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

The bulletin is also a useful resource on health policy and practice for the wider primary care audience, including practice managers and nurses. Therefore, please could you circulate as widely as possible.

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

GMS contract implementation

Primary care trusts and GPs are about to begin discussions about implementing the new GMS contract after the vote in favour of the contract by GPs last month (June).

Some aspects of the contract will be implemented as early as possible.

These will include revised seniority payments which are designed to reward the experience of senior GPs. Full implementation of the contract is expected to come into effect from April next year, subject to legislation.

GPs can also expect extra funding to enable them to prepare for the introduction of the quality and outcomes framework next year.

Introduction of the first directed enhanced services – those aimed at improving access, preparing quality patient information and providing support for staff dealing with violent or abusive patients – will also begin.

The Department of Health has now written to all PCTs asking them to nominate a lead GMS contact and gear themselves up for full implementation.

They should begin by talking to all GPs about the services they intend or would like to provide under the new contract. And they should be making arrangements to replace services that some practices may no longer wish to provide, such as out-of-hours arrangements. Practices (and personal medical services providers) are expected to tell their PCTs by the end of September whether they intend to opt out of out of hours work under the arrangements to be introduced with the new contract.

Lead officers have been established in every strategic health authority to manage the implementation of the contract and the Department of Health will be producing a comprehensive action plan later in the summer.

Seven out of 10 GPs voted on the contract and of those almost 80 per cent were in favour.

Out-of-hours website

A new dedicated out-of-hours’ services website has been established containing information on all aspects of the OOH modernisation agenda. This includes:

• the out-of-hours ‘Carson’ report (2000)
• roles and responsibilities for PCTs, GPs and OOH providers with respect to accreditation and reporting
• quality standards and OOH regulations
• the exemplar programme and provider development project
• the establishment of technical links with NHS Direct which is to become the single gateway for the public to OOH care
• contact details for the National Implementation Team, including regional OOH co-ordinators

As set out in the new GMS contract, GPs may now choose to opt out of their OOH provision. Guidance for PCTs taking over 24-hour responsibility can be found on the site. The website also includes local information, news stories and a wide range of useful documents and links.

GPs can subscribe to a newsletter about the latest additions to the website.

There is also an e-mail address on the website for users to submit comments and suggestions to help develop the site.

The website is at www.out-of-hours.info

For further information please contact your OOH co-ordinator or mark.cockerton@out-of-hours.info

Freedom of Information

GPs are now being asked to register practice plans for implementing the Freedom of Information Act when it comes into effect on 1 January 2005.

A web-based publication scheme has been provided for independent practitioners with easy steps on how to complete your practice’s own publication scheme. The Information Commissioner has kindly waived the completion of a declaration form.

The Act gives a general right of access to all types of recorded information by public authorities. Therefore, any member of the public will be able to apply for access to information held across the public sector. The Act set out exemptions and places a number of obligations on public authorities.

Full access rights under the Act come into force on 1 January 2005, by which time any written request for information must be fulfilled within 20 working days.

The Act will be enforced by the Information Commissioner. Failure to comply carries a maximum punishment of two years imprisonment.

What you need to do now is:

• go to www.foi.nhs.uk/gp and read the guidance
• fill out your details in the GP publication scheme form
• click approve and it will be automatically displayed on the Freedom of Information website.

Ministerial reshuffle

John Hutton remains health minister with responsibility for primary care and NHS workforce issues, including pay, following the Prime Minister’s summer reshuffle.

Mr Hutton’s portfolio includes recruitment and retention, education and training, changing professional roles and the regulation of health care professions. His remit also covers NHS performance, access and IT.

Health secretary John Reid will have overall responsibility for NHS improvement, delivery and reform, finance and resources.

New health minister Rosie Winterton will cover emergency care, NHS Direct, adult mental health services, clinical negligence, patient and public involvement, diabetes services, transplants and organ donation, dentistry and pharmacy issues.

Melanie Johnson becomes the public health minister with responsibility for cancer, heart disease, tobacco policy, communicable diseases, immunisation, health inequalities, drug and alcohol misuse and sexual health matters.

Dr Stephen Ladyman will be the minister for community care, covering adult social services, older people’s services, policy on carers, children’s health services, services for disabled people and long-term medical conditions.

Norman Warner will be the Government health spokesman in the Lords but will also cover NHS performance ratings, the NHS inspections system, quality and clinical governance, the National Institute of Clinical Excellence, pharmaceutical industry issues, genetics and biotechnology, departmental agencies and research and development.

More information at www.doh.gov.uk/about/ministers.htm

Immediate response team project – case study

A GP-led pilot project designed to respond to patients in immediate need is proving a major success.

Appropriate Care at Point of Need (ACAPON), based at a rural Norfolk surgery, brings together a paramedic, nurse practitioner and health care assistant, all under a dedicated GP’s supervision.

The aim is to provide more appropriate immediate and emergency care in the local community by allowing the lead GP to decide who is seen, where and when.

A key aspect of the project, based at the Birchwood practice in North Walsham, is the primary care paramedic, who brings expertise on emergency assessment, treatment and resuscitation.

Over an initial eight-month period, only 11 of the 305 patients who contacted the surgery before being seen by the paramedic needed hospital admission. Only five were transferred to A&E for minor injury assessment.

Unnecessary A&E admissions have reduced by half while 80 per cent of patients have been sent down much more appropriate treatment pathways. About £18,000 has also been saved through decreased ambulance use and unnecessary admissions.

Team leader Dr Paul Everden said: "My greatest frustration was the lack of time spent with patients. If you can get people through the system in a more appropriate way, you will help avoid the unnecessary transfer by ambulance to our already-overstretched hospitals.

"ACAPON has resulted in a faster response to need, a better use of health care resources, more selective use of ambulances and, most importantly, a clear message from patients that they are more satisfied with the care given. "

It is hoped the scheme, which has attracted considerable interest from the Department of Health, can be extended to other practices.

For more information e-mail paul.everden@nhs.net

Double honours for primary care team

Staff at Knowsley Primary Care Trust won two top prizes in this year’s Health and Social Care Awards.

The PCT won the Children’s Award for its children and young persons’ smoking cessation and prevention initiative and the Improving Working Lives Award for its flexible working scheme for podiatrists.

The schools-based smoking cessation project has so far helped 85 per cent of young people using the service to kick the habit or cut down dramatically.

Assistant director of public health Liz Gaulton said: "Young people are motivated to stop smoking and many are confident enough to self-refer to the service. With the right support they can give up, despite peer pressure."

The flexible working scheme aims to increase patient access, improve the working lives of staff and modernise services. It was developed to increase recruitment and retention of staff within Knowsley’s podiatry department and allows staff to identify their preferred working pattern, setting the total hours they want to work in each year.

Acting head of podiatry Samantha Ashton-Mort said: "Staff report high levels of satisfaction with the scheme. Some have reduced childcare costs, have more time with their children and increased leisure opportunities."

"It has been so successful that the PCT is now looking to widen the scheme to include other staff groups," said Wendy Pickard, deputy director of service provision.

The Health and Social Care Awards, now in their third year, recognise the achievements of staff and provide an opportunity to share best practice.

The full list of winners is available at www.doh.gov.uk/healthandsocialcareawards

News in Brief

Public health

A comprehensive action plan has been launched to tackle inequalities in health across England.

Health Inequalities – A Programme for Action sets out detailed ways in which the Government’s strategy to cut inequalities in health can be put into practice.

This will help to improve life expectancy and cut the number of infant deaths in the country, particularly in the most disadvantaged communities.

The programme provides a toolkit to help organisations restructure services to address specific local health problems.

Government chief medical officer Sir Liam Donaldson has also published his annual report.

On the State of the Public Health highlights five areas of concern – the health risks from passive smoking; West Nile virus; obesity; poor clinical performance; and safe injections.

He also reviews progress made in tackling health inequalities, high blood pressure, E.coli 0157, epilepsy and alcohol and liver cirrhosis.

On the State of the Public Health is at www.doh.gov.uk/cmo/annualreport2002

Health inequalities – A Programme for Action is at www.doh.gov.uk/healthinequalities/programmeforaction

Genetics strategy

Advances in genomics and in genetic technology will clearly make a

difference to health care. Increased understanding of the molecular and genetic basis of disease will alter how we categorise, seek to prevent and treat a wide variety of disease.

The timescale and magnitude of this change is uncertain. But over time genetics will become increasingly relevant to virtually all clinical areas and across primary, secondary and tertiary care.

The genetics White Paper Our inheritance, our future – realising the potential of genetics in the NHS was launched on 24 June 2003. It sets out a comprehensive plan that will help the NHS prepare the ground so that patients can benefit from future advances in genetics.

Text of the full White Paper and executive summary are available at www.doh.gov.uk/genetics/whitepaper.htm

Contact: geneticswhitepaper@doh.gsi.gov.uk or Diana Paine on 0207 972 5864 Diana.Paine@doh.gsi.gov.uk or Dr Alison Hill on 0207 972 5380 alison.p.hill@doh.gsi.gov.uk

NHS improvements

The NHS is improving services to patients through targets and action plans, according to the Audit Commission.

Achieving the NHS Plan assesses the work done so far to meet Government targets. It found the focus on waiting times is beginning to pay off, with more patients being able to see a GP within two working days and the reduction of outpatient waiting times to 21 weeks.

However, the commission warned that some NHS organisations were finding short-term solutions to achieve targets that would reduce the resources for modernising services in the future.

More information at www.audit-commission.gov.uk/

Consultation on children’s services extended

In April, the Department of Health published Emerging Findings - a document setting out some of the early thinking on the development of the National Service Framework (NSF) for Children, Young People and Maternity Services.

The NSF will set standards across health and social care services. It has three key objectives: to put children and families at the centre of care; to develop effective partnership working so that the needs of the child are always considered and to deliver needs-led services.

The Children’s NSF team would welcome your views on this paper by 10 August – now extended from 10 July. The Emerging Findings document is available at www.doh.gov.uk/nsf/children.htm

You can send your comments in writing to: Claire Phillips, Children’s National Service Framework, Room 526, Wellington House, 133-155 Waterloo Road London SE1 8UG, or by e-mail to MB-Childrens-NSF@doh.gsi.gov.uk

Seroxat ban

Children under 18 should not be treated with the drug Seroxat (paroxetine), the Medicines and Healthcare Products Regulatory Agency (MHRA) has warned.

MRHA recently launched an inquiry into antidepressant drugs.

New evidence shows there has been an increase in the rate of self harm and potentially suicidal behaviour among teenagers when Seroxat is used to treat their depression.

More at www.mhra.gov.uk

NHS Direct self-help guide

The NHS Direct self-help guide Not feeling well? is now in its third edition.

The 136-page guide works alongside the NHS Direct helpline service and contains advice on the most common symptoms about which people call the service.

While the guide is available to everyone, limited stock means we have to be more targeted with its distribution. NHS Direct is currently concentrating on socially-disadvantaged groups and older people.

However, this should not affect the already established strong distribution links through GP surgeries and pharmacies.

If you can help with this targeted distribution, copies are free and can be obtained by calling the NHS Responseline on 08701 555 455.

The guide is also available at www.nhsdirect.nhs.uk/selfhelp/index.asp

Salt risk

Doctors are being asked to note new recommendations for daily salt intake.

Too much salt can cause high blood pressure, which is a significant risk factor for cardiovascular disease, a major cause of death.

On average, people consume nine grams of salt per day. A recent report from the Scientific Advisory Committee on Nutrition (SACN) has recommended that consumption of salt be reduced by one-third to no more than six grams a day.

For the first time, recommendations on salt intake have also been set for children.

More information on how to reduce salt intake is available at www.food.gov.uk and a copy of the SACN report is available from www.sacn.gov.uk

Safety and justice

GPs are being asked to respond to the consultation paper Safety and Justice.

This sets out the Government’s proposed strategy for tackling domestic violence.

The strategy aims to reduce domestic violence - which affects one in four women and one in six men - and to increase reporting. It is based around three elements – prevention, protection and support for victims.

The Government is keen to hear the views of healthcare professionals on issues such as early intervention, the role of GPs and the impact on children.

The consultation paper is available at www.homeoffice.gov.uk

The consultation exercise ends on 12 September.

The Digest

New clinical negligence system proposed

A new system for handling cases of clinical negligence in the NHS has been proposed by the Government’s chief medical officer.

In his report Making Amends, Sir Liam Donaldson recommends the creation of a new NHS Redress Scheme to speed up the process.

Under the plans, a national body building on the work of the NHS Litigation Authority will administer the redress scheme offering remedial treatment, rehabilitation and care where needed; explanations and apologies; and financial compensation where appropriate.

Under the proposals, the redress scheme will be initially applied to NHS hospitals and, if successful, the Department of Health will consider extending it to primary care.

There will now be a period of consultation running up to October before a definitive statement of policy is published towards the end of the year.

The full report is at www.doh.gov.uk/makingamends

Personal medical services: new ideas

Ideas for the future development of personal medical services (PMS) have emerged from a series of listening events.

Primary care commissioning, funding and quality of care were among issues raised. The PMS National Development Team wishes to thank all those who attended or submitted written suggestions. The Department of Health is now studying the ideas put forward.

Further information on PMS is available from the National PMS helpline 0845 900 008 or at www.doh.gov.uk/pmsdevelopment

Waiting, booking and choice

The Department of Health has launched a new website section focusing on waiting, booking and choice.

It sets out the vision and strategy for delivering the reforms needed to ensure NHS patients obtain faster and more convenient access to health care, including within primary care.

The new section highlights tools available to managers and gives examples of primary care trusts or practices that are giving their patients better access to NHS services.

It is at www.doh.gov.uk/waitingbookingchoice

Doctors and dentists’ remuneration

The Review Body on Doctors' and Dentists' Remuneration (DDRB) have published a supplement to their 32^nd Report dealing with general dental practitioners, salaried primary dental care services, GMP registrars and salaried general medical practitioners employed by a primary care organisation.

A copy of the report and a message to staff from DDRB can be found at www.ome.uk.com/dnd_review.cfm

Asylum seekers

Caring for Dispersed Asylum Seekers - A Resource Pack was launched by the Department of Health on 19 June.

The pack, developed with the Refugee Council, provides those who work with asylum seekers and refugees information on key policies including entitlement to primary care, advice on GP registration and guidance on language issues and mental health.

More at www.doh.gov.uk/asylumseekers

Miscarriage leaflet

Leaflets about miscarriage have been produced in a range of minority ethnic languages by The Miscarriage Association with the aid of a grant from the Department of Health.

The leaflet We are sorry that you had a miscarriage has been updated and translated into Urdi, Punjabi, Bangla and Gujerati.

The association has also produced leaflets on infertility issues after miscarriage or ectopic pregnancy; post-24 week loss; recurrent miscarriage; and advice for men.

All leaflets and ordering information are available at www.miscarriageassociation.org.uk or on 01924 200795.

Screening for haemoglobinopathies

The NHS Plan set out a commitment to new and effective screening programmes for women and children including a new national linked antenatal and neonatal programme for haemoglobinopathies.

A development programme is in place and is consulting on a number of processes for the screening of newborn babies for sickle cell disorders and women for sickle cell disorders and thalassaemia in the antenatal period.

Details of the consultation are at www.kcl-phs.org.uk/haemscreening and click on 'Consultation' at the bottom left of the page.

Orthopaedics boost

A £50 million drive to eliminate long waits for NHS orthopaedic patients has been launched. It is expected to lead to an extra 41,000 patients per year undergoing operations, such as hip replacements.

The funding is being shared across NHS orthopaedic services, including primary care trusts and NHS diagnosis and treatment centres. It will be used to modernise theatres and buy new equipment.

The extra resources will deliver shorter waiting times for patients and ensure that no orthopaedic patient is waiting more than six months for treatment by December 2005.

Dangerous pathogens guidance

Updated guidance for healthcare and laboratory workers on safe working with transmissible spongiform encephalopathies (TSEs) such as Creutzfeldt-Jakob Disease (CJD) and bovine spongiform encephalopathy (BSE) has been published at www.doh.gov.uk/cjd/tseguidance

Sexual health

The Department of Health will publish a full response later in the year to a health select committee report on sexual health.

The department’s sexual health and HIV strategy was launched at the end of last year and is still in the early stages of implementation.

It can be seen at www.doh.gov.uk/sexualhealthandhiv/index.htm

Tackling drugs

An extra £3.6 million is being invested in the Government’s community engagement programme to tackle drugs abuse.

This follows a report that found the programme had successfully identified the needs of black and minority ethnic communities in treating substance misuse effectively.
More at www.doh.gov.uk/drugs/

Talk to Frank

A drugs campaign offering advice and information to young people and parents has been set up.

‘Frank’ is a helpline and website providing information about Class A drugs such as heroin and cocaine.

The helpline number is 0800 77 66 00 and the website is at www.talktofrank.com

Older people’s services

Health care for older people has been assessed by the Commission for Health Improvement (CHI).

CHI looked at how the NHS was improving services in line with the National Service Framework (NSF) for Older People launched two years.

Since then an extra 3,000 extra intermediate care beds have been provided and mixed sex wards have been virtually eliminated. Cataract, knee replacement and heart operations have also risen.

The CHI report is at www.chi.nhs.uk
The NSF and a progress report are at www.doh.gov.uk/nsf/olderpeople

Older people’s services – newsletter

A newsletter from the national director for older people's services Ian Philp is now available at www.doh.gov.uk/nsf/olderpeople/news.htm

The current edition, aimed at older people’s champions, looks at the Shaping our Future conference, the national service framework progress report and good practice around falls.

For further information contact Bonnie.Yandall@doh.gsi.gov.uk

Thrombolysis targets review

A review of the National Service Framework for Coronary Heart Disease thrombolysis targets has been published. The document:

• confirms the importance of early thrombolysis
• outlines the success of the NHS in delivering faster treatment
• provides a checklist of good practice developed by the CHD Collaborative
• emphasises the need for NHS ambulance services and acute hospitals to work even more closely to secure better and faster care for heart attack patients.

Smoke less

Smoking cessation services celebrated further successes when the latest figures showed 79,600 people successfully quit between April and December 2002.

About three out of four smokers were treated exclusively with nicotine replacement therapy.
Full report at www.doh.gov.uk/public/stats1.htm

Reducing delays

Grants worth a total of £50 million have been allocated to councils across England to help them cut the number of delayed transfers from hospitals.
Further information at www.doh.gov.uk/reimbursement/index.htm

Excellence in midwifery

A report highlighting examples of innovative practice in midwifery is now available at www.doh.gov.uk/cno/midwives.pdf

Mental health consultation

A consultation to help drive forward initiatives to tackle social exclusion of people with mental health problems ends on 5 September.
The consultation paper is at www.socialexclusionunit.gov.uk/mental_health/mental_health.htm

IT in the NHS

Plans to create a modern IT infrastructure for the NHS are making good progress.

Ultimately, all strategic health authorities will have to work through a local provider to replace or provide new IT equipment and systems for the NHS.

A list of individual companies and consortia has now been compiled and will be invited to negotiate for IT contracts for each region.

More at www.doh.gov.uk/ipu/programme

Chief dental officer digest

The latest monthly digest, covering topics such as the dentistry role in NHS modernisation, an update on Options for Change, conscious sedation guidelines, dental nurse pioneers and other news, is available at www.doh.gov.uk/cdo/digest.htm

Primary Care Magazine

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

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