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Included in this edition:
Information, Guidance and News
QSSP
GP contract changes guidance
Following the announcement of the GP contract changes for 2023/24, which were imposed on 1 April, BMA have updated the guidance explaining what it means for practices. The changes are in the following areas:
Note that the changes on ‘access to general practice services’ have not been laid before Parliament yet and ICBs will therefore not have sent contract variations to practices. This means the changes have not yet come into effect. GPC will share further information on this imposed contractual change as soon as it is available.
In the meantime Suffolk LMC advises that practices may wish to consider the conundrum between the impending contractual change that requires patients be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice, and that of IIF ACC-08 that sets targets around the percentage of patients whose time from booking to appointment was two weeks or less (5%/90%/98%). There is currently no facility to exception report those patients who clinically require appointments at a date beyond two weeks although we understand this may be in place next year. Practices may wish to consider therefore the work involved in achieving the IIF target (around 22 points and worth around £4350 for the average PCN) against the financial gain from doing so.
GPC are asking for practices’ feedback – evidence of the negative impact of imposed 23/24 contract changes
In the regular engagement sessions with LMCs, GPC are already hearing of issues relating to unresourced increased costs for practices, e.g. relating to cloud-based telephony. These issues need to be fed back to GPC so they can be collated and shared with the DHSC and NHS England as a body of evidence against their ill-advised imposed changes. Please email your evidence, as well as any other feedback you may have, to feedback.gpcontractimposition@bma.org.uk
Read more about the 2023/24 GP contract changes on the BMA website
Wellbeing and stress awareness month
The contractual changes imposed by NHS England on 1 April do nothing to recognise the pressures that GPs are under and was a failed opportunity by the Government to support GPs, their practices, staff and patients. April is stress awareness Month, and GPC have been working hard to highlight the stress GPs face to the public. Read the chair’s response to this heartfelt blog from an anonymous GP in The Guardian, and a similar letter was also published in The Times.
GPs are being forced into a position where they worry about the care their patients are getting, which adds to their stress. The recent study on the impact of COVID-19 on GP wellbeing showed that the pressures GPs faced during the pandemic have had a negative effect on their wellbeing. The study also highlighted that if GPs continue to face stress and burnout, more GPs could leave the profession, threatening patient care and the need to focus on supporting GPs to prevent this and to improve their working lives.
UEMO’s response to the recent WHO Bucharest declaration the health and care workforce on what is needed to help health services meet demand, also highlights the importance of properly resourced and supported primary care for continuity of care and improved health outcomes. The present crisis is severe that we recommend all GP practices to take some time to meet to reflect on their wellbeing and what they can do to protect it during Stress Awareness month.
To help manage your stress, we encourage you to use the new QOF targets in the GP contract to do your quality improvement project on staff wellbeing. GPC has put together a document (also attached) which can help guide and inform your project, which includes some tangible recommendations and tools for improving workload and safe working.
Practices are encouraged to continue to use the safe working guidance to enable them to prioritise safe patient care, within the present bounds of the GMS contract.
Wellbeing resources
Self-care is more important than ever for the demoralised and over worked GP profession. If you are feeling under strain the BMA can help, read an account on how the BMA supported an overworked doctor and find out how the BMA can support you during #StressAwarenessMonth.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s wellbeing support services page for further information and resources.
GP workload management and triage toolkit
As there is currently no standardised triage system for GP practices to help with the increasing workload, the BMA have developed a tool to support practices with implementing a triage system if they wish to do so.
The toolkit aims to provide a cost neutral aid to reduce the administrative burden on staff members, ensure patients are seen by the right clinician at the right time and allow GPs to spend their time where it is needed the most. This toolkit will not apply to all practices, but provides a number of case studies, along with examples of how you can tailor the system to your practice.
Exploring safe working in general practice: how we triage
With the news that the impending contract imposition is going to require practices to assess the need for every contact made each day, triage systems are going to become increasingly important. It’s not yet clear if this requirement is even achievable but we also know that GPs will be faced with patients armed with the news of this change, so the tide is coming. Read the blog by GPC member James Booth
Life time allowance scrapped
At the recent budget announcement the Government has finally taken meaningful steps to address the impact of punitive pensions taxes by scrapping the lifetime allowance that means doctors will no longer be forced to retire early because of pension tax.
The additional rise in the annual allowance to £60,000 will mean that far fewer doctors will face large, unexpected tax bills and will significantly reduce the perverse incentive to reduce hours.
This is a significant win for the BMA and the BMA’s pension committee has campaigned extensively for the Government to provide a fix to the pension crisis that has left a significant number of doctors with no option but to retire early or reduce their hours. This will help us to retain the most senior doctors who have a pivotal role to play not only in providing care for patients but in teaching and mentoring junior colleagues.
However, it doesn’t address all the issues and the BMA will be continuing to support those doctors who continue to be impacted by big pension tax bills, including those affected by the tapered annual allowance, and will aim to work with the Government to find appropriate solutions to address this.
Read the press statement here
General practice pay declaration: guidance
NHS England has now published guidance setting out which individuals are required to make a pay self-declaration and outlines the definition of NHS earnings for the purpose of the general practice pay declaration. It also explains the process of making the self-declaration and how the data collected will be used. It could affect contractors, salaried GPs, self-employed locums and those employed through third party providers.
GPC England is opposed to this policy, believing that it will increase the risk of abuse on of GPs and practice staff. This may also lead to further GPs leaving the profession which will harm patient care. GPC have repeatedly lobbied for this policy to be reversed. It is recommended that all GPs read our read the guidance which is in the process of being updated.
See Suffolk LMC guidance note on pay transparency here
Guidance on HRT Pre-Payment Certificate (PPC)
The government has a new policy effective from 1 April 2023 to support patients having menopausal symptoms with the cost of treatment. Patients who are not already exempt from NHS prescription charges will be able to purchase an annual HRT Pre-Payment Certificate for the cost of two single prescription charges – £19.60. This will only be valid for HRT preparations published in the Drug tariff Part XVI. These drugs can be prescribed for any clinical reason and still qualify for the HRT PPC.
The amended regulations require the script for HRT be issued separately from non-HRT items (whether paper or EPS). GPCE supports the Government’s decision to make HRT medicines more accessible to patients at reduced cost, but it is considered that the introduction of this new prepayment certificate, specifically for HRT medicines, is too complex. It is disappointing that despite GPC advice, the DHSC has decided to proceed before the IT for automatic separation of prescriptions is ready, in contravention of the bureaucracy concordat, which they agreed to only a year ago. From 1 April, new FP10s will be introduced with a box ‘w’ for HRT PPC, but old stock can continue to be used with the patient selecting box ‘f’ general PPC and the dispenser checking for valid HRT PPC.
When applying for the HRT PPC patients will be advised that they must inform the practice/prescriber that they hold an HRT PPC and ask that the script be issued separately.
Pharmacy Contractors and dispensaries may either:
GPCE recommends that GP practices and LMCs should discuss with their local pharmacies and LPCs about local approaches to this guidance. GPC will continue to work with DHSC and system suppliers to ensure a digital separation solution is in place as soon as possible.
The patient can choose to apply for an HRT PPC backdated for up to 1 month. If they have not yet applied the pharmacy can issue a FP57 refund form. Patients who already have a valid 3 or 12-month pre-payment certificate for all their prescriptions will not need an HRT PPC. For patients that are stable on HRT it is recommended to issue via repeat dispensing at review, with one authorisation to cover a 12-month period, thus ensuring HRT is issued on a separate prescription.
The items included all contain oestrogen/progestogen or both as listed in DHSC guidance. Other medications sometimes used in menopause are not included and would need to be paid for as normal. For further information and guidance for dispensaries see the full DHSC guidance.
Medical Examiners
The new medical examiner system continues to be rolled out across England and Wales. While initially supportive of the increase in scrutiny of deaths, the BMA continues to have concerns around the system and its implementation. In England, the roll-out is expected to take place at a local level, with the risk of inconsistent decision making and unequal support for practices.
There is currently nothing within the GP contract requiring doctors to interact with this system. The role of the medical examiner has been created through the Health Care Act, however the way the medical examiner system is expected to operate is not currently subject to legislation (it is expected this will change in the next 6-12 months).
DWP Special Rules update
From 3 April 2023, individuals who are likely to have less than 12 months to live can now claim PIP, DLA, AA, UC and ESA via the Special Rules. For more information: www.gov.uk/dwp/special-rules
New to partnership scheme (N2PP)
The N2PP scheme was introduced in July 2020 for an anticipated two years. In December 2021, NHS England extended the scheme into 2023. GPs and other clinical staff intending to apply for the scheme need to have entered into an equity partnership by 31 March 2023 to be able to submit an application by 30 June 2023. Find out more about the application process online or email england.newtopartnershipenquiries@nhs.net
A Reminder about LMC Buying Group Membership
The LMC Buying Group helps GP practices save money on products and services they regularly buy. The Buying Group have negotiated excellent discounts on a wide range of products and services from their approved suppliers.
Buying Group membership is completely free and there is no compulsion to use all the suppliers. They do the hard work associated with finding the most competitive suppliers in cost and customer service, so they save you time as well as money on your purchasing!
Although the Buying Group was originally set up to help GP practices save money on the products and services they regularly buy, membership is now also open to GP Federations and Primary Care Networks.
Why use the Buying Group?
If you’re not sure whether you’re a member and/or have access to the Buying Group website (this is where you can view the pricing/discounts and get quotes) then contact the Buying Group team on 0115 979 6910 or info@lmcbuyinggroups.co.uk. They can also help you with any questions you might have about your membership or the suppliers.
One Life Suffolk – changes
Please find attached the latest briefing for GPs and primary care teams about changes to the adult weight management service offered by OneLife Suffolk. Further updates will follow.
Spirometry
Just a reminder that the relevant form to refer into this service is on the DXS
Practice Vacancies
Can be found on the LMC Website http://www.suffolklmc.co.uk/jobs
