Category: Procedural changes
Practice nurse support4-Mar-19 You will recall that the practice nurse facilitator programme has been stopped. We have spoken with the CCG and they assure us that the funding is not being reduced but is being used to fund GDoc to: provide training and mentoring for new practice nurses; facilitate practice nurse meetings and maintain a database of available practice nurses and their skill sets. The aim is to be able to 'parachute' staff into a practice where that support is needed. Death Certification - the Medical Examiner (ME)4-Mar-19 From April 2019 a new medical examiner-led system will begin to be rolled out within hospitals in England and Wales. The non-statutory system will introduce a new level of scrutiny whereby all deaths will be subject to either a medical examiner's scrutiny or a coroner's investigation. For GPs, the current arrangements for certifying death will continue for at least 2 years until the ME system is set up and fully functioning within secondary care. The ME system housed in the Trust will then look to expand its remit into the community. GPs are therefore not precluded from applying for an ME role for a Trust; experience working within primary care will no doubt be welcome for when the system moves into the community. All Medical Examiners must be fully registered for at least five years as a medical practitioner, hold a licence to practice and have received special training in the role. The Royal College of Pathologists as lead college has developed the compulsory online training and is in the process of drafting standards to support the revalidation process. Further news about the Falsified Medicines Directive4-Mar-19 As part of the government's preparations to leave the EU, all eventualities are being considered, including leaving without an agreement. In a 'no-deal' scenario, we expect the UK would not have access to the EU central data hub, and therefore stakeholders would be unable to upload, verify and decommission the unique identifier on packs of medicines in the UK. In that case, it is unlikely that the Directive would come into effect in its current form. Therefore, the legal obligation related to this would be removed for practices in the UK supply chain. Packs containing the FMD safety features would still be accepted in the UK, provided that they are in line with other UK packaging requirements. Nevertheless, the government has been clear that it wants to retain a close working partnership with the EU to ensure patients have access to a safe medicine supply. This means that the MHRA regulations will need to be modified to achieve this. PCSE procedures1-Feb-19 As earnest of their good intentions the Engagement Manager in the GP Team for the South West, Tracey Bird, came to the LMC. She had several key points to put across:
Practice code - year ending - GP's full name For example: L84640-YEND2018-Dr John Smith PCSE's customer support centre can provide NHS England's bank details over the phone.
https://pcse.england.nhs.uk/about/what-s-changing/national-performers-lists-changes/ When the Performer List process is transformed it will help to modernise the steps, as the practice will receive a notification of any Performer List change requests within their practice. PCSE will share more information on this nearer the time. The PCSE website gives current information. (From an LMC viewpoint we would hope that this notification would trigger the practice manager to tell us of any significant change e.g. GPs arriving, GPs leaving, salaried GPs becoming partners, etc). For individual GPs: When making changes to your Performers List record it is very important that you put in the Subject Heading, as appropriate:
This then sends your form directly to the correct office for recording the change and is then sent on to the Payments and Pensions office for action. Here is the guidance link for ease of access: https://pcse.england.nhs.uk/services/performers-lists/
https://pcse.england.nhs.uk/news/2018/january/outstanding-medical-records-faqs/ PCSE are trying to get all medical records traced and they have sent practices notifications/ reports to practices based on the last known OSMR location. PCSE plan to conclude this project by the summer of this year. If you have any OSMRs lurking in a cupboard somewhere (e.g. because they were delivered to you in error) then get on to PCSE at their 'Contact Us': Phone: 0333 014 2884. For those medical records which you need then the stop-gap is a GP2GP transfer of the electronic record, with the Lloyd George folder to follow in due course. For Urgent Medical Records PCSE have provided the latest guidance: https://pcse.england.nhs.uk/services/gp-records/urgent-medical-record-request/ Confidential patient information
PCSE would really appreciate it if the Contact Us process could be followed to help PCSE to assist you with your query. We (the LMC) are working closely with the PCSE Engagement Manager, so if all else fails do let us know, together with the evidence of the steps that you have taken prior to contacting us, and we will work with her to get things moving. STI testing3-Jul-18 The Specialist Sexual Health Service During 2017 the Specialist Sexual Health Service underwent redevelopment to focus the Service on patients with complex GUM or contraceptive needs; and those who might be more vulnerable to poor sexual health (including those under the age of 25). All access to the Specialist Service (including district clinics) is via the central telephone booking line (0300 421 6500). The Service now operates a telephone triage system. This helps ensure that patients are booked into routine or emergency appointments; or signposted to alternative points of care, based on need. The Service also provides postal self-testing for asymptomatic patients who contact the Service for STI testing. If anyone presents in Primary Care with an STI concern or a risk factor (such as unprotected sex) you should always engage the patient and test while with them. A missed opportunity can be costly for the individual and the wider health of the public. District Clinics The Specialist Service runs a number of district clinics. These are all bookable appointments (not walk in) and access is via the central telephone booking line (0300 421 6500).
For up-to-date opening times, please visit the Hope House website www.hopehouse.nhs.uk What should I do if someone presents for STI testing? When a patient presents with an STI concern or has identified a risk factor (such as unprotected sex), the opportunity should always be taken to test while they are in front of the practitioner. Delaying the test can lead to poor outcomes for the individual and the health of the public in cases where they are positive. BASHH and RCGP guidance on STI testing in primary care can be found here. What should I do if a patient presents with a STI positive result? If the patient has been diagnosed as positive for a STI from the postal self-testing service they will always be invited into the Specialist Sexual Health Service for treatment. If this is unacceptable to the patient, they may opt to seek treatment from their GP. This happens very rarely. However, if a patient presents in Primary Care with a STI positive result, the patient should be treated following local treatment guidelines. In these circumstances the Specialist Service will always endeavour to contact the GP Practice to confirm the result and offer support if required. If a patient has self selected to order a dual test (Chlamydia and Gonorrhoea) via postal self-testing and has received a positive result, the practice should offer the patient a full STI screen and additional swab sites (where appropriate). Partner notification Where GPs are managing a patient who is positive for an STI (the Service will initiate partner notification for patients they are managing), they are encouraged to initiate partner notification (PN). This involves having a conversation with the patient to explain the importance of partner notification and (if acceptable to the patient) provide the patient with a letter they can provide to contacts. Guidance on PN in Primary Care, including a sample letter for patients to provide to contacts, produced by the British Association for Sexual Health and HIV (BASHH) and the Royal College of General Practitioners (RCGP) can be found at Appendix 1 of 'Sexually Transmitted Infections in Primary Care', which can be found here. For more complex cases or where support is needed, consent should be obtained from the patient and PN can be referred to the Specialist Sexual Health Service via 0300 421 6500. New 2ww referral forms5-Jun-18 Remember that the new forms to be used for 2ww referrals can be found in G-Care at: Access to Medical Records14-Mar-18 An example has been shown to us of a lengthy form which an insurance company is asking GPs to fill in for a set fee of £30. This is not an agreed fee by GPC. The usual rules apply: if it is work outside your contract then you are entitled to charge a reasonable fee to cover the work involved. As usual it is best to let them know what fee you will demand in advance and get their agreement before doing the work. In the same vein, you should look at the latest GPC guidance at:https://www.bma.org.uk/advice/employment/gp-practices/service-provision/access-to-medical-reports-for-insurance-purposes. This confirms that agreement has been reached with the Association of British Insurers that the use of SARS is inappropriate – they are now using the Access to Medical Reports Act 1988 process. Note that electronic consent is acceptable (for details follow this link.) Guidance on setting fees for insurance reports is here.
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