Download Subject Chief Executive`s Report To West Sussex LMC Author Dr

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Chief Executive’s Report
West Sussex LMC
Dr Julius Parker
April 2015
Financial Issues
i) The 2015/16 GP Contract and DDRB Award
I have written to all practices outlining in full the financial implications of the 2015/16 GP
Contract and also of this year’s DDRB Award, as enclosed.
As Chaand has stated, this year’s award will not make a significant impact on the many
problems facing General Practice, but it will not make them worse, and in many ways
the contract changes are designed to supplement the Core Contract - importantly all the
DDRB Award was applied to the Global Sum - and simplify the other main income
streams of QOF and Direct Enhanced Services.
ii) Payments to Practices
The HSCIC has published its first analysis of NHS payments to General Practices under
the main payment categories. This information is presented as “experimental” and the
HSCIC has invited comment on the methods used.
The payments exclude certain sources, such as Local Authority Public Health funding.
They also do not take any account of the expenditure incurred in delivering services.
In terms of contract types, the mean average sum of payments per registered patient is:
GMS Contracts
PMS Contracts
APMS Contracts
Dispensing
Non-dispensing
£131.45
£140.52
£192.85
£186.37
£126.54
In part, this data has been prepared to assist in the publication of practice NHS contract
income: there will be further guidance for practices in analysing and publishing this
shortly.
It is also helpful for CCGs in considering re-imbursement of locally commissioned
services, and the extent to which individual practices take up both Locally
Commissioned Services, and DESs, which under co-commissioning Level III will also
become the CCG’s responsibility.
iii) Seniority Payment Figures
The HSCIC (Health and Social Care Information Centre) has published the 2011/12
Final Seniority Figure for England:2011/12 Final Seniority Figure:
£92,034
2011/12 Interim Seniority Figure: £93,972
Colleagues should ensure their practice accountants are aware of this information, as it
permits the calculation of seniority entitlement.
Although the seniority pool is reducing over seven years, those currently entitled to
seniority payments remain eligible to receive them.
The HSCIC has also noted that in some areas GPs’ seniority entitlement may have
been miscalculated, as entitlement is based on average superannuable income,
excluding any seniority
component, that is, seniority entitlement should be calculated based on average
superannuable income less seniority payments.
In 2011/12 the Average Superannuable Income was £97,918 with Average Seniority
payment being £5,884.
Full details are available at:http://www.hscic.gov.uk/catalogue/PUB17051/Final%20Seniority%20Factors%20Englan
d%20and%20Wales%202011-12%20V1.0.pdf
2 Immunisation changes for 2015/16
There have been a number of changes to the immunisation schedules for 2015/16;
these include:
New Programmes
HPV Booster
The previous local ad hoc arrangements under which teenagers who had missed school
programmes were vaccinated via their GP practice have been formalised within the
Statement of Financial Entitlements (SFE). The cohort target age is 14 – 16.
Meningitis C Freshers programme
Again, the ad hoc arrangements for this target age is 14 – 25 years have been included
in the SFE.
However, GPs are currently being asked not to immunise eligible patients with Men C,
because a new Men ACWY vaccine is being procured for intended commencement
later this year, and deferring the Men C programme for now will avoid patients having to
be recalled for the quadrivalent vaccine later this year. At present Public Health
England anticipate obtaining sufficient quantity of Men ACWY vaccine to be able to
vaccinate Year 13 this summer.
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Changes to current vaccination programmes
Childhood seasonal influenza
The timeframe for the programme has been changed to 1st September to 31st August to
align with the school year. The target age range (2 – 4 years) remains the same.
Seasonal flu for at-risk patients
This programme will now commence on 1st September rather than 1st August.
Pneumococcal
The at-risk group has been extended to include all patients over 2 and under 64 who
have never had PPV23 and to all those 65 and over who are within at-risk groups. The
immunisation programme will now run throughout the year.
Men C for freshers
This programme is a booster Men C immunisation for first time university or further
education students aged 17 – 25 not previously vaccinated against Men C.
However, PH England has asked GPs not to commence this programme for now
because of the current Men W outbreak and a JCVI recommendation to vaccinate all
school years 10 – 13 with the Men ACWY vaccine.
Shingles
A catch up programme for patients who were aged 70 on or after 1st September 2013
and who remain eligible for shingles immunisation if they have not previously had it until
their 80th birthday.
Current programmes that are continued unchanged:
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Childhood immunisation
Hepatitis B for new born babies at-risk
MMR
Rotavirus
Pertussis for pregnant women
In addition colleagues should note the publication of the Flu Plan: Winter 2015/16.
The national uptake % up to 31st January 2015 are as follows:
65 years or older
72.8%
Clinical risk groups
6/12 to 65 years
Pregnant women
2 year olds
3 year olds
4 year olds
Frontline
healthcare
workers
50.3%
44.1%
38.5%
41.3%
32.9%
54.9% (to end of Feb. 2015)
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Unfortunately flu protection for 2014/15 was not as effective as planned because of a
drifted strain of flu A(H3NZ) following choice of this strain by the WHO in February 2014
for inclusion in the 2014/15 vaccine.
Immunisation uptake figures within Surrey and Sussex are enclosed with this report.
3 Workforce Minimum Dataset (WMD)
As colleagues will know there are real concerns about the workload implications and
intrusive nature of the Workforce Minimum Dataset proforma; there have been some
concessions, which however are of interest to London colleagues, as across Kent,
Surrey and Sussex I am pleased to say that the Area Team, KSSHEE and both LMCs
are, hopefully with CCG support, offering a local workforce template that is an
alternative to the national WMD, and in addition provides a modest financial incentive.
This is part of a practice nurse training initiative being developed by KSSHEE which
encourages nurse graduates from Brighton and Surrey to gain experience in GP
practices and for current practice nurses to develop training and mentoring roles.
4 National Induction and Refresher Scheme
Many colleagues will have seen NHS England’s announcement of a new Scheme to
assist GPs who have not practiced for two or more years, or who have been working
abroad, to return to work within the UK. A bursary of £2300 will be paid to the returning
doctor, and practices which provide supervision for the required six month period will be
paid £645.92.
Currently the Surrey and Sussex Area Team have been pragmatic in terms of
interpreting the experience of colleagues who have either trained in the UK, and worked
abroad, or who have trained and/or worked abroad, either from the EU or elsewhere. It
is not envisaged the currently announced national Scheme will cover all applicants, but
it is hoped the Scheme will be expanded.
5 Drug Driving
I have written to all practices about a new offence related to driving whilst taking a
number of specified drugs which was introduced in March. It is likely colleagues will
start to receive queries about this from patients and I included a patient leaflet with my
guidance.
Essentially there are two classes of drugs covered by the offence: the first includes
commonly abused drugs, such as cannabis, cocaine, and heroin, for which very low
legal blood limits have been set. The second are commonly prescribed drugs, including
benzodiazepines such as diazepam and temazepam, as well as methadone and
morphine, which have the potential for abuse and for which higher legal limits mean
most patients taking such medicines as prescribed will have blood levels below the legal
limit. Some will not, and in both classes there will be a statutory “medical defence”
which will mean patients taking their medications in accordance with prescribing advice
will not be prosecuted if their blood drug levels are above the legal limit.
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In neither case is the “medical defence” available whilst a patient is driving whilst
impaired, since whatever medications or drugs are being taken patients should not drive
if they are impaired.
The guidance includes a list of factors commonly discussed with patients when driving
is at issue, and also a further discussion of the “medical defence”. Patients may find it
helpful to be able to provide evidence they are being prescribed the medication in
question, such as a repeat prescription slip. GPs are under no obligation to provide
separate confirmatory letters in these circumstances.
6 Pregabalin (Lyrica) Guidance from NHS England
I have written to all colleagues drawing attention to the highly unusual guidance sent out
by NHS England to both General Practitioners and Community Pharmacists in relation
to prescribing pregabalin for neuropathic pain. This guidance was sent following a
Court Order concluding a case brought by Pfizer to protect a “secondary medical use”
patent applicable to the use of pregabalin for neuropathic pain; this patent remains in
force until July 2017.
The GPC have advised that GPs should comply with the prescribing instructions
contained within the NHSE guidance although workload pressures will doubtless meant
the reasonable deferral of a review of all patients currently receiving pregabalin
generically for this indication.
I do have further background information (Court Summary, etc) if any colleague is
interested: the most interesting aspect of this case is whether it may trigger further
patent cases.
7 Surrey and Sussex LMC Levy
After six years I have written to all practices to advise the LMC Levy will rise to 39p per
patient from financial year 2015/16. Unfortunately having run at a deficit for the last two
years this increase can no longer be postponed and reflects the increasing workload of
the LMC Secretariat. I am very conscious both that there can never be a good moment
to raise the Levy and the current financial pressures on practices but nonetheless I
believe the LMC does deliver value for money and successfully fulfils its purpose, which
is to provide advice and support to General Practitioners, Practice Managers and their
practices.
Comparisons include Londonwide LMCs (56p), Bedfordshire and
Hertfordshire (41p) and Devon (50p).
Colleagues could help by continuing to support the LMC Buying Group (from which we
receive a modest commission).
The LMC Board would also welcome views of the comparative merits of incremental or
episodic Levy changes.
Dr Julius Parker
Chief Executive
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