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

Please send any feedback on the format and content of the GP Bulletin to GP-Bulletin@doh.gsi.gov.uk

We do read all your comments and take your concerns on board. Recently we received feedback on the presentation of the bulletin that it can be difficult to download the pdf (portable document format) version from the website. We're looking into additional formats in order to assist you, including providing a plain text version.

If someone has cascaded this bulletin to you, we would like you to receive it directly by e-mail. Please forward your details to gpbulletin@doctors.org.uk giving your name, practice name and GMC number.

Editor, GP Bulletin, DH, Quarry House, Quarry Hill, Leeds LS2

Top News

GP contract - update

The British Medical Association (BMA) and the NHS Confederation have reached agreement over a proposed new GP contract that will safeguard the future of individual practice incomes.

Every GP will be offered a Minimum Practice Income Guarantee (MPIG), ensuring a rise in income if they back the contract and meet minimum quality standards.

Funding is likely to rise by some 33 per cent, which will include money for IT facilities and improvements to practice premises.

The BMA's General Practitioners' Committee has written to all 43,000 GPs in the UK to spell out the terms of the new agreement.

The committee's letter states: "We can now guarantee that no practice will lose out if the new contract is accepted, provided it delivers a minimum level of quality."

GP representatives will discuss the contract in May after which a nationwide ballot date will be set. Further details can be found at www.bma.org.uk and at www.nhsconfed.org.uk


Expanding primary care services

GPs and nurses are to be supported to take on more specialised roles to expand primary care services, improve access and reduce waiting times, the Department of Health has announced.

New guidance to the NHS recognises that the extensive skills of GPs and nurses in some specialties can enable patients to receive specialist care and treatment in primary care settings. Outpatient appointments, investigative procedures and minor surgery will be available in GP surgeries and healthcentres.

Providing expertise or undertaking more procedures traditionally carried out in hospitals will offer patients greater convenience and healthcare, often nearer their homes, and often with a shorter wait.

About 650 GPs with special interests (GPwSI) are already delivering extended services in specialties such as ear, nose and throat (ENT), musculo-skeletal and endoscopy.

New guidelines have now been published for other specialties including: child protection, drug misuse, emergency care, epilepsy, headaches, mental health, palliative care, respiratory disease, sexual health and dermatology.

The introduction of GPwSIs has already helped to cut waiting times for patients. By 2006, one million more procedures or tests will take place in primary care. A step-by-step guide to setting up GPwSI has been created by the NHS Modernisation Agency and is available at www.natpact.nhs.uk/special_interests

A Framework for Nurses with a Special Interest has also been published. This will help PCTs to develop the skills and knowledge of experienced nurses expanding the care they can provide to meet patient need in the community.

This may happen in specialties such as heart failure, diabetes, stroke care and falls prevention.

Further guidance on the expansion of primary care is available at www.doh.gov.uk/pricare/gp-specialinterests.

There’s more about expanding primary care services in the May edition of Primary Care Magazine from 2 May at www.nhs.uk/nhsmagazine/primarycare/perm/pcexpansion.asp


Campaign to crack down on violence against staff

The campaign supporting a zero tolerance stance towards people who use violence against NHS staff has been stepped up.

Figures reveal that more than 50 people have been prosecuted by NHS trusts for violent or abusive behaviour toward staff over the last eight months.

Now GP surgeries are taking centre stage in a new poster campaign aimed at delivering a clear message - violence or abuse will not be tolerated.

Trusts have been urged to take even tougher action against people who threaten, intimidate or assault healthcare staff.

The message of the poster campaign is clear: GPs, nurses, practice nurses and other practice staff have the right to care for others without fear of being attacked or abused.

The posters, which include images of GPs and their staff being physically and verbally abused, have been distributed to all GP surgeries. They also carry a clear warning that violent and abusive patients will be reported to the police, may be subsequently prosecuted and also struck off a GP's list.

A working group including representatives from the British Medical Association's (BMA) General Practitioners' Committee and primary care trusts has also been set up to oversee this latest stage of the NHS zero tolerance zone campaign, which was first launched in October 1999 by health minister John Hutton.

It also follows the recent publication of a National Audit Office (NAO) report, which highlighted the good progress already made to improve the safety of NHS staff at work, and rightly highlighted where more work was needed.

NHS chief executive Sir Nigel Crisp wrote to all primary care trust chief executives last year, asking trusts to:

• assess the risks faced by GPs and their staff
  
• draw up anti-violence strategies
  
• instruct GPs on arrangements for secure facilities for dealing with violent and abusive individuals

Guidance, through a document called Primary Care - Preventing Violence and Abuse Against General Practitioners and Their Staff, has also been issued to GPs.

Dr David Colin-Thome national clinical director for primary care said: "Depressingly, violence to staff continues to occur. Of course, so-called 'zero tolerance' applies to the perpetrators but many of them are in need of clinical attention.

"Safe and secure premises and using clinicians with special skills with such patients are high priorities for the NHS."

Dr Colin-Thome also said the enhanced services element of the proposed new GP contract offered opportunities to address the issue.

"Safety of staff is paramount but also to provide services to all patients, however difficult, is one of the founding principles of the NHS," he added.

In 2001, for the first time, central funding was made available to support local measures for tackling violence against staff. By 2004, more than £3 million will be allocated to support managers and staff.

Further funding will be allocated over the coming year as part of the Improving Working Lives Programme.

From 1 April, the new Counter Fraud and Security Management Service (CFSMS) Special Health Authority (SHA) took over lead responsibility for tackling violence against NHS staff.

Security staff in health organisations will, from 2004, be trained in law enforcement techniques, such as interviewing and taking witness statements, as part of their accreditation process.

More information is available at www.nhs.uk/zerotolerance while GPs can obtain copies of Primary Care - Preventing Violence and Abuse against General Practitioners and Their Staff from the NHS Responseline on 08701 555 455

Extra NHS investment saving thousands of lives

Patients are starting to see the benefits of increased investment in the NHS, according to the new Delivering the NHS Plan - Expenditure Report document.

A total of £55 billion was invested during 2002-2003, with £2.2bn alone spent on priority areas like employing extra staff, primary care prescribing and buying more goods and services.

This included vital drugs such as statins which alone are estimated to be saving 6,000 lives a year.

Overall NHS spending will rise to £60bn over the coming year, with more than half going on improving access, increasing quality and also recruitment, including 1,300 more GPs by March 2004.

The report says one-quarter of all NHS spending is in primary care, a trend set to continue as more traditional hospital-based services are provided in the community.

It also forecasts that £650 million more will have been spent on GP and nurse prescribing during 2002-2003, an increase of 11.5 per cent.

A report by the Audit Commission found the cost of GP prescriptions was outstripping the overall primary care spending budget but this has not reflected the overall financial picture for PCTs which, over the next three years, will see their budgets escalate by 30 per cent to £148bn.

Dr David Colin-Thome national clinical director for primary care said drug prescribing was one the most effective bio-clinical interventions that doctors, and, through supplementary prescribing, increasingly nurses and pharmacists could make.

"The evidence base for such prescribing shows that patients' lives will be saved and quality of life vastly improved.

"Of course the Audit Commission is right in that we must prescribe the cheapest drug if the alternatives are no more effective and, as with all clinical interventions, challenge inappropriateness," he said.

The full NHS spending report can be viewed at www.doh.gov.uk/nhsplanexpenditurereport/index.htm


NHS Direct - key partnership between NHS Direct and out-of-hours

NHS Direct will continue to play a pivotal role in the provision of out-of-hours services, according to a recent review published by the Department of Health.

The review entitled Developing NHS Direct - A strategy for the next three years identifies the development of out-of-hours service provision as one of its three key priorities for NHS Direct.

The other two priorities are growth of its core service on the 0845 4647 number to provide 24-hour health advice and information to callers - this includes further expansion of its online and digital TV services, in addition to supporting emergency care through handling low priority ambulance calls from 2005 onwards.

By 2005/6 NHS Direct's current budget will increase from £100 million to £180m a year.

Although the service currently handles more than half-a-million telephone calls and half-a-million online transactions a month, by 2005/6 it is expected to handle more than 700,000 a month resulting from year-on-year growth. The service is also expected to reach a much wider cross section of people with the expansion of NHS Direct digital television.

Currently NHS Direct is integrated with 34 out-of-hours providers through the Exemplar programme, which was set up in November 2001 to aid integration between NHS Direct and the out-of-hours providers. As a result of this programme, NHS Direct now handles 90,000 out-of-hours calls and covers 10 million patients a year. But by December 2006, out-of-hours calls are predicted to rise from 90,000 to 530,000.

The Exemplar programme has been instrumental in providing opportunities to review service models for out-of-hours provision. It has also helped to understand how best NHS Direct can work with GP out-of-hours services to provide consistent standards of care and reduce GP workloads.

NHS Direct will now be working with other stakeholders to ensure that by December 2004 technical and operational links are in place to allow NHS Direct staff to transfer calls to any out-of-hours provider in the country. Full integration of the service is expected to follow as soon as possible thereafter.

In future PCTs will have a far greater role to play in the provision of services by NHS Direct. PCTs will not only be in a position to commission NHS Direct services, they will also have control over the pace at which out-of-hours integration takes place.

In order to maintain clinical quality, achieve economies of scale and protect the consistency of the service, a new national NHS Direct provider organisation will be set up from April 2004. This will allow the service, which started as a pilot project five years ago, to expand into a national service in its own right within the NHS. The new body, once set up, will also encompass all staff currently working for NHS Direct.

A copy of the review Developing NHS Direct - A strategy for the next three years is available on www.doh.gov.uk/developingnhsdirect .

News in Brief

Doctors' Forum update

The Doctors' Forum met recently to begin their programme of work for 2003 -2004.

The forum continues to bring together doctors ranging from GPs and consultants to medical students, to help bridge the gap between policy makers and the frontline.

The programme for 2003-2004 includes: ·

• Improving Working Lives (IWL)
  
• The European Working Time Directive (EWTD)
  
• medical careers and education
  
• medical management

The forum has been instrumental in improving communication between the Department of Health and the frontline.

For more information on the work of the forum e-mail emma.tate@doh.gsi.gov.uk

NHS LIFT seeks GP Champions

Potential GP 'champions' are being asked to put themselves forward to help encourage GP involvement in NHS Local Initiative Finance Trust (LIFT) schemes.

Likely to suit full-time practising GPs, the role would mainly involve extensive networking and sharing information about LIFT with other GPs. They would also be required to attend quarterly national meetings, as well as LIFT project board meetings.

GPs would have to commit up to 15 days a year to the role, which would be worth up to £6,000 a year.

Any GPs interested in getting involved should contact either their own primary care trust or SHA, or call Paul Betts at the Department of Health on 0113 254 6783, e-mail paul.betts@doh.gsi.gov.uk



New licences to practise

GPs are being invited to attend a series of symposia nationwide in May and June to introduce the new licence to practise being introduced by the General Medical Council (GMC).

Dates and venues are: ·

• 27 May, Royal College of Physicians, London
  
• 5 June, Westlain House, University of Brighton
  
• 9 June, Carnatic House, University of Liverpool
  
• 16 June, 2 West Building, University of Bath
  
• 18 June, Medical School, University of Newcastle-upon-Tyne
  
• 19 June, Middleton Hall, University of Hull
  
• 26 June, Roots Social Building, Warwick

Child-friendly hospitals standard launched

The first stage of the new children's national service framework (NSF) Getting the Right Start has been launched to raise standards of care for children and young people in hospital.

It has three distinct sections - child-centred hospital services, which consider the 'whole child' and not just the illness; the quality and safety of care provided; and the quality of the setting and environment.

A consultation paper examining the thinking behind other health and social care standards, including those associated with primary care, has also been launched. Staff are encouraged to give their views.

Comments should be sent, before 10 July, to the children's national service framework team, Wellington House, 133-155 Waterloo Road, London, SE1 8UG or by e-mail to: MB-Childrens-NSF@doh.gsi.gov.uk

Getting the right start: National Service Framework for Children - Standard for Hospital Services and Getting the right start: National Service Framework for Children - Emerging Findings are available at www.doh.gov.uk/nsf/children.htm .

Response to retail pharmacies report

A detailed Government response to an Office of Fair Trading (OFT) report into retail pharmacies will be published this summer.

The OFT study argued for the abolition of entry controls, saying it would bring benefits for consumers in terms of reduced prices, better quality and better access.

The Government will now draw up a balanced package of measures to open up the market and improve quality and access without diminishing the crucial role that pharmacies play, especially in poorer and rural areas.

A progress report, containing various proposals, will be published by the Government at the end of June.

The OFT report is available at www.oft.gov.uk/Market+investigations/Investigations/pharmacies.htm

NHS Estates briefing - update

The NHS Estates Quarterly Briefing magazine, originally created to provide quarterly construction figures, now features topical issues, estates information, health and safety and environment, primary care and construction statistics and information.

It is now available at http://195.92.246.148/knowledge_network To request a password for the site e-mail Moni Choudhury at Moni.Choudhury@doh.gsi.gov.uk or Erica Ricks at Erica.Ricks@doh.gsi.gov.uk

For more information about content, submissions and subscriptions e-mail Danielle.Holme@doh.gsi.gov.uk

Building Better Healthcare (BBH) Awards scheme

Best Designated Primary Care Project is among this year's categories in the BBH Awards scheme, run by NHS Estates.

Criteria include innovative design, achieving quality standards, meeting the needs of patients, staff and the local health plan and any beneficial impact on the local environment.

Judges will also be looking for evidence of partnerships between different agencies and how effectively services are being shifted from secondary to primary care.

Entry is free and submissions are needed by the end of June. The ceremony will be held this autumn.

More information at www.nhsestates.gov.uk/news_update/index.asp

The Digest

Did you see the news about.....? If you missed an announcement or new development of interest to you, the chances are it could be listed in The Digest . Each month in The Digest we feature subjects of note, including where to obtain more information.

In-patient waiting lists down

The overall in-patient waiting list fell by 25,800 during February to 1.027 million, Department of Health figures have revealed.

That is 23,000 fewer than the corresponding period last year, and more than 130,000 fewer than 1997.

By the end of February, only 6,700 patients were still waiting more than a year for treatment, down 2,900 on the previous month and down 19,100 on the previous year.

More information available at www.doh.gov.uk/waitingtimes



'5 A DAY' logo launched

A new logo reminding people of the benefits of eating five portions of fruit or vegetables a day is to be displayed in GP surgeries.

Launched by the Department of Health, the logo, which will also appear in supermarkets and on food packaging over the next few months, is part of a wider strategy to reduce the risk of cancer and heart disease, and promote healthy living.

More information at www.doh.gov.uk/fiveaday/index.htm

Emergency care project cutting waiting times

Patients are spending less time in accident and emergency departments throughout England, thanks to the Emergency Services Collaborative (ESC). Run by the NHS Modernisation Agency, the ESC is a programme that supports clinical teams in making improvements across the emergency care system. It aims to ensure that every patient is seen, treated, discharged, transferred or admitted within four hours of arrival in accident and emergency (A&E) by December 2004.

To learn more about the ESC, read individual case studies of improvement and monitor the ESC's progress, see www.modern.nhs.uk/emergency or e-mail Kerrin.Howard@doh.gsi.gov.uk.

Smoking, drinking and drug-taking trends in young people

A significant proportion of 11-15 year-olds questioned in an annual survey admitted to regularly smoking, drinking and taking drugs.

The full findings of the survey, conducted by the National Centre for Social Research, on behalf of the Department of Health, are available at www.info.doh.gov.uk/doh/intpress.nsf/page/2003-0130?OpenDocument

Improved services delivered to older people

New intermediate care services have led to a 65 per cent rise in older people receiving heart bypass treatment and an extra 100,000 people getting help to live independently at home.

Those are some of the main achievements highlighted in the report Progress and Future Challenges to mark the second anniversary of the launch of the National Service Framework for Older People.

Other examples include a fall of 2,000 in delayed discharges and 90 per cent of old-style 'Nightingale' wards modernised.

The full report is available at www.doh.gov.uk/nsf/olderpeople/publications.htm

Complaints reform

The new Commission for Healthcare Audit Improvement (CHAI) will become responsible for independent reviews of health service complaints.

Reforms proposed in the report NHS Complaints Reform - Making Things Right include increasing support and information for people who make complaints through local patient advice and liaison services and independent complaints advocacy services and providing customer care training for NHS staff.

The reforms also aim to help the two per cent of NHS complainants who request an independent review of their cases - many of whom think the current system is not impartial.

The document is available at www.doh.gov.uk/complaints For more information e-mail: dani.lee@doh.gsi.gov.uk

New delayed discharges system

The Community Care Act, which introduces a reimbursement system for delayed hospital discharges, has been passed and comes into effect in October.

It will also remove local authorities' ability to charge for community equipment and intermediate care.

NHS trusts will also have to tell authorities when it is clear an acute care patient may need community care after being discharged. More information is available at www.doh.gov.uk/jointunit/delayeddischarge/index.htm

Social services payments

New regulations requiring councils to offer direct payments to all adults in need of social services payments are being introduced.

This is seen as a key step in the drive to promote independence and freedom of choice, enabling people to make day-to-day decisions about care that best caters for their needs.

More information will be available at www.doh.gov.uk/directpayments by the end of April.

New drugs appraisal by NICE

The National Institute for Clinical Excellence (NICE) has been asked to develop guidance on several new topics by the Department of Health.

Subjects to be examined will include the best ways to treat eczema, the management of dementia, supporting parents of children with conduct disorders and new drugs for Alzheimer's.

Details of the timetables for these topics will be published on the institute's web site before the end of May at www.nice.org.uk

Recruiting wider healthcare team

More than 170 managers attended the recent Recruiting and Retaining the Wider Healthcare Team conference.

The Wider Healthcare Team plays a crucial role in helping to deliver the aims of the NHS Plan.

The conference was an opportunity for managers to share good practice and learn how to run an effective local recruitment campaign.

Methods for introducing the NHS Improving Working Lives (IWL) scheme were also discussed, along with how to bring in more attractive wider healthcare career pathways.

For more information call either Susan Maxfield on 0113 254 6739 or Peter Grummitt on 0113 254 5755

Primary Care Magazine

Primary Care Magazine, sent to all GP practices, aims to spread good practice, stimulate debate and keep health professionals working in the primary care sector up to date with the latest developments affecting GPs, nurses, pharmacists and other staff.

It can be read at www.nhs.uk/nhsmagazine/primarycare/index.asp

Diary

Meeting the Challenge - conference 3 October

This conference is aimed at primary care professionals, both clinicians and managers, who are involved with the planning, delivery and management of mental health care in primary care settings.

The key theme - changing roles, responsibilities and relationships - reflects the role that primary care will continue to play as a major provider of mental health care and the major changes that have taken place over the past two years in the NHS.

It is also open to primary care mental health research workers and educators. Booking forms are available from Helena Wilton at the National Primary Care Research and Development Centre, 5th floor, Williamson Building, Oxford Road, Manchester, M13 9PL.
Fax: 0161 275 0611
Tel: 0161 275 7610
e-mail: hwilton@fs1.cpcr.man.ac.uk
Laura Blake, National PC R and D centre, 0161 275 7647

New licences to practise - reminder

GPs are being invited to attend a series of symposia nationwide in May and June about the new licence to practise being introduced by the General Medical Council (GMC).

The venues are London, Brighton, Liverpool, Bath, Newcastle-upon-Tyne, Hull and Warwick (see News in Brief above for full details).

To book a place call Tessa Nicholson on 020 8747 4467 or go to www.revalidationuk.info

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