March / April 2021 Newsletter

Included in this edition:

  • GMS/PMS regulations – pandemic amendments (England)
  • SFE and global sum calculation (England)
  • Implementing the 2021/22 GP contract changes to personal medical services and alternative provider medical services contracts (England)
  • Government evidence to DDRB (UK)
  • QoF Payments
  • Covid Vaccine certificates
  • Access to vaccination for parents with children
  • Vaccinating during Ramadan
  • Flu vaccination programme 21/22
  • Spirometry
  • Clinical assessment for shielded patients in care homes to receive visitors
  • AZ Guidance for patients
  • Turning off e-consult out of hours
  • Ring Pessaries
  • Pushing Back on Inappropriate Workload
  • ESNEFT Diabetes Remote Service
  • CHC Referrals/Assessment
  • Corporate Criminal Offence Guidance Note
  • Improving GP appointment data
  • Vaccinations and immunisations guidance (England)
  • Practice Vacancies

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Information, Guidance and News

Key Matters reviewed by the Committee 

  • QOF
  • Turning Point requests for bloods
  • IUC contact proposal
  • CQC strategy
  • Institute of General Practice Management
  • PCN ARRS restrictions
  • Covid vaccination programme
  • CCG liaison meeting
  • ESNEFT Liaison meeting
  • West Suffolk Hospital liaison meeting
  • SNE APC update
  • Hospital prescribing in virtual age
  • Alliance structures
  • Consultation on healthcare professional regulation
  • AZ issue
  • Phlebotomy
  • QOF payments
  • Appointment slot types


PCN Training

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 


PM Training

The first workshop on Managing Complaints has been arranged for 26th May.  This session is now fully subscribed but a further session is being arranged and we will write out when the date has been organised.


GMS/PMS regulations – pandemic amendments (England) 

NHSE/I has confirmed that the temporary changes to the GP contract under the pandemic regulations which were due to lapse at the end of March have now been extended until 30 June 2021.  

As with previously, this means a continued suspension of the Friends and Family Test requirement; a continued suspension of the requirement for individual patient consent for electronic repeat dispensing (eRD); and a continuation of the amendment to NHS 111 direct booking with sufficient slots available for NHS 111 to refer into a triage list; for most practices offering 1 per 3000 as per the pre-pandemic arrangement is likely to be sufficient but this can increase to 1 per 500 if demand requires. 

Read more about what services practices should be providing, and what should be prioritised during the pandemic via COVID-19 toolkit for GP practices.  


SFE and global sum calculation (England) 

An official consolidated version of the SFE (Statement of Financial Entitlements) has been published for 2021. This updates the SFE from the last fully consolidated version from 2013 and includes the amendments made up to the current 2021/22 contract year. The global sum figure has now been finalised for 2021/22 (£96.78) and amended from early figures we shared as it now takes in to account the full impact of the final MPIG correction factor recycling. The global sum out-of-hours deduction will be 4.75% (£4.59). 


Implementing the 2021/22 GP contract changes to personal medical services and alternative provider medical services contracts (England) 

NHSE/I have published this document which sets out the approach to the funding changes that will apply to Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts. Commissioners will update local PMS and APMS contracts as soon as possible, applying the funding changes identified in this guidance with effect from 1 April 2021. 


Government evidence to DDRB (UK)

The Government and Department of Health and Social Care has published their evidence to the DDRB, which suggests a pay uplift of 1% for those within the remit.  

The BMA has already submitted its evidence to the DDRB, including for UK salaried GPs, all GPs in NI, Scotland and Wales.  A submission for GP partners in England has not been made as there is already a practice funding agreement in place for England which enables a pay uplift this year of 2.1%.  


QoF Payments

The LMC is aware that, for almost all Suffolk practices, the implementation of income protection measures relating to QoF 20/21 has resulted in a reduction in income when compared against achievement under normal circumstances*. This appears to have arisen through the way in which income protection is defined – financial terms in 19/20 switching to a points-based definition in 20/21. This switch in definition coupled with mandated focus on COVID has had particular impact on the 80 new points introduced in 19/20 alongside, in some cases, changes in disease prevalence.

We are clear that income protection should account for the inflationary uplift intended to be delivered via QoF & should also fairly reflect practices pre-COVID achievement rates. At the time of writing GPC are reviewing Suffolk’s figures as an exemplar and liaising directly with NHSE.

* The easiest & fairest way to define this is as % QoF score in 18/19 & uplifted for QoF point inflation & change in baseline points available.


Covid Vaccine certificates 

The Government confirmed that a COVID-19 status certification system will be developed over the coming months which could allow higher-risk settings to be opened up more safely and with more participants. Over the coming months, a system will be developed which will consider three factors: vaccination, a recent negative test, or natural immunity (determined on the basis of a positive test taken in the previous six months). Events pilots will take place from mid-April to trial the system. All pilots are checking COVID status, which will initially be through testing alone but in later pilots, vaccination and acquired immunity are expected to be alternative ways to demonstrate status. 

GPC England has been discussing these proposals with the Government and NHS bodies to ensure there would be a minimal impact on GP practices, and this has been accepted.  The expectation needs to be avoided that people can secure evidence of vaccination or testing by obtaining a letter from their GP practice. 


Access to vaccination for parents with children 

An incident occurred where a parent was prevented from brining their dependent children to their vaccination appointment at a hospital vaccination site.  BMA took this up directly and after intervention the matter has been addressed and the following guidance published: 

As we vaccinate the younger groups of patients, it may be the case that parents bring dependent children to their vaccination appointment.  Colleagues are reminded that reasonable adjustments can be made for people in such circumstances, and every effort should be made to ensure that individuals can receive their vaccine at their stated appointment time. 

Ultimately, the senior clinician on duty has the responsibility for patient safety and it is important that they are informed of any concerns that other colleagues may have about an individual, so that they can make a risk assessment at the time and that any necessary adjustments can be made.  

Denying treatment/intervention, for any reason, is a clinical decision and it must be made by the most senior clinician on duty at the time. They will be able to assess the risks and make a clinical decision which will then be documented. All staff need to be aware of the need to escalate these situations to the senior clinician. 

In the meantime, as a way of preparing for the younger cohorts, we are looking at ways of strengthening the guidance for parents at the point of booking. Patients booked in for vaccination are currently asked to attend on their own where possible to minimise the risk of COVID-19 infection. However, any individual is allowed to attend with another person, particularly if they need support, for example if they are in a wheelchair, are frail or have a learning disability. Parents with young babies or children need not be turned away, unless following a risk assessment by the senior clinician.  They do need to be supported to receive the vaccine. As the cohorts move to younger populations, it is more likely that adjustments will need to be made to ensure no one is disadvantaged because they have dependents with them.” 

The VC operational guidance has been updated to reference the above, along with the guidance for the National Booking Service including briefing notes for call handlers. 


Vaccinating during Ramadan 

NHSE/I has published guidance on supporting COVID-19 vaccine uptake during the Islamic month of Ramadan which began on Monday 12 April 2021. The guidance aims to help vaccination sites build confidence, reduce barriers to access and support the uptake of the COVID-19 vaccine amongst Muslim communities during the month of Ramadan. 


Flu vaccination programme 21/22 

Confirmation has now been from NHSEI that there will not be central procurement of flu vaccine for the coming year’s scheme, but the at-risk group will be extended as it was this year. Practices should therefore, where this is possible due to the late notice, take this into account when placing orders. The annual flu reimbursement letter was updated on 1 April. A copy of the latest version can be found here. The letter confirmed that those aged 50-64 year old will be included in the 21/22 flu programme and also confirmed the inclusion of a QIVr vaccine (Supemtek). 



See the BMA general guidance on spirometry  Whilst spirometry is in QOF practices can refer patients for this.  If services are not available practices can use personalised care adjustments (formerly exception reporting).  Remote consultations are an acceptable way of doing annual reviews, even if doing an FEV1 is not possible.

Practices are advised against doing spirometry during the pandemic but if national restrictions are eased as we all hope then practices could review what they do, but we are not there yet.

This is the advice from the Primary Care Respiratory Society

Practices may wish to add the code ‘no local service available ‘until such time as the respiratory hubs are operational.  


Clinical assessment for shielded patients in care homes to receive visitors

Public Health England (PHE) have issued advice about shielding patients who are residents in care homes. It is understood that some PHE personnel are recommending individual GP assessment to see if shielding patients are suitable to have visitors.  This is incorrect, the guidance suggests that even for shielded patients, care home managers are best placed to make the risk assessment.  Such risk assessment may need to be dynamic depending on a change of circumstances for instance that could not always have a clinician’s approval, such clinical opinion is also only needed if it is clinically appropriate. 

Suffolk has a care home LES and practices aligned to care homes to support any requests needed from care homes in a measured way consistent with the workload pressures already facing GP practices during the Covid pandemic, i.e., not as a default option but when it is really needed.

Care Home managers will be supported to continue making good use of the guidance they are now well accustomed to interpreting and be safe in the knowledge that when they need clinical opinion it will be in support of decisions that are more difficult to make.


AZ Guidance for patients

The following presentation is helpful in supporting discussions with patients:

PowerPoint Presentation (

All vaccine sites are expected to provide information to people attending.  Leaflets and product information sites will be updated with the new details.  See links below to a PHE document that might help and also the script that could be added to practice websites for patient information 

COVID-19 vaccination and blood clotting (

website script for AZ concerns 


Turning off e-consult out of hours

Both national and local data sources suggest the number of online consultations is growing dramatically. Whilst such digital first methods bring a number of advantages they are also a major source of work for primary care and may drive demand.

Whilst offering online consultations is contractual, reviewing your online consultations and maintaining access to the web portal 24/7 is not. The LMC will therefore support any practice who chooses to disable access to their portal outside core hours. 


Ring Pessaries

The LMC wishes to clarify to practices that work associated with insertions/removals of ring pessaries not a contractual requirement.  Patients requiring these services will therefore need secondary care referral.    In other areas this work is offered as an enhanced service and the LMC will raise this issue with the CCGs.


Pushing Back on Inappropriate Workload

Just a reminder that there are a suite of template letters available via the link below


ESNEFT Diabetes Remote Service

Following the LMC’s intervention, there has been assurance from the hospital Diabetes Department that the letter to patients will be changed to reflect that patients will be asked to undertake a virtual/self- foot check in the first instance, rather than be asked to attend their practice as the original letter stated.  We would ask practices to be vigilant that this is actually happening and notify the LMC if there are any issues. 


CHC Referrals/Assessment

For clarification practices and DNs are not commissioned to do CHC assessments and a dedicated team exists within the CCG to do this work.  The link below from the CCG website is useful in describing the process and provides a contact phone number.  

Continuing Healthcare (


Corporate Criminal Offence Guidance Note

The LMC thought it appropriate to remind practices of this legislation that was introduced in 2017, applicable to partnerships and companies, whereby falling foul of the requirements can result in an unlimited penalty being imposed in addition to criminal conviction.  The guidance note available via the link below has been prepared by legal firm Mazars for LMCs.  

Mazars Guidance Note on Corporate Criminal Offence  


Improving GP appointment data 

NHSE/I has published information aimed at improving the quality of GP appointment data. This is to ensure that published general practice appointment data fairly represents the appointment activity carried out across practices and general practice providers in England. This year’s PCN Investment and Impact Fund provides additional funding to support this through an indicator covering the mapping of appointment slot types to the new set of national appointment categories by all practices within the PCN.  This should only require a short one-off exercise, mapping each slot type that the practice uses to one of the national categories. Practices should note that this only relates to appointments from 1 April 2021 onwards and shouldn’t require changes to wider processes or appointment books. 

GPC are proposing to issue some specific guidance around this shortly, particularly in relation mapping the different types of patient encounter, so that the true workload of general practice is fully captured.   


Vaccinations and immunisations guidance (England) 

The BMA have now published guidance about the recent changes to the provision of routine vaccination and immunisation in general practice which come into place from 1 April 2021.  The changes include: 

  • The provision of V&I services becoming an essential service for all routine NHS-funded vaccinations with the exception of childhood and adult seasonal influenza and COVID-19 vaccinations. 
  • The introduction of five core contractual standards to underpin the delivery of immunisation services. 
  • A single item of service fee for all doses delivered in vaccination programmes funded through the GMS contract 
  • The Childhood Immunisation DES with its 70% and 90% targets was retired on 31 March 2021 and a new V&I domain in the Quality and Outcomes Framework introduced for 2021/22. 

The following BMA guide is very useful BMA Reforming arrangements for vaccs and imms 

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