General Medical Services Committee Research Articles

Simon Albert Philip Jenkins

Simon Albert Philip Jenkins was born in Ellesmere, Shropshire. He qualified from Birmingham University in 1960 with distinction in social medicine. His preregistration jobs were at North Staffordshire Royal Infirmary,...

John Godfrey Ball

After service in the Royal Army Medical Corps (RAMC), hospital posts in the Birmingham area and a traineeship in Stourport, John Godfrey Ball succeeded to a single handed practice in...

GPs must continue to provide some non-core services NHS trusts could save (pounds sterling)150m by improving supplies management Level of provision for long term care must be defined GMC advises doctors on intimate examinations GMC wants to improve reporting of conduct cases Open information is a closed book

# GPs must continue to provide some non-core services {#article-title-2} General practitioners must continue to provide some non-core services until there have been national negotiations to change their terms and conditions of service. Failure to do so would put doctors in breach of their terms of service. The General Medical Services Committee's document, Core Services: Taking the Initiative, which was sent out to all general practitioners this week, identifies the services which should be provided by every doctor or practice (26 October, p1032). Among the non-core services there are some which general practitioners are still obliged to provide under their terms of service. The GMSC hopes to negotiate with the government to remove this obligation so that in the future these services may be contracted for separately and paid for outside intended average net remuneration. They hope to make the following changes: removing the requirement to provide certificates for social security purposes; allowing a charge for all travel immunisations; abolishing the requirement to offer annual health checks to the over 75s; and removing the training of general practitioner registrars, intrapartum care, minor surgery, child health surveillance, and dispensing (other than of personally administered items) from core services and average intended net remuneration. The medical care of highly dependent patients living in the community, often in nursing or residential homes, is another non-core service. The chairman of the GMSC, Dr Ian Bogle, said: “In the past these patients would have been in long stay hospital beds and so would have had resident doctors and specialised nursing care …

GPs to produce a strategy for the future Academic staff seek prime minister's help over funding Calman proposals will affect hospital manpower Tobacco companies curb advertising NHS chairmen will have charters Correction

# GPs to produce a strategy for the future {#article-title-2} The General Medical Services Committee will begin to discuss its strategy for the future of general practice at its September meeting. This will be the first stage of the GMSC's response to the government's document Primary Care: The Future (15 June, p 1500). Dr Ian Bogle, who was re-elected unopposed as chairman but said that it would be the last year that he stood, said last week that he and the negotiators planned a weekend meeting to draft the strategy. This would be wide-ranging and cover a definition of core services, contractual options, recruitment, workload, and funding. Welcoming the move Dr Tony Stanton, secretary of the inner London local medical committees, said that the committee needed to debate all the issues urgently. General practitioners' wish to recruit more doctors and reduce list sizes might not be achievable. He did not believe that they wanted to see the hospital service depleted further to pay for additional primary care services. The GMSC has set up a task group to examine how it conducts its business. Dr John Ball will chair the group, and its other members are Dr Lawrence Buckman, Dr John Canning, Dr Grant Kelly, and Dr Fay Wilson. Dr Ball, a former chairman of the GMSC, told the committee that there was a wealth of talent on the committee that was never tapped and he wondered whether concentrating so much work and responsibility on a few people was the right way …

Ombudsman appoints clinical advisers BMA wants coordinator for partnership campaign Seventeen million fewer forms for GPs Commissioning GPs set out national standards University employers want more money for academics BMA supports GMSC election changes Correction

# Ombudsman appoints clinical advisers {#article-title-2} The health service ombudsman, Sir William Reid, has appointed four medical and nursing advisers to help him deal with complaints about the clinical decisions of doctors, nurses, and other health professionals.The ombudsman's jurisdiction was extended this year to cover complaints about family practitioner services and clinical competence. The new advisers are Dr Elizabeth Bingham, general practitioner in Reading and an examiner for the Royal College of General Practitioners;Dr Hugh Thelwall-Jones, former consultant obstetrician and group medical director, BUPA, 1990-5; Dr Richard Waldram, former consultant and clinical director, North Hampshire Hospital; and Dr Lyn Martin, former nursing officer, Department of Health, and principal, Bloomsbury and Islington College of Nursing and Midwifery, 1990-5. Sir Williams says that the advisers will maintain high investigating standards and will help to appoint independent assessors to advise on professional matters. # BMA wants coordinator for partnership campaign {#article-title-3} General practitioners want a full time national coordinator appointed to facilitate local initiatives and provide materials to keep up the momentum of the doctor and patient partnership campaign. The health secretary and the chairman of the General Medical Services Committee launched the patient education campaign earlier this year and £750 000 has been spent on advertising in the national press. Each health authority and health board has been allocated a further £20 000 to spend locally during 1996-7 in publicising out of hours initiatives and encouraging …

GPs should not have routine role in authorising handguns Juniors issue guidance on "English clause" Minister says there are recruitment problems in general practice British doctors returning from abroad and specialist training Bradford GPs win out of hours award Senior hospital doctors complain about manpower "black hole" GPs' staff should have NHS pensions

In its evidence to the Cullen inquiry into the possession of handguns following the Dunblane massacre, the General Medical Services Committee says that the position of doctors as potential countersignatories of applications for shotgun and firearm certificates is unsatisfactory. The committee says that general practitioners should have no routine role in the process by which certificates are issued because of the lack of scientific evidence that such involvement would predict future violence. Doctors should be told when their patient has been issued with a certificate. Under the General Medical Council's guidance doctors are able to disclose information without consent if this would avert the risk of death or serious harm. The GMSC recommends that a confidential helpline should be set up at the Home Office, the Scottish Office, and the Welsh Office to allow doctors to disclose information about a perceived risk of violence through the use of firearms to a fellow professional. # Juniors issue guidance on “English clause” {#article-title-2} The Junior Doctors Committee has issued revised guidance on when the “English clause” can be invoked. The terms of service provide that after 31 December 1996 higher specialist trainees may continue to contract for duties in excess of a 72 hour maximum average per week (though not more than an average of 83 hours) “providing proper support staffing exists and providing the duties are not harmful either to the trainees or to patients.” The doctors must be willing to do the extra hours, which should benefit their training. It will be …

GPs are disappointed at review body on out of hours General practice should encourage physical activity Labour party survey identifies GPs' problems Minister accepts scrutiny team proposals

# GPs are disappointed at review body on out of hours {#article-title-2} The Doctors' and Dentists' Review Body has failed to produce a supplementary report giving the value of general practitioners' out of hours work, but it has agreed to “a broad ranging appraisal.” This will start immediately, will be funded by the review body, and will be available in time for the 1997 report. As a result of the survey and further evidence from the government and the profession the review body will decide whether it is possible to put a notional price on out of hours work and responsibility. At its February meeting the General Medical Services Committee had called for a report by the middle of May (24 February, p 465) and many speakers at last week's meeting were disappointed that this had not appeared. They were worried how the failure would be perceived in the profession and at the local medical committee conference in June. Dr Peter Fellows (Gloucester) believed that the government had diffused the situation by agreeing to the £45m development funding for out of hours services. He believed that in hours work should be priced. But Dr Brian Gibbons (Port Talbot) said that he was not surprised that the review body did not want to drink at the poisoned chalice of pricing out of hours. “It will be impossible to come up with a figure that will be acceptable throughout the country,” he said. The review body was asked for a price for individual doctors; out of hours was becoming a suprapractice activity. One of the deputy chairmen, Dr Judy Gilley, agreed that …

Junior doctors deplore phasing of review body award Ministerial group on new deal should be recalled GPs will discuss their core services Patients get guidance on living wills

# Junior doctors deplore phasing of review body award {#article-title-2} Representatives of junior hospital doctors have unanimously deplored the government's decision to phase the implementation of the 1996 award of the Review Body on Doctors' and Dentists' Remuneration. Senior registrars, registrars, and specialist registrars were awarded a 5.3% increase and senior house officers and house officers a 6.8% increase from 1 April but 1% has been withheld until 1 December. The higher award for junior grades was made partly to compensate for a reduction in the rates for class 3 additional duty hours of 2.5% to 50% of basic pay. The Junior Doctors Committee welcomed the fact that the awards have partly addressed the relative deterioration in the pay of training grade doctors but at its recent meeting it also criticised the government for not funding the awards in full and insisting that they will have to be funded, in part, from local efficiency savings. “Hospitals will have to take our pay increases from patient care,” according to Dr Edwin Borman, an anaesthetic senior registrar in Birmingham. “It is quite wrong that the government is allowing hospitals to squeeze the service.” The representative from the General Medical Services Committee, Dr Ian Banks, pointed to the differential in pay—as much as £7000—between the salary of general registrars and hospital registrars. The review body had not accepted that there was a recruitment crisis in general practice. Specialist registrars should have automatic increments. The JDC also deplored “anything other than the automatic implementation” of the salaries of doctors in the new specialist registrar grade. The review body recommended …

GPs' leader to meet review body on out of hours GPs' committee will be elected by wider franchise Health secretary agrees to revise deputising circular New group will look at public health manpower Consultation document launched on data protection

# GPs' leader to meet review body on out of hours {#article-title-2} There was anger at last week's meeting of the General Medical Services Committee at what it saw as slow progress in solving the outstanding issues on out of hours services in general practice. At the February meeting the committee called for a supplementary report from the Review Body on Doctors' and Dentists' Remuneration on a separate pricing for out of hours by 16 May. If this was not forthcoming the committee resolved to ballot the profession on the out of hours settlement and to recommend to the BMA council that the review body should resign (24 February, p 465). But when the chairman, Dr Ian Bogle, announced that he had not yet met the review body chairman—a meeting will take place shortly—some speakers called for immediate action. They said that they had sold the September 1995 deal to their constituents on the basis that the out of hours component of their contract would be separately priced. A general practitioner in north London, Dr Laurence Buckman, did not think that the review body was independent. The GMSC had fallen into a trap and was a target for criticism by his constituents. Dr John Canning, who practises in Middlesbrough, urged Dr Bogle to emphasise to the review body how unhappy general practitioners were. “They are in despair, doctors are not going into vocational training schemes, and those who do do not want to be general practitioners.” But other speakers pointed to the progress on the deputising circular and health promotion (see below). Dr Peter Skolar, a …

Clinical academics welcome independent inquiry GPs' leader writes to MPs on partnership campaign Health authorities told to reverse cuts in NHS GMC given more powers to restrict a doctor's practice Intensive care beds may go on a database Guarantee given for trusts' debts Students re-examine advice on electives

# Clinical academics welcome independent inquiry {#article-title-2} Clinical academic staff have welcomed the decision of the Committee of Vice Chancellors and Principals (CVCP) to set up an independent inquiry into the disincentives to a clinical academic career. The BMA's Medical Academic Staff Committee has offered to give evidence to the committee of inquiry, which will be chaired by Sir Rex Richards, former vice chancellor of Oxford University. The CVCP envisages the committee investigating the problems of recruitment and retention of clinical academic staff, taking account of the changes in the NHS and in workload, in the training programmes for future specialists, in university and NHS funding systems, and the effects of European Union directives. According to the CVCP's medical committee there were over 50 vacant established clinical chairs in universities and medical schools in 1995; 20 had been vacant for more than 12 months. Universities are also worried about the loss of posts at clinical lecturer level. Sir Rex Richards has agreed to speak at the BMA's conference of medical academic representatives on 3 June. # GPs' leader writes to MPs on partnership campaign {#article-title-3} The chairman of the General Medical Services Committee has written to members of parliament to emphasise the importance of the patient education campaign, which was launched last week (2 March, p 531), and to seek their support. Dr Ian Bogle points out that some people see a need to consult their general practitioner for every problem and that inappropriate use of doctors' time can prevent them treating patients when …

Report highlights recruitment crisis in general practice

There is a serious recruitment problem in general practice now and this will deteriorate unless specific measures are taken. This is the conclusion of a report on medical workforce from a General Medical Services Committee's task force. The GMSC congratulated the task force's chairman, Dr Michael Wilson, on what many speakers said was an excellent report although it painted a gloomy picture. The committee endorsed the report and the suggestion that the GMSC should cooperate with the Royal College of General Practitioners in getting the recommendations implemented. The health departments and the review body have said repeatedly that …

British GPs call for pricing on out of hours

Britain's general practitioners have refused to accept the failure of the Doctors' and Dentists' Review Body to put a value on their out of hours work. They are insisting that it does this in a supplementary report by the middle of May. During a highly charged debate last week the General Medical Services Committee expressed frustration at the slow tactics of the NHS Executive in resolving the out of hours …

Future provision of out of hours primary medical care: a survey with two general practitioner research networks.

To ascertain general practitioners' views about the future provision of out of hours primary medical care. Self completing postal questionnaire survey. Wessex and north east England. 116 general practitioners in the Wessex Primary Care Research Network and 83 in the Northern Primary Care Research Network. Intention to reduce or opt out of on call; plans for changing out of hours arrangements; the three most important changes needed to out of hours care; willingness to try, and perceived strengths and limitations of, three alternative out of hours care models--primary care emergency centres, telephone triage services, and cooperatives. The overall response rate was 74% (Wessex research network 77% (89/116), northern research network 71% (59/83)). Eighty three per cent of respondents (123/148) were willing to try at least one service model, primary care emergency centres being the most popular option. Key considerations were the potential for a model to reduce time on call and workload, to maintain continuity of care, and to fit the practice context. Sixty one per cent (91/148) hoped to reduce time on call and 25% (37/148) hoped to opt out completely. General practitioners were keen to try alternative arrangements for out of hours care delivery, despite the lack of formal trials. The increased flexibility in funding brought about by the recent agreement between the General Medical Services Committee and the Department of Health is likely to lead to a proliferation of different schemes. Careful monitoring will be necessary, and formal trials of new service models are needed urgently.

GMSC endorses registrars' recommendations on summative assessment Juniors' contracts will have local flexibility Waiting list figures published GMSC wants discussions over violence against doctors Doctors given guide on assessing mental capacity Expert group will look at transplanting animal organs to humans

# GMSC endorses registrars' recommendations on summative assessment {#article-title-2} The General Medical Services Committee has endorsed the recommendations of its registrars subcommittee on summative assessment and agreed that unless and until the regulations are amended trainers should be informed by the summative assessment process but should not be bound by it. At the end of last year the GMSC, the Royal College of General Practitioners, the Joint Committee on Postgraduate Training for General Practice, and the Committee of Regional Advisers in General Practice in England agreed a way forward for summative assessment. This proposes that, although not legally mandatory, the process should be introduced during 1996. The general practice registrars subcommittee, however, remains concerned about the flawed method of introducing the scheme, including its introduction mid-way through many registrars' training, the undue haste of implementation, and the poor quality of advice given to registrars. The GMSC has endorsed the subcommittee's wish that no registrar or trainer should have their accreditation or training state questioned if they decide not to participate in summative assessment. It agrees that universal regulatory summative assessment should be postponed until 1997 at the earliest, subject to satisfactory validation and the necessary regulation changes. The subcommittee insists that all components of the summative assessment package should be implemented at the same time in every region and that all doctors entering the hospital component of vocational training should have clear and comprehensive information about …

Reviewing the GP contract: one step forward Britons walk out of EU medical meeting Parliamentary parties clash over rationing

Under any new contractual arrangements core and non-core services should be separated and the in hours and out of hours parts of the contract should be split. These decisions emerged after last week's meeting of the General Medical Services Committee, which was devoted to discussing various options in open forum and in working groups. As a result of the 1990 general practitioner contract and the NHS reforms there is increasing support among general practitioners for other contractual options. And the chairman of the General Medical Services Committee, Dr Ian Bogle, has always insisted that the recent out of hours agreement was only an interim measure. Each of the eight working groups completed a questionnaire, which included questions on the independent contractor status, salaried employment, commissioning for the provision of general medical services, and patient access to general practitioner services, as well as one on priorities for negotiations--separation of core and non-core services came top of the list. The results of the day's deliberations will be drawn together and taken back to the GMSC before being sent out to local medical committees (LMCs) for consultation. Several members supported the idea of a special LMC conference in the spring of 1996, but Dr Bogle said that the important thing was to get the document right. The debates were helped by contributions from the professor of health policy at Imperial College, University of London, Professor Nick Bosanquet, and the visiting professor of general practice at Guy's and St Thomas's Hospital Medical School, Professor Marshall Marinker. Professor Bosanquet believed that general practitioners were at the crossroads. At present, however, they were trying to do several jobs: they were doing their old job, …

GMSC's extraordinary general meeting

EDITOR,--The proposal that democracy will be better served if regional representatives of the General Medical Services Committee are directly elected by all general practitioners divided into appropriate large constituencies has much merit. The fact that the issue has not been …

Decision on out of hours package endorsed GPs will plan the contract for the future Health secretary spells out future for family doctors Registrars may withdraw from summative assessments Correction

# Decision on out of hours package endorsed {#article-title-2} One month after the General Medical Services Committee took its unanimous decision to accept the government's revised proposals on out of hours without balloting the profession (30 September, pp 827-8) the committee has resolved overwhelmingly to stand by its decision. The meeting failed tosupport a request from the chairman of the Birmingham Local Medical Committee, Dr Fay Wilson, forstanding orders to be suspended so that the GMSC could reconsider its decision not to ballot on the package. The committee did, however, recognise the “widespread concern” on the matter and agreed to communicate with the profession the reasons for taking the decision. Speakers at last week's meeting reported disquiet at some LMC meetings that a ballot had not been arranged; some of the disquiet they accepted had been fuelled by misleading articles in the press. Other committees had endorsed the GMSC's decision unreservedly and did not want the debate to be reopened. When committee members had reported the debate at the September meeting much of the concern had evaporated, although the secretary of Berkshire and Buckinghamshire LMCs, Dr Eric Rose,who believed that the debate should be reopened, reported that there were many disaffected doctors in his constituencies who were threatening motions of no confidence in the GMSC. One of the negotiators, Dr Brian Goss, said that most of the discontented doctors fell into twogroups--those who wanted nothing at all to do with out of hours work and those who thought they would lose financially. The committee could do nothing for these groups. The GMSC will communicate its reasons for not voting for another ballot in briefings to the press and letters to LMCs. …

BMA opposes private ethos in the NHS GPs will discuss a salaried option BMA wants landmines banned EU committee votes to remove tobacco growers' premium Consultants support doctor's freedom of speech Army medical college will leave London

# BMA opposes private ethos in the NHS {#article-title-2} “We believe that introducing a private ethos into the NHS changes the principles under which the service was formulated,” Dr Mac Armstrong told the BMA's fringe meeting at the Labour party conference. He believed that three fundamental questions underpinned the health care dilemma. How much should be spent on health? What should the money be spent on? How do you know what you are buying is the best? A fourth question was emerging--what was the function of the NHS? Dr Armstrong said that although the government insisted that the NHS was safe in its hands there seemed to be a subtle redefinition of the nature of the NHS. The deputy chairman of the Central Consultants and Specialists Committee agreed with him. Dr Peter Hawker, a consultant gastroenterologist in Warwick, said that creeping privatisation was happening and there was now a blurring between the NHS and private care. “If British society cannot support the NHS it has no right to call itself civilised,” he maintained. Several of the questions from the large audience concerned long term care, which the deputy chairman of the General Medical Services Committee, Dr John Chisholm, said was falling on families in an arbitrary way. As well as calling for a full public debate on the subject the BMA is recommending that national guidelines should be drawn up to determine the lines of responsibility for the NHS and local authorities to avoid inequalities and unfair differences due to accidents of geography. In its briefing paper the BMA explained that to make the medical profession fit for the future it had embraced audit to …

GPs approve simpler complaints and disciplinary procedure Health care in remote areas must be flexible Government endorses strategic review of pathology services European Commission reports on Europe's health

# GPs approve simpler complaints and disciplinary procedure {#article-title-2} The General Medical Services Committee has approved the outline of new complaints and disciplinary procedures which would be simpler, quicker, and fairer for general practitioners and patients. In future the complaints and disciplinary procedures will be separated. The complaints procedure is based on recommendations in the Department of Health's report Acting on Complaints, which was its response to the Wilson report, Being Heard. They are due to come into effect in April 1996, are investigative rather than punitive, and aim to resolve most complaints at an informal practice level. GPs would be obliged under their terms of service to operate a practice based complaints system and cooperate with a stage two procedure, which would operate if the practice based procedure did not resolve the complaint, and the new disciplinary arrangements. Doctors would no longer be in breach of their terms of service in relation to complaints but would under the disciplinary procedure. The system of medical service committees would be abolished. The GMSC has urged the government to reduce the time limit of one year for making a complaint and the health minister was due to announce a decision this week. Under the stage one practice based procedure an initial response to a complaint should normally be made within two days and an explanation normally provided within two weeks. If the stage two procedure had to be invoked health authorities would set up panels to hold informal hearings into complaints. They would have to make their report available to the authority, the complainant, and …

GPs accept out of hours offer unanimously

General practitioners in Britain have unanimously accepted a revised offer from the health secretary to resolve the problem of providing out of hours care (see also p 824). The issue has been at the top of their agenda for the past three years. Members would have been balloted on whether to take sanctions if the offer had been rejected. The chairman of the General Medical Services Committee, Dr Ian Bogle, will write to all general practitioners emphasising that, although the settlement may have solved the immediate problem, there will now be a much wider debate on other contractual issues, including separating out of hours work from in hours work. The health secretary, Mr Stephen Dorrell, has already recognised the need for further debate. …