January/February 2023 Newsletter

Included in this edition:

  • Retirement of Christine Watts
  • Phlebotomy interim LES 
  • ADHD Prescribing Requests from Private Providers
  • GP workforce and workload pressures
  • Consultation on NHS Pension Scheme regulations for England and Wales
  • GPC England reject ‘unsafe and insulting’ contract offer
  • Update on the Digital Firearms Flag
  • Health Education England education contract
  • Communication between DWP and GP practices
  • Public Health Enhanced Service Claims
  • Wellbeing
  • Practice Vacancies


Information, Guidance and News

Retirement of Christine Watts

It is with regret that the LMC is losing Christine to retirement after 8 years of supporting practices and practice managers with all of the myriad changes that have occurred in general practice. Her vast knowledge of the GP contract, Suffolk PMS and of the practices that make up the LMC will be really missed, but the advert and job details for a replacement Executive Officer can be found in the vacancies section on the Suffolk LMC website.

Executive Officer Advert  Executive Officer Information Pack

Phlebotomy interim LES 

Practices will have recently received notification of the interim LES for Phlebotomy – a short term proposal using ICS winter pressure funding. 

The LMC is clear that the LES itself is well structured, but the work required is not viable at the proposed tariff (we would suggest that £3.00 per phlebotomy episode is the minimum viable fee for most practices) and therefore strongly encourages partnerships to review their own costs using the attached spreadsheet before making a decision. 

As an LMC we need to be mindful of the complex and rather messy situation across the ICS – there are, in essence, 5 different scenarios: 

  1. Mainly rural PMS practices providing large amounts of phlebotomy and generating a financial deficit.
  2. GMS practices – variable depending on amount provided, but due to payment per registered patient rather than unit of activity they are almost all loss making if activity levels are near or over suggested baselines.
  3. PMS practices near phlebotomy centres – variable, some with small profits if activity significantly below baseline.
  4. Hospitals – increasingly looking to outsource the work
  5. GP Fed in Essex – contracted at £2.10 per bleed with practices not involved.

This LES may assist those practices in the first and (some in the) second group by reducing losses on activity already being carried out, but it is not, at current rates, a sustainable solution or one that the majority of practices are likely to engage with. 

The ICS Phlebotomy working group is part way through a longer term solution which is slated for implementation later this year and we are therefore particularly keen that ‘grassroots’ feedback is heard – via this LES and other routes – and so would ask any practice signing up to provide clear feedback – including, where applicable, stating that they are engaging to reduce current losses rather than as tacit endorsement of the arrangements.

*Attach spreadsheet*

ADHD Prescribing Requests from Private Providers

Practices are reminded, as per the attached, of the ICB position on private:NHS prescribing, which is highly relevant to requests to prescribe ADHD medications originating in the private sector.

*attach document*

GP workforce and workload pressures

GP practices continue to experience significant and growing strain with declining GP numbers and rising demand, as shown by the latest GP workforce figures. In December 2022, the NHS lost the equivalent of 17 full-time fully qualified GPs compared to the previous month, and there are now 1,990 fewer fully qualified full-time GPs than in September 2015.

This long-term decline coincides with a rise in patients. In Dec 2022, 62.2m patients were registered with practices in England, with a record-high average of 9,689 patients per practice.  As a result, the average number of patients each full-time equivalent GP is responsible for has now reached 2,273 – a 17% increase since 2015 – demonstrating the mounting workload in general practice.  

Practices are encouraged to continue to review their working practices – the BMA Safe Working document has been updated again and added in some more elements.  In particular there is a ‘master list’ of enhanced services from across England – see:



GPC is working with the LMC support network to develop a safer working toolkit to give more practical advice to practices as to how to apply safer working practices. This will be published as parts of it become ready, and we should have the first section available after New Year.

GPC are  also looking to publish much more specific guidance on what is and what is not core general practice. As a general principle, if there is an enhanced service anywhere, then it cannot be core general practice anywhere. There are nuances to this, in terms of what is custom and practice, but it should certainly be the central argument locally and nationally.

Consultation on NHS Pension Scheme regulations for England and Wales

The Government’s consultation on proposed amendments to the NHS Pension Scheme regulations for England and Wales closed on 30 January.  Although they implement some of the immediate mitigations that the BMA has been calling for, such as new retirement flexibilities which are helpful for small groups of doctors, they do nothing for the majority of the workforce that is impacted by pension taxation. The proposals fall well short of the long-term solution that the NHS desperately needs, and without further action doctors will continue to incur sky-high and completely unexpected tax bills, simply by continuing to provide care for patients.    

GPC England reject ‘unsafe and insulting’ contract offer

GPC England (GPCE) met on 2 February to discuss the negotiations for the 2023-24 contract, the final year of the five-year contract deal, the committee’s strategy going forward, and the Junior Doctors and GP Trainees ballot for industrial action.

At the meeting, GPCE voted to reject the ‘insulting’ proposed changes to the GP contract in England, which completely ignore the unsustainable and unsafe pressures practices are under right now.

With no additional investment to counter the damaging impact of soaring inflation on practice expenses – and to cover rising fuel bills and increasing staffing costs – this year’s offer from NHS England risks safe patient care, brings the very future of practices into question and will cause even more GPs to leave when they are needed most.

If the Government and NHS England refuses to negotiate an improved offer, and a contract is imposed on practices, this would send entirely the wrong message to patients and a profession speaking up to defend patient safety. We would therefore be forced to consider all options, including the potential for industrial or collective action. More information / guidance will be shared shortly. Read my statement here

Update on the Digital Firearms Flag

The digital firearms flag was due to be relaunched on SystmOne (TPP) and EMIS Web (EMIS) systems on Monday 6 February, and is scheduled for deployment on Cegedim/Vision systems in March 2023.

There will be no further changes with SystmOne (TPP), as this has been operating with the flag. The digital marker and flag have been tested and brought before the Joint GP IT Committee since being taken down in July 2022.  GPs should add the appropriate SNOMED code to a patient’s record when they receive notification of a firearms certificate application or when a certificate is granted, and this will automatically add a marker to the patient’s record.  If a potentially relevant condition of concern is added to their medical record during the application process or after a certificate has been issued, an alert will pop up.  Further information is on the BMA website and NHS Digital.

GP Registration

Practices are reminded of the guidance clarifying the conditions surrounding patient registration in GP practices in England. The main principle is that anyone, regardless of nationality and residential status, may register and consult with a GP without charge.  Proof of address is not needed, and this is outlined in our guidance.  It is important to ensure the right patient is linked up with the online PDS service.

Health Education England education contract

Nationally, there have been some queries regarding the HEE (Health Education England) education contract that some practices have been asked to sign. Following discussions with HEE GPC continue to advise that practices do not need to sign this contract if they are not happy to do so.  The contract was introduced in some locations to formalise the payment mechanism for practices to be paid for training and supervision, however the contract was not general practice specific and included much which applied to hospitals.

GPC will be working with HEE and NHS England towards a more suitable contract for general practices and will update when there are any developments.

Communication between DWP and GP practices

To support the NHS move away from use of fax as a method of communication and in response to the removal of fax machines from GP surgeries, the Department for Work and Pensions (DWP) has been working with Centre for Health and Disability Assessments (CHDA), to respond to this change.

From 30 January 2023 CHDA will be using email in place of existing fax processes for some communications with GP surgeries across England, Scotland and Wales. The email from CHDA will be in the format firstname.lastname@chda.dwp.gov.uk or location.furtherevidence@chda.dwp.gov.uk. GPs should reply to the indicated location.furtherevidence@chda.dwp.gov.uk email address.

DWP has confirmed that this process meets information governance standards and is covered by existing data sharing agreements. Please note, as per the current arrangement, for all urgent information CHDA will call the GP surgery by telephone. For further information, please contact hdas.digitalchange@dwp.gov.uk

Public Health Enhanced Service Claims

Surgeries should now submit all claims to admin.publichealthsuffolk@suffolk.gov.uk.


With the continuing overwhelming pressures in general practice, practices are encouraged to focus on their own team’s wellbeing.

A range of wellbeing and support services are available to doctors, from the 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, 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 http://www.suffolklmc.co.uk/jobs


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