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August / September 2020 Newsletter
Thursday 1st October 2020 in Suffolk LMC Newsletter
Included in this edition:
- Announcement of Medical Director
- GMS and PMS regulations changes from October 2020 (England)
- NHS England/Improvement “Third phase of NHS response to COVID-19”
- QOF 2020/21
- EPS and Secondary Care
- Flu Campaign 2020-21
- Vaccine supply for the 2020 to 2021 children’s flu programme
- PPE portal
- Indemnity for flu vaccinations
- Health and care workers to self-isolate on return to UK from high-risk countries
- Appraisal 2020
- Supporting Mentors Scheme and GP Fellowship programme (England)
- DVLA – Section 88 of the Road Traffic Act 1988
- PCN Workforce Plan – ARRS
- Covid Support Fund
- DSQS
- Local Authority Enhanced Services
- NHS Pension Scheme – sessional & locum GPs
- Practice Vacancies
Key Matters reviewed by the Committee August 2020
The committee does not meet formally in August however liaison meetings with both the CCG, hospitals and ICS continue.
Key topics of discussion have been:
- The waiting list backlog at the hospitals and the inconsistencies in how the different departments are dealing with this; the lack of patient portal to liaise with the hospital directly; the continuing increase in the transfer of unresourced workload from hospital to primary care.
- Re-starting the health system (including extended hours)
- The flu campaign 2020/21
- Shared Care Drugs LES (West)
Announcement of Medical Director
Announcement from Simon Jones, LMC Chief Executive:
Due to family commitments I have decided to reduce my working days to Tuesdays and Wednesdays with effect from 1st September, this has allowed the LMC to recruit a Medical Director who will work on Thursdays and Fridays. I am pleased to announce that Dr Peter Smye will take up the LMC Medical Director role from 3rd September 2020.
GMS and PMS regulations changes from October 2020 (England)
The amendments to GMS and PMS regulations in England from October have now been published. These mainly bring into force elements of the GP contract agreement from earlier this year. The amendments include:
- Requirement for monthly data submissions to the NHS Digital Workforce Collection
- Requirement to participate in the existing GP appointments data collection
- Requirement for practices to ensure patient registration data is regularly updated
- Removal of patients who move outside of the practice catchment area: the practice is responsible for the patient’s care for up to 30 days (unless and until the patient registers at another practice) but is not responsible for home visits or out of hours services during that period.
- A modification to make sure that patients who have previously been removed from a practice list and been put onto a violent patient scheme cannot be permanently refused readmission to a practice list if they have been correctly discharged from that scheme.
- Patient assignment to any practice within the patient’s local CCG, rather than within the practice area.
- Patient assignment as part of a list dispersal
- An exemption to the ban on subcontracting a subcontract in order to allow PCNs greater flexibility to deliver the DES
- Final cancellation of CQC registration is a ground for termination of a GMS contract
- Other minor amendments to wording without significant change to the meaning
NHS England/Improvement “Third phase of NHS response to COVID-19”
NHSE/I recently released their Third phase of NHS response to COVID-19 letter. This highlights the priorities for the NHS as a whole, including accelerating the return of non-Covid services, in particular cancer services, and Trusts are asked that they should ensure, working with GP practices, that every patient whose planned care has been disrupted by Covid receives clear communication about how they will be looked after, and who to contact in the event that their clinical circumstances change.
Much of the focus of the LMC liaison with the CCGs and hospitals is currently around the increasing trend of transfer of workload from secondary to primary care, the changing of pathways without consultation plus the lack of facility for patients to be able to make a direct enquiry with the hospital where their referral is sitting in a ‘backlog’.
In the meantime, the BMA link below provides a range of template letters for various scenarios of workload transfer to push back on unfunded transfers of workload.
The NHSE letter also talks about restoration of primary and community services being seen as a priority and the encouragement to focus on childhood and flu immunisations, cervical screening, building on the enhanced support practices are providing to care homes and reaching out to clinically vulnerable patients and those whose care may have been delayed.
CCGs are being asked to work with GP practices to expand the range of services to which patients can self-refer, freeing-up clinical time. All GP practices are now expected to offer face to face appointments at their surgeries as well as continuing to use remote triage and video, online and telephone consultation wherever appropriate – whilst also considering those who are unable to access or engage with digital services.
The letter also requests that organisations achieve 100% of patients coded for ethnicity by 31st December 2020. The CCGs have written to practices to request this work is carried out. For some practices this extends to an onerous piece of work and the LMC is liaising with the CCGs to establish what manpower/financial support is available to assist practices to undertake this extra-contractual activity.
QOF 2020/21
QOF NHS England have now published revised QOF guidance which details the requirements for 2020/21. This includes detail of the following:
- The points and payment changes for the four flu vaccination and two cervical screening indicators;
- The indicators which will continue to be paid on a conditional basis;
- The refocused requirements for the Quality Improvement domain to support the restoration of key services to people with a learning disability and early cancer diagnosis;
- The indicators which will be subject to income protection arrangements and the conditions upon this income protection.
This guidance is effective immediately and the Statement of Financial Entitlement will be amended shortly to reflect this. You can access full QOF guidance here
EPS and Secondary Care
GPC and the Consultants Committee have written to Steve Powis at NHSEI to suggest EPS is extended to secondary care along with some other solutions that might better support workload management across primary and secondary care. They are due to meet with NHSEI shortly to discuss this further.
Flu Campaign 2020-21
NHSEI have now published the updated flu & pneumonoccal DES specification for 2020/21 – the document can be accessed here. It has a number of changes to the earlier version and expands the eligible groups with potential further expansion later in the year. In addition, when offering vaccination to eligible patients, practices are asked to request the patient/carer advises the practice of their ethnicity status (if not previously recorded) and record it in the patient record. Many practices will have already issued invitations to patients and the view of the LMC is that it would be unreasonable given this late change to the specification to issue a second invitation. Commissioners will invite practices to participate in the 2020/21 Flu DES before 7 September 2020 and practices will need to respond no later than 14 September. Additional BMA guidance and NHS England FAQs will be published shortly.
This year’s flu programme is destined to be the most challenging yet with the expectation that the number of vaccinations may well be double that of the previous year – together with the added complexity of doing this at a time with the increased threat of Covid19 and needing to factor in measures around social distancing and using PPE to protect patients and staff.
Wessex LMC has kindly made available to us a range of resources to help practices in planning the campaign:
- Top Tips Booklet for flu vaccination 2020/1 https://www.wessexlmcs.com/flu202021toptipsbooklet
- The Wessex Flu Vaccination Guidance 2020 – this provides detailed guidance about this years’ Flu Vaccination programme and contains some suggestions for practices. Wessex Flu Vaccination Guidance 2020.
- The Flu calculator – this is an Excel spreadsheet which will allow practices to enter their data such as list size, numbers in the various at risk groups, including the shielded group and children. This will help practices with their planning and the capacity they will need. https://www.wessexlmcs.com/flu202021theflucalculatorandoverviewguidance
- A summary overview in PowerPoint https://wessexlmc.sharepoint.com/:p:/g/ESdbjKmhXTRAmCVoyIFlWJ0BVIEczWJgap5dGP1vvNHZsw?e=wj6Thc
- Winter Flu Vaccination – practice premises check list https://wessexlmc.sharepoint.com/:w:/g/ERi228lIgS5Av1LK5wFriJwB2y3Mhx0mLl2JSlFuJgrqlg?e=kHEpDa
- Drive Through – options check list https://wessexlmc.sharepoint.com/:w:/g/EcO_BHixdPdMtvifnoroSXABGPI_KDx3gFZEIIK93811rQ?e=65TSGW
Other useful resources below from RCN and RCGP:
Vaccine supply for the 2020 to 2021 children’s flu programme
The Fluenz Tetra vaccine will be made available to order by all NHS providers of the 2020/21 children’s flu programme on Friday 28 August. First deliveries will be made on your normal scheduled delivery day, beginning on Wednesday 2 September.
The inactivated vaccine (QIVe) for children in clinical risk groups for whom LAIV is unsuitable will be available to order from ImmForm by early September.
These timings remain subject to change and plans for vaccination sessions should be made with this in mind. Any changes to this schedule will be communicated on the ImmForm website and PHE Vaccine Update.
PPE portal
Practices are reminded to register and place orders for PPE via the PPE portal, to ensure regular free supplies of PPE in advance of the winter and flu campaign. More information is available on the DHSC PPE portal guidance page and the portal customer service team can be reached on 0800 876 6802 for enquiries or registration support.
Indemnity for flu vaccinations
All three Medical Defence Organisations (MDOs) have confirmed that they will provide indemnity cover, at no extra charge, for practices who vaccinate their own staff against flu this year. GPC are in discussions with NHSR about the indemnity arrangements for staff vaccinations for any coronavirus vaccine that may become available.
Health and care workers to self-isolate on return to UK from high-risk countries
The Department of Health and Social Care has announced that registered health and care professionals travelling to the UK from high-risk countries will be required to self-isolate for 14 days. The BMA have published guidance and advice for doctors planning to travel to or from countries that are considered a COVID-19 risk.
Appraisal 2020
Following the suspension of appraisals at the end of March due to the COVID-19 pandemic, NHSE/I has together with the Academy of Medical Royal Colleges, GMC and BMA, agreed to a rebalanced approach that focuses on the doctor’s professional development and wellbeing, and simplifies expectations around supporting information and pre-appraisal paperwork.
The appraisal will be simplified as far as possible, and NHSE/I has written to responsible officers asking them to take a flexible approach, aiming to begin reinstating appraisals by 1 October, with a view to resuming normal levels of activity by 1 April 2021.
The BMA have been in discussion with NHSE/I to ensure the planned restart is not overly disruptive for practices while allowing public confidence to be maintained, and it is encouraging to see the significant simplification of the requirements and the reduction in paperwork, which allows both appraisers and appraisees to focus on treating patients rather than bureaucracy. This slimmed down system is a step forward in empowering doctors to use their appraisal to reflect on their professional development, and forms part of a wider drive by the BMA to reduce bureaucracy.
Read more about ‘Appraisal 2020’ on the Academy of Medical Royal Colleges website here
Supporting Mentors Scheme and GP Fellowship programme (England)
Following the 2020/21 GP contract agreement, NHSE/I has now launched the Supporting Mentors Scheme and GP Fellowship programme, as part of a group of GP recruitment and retention initiatives.
The supporting mentors scheme aims to support the training of at least 450 GPs as mentors, who will then form a cohort of locally based and highly experienced doctors who can each support between 4-6 mentees. GPs on the scheme will be provided with funded training, leading to a recognised mentoring qualification. Once trained, GP mentors will be reimbursed to conduct one session of mentoring every week.
GP mentors will be able to connect with newly qualified doctors on the GP Fellowship programme and to support them into become part of the local primary care team.
NHSE/I has also recently published a letter about Expanding the primary care workforce in 2020/21, which highlights the New to Partnership Payment Scheme, to support practices to recruit GP partners, and highlights the inclusion of nursing associates to the Additional Roles Reimbursement Scheme.
DVLA – Section 88 of the Road Traffic Act 1988
During COVID many driver’s licences have expired and DVLA gave extensions so that they could continue to drive and work. For many this extension is coming to an end and drivers are now being told by DVLA to ask their GP if they are “fit to drive” so that they can continue to drive under Section 88 of the Road Traffic Act 1988 (RTA 1988). DVLA has produced a leaflet which explains RTA 1988.
Many GPs may not feel confident to advise patients whether they are fit to drive or not, and in normal circumstances a factual report would be supplied to the DVLA so that their expert medical advisers can decide upon fitness. If an opinion is provided that someone is fit, and then an accident occurs, questions may be raised around the judgement of the GP. If the GP states the patient is not fit, then this can adversely affect the long-term relationship with that patient. For these reasons, if there is any doubt about whether a person is fit to drive, the GP should decline to provide this assurance, and should write to DVLA explaining that an opinion cannot be given but offer to provide factual information about a person’s health.
Practices may wish to have an explanatory note on their websites or noticeboards, so that patients are forewarned that this is the practice policy.
PCN Workforce Plan – ARRS
PCNs will have sent in their workforce plans to the CCGs at the end of August. The CCG finance team will calculate from the returns if there is any unspent funding. If there is an underspend this will then be offered to PCNs to bring forward their recruitment plans for next year. The CCGs are, however, not anticipating that there will be an underspend.
Covid Support Fund
The recent letter from NHSEI to GP practices confirms that extra funding will be available for practices to submit claims to their CCG for extra costs incurred as a result of the Covid-19 pandemic (to include staff and non staff costs) – unless this has already happened by local agreement. See detail here. Practices will note that this is only for costs incurred up to 31st July 2020. However, the pandemic is far from over and costs have continued after this date. The LMC understands that the CCG will be reviewing the potential for additional support once the current claims have been assessed.
DSQS
NHEI previously confirmed that the DSQS would be reinstated from 1 August 2020. Income protection arrangements have been in place for the period between 1 April 2020 and 31 July 2020. Following discussions with BMA, the Scheme’s requirement in relation to patient medication reviews this year have been revised.
The Scheme normally requires dispensing practices to undertake medication reviews for at least 10% of their dispensing patients. This requirement has been reduced to a minimum of 7.5% this year in the light of the current circumstances. Practices are asked to prioritise patients who they consider to be higher-risk or would benefit most from a review. Practices will also be able to undertake these reviews remotely if they wish and it is clinically appropriate. The Statement of Financial Entitlements (SFE) will be amended shortly to reflect this. The other requirements of DSQS remain the same.
Practices will note that commissioners are expected to take a supportive approach to DSQS given the current circumstances. This includes taking a proportionate approach to the requirement for practices to partake in one clinical audit of dispensing services and have due regard to the impact of Covid-19 on practices’ training plans.
Local Authority Enhanced Services
One Life Suffolk will continue to pay ‘average’ activity payment for smoking cessation for Q2 (July-Sept).
The LA public health department have agreed to pay ‘average’ activity payment for health checks only for the month of July 2020 with the expectation that Health Checks will re-commence from 1st August. However, it is noted that ACE have not yet commenced call/recall invitations and therefore it is likely that practices will have little opportunity to achieve much activity for the whole of Q2 – a point much laboured by the LMC in our discussions with the public health team. Thereafter with the commencement of the flu campaign with its additional challenges this year we have stressed to public health that practices may well be unable to prioritise health check activity over the winter pressure period.
NHS Pension Scheme – sessional & locum GPs
Dr Krishan Aggarwal, a GPC England and Sessional GPs Committee member, and deputy chair of the BMA Pensions Committee, has written a webpage for sessional and locum GPs on the NHS pension scheme, which replaces his previous blogs on this issue.
The webpage is going to be a live document and if there is anything you would like to be covered please email Sessionalgps.gpc@bma.org.uk . The guidance sets out which pension tier to use, submitting the right forms, annualisation, the total rewards statement (TRS), the upcoming the upcoming PCSE portal and how to escalate complaints to PCSE. The webpage is https://www.bma.org.uk/pay-and-contracts/pensions/being-a-member-of-a-pension-scheme/the-nhs-pension-scheme-as-a-sessional-gp