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Wessex LMCs Bulletin - December 2004
CONTENTS
1) Editorial
2) Medical Directors
3) Freedom of Information - Implementation of General Access
4) Inactivated Polio Vaccine
5) Charging Patients
6) Confidentiality Issues
7) Farewell to Uncle Bob
Key to Contributors
1) Editorial
Farewell ! Pour prendre conge´
As I take my leave of you, after a medical career that began almost 45 years ago, I realise that there have been significant changes.
The essence of medical education in my day was to make you self-reliant since it was very often the case there was no other doctor working with
you and single-handed practice was almost the norm. On my first locum as a GP I remember un filing the notes, consulting the patient, writing
the prescription and going into the dispensary at the back formulating it; which meant in those days actually mixing it; and then giving it to the
patient and refiling the notes before beginning the whole process again. There is no doubt that in those days doctors (and this usually meant GPs)
were highly respected members of the community. I don't think they actually earned as much as they do now but what they lacked in financial recompense they more than made up in terms of respect. There are
some of you reading this who, like me, remember when it was still routine practice for clean towels to be available in case the doctor wanted to wash their hands on a home visit. There were also the houses
you went to where it was normal to wipe your feet on the way out! Domiciliary obstetrics was commonplace and I remember answering a question in finals as to what criteria might make me think it was
appropriate for a woman to be delivered in hospital. In those days a case had to be made for such a happening. As a result the “Obstetric
Flying Squad” was in regular use. I remember evacuating a retained placenta at home under Chloroform anaesthesia, with an open fire in the grate, not something I would recommend now!
Obviously many things have changed in medical care since then but in my opinion the greatest may be the propensity now for team working.
Every team certainly still has a leader, but God help the leader who does not take into account the views of the other team members. The days of the authoritarian dictator are certainly over.
It was routine to be on call for all your patients at all hours of the day or night, and this was well understood by patients who would be sparing
about contacting their doctor outside the usual hours. In the days before the advent of all houses having telephones it could mean someone
knocking on the door in the middle of the night. This meant that at the most you received only about three night calls during an average week but these tended to be quite serious, such as LVF or status
asthmaticus. Only after I began training was frusemide invented, prior to that the treatment was to administer morphine for LVF. Salbutamol only
appeared on the scene very much later and if subcutaneous adrenaline did not do the job the patient would often die. There are few more heart-rending situations than having a young child die in front of you of
asthma without being able to do anything at all to save them. I think I would place those two drugs as possibly the ones that made the greatest difference to my GP coping abilities during my career.
When we complain about the situation in modern medicine, that GPs are often little more than technicians with a preventive role, it is wise to
remember how far we have come in the last 40 years. I am sure that patients now would not wish to go back to the old situation, and in truth the GPs could not bring themselves to do it either. The fact that I
remember such situations probably means I am even more of an anachronism than I already appear.
I have been doing this LMC job now for nine years, which on reflection is probably a year too long, but it would not have been fair to retire
when the nGMS contract was due to be implemented. When I began at the LMC it was very much as a reactive one-man band. The responsibility was to know the Regulations and defend the GP’s rights
especially for complaints that resulted in Service Committee hearings, as well as ensuring that all provisions of the Red Book were forthcoming.
I remember the Red Book starting in 1965; it was revolutionary; in that for the first time GPs accepted financial support towards the cost of
running their practices. Prior to that a better service offered to patients meant less profit because there was no reimbursement of the staff or premises costs. It is from this that the present direct
involvement in practice affairs by health authorities and latterly PCTs derives. The new contract by ending the staff reimbursement could risk
return to practices not developing their staff skills and numbers in order to ensure profit stays high, especially as their pension will be dependent on the profit figure.
The situation in the LMC now however is that the multifarious questions that we get posed, and the representation which is asked of us,
necessitates a wider knowledge of both law, employment law, financial understanding, as well as an ability to communicate widely with the profession and the media both orally and in written form than might
have been the case in the past. Add to this the enormous impact that IT has had on our daily lives, coupled in particular with the advent of e-mail, and you see that is no longer realistic to imagine the job can be
done by only one person. Whereas in the past I would only receive letters or if it were urgent telephone calls, now 50 – 100 emails to the
office are not unusual each day. E-mail can be a mixed blessing!
It is also the case that we are involved in a way we never were before, with the planning of future activities and liaising with the PCTs across
the wide area that Wessex LMCs now covers. The very fact that Wessex LMCs covers 2500 doctors and 19 PCTs and also advises practice managers as well as liaising with the GPC and the BMA makes it
imperative that the LMC is now run as a team.
I firmly believe that whereas when I began this job it was perfectly possible to do it without any longer being in active clinical practice;
having had over 25 years of experience; now it is better to be working under the new GMS contract in order to fully understand its implications.
However good a team there is, it will never be really efficient unless it has a clearly established leader. Over the past nine months Nigel
Watson and I have exercised together the role of Chief Executive. This is completely untenable in the long term, and it is vital that Nigel, full of
new ideas, as well as energy that makes me feel tired, is allowed to go forward and lead his extremely competent and talented team, without the dead wood that I could become.
Whenever a person decides to retire there will always be unfinished business, but it has always been my earnest wish that I should not
overstay my welcome. Even Presidents of the United States only get allowed eight years, (not that I want to stretch that analogy too far!),
and I have had nine, so cannot complain. I am absolutely certain the Wessex LMCs will proceed to greater success than in the past and that
none of our constituents will in any way feel the lack of my presence.
So now, as an old soldier should, I will fade away, and in so far as you need it –
“Good Luck”
in the brave new Contract world of the future.
Bob Button
Dr R I Button
Chief Executive
Wessex LMCs
1st January 1996 – 31st December 2004
2) Medical Directors
With the imminent retirement of Dr Bob Button, the LMCs been looking at the options for replacing his time and expertise (an impossible task)
and considering how best to represent GP Partners, Sessional GPs and practices over the next few years.
It has been decided to employ two practising general practitioners who will work part time for the Wessex LMCs with the title of Medical
Director. In addition the present LMC Medical Secretary, Dr Christine Dewbury, has had her job reviewed and has been appointed as a third Medical Director.
The two new appointments are:
Dr Anthony D’Arcy
a GP in Eastleigh, who has served for many years on LMCs, initially
Hampshire, then Southampton & SW Hants and currently West Hampshire LMC. He will remain in practice in Eastleigh.
He has gained significant knowledge about the political aspects of
general practice over those years. He has also taken a particular interest in IT.
Dr Andrew Mostyn
a half time GP in Locks Heath who has also served as the Medical
Advisor to the three Southampton PCTs.
He has worked closely with the LMC over a number of years on a wide range of issues relating to poorly performing doctors, PMS, nGMS and complaints.
The Wessex LMCs now cover Dorset, Hampshire, the Isle of Wight and Wiltshire and there is an urgent need to expand the team. This is a huge
compliment to Bob who has shouldered a significant burden for a number of years and will be greatly missed.
NW
3) Freedom of Information - Implementation of General Access
The Freedom of Information Act designated all GP practices as public authorities for the purposes of the Act.
As a result all practices have been required to have an approved Publication Scheme in place since 31st October 2003.
The Act will be implemented in full on 1st January 2005.
At that time the general right of access to information held by public authorities will come into force.
Personal confidential data and commercially sensitive data will be exempt from the general access requirements.
The general access requirements will cover all recorded information. This includes paper files, computer files, internal e-mails, audio and
video recordings, brochures and photographs.
The legislation is fully retrospective.
All public authorities will be obliged to respond to any written request within 20 working days.
Based upon the draft regulations, we believe that public authorities will be able to make a reasonable charge to cover the costs of informing the
applicant whether it holds the requested information and in communicating that information. This will include the cost of copying, printing, postage and other ‘disbursements’.
The practice will be not be able to claim the ‘prescribed costs’ for determining whether it holds the information requested or for locating
and retrieving that information.
The Freedom of Information (Fees and Appropriate Limit) Regulations have not yet been laid before Parliament to date, but will be published
on our website as soon as they are available.
Further information is available at www.lmclive.co.uk
It will be found in the Guidance section under Freedom of Information.
CED
4) Inactivated Polio Vaccine
In the SFE inactivated polio is one of the childhood vaccines supplied free of charge.
However with the introduction of the new childhood vaccines, inactivated polio vaccine is no longer a childhood vaccine.
As a result GPs are no longer able to claim reimbursement through the PPA for inactivated polio given to patients intending to travel abroad.
Those patients must take a prescription to the pharmacy and then take the vaccine to the practice for administration.
The PPA believes that the SFE needs to be altered to allow reimbursement and is in discussion with the Department of Health.
The GPC is aware of the problem but has no knowledge as to if or when the SFE will be changed.
CED
5) Charging Patients
We receive numerous queries from practices about whether they may charge patients for miscellaneous services.
Regulation 24 prohibits any fee or other remuneration from a registered
patient for the provision of any treatment or prescription for any drug, medicine or appliance, unless it is specified in Schedule 5.
Recent enquiries relate to whether a GP may charge to;
- provision of travel advice - NO
- supply book on travel advice - NO
- supply book on medical condition - NO
- supply BP monitor - NO
- supply or rent of a nebuliser - NO
- supply travel kit for possible use outside UK - YES
Where there is doubt as to whether a charge is permitted under the regulations it is generally safer to err on the side of caution. The very
small additional profit is rarely sufficient to justify the risk of breaching the Regulations.
You are, however, obliged to provide your registered patients with appropriate healthcare advice which may well consist of referring them
to a travel clinic, bookseller, high street chemist or respiratory specialist!
GPs may wish to carry a stock of travel kits for sale to their patients as specified in Schedule 5 ( i.e. a collection of drugs, medicines or
appliances for possible use while outside the United Kingdom, but which were not required when the medicine was prescribed).
It is probably justifiable to include a book of travel advice as an integral part of that kit. This would be a sensible precaution since the GP must
always act in the best interests of the patient and has a legal and professional responsibility to ensure that the patient understands how to use the kit safely.
CED
6) Confidentiality of Patient Data and the LMC: a gentle reminder
GPs often copy the LMC doctors in on letters relating to their patients or seek advice in relation to a particular problem relating to a patient.
This is absolutely fine and we would always encourage you to make full use of our services.
However, GPs sometimes provide us with identifiable patient data.
This is fine, provided you have sought the informed consent of the patient.
- However, in general it is perfectly easy to blank out the name and contact details together with any confidential medical
information. More often than not this is quite sufficient for our purposes.
- If it is absolutely essential to include sensitive personal data relating to the patient, you should first seek the patient’s permission.
- If it is not possible to acquire the patient’s consent you may disclose the minimum data that is essential for us to carry out our
statutory duty of providing advice and support.
Each member of LMC staff has a contractual duty of confidentiality.
However, any correspondence containing confidential patient data should be marked:
“Private and confidential
For the attention of a named doctor (or any one of the LMC doctors.)”
All doctors registered with the GMC share your professional duty of confidentiality, regardless of their professional role.
When the LMC is advising a GP regarding a complaint under the NHS complaints procedure, it will usually be necessary for the LMC and the
PCT to have access to confidential details. The patient should be asked to consent to any disclosure necessary for this process.
CED
7) Farewell to Uncle Bob
Some nine years ago the Hampshire LMC was divided into three parts with a District Committee of General Practitioners electing 3 LMC
members each to the Hampshire LMC. We were all practising GPs and LMC work was definitely the second job. Great changes were afoot and we were to become three separate LMCs. We felt that we had a
reasonably loud voice as Hampshire but there was a suspicion that we would be swamped as smaller LMCs. We decided, or at least Hampshire LMC decided that we should have a full time Medical Secretary. So we
found ourselves interviewing for this post at the Red Cross Head quarters in Winchester. The result was the unanimous selection of Dr Bob Button to the rôle.
Bob had to start from scratch. The LMCs were chaired by comparatively inexperienced GPs and in one case the chairman had never been on an
LMC in any capacity. We were naive as medical politicians but we were willing to learn; Bob was willing to teach. Fairly quickly we had to climb the steep learning curve and represent our fellow GPs in ways that had
not been previously envisaged. We were right to feel that we would be stronger as a unified Hampshire cohort and Bob served the three very different LMCs with aplomb.
In addition to educating the Chairs and Vice Chairs, negotiating with Health Authorities, dealing with practice problems and disputes,
handling disciplinary hearings, preparing us for the cut and thrust of conference, he suggested we needed bigger offices. We were not comfortable spending our colleagues money in such a way but we were
persuaded. Then he wanted more staff to man the offices. The organisation was growing like topsy. Bob had an uncanny knack of having an answer to all our questions. He reassured us that we were perfectly
safe in putting our signatures to lease agreements and to contracts of employment. For what seemed a very tiny levy we were remaining financially solvent as organisations.
Bob drove the early days of the Hampshire LMCs and it is down to him alone that we found ourselves with the solid foundations of a
professional set up. The rapidly maturing LMC members supported his drive and vision but we could not have achieved any of it without Bob’s phenomenally hard work.
The three Hampshire LMCs had entirely distinctive characters but he was able to keep them separate in his mind and to represent each one
individually, reflecting their own peculiarities in his dealings with the Health Authorities and others. It was during this time that he acquired his reputation as the LMCs’ rotweiller.
As Bob’s reputation grew other LMCs wondered if they could benefit from his expertise. The Isle of Wight, Dorset and Wiltshire eventually
joined Bob’s growing empire resulting in the Wessex LMCs.
There is no doubt that at one time, in the eyes of the Health Authorities that Bob Button was the LMC and the LMC was Bob Button. However,
Bob himself is the most vociferous proponent of the axiom that “no-one is indispensable.” The LMCs acquired medically qualified personnel and
Bob became the Chief Executive Officer of an organisation growing in ability, professionalism and stature. When he retires at the end of the year the organisation will have gone from talented and gifted amateurs
working almost full time in General Practice, through one full time “Medical Secretary”, to four high-time part-time GPs, a Director of Liaison and Development and a veritable army of highly professional
administrators in a large office supporting five LMCs with talented, gifted and trained officers and members.
Bob has taken us from the 1950s, kicking and screaming into the 20th century and through to the 21st century. He has constructed the
springboard for us to leap willingly to the challenges of the future, secure in the knowledge we have the background to cope with whatever the politicians have in store.
No, Bob, no-one is indispensable, but you came pretty close!
I know that all of the GPs in the Wessex family will unite in wishing you and Rosemary all that is good in your retirement and may your future
together be long healthy and happy.
Jim Warner
Dr Jim Warner
Chairman Wessex LMCs Secretariat
Key to Contributors
RB Dr Bob Button Chief Executive
NW Dr Nigel Watson Chief Executive
CED Dr Christine Dewbury Medical Secretary
Wessex LMCs
59 Tower St Winchester SO23 8TA
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