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Scottish General Practitioners Committee

Scottish Local Medical Committee Annual Conference

14 March 2014

Appendix I - ResolutionsAppendix II - Election ResultsAppendix III - Motions LostAppendix IV - Motions not ReachedAppendix V - Motions Moved to Next

Business

SLMC 22013-

Appendix 1

SCOTTISH LOCAL MEDICAL COMMITTEE CONFERENCE

14 MARCH 2014

Resolutions

CONTRACTS AND NEGOTIATIONS

1 (6) That this conference:i. supports the 2014/15 GMS contract changes that

SGPC have agreed with the Scottish Governmentii. welcomes the GMS contract agreement with its

emphasis on co-operative working, quality, professionalism and reduction in ‘bean counting’ activity and hopes this will continue in any further contractual changes

iii. congratulates the negotiators on their success with this year's GMS contract settlement and calls on SGPC to work closely with GPs and LMCs in developing a 3 year contract for 2015/16.

2 (10) That this conference, given the increasing divide between GMS in England and Scotland, calls on SGPC to move towards a Scottish GP contract.

3 (13) That this conferencei. believes that current GP workload is unsustainableii. calls upon SGPC to ask all GPs working in Scotland

to determine their priorities before our elected GP leaders negotiate on any Scottish contract in future

iii. calls upon SGPC to define what GPs are required to do under GMS so that GPs working in Scotland can finally put a stop to the unresourced shifting of work from secondary care

iv. calls upon SGPC to carry out a comprehensive GP workload survey to inform future policy on the GP contract.

4 (16) That this conference: i. maintains our national contract in Scotland is our

strength, rather than a hindrance, and should be

supported at all costsii. insists that any new Scottish GP contract should

apply across the whole of Scotland, and not be left up to boards to negotiate 14 different versions.

5 (21) That this conference is extremely concerned at the promotion of 17c contracts by some NHS Boards and calls on Boards to:i. cease encouragement to practices to take up

interim and so called 'development' contracts which lack sufficient detail to allow practices to make properly informed decisions

ii. provide only balanced information to practices which includes explicit information on any future risk to practices moving to 17c contracts

iii. be transparent with GPs if they have developed a policy aim of moving practices to 17c contracts in order to achieve other board strategic objectives

iv. acknowledge the threat to the national (Scottish) GP contract which this policy presents.

6 Referred to UK Conference

(22) That this conference demands that any publication of GP NHS earnings preserves GPs’ right to privacy and that the data must reflect the differing workload and services that practices provide.

7 (23) That this conference recognising the threat to seniority payments created by changes elsewhere in the UK:i. believes that the experience, commitment and

sacrifices of senior GPs and their families should be recognised by an alternative method if seniority payments are to disappear in Scotland

ii. insists that any changes to the scheme in Scotland must reflect and address the problems seen in many parts of the country in recruiting and retaining GPs, and not add encouragement to senior GPs to retire early.

HEALTH & SOCIAL CARE

8 (27) That this conference believes that for health and social care integration to succeed in enhancing patient care:i. it must be recognised that the GP practice is at

the core of patient careii. it is essential that general practitioners are

actively involved in strategic planning, decision

making and implementationiii. GP time must be adequately resourced to enable

GPs to contribute without diverting GPs unnecessarily away from patient care

iv. more social care workers, more district nurses and more general practitioners will be required to provide the care

v. SGPC must ensure that GPs are given the opportunity to be effective active players in the process of health and social care integration

9 (35) That this conference:i. is concerned about how health and social care

partnerships (HSCPs) are being currently developed

ii. condemns the top down restructuring of primary and community care that is resulting from the development of these HSCPs

iii. condemns the marginalisation of GPs in the current transitional integration boards

iv. demands that there is a moratorium on the development of HSCPs until GPs are appropriately represented, involved and engaged in the decision making process.

UNSCHEDULED CARE

10 (36) That this conference recognises that general practice provides the vast majority of unscheduled care in Scotland and:i. is concerned that some OOH services have been

unable to recruit adequate numbers of doctors to fill shifts and to maintain services

ii. believes that LMCs should work with OOH providers to improve the service

iii. agrees that patients with unscheduled care needs should be (re)directed to the most appropriate service

iv. believes more general practitioners would take part in OOH if daytime workload was less intense and the service was better resourced

v. asks Scottish Government to ensure boards invest in primary care OOH services to support a high quality service.

11 (43) That this conference:i. recognises that 7-day practice opening hours are

unaffordable and undeliverableii. commends GPs for already providing unscheduled

general practice care for 24 hours every day, 7 days every week.

HEALTHCARE PLANNING AND PROVISION

12 (50) That this conference considers that the recent NHS reforms in England constitute a threat to the integrity of general practice and to the ethos of the NHS and calls upon SGPC to continue/mount a

campaign of active opposition to any similar future NHS reforms in Scotland.


(51) That this conference:i. supports closer working between GP and

secondary care colleagues when designing clinical services

ii. believes that GPs should co-operate to help solve the problem of transferring work to primary care

iii. calls on the Scottish Government to direct Health Boards to facilitate closer working between GP and secondary care colleagues

iv. insists that any work shifted from hospitals into primary care must be accompanied by funding in advance.

14 (55) That this conference:i. is dismayed that while we talk about closer

integration between health and social care, we are witnessing a disintegration of the primary health care team

ii. calls on NHS Boards to re-establish multidisciplinary teams based around the GP practice, as the best and safest way of delivering good quality patient care

iii. (Taken as a reference) believes that core community nursing responsibilities and tasks should be defined, be adequate for 2020 Vision and demographic change, and be delivered by community nurses

iv. lost

SESSIONAL GPS

15 (65) That this conference believes that the current PVG scheme is not fit for purpose for GP locums and:i. limits GP locums’ ability to be able to respond

timeously to workforce gaps in different areas of Scotland

ii. should be altered to an on line checking facility as there is in England

iii. calls on SGPC to demand Disclosure Scotland improves the scheme in order to reduce the bureaucracy and expense for locums.

16 (66) That this conference calls on SGPC to work with LMCs to reduce professional isolation of locum GPs by developing support structures and schemes for locum GPs.

WORKFORCE

17 (69) That this conference is dismayed by the increasing GP recruitment difficulties in many parts of Scotland and:i. is concerned by the increased workload pressures

faced by GPs ii. is concerned that services to our patients are

being threatenediii. demands that the Scottish Government increases

funding to general practice significantlyiv. (Taken as a reference) demands that the Scottish

Government incentivise general practices to increase the number of whole time equivalent GPs in Scotland

v. lost18 (78) That this conference believes that Scotland

should have a national GP performers' list and believes this will:i. reduce bureaucracy for health boards and GPs ii. assist the recruitment of overseas and returning

doctors to general practice iii. enable a mobile responsive GP locum workforce iv. ensure patient safety is maintained.

19 (81) That this conference in view of the current difficulty in recruiting GPs to remote and rural locations should urge the Scottish Government to:i. fund medical students to do the attachments in

these locationsii. encourage the universities to have a 'rural GP

module' as part of the main curricula.20 (82) That this conference:

i. recognises that female GPs are a valuable asset to the NHS

ii. recognises that increased part time working can lead to a more flexible workforce

iii. asks that SGPC strongly defend female GPs against the negative media coverage they have been recently subjected to.

PUBLIC HEALTH


(83) That this conference notes with dismay the recent revelations that not only are girls and young women living in Scotland being subject to female genital mutilation (FGM) but there is evidence that girls and young women are being brought to Scotland to be subjected to FGM because of perceived lower awareness of this abuse in Scotland. This conference therefore calls on the Scottish Government to protect girls and young women from this illegal practice by:i. promoting joint training on FGM for health, social

work, education, police and prosecution servicesii. developing a strategy for protection shared by the

police, health, social work and education sectorsiii. taking urgent measures to secure prosecution of

perpetrators of this crime in Scotland.22 Referred to

UK Conference

(84) That this conference is concerned at the current lack of regulation of electronic cigarettes and, whilst welcoming the decision by the MHRA to regulate electronic cigarettes as a medicine, calls on the Scottish Government to:i. include e-cigarettes within the products banned

from use in enclosed public placesii. prohibit the sale of e-cigarettes to those under 18

yearsiii. ensure that e-cigarettes are only displayed for

sale alongside other nicotine replacement therapies.


(85) That this conference believes that the UK Government’s welfare reforms are having a detrimental impact on the health of many of our most disadvantaged patients. In view of this danger to the health of the public, urgent reform is required to prevent further harm.

EHEALTH


(86) That this conference welcomes the proposed pilot of GP2GP in 2014 as this is long overdue.

25 (87) That this conference urges SGPC to explore with the Scottish Government the possibility of extending the Emergency Care Summary (ECS) to include key clinical diagnoses.

26 (90) That this conference:i. (Taken as a reference) believes that the electronic

medical notes held by GPs are the best and most complete record to allow patient assessment at times of acute need

ii. welcomes the emphasis on Anticipatory Care Plans using the Key Information Summary (eKIS)

iii. recognises the sterling work already done by GPs to ensure that the out of hours community is aware of anticipatory plans for their complex patients

iv. believes that if GPs are to be expected to do eKIS entries for patients with specific illnesses and medications, to help patient care out of hours, this must be adequately funded

v. believes that many potential benefits of anticipatory care plans and eKIS are lost as unresolved software issues hinder their access by secondary care.

27 (94) That this conference is dismayed that some health board areas still are unable to provide reliable clinical IT systems for general practice, and calls on the establishment of robust national standards to allow safe and timeous access to these essential systems.PROFESSIONALISM AND QUALITY

28 (99) That this conference:i. welcomes the move of 264 QOF points into core

funding ii. congratulates SGPC and the Scottish Government

on extending the time frame for the majority of QOF indicators

iii. requests further moves away from the unnecessary and unhelpful bureaucracy associated with QOF

iv. appreciates that 264 QOF points have been retired but is concerned by the potential ‘fossilisation’ of them in the core standard payment.

29 (103) That this conference believes that the Scottish QOF changes will reduce the pressures on practice nurse and administrative staff in particular, but that excessive GP workload remains an ongoing concern.

FUNDING


(105) That this conference:i. believes that primary care is not sufficiently

resourced to meet increasing health needsii. wholeheartedly supports the RCGP campaign to

‘Put Patients First: Back General Practice’iii. supports the call to increase the percentage of

NHS resource allocated to general practice to 11% by 2017.

31 (111) That this conference:i. (moved to next business) believes that the

Scottish Allocation Formula discriminates against urban and, in particular, deprived practices

ii. (moved to next business) believes that Scottish contract negotiations should focus on finding mechanisms to adequately fund GPs whose workload is affected by deprivation and the demographic time bomb

iii. notes that without significant new investment, any new contract or allocation formula that simply moves resources around could have destabilising effects on patient care

iv. calls on SGPC to consider a core practice funding model which has elements of the old practice allowances and elements of the Scottish Allocation Formula

v. asks SGPC to ensure that any changes to the Scottish Allocation Formula are fully modelled and agreed by the profession.

32 (117) (Taken as a reference) That this conference believes that the ongoing drip of short term funding in general practice attached to LESs, DESs and local initiatives is hampering the development of sustained improvement in primary care as it does not allow practices to increase substantive GP time leading to increased individual GP workload.

DISPENSING DOCTORS

33 (118) That this conference:i. recognises the threat to rural dispensing practices

caused by the current pharmacy regulationsii. welcomes the Scottish Government review of the

Control of Entry Regulations for Pharmacyiii. deplores the opportunism and cost to Health

Boards of speculative applications attempting to beat the proposed moratorium

iv. reinforces its support for dispensing practices who are under renewed and sustained threat from commercial pharmacies where the loss of a dispensing practice would lead to markedly poorer general practice provision

v. (Taken as a reference) calls for guaranteed funding to replace lost income for any affected practice required to stop dispensing thus maintaining essential GP services in the locality.

PRESCRIBING AND PHARMACY SERVICES


(124) That this conference believes the recent changes in the supply of oxygen to patients have adversely affected the availability of oxygen in emergencies in GP practices. This conference believes that oxygen for use in emergencies should be available to all GP practices free of charge.


(127) That this conference believes that there should be a simple fast-track system for obtaining oxygen for palliative care patients who would benefit from it.

APPRAISAL AND REVALIDATION

36 (131) That this conference believes that current attempts by individual boards to set a minimum limit of sessions GPs work before they are eligible to be appraised should be opposed and urges SGPC and the BMA to discuss the implications this would have for the profession as a whole with the Scottish Government and the GMC.

PREMISES

37 (133) That this conference believes that the current inadequate funding and investment in premises by Health Boards is detrimental to GP services.

38 (134) That this conference is dismayed that the rhetoric about transferring care closer to the patient hasn’t been recognised with any significant premises expansion to cope with this work.

MISCELLANEOUS


(135) That this conference is concerned that some food banks are demanding that people have to be referred to them by GPs before they are given support.

40 (136) That this conference understands the need for custodial health care to be managed by local Health Boards, however the cost of purely forensic investigations should not be met from the health budget.

41 (137) That this conference believes that the fee for the release of information under the Data Protection Act should reflect the work entailed and not be restricted to £50.

42 (138) That this conference, in relation to firearms certificates, believes that GPs should not be asked for a medical opinion on the fitness of an individual to hold a firearms' license.

43 (139) That this conference believes that patient safety is paramount when a GP is considering referral to a consultant and particularly when referring an ill patient for assessment. Patient safety takes precedence over any referral management initiatives.

EDUCATION AND TRAINING

44 (150) That this conference recognises the importance of protected learning time (PLT) for primary healthcare teams and:i. insists that PLT continues to be funded by health

boardsii. deplores the reduction in PLT sessions in the last

year due to the reduced availability of NHS 24iii. demands that PLT is fully supported by NHS 24 iv. demands that the number of PLT sessions is

maintained or increased in the future.45 Referred to

UK Conference

(154) That this conference believes all doctors in training should now spend a minimum period of time working in general practice to help promote the GP career option and improve the understanding between primary care and secondary care doctors.

SUPERANNUATION


(160) That this conference deplores the ongoing fallout from the imposition of unfair pension and tax changes affecting doctors and insists that the UK government:i. acknowledges and addresses the unintended

consequences of the NHS Superannuation Scheme and working age changes

ii. should delay the changes to the NHS Superannuation Scheme until the unintended consequences have been fully evaluated and addressed

iii. should protect all members of the current NHS Superannuation Scheme from the changes being imposed in 2015

iv. delay any changes to the NHS Superannuation

Scheme until the NHS has been fully resourced to take account of the unintended consequences of the changes to be implemented in 2015.

47 (166) That this conference calls on the SGPC to demand the Scottish Government instructs the Scottish Public Pensions Agency to:i. allow GP Locums providing services in NHS Board

operated practices, including prison health centres, to submit superannuation payments for the work they undertake for the NHS in Scotland

ii. allow appraisers who are GP locums to superannuate their earnings from appraisals within the NHS Superannuation Scheme

iii. stop their plans to charge doctors for providing information they hold on pensions.


(170) (Taken as a reference) That this conference asks that general practitioners should be allowed to opt out of paying superannuation contributions for work undertaken 'out of hours' in order to encourage GPs to continue to provide medical cover in this period

GENERAL PRACTICE

49 (172) That this conference calls on the Scottish Government to:i. urgently address the unfettered expansion of

demand within general practiceii. accept as a problem the ever increasing stress

and workload in general practiceiii. urgently address diminishing resource for general

practiceiv. rapidly address the mismatch between workload

and funding in general practicev. adequately resource general practice to enable

GPs to continue to provide high quality general practice.

50 (179) That this conference believes that there are already efficient systems in place within general practices for ascertaining the urgency of requests for appointments, and calls on SGPC to resist any suggestion that some general practice appointments can be allocated by organisations other than the individual practices.

Appendix II

Election Results

CHAIRMAN: Dr Hal Maxwell (Ayrshire & Arran)

DEPUTY CHAIRMAN: Dr Mary O’Brien (Tayside)

AGENDA COMMITTEE: Dr Stuart Blake (Lothian)Dr Teresa Cannavina (Forth Valley)Dr William McAlpine (Ayrshire & Arran)

Appendix III

Motions Lost

GENERAL PRACTICE

51 (180) That this conference believes that the only way forward for general practice is via direct employment of salaried general practitioners by Health Boards.

Appendix IV

Motions not Reached

CONTRACTS AND NEGOTIATIONS

52 (26) That this conference recognises that there is a significant under-provision of practices and GPs in some areas of Scotland and this must be taken into account during negotiation of the review of access process, which should focus solely on the review process itself.

UNSCHEDULED CARE

53 (44) That this conference deplores the wide-spread blame attributed to GPs for the apparent crisis in hospital accident and emergency departments.

54 (45) That this conference does not accept that the alleged lack of appropriate patient access within general practice is a significant factor in the inability of some accident and emergency departments to meet target times for the assessment of their patients.

55 (46) That this conference is concerned about the effect of health want as opposed to health need on A&E attendance.

56 (47) That this conference recognises that appropriate skill mix is important in our out of hours organisations, but calls on NHS boards to ensure that GPs remain at the core of the OOH provision of urgent medical care.

57 (48) That this conference believes that if 16% of unscheduled care is to be shifted to primary care, at least 16% of the unscheduled care resource should also move to primary care.

58 (49) That this conference urges Health Boards to adopt the BMA out of hours salaried contract, for the benefit and protection of out of hours doctors.

HEALTHCARE PLANNING AND PROVISION

59 (60) That this conference calls on Scottish Government to give a clear commitment that Health

Board boundary changes will not adversely affect the services that GP practices provide to patients nor adversely affect the support that practices receive from the Health Board.

60 (61) That this conference recognises the potential for adverse outcomes following inaccurate or incomplete transfer of information at the interface between primary and secondary care and supports (further) initiative to permit receipt of timely and complete discharge summaries.

61 (62) That this conference agrees that sharing clinical information is good practice but believes that in a patient centred NHS the patient should primarily be responsible for providing this information.

62 (63) That this conference asserts that some detecting cancer early initiatives are of unproven benefit, and can cause harm and delay in identification of cancers. Future initiatives should be both evidence based and adequately piloted.

63 (64) That this conference believes that there should be NHS audiology services on the high street - analogous to optometry ones - to provide a wider, better and more local service, particularly in view of our ageing population.

SESSIONAL GPS

64 (67) That this conference welcomes the decision by NHS England to ensure all locum GPs are able to access flu vaccination, free of charge and to fund those GP practices providing this service and calls on the Scottish Government Health Department to adopt the same policy in Scotland.

65 (68) That this conference thinks that workforce planning processes don’t have enough good data around the capabilities of GPs who perform locum duties and the contributions that they make.

EHEALTH

66 (95) That this conference believes that patient safety is paramount and in this modern day with the increase in electronic communication it is essential

that all GPs be operating from a dual screen system.67 (96) That this conference believes that computers in

clinical consulting rooms should have dual monitors to facilitate effective paperless working.

68 (97) That this conference is in favour of arrangements that support GPs having remote access to their own clinical notes when they visit their patients who stay in care homes, recognising the utility and patient safety benefits that are associated.

69 (98) That this conference believes that a shared medication record is the only safe method for recording all patients’ medications across primary care, hospital, community and mental health services.

PROFESSIONALISM AND QUALITY

70 (104) That this conference maintains that lipid management remains an effective evidence based cornerstone of secondary prevention, which also contributes to addressing health inequalities, and that SGPC and the Scottish Government should ensure that we continue to be electronically prompted for this medically important work.PRESCRIBING AND PHARMACY SERVICES

71 (128) That this conference asserts that GPs should not face barriers to emergency care, and should have access to free emergency oxygen and defibrillators.

72 (129) That this conference believes that should the ‘Prescription for Excellence’ pharmacy policy progress, general practice negotiators should have a steering role. Otherwise there is a danger of creating a service of dubious additional benefit with risks to patient safety, which substantially duplicates some existing general practice services, and is more expensive.

73 (130) That this conference feels that the proposed changes to how the Scottish Medicines Consortium operates are likely to have a detrimental effect on prescribing budgets and therefore asks the Scottish Government to reconsider them.

APPRAISAL AND REVALIDATION

74 (132) That this conference is concerned that NHS boards are withdrawing existing access to GP appraisal by introducing arbitrary minimum session requirements and calls for;i. a nationally agreed minimum requirement of work

undertaken in general practice settings by which an individual GP would be entitled to be appraised under the Scottish GP appraisal scheme

ii. this agreed minimum requirement to have an evidence base either in maintenance of skills or availability of clinical governance information, or in the absence of this, to be agreed by all major stakeholders

iii. any minimum requirement to be implemented only with reasonable notice to allow GPs to make any necessary adjustment to their working pattern

iv. the impact of the imposition of this minimum requirement on the GP workforce to be monitored

v. this minimum requirement to be applied equally to GP contractors and sessional GPs

vi. the impact of this unilateral and potentially demoralising action to be offset by evidence of commitment from boards to assist sessional GPs in their efforts to maintain skills and learn from clinical governance information.

MISCELLANEOUS

75 (140) This conference considers the recent political rhetoric, describing a return of “proper family doctors” with a simultaneous improvement in access and continuity, as a populist notion that is both impractical and unsustainable.

76 (141) That this conference remains extremely concerned at the current situation whereby GPs are not informed of convictions for violent crime, particularly crimes of sexual violence, when individuals register as patients with their practice on release from prison. Conference therefore calls on the Scottish Government to work with the "responsible authorities" delivering multi-agency public protection arrangements (MAPPA) to develop a process which will allow GPs to take reasonable steps to manage any risk to the personal safety of themselves and their staff, without prejudice to

patient care. 77 (142) That this conference notes that some secondary

care colleagues are working in paperlite environments without adequate workflow systems for following up and actioning of test results, and is concerned about the impact of this for clinical safety and the patient journey.

78 (143) That this conference recommends that our secondary care colleagues use relevant clinical reasons for refusing referrals and not a reference to an arbitrary guideline.

79 (144) That this conference believes that face-to-face interpreting services should continue to be available for GP practice consultations and resists any attempts by health boards to move to a telephone only interpreting service.

80 (145) That this conference is concerned about the frail nature of some people who stay in Scottish care homes and:i. believes that many residents who currently stay in

care homes would have been in-patients in long stay hospital wards in the 1980s and 1990s

ii. calls upon SGPC to negotiate additional resources to free up GP time to allow regular proactive medical input for care home residents.

81 (146) That this conference believes that practices operating extended hours should have access to collection services for blood samples to facilitate effective patient care.

82 (147) This conference believes that the introduction of 12 hour shifts for our district nursing teams may result in a reduction in continuity of care in real terms for our patients.

83 (148) That this conference agrees that the ‘named person’ proposals for children under 5 lack an evidence base and will increase risk.

84 (149) That this conference believes that GPs should be able to prescribe a pedometer on a GP10 to effectively promote exercise.

EDUCATION AND TRAINING

85 (157) That this conference is concerned about the decision to treat Scotland as one geographical area for training and the effect this can have on the personal and family life of doctors.

86 (158) That this conference calls upon the Scottish Government, NHS Education Scotland and health boards to agree criteria and facilitate training for returning doctors who need further training to practise.

87 (159) That this conference notes that the location where a GP trains is a significant predictor of where they will work once their training is completed; recognises that there are inequalities in distribution of GP training resources throughout Scotland and calls for the Scottish Government Health Department and NES to ensure that the current bias towards cities in allocating GP training posts is minimised.

SUPERANNUATION

88 (171) That this conference calls upon SGPC/GPC to explore an alternative, less vulnerable pension scheme.

GENERAL PRACTICE

89 (181) That this conference demands that, in order to support a cost-effective foundation for 2020 Vision, Health Boards should be obligated to provide a universal domiciliary phlebotomy service, accessible directly by both primary and secondary care clinicians.

90 (182) That this conference believes that the standard 10 minute appointment is no longer appropriate due to the increasing complexity of care provided within general practice and that the SGHD should engage with general practice in Scotland to explore alternative models that ensures general practice in Scotland remains equipped to continue to deliver high quality care to future generations.

91 (183) This conference believes that we need to be realistic about our ability to offer care at home such as home visits.

92 (184) That this conference maintains that increasing patient online access to general practice:i. would compromise patient safetyii. would divert GPs from core activity.

93 (185) That this conference shares the Scottish Government’s concern regarding non-attendance at appointments but feels that schemes to alleviate this such as text reminders should be fully funded rather than be at the expense of practices.

94 (186) That this conference believes that innovation within practices will continue to be stifled unless capacity is increased.

95 (187) That this conference believes it is time to rebrand general practitioners as "consultants in primary care".

96 (188) That this conference believes that general practice is entering a palliative phase and urgently requires an anticipatory care plan.

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