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January 2020 Newsletter
Saturday 1st February 2020 in Suffolk LMC Newsletter
Included in this edition:
- West Suffolk Hospital – Media Coverage
- PCNs: Draft Service Specifications (2020-21)
- GPC England votes down contract package
- Local Authority Public Health Enhanced Service Specifications
- Tax status for Clinical Directors
- NHS pensions records
- BMA briefing – Impact of pension taxation on the NHS
- NHS Pension Scheme – employees
- National Minimum Wage changes from April 2020
- New FP10 and prescriber endorsement (part of the GP contract agreement for 2019-20)
- Flu Jabs
- GP Contract – Travel Immunisations
- Coronavirus
- NHS England campaign materials
- Updated BMA handbook for salaried GPs
- QOF Personalised Care Adjustments
Practice Manager/GP Development 2019/20
18th March 2020: General Employment Law Update (Wherstead Park)
22nd April 2020 Partnership Agreements – evening meeting (venue tbc)
April/May 2020 Finance for Practice Managers -2 half day sessions geared towards experience (dates and venue tbc)
Information, Guidance and News
Key Matters reviewed by the Committee January 2020:
Whilst not meeting formally in January the key topic of discussion by the Committee since the Christmas period has been the release of the PCN DES draft service specifications.
West Suffolk Hospital – Media Coverage
Practices will be aware of the recent Guardian coverage of allegations of bullying at West Suffolk Hospital. It is understood that the matter is currently being investigated. Following discussion at the December committee meeting it was agreed that the LMC stance on the matter is in alignment with the BMA in condemning such behavior in the strongest terms. It is understood that the BMA are in touch with the doctors at the hospital to offer support to those who need it.
PCNs: Draft Service Specifications (2020-21)
Suffolk LMC along with other LMCs across the country has sent in considered responses to GPC negotiators on the draft service specifications. The Suffolk LMC position statement is as follows:
Following consideration of the Draft PCN DES service specifications, Suffolk LMC considers the proposal completely untenable for the following reasons:
- An already overworked general practice system is expected to take on an additional extremely high workload without any workforce to deliver or adequate funding to sustain.
- It is estimated that the average practice taking on this workload will incur costs in excess of £100,000 a year when practices are already underfunded.
- The specifications offer no benefit to practices and are completely unrealistic.
- Withdrawing from the DES would have a financial impact on practices, but it pales into insignificance compared with the costs of participating
- While the specifications are draft they are so far removed from reality that we have no confidence that they could be made credible without a major re-working
- The DES ignores all of the implications of rurality: lack of existing services, infrastructure and population scattered across a large geography
- The burden on existing GPs will be exacerbated by training and supervising the extra workforce if it can even be recruited
- If PCNs are to make any significant improvement to the health of their local population, there needs to be greatly increased support and resource (financial and in terms of health personnel) taken from secondary care to bolster the primary care workforce. CCGs need to be able to review commissioning decisions in this regard.
- The extra funding coming in the draft PCN specification is tied to roles that undertake EXTRA work that the draft is asking practices to undertake (with the GPs having to find 30% of funding for these roles).
The view of Suffolk LMC is that these specifications acutely threaten the survival and viability of general practice, therefore we believe that the 2019/20 DES arrangements should be extended into 2020/21 while the specifications are properly negotiated with GPC for implementation in 2021 onwards; or that practices in Suffolk LMC withdraw from the DES but remain in their groupings to enable the commissioning of local services by the CCGs.
GPC England votes down contract package
Following the vote not to accept the contract package on 16 January, GPC England have been in further negotiations with NHS England and NHS Improvement. There will now be a further meeting of GPC England on Thursday 6 February to discuss the outcome of negotiations.
Local Authority Public Health Enhanced Service Specifications
The LMC is awaiting revised service specifications proposed by Suffolk County Council Public Health from April 2020. Currently only the Sexual Health Services (GMS) specification has been made available to us for review. The LMC has continually stressed to the public health team the importance of adhering to timescales to allow reasonable time to undertake a thorough review ahead of a proposed starting date for the service. We will keep practices posted on developments.
Tax status for Clinical Directors
HMRC will judge the employment status of PCN CDs on an individual basis dependent on their terms of engagement for the role (as they do for most roles). HMRC may judge the CD to be an ‘office holder’ (although this will depend on the information provided by the accountant on the current arrangement within the PCN) and in this scenario Section 5 of the Income Tax (Earnings and Pensions) Act 2003 applies and means that office holders pay income tax and national insurance contributions as if they were employed. The HMRC recommended and standard way to make these payments is by PAYE.
Additionally, an individual can be both an office holder and employed. Income received in respect of the office holder should (according to ITEPA) be treated as if it is employment income. Any separate income received in respect of any other employment, for example, as a self-employed or employed GP should be treated according to that employment (i.e. deducted by PAYE or charged by HMRC following completion of a tax return declaring self-employed income).
NHS pensions records
GPC has written to Sir Simon Stevens, chief executive of NHSE/I, about the need for urgent action to resolve pensions issues impacting GPs. High numbers of GPs have not been given up-to-date NHS pension statements which in turn could lead to incorrect tax bills. GPC has stated that “the body tasked with issuing these statements, the NHS Business Services Authority, is woefully under-resourced and unable to cope, while the involvement of Capita’s Primary Care Services England, which has a history of failure, just makes matters worse.”
GPC is also seeking from NHSE/I full details of how GPs can benefit from the commitment made at the end of last year to cover annual allowance tax charges incurred in this financial year.
BMA briefing – Impact of pension taxation on the NHS
As part of the BMA’s ongoing campaign to address the current pension taxation crisis impacting doctors across the country a briefing paper has been produced which highlights the current situation, background to the issue and consideration of possible solutions. This includes an overview of the BMA’s preferred solution removing the annual allowance in defined benefit schemes, such as the NHS pension scheme. Read the briefing here
NHS Pension Scheme – employees
Practices sometimes ask if they are bound to offer employees membership of the NHS Pension Scheme – ie as opposed to auto-enrolling staff on to an alternative (NEST) pension scheme. To confirm, it is a mandatory offer and this is written into the contract regulations which can be found here http://www.legislation.gov.uk/uksi/2015/94/regulation/18/made (section 18, 1b). Also see BMA guidance at https://www.bma.org.uk/advice/employment/pensions/auto-enrolment-gps-as-employers
National Minimum Wage changes from April 2020
Practices will be aware that from April the rates are set to rise and will mean a 6.2% increase for workers over 25 years of age. We are advised that GPC are sighted on this and have already raised with NHSE that this needs to be fully funded. GPC will keep us updated on these negotiations.
https://www.gov.uk/national-minimum-wage-rates
New FP10 and prescriber endorsement (part of the GP contract agreement for 2019-20)
NHSE/I have published a new FP10 NHS prescription form with the new prescriber endorsement ‘FS’ for free supply of sexual health treatment – please see guidance here and toolkit here. The new FP10 form is being rolled out at the end of January. Existing stocks of the old form already in the system, such as in GP practices and pharmacies, should be used up prior to use of the new form. Both forms will be accepted for processing during the transition to the new form.
The new prescriber endorsement will become live from 1 February 2020. Until the necessary changes have been made to prescribing systems, prescribers should revert to issuing paper prescriptions with ‘FS’ manually endorsed next to each item intended for the treatment of an STI. Where ‘FS’ has been added as a handwritten endorsement, for example, on a computer-generated form, this should be counter-signed in the usual way. Dispensing doctors will continue to use paper prescriptions with a handwritten endorsement. More information is available here
Flu Jabs
In response to questions about flu vaccine ordering for the over 65’s for the 2020/21 season, Public Health have confirmed that aTIV is the recommended reimbursable vaccine. However, in the event there are any delays in the manufacture or delivery of aTIV, QIVc could be used as a suitable alternative in this cohort.
They further advise that aTIV ‘not available’ means only if there are supply issues with aTIV; not that it hasn’t been ordered and the expectation is that all surgeries place orders for aTIV for the >65’s.
For the under 65’s there is a slight preference for QIVc; but QIVe is a suitable alternative in this cohort, both reimbursable.
To address the risk of over reliance on one manufacturer, the national team encourage a mixed approach of ordering a quantity each of QIVc and QIVe. Ordering QIVc will also allow some extra flexibility if there is an issue with either aTIV or QIVe.
GP Contract – Travel Immunisations
The LMC is often asked whether this is mandatory under the contract. Certain vaccinations should be offered under the contract – see the summary guidance here Focus on travel immunisation
– this document explains which travel immunisations are available on the NHS and which can be charged for privately.
Coronavirus
Public Health England has now published guidance for primary care to reduce the risk of spread of infection during and following consultation with a suspected case of the Corona virus (WN-CoV). The main principles are:
- identify potential cases as soon as possible
- prevent potential transmission of infection to other patients and staff
- avoid direct physical contact, including physical examination, and exposures to respiratory secretions
- isolate the patient, obtain specialist advice and determine if the patient is at risk of WN-CoV infection, and inform the local Health Protection Team (HPT)
All the coronavirus guidance is available here: https://www.gov.uk/government/collections/wuhan-novel-coronavirus . NHS England has sent through the following documents to practices
NHS England campaign materials
Practices in England should now have received the materials to support the NHS ‘Measles, Mumps and Rubella (MMR) – Help Us Help You, Get Protected’ campaign (also available on the PHE Campaign Resource Centre). This is final one of the six campaigns that practices are required to take part in as agreed in contract negotiations last year.
Updated BMA handbook for salaried GPs
The sessional GP committee has updated the salaried GP handbook which is written for salaried GPs and GP employers. It will also be of interest to those who are intending or about to become salaried GPs. It explains the legal entitlements of salaried GPs as employees and helps to ensure that salaried GPs are aware of their statutory and contractual rights.
One of the aims of this handbook is to help ensure that all salaried GP members receive appropriate employment terms and conditions. It does this by setting out the legal entitlements that salaried GPs receive as employees, as well as the additional contractual benefits that are, or may be, available. It provides a comprehensive overview of the employment contracts available to salaried GPs and the effect of the various provisions of the model salaried GP contract. The handbook also provides guidance on negotiating improvements to salary and other contractual provisions.
The handbook provides detailed guidance for salaried GPs. However, this cannot replace the expert and confidential advice on individual employment issues that salaried GPs should and can obtain.
The handbook is a valuable tool for GP employers. It explains the statutory entitlements that a GP employer must provide to its salaried GPs in order not to fall foul of the law. It also highlights various contractual obligations, including those under the model salaried GP contract.
You can access the updated handbook here.
QOF Personalised Care Adjustments
Following the concerns raised by practices about the loss of opportunistic prompts following the roll out of the QOF changes in 2019, TPP have confirmed to NHS Digital that they will add a status flag to the patient record which will alert practices to the fact these patients may be missing QOF care as part of their roll out of v44 of the QOF business rules. This will be implemented in the next two weeks.
NHS Digital will explore whether additional functionality can be added to v45 of the QOF business rules to ensure that the two invitation PCA will only come into force at the end of the reporting period i.e. 31st March.