Introduction

Welcome to the 13th edition of the GP bulletin, aiming to keep you up to date with useful information for your daily work.

This is the September edition. Last month’s bulletin was intended to cover July and August. I do apologise if this has caused any confusion.

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.

Please send feedback or views on the GP bulletin to me at

sonny.dutta@doh.gsi.gov.uk

Sonny Dutta

Editor, GP Bulletin, Department of Health

Quarry House, Quarry Hill

Leeds LS2 7UE

Boosting GP numbers and improving working lives

On 12 July, health minister John Hutton announced a package of measures to boost GP numbers and make primary care a better place to work. They include:

• GP delayed retirement scheme

The delayed retirement scheme (formerly the golden goodbye scheme) pays £2,000 a year to GPs aged 60 to 64 inclusive on or after 1 October 2001, working at least 25% of full time. Payments will be backdated to 1 October 2001.

Primary care trusts will make payments to qualifying GPs on a quarterly basis. GMS principals will be paid automatically via the EXETER system. PMS GPs and GMS non-principals are required to complete an application form that should then be sent to their primary care trust.

Application forms and full details of the scheme can be found at www.doh.gov.uk/pricare/delayed

retirement

• Amendment to the Statement of Fees and Allowances – GP retainer scheme

Paragraph 39 of the Statement of Fees and Allowances has now been amended to allow the retainer fee to continue to be paid to practices whilst the GP retainer is absent due to:

• annual leave

• maternity, paternity and adoptive leave

• parental leave

• an emergency involving a dependent

• other pressing personal or family reasons, where the primary care trust agrees that the doctor’s absence is necessary and unavoidable.

The amendment can be found at www.doh.gov.uk/pricare/fees.htm

• Amendment to the Statement of Fees and Allowances – addition for seniority

Paragraph 16 of the Statement of Fees and Allowances has now been amended to remove the qualifying period that GPs were required to serve following a career break before they were entitled to claim seniority payments. This amendment has been backdated to 1 April 2002. Any GP serving a qualifying period at 1 April 2002 will receive payments backdated to that date. The amendment can be found at www.doh.gov.uk/pricare/fees.htm

• Flexible career scheme for GPs

The flexible career scheme that currently operates for hospital doctors is to be extended to primary care. The scheme will offer new flexible and part-time working options and will be launched for GPs later in the year.

Further details to be published when they become available.

Personal Medical Services development

The first phase of fourth wave Personal Medical Services (PMS) pilots went live on 1 April. This tranche saw the highest percentage of pilots to date transfer successfully from approval to become live pilots.

This increasing capacity to support the implementation of PMS has been heralded as a direct result of the work of the national PMS facilitators. They have worked with primary care trusts and, in some cases, directly with aspiring pilots, to increase awareness of the benefits and to guide trusts and pilots through the application process.

The PMS facilitators are coordinating a number of events during September to support the implementation of wave 4b – in particular around financial allocations and developing PMS agreements.

Full details of the facilitators and training events can be found at www.doh.gov.uk/pmsdevelopment. For advice on PMS pilots, call the PMS helpline on 0845 900008.

National Primary Care Collaborative – update

Eleven National Primary Care Development Team centres are now established across the country. These will support the roll-out of the National Primary Care Collaborative and run their own collaborative workshop programmes, ensuring that in the next few months every primary care trust in England will have the chance to take part in the Primary Care Collaborative.

The first 80 trusts to take part in the programme have delivered significant improvement to about 1,000 practices, covering a population of 7 million patients. This constitutes the largest health development programme in the world.

Each wave is delivering a faster rate of improvement, through expanding knowledge and increasing weight of evidence gleaned from the early waves. The recent access statistics demonstrate this: the first three waves have delivered a remarkable 60% reduction in wait time, while the fourth has already delivered a 65% reduction in only 10 months.

Further information at www.npdt.org/

Health action plans for people with learning disabilities

In July the Department of Health issued good practice guidance on health action plans and health facilitation – key elements of a strategy for addressing the health inequalities experienced by people with learning disabilities. It is part of a series of good practice guidance to support the implementation of the White Paper Valuing People: A New Strategy for Learning Disability for the 21st Century.

A health action plan is a personal plan setting out action to maintain and improve the health of an individual, and any help needed to achieve this. Health facilitation involves both helping people access mainstream services and also helping mainstream services to respond to the needs of people with learning disabilities. It is expected that health facilitators will be identified in each PCT and that there will be a named contact for health facilitation in each general practice.

The guidance is produced in three parts:

• a summary version for learning disability partnership boards which is designed to be accessible to all members, including those with a learning disability

• a booklet for people with learning disabilities

• a detailed version to help those directly involved in implementation.

All versions, and a flyer with details of where to obtain hard copies, are available at www.doh.gov.uk/publications/coinh.html and on the learning disability website pages at www.doh.gov.uk/learningdisabilities

For further details, please contact Elaine Cooper at elaine.cooper@doh.gsi.gov.uk

Product prescribing changes

With effect from 1 August 2002 GPs may not prescribe or dispense the following products on the NHS:

• Healthaid Glucosamine Sulphate Tablets

• Lamberts Glucosamine Sulphate Tablets

• Boots Glucosamine Sulphate Capsules

• Vega Glucosamine Sulphate Capsules

• Solgar Glucosamine Sulfate Tablets

With effect from the same date the current prohibition on GP prescribing and community dispensing of two infant formulae for premature babies is lifted. The two products are:

• Cow & Gate Nutriprem 2

• Farley’s Premcare

Schedule 10 to the National Health Service (General Medical Services) Regulations 1992 has been amended to give effect to these changes. In addition, the Advisory Committee on Borderline Substances has reinstated its earlier recommendation of the two infant formulae as "suitable for catch-up growth in pre-term infants (i.e. less than 35 weeks at birth) and small for gestational age infants, until 6 months post-natal age."

These changes are recorded in Part XVIIIA of the Drug Tariffs for August 2002 and subsequent months (changes to Schedule 10) and Part XV of the same Tariffs (amendments to the ACBS recommended list).

NHS walk-in centres – update

Approval has been granted for a new NHS walk-in centre in Luton. The new centre will be based on a site offering a range of other services, including a Personal Medical Services pilot, NHS Direct, a GP with special interest diabetes clinic, and weekend and evening health visitor sessions for working mothers.

Central funding has also been agreed towards the costs of developing two existing centres:

• Peterborough NHS walk-in centre is to move to new premises where it will offer a wider range of services, including GPs, and will be co-located with other services, including NHS Direct, paramedical service, and evening and night community nursing.

• The Manchester Airport centre is to establish a satellite at Wythenshawe. The new satellite centre will bring a much-needed health care facility to a deprived urban area and contribute to the Wythenshawe town centre regeneration programme.

These developments take place against the backdrop of publication in July of a positive independent national evaluation report on NHS walk-in centres. The evaluation was carried out by the University of Bristol. The findings have been published at

www.epi.bris.ac.uk/wic/

The Bristol team found that the 42 NHS walk-in centres are a safe, popular and well-used addition to the NHS family, with high levels of patient satisfaction. They also improve access, reach a different population from traditional general practice and help relieve pressure on other NHS services.

In the light of this report ministers are considering the future development of NHS walk-in centres and the services they provide. The outcome will depend on wider decisions on the deployment of the 2002 spending review settlement.

Reducing burdens in hospitals

Practical ways to reduce unnecessary burdens on hospital staff were identified in a joint report by the Department of Health and the Cabinet Office, launched in July.

Forty actions will be implemented to free up time for front-line staff to concentrate on delivering care. The ideas have come from front-line staff, and are agreed outcomes rather than recommendations.

The outcomes are grouped under 12 categories, including the interface with primary care.

Full copies and one-page summaries of the report are available at www.doh.gov.uk/reducingburdensinhospitals

For hard copies or queries please contact Vicky Lawrence at the Cabinet Office public sector team, tel 020 7276 2194, or e-mail psinfo@cabinet-office.x.gsi.gov.uk

Hepatitis C

• Guidance on hepatitis C infected healthcare workers

The Department of Health issued guidance on hepatitis C infected healthcare workers on 14 August, following consultation last year.

The new guidance restricts healthcare workers who are known to be infected with hepatitis C from carrying out exposure-prone procedures as a measure to protect patients, following 15 reported heath care worker to patient hepatitis C transmissions in the UK. It also recommends testing of certain other groups of health care workers, such as those who are about to start careers or training that will rely on the performance of exposure-prone procedures. The vast majority of procedures in general practice are not considered to be exposure-prone, except for some minor surgical procedures.

The guidance is at www.doh.gov.uk/hepatitisc

Hard copies may be requested from the NHS Responseline 08701 555455. For further information, please e-mail Gerry Robb gerry.robb@doh.gsi.gov.uk or tel 020 7972 5732.

• Consultation on a hepatitis C strategy for England

A consultation paper on hepatitis C strategy for England was published on 14 August 2002.

Hepatitis C has emerged in recent years as a significant public health issue. The strategy proposes raising professional and public awareness of hepatitis C and strengthening services for its prevention, diagnosis and treatment. The proposals in the strategy are intended to form the core of an action plan for hepatitis C, arising from the Chief Medical Officer’s infectious diseases strategy, Getting Ahead of the Curve. The closing date for comments is 15 November 2002.

The consultation paper is at www.doh.gov.uk/cmo/hcvstrategy

Hard copies may be requested from the NHS Responseline 08701 555455. For further information, please e-mail Gerry Robb at gerry.robb@doh.gsi.gov.uk or tel 020 7972 5732.

Senior House Officer modernisation

Unfinished Business, the Chief Medical Officer’s report on proposals for reform of the Senior House Officer (SHO) grade, was published for consultation on 21 August.

The report acknowledges long-standing problems with the grade and offers a new approach to SHO training. This new approach will see pre-registration house officers, doctors at the start of their careers, entering foundation programmes which will give them broadly-based experience before they make major career choices. They would then enter well-structured and managed SHO programmes designed to produce high-quality trainees ready to go on and become general practitioners or consultants.

The report is at www.doh.gov.uk/shoconsult For further information, please e-mail Andrew Matthewman at andrew.matthewman@doh.gsi.gov.uk

Flu Immunisation advertising campaign

The Flu Immunisation advertising will be launched on 1 October 2002. The campaign aims to encourage people over 65 and those in at risk groups, to make an appointment for their free flu vaccination. The campaign includes national TV and press advertising featuring Sir Henry Cooper, supported by public relations activity.

Leaflets and posters supporting the campaign are available to order free of charge. Practice managers will shortly receive sample materials and an order form, but details of the campaign and an order form are also at www.nhs.uk/flu

For more information about the advertising campaign, please contact Katie Foreman by e-mailing katie.foreman@doh.gsi.gov.uk

NHS LIFT schemes

A further 24 LIFT schemes have been agreed by ministers. This brings the total number of LIFT schemes in development to 42, with six schemes with a capital value of £170 million timetable to begin construction within the next 6 to 12 months. It is anticipated that the value of the capital investment across the 24 third wave schemes will be around £400 million.

NHS lift aims to deliver improved primary care facilities by "batching" together a number of primary care developments within an area. NHS LIFTs will be established as public-private-partnerships with the private sector providing the majority of funding.

The locations of the 24 schemes are Ashfield; Leigh and Wigan; Barnet, Enfield and Haringey; Brent and Harrow; Bristol; Bromley, Bexley and Greenwich; Colchester and Tendring; Derby; Doncaster; Dudley; Ealing, Hammersmith and Hounslow; East Hampshire and Fareham and Gosport; Gedling; Lambeth, Southwark and Lewisham; Leeds; Norfolk; Oldham; Oxford City; Sheffield; St Helens, Knowsley, Halton and Warrington; Tees; Plymouth; Wandsworth, Kingston, Richmond and Twickenham and Wolverhampton.

For further information on the LIFT scheme, please ring Joe Clyne on 0113 2545603 or e-mailing joe.clyne@doh.gsi.gov.uk

Please see press release at end of this publication.

Day surgery operational guide

An operational guide has been published to help managers and clinicians look at ways to increase day surgery rates.

Day surgery offers safe, efficient and effective treatment that provides the least possible disruption to patients’ lives. It also offers the potential to increase capacity within the NHS. Increases in day surgery will enable the current overall day case rate of 68% to rise to meet the intention of 75% set out in The NHS Plan.

GPs are asked to make best use of this guide and to ensure that it is cascaded to all staff involved in the day surgery process. Hard copies have been sent to medical and financial directors in trusts and strategic health authorities.

Work on the day surgery strategy also includes:

• clinical guidance being produced by the Royal College of Surgeons which will complement the operational guide

• a summit to be held on 24 September, to which trusts have been invited to consider ways of improving day surgery rates

• implementation work by the Modernisation Agency, which has appointed a national programme lead.

For further information, please contact Paul Woods, tel 020 7972 481, or Kate Bowe, tel 020 7972 4010.

Please see press release at end of this publication.

Clinical Evidence free to clinicians and public

The Department of Health and the BMJ Publishing Group have agreed a three-year licence making Clinical Evidence freely available via the National Electronic Library for Health.

Clinical Evidence is an international source of the best available evidence. It is published by BMJ and contains clinically important questions with summaries weighing the evidence. Much of the evidence is derived from reviews undertaken by The Cochrane Library and the NHS Centre for Reviews and Dissemination, both of which have been funded from their beginning by the NHS Research and Development programme.

Free access to Clinical Evidence will help clinicians and patients decide the best course of action. It can be accessed on www.nelh.nhs.uk without the need for a password. The online version is updated frequently and will always contain the latest and most detailed information. Under the terms of the new licence, it can be accessed by patients and the public in the same way.

The department has distributed copies of the printed versions 6 and 7 (Concise) to GP surgeries, trust libraries and other professionals. If you already have a copy, please consider passing any spare copies to a colleague or library.

Version 6 will be the last full version to be distributed by the department, but it will continue to be published in full by BMJ Publishing and can be ordered from them.

This initiative is part of the government response to Learning from Bristol. Following that report, the government announced the development of a national knowledge service for the NHS, to support the delivery of high quality information for patients and staff. It promised to meet the needs of health professionals, patients and the public for up to date, cross-referenced, evidence based information by integrating NHS knowledge systems.

Action to prevent accidental overdose with intravenous potassium

The National Patient Safety Agency issued a patient safety alert on 23 July. It outlines two actions to prevent accidental overdose of intravenous potassium in hospital:

• limiting storage and use in hospitals of potassium chloride concentrate and other strong potassium solutions to pharmacy departments and critical care areas

• promoting greater use of commercially-prepared, ready to use, already diluted solutions containing potassium.

The alert is available at www.npsa.org.uk and from NHS Responseline. A version of the alert for patients and the public has been sent to patient organisations.

Advice to travellers in the European Union

The Foreign and Commonwealth Office has launched a new leaflet, Travelling and Living in the European Union, which sets out the right of Britons travelling, living, working, studying or retiring in the EU.

The leaflet reminds travellers that free emergency medical care is available in EU countries (plus Iceland, Liechtenstein and Norway) using form E111. It also points travellers to the Department of Health website, where further travel and treatment advice can be found, and reminds them to take out adequate insurance to cover other health risks.

Copies of the leaflet are available, direct to the public or for distribution by surgeries, by request from the Foreign and Commonwealth Office on 020 7270 3621.

Young men’s health: what works and why

– 6 November 2002, Birmingham

A conference in Birmingham will share examples of good practice from projects across England working to improve young men’s health.

Young men’s health – what works and why has been organised by the Health Development Agency’s young people’s health network. The day will feature workshops led by coordinators from some of the most successful and innovative projects working with young men. Topics will include work with young black men, engaging with young men in school settings and young fathers.

Guest speakers will include health minister Hazel Blears; Trefor Lloyd, Working With Men; Simon Forrest, director of the Sex Education Forum; and Cathy Aymer from Brunel University.

The conference will bring together a wide range of professionals including those from local authorities, education action zones, youth justice workers and health specialists. For more information visit www.hda-online.org.uk call 020 7843 6042 or e-mail conferences@ncb.org.uk

Certificate in research methods for primary health care by web-based distance learning

This University College London course is part-time over one year, and it is anticipated that graduates will be able to undertake original research competently in a primary care setting.

The course covers basic study skills, literature searching, qualitative and quantitative methods, questionnaire development, biostatistics, research ethics and the patient perspective, and critical appraisal.

There is the option (but no requirement) to continue with additional modules towards an MSc degree that includes a selection of more in-depth modules and a research dissertation.

The next intake for the certificate course is September 2002. There is a compulsory one week on-site course in London at the beginning (2002 dates 9-13 September) to provide intensive face-to-face training in database searching and relevant software packages. All subsequent teaching is via a password protected internet site. For further details, please see www.ucl.ac.uk/openlearning/

msc/cert.html or e-mail the course administrator on webmsc@ucl.ac.uk

Medical Devices Agency

The Medical Devices Agency (MDA), an executive agency of the Department of Health, is the primary source of support, advice and guidance on all medical devices and equipment.

One of its main functions is the investigation of device related adverse events. Reports are currently running at over 8,000 a year. These investigations are handled on a priority scale and may result in one of a number of actions, including the issuing of advice to the health service or modification/recall of the device in question.

Although the MDA receives a number of adverse incident reports directly from the manufacturers, these mainly relate to problems arising from shortcomings with the device or its operating instructions. Increasingly, adverse incidents are recognised to occur as a result of user practices, conditions of use, poor maintenance or difficulties with cleaning, decontamination and sterilisation. They are mainly reported by the user.

Since increasing numbers of medical devices are being used in the community it is vital, if improvements in safety are to be made, that MDA receives reports directly from GPs and other primary care staff.

Current Safety Warnings

DEVICE ALERTS

DA2002(04) – JRI Furlong Modular cemented total hip replacement system – a typical pain associated with corrosion of the polished titanium alloy femoral stem

DA2002(07) – Eli Lilly HumaPen Ergo insulin pens

DA2002(08) – Resuscitator: Ambu infant/child single-use model A243004000, serial no. OCN0105679, lot no. 243002619: risk of overpressure

SAFETY NOTICES

SN2002(18) – Scandinavian Mobility, Popular Plus Powered Wheelchair – risk of overheating or possible fire in the battery cables and connector plugs

DEVICE BULLETINS

DB2002(05) – Decontamination of Endoscopes

PRESS RELEASE

Friday 16th August 2002

Thousands of NHS patients to benefit from day surgery expansion – Hutton

Extra investment for primary care and diagnostic and treatment centres

Health minister John Hutton today unveiled further steps to improve the efficiency and effectiveness of NHS service, with a major expansion of the number of operations performed as day cases.

The minister also announced a series of measures designed to boost NHS capacity in both primary and secondary care.

£68 million will be made available over two years to expand day case surgery. Day surgery – where a patient undergoes an operation without an overnight stay in hospital – is safe, efficient, effective, and convenient for patients.. Today’s announcement means that around 120,000 more NHS operations a year could be undertaken in day surgery units, as recommended by the Audit Commission.

On top of extra investment John Hutton today also published new operational guidance to improve day surgery rates. The guide will help trusts reduce waiting times, implement booking systems and introduce more choice.

The new guide suggests 17 new procedures proposed by the British Association of Day Surgery, which are suitable for day surgery in some cases – including breast cancer operations, perforated ear drum repairs, keyhole surgery on knee cartilage or shoulder joints and keyhole repair of abdominal hernias.

Mr Hutton also confirmed investment in three key areas which will help increase overall NHS capacity:

• Investment expected to total between £35 – £40 million for 10 more fast-track Diagnosis and Treatment Centres in the next two years – which in total will treat over 20,000 extra cases a year.

• £22 million allocation to fund 100 schemes aimed to improve access to expanded care centres in rural and urban areas where access to GP services is limited.

• 24 new NHS Lift schemes to build new primary care facilities, including GP surgeries. Schemes will improve patients’ access to services with more services provided closer to home, in primary care settings. It is expected that these schemes will provide around £400m worth of mainly private sector capital investment in primary care facilities.

Mr Hutton said:

"The investment going in to the NHS is expanding its capacity. But we also need to use that capacity more effectively – and day surgery is an important of making the NHS more efficient and more convenient for patients.

"Today’s day surgery guidance is a challenge to managers, commissioners and clinicians. They need to be asking as a matter of course: "Do we have to admit this care as an inpatient?"

"And building new Diagnosis and Treatment Centres will also make a massive contribution to the rapid and large-scale capacity increase required in the NHS. They will bring about new ways of delivering services, setting new standards of value for money, clinical productivity and patient convenience and choice.

"Expansion of the NHS is not just about acute care. We need to improve access to primary care as well. New one-stop primary care centres are the GP surgeries of the future. And our programme of public/private partnership is starting to deliver real change to improve the fabric of GP surgeries with better, more modern family doctor surgeries with an extended range of local services in the community.

"This programme of investment will enable doctors to perform more operations every year. It will also bring reforms to the way health care is delivered. Patients will be treated in modern high quality facilities with the latest equipment and the best trained staff. Waiting times will be reduced. Patients will be the winners."

David Ralphs, President of the British Association of Day Surgery, said:

"The Operational Policy for Day Surgery is greatly welcomed as a tool to help managers and clinicians further develop day surgery practice in individual trusts. It is timely that the government has recognised both the potential day surgery has in helping trusts meet targets and the need for a renewed and sustained impetus to develop the practice further.

"The potential of day surgery will only fully be realised if managers resist the temptation to encroach on day surgery facilities and recognise that these have to be ring-fenced if the large majority of patients listed for elective surgery can benefit from this form of treatment which has been shown to meet their needs best".

Today’s announcement of 10 more Diagnosis and Treatment Centres brings the total to 19. The 10 schemes will all be fully operational within the next two years and will deliver additional NHS capacity to treat more than 20,000 extra cases a year.

In addition to GP and community services, one-stop primary care centres may also offer dentists, options, health visitors, pharmacists or social workers and so make access to health services and care more convenient for patients.

The first six LIFT schemes were announced in 2001, and a further 12 in January this year. These were mainly in the poorest areas of the country where traditional funding routes have not delivered premises that are needed.

The 24 new LIFT areas will provide new, and refurbished, primary care premises as well as offering GPs flexible lease arrangements. Each area will now work up detailed initial investment plans for new primary care facilities. For example, one scheme involves three primary care trusts which provide services for the London Boroughs of Ealing, Hammersmith and Fulham, and Hounslow. New primary care centres will be developed and improvements will be made to existing GP premises and health centres.

In Oxford the LIFT scheme will provide increased capacity to reduce demand on local acute hospitals. Three new primary care resource centres will provide out of hours services, multi-specialty, rapid access, diagnostic and treatment services, and integrated childrens services. The scheme will also provide four new larger health centres in modern, multi-purpose buildings.

There are now a total of 42 NHS LIFT in development, with six schemes with a capital value of £170 million timetabled to begin construction within the next six to 12 months.