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Newsletters - September 2015

Reading the monthly LMC Update should be logged as 1 hour of CPD time. Actions taken as a consequence of this learning should also be logged for further CPD time as quality improvement activities.


Contents

1 Pulse article – Rising Star

2 Meningococcal B vaccination

3 Reminder - Newborn Hepatitis B vaccination

4 GMS contract and NHS body status

5 New dates for DSCB courses

6 Sharing information with school nurses

7 Pharmacy Forum

8 Investment in general practice

9 Payment for flu immunisation

10 Flu vaccination resources 2015/16

11 Flu immunisation for patients with BMI over 40

12 Weight Management Services currently available in Doncaster

12 Disability Living Allowance claimants

13 Sessional GPs e-newsletter

13 SYB Appraisal and Revalidation




Pulse article - Exciting new GPC voice

Congratulations to Dr Dean Eggitt who in the September 3rd edition of Pulse was placed at number one in the list of “New Rising Stars”. A copy of the article follows:-


Dr Dean Eggitt is an exciting new voice on the GPC. During his first year on the committee, he has colourfully laid into NHS England plans for ‘golden hellos’ to attract new GPs (‘Keep the bloody money’) and Jeremy Hunt’s ‘new deal’ for general practice (‘We are not looking for sticking plasters’). But he is no rent-a-gob. As medical secretary of Doncaster LMC there have been numerous examples throughout the year where he has gone the extra mile for colleagues. He has pioneered a rapid-access pastoral service for GPs struggling to cope and supported a local GP preparing a legal case against NHS England after he was served with a breach notice on his first day off work with burnout. Dr Eggitt has also personally taken on a fundraising drive for a locum GP’s family that faces losing the family home after being denied ‘death in service’ payments, because the GP died on a day off. ‘What is happening is grossly unjust and must be challenged. Together we can help,’ he says. And that goes to the heart of Dr Eggitt’s philosophy. ‘I have a personal need to ensure my team and colleagues are successful in their endeavours. We all have similar goals and aspirations, so we may as well help each other,’ he says. This stems from a tough upbringing. ‘I am loud and persistent with my opinions, so I’m difficult to ignore,’ he says. ‘I have an obligation to give back to a society that lifted me from destitute poverty as a child to middle class as an adult.’ And this is what he has been doing this year: setting up free educational workshops for GPs in his region, intervening to ensure local GPs are able to cope and defending the profession in radio and TV interviews.


All this from a man who was told he would not make a good doctor. ‘My college teacher told me to be a bricklayer, because it was what I was made for,’ he says.


Meningococcal B vaccination

As from 1 September 2015 the Men B vaccination has been added to the Childhood Immunisation Programme in England.

The programme is for all infants born on or after 1 July 2015, and consists of three doses at 2, 4 and 12 to 13 months, with a catch-up element for children born on or after 1 May 2015, who can be vaccinated up to 2 years on an opportunistic basis.

The Joint Committee on Vaccinations and Immunisations has recommend three doses of prophylactic paracetamol (2.5ml of infant paracetamol 120mg/5ml suspension) following the vaccinations at 2 and 4 months. 5 ml sachets and dosing syringes are available to order via ImmForm.


Many practices have been asked by parents to provide this vaccine privately to children outside the cohort. Although practices would be able to offer this on private script they would not be able to claim the cost of the vaccine, nor would they be able to charge the patient for providing it (as per Schedule 5 of GMS Regulations 2004 which lists the limited circumstances in which GPs may charge fees for providing treatment to their NHS patients). We would recommend that practices advise their patients requesting this to attend another practice, who are then able to charge for providing the vaccine.


Further information about the meningococcal vaccine, including a protocol for healthcare professionals for Men B and paracetamol use is available on the Public Health England website.


The service specification for this vaccination is available on NHS England website and Vaccine update also has some useful information, including a parent information leaflet.


General information about all the vaccination programmes is available on the BMA website vaccinations pages.


Reminder - Newborn Hepatitis B vaccinations

Neonatal Hepatitis B vaccination is an enhanced service contracted by Public Health England. Practices need to remain vigilant of the opportunity to vaccinate suitable new born babies against Hepatitis B as they are a cohort that may be easily missed.

Screening mothers during pregnancy of testing for Hepatitis B in hospital will identify most babies at risk of Hepatitis B and the hospital should routinely administer the first vaccination dose of Hepatitis B. The red book or medical record will then be updated and arrangements should be in place to ensure that information is shared with appropriate local agencies and GP practices to facilitate follow up.


However, due to the importance of timely immunisation and the risk of babies not receiving the first dose in hospital, during a home birth or being registered out of the area, practices cannot safely rely on hospital notice alone. Accordingly, practices should ensure that they have safe procedures in place to identify and vaccinate all newborn babies registered with the practice after 1st April 2014 who are at risk of Hepatitis B.


To ensure that the vaccination course is completed, it is recommended that practices routinely enquire as a matter of good practice as to a baby's immunisation status when they are registered with the practice.


GMS contract and NHS body status

Doncaster LMC understand that in some areas of the country, NHS England have made an amendment to the GMS contract without informing practices. The amendment forces the GMS contract holder to hold NHS body status where nationally this has been negotiated as an option.


We are not aware that GMS contracts in Doncaster have had this clause added. However, it would be pertinent to check your contract before signing it to ensure that you still have the option to opt out of being an NHS Body should you so choose.

NHS body status limits a contact holder to using NHS dispute resolution regulations should a contract dispute occur. Should a GMS contract holder elect not to be an NHS body, the GMS contract holder can choose to use either the NHS dispute procedure or the Law Courts to resolve a dispute.


New dates for DSCB courses

Please follow the link for dates and booking information. https://www.engagedoncaster.co.uk/dscb


Sharing information with school nurses

Following a TARGET session on asthma the school nurses highlighted a project they have run in schools to help improve the understanding and care of children with asthma in schools and in primary care.


The school nurses want to identify the children with a diagnosis of asthma and the best way to do this would be for surgeries to share this information with them, although this has been met with resistance from some surgeries.


The information required should not generate any extra work for the practice as they should have a list of patients with asthma for QOF and on the up side this project should increase the practices income via flu success and generate QOF points if more children come for asthma reviews.


Pharmacy Forum

You may not be aware but Weldricks are partners in an EU funded research project looking at Codeine use, abuse and misuse. They are required to hold a dissemination event to share progress and thoughts on future innovation to ensure Codeine is sold and used appropriately.


Investment in general practice

The reports on investment in general practice, and payments to general practice have been published and can be found on the HSCIC website here http://www.hscic.gov.uk/catalogue/PUB18469


Dr Chaand Nagpaul, Chair of the BMA’s GP committee, said “Yet again this report demonstrates that limited amount of NHS resources spent on general practice at a time when workload pressures on GPs are rapidly rising. The limited rise in local funding is likely to be the result of the extra work done by practices on admission avoidance last year. Unfortunately, there is little evidence that this money will be recurrent and enable GP practices to invest in long-term frontline patient care. It also remains unclear whether all this funding reached frontline patient services.


“GP practices are also continuing to see their budgets squeezed by rising costs for utilities, building upkeep and vital staff such as receptionists and nurses. Expenses now amount to as much as two thirds of an average practice’s income. At the same time many practices are struggling from a combination of rising patient demand, staff shortages and more care being moved into the community from hospitals.


“We need politicians to address the fundamental long term funding pressures facing general practice and commit to a sustained period of investment that gives GP services the resources to meet the needs of patients.”


Payment for flu immunisation

The service specification for the community pharmacy flu vaccination Advanced Service has been published by PSNC, NHS England and NHS Employers.


The specification sets out information about provision of the service and it should be read alongside PSNC’s detailed guidance on the service.

http://psnc.org.uk/our-news/service-specification-for-national-flu-service-now-available/


Flu vaccination resources 2015/16

Patient information leaflets for the annual flu vaccination programme are now available. In addition to a general leaflet, tailored versions targeting pregnant women, parents of eligible children and people with learning disabilities are available. Hard copies can be ordered through the DH Orderline https://www.orderline.dh.gov.uk/ecom_dh/public/home.jsf or by phoning 0300 123 1002 and quoting the reference numbers on the back pages. The Winter Marketing Campaign 2015/16 also incorporates flu vaccination, and materials for this will be made available in late September.


Flu immunisation for patients with BMI over 40

The Joint Committee on Vaccinations and Immunisations has recently recommended that those with BMI over 40 should receive the Flu vaccination. GPC has confirmed that there will be no changes to the current enhanced service to include the morbidly obese. This means that vaccinations for morbidly obese patients with no other risk factor are not eligible for payment under this ES.


The wording in the service specification http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/09/seasnl-flu-pneumococcal-upd.pdf addresses this (page 24, footnote 33 of the specification):


In addition NHS England confirmed that the morbidly obese are not included in the pharmacists additional service so they should not be directed to pharmacists unless recommending a private vaccination.


The GPC’s advice to practices is that there is no obligation to vaccinate patients with BMI over 40 and that no pressure can be applied to practices as this is not about clinical risk, but due to a funding decision by NHS England.


Weight Management Services currently available in Doncaster

Healthy Lifestyles Doncaster (Tier 3)

Healthy Lifestyles Doncaster provides one to one and group support for adults, children and families. Sessions include group education and activity sessions and one to one appointments with a multi-disciplinary team including dietitians, physiotherapists and cognitive behaviour therapists.


Acceptance Criteria:

Adults: BMI 35kg/m2 or above and aged 18 years or over

Children: BMI> 98th centile and aged 4 years and over


A poster and referral form for the service is attached to the update. The referral forms are for health professionals who would like to refer someone, however, people can refer themselves for either service by calling us on 0800 917 6264.


Healthy Weight Solutions (Tier 2)

Healthy Weight Solutions is a FREE 12 week group service for adults (aged 18+) with a BMI of 25kg/m2 or over. The service is led by friendly, approachable NHS staff and includes practical, interactive sessions that help people develop the skills, knowledge and confidence to manage their weight. As well as providing weekly support with discreet weigh-ins and goal setting, each week the group will be educated on a different topic specific to leading a healthier lifestyle e.g. fats, sugar, food labelling and portion sizes. By the end of the last course in Rossington, participants had lost a combined weight of 5st 10lb.


A leaflet is attached to the update for more information. Healthy Weight Solutions is now accepting referrals via a simple phone call to make it easier for people to access. People can self-refer into the service or be referred by a health professional.

The contact number is 01302 366666 ext.3711 or Dietitians@dbh.nhs.uk .


Disability Living Allowance claimants

We have received the following information from the DWP.


The DWP is writing to all Disability Living Allowance (DLA) claimants aged 16 to 64 on 8 April 2013, to tell them that their DLA is ending. This includes people on lifetime or long term DLA awards. The letter gives information to help people decide whether to claim a Personal Independence Payment (PIP). People will be asked to contact DWP with their decision. If people do not take any action their DLA will stop. The first letters were sent out in July to a small number of people within a limited number of postcodes in the North-West and the Midlands. Volumes and areas will gradually increase, until all eligible DLA claimants have been contacted by September 2017. If someone decides to claim PIP then their DLA will remain in payment, providing they comply with the process, for example attending an assessment if asked to do so. DLA will continue to be paid until they have received a decision on PIP entitlement.


The DWP has pointed out that GPs may be asked to provide Further Medical Evidence in the normal way for DLA claimants who decide to claim PIP and may receive enquiries from patients currently on DLA who have received a letter or heard that DLA is ending. If the patient has not received a letter yet, they don’t need to do anything. Their DLA will continue to be paid as normal. If they have received a letter, then they need to contact DWP with their decision about claiming PIP.


Sessional GPs e-newsletter

The sessional GPs e-newsletter is available on the BMA website http://bma-mail.org.uk/t/JVX-3O7BF-1BJCJOU46E/cr.aspx .

The main items this month are news on the national occupational health service for GPs suffering from stress and burnout, and an update on what we are doing to change the unfair rules on death in service benefits for locum GPs. It also features news and information aimed at supporting sessional GPs as well as blogs from sessional GPs, including one this month from sessional GPs subcommittee member Mary Anne Burrow on doing out-of-hours work.


The e-newsletter has been sent out to all the sessional GPs on the BMA's membership database, but to ensure that it gets to as many sessional GPs as possible we would encourage you to distribute the link as widely as you can. Using the new format it is also possible to easily highlight different sections of the newsletter via social media if you use Twitter, etc.

SYB Appraisal and Revalidation August 2015


Quality Improvement Activity (QIA)

GMC guidance sets out that for the purposes of revalidation, doctors need to demonstrate regular participation in activities that review and evaluate the quality of their work. Involvement in QIA is expected at least once every revalidation cycle; however the extent and frequency will depend on the nature of the activity. It has previously been perceived that completion of a full audit is required to meet QIA. However other examples of QIA could include a formative SEA, a review of clinical outcomes, a clinical case review, etc. (though formative SEAs should not be confused with SUIs).


NHS England have approved nationally that QIA should be an annual requirement. Each annual appraisal should include a minimum of one example of personal involvement within a QIA which would demonstrate reflection, action and a change outcome or maintenance of quality.


There are many resources to assist doctors with this and with the appraisal and revalidation requirements, for example audit and SEA templates (examples can be found by typing ‘Structured Reflective Templates - Doctors Appraisal’ in the internet search engine – the Leicester ones have been found to be good); and support from your appraiser and the appraisal and revalidation team (england.sybappraisal@nhs.net).


CPD - It is expected that a minimum of 50 CPD credits are obtained per year with appropriate reflection on outcomes.


Please provide your appraisal form and supporting information to your appraiser 2 weeks prior to your appraisal and advise the appraisal team of the date booked. It is also expected that your appraisal will be conducted within the month which you have been allocated; any requests outside of this date should be previously agreed with the appraisal office.


Medical Appraisal Policy / Database Change / Appraisal Format NHS England has updated its Medical Appraisal Policy. Please find below a link to the NHS England webpage containing the new policy and a document which outlines the changes incorporated including adoption of a national database and information on appraisal formats.

http://www.england.nhs.uk/revalidation/appraisers/app-pol/