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Last week, in my practice we had our quarterly meeting with the CCG (clinical commissioning group) prescribing adviser, as part of a local incentive scheme. It was a struggle for all the GPs to finish their morning surgeries, admin and visits in time to get to the meeting for 1pm. We were presented with a wealth of information about our prescribing spend and specific performance indicators comparing us with other practices. This stimulated an interesting discussion about any reasons for variation and whether there was possibility for improvement. In many cases we found differences to be entirely justifiable due to our patient demographics, reiterating the need for caution in interpreting superficial unadjusted comparisons. However, other indicators were simply crude targets and questionable in judging the quality of our prescribing. In some target indicators, the 'saving' to be made was minimal and would have been offset by the time and effort taken - as usual the cost of GPs' and staff time was not factored in. We agreed an action plan to look at three priority areas, together with clinical audits. No sooner had the meeting finished than we rushed to complete our home visits, and thence straight to evening surgery, having skipped lunch (again). After surgery, I dealt with a bundle of repeat prescriptions and queries, waded through a mountain of Docman correspondence, and phoned my last patient back at 9pm, before finally heading home. A typical day in general practice, and one that I'm sure will sound familiar to most of you. It's sad that even an educational meeting comes to feel like an interference in an exhausting day where we simply don't have seconds to spare. The truth is the pressures on GPs have become so extreme that there just isn't the space to reflect and learn. Even finding the time for all the GPs in the practice to collectively meet before the next prescribing visit will be a challenge, and inevitably we'll end up meeting at the only time that can be found - late one evening after an exhausting 12-hour day. This is yet another consequence of general practice being stretched well beyond capacity - that GPs are unable to fulfil their true educational and professional potential to provide optimal quality care for patients. This is a point we should all be making in our appraisals, and another reason why the BMA's GPs committee is pressurising government to implement our plan for urgent measures to support general practice. Ebola guidance for primary care PHE (Public Health England) has updated their Ebola guidance on managing patients who require assessment in primary care. The GPC remains in regular contact with PHE in order to ensure that appropriate guidance for GP practices is available, and we have been involved in the update of this guidance. Please note that this guidance is subject to change, so the online version should always be used. The GPC will notify LMCs (local medical committees) when changes occur, and they in turn are asked to cascade this to their GPs. The BMA website has been updated to link to PHE's guidance, which replaces our previous advice. Read the latest Ebola advice QOF contract amendments 2015-16 Last week, we announced internal QOF (quality and outcomes framework) changes for 2015-16. In line with the contract agreement, the overall points value and thresholds remain unchanged. However, we have negotiated that 26 CKD (chronic kidney disease) indicators will end (the register remaining), with most of these points transferring to the dementia domain. This will increase the value of carrying out dementia care plans, reflecting the greater workload for GPs in this area. In addition, the CHD indicator (CHD006) for quadruple therapy post MI (myocardial infarction) will also end, with the points transferred to amended AF (atrial fibrillation) indicators, reflecting the increased workload associated with current clinical management of AF with anticoagulation. We hope you agree that this provides a more clinically appropriate weighting of QOF points. Find out more and read our FAQs on the contract changes PMS review guidance As part of our contract negotiations, we argued hard and secured agreement with NHS England that all monies from PMS (personal medical services) reviews 'should always' be reinvested in GP services. This is now explicitly stated in new NHS England guidance - a significant agreement given that we were hearing reports of several area teams intending to raid PMS resources for other cost pressures. Please contact the GPC secretariat ([email protected]) if this agreement is not being followed at a local level or if you know of any attempt to use PMS monies for other purposes. Dementia enhanced service Last Friday, NHS England announced a new dementia national enhanced service, to run with immediate effect to 31 March 2015. This enhanced service is designed to operate in addition to the existing dementia enhanced service, not instead.
I would like to be absolutely clear that the GPC did not have sight of or approve the specification for this enhanced service; this is an NHS England proposal that does not have the support of GPC. While it is for practices to decide whether to sign up to the scheme, we advise you to consider the following points and read the NHS England service specification carefully. The key elements are as follows:
The scheme does not address the wider issues such as inadequate provision of care and services for patients diagnosed with dementia. As always, please visit our website www.bma.org/gpc for latest