BMA fees calculator
The BMA’s Fees Calculator BMA fees calculator has been made available for BMA members who charge professional fees, with the aim of helping to determine how much to charge in order for a service to be financially viable. The BMA recommends the use of the calculator for members to calculate how much it costs to provide a service that is performed in the doctor’s own time outside of their contract.
GP Pension Scheme Changes
The recent soaring rate of inflation will have significant tax implications for some GPs’ pensions. This applies to those who are active members of the scheme contributing at any point in current 2022/23 tax year, as there could be substantial Annual Allowance charges, when such charges become due, depending on accounting / pensions administration. The Pensions Committee of the British Medical Association (BMA) has launched a CPI modeller CPI modeller for GP pension scheme (bma.org.uk) for the GP pension scheme for GPs to look at their pension growth in 2022/23 and 2023/24 tax years, and to explain the problems with poor design of the Annual Allowance and how it will interact with the 1995/2015 GP pension scheme, and Annual Allowance taxation. It is important that GPs urgently take steps to at least understand their position and the potential impact this may have on future Annual Allowance charges.
Annual health checks to patients aged 14 years or over on the learning disabilities register
Under the LDHC (Learning Disability Health Check Scheme) DES, GP practices are required to offer an annual health check to each patient aged 14 years or over on the learning disabilities register. The requirements are set out in the DES Directions 2022. During the pandemic, NHSE/I advised GP practices that the LDHC could be undertaken with a blend of remote and in person appointments.
However, recent feedback of patient experience gathered by NHSE/I has indicated a preference to return to face-to-face checks, so NHSE request that GP practices ensure at least part of the check is face to face unless there is a strong clinical and/or patient preference for not doing so. Where the LDHC has already been delivered virtually this financial year, this will still be counted. More information can be found here Learning disabilities – Annual health checks – NHS (www.nhs.uk)
Liberty Protection Safeguards: what they are they
The Liberty Protection Safeguards will provide protection for people aged 16 and above who are or who need to be deprived of their liberty in order to enable their care or treatment and lack the mental capacity to consent to their arrangements.
People who might have a Liberty Protection Safeguards authorisation include those with dementia, autism and learning disabilities who lack the relevant capacity.
The Liberty Protection Safeguards were introduced in the Mental Capacity (Amendment) Act 2019 and will replace the Deprivation of Liberty Safeguards (DoLS) system. The Liberty Protection Safeguards will deliver improved outcomes for people who are or who need to be deprived of their liberty. The Liberty Protection Safeguards have been designed to put the rights and wishes of those people at the centre of all decision-making on deprivation of liberty.
The Liberty Protection Safeguards came into force in April 2022.
Further information can be found here Liberty Protection Safeguards: what they are – GOV.UK (www.gov.uk)
Key changes introduced by the Liberty Protection Safeguards
- Three assessments will form the basis of the authorisation of Liberty Protection Safeguards:
- Greater involvement for families
- Targeted approach
- Extending the scheme to and 16 and 17-year-olds
- Extending the scheme to domestic settings
- Clinical commissioning groups (CCGs), NHS trusts and local health boards as Responsible Bodies
The Liberty Protection Safeguards creates a new role for CCGs and NHS trusts in authorising arrangements. In England, if the arrangements are mainly taking place in an NHS hospital, in most cases the Responsible Body will be the ‘hospital manager’ (which in most cases will be the NHS trust responsible for that hospital).
New training requirement for all staff who support people with a learning disability and autistic people coming in on 1 July
From 1 July 2022, all health and social care providers registered with CQC must ensure that their staff receive training on learning disabilities and autism appropriate to their role. This new legal requirement is introduced by the Health and Care Act 2022.
The government is required to consult on and publish a Code of Practice. We understand that this will outline the content, delivery and ongoing monitoring and evaluation of the Oliver McGowan Mandatory Training, which is training they have developed and trialled. The government anticipates that the publication of the Code of Practice may take at least 12 months.
CQC will provide statutory guidance while the Code of Practice is being developed. During their assessments and inspections of providers, they regularly look to see if staff are working with people appropriately, and if not, they consider what training and support has been provided to staff to ensure their understanding. Following the introduction of this requirement, they will be looking to see whether providers have provided learning disability and autism training and have assessed the competencies of their staff following the training. In line with current inspection procedures, CQC will not be looking at what the training itself has involved.
CQC will continue to engage with the government and they will update statutory guidance to reflect this new requirement in due course.
NHS estates and facilities workforce action plan
This NHS England » NHS estates and facilities workforce action plan sets out the ambition for the estates and facilities workforce across England over the next ten years, with a focus on the immediate priorities. It highlights four key areas of work: developing their people; building the next generation of estates and facilities management people; embedding equality, diversity and inclusion; and improving health and wellbeing.
Other professionals able to do Fit Notes/sickness certificates
From 1 July 2022 nurses, occupational therapists, pharmacists, and physiotherapists will all be able to legally certify fit notes – something that at present only doctors can do. If you’ve been off work with illness for more than seven days, a fit note provides evidence to your employer about your absence and any relevant advice on how to support you to remain in or return to work.https://www.gov.uk/government/news/more-healthcare-professionals-given-powers-to-certify-fit-notes Non-statutory guidance has been developed to help individuals identify if this task is within their scope of practice as well as a new training module which should be completed before taking up this task. These new products will be available from 1 July. There will be a rollout period from this date where GP IT systems will be updated to reflect the change.
Initial Health Assessment services in support of new arrivals from Ukraine
To support Ukrainian refugees arriving in England, NHSE/I is asking CCGs to commission Initial Health Assessment services in support of new arrivals from Ukraine. Whilst CCGs will be free to determine how best to undertake this, and who from, NHSE have developed an outline specification and a template Local Enhanced Service to support delivery by patients’ own registered GP practice when they register, should practices wish to sign up. Details this can be found on the NHS England website.
The DHSC has also published bilingual versions of the GMS1 registration form:
English / Ukrainian: https://www.gov.uk/government/publications/gms1.uk
English / Russian – https://www.gov.uk/government/publications/gms1.ru
Update on NHS Property Services (NHSPS) legal case
Since early 2020, the BMA has been supporting 5 GP practices in legal dispute with NHS Property Services (NHSPS) around inflated service charges. The case has been broken into two phases by the court: phase one to look into the principles of which services NHSPS can charge the practices for, and phase two to look into what the exact amounts of any charges will be. We have now received the judgment on phase one of the trial, and in determining which services practices are liable to pay, the court has decided in favour of NHSPS.
The complex judgment is 170 pages long and gives some clarity to these practices about what services they are and are not obliged to pay for. The length of the judgment underlines the difficulties caused by the drastic change in approach by NHSPS to service charges that busy practices, working to provide care to patients under the most difficult circumstances, are being forced to navigate.
These proceedings were initially launched because NHSPS appeared to be increasing GP practices’ service charges in reliance on its Consolidated Charging Policy. However, in June 2020 NHSPS conceded that its charging policy did not impliedly vary these practices’ obligations retrospectively, and the recent judgment confirms that in none of the five practices’ cases was NHSPS’ charging policy incorporated into the terms of their tenancy.
GP practices’ service charge obligations can only be determined on a case-by-case basis. The judgment confirms that practices facing demands for fees that they do not understand should take a constructive approach and seek their own advice to investigate what is and is not recoverable by way of service charges. This has always been the BMAs approach and they have consistently advised practices to do their own due diligence.
During these proceedings NHSPS’ claims for outstanding service charges has been revised vastly, in one case being reduced by as much as 34% (more than £178,000). This underlines the opacity of NHSPS’ methods for calculating charges. Had the BMA not supported the GP practices in this case to defend NHSPS’ claims for charges they could have overpaid hundreds of thousands of pounds to NHSPS, which NHSPS was unable to substantiate when required to do so.
The case is not over, with the next stage to determine how much these practices may owe, if indeed they received the services to the required standard or even at all. BMA are discussing the next steps with the legal team and will provide further updates and guidance as they become available.