PICCOLE ASTUZIE PER GRANDI RISPARMI ENERGETICI Per uniformare Calorie in cassaforte la nomenclatura tura, l’evaporazione, l’effetto di di-LO ESIGE L’AREFLH PER ARMONIZZARE LE RICHIESTE DELLA GDO Da Oniflhor L’Ue arbitro della sicurezza a Viniflhor La recente assemblea dell’Areflh (Associazione dellenel 2008. L’Areflh da oltre due anni ha posto l’attenzione suR
Conversely, injection forms, though being painful and needing help of medical personnel for application, help to quickly achieve necessary concentration of preparation in blood amoxil online Antibiotic is usually chosen in an empiric way (at random). But when choosing one is obligatory guided by definite rules.
Jan 2010JANUARY 2010
S O U T H STA F F O R D S H I R E
weeks to respond if they do not want to have a SCR. The PCT provided 5 SCR awareness sessions for GP practice staff over the last 6 months to provide an understanding of the project. In order to secure the central funding to support this national initiative the PCT would need to complete the A Patient has asked for a report to support The LMC sought the views of the GPC and the IT Lead The overall view is that the SCR is beneficial to healthcare. charge for a consultation linked to travel However, the BMA view is that it has been over expensive, that the consent model is wrong (i.e. there should be individual consent prior to upload), and that the work Support for Patients with Managing their required to prepare records for upload should be remunerated. He also felt the consent issue is one which he does not believe we will ever reach agreement on. LMC members raised concerns with the PCT about the security of the system. Whilst recognising there may be benefits the LMC have grave concerns about implied The majority decision of the LMC was that it is unable to support the PCT recommendation for the Summary Care Record implementation across South Staffordshire. The 2010/11 CONTRACT
LMC notes that it will be individual GP practice choice whether they wish to switch on the upload after the public The GPC have confirmed that following their negotiations information programme. with NHS employers for 2010/11, the Extended Hours Access Scheme DES and four clinical DESs will be rolled over to 2010/11. QOF BUSINESS RULES
The PCT need to have a plan by 26.03.10 which shows
they are using the Extended Hours monies from practices Version 16 of the business rules has now been published.
that have declined the DES. This may involve other Please note that for the QoF CVD PP1 indicator
practices that are willing to provide the DES.
(Cardiovascular disease—primary prevention 1), the business rules have been amended to exclude patients under 30 years of age from indicator PP1. The age range
for this indicator is now set as 30-74 years. Patients
SUMMARY CARE RECORD (SCR)
outside this age range should still be individually assessed and their risks reduced, although risk equations do not South Staffordshire PCT would like to progress the national apply and thresholds for reductions are not currently initiative of implementing the Summary Care Record across available. PP2 applies to all age groups, as do the blood the South Staffordshire area. This will involve a public pressure control indicators in the hypertension set. information programme informing them of the SCR and providing choice to the general public. It gives the public 12 South Staffordshire Local Medical Committee, Suite 5b, Anson Court, Horninglow Street, Burton on Trent,
SWINE FLUE VACCINATION
fee for advice from the fee for the administration of the vaccination because some of the vaccines are given on the The Swine Flu Vaccination LES for under 5 year olds has NHS and charging for giving travel advice when
been finalised by the PCT. They have authorised the use of administering Hepatitis A or Typhoid would be charging the
extended hours between now and March for the delivery of patient for an NHS service.
the vaccination and provision by the PCT of stationery and
postage for letters to patients. The current position is that There is also guidance on this on the BMA website: -
there are 33,048 children to be vaccinated. 58 practices have accepted the LES and 38 practices have declined the drugs_prescribing/InfoOnPrescribe0904.jsp?page=5
LES. The PCT has commissioned its Provider Arm to
undertake the vaccination programme for those practices
who declined the LES. The LMC will reflect later on the
With respect to the Swine Flu letter sent by the PCT to The LMC would like to clarify that it is now mandatory for housebound patients, please note that 385 patients out of those taking up a new post as a GP, practice nurse or 2298 have responded to the request to attend the healthcare assistant (as they undertake 'regulated activity') vaccination centre or arrange a home visit. The LMC is to have had an enhanced CRB check undertaken. This concerned at the poor uptake by this vulnerable group who only applies to new recruits and those who are changing should have been automatically visited. jobs who will undertake 'regulated activity'. It does not apply to receptionists, practice managers, cleaners, etc. A PATIENT HAS ASKED FOR A REPORT TO SUPPORT
HIS APPEAL AFTER HAVING HIS INCAPACITY With regard to the issue of whether employers have to see
BENEFIT WITHDRAWN. DOES HIS GP HAVE TO an enhanced CRB check before taking on a new recruit to a
PROVIDE A REPORT?
'regulated activity' (namely, the post of a GP, nurse or healthcare assistant), the GPC lawyer's opinion is that the No. GPs, as certifying medical practitioners, have a employer does NOT need to see this. statutory obligation to provide statements of incapacity to patients on their list and certain information to a Medical Section 9 of the Safeguarding Vulnerable Groups Act 2006 Officer when requested. However, under their NHS contract states as follows: there is no requirement for GPs to provide reports or offer an opinion on incapacity for work to anyone else unless "9 Use of barred person for regulated activity requested to do so by Jobcentre Plus. (1) A person commits an offence if— (a) he permits an individual (B) to engage in regulated Claimants should contact Jobcentre Plus or the Appeals activity from which Service, where appropriate, if they think that further medical B is barred, evidence is necessary to support their claim or appeal. (b) he knows or has reason to believe that B is barred from They should state clearly their reasons for believing that that activity, further evidence is necessary. If Jobcentre Plus or the Appeals Service consider that In order not to fall foul of the law, we advise employers to further medical evidence is necessary, they will seek it. ask new recruits who will be undertaking a regulated activity They will be responsible for paying any fee to the doctor (as defined above) if they are on a barred list. Also, of course, if you suspect that a person undertaking a regulated activity is on a barred list then further investigations must be So NHS GPs are under no obligation to provide such sought. But as noted above there is currently no legal evidence to their patients nor to provide it free of charge. If requirement to require or see an enhanced CRB check for a GP does not agree to provide additional evidence for their those that you do not suspect. patient then it is a private matter to be resolved between the Please note that from July 2010 ISA registration will be introduced for new recruits and will become mandatory from (This is an extract from the DWP website)
A PRACTICE MANAGER ASKS: CAN GPS CHARGE More detailed guidance will follow.
Whenever a GP gives a vaccination it is good practice to advise the patient of the efficacy/value of the vaccine, and any other protection that may be advisable, and to discuss relevant side-effects or concerns the patient may have. This advice should be accepted as part of the normal process in the provision of travel vaccinations. The supply of travel vaccines is a predominantly private service, and it is appropriate for the fee charged by the GP to reflect the necessary advice. We do not advise GPs to separate the SUPPORT FOR PATIENTS WITH MANAGING THEIR VIAGRA FOR ERECTILE DYSFUNCTION
MEDICINES AND SEVEN DAY PRESCRIPTIONS
A GP has queried whether he must continue prescribing Under the Disability Discrimination Act (DDA) 1995 it is the Viagra on the NHS after his patient has been discharged responsibility making from a specialist centre following the diagnosis of severe reasonable adjustments to help disabled people take their distress. medicines appropriately. It should be emphasised that the definition of disabled is not restricted to those registered as The DH has made it clear who can receive these drugs on disabled. A person is said to have a disability if they have the NHS and the regulations are outlined in the BMF. a physical or mental impairment which has a substantial When the condition is causing severe distress as defined and long term (> 12 months) adverse effect on their ability by the DH it is available from specialist centres to carry out normal day to day activities. This could include commissioned by PCTs. The patient must receive the for example patients with severe arthritis, MS, visual drug from the specialist centre and therefore the GP impairment and/or poor short-term memory. cannot prescribe it for severe distress. Prescribing responsibility remains with the specialist. professionals should determine if the service they provide The GP is required to endorse the prescription “SLS” to
make it impossible or unreasonably difficult for the confirm the patient meets the criteria. We are advised that
disabled person to use their medicines. Prescribers to prescribe for severe distressed patients and endorse
should therefore take account of a disabled patient’s ability SLS is potentially fraudulent, and therefore, one of the
to comply with, and be prepared to make reasonable reasons why we should insist that the specialist service
adjustments to, their medicines regimen. This may for retains prescribing responsibility.
example, include altering the choice of drug and or
formulation in order to simplify a complicated drug regimen LMC CONFERENCE, LONDON, 10 & 11TH JUNE 2010
that is impossible or unreasonable difficult to follow for a
patient with a loss of short-term memory.
The last date for motions to the Conference is 12th April 2010. Please forward to the LMC any topics that you Dispensers should make reasonable adjustments and would like South Staffordshire LMC to raise on your behalf.
action should be taken to help disable patients comply with
their medicines regimen. This may, for example, include Dr David Dickson
supplying medication in an easy open container as a child LMC Secretary
unreasonably difficult for a patient with severe arthritis to DATES OF NEXT MEETINGS
use their medicines. It may also extend to the provision of
reminder charts and medicines compliance aids (MCA).
South Staffordshire LMC - 11th March 2010, South Staffordshire PCT, Anglesey House, Towers Business Under the new pharmacy contract disabled patients may Park, Rugeley.
ask the pharmacist for support with medicines use. If a
prescriber is aware that a disabled patient has problems South East Staffordshire Sub Committee - 25th January
using their medicines, and they have made all reasonable 2010, Samuel Johnson Community Hospital, Lichfield
adjustments to their medication regimen, they can suggest
that the patient approaches the pharmacist for advice and South West Staffordshire Sub Committee - 21st January
assessment. Historically pharmacists have asked for 2010, South Staffordshire PCT, Anglesey House, Towers
seven-day scripts as a means of covering the cost of Business Park, Rugeley.
providing an MCA. There should now be no need for new
requests for seven day scripts but the pharmacist is under LMC MEMBERS
no obligation whatsoever to supply patients who are not
disabled with an MCA.
The following is a list of current members of the South ASSESSMENT OF MENTAL CAPACITY
New guidelines to help professionals assess mental Dr D Dickson (Secretary) capacity has been published by the Law Society. This Dr C Pidsley (Vice Chair/Treasurer) edition provided jointly with the BMA provides practice advice on assessing a persons capacity where it may be in Dr A Parkes doubt. It also provides up to date guidance on the Dr V Singh lawfulness of providing treatment to people who lack Dr E Wilson capacity to consent to treatment on their own behalf. This Dr A Yi new guidance is fully compliant with the Mental Capacity Dr A Burlinson and Dr O Barron Act 2005 (MCA). Gordon Brown agreed with the majority of GMPs that he could save money in the NHS without damaging patient care by: - Cancelling the National Information Spine Reclaiming all profits for PFI initiatives Banning the use of Private Management Consultants Dr V Spleen’s New Year Dream
The money saved – half could be spent on patient care gaining votes, with the other half going back to the treasury. A small I drove to work – there was no traffic. amount could be spent on clinical IT that actually worked. I entered my surgery room – the computer started immediately The bankers decided not to take their Christmas bonuses and and worked without hiccup, at my pace, all day. give it to carers and low paid workers in the NHS that need and I treated patients all day, for their problems only. I try to put a HAD score into my computer and it flashes input I wrote prescriptions for drugs that the patients needed. error, the QOF has been cancelled, it has been shown to an extremely costly distortion of quality health care. Mrs Jones - diabetic, hypertensive, angina sufferer, with a BMI of 45 admitted that she was the way she was because she ate My Practice Manager rings me and says for some reason there cream cakes and chocolates all day. have been no requests for appointments or visits tomorrow so I Bill - drug addict – requested an early script for his dihydrocodeine and diazepam so that he could sell them on the I suddenly wake with a slight sweat, palpitations, heartburn and street to pay for extra heroin. central chest pain. Was that a dream, or nightmare of life past, life present or the future. None of these, the blue cheese was The PBC chairman thanked me, even though I had a million off!!! Where’s the Gaviscon Advance? Bugger I can’t even pound overspend on my acute medical services bill, it was more have that! important that my patients had choice and got their problems sorted fully and quickly. The Chief Executive of the local PCT wrote asking me to Venture
organise a patient centred community based Primary Health
Care Service that would be fully funded. The Secondary care The views expressed in this column are those of the author
would have to deal with what was left.
and not necessarily those of the LMC
I rang a Consultant about a clinical problem with a patient and
he said “just send him up to the next OPA with a covering letter
and he would have a look at him”.
I have a discharge letter from the local hospital that contained all
relevant information to enable me to provide ongoing care.
A mentally disturbed patient was threatening suicide. The Crisis
Team Social Worker said they would love to help and would see
and assess the patient immediately.
All the Government Specialist Medical Advisors resigned and
offered to retrain in the purpose of population medicine by
becoming face to face HIV workers in Africa.
The Chief Medical Officer wrote to me apologising for the total
cock up in managing the Swine Flu Epidemic, in causing so
much confusion to the profession and public as well as wasting
so much public money.
The local Darzi Centre has been closed down and re-opened as a
day centre for the elderly and in the evening as a Casino to raise
money for Community Projects.
Transboundary Species Project – Background Study Hippopotamus APPENDIX 2 Relationship between A ge and Body W eight for Hippopotamus Laws (1968) gives a relationship between age and body length for hippopotamus based on asample of 1,219 hippos (505 males and 714 females) culled in Queen Elizabeth National Park, Uganda,between 1961 and 1966. Pienaar ( et al 1966) give body length an