NEGOTIATORS REPORT for the GPC MEETING 18 May 2006

Appendix 1

NEGOTIATORS’ REPORT

Survey of maternity payments NHS Employers had previously promised to conduct a survey of SHA/PCOs on whether they are awarding the £1500 locum payment to practices from week three of entitlement for maternity, paternity and adoption leave, following the agreement to uplift the level of potential entitlement as part of the review of the GMS contract for 2006/07. Despite repeated requests, this has still not been conducted. We are aware, anecdotally, that many LMCs have faced problems in getting PCOs to pay this amount, and in some cases PCTs are paying nothing at all. To allow us to continue negotiations on this issue, and make a sound case about how this agreement is not being applied in the spirit in which it was intended, we have decided to conduct our own survey of LMCs. LMCs have been encouraged to make sure that, when they received the survey, they make every effort to complete it fully to inform us what is happening locally.

Formula review report The joint GPC/NHS Employers report on the outcome of the consultation on the recommendations of the review of the GMS global sum formula for England and Wales was published on 10 September.

The report followed a three month consultation to seek the views of GPs, PCOs and other stakeholders on a number of proposals to change the formula. It is the result of over 18 months of work in which the Formula Review Group (FRG) conducted a detailed examination of all factors in the current General Practice funding formula and investigated a number of additional factors for possible inclusion in a revised formula.

Not surprisingly, the outcomes of the consultation showed marked differences between GPs and PCOs in their attitudes towards a revised formula to decide on basic practice funding. In the present financial and political climate, it is clear that a very small minority of GPs want to proceed to implementing its findings at the moment, whereas most managers seem relaxed about the damage that such a change might make to practices.

The FRG’s report will be submitted to the health departments who will consider how, when, or if at all, they wish to see the recommendations of the formula review group taken forward. We have made it very clear that the GPC would only consider implementation when the time was right.

Choice Read codes for the 2007/08 Choice and Booking DES (England) It was agreed last year that codes would be developed for identifying a survey sample population for the Choice aspect of the Choice and Booking DES this time round. We were informed at a GP Patient Survey board meeting the codes to be used with each referral for the basis of the sampling method. In order to ensure that GPs could start using these codes as soon as possible, we wrote to GPs on 9 August setting out the details of the codes to be used. The codes should have been used from 1 September. However, following this letter, there were a number of queries raised in relation to the use of these codes.

There has been a lot of confusion among GPs about the use of these codes, particularly confusion between the ‘Choice’ and ‘Choose and Book’ aspects of the DES. It is important to note that GPs only need to use the codes for the choice part of the consultation. These codes allow the patients who have been identified as having been referred for a first consultant outpatient appointment which is subject to choice by a GP for inclusion in the survey. These codes have nothing to do with Choose and Book. There was also some disquiet that practices had been using other codes for choice referrals and that the introduction of these new codes required practices to change the codes used. Further questions were asked by practices about which of the three codes detailed in the letter should be used.

GP patient survey and Choice and Access DESs 2007/08 (England only) The GP patient survey board has continued discussing the operation of the survey for 2007/08 and evaluating the process from last year. Essentially there will be no change made to the survey questions at all this year and very little change to the process. One important change concerns the

1 use of Choice Read codes for the 2007/08 Choice and Booking DES, as detailed above. The choice element of the Choice and Booking DES will, from this year, be included in the patient postal survey and we are in the process of clarifying the sampling methods that will be used.

The SFE amendment directions which introduce the two new sections to the SFE reflecting the carrying forward for a further twelve months of the Improved Access Scheme DES and the Choice and Booking DES were released by the Department on 3 August 2007. These are available here: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_077188

National Diabetes Audit (NDA) The NDA is developed and delivered by the National Clinical Audit Support Programme (NCASP), which is part of the Information Centre (IC) for health and social care. The audit provides an infrastructure for the collation, analysis, benchmarking and feedback of local clinical data to support effective clinical audit across the NHS.

This audit has taken place for some years but, this year, the process for data collection has changed. It was agreed that the data would be extracted via Apollo software that would facilitate the required report run - in previous years, PCT staff have had to visit practices to run MIQUEST queries for the data extract. We did meet with the IC prior to the letter detailing the change in process being sent to all practices. We were assured that the NDA had PIAG approval to collect the data required to conduct the audit, and that the query would recognise those patients that have opted out of audit involvement and that no data would be collected for these patients. Additionally we were reassured that no patient or practice data would be released to anyone outside the NDA and that no information will be passed to PCTs in a practice-identifiable form.

We are aware that, despite these assurances from the IC, practices remain concerned that a query has been installed on their computers without prior consent being given to Apollo and that identifiable patient data will be taken from the practice system by Apollo medical systems, without explicit patient consent when it is not intended for direct patient care. There is also concern that practices can only opt to have data removed from the audit analysis after the extraction has taken place.

We raised these issues directly Apollo and have had discussions which, we believe, confirm that appropriate legal and confidentiality approvals are in place. This is a very sensitive issue and we understand the need of LMCs and practices to be fully informed about consent and confidentiality issues before practices feel comfortable having data extracted. We will continue to work with Apollo, through the IT committee, to ensure that these concerns are addressed in future including communication to practices, the ability of practices to opt out if they are not content to participate, and appropriate consent models. We are also working on some Q&As to address some of more common queries with regard to extraction of data by Apollo.

Wanless report Following the release of the new Derek Wanless report on NHS spending, we responded to the numerous stories that appeared in the media. The press reports, which focussed on the lack of productivity were, on the whole, fairly negative. We made clear the role doctors had played in delivering increased cancer survival rates, performing more operations etc. and that the QOF is a measure of quality of care which will result in significant savings to the NHS in the long-term.

Workload survey The 2006/07 UK General Practice Workload Survey was published on 31 July. The report was produced by the Technical Steering Committee (TSC), which includes representatives from the four UK health departments, NHS Employers and GPC. As the survey was targeted at work in the practice it excludes work done elsewhere as well as any work identified as out-of-hours (OOH) not relating to the GMS/PMS/ PCTMS practice contract. Staff in a representative sample of 329 practices across the UK completed diary sheets for one week in September or December 2006.

There were some attempts to compare these results unfavourably with those of the last major survey carried out in 1992/3. Direct comparison of the two surveys is difficult because they were carried out in very different ways and measured different aspects of workload. In particular, the 1992/3 survey included out-of-hours work, which was not recorded in this survey. There have also been significant

2 demographic changes in the GP workforce in the last 15 years, not least the increase in part-time working, employment of salaried GPs and changes in skill mix.

A day in the life of a GP The press office undertook a nationwide poster campaign to help patients understand just what their GP does for them.

“ A day in the life of a GP” shows patients that while daily surgeries take up a large part of their doctor’s working day they are also busy carrying out telephone consultations, tackling huge amounts of paperwork and making home visits. They also have to maintain the business of actually running the practice and many will still work for the local out-of-hours service.

The BMA poster was sent to every GP practice in the UK. A press notice was sent to regional media and, in addition, it was sent to selected newspapers in areas where individual GPs have volunteered to have a journalist shadow them to demonstrate the value of general practice.

Survey results “GP patient survey: Your doctor, your experience, your say” (England only) The results of the survey were published on Tuesday 24 July. The survey revealed the following results for England: o 86 per cent of people reported that they were satisfied with their ability to get through to their doctor's surgery on the phone o 86 per cent of people who tried to get a quick appointment with a GP said they were able to do so within 48 hours o 75 per cent of people who wanted to book ahead for an appointment with a doctor reported that they were able to do so o 88 per cent of people who wanted an appointment with a particular doctor at their GP surgery thought they could do this o 84 per cent of people said they were satisfied with the current opening hours in their practice o 94 per cent of people who were referred by a GP discussed choice of hospital

These results indicate that patients are generally satisfied with GPs’ hours of availability and that very few patients actually wanted practices open longer in the evenings or at weekends.

Letter from Mark Britnell – Improving access and responsiveness in primary care A letter was issued from Mark Britnell, Director-General Commissioning and Service Management at the DH, to all SHAs and PCTs setting out plans to improve access and responsiveness in primary care. Possibly the most worrying aspect of this letter was the suggestion of the creation of a local QOF, something we will oppose vigorously. Although it may be reasonable to use the results of the patient survey done as part of the QOF to inform local action plans, LMCs should encourage practices to ask their PCT for additional help if they have performed less well in any areas.

Confederation of British Industry (CBI) report on GP opening hours and cost to industry Concern was raised about the CBI preparing a report calling for Alan Johnson to give urgent consideration to opening doctors' surgeries on Saturdays and Sundays. The CBI says it costs industry £1 billion to cover the cost of three and a half million working days lost last year. We wrote to the CBI to point out that many industries could do better by offering occupational health services on-site and by not sending patients to their GPs to get a certificate very early in their illnesses. This report has now been released and we have responded publicly and vigorously, and have arranged to meet with the CBI to set out our concerns and clarify the issues.

NHS Choices Following a meeting with NHS Choices we received further communication from the team in charge about the October release of information on NHS Choices, and some planned future releases too. The negotiating team considered proposals and have agreed that, if the DH take the project forward in a worthwhile way that GPs will be happy to engage in, we will encourage GP practices to engage with the project. We have said that we are happy to discuss their proposals further and highlighted the concerns we have at this stage. In particular we wish to ensure that practices are able to control the publication of information about their practices.

3 Welsh Audit Office Report on the GMS Contract The Welsh Audit Office published a review of the new GMS contract in Wales. The link to the report is below. www.wao.gov.uk/assets/englishdocuments/GMS_contract_eng.pdf

GPC Wales responded to the report which included a number of misunderstandings about how the contract works, despite the best efforts of those GPs in Wales who were involved in providing evidence for the report. Particular areas of concern include the recommendation for continual change to the content and difficulty of the QOF, and the need to abolish the MPIG rapidly. Whilst there are some welcome areas, including premises development funds, it was in general a rather unsupportive document.

The GPC Wales response concentrated on the benefits of the contract to patients, including the long- term health and financial benefits of an evidence-based QOF and the context of the negotiations (i.e. that the Government too wanted a new contract). GPC Wales is also responding formally to the Welsh Audit Office and the Welsh Assembly Government.

The English National Audit Office is also in the process of conducting a review into the new GMS contract. We have already given preliminary evidence and will be giving further evidence in due course. We wish to ensure that the NAO has a good understanding of the reasons behind the contract and how it works now. We will also highlight some of our key concerns about the Welsh report to help aid this understanding.

Use of Non-Geographical (‘084’) Telephone Numbers There have been numerous newspaper articles recently complaining about GPs making money from 0844 telephone numbers. This is particularly galling as there are many other NHS services (NHS Direct for one, as well as many hospitals) and other public services (like the police) that are not using local rate numbers which have not been picked up by the press.

Firstly, it seems unacceptable that practices be expected to move away from 084 numbers when, only a year ago, practices were encouraged to move to these numbers when the use of premium rate numbers was banned. Secondly, whilst we fully support the view that practices should not seek to make significant financial gains from their telephone systems, there is no evidence to suggest that using an 084 number allows practices to do this. In fact, many practices using 084 numbers are often able to deal with their calls more efficiently and quickly, therefore costing patients less overall.

Hib B catch-up programme GP practices should have received, via the public health link in England, a bulletin from the DH announcing a Hib B catch-up campaign. This involves for some children a change in vaccination schedule/vaccine and for a small cohort a further visit to the GP practice for a catch up vaccination.

The bulletin states that that this further work should be negotiated through a LES. The flu DES and pneumoccocal catch up campaign are priced at £7.51 and we are aware that some LMCs have already managed to achieve a LES for payment for Hib B at the same level. The GPC did point out to the Department of Health that this should be negotiated nationally as a DES to avoid repetition of local negotiations (there is for instance a national agreement for this in Wales). We have also written to the DH to clarify the prospect of a DES but in the absence of a national agreement in England, LMCs will want to negotiate a LES in line with the current payment system.

International Medical Graduates: F2 posts A number of International Medical Graduate (IMG) doctors already in F1 posts who were due to start their Foundation Year 2 (F2) post were prevented from so doing due to a delay in them receiving their full GMC registration. This resulted in them not being able to provide a service to patients as well as a loss of income during this time. Although we understand that the GMC redeployed staff to increase capacity for granting registrations, the situation was unacceptable, particularly for those who submitted their applications three months in advance. We raised these issues with the GMC directly and the GMC apologised for this and explained that it was due to them receiving a larger number of additional applications than anticipated. To help to rectify the problem, the GMC assigned additional

4 staff to deal with this, and encourages all IMG doctors to apply well in advance. Hopefully lessons will be learned in the future from the problems that have occurred this year.

Salaried GPs We have revised the GPC's Focus on Salaried GPs guidance note following the seeking of expert legal advice on the continuity of service provisions in the model salaried GP contract and the impact on maternity pay, sick pay and redundancy pay entitlements. The guidance is written for both salaried GPs and GP practice employers, and both parties should be encouraged to read this. As always, BMA members should contact AskBMA for expert individual advice.

GP returners’ scheme Together with Dr Arthur Hibble, Chairman of the General Practice Education Directors, Laurence Buckman has written to all SHAs and PCTs in England setting out the requirements for PCTs to adopt a policy so that GPs wishing to return to practice are not unnecessarily hindered from doing so. This includes considering each application to be on the Performers List on an individual basis and ensuring that, working with the deanery, each GP’s training and support needs are individually tailored. We have asked PCTs to let us know of the policies they current adopt and will maintain a log of these.

Regional LMC meetings September – October 2007 The next series of GPC-LMC road shows will take place in the last week of September and first week of October 2007. The purpose of these is to provide an opportunity for the negotiators to give an update on current issues and to give LMC members the chance to have questions answered.