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Key Matters reviewed by the Committee July 2020:
The Government has announced agreement with the DDRB’s recommendation of a 2.8% pay uplift. This applies to salaried GPs, GP trainers and GP appraisers, with payments to be backdated to April 2020 – but does not include GP contractors.
This is the second year of the GP 5-year contract agreement which was meant to fund an annual staff pay increase of 1.8% this year. GPC is having urgent talks with the Health Minister about the lack of recognition of the work effort in recent months by all practice GPs and staff and that funding is required for similar pay increases (as well as funding the gap for salaried GPs) is to address this unacceptable situation.
Applying the uplift
Whilst GPC continue to put pressure on DHSC and NHSE/I for more funding, practices are encouraged to provide the full 2.8% uplift for all Salaried GPs, although how any pay uplift is provided to Salaried GPs, as with all practice staff, will be determined by the terms of their employment contract.
The GMS contract regulations, and Suffolk PMS agreement state that practices must employ Salaried GPs on terms no less favourable than the model contract. Therefore, all GMS and PMS practices (but not APMS practices) must employ Salaried GPs on terms no less favourable than the Salaried GP model contract.
The Salaried GP model contract states ‘annual increments on [incremental date] each year and in accordance with the Government’s decision on the pay of general practitioners following the recommendation of the Doctors’ and Dentists’ Review Body’. Therefore, if this wording is included in the employment contract, the full 2.8% uplift must be provided. The model contract however may be amended by agreement, so it will depend on the individual agreement between the practice and the Salaried GP. If a different annual increment/calculation is included in the contract, or if the contract is silent on this point, then the practice is still encouraged to pass on the full 2.8%. The pay award should not be a source of division between GP contractors and salaried GPs.
A second flu letter with all the details will be issued by the CMO next week, but the government have made an announcement about the flu campaign this week about the extension to the programme. Any decision on extension to 50-64 year olds will be finally made later in the year and will depend on vaccine availability following the initial focus on those most at risk. All vaccinations done by general practice will receive the IoS payment.
The programme will also include households of those on the shielded patient list and for the school programme to be expanded to the first year of secondary schools.
GPC have been in discussions with NHSE/I about the delivery of the programme, including the operational issues, implications for PPE, vaccine provision and for additional funding to support the programme.
The Royal College of GPs has published guidance on delivering mass vaccinations during COVID-19, including guidance on using non-traditional vaccination settings. The guidance is written with the understanding that a number of mass vaccination programmes may need to be delivered during mid-2020 to 2021, while COVID-19 continues to be in general circulation.
LMC has not been made aware of any formal communications on the expectations around resuming minor surgery as yet but when asked we received the following response from NHSE:
‘We believe the existing guidance is that practices should carry out procedures where clinically necessary and where safe to do so; and that CCGs should be considering minor surgery within their ‘back to normal’ recovery plans’.
Practices may find these two documents useful in the context of their plans and risk management:
Reinstating Minor Surgery (credit to Lincs LMC and Lincs CCG)
ASPC Guidance on restarting Minor Surgery (Association of Surgeons in Primary Care)
Following the Government’s announcement that face coverings will be mandatory for people visiting shops in England as from 24 July, BMA have been calling for the policy to be extended for all places where social distancing cannot be maintained, including GP practices.
Public Health England has now published New recommendations for infection control in primary and community health care providers, which states that:
This guidance is in addition to existing national COVID-19 IPC guidance, which advises on appropriate PPE usage in patient facing clinical settings and other measures to reduce transmission risk.
LMC Law have advised practices make the requirement clear that face coverings are expected to be worn by patients whilst in the practice. This should be communicated at the door (by signage), on the website and on any leaflets/posters/screens. Repeated failure by a patient to comply with the request (without acceptable reason) could be considered breakdown in the doctor/patient relationship and a warning letter may be appropriate. Ultimately this could lead to removal from the list. There is a need to tread carefully however and there is no suggestion that a patient in need of urgent medical care would be turned away.
Letter for exemptions
BMA guidance on Reducing COVID-19 transmission and PPE now includes updated advice on face coverings, which confirms that practices do not have to provide letters of support for those who fall under the list of exemptions, or to those who do not. Individuals should self-declare if they believe they should be exempt from wearing a face covering. They should not be directed to their GP to ask for evidence to support this.
Fitness to fly certificates are not part of GMS contractual work and so GPs are under no obligation to issue them. If you do decide to issue a certificate, then you can charge a private fee. The BMA advises caution when considering undertaking this sort of work as there can be potential medicolegal implications.
‘We discourage doctors from signing certificates which indicate that the patient will, for example, be fit for the duration of the holiday, as current fitness is not a guide to future fitness. Doctors can only report on what is written in the patient notes and reporting on future fitness could have medico-legal consequences for you.’
Fitness to fly assessments can be complex and may require specialist training or knowledge especially when advising around patients with underlying chronic health conditions. There are specialist private clinics that can undertake these assessments and provide necessary certificates.
One also has to be mindful that the NHS Clinical Negligence Scheme for General Practice will not cover liabilities arising from the issuing of one of these certificates so any clinician issuing a certificate would need to check that their MDO covers this.
Some patients may be asking for ‘Covid certificates’. Again, there is not contractual requirement to provide these. Covid swabbing for asymptomatic patients is not currently available in primary care. Antibody testing is currently being targeted at front line staff and those patients having blood tests for other reasons. Furthermore, the significance of antibody test results is as yet unknown, giving no assurances about whether someone has had past or current infection or lasting immunity.
The BMA has updated the guidance on shielding following the announcement that the guidance for clinically extremely vulnerable people who are currently shielding from coronavirus, will be eased in two stages – on 6th July and 1st August.
These patients will be sent a letter advising them to continue with the care/treatment arrangements currently in place. More detailed advice will be provided by the Government as the changes in advice come into effect, and unless there is a significant rise in COVID-19 cases the shielding programme is expected to be paused on 31 July.
The shielded patients list will continue to be maintained after August so that it can be used again in the future if necessary. Work is also being done to develop a new predictive risk tool which could lead to an updated list in the future.
Situations have been reported where individuals, employers, businesses or insurance companies have been suggesting that shielding patients obtain a letter from their GP to engage in certain activities, including having their hair cut. There is no requirement or necessity for such letters and patients and others should follow the government guidance relating to social distancing and other necessary precautions.
Read the Government’s guidance on shielding for patients and the letter to the NHS on shielding
Shielding will be coming to an end in England, Northern Ireland and Scotland on 31 July after which those who have been shielding will be able to return to work provided their place of work is ‘COVID-19 safe.’ The BMA has published guidance on Making the NHS ‘Covid-19 safe’ and supporting return to work, setting out recommendations for safe return of staff:
Last week NHSE/I released its most recent letter regarding arrangements for practices for the rest of 2020/21. The BMA has updated its comprehensive COVID-19: toolkit for GPs and GP practices to reflect these new arrangements, including service provision, funding, and QOF. As has been the case throughout the pandemic, practices can only work within their capacity and capability, and with the on-going constraints relating to social distancing, the use of PPE, risk assessments, workforce pressures and many other challenges, practices must be supported by CCGs and NHSE/I and not burdened with unrealistic expectations.
Public Health England has published a document about restarting NHS Health Checks, which advises that the previous advice by NHSE/I to stop NHS health Checks during the pandemic, expires on 31 July 2020. The decision on when to restart NHS Health Checks is one for local authorities to take and the LMC has been discussing this with them. Negotiations have been problematic with the local authority remaining steadfast on its assertions that they cannot continue to support ‘average’ payments to practice for Q2 (as was the case for Q1) and that payments must return to being activity based. The demands on practices at this time have been made very clear to the local authority and they are appreciative of this. Discussions have also taken place on flexibility to offer health checks remotely. The local authority have proposed writing out to practices shortly with a questionnaire and will gauge willingness to re-commence health check activity as well as obtain practice feedback on different deliver models.
From 1st October 2020, the interim COVID-19 care home service will transition into the Enhanced Health in Care Homes service as described in the Network Contract Directed Enhanced Service (DES). GPC has agreed with NHSEI that to provide some continuity and stability the Network Contract DES will be amended so that when appropriate the clinical lead role for the service may, as now, be held by a clinician, other than a GP, with appropriate experience of working with care homes provided this is agreed by the practices in the primary care network, the CCG and the relevant community provider.
The link below may be useful from the Health & Safety Executive on the use of fans and AC although note this doesn’t specify if this would be the case in a patient facing environment so may be only applicable in administrative areas of the building.
https://www.hse.gov.uk/coronavirus/equipment-and-machinery/air-conditioning-and-ventilation.htm
NHSE/I has confirmed the joint agreement with Health Education England that GPRs due to start training in August 2020 are exempt from the requirement to be included in the England Medical Performers List.
Health Education England has released figures which show that GP trainee numbers in England have risen for the third year in a row, with recruitment up by 15% compared to the same time last year.
Following a few enquiries, it was felt useful for practices to have a recap on the regulations in terms of the ‘offer’ for health checks for patients over the age of 75.
(1) Where a registered patient who requests a consultation—
(a)has attained the age of 75 years; and
(b)has not participated in a consultation within the 12 month period prior to the date of the request,
the contractor must provide such a consultation during which it must make such inquiries and undertake such examinations as it considers appropriate in all the circumstances.
(2) A consultation under sub-paragraph (1) must take place in the home of the patient where, in the reasonable opinion of the contractor, it would be inappropriate, as a result of the patient’s medical condition, for the patient to attend at the practice premises.
(3) This paragraph does not affect the contractor’s other obligations under the contract in respect of the patient.
