LMC Chair update to members - 13th October
Update to LMC members from Dr Ingrams, LMC Chair following first LMC board meeting.
We discussed the following items.
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LMC Development Session
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Shared Care Medications
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Change in Radiology Referral Pathways
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LMC Conference England
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Cases
1. LMC Development Session
The Board will be taking time next month to set our agenda for the term of this LMC Board. As an LMC we wish to become more pro-active setting the agenda rather than be mainly reactive.
We will be sending out a very short questionnaire over the next week asking for your views about the areas we have been receiving the most queries about. Your replies will set how the LMC will approach these important areas.
2. Shared Care Medications
The LMC is concerned regarding both that the funding for this additional work has been wrapped up in the Primary Care Funding Formula, and about medication whose RAG rating is ‘downgraded.’
The GMC[1] reminds GPs that they “are responsible for the prescriptions you sign” and “must recognise and work within the limits of [their] competence[2].” GPs must have “have sufficient information to prescribe safely.”
“Decisions about who should take responsibility for continuing … treatment … should be based on the patient’s best interests, rather than on convenience or the cost of the medicine and associated monitoring or follow up,” and the GMC remind us that “shared care requires the agreement of all parties.”
NHS England advise that “Shared care is a particular form of the transfer of clinical responsibility from a hospital or specialist service to general practice[3]” and “it is important that the GP, or other primary care prescriber, is confident to prescribe the necessary medicines”
NHS E further state that:
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“shared care may not be the most appropriate mechanism, and where specialists would therefore normally retain responsibility for prescribing, … [for medications] that are unlicensed; or are used off-label without an associated evidence base or being recognised as standard treat.”
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“However, when decisions are made to transfer clinical and prescribing responsibility for a patient between care settings, it is of the utmost importance that the GP feels clinically competent to prescribe the necessary medicines.”
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“Legal responsibility for prescribing lies with the doctor or health professional who signs the prescription and it is the responsibility of the individual prescriber to prescribe within their own level of competence.”
Therefore regardless of the Shared Care ‘Rag Rating’ when considering whether to prescribe a medication, GPs must consider whether they have the appropriate knowledge and clinical competence, whether they have the right information, and whether the medication is appropriate and supported by current evidence.
3. Change in Radiology Referral Pathways
The LMC are appalled at the recent change to radiology referral pathways using ICE. Changing the pathways without prior discussion with the LMC, and providing the rationale and warning in advance to GPs and other clinicians using the pathways is disrespectful and inappropriate. The LMC will be writing to the ICB to raise this significant issue.
4. LMC Conference England
Next month, some members of the Board will be representing you at this annual conference that sets the policy agenda for GPC England, including for the next GP Contract. Although the areas for discussion have already been submitted, if you feel that there is any particular issue or view you want the LMC to raise please let us know.
5. Cases
So far, this year, the LMC has opened 280 individual cases where we are supporting individual GPs or practices with specific problems. Our case lead is Dr Shiraz Makda.
Although, as each case is unique, it is difficult to identify themes, one crucial factor that occurs recurrently is the extreme importance in having an up to date Deed of Partnership which has been drawn up by a specialist law firm. This sets out your agreement about how the practice will be run and what to do if there is a problem. Failure to have one can result in the breakdown of the partnership and/or expensive legal costs to try and resolve the problem. The LMC is providing a seminar in November led by a specialist solicitor on this and related matters.
Yours faithfully
Dr Grant Ingrams
0116 2962950
[1] GMC: Good Practice in Prescribing and Managing Medicines and Devices
[2] GMC: Good Medical Practice
[3] NHS England “Responsibility for prescribing between Primary & Secondary/Tertiary Care”