My partnership is keen to involve our nurses and other staff in the practice-based commissioning process (PBC), but other GPs in our commissioning group seem less keen. Why is this and how can we overcome their resistance?
The prevailing view in general practice is that PBC is solely a GP issue and that nurses and other staff are not welcome at the table. This is not the view of ministers and it is important that GPs and nurses do not revert to the old tribalism.
For the past 150 years, nurses have worked within a culture where other people tell them what to do and when to do it.
As a result, many nurses passively believe that they cannot take part in healthcare initiatives unless they receive a personal invitation.
Nurses usually have excellent interpersonal skills with patients. This stimulates ideas about what patients do and do not need and how duplication can be avoided. This makes them key players in PBC and they should be encouraged to become involved.
The NHS is determined to see plurality of provision and that is why nurses can apply to develop specialist PMS and APMS schemes.
The next 10 years will see general practice working in partnership with myriad bodies to deliver health and social care. Let the first step on this path be with fellow professionals, your nursing colleagues in primary care.
I am a partner at a PMS practice. We currently employ three associates as salaried GP assistants who are less zealous than the profit-sharing partners in collating quality framework data. The partners are concerned that we will have difficulty achieving quality targets, particularly in the light of this year's additions to the framework.
We are being reimbursed about a third of our salaried assistant wages bill under PMS. Would taking on a new profit-sharing partner at the expense of our some of our assistant time be sensible?
While the proposal to take on an extra profit-sharing partner and replace existing assistant time may improve efficiency and consequent profitability, it is difficult to make a specific comment about whether profits would improve without having a detailed picture of the practice's finances.
You do not indicate the cost of the salaried assistants or the level of profitability enjoyed by the existing partners.
I suggest you ask the practice accountant to undertake a review to establish if indeed this will be financially efficient.
Have you any suggestions about how my practice can provide training to foundation year two (FY2) doctors? What is the best way to organise their surgery sessions?
To train FY2 doctors actively the practice must be registered with its postgraduate deanery as a training practice. All deaneries have guidelines on how they expect FY2 doctors in their area to be trained. In general, most practices arrange for the FY2 doctors to see patients jointly with experienced GPs.
Once the doctor has settled in at the practice, they can have their own surgery sessions alongside their GP trainer's sessions.
Patients are usually booked at 20-minute intervals while the trainer's surgery session has scheduled gaps to enable them to advise the FY2 doctor and help agree the patient's management plan.
This has proved to be the most successful model. In some cases (as with all postgraduate training) it may be necessary to organise supervision differently to meet the needs of the doctor concerned.
Dr Mo Dewji
I am a GP registrar in the Army. When I joined, I transferred my NHS pension fund to the armed forces scheme. I plan to return to NHS work in two years' time and can either draw my armed forces scheme benefits at age 60 or transfer the fund back to the NHS scheme. Can I rejoin the NHS scheme while working as a locum GP and how I can buy added years in the scheme after rejoining?
Taking a post at a GP contractor practice or at a NHS hospital will enable you to rejoin the NHS pension scheme as will being a self-employed locum in relation to NHS work performed while deputising for an NHS GP.
If you work for a APMS provider contracted to the NHS, you might not be eligible for the NHS scheme, so check up on this.
After rejoining the NHS pension scheme, you will need to contact the finance/pensions officer at the local primary care organisation or hospital to request information about added years and an application form. For more information, see www.nhsps.gov.uk
ASK THE EXPERTS
Dr Tim Kimber is a Littlehampton GP and a member of West Sussex LMC.
ACCOUNTING AND PARTNERSHIPS
Stuart Williamson is a partner at accountants Williamson West.
Email: firstname.lastname@example.org LEGAL
Lynne Abbess is a partner at solicitors Hempsons. They can offer 10 minutes of free advice only, from 10am-4pm weekdays. Phone: (020) 7839 0278
John Hearle is a chartered surveyor and chairman of Aitchison Raffety.
Email: email@example.com or fax: (01727) 844472
PENSIONS AND PERSONAL FINANCE
Kevin Quinn is a financial planner at Ramsay Brown & Partners.
GP CONTRACTORS AND APMS
Dr Mo Dewji is a Milton Keynes GP and clinical director for primary care contracting. Email: firstname.lastname@example.org
ACCOUNTANCY AND TAXATION
Jenny Stone is a partner at Ramsay Brown & Partners. Email: email@example.com or call (020) 8370 7739 9am-5.30pm weekdays
Maggie Marum is a management consultant for the NAPC and runs its practice-based commissioning helpline.
Call: 020 7636 8626. www.napc.co.uk
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