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Included in this newsletter:
Information, Guidance and News
Private Referrals
The LMC advises that a charge should not be made for private referral letters as we think they are fulfilling a professional, rather than contractual responsibility, towards the patient, but ultimately it is a matter for each practice.
This is because we believe writing a referral letter is a core GMC Good Medical Practice responsibility, as below:
44. You must contribute to the safe transfer of patients between healthcare providers and between health and social care providers. This means you must share all relevant information with colleagues involved in your patients’ care within and outside the team, including when you hand over care as you go off duty, and when you delegate care or refer patients to other health or social care providers.
Private Bariatric Surgery
The LMC is aware that the care of patients who have undertaken private bariatric surgery (often abroad) is a very difficult area for practitioners and that such scenarios are occurring increasingly frequently.
In response to this and LMC lobbying, SNEE ICS is in the process of finalising definitive guidance on the matter, alongside patient leaflets, which we anticipate will be published shortly.
Our advice to practices is:
(a) where possible, be informed, pre-operatively, that the NHS is highly unlikely to cover their post-operative monitoring and they (alongside their private provider) will need to make separate, non-NHS arrangements. We await a list of suitable, UK based, private providers in the aforementioned guidance in this regard.
(b) be managed post-operatively by teams with sufficient experience and expertise to allow safe clinical care. This is in line with the NICE quality statements:
“….people who have had bariatric surgery are offered a follow-up care package within the bariatric service for a minimum of 2 years”
(c) ,when reviewed in the context of an emergency presentation, be admitted under NHS care in the usual fashion
6% Pay Uplift for Employed Practice Staff
Practices will get a funding uplift to cover a 6% pay rise for salaried GPs and other employed staff. The uplift will be backdated to April and the Government said it expects the funding to be ‘passed on promptly to all general practice staff.’
However, the arrangement has yet to be agreed with the BMA. There are concerns that the on costs of such a rise have not been included and that the funding is not extra but will come from existing budgets.
New IT System for Smear Samples – Cervical Screening Management System (CSMS)
NHS England is stepping up preparations for switchover to the new NHS Cervical Screening Management System (CSMS) towards the end of 2023. With the new system, accuracy and security of patient information will be improved, making sure every person eligible for a screening appointment continues to be invited on time and followed up if required. The new CSMS will be much easier to navigate, freeing up more time for frontline staff. Access to the new CSMS will be via Smart Card and users have been contacted previously to ensure they have these and will need to arrange to have additional access rights added. In the next month or so NHSE will be in contact with all sample takers/GP practices to inform them of these changes and actions that are required. The CSMS website (New NHS Cervical Screening Management System – NHS Digital) has been updated.
Shingles Vaccination Programme: Changes from September 2023
The Shingrix bipartite letter for England has now been published. The updated Green Book chapter 28a and the healthcare practitioner information and guidance to support the Shingrix programme including e-learning and a training slide set will be available on the Shingles vaccination guidance for healthcare practitioners webpage will be live shortly. Updated patient information materials will be available on the Shingles vaccination programme webpage by the end of the week and to order from the Health Publications website shortly. The updated Shingrix® PGD template will be available from the PGD collection later in July.
Are you making the most of your Buying Group membership?
When was the last time you reviewed how much your practice is spending on the products and services you regularly buy?
The cost-of-living crisis is really starting to bite and even GP practices will be looking for ways to reduce running costs.
This is where your free membership to the LMC Buying Group can really come in handy as it offers practices access to discounts on a wide range of products and services. They can help you save money on the following areas:
The Buying Group suppliers won’t just offer you a great price one week and then ramp up the price the next so you can be assured that if you order from their suppliers, you’ll get a great price every time you shop meaning you don’t have to ‘shop around’ to find the best deal every month anymore.
If you’re not sure whether you’re a member and/or have access to the Buying Group website (this is where you can view the pricing/discounts and get quotes) then contact the Buying Group team on 0115 979 6910 or info@lmcbuyinggroups.co.uk. They can also help you with any questions you might have about your membership or the suppliers.
BMA GPC Update
GP workforce figures
The latest GP workforce data published today showed that the number of fully qualified GPs continues to decline significantly. In May 2023, the NHS in England had the equivalent of 27,200 fully qualified GPs, which is 2,165 fewer than in September 2015. The longer-term trend clearly shows that the NHS is losing GPs at an alarming rate: over the past year (between May 2022 and May 2023) it lost the equivalent of 427 fully qualified full-time GPs, and the equivalent of 36 fully qualified GPs per month over the past year. This coincides with a rise in patients: as of May 2023, there was another record-high of over 62.49 million patients registered with practices in England, with an average number of patients each full-time equivalent GP is responsible for continues to rise, and now stands at 2,297. This is an increase of 360 patients per GP since 2015, demonstrating the ever-mounting workload in general practice. Read more about the pressures in general practice here.
COVID therapeutics CMDUs (Covid Medicines Delivery Units)
Ceased from 27 June 2023, and NHS England has written to ICBs to ensure provision of Covid therapeutics is commissioned. GPCE has produced guidance for GPs about this, and practices should have a clear pathway to refer/signpost patients to continue access to COVID therapeutics for vulnerable patients. This cohort of patients will have been contacted and may call practices about how to access their locally commissioned service (other services can also refer/signpost directly such as 111). Read the guidance.
PCN IIF capacity and access support payments
ICB templates for PCN ‘access improvement plans’. We are aware that some ICBs are circulating template access improvement plans for PCNs and constituent practices to complete. It looks like the intention is to ensure ICBs have evidence that PCNs / practices have met the requirements of NHSE’s guidance to secure payment.
The funds from the capacity and access improvement fund have been provided to improve patient access, not to support PCNs to complete bureaucratic templates for ICBs. GPCE thus believes that any governance should be light touch, and agreed by LMCs, before being implemented. If you believe the ICB has gone beyond the realms of reasonable expectation within any bespoke local planning template you receive, please share it with GPC England (info.gpc@bma.org.uk) so it can be raised with NHSE’s central GP contract team for investigation and simplification.
Re-ballot for junior doctor strike action and important information re eligibility to vote
This week the re-ballot for junior doctors (including GP trainees) opened. Please encourage your GP trainee colleagues to vote YES and post their ballot as soon as possible, and no later than 26 August.
It is important to note that if you will no longer be a junior doctor / GP trainee on 31 August, you have to contact the BMA (0300 123 1233 or doctorspay@bma.org.uk) and opt-out from receiving a ballot. This includes if you are due to obtain your CCT (certificate of completion of training) and have a starting date for a GP post which is on or before the start of the mandate period, or you are on maternity leave for the whole mandate period from 31 August to 29 February 2024. However, if you are a junior doctor even for one day of the mandate period, you are eligible to vote. This includes if you are in your period of grace.
Please inform all GP trainees within your practices – they can update their membership details here
GPCE concerns about new health data deal for large multinational firm
Responding to news reports that NHS England has awarded Palantir a new deal to transition existing NHS projects into a new federated data platform (potentially worth over £400m), David Wrigley, deputy chair and digital lead of GPC England, said: “GPs have long raised concerns about the appropriate use of patient data, and today’s decision by the Government to give £25m to a huge US-based multinational company, to do further work on a large NHS patient data project, only exacerbates these concerns.” We have called for NHSE and DHSC to urgently discuss with us how they plan to use confidential patient data within this data platform and what role Palantir will play. Read our full statement here
Statement on “the primary care doctor”
GPC UK and SASC UK have produced a statement in response to proposals from the GMC and NHS England for regulatory change and the creation of a “primary care doctor”. We do not believe that general practice currently has the staff, financial or premises resources to accommodate an intake of “primary care doctors”, nor do we believe that the proposals are being designed to benefit doctors who want to make the switch into primary care. The statement outlines our concerns with the different ways in which “primary care doctors” could be introduced.
2023/24 PCN DES ready reckoner
Now available on NHSE website as with previous years, NHSE has updated the PCN DES ready reckoner originally agreed at the start of the 2019-24 contract framework for use by GP practices. Should you have any questions or queries about it, please contact info.gpc@bma.org.uk .
Wellbeing resources
As we continue to face overwhelming pressures in general practice, we encourage practices to continue to focus on their own team’s wellbeing and take time to meet to reflect on their wellbeing and what they can do to protect it. This will meet the requirements of the QOF targets in the GP contract to do your quality improvement project on staff wellbeing. We have produced a document which includes some tangible recommendations and tools for improving workload and safe working.
A range of wellbeing and support services are available to doctors, from our 24/7 counselling and peer support services, NHS practitioner health service and Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions. See our poster with 10 tips to help maintain and support wellbeing. Please visit the BMA’s wellbeing support services page for more information and resources.
Practice Vacancies
Can be found on the LMC Website http://www.suffolklmc.co.uk/jobs
