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Key Matters reviewed by the Committee
The committee does not meet formally in January
The LMC has been approached about putting on some training for PCNs – please do get in touch with your suggestions for what topics you would like to cover christinewatts@suffolklmc.co.uk
Please see below a link to a new website which aims to offer residents across Suffolk and North East Essex a single, comprehensive and accurate source of information about COVID-19 and the roll out of the vaccination. www.sneevaccine.org.uk
The JCVI and NHSE/I have advised that vaccinating all healthcare professionals is a priority and, whilst hospital hubs have been tasked with doing this, practice sites also have a contribution to make alongside their major role in vaccination those in eligible cohorts. NHSE/I also published an update which provides additional operational guidance on the immediate requirement to vaccinate frontline health and social care workers. Practices should ensure locum GPs they are in regular contact with are invited for vaccination either via hospital hubs or by the practice grouping itself. Additionally, any healthcare staff who self-identify to their own registered GP practice should be vaccinated as per the JCVI guidance above. The LMC is aware that this data is not routinely read coded and has advised the other primary care representative bodies – LPC, LDC and LOC, how to access vaccination for their staff in lieu of a recall system. It is essential that the vaccine is readily available to all healthcare staff.
NHSE/I has also amended the Enhanced Service specification to permit the vaccination of unregistered frontline health and social care workers as well as those who are registered with a practice outside of the PCN grouping and to reflect the JCVI guidance on administration of the second dose, with the item of service payment now to be paid per dose.
Following the recent announcement about additional funding to support the rapid delivery of vaccinations to care home staff and residents, NHSE/I has now published Process for the payment of Item of Service fees and Care Home Supplement payments to PCN groupings (log in required, so document is also attached). GPC have raised concerns about the complexity of this process but PCNs bringing in additional workforce between now and the end of January to ensure that all records for vaccination of priority cohorts are up to date and recorded properly in Pinnacle will be eligible to claim up to £950 per week (a maximum of £2500 per PCN grouping) of funding support.
The COVID-19 local vaccination services deployment in community settings Standard Operating Procedure has been updated to reflect the addition of the AstraZeneca vaccine and the change to the second dose.
The Patient Group Direction for the Pfizer vaccine has been amended to permit the drawing of 5 or 6 doses from the vial, and the administration of a potential sixth dose is now covered within the PGD. All the NHSE/I guidance about the COVID-19 Vaccination programme can be accessed here.
The PGD for the AstraZeneca (Oxford) vaccine and guidance about the movement of the AZ/Oxford vaccine have now been published. The Green Book chapter about COVID-19 has also been updated to include advice about the AstraZeneca (Oxford) vaccine. Unlike with the Pfizer/BioNTech vaccine, there is no requirement for 15 minutes observation after administering the AZ/Oxford vaccine unless this is indicated after clinical assessment
See updated BMA guidance BMA’s guidance on the COVID-19 vaccination programme
Following the introduction of another national lockdown, the Government will be sending a letter with updated guidance to all clinically extremely vulnerable people, which again advises to take extra shielding measures to protect themselves, until at least 21 February 2021. The Government has also extended the offer of a free 4-month supply of vitamin D supplements for all adults who are clinically extremely vulnerable to support general. Access their updated guidance for clinically extremely vulnerable people
GP practices continue remain open and whilst remote consultations should be the main way in which patient care is delivered, when it is clinically necessary to see vulnerable patients face-to-face they would normally be expected to attend the surgery. Read the updated guidance.
Practices will note that a temporary amendment to the performer list regulations allows for the regulation not to apply to those ex-GPs who have returned to the workforce for the purpose of employment in relation to the Covid Vaccination Programme. See regulation here https://www.legislation.gov.uk/uksi/2021/30/note/made
On the same thread – see below for information on DBS fast track service
Also on the same thread – the Suffolk GP Federation have produced a suite of documents ‘Vaccination Induction Pack. Clearly some of the information is organisation specific but practices may find the general content useful. (credit to Suffolk GP Federation)
Covid Vaccination Induction & Mandatory Training Booklet v1
Accessing Pinnacle Health Online Training
LMC Law recently provided a response on this issue:
In summary each case should be treated on its own facts, as without government guidance or early stage caselaw on the matter, it is very difficult to give a general view on the position other than an employer must be very cautious how it approaches the matter, due to the potential claims it may face, including discrimination claims.
The vaccination is not mandatory under law, and although ACAS has recognised that in theory there may be some cases where an employer may be able to make the vaccination mandatory if it is necessary for the employee to do their job (e.g. where the employee travels abroad and needs to be vaccinated), I think as the law currently stands if disciplinary action where to be challenged in an Employment Tribunal by an employee, the Tribunal would be very sympathetic towards the employee.
The best I can say at this stage is trying to change an employee’s contract to require a vaccination or taking disciplinary action against an employee who refuses a vaccination will be very high risk.
As far as pay is concerned, at this stage I think the usual guidance will apply.
The Government has announced that it is extending the provision of free COVID-19 PPE for all health, social care and public sector workers, until at least the end of June.
Practices should continue to access COVID-19 PPE via the PPE portal. The BMA has called for enhanced and more appropriate PPE to be made available to staff in all healthcare settings, in a letter to Jo Churchill and a letter to Public Health England. Read more here
GPs are reminded that they are still required to issue fit notes (med 3) as normal. There are specific scenarios relating to COVID-19 where patients can use the isolation note service, instead of seeing a GP, as outlined below. Please do not signpost patients to NHS 111 in order to get a fit note as they are not provided by the service. During the pandemic DWP is encouraging employers to use their discretion as to what medical evidence is required to support periods of sickness absence.
Previously advice was issued on issuing fit notes (med 3s) remotely during the pandemic, which remains in place until further notice. A properly signed and scanned fit note sent via email to the patient will be regarded as ‘other evidence’ and will be accepted by DWP for benefit purposes. Not signing fit notes can mean that they are rejected by employers and DWP, so we have been asked to remind GPs that fit notes must be signed. The original hard copy does not need to be retained if there is an electronic copy of the fit note in the medical record.
If the patient is unable to receive their fit note electronically, they will be required to collect a hard copy from the practice or it could be posted to them, at the practice’s discretion.
The covid 19 isolation service does not provide fit notes (med 3s). It is an automated service that can be used to provide evidence of the need to self-isolate by those who:
It can be used to cover continuing periods of isolation if patients still have symptoms or develop new symptoms following their initial isolation period.
Confirmation has been received from the Deanery (as part of the GP pay protection arrangements) that for the period April–August 2020 HEE will pay the training allowance for the GP trainees who in some instances were re-deployed elsewhere during the first wave of the pandemic. For practices who have not received payment for this period an invoice should be submitted to Lorna.Lambert@wsh.nhs.uk.
In November, the LMC England conference passed the following resolution: Conference notes that the BMA GPC (GP committee) England has never secured a robust democratic mandate for the PCN DES and so again asks the GPC England to secure a firm mandate from the entire profession by means of ballot before negotiating any extension or changes to the PCN DES for the year 2021 / 2022.
GPCE have completed a ballot, with the question based on the motion: “Prior to any further negotiations, extension or changes for 2021/22, do you give GPC England a mandate for the PCN directed enhanced service?
The result of the ballot was:
Yes: 80% (3,619)
No: 20% (915)
Total number responding: 4,534
The outcome provides a clear mandate from the profession and GPC will therefore continue to negotiate on this, seeking improvements and further developing it, as part of the whole GP contract, for the benefit of practices and patients. Read more here
Suffolk LMC has responded to the proposals which have been put forward by NHSE/I which would see ICSs being made statutory bodies and which will dramatically alter the role of the CCGs. Broadly, the concerns which have been put forward focus on the need to ensure GP representation through maintenance of the LMC as the statutory body for consultation purposes and also to ensure there is a mechanism for retaining clinical input; ensuring ringfencing of primary care funding; and calling for a review of the current mismatch of boundaries that exist within the current proposal.
Mindful of the legislative change required to bring about these proposals, a copy of the response has been made available to Suffolk MPs.
The BMA has also responded to new legislative proposals put forward by NHSE/I.
The response is critical of the manner in which the consultation has been carried out but also examines the potential implications of the proposals which it is believed are currently incapable of delivering the integrated and collaborative NHS that staff and patients need. It also sets out where further changes have to be made – both to the proposals and to the present system itself – including highlighting the need for strong clinical voices within ICSs and for the NHS to be made the preferred provider of NHS services, for example. BMA has been clear about the fundamental importance of the independent contract system for general practice and of the role of LMCs as the representative of all GPs in an area.
The response is now available on the BMA website here
Following the recent NHSEI letter on suspension of certain activities in the practice, concern has been expressed by the committee that the measures fall short of what is necessary and further areas of work where suspension is appropriate have been put to GPC. The LMC also raised concerns about the potential flaws in the recently published appointment data collection following examples locally of significant discrepancies. Practices should be aware that their appointment data is being scrutinised and used as a proxy for activity levels.
GPC have responded that they are continuing to press NHSEI on suspending DSQS activity. In relation to LD health checks, Dr Vautrey has confirmed that these can be done remotely if it is appropriate for the individual patient. GPC acknowledge that the appointment data collection needs improvement and work is continuing on this, but it has been emphasised by GPC that, whilst flawed, the current level of appointments recorded does help to demonstrate to policy makers that general practice is not only open but busier than ever and has helped in securing some of the recent additional funding.
Practices have raised concerns about transfer of workload from private consultants – examples received include:
(a) Cardiology requesting patents’ own GP perform a 24hr ECG, bloods and other baseline investigations before referring back on a private basis.
(b) Dermatology requesting GP prescribe short term topical treatments.
(c) General Surgery sending patients to their own GP for oral antibiotics.
The LMC advises that this is inappropriate transfer of workload from the private sector and should be responded to in the same way as transfers from NHS Hospitals. We would advise use of the BMA template letters in this situation with a copy sent to the LMC for further action and, in keeping with this, we are in talks with Nuffield hospital, Ipswich.
Practices may find this useful and can be found via https://www.mims.co.uk/drug-shortages-live-tracker/article/1581516 (does require a log in)
Following our call on CQC to suspend routine reviews they have now published an update on their regulatory approach during the pandemic, which states:
‘For primary medical services we will only inspect in response to significant risk of harm – including concerns raised by people working in services and people using them – and when we cannot seek assurances through other routes. If an inspection is necessary, we will carry out as much activity off-site as possible’
CQC will however continue to monitor activity through the Transitional Monitoring Approach (TMA). This has replaced the ARR process. As part of the monitoring, CQC advise they will not be making contact with practices unless they are unable to gain assurance by other means.
