News
New RCGP credit system for CPD and Revalidation A new credit-based system for Continuing Professional Development to support Revalidation has been agreed by RCGP Council after consultation with stakeholders, including the General Practitioners Committee of the BMA The new system enables GPs to record their CPD based on the time spent on the activity and the impact it has on patient care. It will help GPs meet their revalidation needs by providing a mechanism for collecting and demonstrating their CPD Credits. Each recorded hour spent on a CPD activity – which can include planning and reflection – counts as a credit; and additional credits can be earned by demonstrating the impact of the learning. Credits are self-assessed and verified at appraisal, and account should be taken of the need for GPs to use their CPD to ensure that they are up to date in all areas of their work. Revalidation requires each medical Royal College to have a system for recording and quantifying the CPD of each doctor in their specialty. The RCGP system is unique in that it is proposing a scheme whereby doctors can claim additional credits for the impact that the learning activity has on their practice – rather than credits being solely determined by time spent on CPD. The system encourages and rewards reflection on the learning activity and its integration into a doctor’s practice. Between September 2008 and May 2009 a pilot of the CPD scheme – based on impact and challenge (but to a lesser extent) – ran at ten sites across all four home nations. Impact was calculated as a result of the positive change brought about by the activity on the individual GP or their practise. Challenge was calculated as a product of time and other factors involved in the CPD activity; the full results of the pilot are available. Based on the feedback from the pilot, and in-
ternal and external consultation, the RCGP has simplified the Credit System so that Challenge is replaced by a time-based element. Explanatory documents, examples collected from the pilot and a benchmarking tool (live on the RCGP website) will enable simple recording of credits. RCGP Chairman Professor Steve Field said: “The RCGP recognises that GPs have a wide variety of working environments and careers – and that GPs have individual learning preferences and styles. There are therefore major differences in learning needs and activities from individual to individual. Our CPD credit system will help doctors fulfil the needs of appraisal as part of Revalidation. “The development of the new system is an excellent example of the RCGP working with jobbing GPs to come up with a way forward that is flexible, workable and that takes into account the pressures faced by busy GPs. “I would like to thank all the GPs across the UK who piloted the system and gave us their feedback. We have listened to what you told us and the end scheme reflects your views. “My particular thanks go to Professor Nigel Sparrow who chairs the RCGP Professional Development Board for the time, intellect and academic rigour he has invested in this project. “We recognise that the system is new and that we need to ensure it can be used easily by all GPs. In common with other requirements for revalidation, the credit system will be subject to evolutionary changes. We want your views so that we can adapt the scheme if necessary as we move closer to revalidation.”
Definition of a Credit A CPD Credit is defined as being based on an hour of learning activity (including planning and reflection) recorded in such a way that it demonstrates the learning achieved relevant to the working situation of the GP.
Impact Impact in this context refers to: ● Impact on patients (eg, a change in practice, implementing a new clinical guideline, initiating a new drug for the first time) ● Impact on the individual (personal development: eg, development of a new skill or further development of existing skills) ● Impact on ser vice (eg, developing and implementing a new service, becoming a training practice, teaching others) ● Impact on others (teaching, training, NHS locally or nationally) Demonstration of Impact would enable timebased Credits claimed for an activity to be multiplied by a factor of 2.
Calculation of Credits Activities attracting one Credit The accumulation of knowledge is an essential part of any doctor’s development. Examples of accumulation of knowledge would be reading, attendance at educational meetings or completing an online learning resource. A record of the learning activity demonstrating that it is relevant to the GP’s practice is essential in order to claim a credit. It is recognised that unplanned learning (eg, reading the BMJ, attended a meeting because it looks interesting, or completing an online resource because of a prompting e-mail) is a valuable activity. In these circumstances the number of hours spent is equivalent to the number of credits earned.
Conference countdown: Book now or miss out Only five weeks to go to the RCGP Annual National Primary Care Conference in Glasgow so book now if you don’t want to miss out on THE primary care event of the year. Now in its third year, the 2009 conference Excellence in Practice: Winning ways for primary care takes place at Glasgow’s SECC from 5-7 November. Revalidation Ready? – a one-day conference to support all GP appraisers preparing for revalidation– will be held at the venue the previous day, with the £49 fee refunded if you stay on for the main conference. Chaired by Niall Dickson – current Chief Executive of the King’s Find and incoming Chief Executive of the General Medical Council – the main conference programme has been developed by experts to ensure that there is something to suit everyone. The central theme for 2009 will be GP revalidation and the challenges facing the College and individual GPs. It will showcase the latest clinical and policy developments across the UK and bring together an impressive range of national and interna-
Clare Gerada: This year will be bigger and better tional speakers alongside the political perspective. Alongside the ever-popular clinical, policy, research and education streams, this year’s event addresses the learning and development needs of the whole primary care team, with
specific streams for practice managers and practice nurses. As well as updating yourself on the latest developments in primary care, the Conference offers a fantastic opportunity to meet, network and exchange ideas with over 1,000 primary care professionals. Find out at first hand how the College is supporting GPs preparing for revalidation by visiting the ‘RCGP Village’ and exhibition where College departments, faculties and councils across the UK will be promoting their work, products and services. An extensive social programme includes the Conference Dinner and Ceilidh on the Friday evening at the stunning Kelvingrove Museum. Back by popular demand, there will be a special Associates in Training Curry and Karaoke night and a GP Jammin’ Session for musically talented delegates. Professor David Haslam will be marking his final weeks as RCGP President by being the castaway in the College version of Desert Island Discs. RCGP Vice Chair and Conference Lead Dr Clare Gerada said: “I think I can safely say that this year’s conference will be bigger and better than ever. Time is running out, so register today or miss out on the biggest event in the primary care calendar.”
ThE NEwspApEr OF ThE rOyAl COllEgE OF gENErAl prACTITIONErs
OCTOBER 2009
Inside this issue... A firm foundation RCGP to launch special initiative for primary care professionals
Countryfile New RCGP Forum for Rural GPs
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Fleming on flu Dr Douglas Fleming showcases the groundbreaking efforts of the Birmingham Surveillance Unit
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NICE work RCGP takes the lead in developing quality indicators
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A matter of life and death Professor Keri Thomas on the new RCGP End of Life Care Strategy
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Malignant hyperthermia How GPs can raise awareness among unsuspecting patients
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Excellence in practice Have you reserved your place at the RCGP Glasgow conference?
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Planned learning (where an individual sets out to learn a skill or cover a topic for a purpose) may appear more valuable to the individual. Once again until the learning is incorporated into practice it remains at the level of knowledge rather than application; and as such qualifies only for one credit.
Demonstration of Impact to attract Additional Credits (x2) Activities which attract additional credits demonstrate the introduction of newly-acquired knowledge or skills. They may be evidenced by an individual case report or series of reports; a reflective commentary demonstrating a change in practice (eg, as a result of an e-learning module); a significant event leading to risk avoidance; a practice protocol or a change at the individual level could also be highlighted. This activity will benefit the individual, the patients or the system more than simply knowing about a development and should be rewarded by additional credits. This phase may happen long after the learning experience. The RCGP recognises that any CPD accreditation system for GPs must be applicable in all of the diverse working environments, job roles and circumstances of general practitioners. To be valid and educationally fit for purpose, the CPD system must be based on the self-declared reflection of individual GPs which is then validated at appraisal. The assessment of impact and time spent to determine CPD credits should encourage learning activities that have a direct effect on patient care and the GP’s working situation. The model will evolve with time and experience.
Further information RCGP Guide to the Revalidation of General Practitioners Version 2.0, RCGP. August 2009 Price, C. Impact and Challenge model of CPD Credits – Pilot Report. RCGP. June 2009 Price, C; Sparrow N. Credits Based System for Continuing Professional Development (CPD). RCGP. June 2008 RCGP Benchmarking Tool: www.rcgp.org.uk/practising_as_a_gp/ professional_development/cpd_credits_scheme/ benchmarking_tool.aspx
■ To find out more about the RCGP’s current plans for Revalidation or to comment and contribute, please go to www.rcgp.co.uk/revalidation
NEWS
New initiative strengthens the sign up now for new foundations of general practice rCgp Forum for rural gps A new General Practice Foundation to support practice managers, nurses and physicians’ assistants working in general practice will be launched at the annual national conference in Glasgow. The Foundation will provide educational and peer support to members of general practice teams who are not GPs but who play an integral role in raising standards of care for patients. The purpose of the General Practice Foundation is to enhance patient care by: ● Supporting the professional development of professionals working in General Practice ● Exploring opportunities to share learning material and learning media ● Collaborating on the development of policy that impacts on General Practice ● Championing the key features of UK General Practice, while ensuring future developments positively improve standards of care for patients ● Encouraging high quality professional delivery of care for patients ● Encouraging enhanced team-working in General Practice The Foundation is being established as part of the College but will have no separate legal status. A wide range of benefits from access to RCGP educational and CPD resources to reduced rates for RCGP events will be offered to healthcare professionals who sign up but they will be members of the GPF – not members of the College – so will have no corporate rights such as being able to vote in College elections or participate in general meetings. Market research has been conducted among each of the professional groups to identify levels of support and the Foundation has the backing of representatives from the three professions – including the Royal College of Nursing and the Institute of Healthcare Management – who have been part of the Steering
Group taking the proposals forward. The concept of a General Practice Foundation first came about during a session at the 2007 RCGP National Primary Care Conference in Edinburgh where it was agreed to explore further the potential of a relationship between the College and other key professional groups. After an extensive scoping exercise, the proposals were agreed at the June meeting of RCGP Council. RCGP Honorary Secretary Dr Maureen Baker said: “Practice managers, nurses and physicians’ assistants are playing an increasingly important role in supporting GPs and improving care for patients, yet their status can go unrecognised and the peer support and funding they receive for education and professional development is variable. “Having a Foundation within the RCGP that is dedicated to the support and development of general practice nurses, practice managers and physicians assistants will ensure that they have a stronger voice in the future development of general practice across the UK. This is good news for GPs and for patients as it will undoubtedly enhance the care they receive.” The GPF will with three sub-groupings within it:
q Forum of Practice Management w Forum of Nursing in General Practice e Forum of Physician Assistants Its Executive Board will be chaired by the Honorary Secretary of Council with membership that includes the Chairman of the Professional Development Board, leads for each of the three Fora and patient representation. Any manager working in practice management, registered nurse or Physician Assistant working in General Medical Practice in the UK will be eligible. The GPF will initially focus on practitioners in the UK, although options for receiving registrations from those working in similar roles overseas could be looked at in the future. The inclusion of trainees/students in each profession (particularly in relation to PAs) was considered but decided against at this stage on the basis that many PA trainees may not end up working in General Practice.
rCgp patient partnership group seeks new gp and patient reps The College’s Patient Partnership Group (PPG) is recruiting for a GP and lay members. The Patient Partnership Group consists of GPs and lay members who meet four times a year to put forward the patient perspective on RCGP policies and wider general practice. Members have a high profile inside and outside the College and are involved in several important policy development projects, as well as providing representatives to working groups and committees. If you know of any patients who may be interested in this opportunity please contact ppg@rcgp.org.uk or call 020 7344 3050 for information. The Group is also looking for a new GP member as Dr Catti Moss who has made significant contributions to the Group leaves in November – this role is open to all College members. Lay Chair Ailsa Donnelly is also stepping down in November and will be succeeded by Antony Chuter, current Lay Vice Chair.
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He said: “It’s an exciting and challenging time – the PPG’s work is so varied and we have never been so busy: we’re commenting on consultations, publications, participating in policy and sitting on many College Groups. “It’s a great time to join PPG as a GP member and help us build on our work so far. We’d be delighted to hear from you if you think you could fill this vacancy or if you know any lay members who may be interested.” A mini-survey of GPs carried out by the RCGP Patient Partnership Group and the Patient Liaison Group of the Royal College of Anaesthetists found that over 90 per cent would welcome more good quality information to give to their patients awaiting surgery about anaesthesia, its risks and side effects. As a result, the RCoA has arranged for the information from its patients’ section of the website www.rcoa.ac.uk to be made easily accessible to GPs using EMIS. A wide range of leaflets is available on the RCoA site including You and your anaesthetic and Your child’s general anaesthetic. More detailed information on specific risks is also provided, along with an FAQ section.
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© Royal College of General Practitioners. All rights reserved. Published monthly by the Royal College of General Practitioners 14 Princes Gate, London SW7 1PU email: rcgpnews@rcgp.org.uk website: www.rcgp.org.uk
The College’s Rural Practice Standing Group is to change its status and become a Forum for rural GPs. The Rural Practice Forum (RPF) will be launched at the RCGP annual national conference in Glasgow. It is open to any College member who has an interest in rural practice and will be piloted over two years. You can register your interest now by going to www.rcgp.org.uk/ruralforum or by emailing ruralforum@rcgp.org.uk and start receiving updates about the Forum. There is no cost to join. The main aims of the RPF are to: ● Develop a forum that will represent rural and remote general practitioners in the RCGP with the potential to promote rural issues within and outside the College faculties and be the rural face of the College ● Encourage engagement with the College of Fellows/Members working in rural and rural practice ● Advance the College’s objectives in rural and remote practice ● Facilitate communication and networking between remote and rural doctors across the UK ● Support the professional development of remote and rural general practitioners with particular reference to the required knowledge, skills and attitudes of a GP to care for patients in a rural setting ● Promote remote and rural issues at the appropriate level, engaging with the profession, managers and informing political debate. Dr Malcolm Ward, Chair of the Rural Forum, said: “It is more important than ever that rural and remote practice is adequately represented within the RCGP and we hope that the Rural
Practitioners’ Forum will attract a large membership of grass-root rural practitioners throughout the UK. “By ensuring an adequate voice for rural and remote practitioners within the College we will be able to co-ordinate and share innovation, feedback and support. “Response to this Forum will also determine whether further initiatives are necessary. The more members we have, the more influence the Forum can have in rural proofing future RCGP policy and initiatives. This is your opportunity to show support for the Rural Forum and help shape the future of rural primary care.” Allied to the Forum is a new Rural blog – www.ruralgp.org.uk –set up by RCGP member David Hogg and is already proving to be a very useful resource for rural doctors and all those with an interest in rural medicine.
Malcolm Ward: Grass roots need representation
loss of sight can be a maze Barbara McLaughlan Campaigns Manager Eye Health and Social Care, RNIB
RNIB will be bringing our interactive maze to the RCGP Conference in Glasgow this November. It is designed to help you understand what your blind or partially sighted patients face in everyday life, including difficult everyday tasks such as crossing a road, visiting a bank or attending a GP surgery. When people lose their sight, they lose more than their ability to see, they lose their life as they once knew it. GPs have a key role in supporting patients with long-term conditions, including those losing their sight, yet many claim they do not understand the basics. With an ageing population meaning an increase in the prevalence of eye conditions causing sight loss and a rising demand for services, this challenge is set to rise. GPs can have a real impact on a patient’s experience of sight loss. Often you are the medical professional who has the most contact with an individual and has already developed a relationship of trust with them. As such you are a valued source of health information and advice. As well as providing information on eye conditions, if a patient has sight loss it is important to build a picture of the other needs they may have. Are falls, burns or depression signs that someone is not coping well and would benefit from a referral to an eye clinic or to social serv-
ices? The GP’s insight here is invaluable. Working with other members of the medical community is also important. Understanding the role of the optometrist, ophthalmologist and social services in a patient’s sight loss journey will help you to work with them to support your patients. It is also important to understand how the process of certification-registration as ‘partially sighted’ or ‘blind’ operates as a gateway to long term support and care, as a patient may be relying on your advice. RNIB offers support service you can refer patients to as well as a handy resource to help you meet these challenges. They have also developed information and resources that support GPs in their provision of emotional and practical services to blind and partially sighted people. As well as access to training programmes, research and comprehensive eye-health information to complement your own knowledge, RNIB also has a range of products and services specifically designed to help your patients. The RNIB Helpline – 0303 123 9999 – provides blind and partially sighted people with a direct line to a range of support, advice and products which they may need. It has recently launched an enhanced service with speciallytrained advice workers to offer one-to-one support, helping people decide which services they need, whether offered through RNIB or not. ■ For more information about RNIB, visit rnib.org.uk or come to our sight loss maze at the RCGP Conference ■ RNIB award-winning series of Understanding booklets, in partnership with the Royal College of Ophthalmology explain a range of eye conditions to patients. To order these email helpline@rnib.org.uk or visit rnib.org.uk/eyeconditions
+++ LAST CHANCE TO BOOK +++
ONLY FIVE WEEKS TO GO -RCGP NEWS • OCTOBER 2009
PROFILE
Keeping an eye on the health of the nation The outbreak of H1N1 flu has gripped the nation and the world – with GPs centrestage in the battle to contain and manage the spread. But one person taking it all in his stride is Dr Douglas Fleming. Here, he reveals how he and his team spend 52 weeks a year predicting, planning and monitoring to ensure that the medical profession is geared up for health scares and emergencies.
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ROM AN OFFICE over a surgery in the suburbs of Birmingham, Dr Douglas Fleming and his team at the RCGP Research and Surveillance Centre keep a close eye on diseases threatening the UK. Formerly known as the Birmingham Research Unit, most people know the Centre for its weekly reports of diseases common in general practice. With the emergence of swine flu this year their monitoring has been eagerly awaited by politicians, the media and health officials. Dr Fleming is the Director of the Centre, which is funded by Department of Health and the work undertaken with the Health Protection Agency. He has been involved in the activities of the Centre for most of his medical career. “The monitoring service and the information we have gathered are unique on a worldwide scale, because of the uninterrupted operation over such a long period. The service provides timely estimates of the population suffering illness sufficient to prompt consultation with a doctor. “The database generated is valuable for describing annual and seasonal variations and considering the impact of health interventions.”
A career in surveillance After qualifying in 1959 Dr Fleming began practising in Birmingham and has remained in the city ever since. He says it was an easy decision choosing general practice: “The lifestyle at-
tracted me, and the rewarding relationships you develop with people.” Yet as much as he enjoyed general practice, he became involved with the RCGP Records and Statistical Unit (as it was then known) in 1964 after feeling “academically starved.” “In those days general practice was much more limited. You had to refer so many patients to specialists, even for basic investigations such as haemoglobin estimation, urine culture or X-rays.” Initially the Centre was set up by the College to develop standardized recording instruments such as the age/sex register and diagnostic ledger. These led to national morbidity surveys and a number of therapeutic studies. The main operation, however, has always been the weekly surveillance operation. Gathering information has become a much easier task in recent years. “In the 1960s, around half of practices in the UK were single-handed and our returns were done by the few GPs who were willing to gather weekly paper summaries and send them to us.” Currently the network includes approximately 100 GP practices (500 GPs) throughout England and Wales. “From 1989, when I became Director, we started using data from computerised practices and our data extraction routines are now fully automated. “Currently we’re undergoing a transformation in the way we receive data. Tabulated summaries by disease are being replaced by
monitoring ❛ The service and the information we have gathered are unique on a worldwide scale... The database generated is valuable for describing annual and seasonal variations and considering the impact of health interventions...
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RCGP ANNUAL NATIONAL RCGP NEWS • OCTOBER 2009
CONFERENCE GLASGOW +++
Neighbourhood watch: Dr Fleming in his office and (right) the Research and Surveillance Centre in Harborne anonymised – but person-linked – data sets. This makes a huge difference because now we can look at linked events for the first time. For example, we can look at people who’ve received a flu vaccine and see how many of them actually get the flu. “In the future I’d like to see clinical and microbiological data fully integrated. It will happen, gradually, as we standardise our recording arrangements.” Over his 50 year career Dr Fleming has seen a variety of changes: “There have been declining rates of infection and much better, more active management of chronic diseases. Personal hygiene has greatly improved and this may be the main reason why there are many fewer episodes of infection. “The use of contraceptives and psychotropic drugs are probably the developments with the biggest impact that I’ve seen in medicine. In terms of changes to the GP profession, the changing responsibility from 24/7 care to a job without emergency work has been the most significant.”
The impact of swine flu While swine flu has brought the Centre increased attention, Dr Fleming says it still doesn’t compare with previous pandemics. “It’s had an impact on our work, but the flu outbreak in 1969 was infinitely bigger. My partner and I did 40 visits on Boxing Day that year plus various telephone consultations. There was nobody else apart from GPs to deal with it! “Even the 1999 winter flu epidemic was a much bigger outbreak, with more fatalities.” Yet Dr Fleming says the attention given to the swine flu is understandable, given the fatality rates of similar viruses in the past such as Avian (bird) flu. “The preparations may have been over and above what was required but we just do not know. The planning situation can be likened to an insurance policy. You set the risks you want
to cover, and decide what’s reasonable and realistic to prepare and pay for.” He warns that the virus is likely to come back in successive waves over the next few winters. “Following the introduction of a novel influenza virus in 1969 we saw generally higher levels of flu for several winters afterwards and this is likely to happen again. Sometimes the first wave of the pandemic virus is not the most severe.” With a vaccine for swine flu soon to be available, Dr Fleming believes that health professionals have a responsibility to be immunised. “Taking the vaccine will limit the chance we pass the virus onto our patients, and we should have that concern for our fellow citizens.” He says that falling rates of immunisation help to explain why other diseases like measles and whooping cough have re-emerged in recent years. “Viruses can re-establish themselves if the level of herd immunity falls below a certain threshold. In effect, people who don’t take vaccinations are free-riders, hoping to enjoy the benefits from the efforts of other people.”
Family man Over the last five years Dr Fleming has gradually given up his occasional locum work and in some ways is even more involved with the Centre. Outside this absorbing interest, he enjoys bridge (“I like the problem-solving element”), is active in his local church and was a passionate squash player before knee problems ended his playing days. His 15 grandchildren and five children keep him busy these days – “I’m good at being a grandfather!” he says proudly.
DON’T MISS OUT +++ GET READY FOR REVALIDATION
+++ LAST CHANCE 3
NEWS
how NICE guidance can In the frame: It’s NICE work reduce differences in the developing the QOF indicators uptake of immunisations in children and young people Dr Tim Stokes is Consultant Clinical Advisor for the NICE QOF programme and a practising GP in inner city Leicester.
An academic GP by background, he is an experienced clinical guideline developer, having been involved with the NICE clinical guidelines programme through the RCGP-hosted National Collaborating Centre for Primary Care and the University of Leicester.
Dr Anthony Harnden GP member of the Joint Committee on Vaccination and Immunisation and co-opted expert of the NICE Public Health Interventions Advisory Committee for this guidance IMMUNISATION is arguably the most important primary prevention delivered to children in primary care. Immunising children both protects the individual child and, by herd immunity, vulnerable children who are either too young or too ill to be immunised. We continue to be reminded of how effective immunisation is – recent immunisation programmes such as those for Meningitis C and Pneumococcal disease have resulted in a sharp decline in morbidity and mortality resulting from these infections. It is the responsibility of all primary care professionals involved in childhood immunisation to try to increase vaccine uptake in children and young people. Despite the importance of immunisation, a significant minority of children and young people are either unimmunised or incompletely immunised. There are certain groups of children and young people who remain at risk of not receiving universal immunisations (see Table 1 below) and other groups of children whose parents will not consent to a specific vaccine (for instance MMR). The latter group has been inversely correlated with socioeconomic status. In addition there are several groups that are at risk of developing specific vaccine preventable diseases: ethnic minority women and rubella infection; traveling communities and measles; South Asian immigrants and hepatitis B; residents of deprived and overcrowded neighbourhoods and meningococcal disease. The guidance contains six key areas of recommendations (see Table 2) which include some specific recommendations for GP practices (see Table 3). Although the recommendations in the guideline are straightforward and sensible, there are a surprising number of gaps in the evidence for a number of interventions. Some areas in which funding bodies may consider prioritising research are: interventions aimed at increasing uptake of the pre-school booster; whether there is a differential effect of using different members of the primary care health team; and whether there is a negative effect in sending repeated reminders to those who actively choose not to have their child immunised. Children and most young people don’t choose to miss appointments or to remain unimmunised. For children, the parent or carer is responsible for keeping appointments and for the
Table 1: Groups of children and young people at risk of not being fully immunised ● Those who have missed previous
● ● ● ● ● ● ● ● ●
vaccinations (whether as a result of parental choice or otherwise) Looked after children Those with physical or learning disabilities Children of teenage or lone parents Those not registered with a GP Younger children from larger families Children who are hospitalised Those from a minority ethnic group Those from non-English speaking families Those whose families are travellers, asylum seekers or homeless
Here, he explains how the new NICE-led process for reviewing and developing QOF indicators will work – and the important role members of the RCGP are already playing in the future of the QOF.
Table 2: Key areas of recommendations Immunisation programmes Information systems Training Contribution of nurseries, schools, colleges of further education ● Targeting groups at risk of not being fully immunised ● Hepatitis B immunisation for infants ● ● ● ●
final decision on consent. But it is important to realise that parents do not necessarily have to be present when the vaccine is given, provided it is in their knowledge and they have arranged for another person (for example, grandparent or childminder) to attend with their child. All of us working in primary care have a responsibility for providing clear information and effective communication, and for trying hard to reach out to those children and young people who, for a variety of reasons, fail to receive timely immunisation. This NICE guidance helps to raise the profile of this small but important group.
Table 3: Examples of specific recommendations for GP practices
THE QUALITY and Outcomes Framework (QOF) is an important feature of the landscape of modern UK primary care. It was introduced as part of the General Medical Services (GMS) contract in 2004 as an incentive scheme to reward GP practices for implementing systematic improvements in quality of care for patients. Virtually all GP practices now take part in the QOF and expenditure on QOF is currently just over £1 billion in England (15 per cent of the spend on primary medical care). The Royal College of General Practitioners has been involved with the QOF from the beginning, having been part of the Expert Panel collaboration appointed by the Department of Health in 2005 to review the evidence base for QOF indicators. This year, however, sees the QOF move in a major new direction. Since April, the National Institute for Health and Clinical Excellence (NICE) has been responsible for managing a new, independent process for developing and reviewing the clinical and health improvement indicators in the QOF in all four UK countries. NICE is now responsible for producing an annual ‘menu’ of new, evidence-based clinical and cost-effective indicators where there is a strong case for encouraging uptake of good practice. NICE will also recommend whether or not indicators should continue to be part of the QOF – for example, where the activity being measured has become part of standard clinical practice, there would no longer be a need to provide a financial incentive. The final decision on which indicators are included in the QOF will continue to be decided by NHS Employers, on behalf of the Department of Health, and the British Medical Association and the General Practitioners Committee.
q Ensure the practice has a w
e
r
t
y
nominated lead for the childhood immunisation programme Ensure the practice has a structured, systematic method for recording, maintaining and transferring accurate information on the vaccination status of all children and young people Ensure all practice staff involved in immunisation services are properly trained and that this training is regularly updated Try to improve access to immunisations for all children with transport, language or communication difficulties, physical and mental disabilities and children in care Monitor the age composition of the practice so there is enough capacity to provide timely immunisations. Waiting lists are unacceptable Ensure babies born to hepatitis B positive mothers complete the recommended vaccination course at the right time
Why the change? It is generally considered that the QOF has been very effective in driving quality improvements across primary and community care and in promoting healthy lives. However, the Darzi report, High Care Quality for All (June 2008), highlighted the need for a more independent and transparent process for reviewing and developing indicators.
Professor Helen Lester: Heads the consortium
DON’T MISS OUT – IT’S THE CONFERENCE FOR ALL THOSE WORKING IN PRIMARY CARE 4
In addition, a recent National Audit Office report on GP contract modernisation recommended that indicators be based more on outcomes and cost-effectiveness. NICE has been asked to take on this role because one of its acknowledged key strengths is the robustness of its process for assessing what is both clinically and cost-effective for use in the NHS. It is also extremely important that the process for assessing evidence to review or develop QOF indicators is seen to be separate from the process for negotiating and approving changes to the QOF. NICE acts independently when producing clinical and public health guidance and will bring this experience to the assessment of evidence. NICE clinical guidelines will also continue to be a key source of potential indicators. The key steps in the new NICE-led process will be: q NICE gathers clinical and costeffectiveness information to help prioritise new indicators. Interested parties submit potential clinical and public health topics for consideration through the NICE website.
w An independent Primary Care Indicator Advisory Committee prioritises these topics for inclusion in the QOF. This committee is multidisciplinary, with the majority of members being practising GPs.
e The National Primary Care Research and Development Centre (NPCRDC) (in collaboration with the RCGP and York Health Economics Consortium – YHEC) develops the indicators, testing them in a number of GP practices across the UK. They also provide evidence of costeffectiveness and on thresholds and points for each indicator.
r NICE consults on the developed indicators, validates the proposals through the Advisory Committee and publishes them on the NICE website.
t Each recommended indicator is accompanied by supporting information, such as review date and the supporting cost-effectiveness evidence. There are currently 88 QOF indicators within the proposed scope of the new process. These will be reviewed over three to four years (20 to 30 indicators a year). In addition, NICE is planning to develop around ten new clinical and health improvement indicators in each QOF review cycle. The membership of the RCGP will have an important role to play in the new NICE-led process. The College already has a number of members on the independent QOF indicator advisory committee and forms part of the NPCRDC/YHEC/RCGP consortium commissioned by NICE to develop and pilot potential QOF indicators prior to final approval by the QOF indicator advisory committee and their publication on the NICE website. My role as Consultant Clinical Advisor on the NICE QOF Programme Team is to provide clinical leadership and quality assurance for the QOF Indicator Programme, including the identification and prioritisation of topics for consideration by the independent Advisory Committee as potential QOF Indicators. The role complements that of two other college members: Dr Colin Hunter (Aberdeen GP and RCGP Honorary Treasurer), who chairs the advisory committee, and GP academic and RCGP Council member Professor Helen Lester of the University of Manchester, who heads the consortium. I will be working closely with Colin, Helen and the NICE QOF programme team to ensure the new NICE-managed process delivers QOF indicators that are both evidence based and will improve care for patients. ■ For further information on the new QOF indicator development process, visit the NICE website: www.nice.org.uk/aboutnice/qof/qof.jsp
+++ GET READY FOR REVALIDATION… RCGP NEWS • OCTOBER 2009
NEWS
Time to change the culture of dependency on the Nhs Gopa Mitra Director of Health Policy and Public Affairs, Proprietary Association of Great Britain (PAGB). ‘Self care is the frontline of healthcare’ is a universal truth acknowledged in the NHS Plan ten years ago and a supposition on which the National Health Service was built in 1948. Its founding principle was that healthcare would be free at the point of need and not by ability to pay, thereby establishing the premise of circumstances when there is the need for medical intervention. At a time when tuberculosis, diphtheria and polio were taking a drastic public health toll on the health of the nation, as people went untreated because they were unable to afford to see a doctor, this founding principle of ‘need’ was easy to support. Not even Aneurin Bevan would have thought that the Service would become a substitute for self care for common and minor symptoms replacing it with doctor care. Would he have believed that the common disturbances to normal good health, such as coughs and colds, now take up on average an hour a day of every GP’s time in the country? PAGB’s research among consumers in 1987, 1997, 2005 and most recently in 2009 has shown that there is a high incidence of minor ill-health in the population. Minor ailments are part of normal everyday experience for us all, particularly backache, coughs and colds, headaches and migraine, toothache, indigestion, skin problems, allergy and respiratory problems. In most cases people manage these minor ailments through self care using an OTC medicine but the data from the research spanning more than 20 years has demonstrated a level of de-
pendency on the doctor for minor ailments that must surely be questioned in the 21st century. The data showed that while people do self care they often abandon this practice for the doctor typically within a period of four to seven days. And, according to the GP respondents, this presentation is earlier than needed – generating, in their opinion, unnecessary consultations. While GP respondents felt they were encouraging their patients to self care they also gave a prescription in most cases. This behaviour is compounding people’s dependency on the GP and the NHS as the prescription reinforces their decision to seek out the GP. The NHS now costs over £109bn a year, with reports from the NHS Confederation of there being a £15bn black hole by 2012. If the NHS generations continue to be dependent on the doctor for all care rather than care that needs medical intervention, we will have failed our population in empowering them to look after themselves and their families to best effect. Conditions that are suitable for self care are a defined category which can be interrogated in primary care databases, as demonstrated by IMS in their study on GP workload for minor ailments, which was commissioned by PAGB in 2007. It showed that there are 57 million consultations involving minor ailments, accounting for 20 per cent of GP workload, at a cost to the NHS of £2bn including £371m for the cost of prescriptions. The majority of the cost was for the GP’s time – on average over an hour a day for every GP. In addition, 75 per cent of consultations are accounted for by ten ailments: back pain, dermatitis, heartburn and indigestion, nasal congestion, constipation, migraine, cough, acne, sprains and strains, and headache. It should be possible to encourage these patients to manage these symptoms in self care if the right mechanisms and programmes were in place.
Promoting self care during the flu season The battle against flu and colds is a new leaflet jointly published by the PAGB and the RCGP. A million copies of the leaflet are being delivered to pharmacies and GP surgeries across the UK this autumn. Sheila Kelly, PAGB Executive Director, said: “In a normal cold and flu season many patients visit their GPs unnecessarily, and concern about swine flu is bound to increase the demand this year. “Research suggests that one reason many people give up self care too soon and go to the doctor is because they do not understand that the symptoms they are Health policies already reflect the need for people to take greater responsibility for their health (as indicated in Lord Darzi’s plan). There is quick access when needed (telephone, internet, face-to-face settings) and more choice and less inequality.There is now the need to place the emphasis on how the NHS should be used. RCGP is joining PAGB for our tenth Self Care conference on 17 November 2009. We will ask an invited audience and speakers to consider practical solutions for encouraging self care of the top ten minor ailments in general practice from the perspective of GPs, PCTs and consumers/patients. The event aims to be hands-on and we will ask a health management solutions company to present what a business plan would look like in order to implement the solutions in question. The hope is that at the end of the event delegates will leave with not only ideas but also ways in which they can put them to work when returning to their organisations and practices. RCGP Chairman, Professor Steve Field, will
rCgp Members continue good work on Carers’ Commission RCGP Council Members Professor Nigel Sparrow and Dr Helena McKeown have been appointed to the next phase of work of the Standing Commission on Carers. Appointed by the Office of the Commissioner for Public Appointments, they will serve until autumn 2014. The Standing Commission on Carers was established in 2007 at the specific request of the Prime Minister. It is an independent advisory body, providing expert advice to Ministers and the Carers Strategy Cross-Government Programme Board (chaired by the Department of Health) on progress in delivering the National Carers Strategy. Both Professor Sparrow and Dr McKeown were appointed to the Commission’s first phase and are two out of only ten representatives appointed for the next five years.
Under the leadership of Professor Sparrow – who also chairs the RCGP Professional Development Board – the College has been working with the Princess Royal Trust for Carers for over three years to support GPs and practice teams in offering practical support for carers. Outputs from the initiative include a ‘checklist’ to help all members of the practice team identify patients responsible for providing care; a leaflet on carers’ own health needs; and a Good Practice Guide enabling primary care teams to evaluate the services they provide for patients and their carers against agreed criteria, focusing on teamwork and practice organisation. The College has also been running a series of free training workshops around the country to help GPs and primary care staff to support carers in general practice. The next workshops are this month in Nottingham (6th), Ealing (8th) and Rotherham (21st). See the ad on the right for further details.
Exploring new ways of caring for older people The College has joined forces with the British Geriatrics Society to host a conference on geriatric care. RCGP Vice Chair Dr Clare Gerada and RCGP Clinical Champion for Ageing and Older People Dr Louise Robinson (pictured left) are among the speakers at Interface Geriatrics which will be held in London next March. Examining new models of care for frail older people across primary and secondary care, it will include Expert Perspectives from across the care spectrum, along with examples of evidence-based good practice and workshop sessions for primary and secondary care practitioners. BGS grants are available to support attendance. ■ For a full programme and to book a place: www.bgs.org.uk/Notices/interface_geriatrics.html or call 020 7608 1369.
+++ CLINICAL RESEARCH NETWORKING RCGP NEWS • OCTOBER 2009
experiencing are the body’s normal reaction to a viral infection. The leaflet helps explain to patients the difference between flu and colds, what symptoms to expect and how long they will last.” Dr Maureen Baker, RCGP Honorary Secretary of Council, comments: “With much of the public health information about swine flu focusing on prevention, vaccination and antivirals, the leaflet suggests practical self help measures that people can take to relieve the symptoms of swine flu, as well as seasonal flu and colds, as the virus runs its course.” provide the welcoming address and other members of RCGP Council will form a pivotal part of the thinking for the day. We will also put the NHS on trial for perpetuating the culture of dependency by neglecting to encourage self care. The audience will be the jurors in this trial. And finally – a call to action. The last task of the day on 17 November will be to present an award for best practice in initiatives encouraging self care on the ground. If you have introduced systems using technology or consultation techniques for encouraging your patients to be confident in the self care of their minor ailments, please put yourself forward for the ‘self care in practice’ award by e-mailing Libby Whittaker at libby.whittaker @pagb.co.uk ■ The PAGB/RCGP Self Care Conference is free of charge and you can register by emailing sally.o’shea@pagb.co.uk ■ PAGB is the national trade association representing the manufacturers of OTC medicines and food supplements.
National Education Programme for General Practitioners and Primary Care Staff
Supporting Carers in General Practice The RCGP invites General Practitioners and Primary Care Staff to a half-day workshop on supporting carers in general practice
DID YOU KNOW? ■ One in ten people in the UK is a carer (UK Census 2001) ■ 13 million people can expect to become carers in the next decade (The Princess Royal Trust for Carers, 2001) ■ 1.2 million carers care for over 50 hours a week – equating to a workforce greater than the NHS (UK Census 2001)
Workshops will be hosted by the following Faculties Sheffield Vale of Trent Wessex
• Beds & Herts • North West England • North West London
• • •
FREE training for GPs and Primary Health staff Please book early – limited places available For up-to-date details, please vivit: wwww.rcgp.org.uk/courses For more information about this initiative, please contact Alison Stubbings, CPD Project Officer, RCGP Tel: 0203 170 8238 Email: astubbings@rcgp.org.uk
Registered Charity No. 223105
+++ EVERYTHING YOU AND YOUR PRACTICE TEAM NEEDS TO KNOW UNDER ONE ROOF +++ 5
CLINICAL UPDATE
Improving end of life care: a matter of life and death Professor Keri Thomas RCGP Clinical Champion for End of Life Care National Clinical Lead, GSF Centre Honorary Professor End of Life Care University of Birmingham IN JUNE this year, RCGP Council has approved the End of Life Care Strategy which I, as CIRC Clinical Champion, was asked to develop following wide consultation and debate. The strategy affirms the College’s commitment to promote excellence in end of life care, and agreement to make this a priority for the future, recognising the significant challenge presented to us in this important area. This is more than just care for the dying, vital as this is. This is ‘ante-mortal’ care in the same way as we need ante- natal care, people in the final year or so of life. Specifically, the strategy includes ten recommendations (see Table 2) and the development of an EOLC Working Group to take this work forward in the next few yearsto be launched at the RCGP Annual conference in next month. This UK-wide strategy builds on the national developments of the Department of Health End of Life Care Strategy (July ’08) and the DH Quality Markers in End of Life Care (July ’09) in England and similar developments in the other three home nations. The adoption of this RCGP End of Life Care Strategy will lead the way in defining, enabling and pioneering good practice in end of life care, reflecting the crucial role that GPs play now and in future.
Why is end of life care important? Caring for people nearing the end of their lives is part of the core business of General Practice, and primary care occupies a central role in the delivery of end of life care in the community. This role is greatly valued by patients, contributes greatly to personal job satisfaction and our professional self-esteem and remains pivotal to the effective provision of all other care. Care of the dying is considered by many to be a litmus test for the health service, and challenges general practice to respond with the best that the profession has to offer – clinical expertise, considered professionalism, personalised care and human compassion. The importance of the holistic role of the family doctor is poised to come into its own in a way never previously encountered. We may tend to think of care for the dying in terms of those with cancer or who need hospice or specialist input, but in fact this is not really the whole picture. About one per cent of a practice population dies per year – ie about 15 to 20 deaths/year/GP – and of the main causes of death, frailty, multi-morbidity and dementia is the greatest, and likely to increase in time. Primary Care teams care for a large proportion of these people right up until death, and with the drive to decrease hospitalisation this is likely to increase in future. How can we better identify and care for these patients, help prepare them and their families, and ensure they receive a consistently high standard of care at this their most vulnerable time? The challenge is great, but it’s also one of the most important and rewarding areas of care that remains for us in primary care.
What is the urgency? As a society we face a challenge in healthcare needs never previously encountered. Changing demographic profiles mean more people are living longer with serious illnesses and dying older. A dramatic rise in death rates is predicted from 2012, leading to deaths outnumbering births by about 2030, and a 17 per cent increase in deaths from 2012. This means that instead of about 15 to 20 deaths/GP/year, there will be 18 to 24 deaths/ GP/year, with many more people with complex conditions, multi-morbidities and frailty – leading to complicated health and social issues. We have three key years to get this right, yet current health and social care services appear ill-prepared to fully meet the needs of many approaching the end of their life. Despite recent developments and many areas of good practice, patients still face a lottery of inconsistent, sometimes sub-optimal, care at this most crucial stage of their lives. In preparation for the London Olympics in three years time, and like any Olympic athlete, we need to be preparing now to meet the 2012 challenge in end of life care.
End of Life Care is a matter of life and death While other demands on the GP’s time and energy will come and go, the fact of our mortality will remain the same. This is an area that affects us all (and we all have a role to play) but especially, I would argue, the GPs of the future. As illness patterns change, with increasing complexity of interventions, and as patients and their families seek trusted ‘companions on the journey’, noone is better suited to provide continuity and excellence of care than the GP and the primary care team. GPs are ideally placed to meet this challenge, but must be supported to do this.
Table 2: Summary of Recommended Actions from the RCGP End of Life Care Strategy q Establish an End of Life Care Working Group – UK wide to include groups from each of the four nations to develop best practice and clarify implementation in each area w Build on current good practice eg, GSF Primary Care – new Quality Improvement Training Developed
e Recognise and reward best practice – accreditation, quality recognition etc
r Review and refine existing educational resources to better meet needs – integrate in curricula, e-learning etc
t Support research and development of innovative best practice models, including multi- morbidity
y Develop and promote use of audit tools to improve practice u Strengthen team-working with nurses, as part of the primary healthcare team , working with RCN etc
i Promote and recognise good practice for GPs working in care homes – support best ways of working, encourage more proactive involvement and reduce avoidable hospitalisation etc
o Endorse the use of Advance Care Planning for those patients on the palliative and supportive care registers
The Gold Standards Framework Programme for Primary care Since its development nine years ago, the GSF in Primary Care Programme has helped to improve the coordination and quality of end of life care within primary care in this country, and is now recognised as the leading primary care development, with a strong evidence base and policy support. GSF is now extensively used by GP practices across the UK, with over 90 per cent claiming their palliative care QOF points, and over 60 per cent using GSF in a more depth. We have built on this work to move now into the GSF Next Stage, with updated website resources and a new specific training programme for practices, leading to audit (useful for revalidation), team building, accreditation and quality recognition. GSF has been adapted for other settings, including a widely-used training programme for
Table 1: End of life care in numbers 1% of the population dies each year 17% increase in deaths from 2012 40% of deaths in hospital could have occurred elsewhere 60-70% people do not die where they choose 75% deaths are from non-cancer conditions 85% of deaths occur in people over 65 £19k/£14k - average cost per patient cancer/non-cancer in final year 2.5 million generalist workforce 5,500 Palliative Care specialists
KEY MESSAGES ● End of Life Care is important.
It affects us all ● Most die of non-cancer/
co-morbidity in old age ● Too few people die in their place of choice at home ● Hospital deaths are expensive and often preventable ● Most end of life care is from the usual generalist provider
1) Improve Out of Hours Palliative Care care homes involving almost 1,000 homes, and developing work in hospitals and prisons, out of hours etc. This strengthens the use of GSF as part of important cross boundary working. Further details are available on the GSF website www.goldstandardsframework.nhs.uk
Three Bottlenecks: In the development of GSF, three key bottlenecks or barriers were apparent for primary care teams, for which further support is provided through the GSF key processes: identify; assess; plan.
q identifying the right patients to be included w
e
on the palliative care register (cancer and non-cancer patients); having those difficult discussions, as part of the assessment of patient preferences through Advance Care Planning discussions; and planning for coordinated care provided by the whole team to ensure that the right thing happens at the right time in the right way. These areas are covered further by GSF and through the new training programme ‘Going for Gold’.
Next Steps End of Life Care is a complex area, fraught with practical difficulties and beset by ethical dilemmas. We have a responsibility to our patients to get it right first time – there are no second chances. Our aim is that high quality care for people nearing the end of their life becomes the legacy of this, the baby boom generation, a legacy that we will all benefit from personally and with our patients. If you are interested in contributing to the College’s thinking and developments in end of life care, I would be delighted to hear from you. Do also register your practice on the new GSF website and let us know your thoughts and ideas. We look forward to working with you to improve end of life care for our patients, for ourselves and for future generations. ■ We are looking to recruit GPs with an expertise in all clinical, educational and research areas to act as an Expert Resource within the College. To register, please visit www.rcgp.org.uk/clinical_and_research/ circ/expert_resource.aspx or email rwebb@rcgp.org.uk for further information
+++ RCGP ANNUAL NATIONAL CONFERENCE GLASGOW +++ 6
LAST
RCGP NEWS • OCTOBER 2009
NEWS
CLINICAL UPDATE
Malignant hyperthermia: a family concern Alison Winks, Helen Fowler and Dr Jane Halsall On behalf of the British Malignant Hyperthermia Association (BMHA)
Do you have a patient or family with MH susceptibility? MALIGNANT HYPERTHERMIA (MH) is an uncommon inherited disorder associated with certain commonly used anaesthetic agents often referred to as ‘trigger agents’. These include the depolarising muscle relaxant suxamthonium and all the potent volatile agents. These agents cause a loss of calcium homeostasis in skeletal muscle, resulting in metabolic stimulation. It was first described in Melbourne, Australia in 1960 when a young fit man presented with a fractured leg giving an amazing story of ten relatives dying during ether anaesthesia, but a cousin surviving a ‘modern’ anaesthetic. He was cautiously given a halothane anaesthetic, the then ‘modern’ agent, but quickly became severely unwell shortly after induction of anaesthesia displaying a bizarre set of clinical signs. The anaesthetist, being aware of the family history, wisely terminated the procedure and the patient survived. The fortuitous combination of the large number of family deaths and the clinical signs resulted in the recognition of the autosomal dominant pharmacogenetic condition MH. MH was originally associated with a high mortality rate (70 to 80 per cent) but this is now greatly reduced; there being only two deaths in the UK over the past five years. This is due to the increased awareness of MH by anaesthetists; the vastly improved intra-operative monitoring facilities; and the availability of the specific treatment, dantrolene, which was introduced in 1983 because of its ability to relieve muscle spasms associated with neuromuscular disorders. However, MH is still a cause of significant morbidity in otherwise fit, healthy patients. An MH crisis occurring during an anaesthetic is an emergency: it must be recognised and treated promptly for the patient to survive. No-one knows if they have MH until they or a member of the family suffers an MH crisis. A previously untoward anaesthetic does not preclude the possibility of MH. It often comes as a shock to learn that they have MH and the potential implications for themselves and their whole family.
So if MH is an anaesthetic problem, what relevance does it have for GPs? Back in 1982 the founder of the British MH Association, Alison Winks, lost her seven-year-old son under anaesthesia due to an MH episode. The anaesthetist was very good at explaining the basics of the problem and the need for testing in Leeds. Once the initial shock and impact had sunk in, the inevitable questions arose. Like most people, the GP was the person to turn to. But clinically MH is an anaesthetic problem so most GPs are unlikely to encounter it at all and it might only ring a vague bell from their training. Alison’s GP had never heard of it and we still hear from people today who are in the same position. By the very nature of their job, anaesthetists are not an easy group of doctors for patients to contact, and so most patients would then turn to their GP for information and support. Because of this the BMHA was set up in 1983 as a patient’s support group for families affected by MH. Our aim is to help improve the knowledge and understanding of MH by patients themselves, as well as coping with day-to-day issues of having MH, not just the medical problems. The BMHA runs a hotline for emergency situations. We produce emergency medallions for patients, as well as a range of information
leaflets, including translations for travel abroad. We receive no sponsorship and are run entirely by volunteers. We try to keep families informed through newsletters and an annual meeting when patients get the opportunity to meet and talk to staff from the UK MH centre in Leeds. Another aim is to help promote research into MH and we recently won a Big Lottery Fund grant for improving diagnostic genetic screening for MH Above all we need to get across the message that if anyone suggests to a patient that MH may be the cause of an anaesthetic problem, they should seek advice from a specialist MH centre. In the UK this is the Leeds MH Investigation Unit, with whom we work closely. We are aware that many people are reluctant to have a test for a genetic condition. As their GP you can help them to understand the problem, its implications for future medical procedures and the need for family testing. Otherwise the patient is vulnerable and so are the professionals. MH may not be an everyday problem to live with but it rears its head quickly when surgery, particularly in emergency situations, is required. It is a stressful, traumatic time for patients. The Leeds MH Investigation Unit offers an advisory service, a diagnostic screening service for patients and their relatives as well as maintaining an active research programme. It holds the national database for all MH cases, collating individual and family data. For anaesthetists in the UK it is the first point of contact. The diagnostic service incorporates both invitro studies on muscle biopsy samples and also genetic screening using DNA from blood samples. DNA testing is currently only suitable for around 40 per cent of families. Because the genetics of MH is complex, with a five per cent discordance rate, a negative DNA result requires a confirmatory muscle biopsy before an MH negative diagnosis can be given. When the DNA test is positive, a muscle biopsy is not required. Thus screening for MH cannot be done on the basis of DNA testing alone, as it cannot alter the clinical management of patients. Although MH is a genetic condition, clinically it is an anaesthetic problem, so screening of patients is best co-ordinated via an MH centre who are best able to ensure the patient is fully informed about all aspects of MH. Probands (index cases) are normally referred by anaesthetists but GPs are usually involved in referring family members. Results of screening are always sent to the patient’s GP and should be in a prominent position in the patient’s notes. It is important that MH is mentioned when referring a patient for surgery so that the anaesthetist can be forewarned. It is not uncommon for patients to be sent home because the anaesthetist hasn’t been told and the correct equipment for providing safe anaesthesia not ready. This is not only time consuming and a waste of resources but also very frustrating for the patient who might have had real fears about undergoing surgery after an MH diagnosis. Pregnant patients should be referred to the obstetric anaesthetist during their pregnancy. We recognise that GPs are busy people who have to deal with an extraordinary range of disorders. So we want you to be aware of a new page on our website (www.bmha.co.uk) designed especially for health professionals. As well as plenty of medical and scientific information, sections that maybe of particular use are Referring patients and Screening for MH. We hope that if you have a need for information about MH, you will log on to the website or contact us on the numbers below.
BMHA Patient Group (general information) Tel: 01773 717901 Website: www.bmha.co.uk e-mail: helpline@bmha.co.uk Leeds MH Investigation Unit (clinical advice/ referrals/screening etc) Tel: 0113 206 5270
Visit from Thai delegation
Front row (l-r): Mrs Siriwan, Secretary to Minister of Public Health, Thailand; Dr Kanshana, Deputy Permanent Secretary, Ministry of Public Health, Thailand; Professor David Haslam, RCGP President; Mrs Busaya, Deputy Ambassador, Royal Thai Embassy, London. Back row (l-r): Dr Songphan; Dr Samrit; Dr Amnuay; Dr Garth Manning, RCGP International Medical Director; Mrs Viphawpan; Mrs Pintusorn The RCGP was delighted to host a high level delegation from Thailand, led by the Ministry of Health’s Deputy Permanent Secretary Dr Siripon Kanshana. A Memorandum of Understanding was formally signed by the Dr Kan-
shana and RCGP President Professor David Haslam, acknowledging the agreement of the two parties to work together to provide the best possible guidance and expertise on primary care and family medicine in Thailand.
Call for authors The RCGP is looking for clinicians with excellent writing skills to contribute to the 2010/11 editions of the Essential Knowledge Update programme (EKU), to support GPs with their CPD and Revalidation. We need writers who can research and translate clinical and academic material into accessible information. Applicants should be able to complete a minimum of six sessions per year. An Author’s Workshop will be held at the RCGP on Thursday 29 October, e-mail dmilosevic@rcgp.org.uk for further information.
Could you be a TV doctor? Maverick Television, who make the hit series Embarrassing Bodies, are looking for a GP with an interest in sexual health to front a primetime series for Sky One. No previous TV experience necessary. If interested, email a photo and a short statement about yourself to c.morrison@mavericktv.co.uk
Essential Knowledge Updates • Provides GPs with a six-monthly focussed update on new and changing knowledge central to everyday practice. • Updates on key clinical areas of national significance (including newly published NICE / SIGN guidelines and Gold Standards, new relevant legislation). Take • Ta ake the subsequent Essential Knowledge Challenge to test your knowledge of the Update - scores in excess of 70% eligible for a certificate to use towards CPD and revalidation. • Stay updated - enhance your skills and improve the quality of patient care.
Free to RCGP Members / non-members can purchase an annual subscription for £79. rcgp.org.uk/eku
CHANCE TO BOOK -- PRIMARY CARE EVENT OF THE YEAR +++ RCGP NEWS • OCTOBER 2009
7
Annual National Primary Care Conference 2009
Excellence in Practice Winning ways for primary care
5-7 November Scottish Exhibition & Conference Centre, Glasgow
y d a e r t e G
ARE YOU READY FOR REVALIDATION?
for ion! t a d i l a Rev
Don’t miss the opportunity to attend this year’s conference and learn more about the College’s role in Revalidation, the development and delivery of the system, as well as key timelines and requirements. The keynote address by RCGP Chairman, Professor Steve Field, 'Excellence through Revalidation' will highlight how Revalidation requires a commitment by all to improve the quality of care for our patients. Delegates will also learn about enhanced appraisal - what it means for GPs, what is required of GPs and support available from your PCT.
There are also over 50 different concurrent sessions to choose from, a host of workshops, courses and fringe meetings and of course a great social programme.
Don’t miss out on the event of the year! For further details or to register please visit www.rcgpannualconference.org.uk or contact conference organisers, Profile Productions Ltd, on 020 8832 7311 or email: rcgp@profileproductions.co.uk Principal sponsor
Silver sponsor
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