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DH unveils pandemic planning blueprint

By Lilian Anekwe

The average GP practice could be paid an additional £7,500 per week under 'buddying-up' arrangements during the winter swine flu season, according to new Department of Health guidance.

The document sets out for the first time how primary care services should be reorganised if swine flu workload becomes unmanageable during the coming months.

The DH is considering arrangements to enable PCTs to suspend certain direct enhanced services if necessary, but the guidance states all PCTs should set the wheels in motion now to allow services to be suspended in different areas while short-staffed.

The planning document says that in areas where a ‘level 3' strategy is agreed, a PCT can declare a full suspension of services ‘as it is not safe or possible for the practice to continue to provide services due to the non-availability of staff.'

Under these circumstances, practices should be encouraged to activate buddying up arrangements – including recruiting GP-led health centres to provide urgent or routine consultations, or buddying-up with local out-of-hours providers.

The guidance also sets out payment arrangements for practices forced to provide buddying-up cover, which will ‘approximate to £1,250 per week per 1,000 patients' - and says practices which are forced to close will not be financially penalised.

‘Provided the practice seeking to suspend its services does so in accordance with agreed local protocol the PCT should not take any action under contract to recover monies paid during the period that the practice is closed', the guidance states.

It continues: ‘The PCT will wish to be mindful not to create a bureaucratic burden on practices in this situation.'

OOH providers are singled out as being put ‘at risk of insolvency' during the winter, and the guidance urges PCTs to offer OOH provider staff – including call handlers and drivers – vaccination and to encourage practice-based GPs to take on OOH shifts and ‘step up their contribution to OOH services'.

PCTs should begin to ‘engage the services of GP locums on a longer, fee-based, continuous contractual basis' that would give locums the same status under the NHS pension scheme as GP assistants, the guidance says.

This would mean that if locums were to die between contracts of employment, their dependents would benefit from death-in-service benefits – an issue raised by the GPC.

Locums should be offered terms ‘no less favourable' than the BMA model contract, and the costs of hiring locum cover whilst a partner or salaried GP is sick will be borne by the PCT.

Dr Dean Marshall, GPC negotiator and chair of GPC Scotland, told Pulse the GPC were hastily drafting new guidance for practices on managing workload during a flu pandemic, to update the guidance it published in January.

He added: ‘PCTs need to use this lull to put the building blocks in place for the winter. The message from us is they need to be sitting down with their LMCs and making decisions about what the different levels of swine flu activity look like in concert with LMCs.'

‘Judgment calls about suspension of services and buddying up will have to be made because it depends on what happens in each PCT area.'

‘It's difficult to work out how to fund practices before the next peak hits but the £1,250 is a guide and will be reviewed as the pandemic escalates.'

PCT arrangements for managing swine flu workload

Level 1: Suspension of non-core activities
• Such as the minor surgery additional service, obesity management and non-clinical activities such as referral coding and reporting. ‘PCTs could then continue to pay practices for such services against an assumed level of performance in lieu of the alternative workload being undertaken.'
• Release of all non-essential clinical staff engaged by the PCT, for example practice-based commissioning activities
• Suspension of all non-essential visits by PCTs to practice

Level 2: Managed suspension of services
• The PCT recognises that it is not possible for the practice to continue to provide all core services to patients
• The practice will need to request suspension of various enhanced services, suspension of LES, changes to surgery or opening times.

Level 3: Full suspension of services
• PCTs should set up buddying or reciprocal arrangements between practices, through a time-limited LES

Dispensing practices
• The PCT should ensure adequate medicines supply and pharmaceutical services are available through other providers

Retired GPs
• Should be reimbursed ‘for expenses only'
• The Dh is drafting guidance on the temporary re-registration of retired doctors, but until this is issued, volunteer GPs ‘must not undertake duties which are reserved to registered medical practitioner, including prescribing or certifying deaths.'

Doctors in training
• PCTs may work with local post graduate deaneries, and ‘consider the use of doctors in training should local capacity be depleted.'

PCTs should plan now for an unmanageable swine flu workload

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