December 2022 Newsletter

Included in this edition:

  • Quality Support and Stability Payment (QSSP)
  • Advice to colleagues and practices on strike action being undertaken across the NHS
  • Junior doctors’ guide to strike action – guidance for GP trainees
  • Streptococcus A
  • Latest evidence indicates children’s nasal flu vaccine may help reduce cases of Group A Strep
  • Requests to alter DNACPR forms in Care Homes
  • GP Appointment Data
  • GP Recruitment Campaign
  • Mandatory Training on Learning Disability and Autism – update
  • Autumn statement 2022
  • Pooled code practices warned to check for significant reimbursement shortfalls
  • ARRS roles (digital transformation lead and GP assistant) – new pay codes
  • CQC – guidance on staff vaccinations
  • GP Trainee visas 
  • Wellbeing
  • Practice Vacancies


Information, Guidance and News

Quality Support and Stability Payment (QSSP)

Practices will have received, today, correspondence outlining a payment, based on your QoF and IIF targets, intended to add financial stability and free up practice time to meet the tidal wave of acute demand that we are all facing.  This is an acknowledgement, by the local system, of the extreme pressures of late and has LMC agreement.

In stark contrast to the common sense approach adopted locally, it would appear NHSE, in their recent explicit instructions to systems not to protect QoF or IIF, are no longer fit for purpose and have little concept of front line pressures.

Practices should read the correspondence closely, note that the intent and funding is matched to QoF & IIF streams (uplifted for QoF point inflation this year*), that there is a degree of local commissioner discretion and that there is a built-in post winter pressures window in which to catch up on the few non-protected indicators, outlined in Appendix A, if deemed necessary. It is not perfect and has been agreed within a short timeframe, but is a great deal better than most other areas in the country.

*We have made the point, on several occasions over the past 3 years, that QoF inflation has not been applied during COVID related periods of income protection.

Advice to colleagues and practices on strike action being undertaken across the NHS

Many professional groups are undertaking industrial action this winter as part of contractual negotiations and disputes with government and their employers.  Whilst practice staff are not in dispute with their employing practices, some of these actions will impact on GPs and practices.  The background to these disputes is very similar to pressures that GPs will recognise as currently impacting on them and their practices.  Erosion in real terms pay, lack of effective workforce planning, deteriorated terms and conditions, failure to provide sufficient training places, and a disregard for the wellbeing of an exhausted and demoralised workforce apply to all NHS profession groups.

Government and NHS England have recognised that strikes will inevitably disrupt patient care, whilst unions have committed to preserve emergency care so as not to put patients at risk.

Practices may receive requests to help support secondary care or community services at times of industrial action.  Examples of requests made may include:

  • GPs or practice staff working in ED/urgent care
  • Practice nursing staff undertaking work ordinarily done in hospital
  • GPs supporting ambulance services whether with home visiting or at call centres

Practices should carefully consider the implications and impact on the care of their own patients if becoming involved in these plans. By depleting the practice workforce to support these services it will risk harm to the patients in general practice, potentially increase their waiting times, put practices at contractual risk by reducing the service that they are able to offer, and have GPs and practice staff working beyond their competence in roles they would not ordinarily fulfil.  This is in addition to potentially undermining the cause of clinical colleagues in their trade disputes, and the likelihood of their support of any potential future action by members of the BMA

GPs and practice staff are faced with unmanageable demand for services and skills, and practices are finding it increasingly difficult to provide safe care.  The care of the patient is the primary concern, and it is vital that we devote ourselves to doing this within our practices, and not artificially shoring up other parts of the NHS, which are impacted by industrial action.

More information can be found here

Junior doctors’ guide to strike action – guidance for GP trainees

New guidance for GP trainees has been added to the junior doctors’ guide to strike action. Legally, a GP trainee must picket at or near their place of work.  They are not able to picket at a place that is not considered their place of work.  However, a GP trainee is not barred from taking part in a protest that takes place near to a hospital or other NHS building.  If they are not part of a picket line, they are fine to join any organised protest.

GPC are in the process of preparing more GP specific advice for trainees and practices which will be shared in due course.  

Streptococcus A

With parents and colleagues across the country understandably worried about the Strep A situation, the reported shortages of the supply of antibiotics will likely be even further cause for concern.  As well as the anxiety caused, medicine shortages, particularly at a time when demand for them is higher, can cause increased workload and disruption for GPs and their teams as they have to find alternative treatment options.

While the Government have insisted there are sufficient supplies of antibiotics nationally, this will be little comfort to pharmacists, GPs and patients who are experiencing shortages locally, and therefore those responsible for supply chains must double down on efforts to ensure there are enough medicines to meet demand.  GPC have raised the issue of supply with the Department of Health and Social Care, who has provided assurance that there is sufficient supplies but that the increased demand means some pharmacies have difficulties in obtaining certain antibiotics.

The Chief Medical Officer for England has written to the profession and in his letter he emphasised the importance of prescribers and local pharmacy teams working together to understand availability of antibiotics locally and ordering antibiotic stocks sensibly, in line with patient demand, ensuring that excessive quantities are not ordered and avoiding more pressure on the supply chain. The DHSC Medicine Supply Notification (MSN) also provides advice on the management of the current supply issues, including direction to use alternatives.

GPC have been calling for clear and effective public health messaging on Strep A to ensure that it is clear where to go for help and to reassure the vast majority of people that they will not go on to become seriously unwell, and NHS England, the UK Health Security Agency, and others have now published joint interim guidance for clinicians.

Latest evidence indicates children’s nasal flu vaccine may help reduce cases of Group A Strep

Analysis by the UK Health Security Agency suggests a nasal spray vaccine that offers protection to children against flu may also help reduce the rate of Group A Streptococcus infections.  The live attenuated influenza vaccine (LAIV) is a nasal spray offered each season to most school-aged children to help protect them against flu.  The new study looked back at data from the rollout of the nasal flu vaccine from 2013 to 2017, for primary school children in several areas of the country.  UKHSA compared rates of Group A Strep (GAS) infections in the areas where it is was incrementally rolled out to other areas to measure the vaccine’s impact.

The study found that incidence of GAS was lower in areas where the LAIV vaccine was delivered compared to areas where it was not.  In 2 to 4-year-olds, rates of GAS were 73.5 per 100,000 children in areas where LAIV was delivered, compared to 93 per 100,000 children in other areas.  In 5 to 10-year-olds, rates of GAS were 50.3 per 100,000 children in pilot areas, compared to 57.8 per 100,000 in non-pilot areas.  There was no difference in scarlet fever or invasive Group A Strep (iGAS) notifications.

Requests to alter DNACPR forms in Care Homes

We have received a query around care homes requesting visits specifically to rewrite DNACPR forms due to change of address (often upon admission to the home).

LMC & ICS advice is based on the fact that the DNACPR decision made by the clinician remains valid even if there is a change of address; there is no need to visit a care home solely to alter the address nor to re-write an entirely new DNACPR form. This is supported by the minor amendments rule (such as change in address) ’ Minor amendments are permissible as long as the form remains clearly legible’. Such amendments may be made by the clinician at the time of next routine visit or by the enhanced health in care homes team.

It is also noted that the DNACPR form will be replaced by the ReSPECT form on the 1/3/23.

If there is a significant clinical change / recommendation change then the form should be rewritten.

GP Appointment Data

Practices may be aware that publication, by NHS digital, of practice level appointment data commenced in November and that this is likely to be a source of media interest.  As our position statement (attached) sets out, the data is inaccurate and likely to lead to incorrect conclusions. We would therefore suggest any approach for comment is redirected to the LMC Office in the first instance.

GP Recruitment Campaign

A new GP recruitment campaign has been launched by the Suffolk and North-East Essex Primary Care Training Hub, which aims to highlight that a successful medical career and excellent quality of life can both be achieved in Suffolk and north east Essex, and encourage health professionals to move to the area.

You can view the video HERE  – this has been produced by the Suffolk and North East Essex Primary Care Training Hub, which is leading the campaign to get more GPs working in the area.  You can read the British Medical Journal campaign information here:   

Suffolk and North East Essex Training Hub | BMJ Careers

Mandatory Training on Learning Disability and Autism – update

This was published in a recent NHSE bulletin. The Health and Care Act 2022 states that ‘Service providers ensure that each person working for the purpose of the regulated activities carried out by them receives training on learning disability and autism, which is appropriate to the person’s role’ and goes on to say ‘the Secretary of State must issue a code of practice’ setting out the details around this training.  The ‘Oliver McGowan Mandatory Training on Learning Disability and Autism’, is the title of HEE and NHSE’s preferred training but it is NOT mandatory that this training is completed.  It is unfortunate that the title of the training contains the word mandatory as this appears to have increased confusion.  There was also concern that CQC suggested that this training was mandatory.  After GPC raised concerns with both CQC and NHSE there is an update on the requirements.

CQC has now amended its guidance, which now clarifies that there is no specific training that is mandatory. CQC states that training ‘provided to staff is appropriate and provides staff with knowledge about how to interact and support people with a learning disability’.

The Code of Practice mentioned in the Health and Care Act 2022 has not yet been published and is not expected until April 2023.  GPC contacted the SoS to ask to input into this to ensure the requirements are appropriate and proportionate to the roles. NHSE have also agreed that the specific training mentioned above is not mandatory and that practices should use their judgement as to what training is appropriate to their role. There may be GPs that have had Autism and Learning Disability training already, or may decide that it is appropriate that one person from a practice or PCN is best placed to do the Oliver McGowan or other similar training. This could then be disseminated to the wider team. 

Autumn statement 2022

The BMA has created a briefing analysing the impact of the Government’s autumn fiscal statement on doctors. The statement details the UK government’s plans for tax and public spending over the next five years. Read more about budget and fiscal events here .

Pooled code practices warned to check for significant reimbursement shortfalls

Practices in England and Wales with a pooled list are being advised to check for significant shortfalls in reimbursement since the transition from Open Exeter to PCSE.  An explanatory letter is available to download here .

ARRS roles (digital transformation lead and GP assistant) – new pay codes

NHS England has updated the Network Contract DES to include the pay codes for the two new ARRS roles, digital and transformation lead and GP assistant, that were brought into the Network Contract DES in October (in blue, at the bottom of page 45)

CQC – guidance on staff vaccinations

Following a recent meeting between the LMC and CQC the following Q&A was shared following advice from CQC’s Chief Nursing Officer:

The query was:

“If a clinician cannot evidence (because the previous GP practice may not have coded all childhood imms/ poor historical record keeping since pre-1985) or they have not had a vaccination such as DTP or MMR as they were not routine childhood imms pre-1988, what should the surgery do?

Are the following recommended CQC (HSCA) vaccinations enforced?  Does the clinician sign a waiver?

  • Diphtheria
  • Tetanus
  • Polio
  • MMR
  • BCG
  • Varicella
  • Hep B

For non-clinical staff CQC also advise; 

  • Diphtheria
  • Tetanus
  • Polio
  • MMR

the same issues apply for those staff to, do we enforce vaccinations or have them sign a waiver?”

And the response from CQC national nursing advisor was:

This isn’t straightforward, however good practice is:

  1. Has the activities had a health risk assessment undertaken and if so the risk of these diseases assessed, if yes and the employee hasn’t had or can’t remember having the vaccines then the employer can ascertain their status by sending to Occupation health to have bloods undertaken Green Book & COSHH & Wessex LMC Statement
  2. There are no requirements for employees to sign a waiver , however if employed without the background assessments then this should be articulated on the Employers risk register, ensuring the employee aware of the risks to them
  3. There would also be a Duty of Candour to inform patients that the staff may not be fully vaccinated in line with current PH guidance  

Health and safety law require that employees shall not be charged for vaccines offered or for any blood tests to assess the level of titres

The following can be tested:



Hep B


GP Trainee visas 

The BMA continues to call for a permanent solution to barriers to staying and working in the UK currently faced by trainee GPs as they approach completion of their training.  In October 2022, the BMA wrote to Home Secretary Suella Braverman, to urge her to act and work with colleagues in the Department of Health and Social Care to deliver a permanent solution.  

Conservative MP Matt Warman led a Westminster Hall Debate on international doctors’ visas on 2 November, during which he called on the Home Office and Department of Health to work together on a lasting solution to the issue in the best interests of the NHS workforce and patient care. Ahead of the debate, GPC England Deputy Chair Kieran Sharrock and members of the Public Affairs team briefed Mr Warman, and he drew on the work of the BMA on a number of occasions. During the debate, Immigration Minister Robert Jenrick gave the clearest indication yet that the Government was willing to look at umbrella sponsorship as a potential solution. 

BMA has since written to the Minister directly on the issue and have made clear the BMA’s willingness to be included in conversations with the Home Office on this.   


With the continuing overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing. A range of wellbeing and support services are available to doctors, from the BMA’s confidential counselling and peer support services to networking, 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 poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.

Please visit the BMA’s dedicated wellbeing support services page for further information.

Practice Vacancies

Can be found on the LMC Website

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