I have just read Dr Andrew Orr's article about the epilepsy indicators for the new GMS contract (Guidelines in Practice January 2004). We have been told to use Read code 6676 when recording the patient’s last seizure. However, I am confused about whether we should record this when we see the patient, which shows that we have discussed it, or whether we should record the date of the last seizure – in which case it looks as though it hasn’t been discussed since then! I would be grateful for any advice on this topic.
Dr Jean Madeley, GP, Nottingham
Dr Andrew Orr replies:
The contract does not require the date of the last seizure to be recorded, it is only a recommendation to do so, so you could just ignore it and you would not forfeit contract points. If you do record the date of the last seizure, you may indeed use Read code 6676. Then you still have the dilemma as to which date to record – the actual date of the seizure, or the date when you asked the question. My feeling is that you should use the latter, as computer searches in the future may well disregard old dates, and some patients’ last seizures occurred many years ago.
In Scotland, the Scottish Programme for Improving Clinical Effectiveness in Primary Care (SPICEpc) program has endeavoured to overcome this problem by adding date modifiers to the data entry.
As a rule, when adding a date to any part of the contract it is best to add the most recent one to avoid losing validity because of the very tight time constraints.
Dr Andrew Orr, GP, Montrose
Cross-organisation working will improve antenatal care
Dr Anne White’s article ‘New NICE guideline will standardise care of pregnant women’ (Guidelines in Practice January 2004) emphasises that the guideline focuses on patient need rather than on existing service provision. I think we need to look at the issues across organisations.
For example, the problem of communication about HIV status needs to be addressed. Women with HIV need clearly defined management in secondary and primary care during the postnatal period. Primary care staff should be fully informed about the issues and the protocols to be followed.
Dealing with cases of domestic violence in pregnancy is another area where good communication across agencies and organisations is vital.
The new GMS contract will bring organisational changes and we must take advantage of them to encourage new ways of working. For example, the NICE guideline recommends an early ultrasound scan to assess gestational age and exclude multiple pregnancies. This could be delivered in new treatment centres instead of acute units in secondary care as at present.
The NICE recommendations on antenatal care should be discussed within the broad context of primary and secondary care and in the context of developments in primary care.
Alison Wall, HV Professional Lead for Child Protection/PEC Nurse
Watford and Three Rivers PCT