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Information, Guidance and News
PCN DES – update from GPC
The updated PCN DES specification was published at the start of this month. Whilst GPC England continues to support the principle of the DES – independently contracted practices collaborating, alongside other local NHS providers, to provide services which are designed to support local communities – and given the realities of the unagreed contract changes brought in by NHSE/I for 2022/23, practices should be aware of their options relating to the DES.
GPC believes that the newly added demands within the PCN DES are a risk to patient and practice staff safety in terms of potentially unmanageable/unsafe workload and burnout. Worryingly, the recent GP Worklife Survey confirmed that GPs are overworking, with around 33% likely to quit direct patient care within the next five years. This rises to over 60% for GPs over 50, which is a worrying statistic given over 44% of the GP workforce is over 45.
Following the conclusion of the 2022/23 contract negotiations and the release of the DES specification, GPC sought further clarification from NHSE/I and proposed practical solutions that it was felt would alleviate the concerns of the profession and any potentially negative impact from the unagreed changes. None of them were accepted.
With this in mind, practices need to carefully consider the DES changes for 2022/23 and how this may impact them going forward. In particular, the incoming Enhanced Access requirements from October 2022 and the expanded service offer.
Suffolk LMC will be pressing local commissioners for flexibility in enhanced service implementation especially around the Enhanced Access element, and to request that local commissioners apply pressure to regional and national colleagues to allow this flexibility and understand the workforce assumptions built into the DES.
The LMC will support any practice who wishes to draw from the DES and would encourage practices to provide honest feedback about their extended access capacity to commissioners in writing as soon as possible.
GPC – Contract 2022-23 update
GPC recently held a series of webinars on the contract changes for 2022-23. For those who didn’t manage to join, we have attached the slide presentation here and an audio recording of the webinar can be found via https://www.bma.org.uk/pay-and-contracts/contracts/gp-contract/gp-contract-changes-england-202223 . This explains what the changes mean for practices and the page also provides GPC guidance about the contract changes to support practices in their decision making and next steps.
Friends and Family Test
The requirement to submit Friends and Family Test (FFT) data was temporarily suspended in March 2020 to allow resources to be freed up for prioritisation during the pandemic. This requirement will be reintroduced into the GP Contract from 1 April 2022. To allow practices time to get fully up to speed, practices will only be required to submit data from Q2 in 22/23 onwards and commissioners will be made aware of this.
Practices will need to implement the new FFT guidance, and the key requirements for practices are:
Emergency GMC registration to end in September
The UK government has announced that the temporary emergency GMC registration they introduced to support the pandemic response, will close on 30 September 2022. The GMC will shortly be in contact with doctors who still hold this type of registration to outline their options and to thank them for holding this type of registration during such a challenging period. The options are likely to include retaining temporary emergency registration until the 30th September deadline, asking the GMC to remove it, or applying to restore their routine registration and licence to practise.
Read more about temporary registration on the GMC website
Safe working guidance
GPC have recently published a safe working guide to enable practices to prioritise safe patient care, within the present bounds of the GMS contract.
Some videos have been added to the resources section directing practices to the safest way to continue deliver patient care, including one on redirecting patients to the safest part of the system.
Health foundation report on access to general practice
The Health Foundation and NHSE/I have published an analysis on access to patient preferences when accessing GP services, which suggests that while not suitable for everyone or all conditions, in many cases patients themselves will often prefer and indeed request a remote consultation.
Despite the fact that General Practice continued to provide high quality care throughout the pandemic and in line with national guidance in place to keep patients and staff safe, leading to a rise in remote consultations, this evolution in how we provide care attracted significant criticism.
Going forward it’s crucial that patient choice, clinical need, and staff and practice capacity are at the centre of decisions around how people can interact with their surgery, rather than pressure from politicians or the press. Read the full BMA statement here
Inclisiran
Practices are reminded that there is no local agreement or pathway for Inclisiran and that prescribing this medication under the current, flawed reimbursement model produces a loss for the practice (for clarity this calculation does not account for the cost of providing the associated practice nurse appointments and simply relates to errors made by NHSE in calculating VAT and clawback on PA items).
The LMC continues to engage with all relevant parties and would suggest that local lipid clinics should not be recommending this treatment for initiation/prescribing in primary care until the commissioning pathways are clear.
Diabetes in East Suffolk
The LMC is aware that changes have been made to the provision of community diabetes care by ESNEFT DSNs and that several practices have reported DSNs unwilling to undertake clinics without practice staff being present.
It is our view that such arrangements have confused service provision with education and that it is still incumbent on the ESNEFT service to provide a service level input alongside education of practice staff where mutually beneficial and convenient. In light of this we would be grateful if practices could let the office know if you experience similar issues.
MCCD/Coroner referrals
Following request for clarification, Jane Parker, the Head of Registrars Service & Lead Manager for Coroners Service in Suffolk has provided the following:
The email circulated to GPs in readiness for the changes on March 25th focused on the changes to MCCD completion in light of the removal of the COVID emergency easements. The arrangements for cases that need Coroner involvement/referral are mainly unchanged but detailed below for your information.
Advice for GPs about completing a death certificate | Suffolk County Council
In these cases, it is the duty of the GP to make the referral to the Coroner themselves and advise the nominated relative of the deceased (if there is one) that they have done so. The Coroner’s officers will then liaise with the relatives as needed to take matters forward.
In these cases, you will need to circle 3) and either B) or C) on the MCCD before submitting to the registrar. Please confirm to the relative of the deceased that you have issued the MCCD and that a Coroner referral will be made via the Registrar. This is important to manage the relative’s expectations of what will follow and to avoid them booking a registrar appointment that will be wasted.
To avoid the distress and inevitable delays that Coroner referrals cause to relatives, it is always preferable that MCCD’s are issued that will enable an immediate registration where this is possible. In either case, any death that is referred to the Coroner is exempt from the legal requirement for registration to be carried out within 5 days.
Flu orders
Following the recent publication of the guidance for the 2022/23 flu programme, we are aware that some practices may have based their orders on last year’s expanded cohorts and be experiencing difficulties in amending them. This has been raised with NHS England who have assured us that they have received commitments from manufacturers to being flexible if the reimbursement letter impacted existing orders. If manufacturers are refusing to be provide this flexibility, practices should contact the NHS England flu inbox (phco.fluops@nhs.net) with the specifics and they will assist.
Practices may also wish to account for some paid carers & NHS staff not being fully eligible under this year’s contract. Further details here
DWP change to fit note – from 6 April 2022
On 6 April DWP changed regulations so that fit notes do not require a signature in ink to authorise them. Instead, a new template is being delivered that is authorised by the name of the doctor being included in the form. This means fit notes can be completed, authorised and sent digitally from 6 April. The main points:
Read more about these changes on Gov.uk
Improvements to benefit eligibility at the end of life
From Monday 4 April 2022, eligibility for the Special Rules is changing. These currently apply to people who have 6 months or less to live and will now apply to people who have 12 months or less to live.
From 4 April, two working-age benefits will be impacted by this change. To support people accessing these benefits and to find out more about the new process and medical evidence form, DWP have published this guidance.
Online Access to Patient Records – update in Primary Care Bulletin
General practices were previously informed that from April there will be system changes for all practices using TPP and EMIS systems to provide all patients with easy access to their future health records. GPs will be informed of the go-live date (now expected summer 2022) with 2 months’ notice and provided with resources to support preparations.
Educational sessions have been held to support staff with this change. Over 40% of practices have already attended at least one webinar, with further places available throughout May and June.
Read further information about the change or contact the team if you have any questions.
Vaccs and Imms
National concern continues to mount over loss of income from vaccs and imms under the new system, despite the best endeavours of practices to achieve the points. GPC sent through the following message last week:
GPC England are aware of the concerns that many practices and LMCs have raised with regards to the recent changes to the childhood immunisation programme and associated QOF payments, and are continuing to discuss the problems with NHS England. NHS England have acknowledged the impact that that the changes have had in many areas, especially given the additional pressures on general practice over that time, and we are working to find resolutions for the problems caused in 21/22 and to ensure that these can be solved going forward. We’ll keep LMCs updated as progress is made.
Infection Prevention Control in healthcare settings
The UKHSA has revised the Infection Prevention Control (IPC) guidance for healthcare workers, and now advises returning to pre-pandemic physical distancing in all healthcare settings, including primary care, and returning to pre-pandemic cleaning protocols outside of COVID-19 areas, with enhanced cleaning only required in areas where patients with suspected or known infection are being managed.
The guidance continues to recommend all healthcare organisations should undertake local risk assessments to ensure safe systems of work in the context of the wider impact of COVID-19 on health services. Practices should assess the risk to patients and staff using this guidance, and make decisions based on the needs and risks of everyone entering their practice building. Practices should also continue to triage patients and cohort people with respiratory illnesses. Read our guidance on risk assessments for practices
The guidance still advises that all patients, visitors and staff should continue to practise good hand and respiratory hygiene, including the continued use of face masks by staff and face masks / coverings by visitors and patients where clinically tolerated.
NHSE/I has published a letter setting out these changes Read also the BMA’s briefing in response to the Government’s ‘Living with COVID-19’ strategy which sets out the plans for managing COVID-19 going forward. Download the updated poster about using face coverings in practices.
SNEE Training Hub Newsletter
The ICS training hub newsletter may be found here Practices may find the offers of coaching, mentorship and new to practice fellowships of particular interest.
LMC Law Retainer Services through Suffolk LMC
Through the retainer Suffolk LMC holds with legal company LMC Law, we are able to offer to practices up to one hours’ free advice on the following:
If any practice would like a copy of any of the template documents listed please contact the LM
Where LMC Law is instructed to produce work falling outside of this retainer, in respect of Suffolk LMC constituents, then fees shall be quoted on a fixed and discounted basis.
As required by the Pharmaceutical Regulations 2013, Suffolk Health and Wellbeing Board (HWB) are preparing to publish a revised Pharmaceutical Needs Assessment (PNA) by 1st October 2022. The Draft PNA is now ready for consultation and can be viewed at https://www.healthysuffolk.org.uk/uploads/Suffolk-draft-pna-2022.pdf .
The consultation period is Tuesday 19th April and Saturday 18th June 2022.
We would urge dispensing practices (listed in appendix A page 136 onwards) to check the details for the practice are correct. Practices who wish to make comments can do this via Suffolk 2022 PNA Consultation.
DPA between Provide and Surgeries – Call/Recall service for NHS Health Checks
Suffolk LMC has still not been able to sign off the NHS Health checks call/recall data processing agreement (DPA) and we continue to await amendments to the document following comments raised by our legal retainer LMC Law. As such if your practice uses this service from Provide, we would suggest continuing to hold off signing up to the NHS Health checks ES until this has been satisfactorily resolved.
Later Life GP Group
A later life (defined loosely at 50+) GP WhatsApp group is now in operation across Suffolk with the aim of supporting and linking grumpy old GPs who wish to discuss golf and how they wished they had been a banker. Access is via email to info@thegphub.org
Practice Vacancies
Can be found on the LMC Website http://www.suffolklmc.co.uk/jobs
