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Key Matters reviewed by the Committee December 2020
Key topics of discussion:
The LMC has been approached about putting on some training for PCNs – please do get in touch with your suggestions for what topics you would like to cover christinewatts@suffolklmc.co.uk
Sharing Challenges & Finding Solutions The Development People 13.1.21 @12 noon
HR Update LMC Law late Jan 21 TBC
To increase the speed in which care home residents can be provided with protection from COVID-19, NHSEI has agreed to increase the payment to support the additional time and resource needed to deliver the COVID vaccine to care home residents in the care home setting. There will now be a supplement of £10 per dose on top of the current £12.58 Item of Service fee, for COVID vaccines delivered in a care home setting. The supplement will be payable on completion of the second dose for all vaccines administered between 14 December 2020 and 31 January 2021.
Where exceptional circumstances (as defined in the enhanced service specification) mean that only one dose was able to be delivered, and this dose was delivered on or before 10 January 2021, the supplement will be payable on the first dose only. Further detail of the reporting and payment arrangements will follow shortly.
Concern is already been expressed by LMCs around the country that the claiming window is unnecessarily restrictive. This is being fed back to the GPC negotiators.
Last week a small number of practice groups piloted an approach to deliver the vaccine in care home settings using a roving model. NHSEI are now expanding this rapidly across England to deliver an increased number of vaccinations in these settings as soon as possible.
Where practice groups require additional staffing support, they have been asked to liaise with their CCG and local lead employer as soon as possible detailing the types of workforce required and the time periods it is required for. NHSEI are also asking lead employers and regions to identify staff recruited to support the delivery of the vaccination programme locally to provide support. In addition, they expect community trusts to support short term deployment of staff to support vaccinations of these residents and that these staff are paid by their normal employer for the work undertaken, be this as part of their normal substantive pay arrangements or bank pay if they are an ad hoc worker. In all circumstances the local employer pay and terms and conditions should apply. Funding will be made available and distributed to providers locally for work undertaken to support this. There will be no recharging arrangements to primary care specifically for work related to care home vaccinations. The letter outlining these arrangements can be found here.
The LMC is currently in discussions with EPUT about providing HR support to practice groupings who seek to enable volunteers with a clinical background to work as vaccinators and administrators.
The COVID-19 vaccination programme SOP has been updated and now includes information about the use of the 6th dose in a vial and the details practices will need to start vaccinating care home residents. Earlier this week NHSEI delivered vaccine through some wave 1-3 local vaccination sites to care home residents and their staff, starting with larger care homes. A letter has been sent to waves 1-3 sites with further details. Practices can order packs of 75 doses to take straight to their care homes.
All the NHSE/I guidance about the CVP can be accessed here. The GPC England guidance about the COVID-19 vaccination programme is also regularly updated.
MHRA have produced further information on the 6th dose of the COVID vaccine and how this can be used. Consumables to support the use of the additional dose will be sent directly to designated sites and added to second dose deliveries. Healthcare professionals must always use the correct volume of diluent, and after dilution must aim to secure five full 0.3ml doses of this Pfizer-BioNTech COVID vaccine in line with the manufacturer’s instructions and as outlined in the Information for Healthcare Professionals. After that has been done, there may be potential for a sixth full dose with some vials due to variances in fill volume and the syringe/needle hold up volume combinations used. This should be subject to health care professional judgement on a case by case basis.
The manufacturer has stressed care should be taken to ensure a full 0.3 mL dose will be administered to the patient from the same vial. Where a full 0.3 mL dose cannot be extracted the contents should be discarded. The vaccine does not contain a preservative so it is best practice for all doses to be used as soon as possible after dilution, although all doses from a single prepared vial must be administered within 6 hours of the time of dilution.
It is the view of the LMC that the current income protection & workload prioritisation measures do not go far enough in supporting practices delivering the COVID vaccination programme. We continue to press both CCGs on this matter.
GPC are in discussion with NHS Digital to resolve the current inability to electronically transfer information about COVID-19 vaccinations given in to EMIS patient records. EMIS and NHSD are currently deploying a mechanism for this to be done automatically and this should go live in January. Until then practices do not need to manually process this information. If they do file this they should follow the advice from EMIS on the key qualifiers that need to be manually added. Once the automatic arrangement is deployed it will duplicate this information and it is possible that the practice entered information may be disregarded. The clinical safety processes are currently being worked through and more information will be provided as soon as possible.
NHSEI have written to local commissioners (see letter here) setting out further information on the contractual options and processes that can be deployed to support vaccination of the registered patients of non-participating practices; and across all care homes, even if the lead PCN grouping for the care home has not signed up via its member practices to the COVID-19 Vaccination Programme Enhanced Service or is signed up but has not yet mobilised to commence vaccination. They have also produced a template letter to be used by CCGs which can be viewed here .
The GP Standard Operating Procedure has been updated and republished to reflect some of the changes. The new or amended sections are highlighted throughout the document.
Shielding has been reintroduced in Tier 4 areas in England, and as a result DHSC will be sending texts to patients on the Shielded Patient List in these Tier 4 areas. This is to ensure affected patients receive the right guidance quickly. This text will be sent from GOV.UK and texts are expected to start being sent today.
The Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service has again been commissioned in accordance with the home delivery of medicines and appliances during the COVID-19 outbreak: service specifications and guidance for all patients on the Shielded Patient List living in tier 4 areas from 21 December 2020 until 18 January 2020. All pharmacies and dispensing doctors in England will again be required to ensure patients on the Shielded Patient List receive their medicines at home.
Patients who are Clinically Extremely Vulnerable (CEV) should be encouraged to attend practice vaccination sites. It may be necessary to enable family and/or carers of those who are CEV to be allowed to come along to sites but may be asked to wait outside (if possible). If patients are unable to attend the site their COVID-19 vaccination will need to be organised later in the programme.
The West Suffolk Hospital has discovered that some discharge summaries sent via MESH (rather than as emailed pdfs) have inappropriately truncated free text areas – particular where junior medical staff have copied & pasted content. It is not yet clear how many discharge summaries are affected or what, if any, remedial action is required.
As part of the 5 year GMS contract agreement in England, there were plans to merge the two access schemes from April 2021 – the extended hours scheme and the extended access service that provides services in all areas on evenings and weekends. This would transfer the responsibility and funding from existing providers to PCNs. Some PCNs already deliver both services, either individually or working together with others across their area and have found this a way to help manage daytime workload pressures by making better use of the extended access appointments.
In view of the current focus on the COVID pandemic and vaccination programme, GPC England have encouraged NHSEI to delay this change, unless a PCN wants to progress with it. NHSEI have agreed and will be writing to commissioners this week to say that the national transfer of responsibility be delayed until April 2022 and local arrangements should remain in place until then. They will also underline that existing local capacity can be used for COVID vaccination delivery.
NHSBSA has been requested by NHS England and NHS Improvement to deliver a national post payment verification process regarding flu vaccines for the 2020/21 season. This is to ensure DHSC supplied and locally procured stock is correctly claimed for as was communicated through the DHSC guidance on accessing the government-secured flu vaccines for GPs. See letter from BSA outlining what will be involved here
CQC have been commissioned by DHSC to review Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions during the coronavirus (COVID-19) pandemic. This included reviews in 7 CCG areas. They have now published their methodology which can be seen here.
For awareness, Richard Vautrey recently wrote to Matt Hancock calling for an immediate suspension of all CQC inspections and reviews of general practice (other than those required for serious safety issues) for the duration of the pandemic to enable practices to focus on other priorities, not least the COVID-19 vaccination programme.
The LMC is working with the Safeguarding Leads at the CCGs to explore ways that the process can be streamlined where assessments for mental capacity is relevant. The LMC will report back in the New Year after a planned meeting has taken place early in January.
The guidance for claiming reimbursement for PPE for non-hospital providers, including general practice, has now been published. Claims may be made for COVID-19 PPE purchased from 27 February to 31 December 2020 for use in delivery of NHS clinical services. There will be no further entitlement to reimbursement for PPE purchased after 31 December 2020 as this can be obtained free of charge from the DHSC portal.
Following significant pressure by the BMA, NHS England and NHS Wales introduced the annual allowance repayment scheme last year, which guarantees that any annual allowance tax charge in 2019/20 for eligible clinicians will be compensated for at the time of retirement.
If an eligible clinician who is a member of the NHS England and Wales pension scheme incurs an annual allowance tax charge, they must elect to pay this via scheme pays. The formal scheme pays deadline is 31 July 2021, however, members are encouraged to complete the forms as soon as possible, preferably by 31 December 2020 (to minimise any interest applicable).
As the deadline is fast approaching, and to help members, the BMA has produced a template letter, to be submitted alongside the scheme pays election form. You will then need to complete the 2019/20 Annual Allowance Charge Compensation Policy Form. Find more information on how to apply, as well as resources for employers, FAQs and infographics, on the NHSE/I website.
Read more in this update from the BMA’s Pensions Committee and the guidance on annual allowance repayment scheme on the BMA website.
The GMS regulation (England) amendments for recording of ethnicity information have been laid and will come into force from 1 January 2021. This follows the significant impact COVID-19 has had on BAME people and the need to have better quality data to support the most effective healthcare planning.
This amendment places a requirement on practices to record ethnicity data provided by a patient when a practice ask for this. Read the Statutory Instrument and the Explanatory Memorandum here.
Just a reminder to practices to send in their claims for reasonable expenses incurred as a result of the Roche issue to the CCGs – invoices for the I&ESCCG should go to Claire Pemberton and for the West, Lois Wreathall.
Some concerns have been raised by practices about the Cancard UK website and its proposed ‘GP endorsed’ ID card. The website offers the ability to apply for: ‘A holographic photo ID card. Designed in collaboration with GPs and verified at the patient’s surgery. The card is for people who qualify for a legal prescription but are unable to afford one.”
Applications are said to have opened on 1 November 2020. The Medicinal Cannabis holographic photo ID card is being offered by Cancard UK to patients who meet the following criteria:-
The BMA and RCGP supports the use of ‘cannabis-based products for medicinal use in humans’ under the supervision of specialist clinicians or prescription of MHRA authorised licenced products by doctors who have the necessary clinical experience and competences.
These products must have been produced in accordance with the necessary standards for the production of medicinal products in the UK in order to ensure their safety and authenticity. The BMA & RCGP also supports the call for further research into the safety and potential indications for use of these medical products. The BMA & RCGP cannot however support the use of the Cancard, nor the suggestion that UK registered GPs sign a declaration confirming a diagnosis in order for the card to be issued.
The Cancard UK website states that the Cancard has been designed in collaboration with GPs, but neither the RCGP nor BMA have been formally consulted or given endorsement. Whilst there is sympathy with patients who struggle to pay a private prescription charge, it is not believed that this is a justifiable reason to encourage the purchase of unregulated unlicensed cannabis products from unregulated or illegal dealers. If a patient is deemed to meet the criteria for an NHS prescription for an MHRA authorised prescriptible product then this may be issued where appropriate. Those patients on low incomes or with medical conditions qualifying for prescription charge exemption will be exempt from prescription charge in line with current regulations.
Read the BMA guidance on Cannabis-based medicinal products here
Read the RCGP clinical guidance Cannabis-based medication: an interim desktop guide
Please see stakeholder briefing here from Steve Dunn CEO of WSHFT identifying Hardwick Manor as the preferred site for a new health and care facility.
With very best wishes from the LMC for Christmas & New Year and hoping that everyone gets to have a well-deserved break for a few days…
