information gap. Most white referrals were UK-qualified (89% for GPs and 82% for secondary care), while most non-white referrals qualified outside the UK (79% for GPs and 81% for secondary care).The report marks the start of a new phase of analysis of NCAS casework, which will allow patterns to be identifiedand performance concerns tackled more quickly and effectively.GPs Warned to Get Licenses for Waiting Room MusicThe Performing Rights Society, which administers copyright payments for public performance, has warned GPsthat they need a license before playing music in waiting rooms, or even via telephones for patients on hold. ThePRS estimates that only 34% of UK GP practices have the necessary license to play music for waiting patients.There is no charge for music played in a therapy session or a treatment room.Health Practices Campaign (PRS Advice Page)GUIDANCE:Updated VAT Guidance for Dispensing GPsThe Dispensing Doctors Association (DDA) has provided substantially updated VAT Guidance to GP dispensers,informed by its recent meeting senior representatives of HMRC. It includes: more detailed spreadsheets allowingfor simpler accounting of unrecoverable input tax and the end of year adjustment; a fuller discussion of personallyadministered items and partial exemption; updated allowances information; and a discussion of the lower rate forcontraceptives, and proposed changes to the treatment of NHS rent and rates reimbursements.Medical Secretaries Access to NHS Care Records ServiceNHS Connecting for Health has produced a briefing on how medical secretaries will access patient informationwhen the NHS Care Records Service is rolled-out.It describes how a “standard package” of activities has been developed for the role of medical secretary, whichgroups together the functions they perform - for example, making of appointments, reading clinical records, oradding a clinical record. This standard package is a baseline which sets out the minimum level of accessassociated with a job, and can be adapted to meet local requirements by adding extra activities. Once thestandard package has been agreed, it is built into the software being developed to deliver the NHS CRS. Amedical secretary putting their smartcard into the “reader” should then gain access at the right data level.NHS Care Records Service: how medical secretaries will access patient information (NHS Connecting for Health)Seven Days 3 17th – 23rd July 2006
  • 4. GMS Guidance 2006/07: EnglandFollowing publication of the GMS guidance for 2006/07 on-line, NHS Employers are currently mailing two printedcopies of the guidance to every GP practice, for use as reference document over the coming year. The guidancedetails the changes to the contract for 2006-07 and should be read in addition to the original “blue book” guidanceand supporting documentation, which remains relevant unless otherwise stated.If practices require additional copies of the guidance, further than the two they receive, they will need to downloadand print off: Revisions to the GMS Contract 2006/07: England.CLINICALNEWS:Audit of MS ServicesThe first national audit of NHS services for Multiple Sclerosis (MS), jointly commissioned by the Royal College ofPhysicians and the MS Trust, has been published this week. The report examined whether NICE guidelinespublished in November 2003 were being implemented. It covers SHAs, PCTs, NHS Trusts and people with MS,and represents the first “360 degree” audit of its kind in the UK. The report concludes that: “Current serviceprovision is of low quality and inadequate quantity. Most of the seven recommendations made in the NICEGuidelines are not complied with at present, there are few plans to change this, and the standard of dataavailable within organisations would not allow them to monitor compliance or undertake change.”NHS Services for People with Multiple Sclerosis: a national survey (RCP Summary)Mental Health Patient Safety IncidentsThe National Patient Safety Agency (NPSA) has published its first analysis of mental health patient safetyincidents in England and Wales. The report - With Safety in Mind: patient safety in mental health services -provides the first detailed analysis of patient safety incidents from any national incident reporting systemworldwide.The analysis covers almost 45,000 mental health incidents reported to the agency’s National Reporting andLearning System (NRLS) by mental health staff between November 2003 and the end of September 2005. Thefour most common incident types identified, accounting for over 84% of mental health service reports, were:patient accidents, disruptive/aggressive behaviour, self-harming behaviour, and absconding or missing patients.GUIDANCE:Black Cohosh Linked to Liver DisordersActing on advice from the Commission on Human Medicines and the Herbal Medicines Advisory Committee, theMedicines and Healthcare products Regulatory Agency (MHRA) has confirmed the link between black cohoshand the risk of liver disorders. Both committees have reviewed all available data and concluded that the evidenceunderlines such an association.Black cohosh, an ingredient of herbal products, is commonly used to treat menopausal symptoms and is widelyavailable in the UK. It is unclear exactly how many individuals in the UK may be taking black cohosh, but in 2004an estimated 9 million treatment days were purchased. Warnings are now to be added to the labels of blackcohosh products and the MHRA is working with the herbal sector to ensure the public is fully informed about thispotential risk.Safety Concerns over Black Cohosh and Liver Injury (Press Release)Black Cohosh and Liver Injury: Q&AsENGLANDANNOUNCEMENTS:New Electronic Records TaskforceLord Warner has confirmed the arrangements for a new NHS Summary Care Record Taskforce responsible foridentifying and advising upon outstanding issues and concerns associated with the introduction of the NHS CareRecords Service. It will be chaired by Harry Cayton the DH National Director for Patients and the Public, withMembers including the Chair of the RCGP Professor Mayur Lakhani, the Chair of the BMA, and representatives ofpatients. [Full Member List]Seven Days 4 17th – 23rd July 2006
  • 5. The Taskforce will focus specifically on the concerns of patients and the clinical profession about the creation ofthe summary care record. In conjunction with NHS Connecting for Health, it will draw up an agreed plan for theimplementation of the nationally available summary record, reporting to Ministers at the end of November. Thefirst phases of the NHS Care Records Service will be introduced in a small number of locations from early 2007.The DH has also estimated that the NHS Connecting for Health project, enabling transfer of GP patient recordsbetween practices when patients change to another GP surgery, will be available in several hundred GP practicesby the end of this year.Meanwhile the GP Pan User Group (GP PUG) held its inaugural meeting on 14 July, bringing together chairs ofthe user groups for eight existing GP systems providers. They will meet bimonthly with the GP clinical leads forthe five NHS clusters, plus representatives from the BMA/RCGP Joint IT Committee and the Independent DoctorsForum. The group is chaired by Dr Gillian Braunold and Professor Mike Pringle, NHS Connecting for Healthsnational GP clinical leads. At its first meeting the group discussed the current GP Systems of Choice proposal.OOH National Requirements Clarified by RCGP/DHThe DH and RCGP have reviewed the current requirements for OOH services in England in light of observationsmade in a recent National Audit Office (NAO) report. The resulting document clarifies a number of areas ofmisunderstanding or misinterpretation of the current Requirements, as identified by the NAO. It does NOT makeany changes to the Quality Requirements that were published in October 2004 - which are reproduced in theiroriginal and current form within the document.None of the NAO’s discussions with providers or commissioners revealed any sense that the 2004 QualityRequirements were either inappropriate or unachievable, and this new document serves only to clarify certainissues around compliance, clinical assessment, patient experience, and capacity/demand. Consolidated guidancewill subsume this new advice later in the summer.National Quality Requirements in the Delivery of Out-of-Hours Services (New Advice in “Introduction”)NHS Charges Report: Fees for Prescriptions and DNAsA Commons Health Committee report has found that exemptions designed to mitigate the negative health impactof NHS charges are anomalous, irrational, and procedurally inaccessible to patients. The report into NHS charges(“co-payments”) for certain services and treatments - for example prescriptions, dentistry and optical services -states that the current exemptions policy is not based on ability to pay, and that the list of exempt medicalconditions, which has not been revised for 30 years, creates further anomalies. Apart from several specificrecommendations, the report suggests that two reviews are established:1) Review into Costs and Benefits of Current System, to consider: abolishing all health charges or justselected ones (such as prescription charges); establishing a system of reference pricing for medicines – possiblylinked to a limited NHS formulary; overhauling the list of medical exemptions to the prescription charge;introducing a flat-rate prescription charge with no exemptions; and basing exemption to charges solely on income.2) Review into Costs and Benefits of an Alternative System of Charges based on the principles that servicesthat are clinically necessary should be free; and fees should not deter patients visiting their doctor or accessinghealthcare. The review should include:  The possibility of establishing a package of core services which would be free, and a set of treatments for which the NHS could charge.  Treatments/interventions which are not cost-effective, such as branded drugs where an effective generic exists, could be subject to a charge.  The use of charges to promote more responsible use of services, including: the introduction of a small charge for non-emergency patients inappropriately presenting to A&E, and a fee for patients who do not attend or fail to cancel GP or hospital appointments.The report specifically calls for the immediate introduction of a monthly Prescription Pre-payment Certificate(PPC), and recommends that the annual certificate is costed at no more than 12 times the price of a singleprescription. The monthly certificate should be pegged at the cost of one prescription. Once the NHS IT system isin place a yearly cap on payment for medicines should be introduced making the PPC obsolete. This would allowthose who unexpectedly require many prescriptions within a short space of time to benefit in the same way asthose who currently purchase a PPC in advance.The report also recommends that GP surgeries make available to patients information on charges to which theymight be liable, eligibility for exemption, and assistance with costs associated with attending for treatment.NHS Charges: conclusions and recommendations (Health Committee Summary)Government to Improve Allergy ServicesSeven Days 5 17th – 23rd July 2006
  • 6. In a response to the Health Committee report on allergy services in England, the Government has published areview of the epidemiology, demand for and provision of treatment, and the effectiveness of clinical interventions.It highlights how GPs currently receive no training on clinical allergy diagnosis and management; and lackeffective guidelines for therapy or referral. Consequently GPs are not supported in differentiating between seriousallergies requiring specialist interventions, and those that can be managed in primary care.In the review the Government sets outs plans for: identifying the demand for allergy tests; recognising the skillsand competences required to administer or interpret results; training professionals to advise patients on how tomanage their allergy; developing clinical guidelines through NICE; and working with the Royal Colleges toproduce guidance for referral and care pathways.A Review of Services for Allergy (DH Report)Prescription Costs Fall for First Time Since 1976New Information Centre for Health and Social Care prescription figures for England show that 720 millionprescription items were dispensed in the community in 2005 – a 5% increase on the previous year. This equatesto 14.3 prescription items per head of population compared to 13.7 in 2004 and 9.8 in 1995; with the elderlyreceiving 38.4 items per head compared to 21.8 in 1995. However, net ingredient cost of all prescriptionsdispensed decreased by 1.8% to £7,937 million - a decrease of 3.8% in real terms on 2004. This is the first timecosts have reduced since 1976.While the NHS spent more on heart drugs than in any other specific prescribing area during 2005, the new pricingarrangements meant they cost less. The cost of blood pressure medicines fell by 21% between 2004 and 2005(from £610 million to £484 million), while cholesterol-lowering drugs reduced by 19% (£769 million in 2004 downto £625 million in 2005).In 2005 80.1% of all prescription items were written generically, while 87.6% of all prescription items weredispensed free to patients.Prescriptions Dispensed in the Community Statistics for 1995 to 2005: England (IC Data)Tariffs to Shift Services into Primary CareThe DH has commissioned the National Directors for Heart Disease and for Older People, Professors RogerBoyle and Ian Philp, to identify clinical work that might be shifted to community settings, focusing in particular on:fractured neck of femur; elective hip replacement; community acquired pneumonia; and stroke patients. Theiradvice will form the basis of separate indicative prices for different parts of the care pathway, with this“unbundling” taking effect from next April.Responding to an independent report by John Lawlor, commissioned following the temporary withdrawal of thePayment by Results (PBR) tariff earlier this year, the DH has also published a PBR Action Plan this week - settingout a timetable and framework for 2007/08. The 2007/08 tariff will be published in mid-December, and there willbe no substantial changes to the scope and structure of the tariff for 2007/08, in order to minimise year-on-yearprice volatility.John Lawlor’s report - Report on the Tariff Setting Process for 2006/07 – had set out to identify why the tariff wasinaccurately increased by only 1.5%, when PCTs reported increases of 4% and more in the cost of activity. Thereports recommendations, accepted in full by the Department, included: greater transparency; more resource forthe calculation process; earlier indication of next years tariff; greater clinical engagement; road-testing andpiloting of new tariffs where possible.PARLIAMENTARY NEWS:Consultation on Smoke-Free LegislationThe Government has launched a consultation document - Smoke-free Premises and Vehicles - on new draftregulations which will see virtually all enclosed public places and work places in England become completelysmoke-free from next summer. The consultation is wide-ranging and covers the finer details of how the smoke-free legislation will be implemented and enforced. The new regulations are being made under the Health Bill(Chapter 1 of Part 1). Views are sought (before 9 Oct 2006) on issues such as exemptions and signagerequirements for smoke-free establishments. Views can be submitted online or by emailing:smokefreeregulations@dh.gsi.gov.uk.Recently released data from Scotland shows how popular smoke-free public places and workplaces are inpractice - with three quarters of people saying the ban has been successful and over 99% of places complyingwith smoke-free legislation since it was introduced on March 26th 2006.HER2 Testing Now Widely AvailableSeven Days 6 17th – 23rd July 2006
  • 7. In a written statement to the Commons, Health Secretary Patricia Hewitt has announced that 28 of the 34 cancernetworks in England now provide HER2 testing for all women diagnosed with early stage breast cancer. Thestatement was based on information received from Cancer Tsar Mike Richards in March, as a follow-up to aprevious survey of HER2 testing last October. The remaining six cancer networks expect to have routine HER2testing in place by October this year.WALESANNOUNCEMENTS:Healthcare Commission Confirms Fall in Waiting TimesThe Healthcare Commission has confirmed improved waiting times in Wales, stating in its annual report that: “It isclear that access to care in Wales is improving”. The number of people waiting longer than 18 months for anoutpatient appointment fell by 99.6% between December 2004 and March 2005 (6,270 to 28), while the numberof people waiting longer than a year for admission as an inpatient deceased in the same period by 86.7%.Annual Health Statistics PublishedA new annual National Assembly for Wales statistical bulletin provides information on the health of the populationand the range and quality of health care services. The section on Family Health Services includes data onattendance at GP surgeries and prescribing.Key Health Statistics 2006 (Summary with Headline Figures)Better Healthcare PremisesPlans to improve the way hospitals and other healthcare buildings are designed and constructed, to maximise thelargest ever capital investment programme in the NHS in Wales, have been outlined by Health Minister Dr BrianGibbons this week. The new supply chain models are an important first step in delivering Designed for Life:Building for Wales which will ensure that new buildings - costing more than £5million - will consistently meetnational standards, are built in a sustainable way and achieve good value for money.PARLIAMENTARY NEWS:Smoking Ban Consultation LaunchedHealth Minister Dr Brian Gibbons has launched a consultation on new draft regulations which sets out detailedproposals for smoke-free public places, workplaces and vehicles in Wales. The consultation covers issues suchas the definition of "enclosed" spaces, how the ban will be policed, and requirements for signs advertising theban. The Health Bill, which recently completed its consideration by Parliament, devolves powers to the NationalAssembly for Wales to make regulations for a ban on smoking in enclosed public places in Wales. The new law isdue to come into force by summer 2007.Smoking Ban Wales (Consultation Website)SCOTLANDANNOUNCEMENTS:BMA GP Partnership Guidance for ScotlandThe BMA has produced partnership guidance for Scottish GPs. This issue is particularly important given that GPpartners need to have a robust partnership agreement in place under the new GP contract.The guidance has been promoted via the latest issue of the BMA Scotland Newsletter, which also contains anARM round-up, and information on MMC specialty training and the SAS conference.Heart Operation Survival Rates PublishedFrom this week patients and the public in Scotland will have access to survival rates from operations at heart unitsacross the country for the first time. The dedicated website was developed by the Healthcare Commission and theSociety for Cardiothoracic Surgery in Great Britain and Ireland to help patients who need heart surgery makeinformed choices about their care and treatment. Scotland has now been included in the collection of data fromheart disease units.Seven Days 7 17th – 23rd July 2006
  • 8. Heart Surgery in Britain (Healthcare Commission Website)NORTHERN IRELANDANNOUNCEMENTS:Implementing NICE GuidanceA letter has been sent to Trust CEOs advising them on how and when NICE guidance should be implemented inNorthern Ireland. This follows last month’s announcement that the Department of Health, Social Services andPublic Safety had established a formal link NICE, and that the Institute’s guidance will now be applied asappropriate in Northern Ireland.Implementation of NICE Guidance in the HPSS (Dear Colleague Letter)Consultation on Medical RegulationHealth Minister Paul Goggins has welcomed the publication of the CMO’s report setting out proposals tostrengthen the regulation of healthcare professionals. He commented that: "We will have to consider the impact ofthese proposals in a Northern Ireland context. For example, unlike the rest of the UK we have an integratedhealth and social services which is currently undergoing major reform. In addition, we have differing accountabilityand quality improvement arrangements as well as different legislation." The Department of Health, SocialServices and Public Safety has asked that any response to the consultation on the proposals copy in theDepartment to fully inform its own response.Consultation on Review of Regulation of Medical and Healthcare Professionals (DHSSPS Press Release) SEVEN DAYS Produced by RCGP Information Services RCGP Information Services can be contacted at: E-mail: info@rcgp.org.uk Tel: 020 7581 3232 x 240 Royal College of General Practitioners Disclaimer: 14 Princes Gate Hyde Park Seven Days uses third-party information and links to London third-party websites, but neither endorses nor can SW7 1PU guarantee the accuracy or authenticity of these sources. Tel +44 (0) 20 7581 3232 Fax +44 (0) 20 7584 1992 Website: www.rcgp.org.ukSeven Days 8 17th – 23rd July 2006