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Practice Manager/GP Development 2019/20
18th March 2020: General Employment Law Update (Wherstead Park)
22nd April 2020 Partnership Agreements – evening meeting (venue tbc)
30th April 2020 Finance for PMs -Foundation Session 1 – 1pm-4pm (Stowhealth)
13th May 2020 Finance for PMs- Advanced Session 2 – 9am-12.30pm (Stowhealth)
Key Matters reviewed by the Committee February 2020:
Following further contract negotiations with NHSEI GPC England voted on and agreed to accept the changes to the GP contract for 2020-21, including funding to attract more doctors to take up partnership roles and expand the practice team seeing patients in surgeries. The main changes are:
CCGs will be expected to provide LMCs with an annual report to enable them to monitor local investment in general practice. There is also reference to the important role of LMCs throughout the agreement document.
GPC are planning a number of GPCE roadshows here to outline the agreement
There will now be a special conference of English LMCs on 11th March 2020 to discuss the outcome of negotiations and the contract agreement.
NHSE has revised their DES offer after negotiations with GPC, to a seemingly better deal. However, like Budget statements careful perusal of available details is essential to really understand what is involved.
The LMC cannot unreservedly recommend ongoing participation in the DES; ultimately, it is for each practice to determine whether it wishes to participate as they are voluntary schemes irrespective of whether a practice contract is PMS, GMS or APMS.
The LMC has reached this guarded view based on the following analysis:
Practices may find this helpful to see the baseline changes – geared for GMS but equally useful for PMS practices. Please also note there is information on the definition of care home beds within the document.
https://www.england.nhs.uk/publication/general-medical-services-gms-ready-reckoner-2020-21/
The LMC has sought GPC advice following a query raised by a constituent following a CQC inspection. CQC had expressed concerns about the practice system for prescribing anticoagulants where the monitoring and dosing is carried out elsewhere and had suggested improvements needed to be made. GPC has provided the following response:
We have consulted with the clinical and prescribing policy group and also the contracts and regulations group. They have advised that warfarin prescribing should not be considered as core GMS, and they are aware that warfarin monitoring differs widely – whereas many areas have commissioned with a warfarin clinic which does the testing and dosing and GPs prescribe under shared care agreement, whereas others are not commissioned as with your area. Overall, the prescribing group did not agree with the CQC and does not appear to understand the normal practice for INR monitoring or the principles of team working. Although they are right when they say that the person prescribing is ultimately responsible, in practice few prescribers check the dose with every prescription. Rather, the prescriber relies on the patient being enrolled into a system that provides the protection needed. We are aware that CQC seem to have been targeting this area with quality standards and that other areas have had similar issues with CQC. Due to this there is probably a need for a wholescale review of anticoagulant prescribing and a need to change the interoperability of systems so practices can download INRs remotely and ensure they have a record on the patients’ electronic notes.
Practices need to decide if they wish to continue to prescribe anticoagulants unless they have a safe system that enables the prescriber to have appropriate access to the hospital-based INR monitoring and dosing system so that the responsibilities of the prescriber can be enabled. It is noted that in other areas this is commissioned as an enhanced service.
Practices may also find the “Nigel’s surgery” on anti-coagulation monitoring on the CQC website helpful: https://www.cqc.org.uk/guidance-providers/gps/nigels-surgery-92-anticoagulant-monitoring-primary-care
The LMC is seeking further guidance from GPC on the question of responsibilities arising from public access to practice defibrillators. The LMC understands the East of England Ambulance Service hold a register of defibrillators in an area and will refer callers where appropriate to access the nearest defibrillator. We will report back to practices when enquiries with GPC and the ambulance service have been concluded and we can advise practices accordingly.
Practices will have received the terms & conditions and service specifications for Smoking Cessation (OneLife) plus the T&C for the LA Public Health Health Checks and for GMS practices the Sexual Health Services ES. The LMC has some outstanding queries relating to the OneLife T&C document (smoking cessation).
Changes to the actual service specifications compared with the previous versions are largely related to updates in national guidelines and GDPR changes. The LMC continues to make representations that payments need to increase in line with inflation. The LA continues to emphasise its budget difficulties. Note the specifications this year are for just one year instead of the previous 3-year commitment.
We suggest practices hold fire on signing up to the Smoking Cessation service for the moment and we will email out to practices when we have resolved the outstanding queries. We suggest there is no reason not to proceed to sign up to Health Checks or (for GMS) Sexual Health Services ES.
Practices should ensure that their named DPO is content with the data protection documents.
