NAPC General Practice Bulletin

GPs Advised On Child Neglect

GPs will be told to raise concerns with social services, if they believe a parent’s problems, such as alcohol use or mental health, mean their children are at risk of neglect.

Retail Bond Offers A Stake

Primary Health Properties is the latest company to target income hungry investors with the launch of a retail bond.

PHP owns a portfolio of medical centres used by GPs and health trust and is seeking to raise up to £75 million.  The bonds pay a fixed 5.375 per cent gross until maturity in July 2019, when investors’ original capital should be returned.

Real corporate bonds are becoming increasingly popular with investors who want more certainty of income.  Tesco, Lloyds, TSB, and National Grid  are the firms that have issued them.

Scrip Loophole Threatens Revalidation

Repeated Department of Health failures to update ‘archaic’ systems for tracking GP prescriptions may hamper revalidation and obstruct work to reduce costs, the General Practice Committee (GPC) of the British Medical Association has warned.

The GPC is ‘extremely concerned’ that the system used to track primary care prescribing will undermine efforts to improve the quality of prescribing and impede revalidation of sessional GPs.

GPC prescribing lead, Dr Bill Beeby, who chaired a GPC meeting on the matter this month, said the 2004 Shipman Report said prescriptions must carry doctors’ GMC numbers.

Dr Beeby commented the Department of Health’s ‘persistent failure’ to modernise the system since then has left a ‘huge hole’ in prescribing accountability.  He said the simple answer would be to include GPs’ GMC number and a location code on each prescription. ‘This does not always cover repeat prescriptions, but would greatly improve the problem with providing data for locums.

Sessional GPs are unable to access data on their own prescribing because most do not have an individual prescriber number.  Many who do obtain one from their PCT cannot add it to practice IT systems.

This means practices cannot audit the prescribing of locums and sessional GPs cannot collect data for revalidation.

Whooping Cough Hits 20 Year Peak

Whooping cough, the highly infectious disease that was almost eradicated in the UK, a generation ago, is now more common than at any time in the past 20 years, health authorities have warned.

Tendering LESs Would Be Disaster For Practices

Forcing commissioners to put local enhanced services (LESs) would be a ‘disaster’ for general practice, GPs say.

The General Practice Committee (GPC) of the British Medical Association, said clinical commissioning groups (CCGs) may be forced  to ‘flog off’ LESs to private firms under any qualified provider (AQP) tendering process. 

RXGP chairwoman, Dr Clare Gerada, warned that removing LESs from practices would be a ‘disaster’ for GPs and could ultimately leave some practices financially unviable.

However, Dr James Kingsland, lead of the clinical commissioning network at the Department of Health, said he thought it was ‘very, very unlikely’ that LESs would have to be put out to tender.  ‘If we put services such as warfarin monitoring and extended GP hours out to tender through AQP, we have lost the plot in care reform’, he said.

LESs, currently held by PCTs, are to be devolved to CCGs, which will choose how to commission those services.

Part-Time Women Doctors Could Be Bad For Patients

Women doctors, who only work  part time are causing staffing issues that could create problems in the future, an expert has warned.

Dr Hilary Cass, said children’s units, which attracted higher numbers of women doctors, were a particular cause of concern.

GPs Face Rethink On All Age-Based Decisions

Plans to strengthen age discrimination laws will affect all decisions GPs make in which age plays a part, legal experts have told GPs.

The government announced recently that GPs and other NHS workers would be banned from denying older patients treatment simply on the grounds of their age.

Once the legislation comes into force, the onus will fall on healthcare professionals to make decisions that take the wider position of the patient fully into account.  There will be a greater need for healthcare practitioners to be able demonstrate that each treatment decision, in which age may have ostensibly played a part, was reached based on a broader consideration of the health and well-being of the patient, and not just their age.

The rules will have a much broader impact than simply affecting elderly care.  The NHS will need to review all treatments in which age has been a determining factor in deciding whether they should be provided or not, and introduce practices which ensure that decisions are not made arbitrarily on the grounds of age.

A spokesperson from NICE said that the organisation already took account of its legal responsibilities on all grounds of discrimination when developing its guidance.  Recommendations in NICE guidance that make reference to a person’s age are always based on the clinical evidence of what works best.  In many cases, recommendations are specifically made in order to remove any chance of age discrimination.

Drugs For Women With Advanced Breast Cancer Not Cost Effective

Women with advanced breast cancer will be left with few treatment options after the National Institute for Health and Clinical Excellence turned down the drug, Avastin.

About 800 patients, who had previously been treated with drugs called taxanes, for whom Avastin seemed to work best, will not be allowed the drug on the NHS.

NICE said there were doubts about its improvement of overall survival and that its price, £3,700 per patient per month, meant it was not cost effective.

Work From Hospitals Must Be Funded

GP leaders are calling on the Department of Health to fund the shift of treatment from secondary care to GPs, as Local Medical Committees try to set up a generic local enhanced service to pay for this work.

Several LMCs in the north east are currently in talks with their PCT cluster to create a generic LES to fund future transfer of work to primary care.

A Department of Health spokesperson said: ‘We want clinical commissioning groups to be able to commission the fullest possible range of community based services, including services provided by general practice.  So the funding currently spend on LESs will be devolved to CCGs.

It will be up to CCGs to decide how to commission theses services from within their overall budgets, just as it is now up to PCTs, taking into account best practice on procurement.