All views and opinions expressed herein are those of the Medical Secretary only and do not necessarily represent policy of DPLMC


Many Thanks for looking at the first entry of Pete's Appendix--if you have issues you want me to mention on the blog please e-mail me.

Dyfed Powys LMC Changes

A lot has changed in the world of DPLMC over the last month or two and more changes are set to come.

We are re-structuring the organisation, not because there was anything wrong with how it worked before but because the new incumbents into officer-ship have admitted that for many reasons we can’t follow in David Roberts’s footsteps—it’s just too tough an act to follow!

David’s unstinting dedication to the organisation over so many years and his ability to cover so many areas at once can’t be replaced and practices have changed in their expectations of outside work commitments.

We have therefore decided to split the workload and commitment amongst a larger number of officers and to remunerate more to allow gp’s to take resourced time away from increasingly hard pressed practices.

I really hope this will yield officerships that attract future incumbents.

JULY 2011 WEEK 2

Who should decide competence in General Practice?

The LMC Forums both in Wales and England are frequently discussing posts around the requirements to carry out what used to be routine practice for GP's e.g. cervical smears and coil fittings etc.There is a recurring theme that requirements laid down often by colleges or specialist departments are unrealistic both in terms of the depth of training required and the number of procedures needed to maintain experience.

GPC Wales and UK are continually trying to rationalise attempts to increase these requirements to the point where GP's will simply be unable to comply.

Section 12 approval under the MH Act is an example of an extended role that GP's in Wales are becoming increasingly reluctant to become involved with for the above reasons.  And often this is to the detriment of the service to the patient

It looks as though in England individual PCT's have more autonomy in setting training requirements in General Practice, however examples crop up often in Wales and LMC's need to be vigilant in supporting GP's if LHB requirements are excessive or likely to result in loss of services; whilst the GPC continues to try and insist on more involvement of GP's themselves in agreeing what requirements are reasonable.

In terms of Enhanced Services it's important for practices and managers to remember that LHB's can't unilaterally change the training requirements on  services that are already agreed and up and running. This would by definition change the agreement of the service and would require re-negotiation by the LMC.

Enhanced Service Ideas and Suggestions

We are committed to the negotiation of new enhanced serices with the LHB's. Clearly this needs committment from Health Boards to put funding for enhanced services into use to support and develop these.

We would like to proactively negotiate enhanced service that GP's know will enhance patient care and reduce the need for referral to and the cost of secondary care.

I would be very interested to hear of ideas for enhanced services from GP's and managers, either new ones or past ideas that have never come to fruition. I have tried in the past with DVT and I know others have tried often unsuccessfully to develop new services and secure committments and funding, but let's start pro-actively lobbying for good service suggestions.


 JULY 2011 WEEK 4

Who should procure flu-vaccines?

There is debate and discussion going on over this subject. There is a suggestion that significant funds could be saved if procurement were taken over centrally? In England there is a risk this might happen consultation is underway as per here;


When this kind of excercise is carried out, looking at options to a service delivered in general practice, does it consider all the impacts of removing ownership in terms of motivation and delivery ? Does it consider all the hidden costs to a service such as ours by "changing to save" and possibly assuming that the costs are tranlated into "profits" for the service provider?




It looks as though the government is going to press ahead with further pension reforms for GP’s along with other NHS workers.
We are in a difficult position in the current climate as others are suffering from financial austerity and there can be no doubt of the viability issues surrounding some pension schemes. The NHS Superannuation scheme is however in credit.
Much has been made recently over the “gold plated” pension schemes of which ours is apparently one, however should the following be considered?
A good generous and stable pension scheme has always been a strong recruitment factor for the NHS and specifically for General Practice
Highly pensioned practitioners have made huge investments into the scheme and will be supporting many lower paid workers by keeping the scheme buoyant—have the impacts of potentially huge numbers of practitioners over 50 deferring or drawing on the scheme been assessed?
Has the possible impact on retention of this age group been assessed?
Has the likely longer term impact of retaining a workforce of GP’s who can no longer come into general practice later in their careers (as I did) and will in the future be unable to retire until possibly late 60’s been assessed? Is the prospect of future GP’s having to commit and enter the speciality early due to training demands in their mid 20’s the facing potentially nearly 50 years of service realistic?
Is this in the interest of patient care or practitioner welfare?



Industrial Action

The BMA is suggesting ways of soft action to support the day of Industrial Action on the 30th November


It has intimated that more specific action by doctors could follow and has not been ruled out? An often debated arguement is exactly what could this be without adversely affecting patient care and the standing of doctors within the community locally and nationally?

This was debated again at length at the last GPC conference in London this year and their is little appetite amomngst professionals or their leaders for formal industrial action for Gp's. Much has been said over the years in online discussions etc about the possibility however of stopping non clinical non essential duties such as private insurance work etc. Would this do anything other than inconvenience patients and reduce income?

it looks as though for us in keeping with all the allied essential professions its a case of negotiation negotiation negotiation--but how does the profession respond if the government won't negotiate?

Difficult questions in difficult times?

"Other Practices Do It Already"--Enhanced Services

This is becoming a much used response by Health Boards when trying to negotiate Enhanced Services. Is it a valid reason not to negotiate resourcing for service over and above core practice? LMC's will sometimes advise that if practices underatke additional work and responsibilities without resourcing it makes future negotiation much harder for the profession as a whole but clearly practices can excerise choice.

It does not seen unreasonable however for a practice whihc has been providing an extended role free to sign up to an enhanced service should one become available?

With both Health Board and Practice budgets feeling the squeeze it will be interseting times for negotiators both nationally and locally.


June 2012 Week One

No Appendix Entries

Well, there has been a hiatus in the Appendix--time got the better of me and I took too much on.
The answer? Well part of it is I am about to reduce my clinical commitments to spend more time with family but also to hopefully further develop my role in Dyfed Powys LMC and GPC Wales and I have promised myself to spend more time on this website and on the Appendix so watch this space.
I wonder how many 50 plus GP's are similarly considering their options right now? Increased pension costs, consistent pressure to do more often unresourced, little positive press coverage--when was the last time British General Prectice was lauded in the press?
Revalidation might make some think though we are lucky in Wales in that systems appear to be well in place.
Worcester LMC at the recent Conference in Liverpool said it should be "Time for General Practice again", a great rallying cry but what will turn moral and pending recruitment and retention problems about?


June 2012 Week 3

Shot gun licences have been a source of contention for years in General Practice. Views have ranged from "This is nothing to do with me" to "It's an important public duty". Whatever the point of view there has always been issues around charging for this service and cocern over who takes responsibility should there be a problem?

We now have a new system brought in by the ntaional Police Forces involving a "Notification" that a Licence has been given rather than asking for medical reassurance. We are asked to only reply if there are concerns.

There are still some outstanding concerns about this system on behalf of GP's, Should this ionformation be filed on clinical records? Initial BMA advice was not to but this appears to have changed. Is this now a completely unresourced service? There is no payment for checking the medical records though the BMA are advising that if having checked there are concerns it is reasonable to charge for subsequent correspondence.

Is this a better system? Is it an un-resourced service?

I personaly feel this should be furter followed up at Conference Agenda


What Price Revalidation?

There was strong voice from Conference in Liverpool with re-sounding discontent that Revalidation is being pushed ahead with no apparent idea of how remidiation will look like? I had my e-mail last week. I have been offered the chance to get my first revalidation underway next year.

I have been asked "Am I ready for Revalidation"--teh question I would ask is "Is Revalidation ready for me"--In Wales the answer might well be yes however is it everywhere?

What would really happen if I failed revalidation?

Should I agree to revalidate early if there is no information yet re-remediation?

Would you cross the road if you knew there was one car heading your way with no brakes--even if it were possibly a long way off?

In Wales it is getting harder to recruit and retain Appraisers, I have had Appraisers say to me they are leaving because they signed up to Appraisal not to take part in revalidation, will we kill the golden goose i.e. Appraisal in Wales ad will it simply becaome an appendage to revalidation?