December 2021 Newsletter

Included in this edition:

  • Impact of COVID-19 omicron variant and vaccination deployment
  • Temporary GP contract changes to support Winter pressures and the COVID-19 Vaccination program 
  • Updates to the Network Contract DES
  • Amendments to the Enhanced Service Specification for Phase 3
  • NHS pressures and joint workload prioritisation guidance
  • Infection prevention control guidance
  • Responding to vaccination data queries
  • Recording overseas vaccinations in the National Booking Service
  • MHRA approval of Pfizer/BioNTech vaccine in 5 to 11-year olds
  • Covid Vaccine Defaulters – employees
  • Proof of vaccination for those age 12 and upwards
  • New to Partnership Payment Scheme (N2PP)
  • Firearms licensing guidance
  • Private provider requests for investigations under the NHS
  • Prescription charge waiver for COVID-19 antivirals and therapeutic clinical trials
  • PCSE update relating to GP payments and pension
  • New injectable lipid lowering medication: Inclisiran 
  • PCSE patient list validation requests
  • Application window for 2019/20 Pensions Annual Allowance Charge Compensation Policy
  • New annual leave guidance for employers of salaried GPs
  • Supporting general practice
  • Practice Vacancies

Download here  Suffolk LMC Newsletter December 2021

Impact of COVID-19 omicron variant and vaccination deployment

NHSE/I has published guidance to prepare for the potential impact of the Omicron variant and other winter pressures, and the next steps for the vaccine deployment to ensure the successful ramp up of the COVID-19 vaccine programme.  Practice teams (not only LVS sites) are asked to:

  • Clinically prioritise services to free up clinical capacity that is delivering services which can safely be deferred into the new year, alongside delivering urgent or emergency care.
  • Any patient with an urgent presenting complaint, or potentially serious underlying and unmet clinical need, should be assessed, managed, and referred onwards as appropriate. Increase capacity to the same level or above best day in phases 1 and 2 and consider extending opening hours.
  • GP practices signed-up to the Phase 3 ES should prioritise visits to care homes that have not yet received a visit

To support acceleration of the booster programme, the CQC are postponing all on-site inspection activity for three weeks until the New Year – except in cases where there is evidence of risk to life, or the immediate risk of serious harm to people.

In addition, GPC having successfully lobbied for a temporary suspension of the 15 minute wait for the mRNA vaccine which this has now been announced to allow for an increased amount of vaccinations to be carried out.

Temporary GP contract changes to support Winter pressures and the COVID-19 Vaccination program 

Following discussion with GPC, NHSE/I published a letter announcing changes to QOF and IIF and changes to the COVID vaccination DES. It has now provided further guidance on these changes. 

Given the announcement on QOF and IIF, it is hoped practices will be able to consider how they can support the national vaccination effort while continuing to clinically prioritise patients who need them.  

Updates to the Network Contract DES

Following the letter of 3 December announcing changes to QOF and IIF and the temporary GP contract changes to support COVID-19 vaccination programme, NHSE/I has now updated the Network Contract DES

Amendments to the Enhanced Service Specification for Phase 3

The updated Enhanced Service Specifications for Phase 3 of coronavirus vaccinations has now been published. The amendments include:

  • Extension of eligible cohort to include those aged 16 and over
  • Clarification that where there may be conflicting guidance by JCVI, NHSE, MHRA and UKHSA, NHS England will confirm which guidance shall be adopted
  • Financial supplements and extension of enhanced Item of Service fee to support practices during the national priority booster phase of the ongoing COVID-19 vaccination campaign

GPC had also suggested that NHSE/I make available a reference guide to summarise which vaccines can be given to which groups, and when patients become eligible for a second, third dose or booster, and NHSE/I has shared this chart (available on FutureNHS), which is updated weekly.  

Considering the need to rapidly expand capacity, the MHRA has expanded the circumstances in which the COVID-19 vaccine may be moved from a PCN Grouping’s designated site(s) to another location.

GP practices within a PCN Grouping may move COVID-19 vaccine from their Designated Site to collaborating individual GP practices within the PCN Grouping to increase the possibility of opportunistic administration of the vaccination to increase take up of the vaccine.  Movement continues to be subject to:

  • all requirements and guidance on the movement, storage and handling of COVID-19 vaccines being adhered to;
  • there being no onward movement of the vaccine. For example, it is not permitted for a PCN to transport the COVID-19 vaccine from the PCN Grouping’s designated site(s) to a collaborating individual GP practice and then onto a pop-up site or care home etc; and
  • the arrangements being reflected in the PCN Grouping’s Collaboration Agreement

The NHSE template Collaboration Agreement has now been updated to reflect these changes.

NHS pressures and joint workload prioritisation guidance

Some temporary changes have been made in an attempt to support general practice teams through reducing some of the paperwork.

  • Fit notes (increased to 28-day self-certification)
  • DVLA checks (suspended for all but essential workers – HGV and bus drivers)
  • Firearms licenses (applicants asked to wait until after January to submit, except for urgent – ie needed for work commitments or imminent expiry)
  • Prescription charge medical exemptions (suspend renewals, those due to expire will be extended for 6 months)
  • COVID vaccine exemptions (timeframe for practice processing will be dropped so done to practice timeline)

The emergence of the COVID-19 Omicron variant, with ever increasing demand on healthcare services and rising numbers of staff sickness rates has the potential to significantly impact the delivery of general practice.

Whilst GPs and their teams will do their best to continue to prioritise the care they offer alongside providing COVID-19 vaccines, patients will be understandably be concerned that some appointments will need to be postponed in order to ramp up the booster campaign.

Produced at the request of NHS England to help practices plan their participation in the booster programme,  GPC has worked with the RCGP to update the joint workload prioritisation guide, to support clinicians working in general practice across England to prioritise clinical and non-clinical workload, and to support practices in their planning.  Read the guidance

This follows the announcement of CQC Suspension last week and temporary changes to Fit notes and Certification to support general practice teams with workload and in supporting the vaccination campaign.

Infection prevention control guidance

The national COVID-19 infection prevention and control (IPC guidance) has been updated in light of the rapid spread of the Omicron variant.

While the IPC guidance should act as a further shield against harm – in general practice, as it currently stands, more clarity and support are needed to ensure its effectiveness.  In particular, section 2.1 which now advises: “Where an unacceptable risk of transmission remains, it may be necessary to consider the use of respiratory protective equipment (RPE) in clinical areas where suspected or confirmed COVID-19 patients are being managed.”   

Given what is known to date about Omicron’s high rate of transmissibility, there is continued call for GPs to have access to RPE where needed, particularly as many GP premises lack space and necessary ventilation for suspected COVID-19 patients to be seen in an appropriate and safe setting.  

The Department of Health and Social Care has subsequently confirmed that with regards to primary care access to FFP3, if a local risk assessment has been undertaken and primary care providers have been assessed as needing FFP3, the DHSC’s PPE portal should be contacted with the result of the risk assessment and they will arrange access to FFP3s. Staff would need to be fit tested to FFP3s before the PPE portal can give access to the appropriate masks to which staff have been fitted. 

The LMC has been liaising with Lisa Nobes on this matter and she has confirmed the intention to undertake review of risk assessment in practices in the light of the increased transmissibility of Omicron. 

Responding to vaccination data queries

The Vaccine Data Resolution Service (VDRS) aims to resolve missing or incorrect vaccination records for people vaccinated in England, Scotland or Wales who have a current NHS number and are registered with a GP practice in England.  You can raise data quality issues directly with the VDRS team and you can direct your patients to access the service via 119.  More information is available on FutureNHS

Recording overseas vaccinations in the National Booking Service

Eligible people can now book a face-to-face appointment via the National Booking system at a selected vaccination centre to show evidence of MHRA-approved COVID-19 vaccinations administered abroad and have them recorded in the National Immunisation Management System (NIMS). Support is also provided through 119 to signpost the service, or to make bookings on behalf of users. More information is provided when the user books an appointment.

MHRA approval of Pfizer/BioNTech vaccine in 5 to 11-year olds

Note the JCVI announcement below.   The licensed Paediatric version for age 5-11 is not due to become available till late Jan.  There is an expected volume of 500,000 at risk patients in this cohort. 

There will be obvious questions and asks from worried parents to access the adult formulation. This will need to be managed, flagging early as a possible risk and that you may get asked these questions in coming days.

Covid Vaccine Defaulters – employees

The LMC has sought guidance from our retained legal firm LMC Law.  They advise that they are currently working on some detailed guidance for GPs on the issue of vaccination defaulters in light of the anticipated upcoming regulations. 

Some guidance is also expected from ACAS in January as the regulations pass through parliament.  LMC Law will then complete the guidance and we will forward on to practices. 

Some preliminary points are, however:

  1. There should be legislation making vaccination a requirement for the deployment of frontline health and social care workers by 1st April 2022.
  2. At the moment the only legislation relates to workers in registered care homes in England.
  3. The expected legislation should say that providers of CQC regulated activities in the health and social care sector must only deploy individuals who have been fully vaccinated against Covid-19 (or are exempt) to roles where they have direct, face to face, contact with patients and service users.
  4. Front line workers, as well as non-clinical workers not directly involved in patient care, such as receptionists and cleaners, should be caught by the new rules. It is expected that there will be detailed guidance on this in the near future applicable to GPs.
  5. The legislation should apply whether the regulated activity is delivered through agency workers, volunteers or trainees, or contracted to another provider. This is something that should be covered off in SLAs where services are being contracted.
  6. If a health care worker claims exemption, you must see evidence of medical exemption before that person can deliver care.
  7. The legislation will not force people to be vaccinated, but it unvaccinated, their job may be at risk if they are not exempt from vaccination.
  8. If the regulations and guidance follow the same pattern as those relating to care homes, it is expected that practices are advised to engage with staff about the regulations and of the potential consequences of neither being vaccinated nor exempt.
  9. Depending on the numbers of staff involved, the statutory collective consultation process may also be applicable.
  10. If a worker cannot comply with the legislation, they should be given the opportunity to either get vaccinated or produce evidence of exemption before formal action is taken.
  11. If a worker is neither vaccinated nor exempt, there may begrounds to dismiss, but each case must be treated on an individual basis with HR advice on the particular circumstances, and a proper process must be followed.
  12. There may be grounds for a dismissed worker to claim discrimination. If the care home rules are followed, some types of discrimination claims will not be possible, but others may be possible.

NHSE guidance may be viewed here

Proof of vaccination for those age 12 and upwards

Fully vaccinated patients aged 12 and upwards can now request proof of vaccination via 119 or the internet and a paper copy will be posted which conforms to the EU standards for the EU covid pass. There will be a QR code printed for each vaccine and it will have a validity period of 30 days. The document may need to be ordered again if a foreign trip is planned after the date of expiry.

Patients aged 16 years and over can get a digital pass via the NHS app as well.  This route isn’t open to 12-15 year olds yet but a digital solution should be available in the new year.

To get the pass look here: and the direct link to get the paper copy is here

New to Partnership Payment Scheme (N2PP)

This will be extended into the 2022/23 financial year.  NHSE/I have now removed the requirement to apply within six months of commencing a partnership role. Following a review of the timeframe to apply for the scheme, and in acknowledgement of the challenges the deadline presented to busy new partners as well as the additional pressures created by the COVID-19 pandemic, NHSE/I has removed the six-month deadline, including for submitted applications that meet all other eligibility criteria. When the scheme comes to an end, there will be a cut-off deadline after the scheme closure date by which applications from eligible individuals must be submitted, and NHSE/I will give advance notice of this.

NHSE/I continues to encourage all individuals who have commenced in an equity share partnership on or after 1 April 2020 to submit their application as soon as they can after they become eligible. They are now reviewing all applicants this affects and updating their guidance to reflect the changes > Read NHSE/I’s primary care bulletin

Firearms licensing guidance

After extensive work, BMA have published guidance on the firearms licensing process, setting out the BMA position on firearms licensing and providing information to GPs on what to do when someone applies for a firearms licence, including responding to the police and conscientious objection.

The BMA has had significant involvement in the development of Home Office guidance for chief officers of police on firearms licensing that came into effect on 1 November 2021.   The BMA strongly supports the Government’s overall message, that gun ownership is a privilege and not a right, and that firearms must be in the hands of only those who are deemed safe and responsible.

Private provider requests for investigations under the NHS

Following some queries from several LMCs about requests from private providers relating to investigation and/or treatment of one of the practice’s registered patients, the BMA have produced  guidance here which includes a template letter to respond to private providers.  If the GP is asked by a private provider to arrange investigations or tests, the results of which the GP would not be able to interpret and/or the GP does not feel clinically competent to manage the patient accordingly, then they should advise the patient and the provider that the services do not fall within NHS Primary medical services and to make alternative arrangements.

Prescription charge waiver for COVID-19 antivirals and therapeutic clinical trials

The Government has announced that, from 10 December 2021 until 31 March 2022, arrangements have been made under the NHS Regulations for antiviral medicines to be supplied to patients who have tested positive for COVID-19 and who are in the eligible cohorts of patients. Where the patients are not already eligible for free prescriptions, the antiviral medicines will be supplied free of charge.

The waiver will also apply to therapeutic treatments that are being made available through the NIHR funded HEAL-COVID clinical trial platform treating patients who have been hospitalised for COVID-19, for long-term effects and STIMULATE ICP treating community patients for long COVID. NHSE/I will be issuing guidance on the use of the waivers.

PCSE update relating to GP payments and pension

New injectable lipid lowering medication: Inclisiran 

The LMC has significant clinical and operational concerns (outlined in detail here ) around the recent NHSE decision to assign Inclisiran to delivery within primary care and, at the time of writing, are currently in dialogue with the Area Prescribing Committee (SNEE APC) on the matter.

See also BMA/RCGP joint statement

PCSE patient list validation requests

NHSE/I have agreed to pause PCSE emails to practices requesting full patient list validation exercises. The decision will be reviewed again at the beginning of February.   

Further to this, GPC also challenged the mention in these PCSE requests of a requirement to respond to the requests within five working days. NHSE/I agreed with us that the contractual requirement is actually 30 days. They will raise this with PCSE but, should the wording remain unchanged when these requests are resumed, we would advise practices that they can actually use the full 30 days.

Application window for 2019/20 Pensions Annual Allowance Charge Compensation Policy

The third GP application window for 2019/20 Pensions Annual Allowance Charge Compensation Policy applications is now open on the PCSE website 2019/20 Pensions Annual Allowance Charge Compensation Policy – Primary Care Support England. It closes on Friday 11 February 2022.

New annual leave guidance for employers of salaried GPs

This newly published guidance produced by the sessional GP committee provides advice to the employers of salaried GPs to ensure that the process for processing and allocating annual leave is fair, transparent and flexible.   Read more here

Supporting general practice

Read about how we are campaigning against abuse of GPs and their staff on our  Support Your Surgery campaign page, which includes a number of resources that practices can use.

NHSE/I has now also published materials and guidance for use in primary care settings to encourage patients to treat NHS staff with respect.

Practice Vacancies

Can be found on the LMC Website

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