July 2022 Newsletter

Included in this edition:

  • Dates for your diary
  • Information for Practices in the East: Datix/Interface Issues
  • Phlebotomy
  • Bariatric Surgery performed abroad – follow up guidance for practices
  • GP Pensions – Message from BMA Pensions Committee
  • All CQC-registered providers to ensure their staff receive training on interacting with people with a learning disability and autistic people
  • NHS Primary Medical Care Policy and Guidance Manual (updated May 2022)
  • MGUS follow up project
  • Letter from GP for travel with medication
  • Firearms
  • BMA update – Firearms Marker
  • Certifying fit notes
  • Introduction of ICSs
  • Rising Covid Cases
  • National Standards of Healthcare Cleanliness 2021
  • Professional Development Initiative (PDI)
  • Amendment to the Road Traffic Act 1988 to allow registered healthcare professionals to complete DVLA medical questionnaires
  • Practice Vacancies


Information, Guidance and News

Information for Practices in the East: Datix/Interface Issues

Practices in the East will be aware of discussions around the use of ‘datix’ reports at ESNEFT.  Further to these discussions a non-confrontational, 2-way process which allows both primary and secondary care clinicians to raise concerns, has been established.

Those practices experiencing issues at the primary:secondary care interface (significant discharge medication errors, clinical governance concerns, etc) should email datix@esneft.nhs.uk with details and, where appropriate, copy a member of the LMC office into the correspondence.

These submissions, along with Datix reports generated by secondary care, will be investigated by the appropriate part of the system and the data reviewed at the ESNEFT:GP liaison meetings.


The LMC is well aware that structural changes in the phlebotomy ecosystem coupled with substantial healthcare inflation means that the current reimbursement model for phlebotomy is no longer viable. As a result, the LMC is seeking a revamped, sustainable framework and are engaging with various parties to seek resolution.

Bariatric Surgery performed abroad – follow up guidance for practices

We understand that this is becoming a more frequent request from patients who have had bariatric surgery performed abroad.  We would advise the following where patients are requesting follow up care:

  1. Performing complex surgery without ensuring adequate follow-up is, at best, poor practice. It may be academic, but the surgical team (and the patient) should be asked what arrangements were put in place prior to surgery.
  1. Follow up from complex surgery like this is acknowledged by NICE and others (see https://www.nice.org.uk/guidance/qs127/chapter/quality-statement-6-follow-up-care-after-bariatric-surgery) ) to be outside the competency of core primary care (in this particular case for a well-defined time of 2 years) so the practice should not provide it (since to do so would be operating outside of your competency). It is also understood that referrals under these circumstances into the NHS secondary care services are rejected as they do not provide follow-up services alone, but the GP could offer to check this locally. The net result is that the patient should be asked to seek private follow-up provision and given the number of the local private hospitals (there are appropriate providers in Cambridge).

GP Pensions – Message from BMA Pensions Committee:

I am writing to you in my capacity as Chair of the BMA Pensions Committee.  As you may be aware, there is a major cause for concern that impacts pensions this year due to rapidly rising inflation.  This relates to a discrepancy in the way pensions are revalued/dynamised and a disconnect between different measures of inflation used in the calculations.  This affects career averaged revalued earnings pensions schemes and therefore as GPs have effectively always been in such a scheme, it is a much bigger issue for GP pensions than it is for hospital doctors.

The particular issue is that the annual allowance is only supposed to be applied to pension growth that is above inflation. However, the Finance Act specifies that the opening value of your pension is increased by inflation using the value of CPI from September of the preceding year.   So, for this year, the opening value of your pension will be increased by 3.1%.   However, previously accrued pension will be revalued by CPI from September 2022 plus an additional 1.5%.  Therefore, it is likely to be revalued by around 11.5%, well above the opening value uplift.

This has the effect of producing large growth that will result in significant annual allowance tax bills for those GPs with significant amounts of accrued 1995/2008 pension.  For example, a GP with pensions savings close to the level of the LTA and current earnings of ~£115k (pensionable) may have an AA tax bill over £30k this year.  Most of this tax is caused by “growth” that is simply due to inflation.  What is worse is that next year, the opposite is likely to happen if inflation settles and there will be sub-inflationary growth. (i.e. the opening value will increase by 10% but the revaluation may only be 5%). Although this results in pension ‘growth’ that is negative, this is rounded up to zero meaning that this negative growth cannot be used to offset positive pension growth either in year or allow this to be carried forward/back to previous years.  The net effect of this is that GPs may incur large tax bills on entirely artificial “pseudo-growth” that has the knock-on effect that they are taxed on pension benefits that are simply inflationary and growth that they may never receive.

BMA pensions have developed a tool that you can use to model the impact of this “CPI disconnect” for your own personal circumstances. This outlines the issue in more detail and discusses the solutions that we are calling for.  AISMA have also written separately and independently to Treasury and have made largely the same points.

We have been speaking to MPs, Treasury and NHSEI about this issue and are starting to make some progress.  We have met with Dr Dan Poulter MP and he has agreed to hold an MP briefing event next week. We would be extremely grateful if you could tweet your MP and encourage colleagues to do the same in advance so that we can get as much traction as possible on this before Wednesday.  We have developed a tool for you to tweet your MP here.

BMA Pensions Committee will continue to do everything we can to address this and the wider pensions issues and will keep you updated.

All CQC-registered providers to ensure their staff receive training on interacting with people with a learning disability and autistic people

Practices will have received the following email from CQC – wording below

From 1 July 2022, all health and social care providers registered with CQC must ensure that their staff receive training in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role. This new legal requirement is introduced by the Health and Care Act 2022.  

The government is required to consult on and publish a Code of Practice.  We understand that this will outline the content, delivery and ongoing monitoring and evaluation of the Oliver McGowan Mandatory Training, which is training it has developed and trialled. The government anticipates that the publication of the Code of Practice may take at least 12 months.  

As mentioned in our message of 20 June, CQC will provide statutory guidance while the Code of Practice is being developed. We have now updated our statutory guidance for Regulation 18 on our website to reflect this requirement.   

During our assessments and inspections of providers, we regularly look to see if staff are working with people appropriately, and if not, we consider what training and support has been provided to them to ensure their understanding.  Following the introduction of this requirement on the 1st July, we will be checking whether providers are training their staff in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role. We will also look at whether providers have assessed the competencies of their staff following the training.  In line with current inspection procedures, we will not be looking at what the training itself has involved.  

We will continue to engage with the Department of Health and Social Care (DHSC) on this training requirement.    

Background information 

The Oliver McGowan Mandatory Training is based on the Core Capabilities Framework for Supporting People with a Learning Disability and the Core Capabilities Framework for Supporting Autistic People. It has also been co-designed by autistic people, people with a learning disability, family carers and subject matter experts.  

The government’s Code of Practice will be subject to a public consultation before it is published.  

The LMC have made enquiries of the local CQC inspection team about how they will be making judgements and Melanie Whittall has advised that ‘because this requirement has come into effect very quickly, CQC are still working on statutory guidance.  Therefore, until we have updated guidance, my position locally is that all I will be asking my team to do during inspections is check for and raise awareness of the requirement’.

NHS Primary Medical Care Policy and Guidance Manual (updated May 2022)

This is a useful document to keep handy in the practice.  It is essentially a working manual for commissioning staff but practices will also find it useful (particularly section 4).   https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/

MGUS follow up project

As per our previous correspondence we would strongly encourage West practices to engage with the MGUS monitoring project as a mechanism by which primary care workload might be reduced.  Initial setup does not have to be complex and lists of eligible patients may be generated using pre-built searches within Ardens (please do contact p.smye@nhs.net if assistance needed).

The LMC have approached ESNEFT and other colleagues about establishing a similar project in the East.

Letter from GP for travel with medication

GPC has alerted LMCs that some airlines are advising travellers bringing medication in their hand luggage, should bring a letter from their medical practitioner confirming the type of medication and what it is for.

This issue is being raised with the airline, but in the meantime, we would remind practices that patients can print off their medical record from the NHS app, or alternatively, practices are able to charge for travel-related requests for information.


Practices will be aware of the introduction of a firearms marker (as per the BMA update below) onto GP clinical systems.  Further advice, in light of a recent legal judgement, is anticipated shortly but in the meantime, clinicians should continue to follow best practice principles which include:

-Noting that the ‘marker’ system is based on read codes and is therefore not 100% reliable.

-Recalling that completing firearms application form is an exercise in provision of medical information and not an opinion per se.

-The balance of confidentiality vs public safety is a matter of professional judgement and has not changed.

BMA update – Firearms Marker

As of 6 July 2022, a new firearms marker has been introduced, aimed at providing alerts to GPs during both the application process and the lifecycle of the issued licence. This will integrate with EMIS and system one systems (Vision to follow) to prospectively flag patient coded as holding a firearms licence.

The BMA has had significant involvement in the development of the Home Office guidance on firearms licensing and we have been pushing for an active flagging system within patients’ records that is robust, clear and standardised across the country, and the new digital marker is a positive step in the right direction of improving the contribution GPs make to the licensing process.

We strongly support the Government’s overall message, that gun ownership is a privilege and not a right, and that firearms must be in the hands of only those who are deemed safe and responsible.

However, the public should be under no illusion that this will be an overnight solution.  This new scheme will apply only to new applicants or people renewing their licences, so it will take up to five years before all licensed gun owners are included within this framework.  The introduction of the marker must not imply that the buck for public safety stops with the GP; as the police have acknowledged, they themselves are ultimately responsible for firearms licensing.

Read our guidance about the firearms licensing process

Read the full BMA statement

Further update for EMIS practices (firearms marker)

There will be a temporary pause on the digital firearms marker for practices using the EMIS system, effective from the evening of 14 July 2022. The digital marker system on EMIS should be back up and running after a few weeks, and after it has been cleared through the JGPITC (Joint General Practitioners Information Technology Committee).  This temporary pause is to address some issues that have been communicated by GPs and practices, and to enable testing of the accuracy and completeness of the flags that are currently popping up. The TPP system will continue to run during this time.

GPC hopes to be in a position to provide an update on the digital marker shortly. 

Certifying fit notes

There is guidance and training available to support the new rules about who can certify fit notes.  Employers and healthcare professionals should read the guidance that provides a summary of the knowledge, skills, and experience that healthcare professionals eligible to sign fit notes are expected to have before undertaking this task. Healthcare professionals eligible to certify fit notes should also complete the e-learning training programme which is freely accessible here.

Introduction of ICSs

As of 1 July, the 42 ICSs (Integrated Care Systems) across England have ‘gone live’ as statutory bodies, taking formal control over the planning, commissioning, and funding of NHS services across their footprints.  Visit the BMA’s dedicated webpage to learn more about ICSs and what they mean for GPs and the NHS.

The move to statutory ICSs follows the enactment of the Health and Care Act (2022) and also marks the end of CCGs (Clinical Commissioning groups) which have been dissolved, with their powers, funding, and many of their staff transferring over to local ICSs.

GPC and the BMA continue to lobby ICSs on our core priorities, particularly on the need to enhance representation within ICSs for GPs, including positions on ICS boards for LMCs.

Rising Covid Cases

BMA has also recently updated the guidance on  risk assessments for GPs and GP practices emphasising that employers must continue to conduct risk assessments for those who come into contact with COVID19 and take steps to mitigate risks identified.

National Standards of Healthcare Cleanliness 2021

GPC have recently been asked if the National Standards of Healthcare Cleanliness 2021 guidance is mandatory for general practice.  Clarification on this was sought from CQC last year and it was made clear that it will continue to regulate based on the actual regulations and the official code of practice. Its infection control mythbuster website page addresses this directly.

GPC also clarified the contractual position at that time, receiving confirmation that it was not a mandatory requirement. There has been no contractual change since then.

Professional Development Initiative (PDI)

We have been asked to circulate the attached flyer on the new Professional Development Initiative (PDI), which is being funded by the SNEE Training Hub.

Amendment to the Road Traffic Act 1988 to allow registered healthcare professionals to complete DVLA medical questionnaires

The DVLA have advised that the law has now changed to allow healthcare professionals other than doctors to complete DVLA’s medical questionnaires.  More information can be found on GOV.UK.


Note from the guidance ‘DVLA will continue to send questionnaires to GMC doctors and consultants, and it will then be up to individual GP practices and hospital teams as to which healthcare professional in practice is best placed to complete the questionnaire’.

Practice Vacancies

Can be found on the LMC Website http://www.suffolklmc.co.uk/jobs

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