In this bulletin

Introduction

Welcome to the tenth edition of the GP Bulletin, aiming to keep you up to date with useful information for your daily work.

In issue 7, I mentioned that the bulletin would only be available via email through Doctors.Net with effect from February. This change was delayed for a couple of months to allow time for those GPs not covered by Doctors.Net to register. The next edition of the GP bulletin will be sent only by e-mail. For those GPs who do not access the email version, the GP Bulletin will also be included in the Primary Care magazine from June 02.

Please note that there will be no May edition of the Bulletin, this is to allow for bringing the Primary Care Magazine and the GP Bulletin publication date closer together.

If you would like to receive the bulletin by e-mail, please forward your details to gpbulletin@doctors.org.uk, giving your name, practice name and GMC number.

I do apologise if these changes cause you any inconvenience.

Please send feedback or views on the GP Bulletin to me at sonny.dutta@doh.gsi.gov.uk

Sonny Dutta
Primary Care Development Officer
Editor, GP Bulletin
Department of Health
Quarry House
Quarry Hill
Leeds
LS2 7UE

Headlines

The Bulletin in Portable Document Format

• A New National Contract for GMS
• NHS Budget — Letter from the Prime Minister and the NHS Chief Executive
• GP appraisal workshops
• Revised PMS Agreement Framework — update
• Self-monitoring of anti-coagulation therapy
• International encephalitis conference
• Achieving the primary care access target
• Implementing a scheme for GPs with special interests
• Sales of goodwill
• Revised fees and allowances payable to GPs in England 2002 — 2003
• Referral guidelines for suspected cancer
• National Primary & Care Trust programme

• MSc in Diabetes
• Complexity: a new perspective for the NHS and its partners - Conference

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A new National contract for GMS

After intensive work by the NHS Confederation and the GP Committee of the BMA, the BMA are now consulting GPs on an agreed framework for a new national contract that was published on Friday, 19 April.

The NHS Confederation was appointed to lead the negotiations for the employers’ side of the table rather than a government department of Ministers. This signals the desire to approach discussions in a new and constructive manner led by people who have experience of delivering services at the frontline.

Both Sides recognise that a great deal more work is needed over the next few months to develop the proposals, with then more work needed to implement a new contract.

The agreed framework is available at www.bma.org.uk and is intended to:

• Recognise and engage the full range of professionals working in primary care and allow them to match their time and skills to the relative needs of their patients and so facilitates improvements in appropriate, timely and equitable access to health care;

• Sustain a greater range of employment options, allowing GPs to work much more flexibly, in family friendly ways, with a new ability to develop stimulating careers;

• Encourage recruitment and retention to the profession by offering a career with an interesting but manageable workload and by moving towards removal of the previous obligatory out-of-hours requirement;

• As a further aid to recruitment and retention, through additional investment, increase the profitability of general practice and create new additional personal earning opportunities for GPs;

• Permit an expansion of services in primary care if additional investment allows this, as well as allowing individual GPs the ability to control and manage their personal workload;

• Serve to improve the range and quality of services available to patients by incentivising and rewarding practices fairly for their efforts to provide high quality primary care.

For further detail, please contact Andrew Palethorpe by email at andrew.palethorpe@doh.gsi.gov.uk

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NHS Budget

Introduction

The April 2002 Budget provides for an average 7.5 per cent real growth in the NHS in England over each of the next five years.

As a result, the total NHS budget in the UK will climb from £65.4 billion in 2002-2003 to £105.6bn in 2007-2008.

In Delivering The NHS Plan — next steps on investment, next steps on reform, published the day after the Budget, health secretary Alan Milburn outlined further steps in reform to ensure the extra money is used effectively.

The document covers:

• what the public can expect to see in improved services as the Plan is implemented

• how these improvements will be secured.

Key points include:

• 35,000 more nurses, 15,000 more doctors, 30,000 extra therapists and scientists
• 40 new hospitals and 500 primary care centres
• A new and independent Commission for Healthcare Audit and Inspection and Commission for Social Care Inspection (CSCI)
• 10,000 more general and acute beds
• Primary Care Trusts will be free to buy care from the most appropriate provider — be they public, private or voluntary
• The hospital payment system will switch to payment by results using a regional tariff system
• Patients will be given information on alternative providers and can choose to switch to hospitals that have shorter waits — including private hospitals and hospitals overseas
• New PFI mechanisms
• Legislation to make local authorities responsible for the costs of delayed discharges along with incentives to use the extra investment to fund home care services for older people.

Prime Minister Tony Blair and NHS Chief Executive Nigel Crisp both wrote to chief executives on 18 April. Copies of their letters follow.

Letter from the Prime Minister

I wanted to write to you after the Budget to thank you and your staff for your hard work over the past year and to speak about the opportunities and the challenges for the National Health Service.

I want to thank you because I know the tremendous work that is going on across the country in our health service. Too often the focus, particularly in the national media, is on the things that go wrong in the NHS rather than its real achievements, world-class services and the thousands of lives saved every day by the skills and dedication of your staff.

I also know that there is a tremendous amount of change now underway in the NHS. Like most change, it isn’t easy. So I wanted to say how grateful I am for the way you and your staff have met the extra demands upon you.

Over the last few months, Alan Milburn and I have met many of you. We have both been impressed by your deep commitment to the NHS, your absolute determination to improve the standards of care you provide to your community and your efforts to overcome the many challenges you face in achieving this.

The biggest challenge the NHS has faced, as you have made very clear to us, is its level of funding which has for decades been well below that of other European health systems. Last week’s Budget which set out our long-term plans to close this gap.

The challenge now, for both Government and NHS staff alike, is to ensure this sustained extra investment delivers the improvements in care and service and to ensure we reshape the modern health service around the needs of patients. I know from our meetings you will be determined to get value for money from every pound you get.

This will also need Government to give you and your front-line staff the responsibility and freedom to bring these improvements at a local level. Just as I hoped we have shown we have listened to you over the resources the NHS needs so I hope in the coming months we will show you we have listened about your calls for more local decision-making so that you can do your job better.

I promise as well that we will keep listening to you so our decisions reflect your experience and the needs and priorities of the community you serve. Thank you and your staff again for all you have done in the past — and all I know you will do in the future as we implement the 10year Plan.

TONY BLAIR

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Letter from the NHS Chief Executive

The budget settlement is both an enormous vote of confidence in the NHS and Social Services and a huge challenge.

Your achievements over the last year showed that we can deliver and begin to make improvements for patients and the public. We must build on this year on year.

Progress was made through sheer hard work but it was also partly due to reforming the system and changing the way we organise and deliver services. In rising to the challenges for the future we need to concentrate even more on finding better ways of doing things — making progress through redesigning services, involving the public, giving patients choice and helping staff to achieve their potential.

It often feels as if progress is made despite the system. Today’s announcements offer the NHS a whole range of the reforms we have been asking for — longer term planning and stability, new incentives with payment for delivery, new ways of strengthening the partnership with Social Services, decentralisation and new local freedoms to innovate and improve. They will enable us to continue the changes we need to make to implement the NHS Plan. They are far reaching and radical.

These are real challenges and we must be realistic in facing up to them. It will take time and hard work. There will be tough decisions to make sure we get the best out of the new money. We can’t do everything at once and there will be raised expectations. There will be mistakes. Above all we should remember that providing health care in any circumstances will remain a difficult and demanding — if rewarding — job.

But the extra funding and the reforms give us the tools we need to deliver for our patients and the public. As they become available we must use them wisely. In the mean time, we should remember that we already have a great deal of freedom to innovate, redesign and reform. Let’s make sure that we use our existing resources and freedoms to the full and keep up the momentum for improvement.

Delivering the NHS Plan — steps on investment, next steps on reform

We will be sending you a hard copy of the document together with a letter from the Prime Minister tomorrow. In the meantime, copies of ‘Delivering the NHS Plan — next steps on investment, next steps on reform’ are now available at www.doh.gov.uk/deliveringthenhsplan. Please share the message from the Prime Minister’s letter and the document with your staff. The Executive Summary contains the following very simple chart (Fig 1) which helps explain the changes.

Fig 1

Over the next few weeks we will be working up the details of the new arrangements with Strategic Health Authorities and the involvement of others within the NHS and Local Authorities. I shall be asking Directors of Health and Social Care and StHA Chief Executives to arrange meetings to involve as many people as possible in participating in this.

NIGEL CRISP

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GP appraisal workshops

A series of free workshops have been arranged to help GPs and primary care organisations get the most out of the new GP appraisal process.

Appraisal for GPs was introduced on 1 April. It is intended as a formative and development process for individual clinicians, aimed at supporting good patient care and high standards of clinical practice in the NHS. It is about identifying development needs, not performance management, and is an important building block in the clinical governance culture.

The Department of Health and the NHS Alliance have asked Medical Management Services to organise a series of practical and interactive workshops for GPs and primary care organisations. The workshops have been endorsed by the National Primary and Care Trust Development Team. They will run between April and July 2002, covering all the new Strategic Health Authority boundaries in England. Please see the full programme below.

To book a place, please contact Medical Management Services at workshops@medman.co.uk or by telephone on 01225 333711.

SCHEDULE OF APPRAISAL WORKSHOPS

GP APPRAISAL — MAKING IT WORK FOR GPs & PATIENTS

Revised PMS Agreement Framework — update

An item in the February edition of the bulletin wrongly stated that GMS GPs no longer have to produce an annual report. In fact, the GMS terms of service (Schedule 2, para 50) still require such a report to be produced.

Self-monitoring of anti-coagulation therapy

The testing strips for Coaguchek, a system to enable patients to monitor their anti-coagulation therapy, will be prescribable on the NHS from the beginning of May. The associated Coaguchek meter will not be prescribable.

Patient self-monitoring is expected to be initiated in specialist clinics in most cases. Consensus clinical guidance has recently been issued by the British Society of Haematology (Recommendations for patients undertaking self management of oral coagulation, D. Fitzmaurice and S. Machin on behalf of a BSH Task Force, BMJ 2001 323 985-9). Further details on this can be found on the BMJ website at: http://bmj.com/cgi/content/full/323/7319/985

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For further information on anti-coagulation in patients with atrial fibrillation, please contact Diane Paine — email diane.paine@doh.gsi.gov.uk or tel 020 7972 4844. For general enquiries, email James Nicklin at james.nicklin@doh.gsi.gov.uk or tel 0113 2545158

1^st International Encephalitis Conference — 10/11 September 2002 at Keele University

The first ever conference focussing exclusively on encephalitis is taking place this autumn in the UK.

Encephalitis is a devastating neurological condition with significant morbidity and mortality. The conference will focus on various aspects of the disease, its mechanism, its management, and emerging issues. Speakers will include Professor Peter Kennedy, Glasgow University; Professor David Miller, University College London; Professor Michael Kopelman, St Thomas’s London; and Professor Elaine Funnell, University College London. There will also be an opportunity for presentation of papers and posters.

The constituency for the conference includes all professionals involved in the diagnosis, treatment and rehabilitation of people affected by encephalitis, from both medical and allied professions. CPD approval has been applied for from the Royal College of Physicians.

The conference is run by the Encephalitis Support Group, a national charity which supports people affected by encephalitis, resources those involved in their treatment and care, and promotes research into the condition.

Full conference details available from website: www.encephalitis-international.org: and from the Encephalitis Support Group, 44a Market Place, MALTON, North Yorkshire, YO17 7LW. The phone/fax number is 01653 699599 and the e-mail is conference@encephalitis.org

Achieving the primary care access target

The NHS Plan set a target that by 2004, patients will be able to see a primary care professional within 24 hours, and a GP within 48 hours. The Primary Care Access Survey indicates that the interim milestone for March 2002 of 60% compliance is on the way to being met. Further details from Q4 will be available by mid May.

Implementing a scheme for GPs with special interests

The Department of Health, with key stakeholders, has produced an information document to help GPs and PCTs understand the requirements for implementing a scheme for GPs with special interests. The document will be available on the Department of Health website later this month. It includes information on:

• What are GPs with special interests?
• How such a scheme will operate nationally and locally
• Contractual arrangements between the PCT and GP
• Draft guideline for different specialties and roles

Sale of goodwill

Following the abolition of the Medical Practices Committee on 31 March 2002, the Family Health Appeal Authority (Special Health Authority) will now consider Sale of Goodwill applications.

From 1 April 2002, all applications for certificates as to whether transactions involve the sale of goodwill should be addressed to:

The Family Health Services Appeal Authority (Special Health Authority), 30 Victoria Avenue, Harrogate, HG1 5PR

Tel: 01423 535415, Email: mail@fhsaa.nhs.uk

Revised fees and allowances payable to GPs in England 2002 — 2003

The details of the revised rates for fees and allowances payable to GPs in England from 1 April 2002 are now available at: www.doh.gov.uk/pricare/fees.htm

Referral guidelines for suspected cancer

The charity CancerBACUP has produced a booklet and 12 accompanying factsheets designed for patients, explaining the referral guidelines for suspected cancer.

The publications explain why GPs refer some patients to a cancer specialist for tests — but not others — depending on their symptoms. The publications have been sponsored by the Department of Health and explain the detailed guidelines on:

• Lung cancer
• Cancers of the gullet (oesophagus) stomach and pancreas
• Bowel (colon) or rectal cancer
• Breast cancer
• Gynaecological cancers (womb, ovary, cervix and vulval cancer)
• Urological cancers (cancers of the bladder, prostate, kidney, testes or penis)
• Cancers of the blood (leukaemia, lymphomas and myeloma)
• Skin cancers (melanoma, basai cell cancer and squamous cell cancer)
• Head and neck cancer (lip, mouth, throat, voicebox, nose and thyroid gland)
• Brain tumours
• Sarcomas in the bone or soft tissues of the body
• Children’s tumours

The booklet and factsheets are available to all GPs in England and Wales. Patients and health professionals can get a free copy by contacting CancerBACUP on 020 7696 9003 (Mon-Fri 9am-5.30pm) or in easy-to-print-off format on the charity’s web-site at www.cancerbacup.org.uk (click on ‘cancer information’).

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National Primary & Care Trust Development Programme (NatPaCT)

The National Primary and Care Trust Development Programme (NatPaCT) was established following publication of Shifting the Balance of Power in the NHS. The programme led by Dr Barabara Hakin, Chief Executive of Bradford South and West PCT will support the organisation development of PCTs.

The programme has been shaped in partnership with a wide range of health and social care stakeholders. A series of listening events have been held across the country in order to find out what skills PCT leaders felt they needed to deliver their agendas.

The Organisational Competency Framework — available to all PCTs via a specially created website, provides guidance on personal and organisational competencies for PCTs and their staff. The framework has been developed in consultation with PCT leaders, and will enable PCTs to measure their level of organisation competencies across a number of key work areas.

The key work areas have been broken into the following nine categories:

• Organisation Maturity
• Primary care development
• Service provision
• Securing service delivery
• Health improvement
• Community engagement
• Ensuring clinical quality
• Working in partnership
• Workforce support and development

MSc in Diabetes

This course is available as an attendance course or using distance learning.

The Graduate Certificate comprises two 30-credits M level modules and covers the following content areas:

Module 1: Introduction to diabetes. An introduction to diabetes; Fual Metabolism & Nutrition; Background to Complications; Managing Diabetes and the Organisation and Quality of Care.

Module 2: Management of diabetes. Description of Complications; Managing the Complications of Diabetes; People as patients and Future Developments.

The Graduate Diploma requires satisfactory completion of the Graduate Certificate stage and then provides a range of modules in research methods (both quantative and qualitive), research design and scientific writing as necessary prerequisites for the research project at the MSc stage. The Graduate Diploma also offers the opportunity for additional self-directed study in diabetes as well as specialised modules in relevant aspects of nutrition and immunology.

The MSc requires satisfactory completion of the Graduate Certificate and Graduate Diploma stages before students embark on a research project, which is examined by dissertation. The topic will be supervised by members of the University of Surrey Roehampton staff or one of the diabetes clinical specialists. Students will normally use their workplace environment to provide a suitable setting for data collection.

For more detailed information, contact:

Dr Jorg Huber (Programme convener) Email: j.huber@roehampton.ac.uk

Complexity: a new perspective for the NHS and its partners — A Conversational Conference

17/18/19 September 2002, University of Exeter

‘Complexity theory’ offers new insights into the organisation and delivery of health care, which are already finding an application in the NHS. This series of lectures, seminars and workshops explores how insights from complexity theory can facilitate the organisation and delivery of health care.

Further details at www.complexityprimarycare.org