Legal

NAPC General Practice Bulletin 18 July 2012

Being A Practice Member Of A Clinical Commissioning Group

Now that the Authorisation process for Wave 1 CCGs is underway, you would expect more clarity but GPs, as members of CCGs, still have a lot of questions and there is a lot of confusion surrounding membership rights and responsibilities.

In most cases, CCGs have, under an interim constitution, created a governing body and this governing body is pressing ahead with the authorisation process without, in some cases, keeping the wider membership well informed. 

It has also come as a surprise to many GP practices to learn that it will be a requirement of their GMS contract/PMS agreement that the practice must be a member of a CCG and that each partner of a practice will be bound to secure that the partnership is a member of a CCG.  Some other key issues that have been concerning the wider membership include:

•    The admission and expulsion of members from the CCG;
•    Joint commissioning with other CCGs; and
•    Locality arrangements, particularly the delegation of commissioning powers to localities and the responsibility for such delegated commissioning powers.
•    Accordingly, it is important that practices study the constitution of their CCG carefully and, in particular, are aware of:
•    The functions of the CCG delegated to the governing body;
•    The sub-committee structure and the rights delegated down by the governing body to such sub-committees (including in particular any locality structures);
•    The reporting lines back up from any such sub-committees to the governing body and from the governing body to the members;
•    Any reserved matters requiring the approval of a certain percentage of the membership before it can be transacted by the governing body;   and
•    The procedure for calling a vote on any such matters and the voting rights of each member.



We are conducting a short survey, in conjunction with Hempsons, to gauge reaction to these developments.  Click here to take part.

Census 2011: Population Surges By 7 Per Cent In Ten Years

The population of England and Wales surged by seven per cent between the last two Census surveys, the biggest growth seen in any period since records began.  There were 56.1 million people living in England and Wales when the 2011 Census was carried out.  This means the population has increased by 3.7 million since 2001, when 52.4 million people were counted.

The survey also revealed an ageing population, with one in six people in England and Wales aged 65 or over last year and some 430,000 were aged 90  or over, compared with only 13,000 when the Census was carried out 100 years earlier in 1911.

The number of women living into their 10th decade was nearly three times higher than men, however, with 315,000 females aged over 90, but only 114,000 males.

The median aged of the population increased to 39 in 2011, up from 35 in 2001 and 25 in 1911.  But there was also an increase in the number of under fives, with over 400,000 more in 2011 than in 2001.

The Office for National Statistics results showed that every region in England and Wales had a larger population in 2011 than 10 years earlier.  London saw the largest population boom, with the number of inhabitants in the capital growing by 12% to more than eight million.  This represents an increase of more than 850,000 people.

The population of England at the time of the survey was 53 million, while Wales’ was 3.06 million.  

The population of Northern Ireland also mushroomed to 1,801,900, and increase from around 1.7 million in 2001.

Figures for Scotland will be released later this year.

APMS Loophole Threatens Primary Care Stability

A loophole in APMS contracts allows GP practices to become a ‘commodity traded in the private market’, an inquiry into the closure of a London practice run by a private company found.

A Camden Council report into the closure of Camden Road Surgery in North London urged the NHS Commissioning Board to take action to prevent a repeat of the incident, and called for greater clarity in deals with companies running NHS services.

The report remarked that there appeared to be a serious loophole in the national contract for alternative providers, which allowed them to transfer the contract.  ‘In our view’, it said, primary care by GPs should not be a commodity traded in the private market and prompt action should be taken by the NHS Commissioning Board to remedy this.

‘Contracts should promote the long-term commitment to continuity of GP care, to counter the concerns expressed in evidence that large private providers have less commitment to a local population.’

Protecting Children And Young People: Responsibilities Of Doctors

The General Medical Council has issued new guidance to every doctor in the UK to help them protect children from abuse or neglect.

Protecting children and young people: the responsibilities of all doctors http://dmtrk.com/CUG-VFMV-5091UK-C90FR-1/c.aspx underlines the duty on doctors to act if they are concerned that a child or young person is at risk.  It provides detailed advice for doctors on information sharing, working in partnership with other agencies, consent for child protect protection examinations, acting as a witness in court and where to turn for support.

The guidance will come into effect on 3 September 2012.  Doctors will receive a copy in the post but an electronic version can be found at www.gmc-uk.org/childprotection<http://dmtrk.com/CUG-VFMV-5091UK-C7Q1Z-1/c.aspx>.  On GMC website you will also find:

•    Short guides for GPs – highlighting the sections of the new guidance which are likely to be most suitable for those working in primary care
•    Short guides for doctors who treat adult patients – highlighting the sections in the guidance that are most likely to be relevant for doctors who adult patients may pose a risk to children or young people
•    Learning materials – including case studies and a flowchart to help doctors decide whether to share information about child protection concerns.

This is one of the most sensitive and complex areas of medical practices.  We want doctors to feel confident and supported in raising and acting on concerns about the safety and welfare of children.

National Commissioning Board Plans Pose Threat To Practice Funding

Practices face increasing threats to enhanced services and could see funding for locums terminate under NHS Commissioning Board proposals, experts have warned.

Guidance from the NCB on conflicts of interest appears to confirm the fears of the General Practice Committee of the British Medical Association that clinical commissioning groups (CCGs) will be forced to put most enhanced services out to tender under any qualified provider rules.

A 14 page Code of Conduct document warned that in some circumstances CCGs may be able to contract with GPs without a full tendering process, but only where services are of minimal value.

The draft NCB document Securing excellence in primary care commissioning said that some current PCT functions would not transfer to the NCB but would become the responsibility of providers.  These included ‘provision of locums and other temporary or support staff and block purchasing of equipment and services other than the disposal of clinical waste.

A NCB statement said it was not proposing changes to existing funding support for practices, but Dame Barbara Hakin, NCB commissioning development lead, admitted that cuts to management costs meant that some of the support PCTs gave practices in a quasi employer role would be more difficult to do.

Experimental Drug Could Treat Aggressive Leukaemia

A drug designed to tackle cancer cells in two different ways could provide a new treatment for acute myeloid leukaemia (AML), scientists from the UK say.

The unique drug uses two approaches to target AML cells.  Firstly, it blocks the protein made by a gene called FLT3, which is faulty in around 30 per cent of patients with the disease.  Secondly, it blocks another key protein called Aurora kinase, which is another mechanism that promotes cancer growth.

It is hoped that this ‘double hit’ may help to overcome AML’s resistance to treatment, as the drug is even able to destroy cells that develop new faults in the FLT3 gene.

Tests done on mice found that the drug brought about complete remission in half of the animals, compared with just a quarter of mice that were treated with an existing drug.

Lead author, Dr Spiros Linardopoulos, from the Institute of Cancer Research, revealed: ‘There has been a great interest in using FLT3 drugs to treat AML, but there effectiveness has been limited because leukaemia cells gain new mistakes in the FLT3 gene, causing resistance.  Our new drug has the potential to overcome this and has a range of possible uses in AML.’

The study, which is published in the Leukaemia journal, was mainly funded by Cancer Research UK.

Telehealth For Long Term Conditions

Latest evidence doesn’t warrant full-scale roll-out buy more careful exploration

Almost 50 years of innovation in telehealth have seen great progress in tackling a wide range of conditions using a variety of technologies and covering a wide range of outcomes.  Although this works shows great promise, it also creates challenges for interpretation.  The uncertainties in defining terms like ‘telehealth’ reflect broader difficulties in interpreting the complex interplay of technology, service designs, clinical input and patient involvement.  New studies can challenge existing findings as much as they corroborate them.  For example, two recent large scale trials of telehealth for heart failure found not benefit, whereas previous meta-analyses suggested reductions in mortality.  To this can be added the initial findings of one of the largest telehealth and telecare studies ever conducted: the UK Whole System Demonstrator trial summarised in the British Medical Journal, 14  July 2012.

Telehealth does not ‘work’ or ‘not work’.  Particular interventions may be successful, but this depends on many factors, including the specific contributions of the type of technology  and of the context, such as the willingness and ability of clinical staff to change their care processes; the disease stage and severity of disease in patients involved, their social backgrounds, and their needs and expectations; the predictive power of any monitoring data that are collected; and, indeed, the endpoints that are used to specify success.  The research agenda established by systematic reviews of telehealth consistently argues for study designs that can generate insights into the active components within the black box of telehealth interventions.  Although factors that might be important for successful telehealth can be described, we need more clarity on how to interpret the relative contributions of such elements.

Exercise Is A Cancer Wonder Drug

Macmillan Cancer Support states that doctors and nurses need to ‘bust they myth’ that cancer patients should simply rest to recover.  Frequent exercise such as brisk walking or gardening can halve the chance of bowel cancer returning and reduce the risk of recurrent breast cancer by more than a third.

Jane Maher, chief medical officer for the charity, said: ‘It’s easier to tell people to rest.  But increasingly, many patients will need our help to bust the myth that resting up is always the right thing to do.