Menu
February 2020 Newsletter
Sunday 1st March 2020 in Suffolk LMC Newsletter
Included in this edition:
- GPC England contract negotiations
- PCN DES 2020-21 – Suffolk LMC Updated Position Statement
- GMS Ready Reckoner (incorporating PCN funding)
- Anti-Coagulant Prescribing
- Defibrillators
- Local Authority Enhanced Services 20-21
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)
Information, Guidance and News
Key Matters reviewed by the Committee February 2020:
- Suffolk & NE Essex ICS progress
- Consultation of the LMC by CCGs
- Unnecessary GP workload and risks
- West Suffolk IBS Pathway
- IFR Forms
- UK LMC Conference Motions
- Suffolk PMS Agreement 2020/21
- LMC Special Conference on PCNs
- Population Health
- Anti-coagulant Prescribing
- New GP Contract 2020/21
- ECG Pathway
- E-Consult
- DBS Checks – changes
- Section 28 letter on opioid prescribing
- Addenbrookes – issues with not doing bloods
- Coronavirus guidance
- WS CCG Prescribing scheme
- Liaison meetings with WSFT and ESNEFT
- Liaison meetings with WS CCG and I&ES CCG
GPC England contract negotiations
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:
- The new value of Global Sum from 1st April will be £93.46.
- The new value of a QOF point will be £194.83.
- More roles added to the Additional Roles Reimbursement Scheme.
- Between 2020/21 and 2023/24, the scheme will expand to 26,000 additional roles.
- All roles to be reimbursed at 100%, freeing up the existing £1.50/head to contribute to management support for PCNs.
- Funding entitlements increase from £257m to £430m next year and, in 2023/24, from £891m to £1,412m.
- Extra investment will fund new GP training, recruitment and retention measures with £20,000 plus training support for every new partner.
- Payment arrangements for vaccinations and immunisations to be reformed with an item of service fee for childhood vaccinations, beginning with MMR in 2020/21.
- QOF to be updated.
- PCN service specifications significantly reduced and improved.
- Investment and Impact Fund introduced worth £40.5m in 2020/21.
- Taken together, more funding available at practice level.
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.
PCN DES 2020-21 – Suffolk LMC Updated Position Statement
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:
- The amount of work required in the PCN DES appears to exceed the useable capacity of the workforce provided by the Additional Roles Reimbursement Scheme (ARRS)
- It remains highly unlikely that the practices in an average PCN would see any net financial benefit from the DES and most probably would make a loss delivering the work required.
- There are significant elements of workload due to be added to the DES from 2021 onwards.
- The DES was communicated as a means of relieving and reducing existing workload pressures in General Practice; rather, the inadequate workforce and additional workload appears that it will exacerbate these pressures.
- The DES seems to risk shift of the workload and liability of various other providers onto General Practice.
- There are suggestions in the deal document that aspects of the DES will be later rolled into the core contract, and/or cause changes to the core contract – such consequences are currently unknown and may be irreversible but would at minimum make PCN workload mandatory.
- We have significant concerns that this DES poses a threat to the independent contractor model, the core GMS contract, and the autonomy of individual constituent practices.
GMS Ready Reckoner (incorporating PCN funding)
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/
Anti-Coagulant Prescribing
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
Defibrillators
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.
Local Authority Enhanced Services 20-21
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.