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Welcome to the June 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. Please share the bulletin with any colleagues who may be interested. 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 7UE TOP NEWS New prescribing powers transform roles New prescribing and dispensing powers are set to transform the way GPs work and improve patient care. Bristol South and West Primary Care Trust will be one of the first to introduce repeat dispensing. Shortly patients will be able to access repeat supplies of their regular medicines from their pharmacy. PCT head of medicines management Trevor Beswick said: "Repeat dispensing will be a lot more convenient for patients, considerably reduce the workload on surgeries, in particular GPs, and reduce waiting times to see a GP. It will also allow us to make better use of pharmacists and their skills and reduce medicine waste. Repeat dispensing processes are very important in terms of GP workload and a big improvement for patients." Once modifications to computer systems are in place, surgeries will be able to use the ‘batch’ prescription forms, valid for up to one year, for patients on chronic stable treatments for thyroid problems and diabetes. Supplementary prescribing is also starting to have an impact on primary care. At City Walls Medical Centre in Chester, practice nurse manager Kathy Capper Moore qualified as a supplementary prescriber in April. She is now prescribing for patients with diabetes, specified minor illnesses and minor injuries. As she gains confidence, and with the agreement of the partners, this list will be extended. GP Dr Vish Kini said GPs are already feeling the benefits. "Before Kathy qualified she, like the other nurses, would see patients but have to get doctor approval for prescriptions. Now she can deal with that herself, saving GP time to concentrate on complex cases. Supplementary prescribing has valuable long term benefits but this is a fairly major change to the way the practice works and so we have to take it slowly to get it right." Professor David Haslam, chairman of the Royal College of GPs, said: "With the right safeguards in place, supplementary prescribing and repeat dispensing will benefit GPs and patients, saving everyone time and increasing teamwork, skill mix and efficiency." More information at www.doh.gov.uk/supplementaryprescribing GMS contract - update The British Medical Association’s General Practitioners Committee (GPC) has asked its negotiating team to re-examine the proposed new GMS contract. It follows a meeting of Local Medical Committees on 14 May, and the GPC has asked for the revised contract to be returned at a special GPC meeting on 29 May. It will then make a decision on the timetable for a ballot. Full details of the LMC and GPC meetings are available on the British Medical Association website at Access scheme helps cut primary care waiting times Nationally eighty-eight per cent of patients can now be offered an appointment with a GP within two working days, while more than 90 per cent can see a primary care professional within one working day. Figures published in May show significant progress is being made towards achieving the primary care access targets by the end of 2004. The Department of Health’s national clinical director for primary care,David Colin-Thome, praised the efforts of primary care staff in improving access for patients. "Fast and convenient access may not be seen as a clinical priority, but patients tell us it is their number one priority and something they expect us to deliver," he said. "That is why these figures are so encouraging. They show the work of GPs and other primary care staff is really beginning to pay off.
"However, these access targets are challenging and there is still much to be done. For this reason, PCTs have resources to support practices wanting to take up the Primary Care Collaborative’s Advanced Access model which is proving so successful." The National Primary Care Collaborative, managed by the National Primary Care Development Team, encourages good practice to bring about positive change. It sees the Advanced Access scheme as a key priority, as it helps staff to understand the demand for care, shape how it is handled and ensure capacity matches it. It also helps to improve the working lives of GPs and practice staff. Some practices have shown how telephone management of same-day appointment requests can reduce face-to-face consultations by up to 50 per cent. Emails and websites have also been used successfully for repeat prescribing. The cut in waiting times has also been helped by an improvement in the skill mix in PCTs and practices, making more effective use of skilled nurses and through the increasing use of healthcare assistants, enabling GPs and nurses to target their skills more appropriately. By March this year, practices covering 20 million patients have been involved in activity to improve access through the Advanced Access model. The Department is now planning to support PCTs with a compendium of options to help each PCT to decide how they should improve access. The compendium will contain practical suggestions which could be used as an alternative to advanced access – where that is not the solution, or to complement it. More information is available at www.doh.gov.uk/pricare/improvedaccess.htm. New specialists in mental health Most mental health problems are managed in primary care. GPs and nurses can play a crucial role in the early detection of mental health problems, and are being helped to take on a role to offer patients fast and convenient access to high quality services. They can provide assessment, advice, information and treatment for patients with common mental health problems. New training and development to strengthen primary care mental health will help to improve services at local level. The Government has allocated £2.5 million for 12 new programmes of primary care mental health training to support 1,000 new graduate mental health workers - the first of their kind in the country. In addition the Government has recently published guidelines for the development of GPs with special interests (GPwSIs) and nurses with special interests. Last month 10 new sets of guidelines for GPwSIs, including one for mental health, were issued. The aim is to ensure that all primary care staff are well equipped to support people with mental health problems. National mental health director Louis Appleby said: "I am delighted at the progress being made to strengthen primary care mental health. Together with developments in specialised secondary services these initiatives will lead to a high quality, whole system of care for people with mental health problems." For more information visit www.doh.gov.uk/mentalhealth or www.trentconfed.nhs.uk
NEWS IN BRIEF Waiting lists fall The number of people waiting for inpatient treatment in the NHS has fallen below one million for the first time in 10 years, official statistics show. The new figures were revealed alongside the annual report by the NHS chief executive Sir Nigel Crisp, published on 16 May 2003. The Chief Executive’s Report to the NHS 2002/03 said that 88 per cent of patients can now be offered a GP appointment within two working days and nine out of 10 callers can be offered an appointment with a primary care professional within one working day. Accident and emergency cases have risen by 205,000 to over 13 million during 2002 – 2003 and non-urgent NHS hospital admissions rose by 4.5 per cent to over 5.5m in the same period. Sir Nigel said: "We are now starting to see real improvements across the board. "There is much more to do but these results show an improving trend is now clearly established. "At the same time we are beginning to see the emergence of a new kind of NHS – a more accessible, community-based service with more patients being cared for in primary care and more use of the NHS’s pioneering self-help services. "These achievements are a tribute to the incredibly hard work of staff throughout the NHS and social services – they deserve our thanks and congratulations as well as our continuing support." The Chief Executive’s Report to the NHS 2002/03 is available at the Department of Health website Getting better? Patient care in the NHS is getting better according to a report by the independent health watchdog, the Commission for Health Improvement (CHI). Getting Better? concluded that national standards have led to better and more consistent care. After carrying out 250 inspections of health communities across England and Wales, CHI found that investment in new and existing premises has made a difference to the environment in which patients are treated and confirmed that modern equipment is far more widely available than 10 years ago. Waiting times are also falling and there are more staff available to treat people. CHI chair Dame Deirdre Hine said: "We do not reach a conclusion that everything is rosy in the NHS, but nor do we conclude that it is generally failing. The bottom line is that the NHS as a whole is getting better." Full report available at www.chi.nhs.uk/eng/about/publications/getting_better/index.shtml Leaseplus guide for GP surgeries A detailed guide on the NHS Local Initiative Finance Trust (LIFT) leaseplus agreement is due to be published by the BMA’s General Practitioners Committee (GPC) and Partnerships for Health (PfH). The leaseplus is the standard lease for use in NHS LIFT developments. The guide has been produced specifically for GPs and explains the respective rights and obligations of both the tenant and landlord under the leaseplus agreement. It also includes a summary highlighting the major differences between this type of lease and the conventional ‘third-party developer’ lease. More information is available at www.doh.gov.uk/nhslift/guidance.htm Coronary heart disease improvements Nearly 2,500 improvements to the care of heart disease patients have been introduced in the NHS since the launch of a national collaborative programme in October 2000. The Coronary Heart Disease (CHD) Collaborative, now part of the NHS Modernisation Agency, illustrates ways in which services have been redesigned in its annual report A multidisciplinary challenge: Improving services for people with Coronary Heart Disease. The report illustrates examples of how the collaborative is helping drive improvements in cardiac care across the whole patient journey. Thirty CHD programmes, focusing on the six key areas of angina, heart failure, acute myocardial infarction, revascularisation, rehabilitation and secondary prevention, are working with local clinical teams to make a real impact on patient and carers’ experience of cardiac care. One example is how the redesign of echocardiography services has seen dramatic reductions in waiting times for both inpatients and outpatients. The report is available at www.modern.nhs.uk/chd Severe Acute Respiratory Syndrome (SARS) - advice to health care staff The possibility of SARS should be considered in travellers who have high fever (above 38ºC) and one or more respiratory symptoms including cough, shortness of breath and/or difficulty in breathing, and: · a history of close contact, in the 10 days before becoming unwell, with a person who has been diagnosed with SARS. Close contact means having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS
Further information is available at www.phls.org.uk/topics_az/SARS/menu.htm or www.doh.gov.uk/sars Booklet for staff on safeguarding children Over one million NHS and other frontline staff are being urged to study a new booklet published by the Government which sets out their role in safeguarding children. Child protection is everybody’s responsibility: both staff who come into contact directly with children, and those who work with adults who are parents and/or carers. Lord Laming, in his report into the death of Victoria Climbié, published in January, highlighted serious failures in professional practice, and described the extent of the failure to protect Victoria as ‘lamentable’. The booklet is being sent to NHS and local authority chief executives, asking them to make it available to child protection named and designated professionals. A summary booklet has also been published for all staff who come into contact with children, parents and families. This is being sent directly to all doctors, nurses, midwives and health visitors. The bookletis being sent out from 20 May onwards. Staff can get more information, and a copy of the booklet or summary from www.doh.gov.uk/safeguardingchildren/index.htm New recommendation on duration of breastfeeding Following on from the World Health Organisation’s recommendation on breastfeeding, parliamentary under secretary for public health Hazel Blears has announced new recommendations on breastfeeding.
For further details refer to: www.breastfeeding.nhs.uk Invitation to tender The Department of Health has appointed a Refugee Health Professionals’ Steering Group to allocate funding to projects aimed at integrating refugees into the NHS workforce. The department now invites bids from organisations working to achieve this aim. We welcome particularly bids in support of nurses, dentists and allied health professionals. Bids are welcomed from all areas of England. Each project will be allocated up to a maximum of £50,000 in the first instance; this money cannot be used for supporting individuals undertaking studies. If you are aware of any organisations that offer educational and career support services to refugee health professionals and might be interested in applying, please bring this to their attention. Bids must be endorsed by one or more workforce development confederations. For an application form and a full copy of the project criteria contact Simon Murden on 0113 2546408, or email simon.murden@doh.gsi.gov.uk Applications must be received by 12 noon on 13 June 2003. Medical Device Alerts MDA/2003/010 - infra-red ear thermometer - home Use MDA/2003/011 - blood glucose meter test strips: Roche Accu-Chek Advantage II MDA/2003/012 - all biphasic defibrillators (all manufacturers) MDA/2003/013 - "Infinity" pressure relieving wheelchair seat cushions. Manufactured by Invacare Limited. Further information is available at www.mhra.gov.uk THE DIGEST Improvement pledge A new NHS programme to improve services across the health service has been launched with the publication of Raising Standards - Improving Performance in the NHS. The improvement programme will be targeted at NHS hospitals and primary care trusts that are rated as two stars and below with the backing of an extra £200 million. This will enable all hospitals to achieve NHS foundation status by 2008 while ensuring every PCT has the capacity and the capability to use their control over NHS resources to commission local services that will gain the greatest benefit for their patients. More at www.doh.gov.uk/raisingstandardsnhs/improving_performance.htm Hib catch-up campaign: GP payments GPs in England will receive a 'B' rate item-of-service fee for every additional dose of Haemophilius influenzaeb (Hib) vaccine given, over and above the primary course, as part of the catch-up campaign. This follows agreement by the NHS Confederation and the BMA General Practitioners Committee. PCTs should develop support arrangements for GP practices who are unable to participate in the campaign so that as many children as possible are able to benefit from the additional vaccinations. PCTs will be informed in due course of their ‘fair shares’ of the funds available to remunerate PMS pilots. More at www.doh.gov.uk/pricare/fees-amend-hibcampaign.htm Queries: mark.smith@doh.gsi.gov.uk GPs and primary care organisations should be aware that changes have been agreed to the Statement of Fees and Allowances, to reflect changes in local and national building costs. Details of the changes, concerning paragraph 51 Premises Schedules and paragraph 56 Improvement Grant Schedule, can be found at www.nhsestates.gov.uk/primary_care/index.asp under Guidance. Funding for locum reimbursement for absences due to maternity leave has increased from 18 to 26 weeks. Reimbursement for adoptive leave has also been increased to 26 weeks for adopters of both pre-school and school age children. Both took effect on 6 April and any GPs already on leave or commencing leave on or after that date are eligible. The amendment to the Statement of Fees and Allowances is available on www.doh.gov.uk/pricare/030326para49sfa.htm Queries: Debi.Nicholson@doh.gsi.gov.uk or on 0113 2545218. Further opportunities for nurses to expand their roles were announced during the Royal College of Nursing Congress at the end of April. These include the introduction of nurse governors in new NHS foundation trusts, an update on Agenda for Change, more prescribing powers and quicker approval for consultant posts. More in the chief nursing officer’s bulletin for May at www.doh.gov.uk/cno/bulletins.htm
Further reforms around the use of human organs and tissue are expected after a report on Cyril Issacs, whose brain was given to a university without his family’s consent. Chief medical officer Professor Sir Liam Donaldson said a new Human Tissue Bill would be put before Parliament as soon as parliamentary time allows. Current post mortem and consent guidelines are available at www.doh.gov.uk/tissue/ Copies of The Isaacs Report are available at www.doh.gov.uk/cmo/isaacsreport/ Drive to end eye operation waits A new drive to end long waits for NHS cataract operations has been launched, backed by a £56 million fund. The aim is that by December 2004 no cataract patient is waiting more than three months for surgery. Most areas are expected to achieve the target by the summer of 2004. The initiative starts in August this year and is expected to result in an average waiting time of just six weeks. Primary care trusts are being provided with £52m to fund the extra operations in existing NHS eye units and diagnostic and treatment centres. A further £4m will be used to pilot improvements to services for patients suffering from chronic eye disease and low vision. www.info.doh.gov.uk/doh/intpress.nsf/page/2003-0206?OpenDocument An £8.5 million investment is being made into services to help patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). This will establish centres of excellence in the condition. Community teams will also be recruited to support GPs and other health professionals. Further education and training for health care professionals will be developed and access to specialist assessment, diagnosis and advice improved. More at www.doh.gov.uk/cfs-me.htm NHS job vacancies in England are set to be advertised on the internet. The pilot electronic service is due to launch in summer 2003 with full national coverage at the end of the year or in early 2004. The website will link with local trust sites to become the recognised national first point of call for information about jobs, education and training in the NHS. Arrangements will also be made for the NHS Careers website and call centre to become compatible with the new facility. New Action On pilot schemes have been launched to improve access and quality of care for patients. The new pilots will extend the programme to urology and plastic surgery with each project receiving between £70,000 and £105,000 over the next 18 months to develop improved methods of treating patients. Existing Action On areas include cataract surgery and ophthalmology, dermatology, ear, nose and throat and orthopaedics. Those pilots have already produced good practice guides for use throughout the NHS. For urology, pilot projects include nurse-led assessment and management at Colchester Primary Care Trust and urology in the community at the Royal United Hospital Bath NHS Trust. Plastic surgery projects include hospital at home nursing by University Hospital Birmingham NHS Trust and digital imaging in plastic surgery by Lancashire Teaching Hospitals NHS Trust. More at www.modern.nhs.uk/action-on NHS Direct - drug side effects Patients suffering from suspected side effects to drugs will be able to report their conditions through NHS Direct. The NHS Direct call centre in Beckenham, which covers south-east London, is the first in the country to introduce patient reporting of suspected adverse drug reactions. After a trial period the service could be extended to all 22 NHS Direct call centres throughout England. A £1.3 million award scheme to fund research and development into complementary therapy and alternative medicines has been launched. The new National Complementary and Alternative Medicines (CAM) post- doctoral award will fund studies into areas such as acupuncture and homeopathy. The range of subjects covered by the first five awards includes the use of CAM for asthma and homeopathic treatments for chronic fatigue syndrome. A report from the Health Development Agency (HDA) highlights innovative ways in which local councils are tackling health issues. Local government scrutiny of health: using the new power to tackle health inequalities features case studies from 18 councils on campaigns targeting sex education, teenage pregnancy, drug use and smoking in public places. There are also wide-ranging reviews of issues such as homelessness, children’s diet and the provision of services of older people and children. The publication is available free at The consultation draft of Drugs: Guidance for schools is now available to download from www.dfes.gov.uk/consultations2/08/ Hard copies can be obtained from the DfES publications line (0845 6022260) quoting reference number DfES/0 205 /2003. Your comments should be sent by 18 July to: drugsguidance.consultation@dfes.gsi.gov.uk or by post to: Consultation Unit, Level 1, Area B, Castle View House, East Lane, Runcorn WA7 2GJ. Local UK online centres are to provide free internet starter sessions until the end of June. This is part of a new Government-led campaign to encourage people who have not tried the internet to give it a go. Age Concern is holding a four-week ‘silver surfer festival’ aimed at getting older people online. The Princes Trust is also organising longer courses for the long-term unemployed. If you already know how to use the internet, UK online is asking that you become an ‘internet angel’ and show starters the basics. For more information or to find a local centre, contact 0800 77 1234. The magazine 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
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