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Key Matters reviewed by the Committee March/April 2020:
The BMA have produced a toolkit providing comprehensive guidance for GPs, partners and practice managers to manage employment and contractual issues and service provision during the coronavirus pandemic. See link below
Following the recent letter from NHSEI requesting practices to identify a clinical lead for each registered care home Identifying-a-clinical-lead-for-all-care-homes-12-May-2020.pdf the LMC sought a legal opinion from LMC Law and recommends the folloiwng:
If the Lead is an individual partner from the practice, then it is strongly suggested that the partnership agreement caters for the position whereby that partner does not carry all the risk and that although named, he/she is only a Lead and that any issues are discussed and implemented at practice level.
Clinical leadership and support is mentioned as the duty and this is likely to be shared amongst the practice looking after the home and it needs to be clear that this is just a “lead” and a named person but that the duties are that of the practice as a whole. LMC Law will be forwarding some suggested wording that can be added to partnership agreements should practices submit the name of an individual doctor.
Alternatively, practices may wish to submit their practice/partnership name with contact details rather than an individual clinician to avoid any unforeseen individual liabilities that could potentially arise.
Network Contract DES – key dates:
By 31 May 2020:
A practice who has been unable to identify a PCN willing to accept them as a core network practice must notify the commissioner.
By 12 June 2020
Commissioner must issue an instruction notice for approved changes in details of previously approved PCNs or newly approved PCNs.
By 30 June 2020
Where commissioner decides (after following required process of engagement with LMC) that a PCN must accept a practice as a core network practice, commissioner must notify the PCN.
By 31 July 2020
PCNs and commissioner agree care homes for which each PCN to have responsibility.
From 1 August 2020
Commissioners to arrange for care home premium to be paid.
By 31 August 2020
PCNs must submit a workforce plan providing details of additional roles recruitment plans for 2020/2021.
By 30 September 2020
By 1 October 2020
NHSE and NHSI to publish details of additional funding, criteria for such funding and details of how to claim, to be agreed with BMA’s GPCE.
From 1 October 2020
By 31 October 2020
PCNs submit indicative intentions for additional roles through to 2023/2024.
The BMA having reviewed the guidance on Aerosol Generating Procedures (AGP) agree with the Resuscitation Council UK position that CPR is an AGP. The view, however, of Public Health England is that CPR is not classified as an AGP. The guidance from Resuscitation Council UK provides a clear process for protecting patients and healthcare workers – treating CPR as an AGP. Read the guidance and statement here
The lifting of the cap on retained GP sessions has been extended until further notice. Retainers who are due for scheme annual review before the end of September 2020 may now seek (through the HEE lead) to defer the review until a later date. For retainers approaching the end of the scheme (e.g. doctors in their final three months of the scheme) then an extension can be asked for until the end of September 2020. Further COVID-19 GP retention scheme info can be accessed here
The Sessional GP Committee, working with GPC and BMA Law, has produced a model contract with terms for the engagement of a GP providing temporary COVID-19 services. The model terms are intended to provide practices with the ability to flexibly employ additional GPs to deal with the demands of responding to COVID-19. In particular, it is aimed at locum GPs in order to provide access to employment benefits such as maintaining continuous coverage of death in service benefits while supporting COVID-19 services, and access to the employer’s occupational sick pay and annual leave entitlements.
Dr Krishan Aggarwal, BMA pensions committee deputy chair, has written a blog to provide guidance about the NHS pension scheme death in service arrangements and can be found here.
The NHSEI Primary Care bulletin of 16th April advised that GPs should continue to refer patients to secondary care using the usual pathways and to base judgments around urgency of need on usual clinical thresholds. GPs should also continue to use specialist advice and guidance where available to inform management of patients whose care remains within primary care including those who are awaiting review in secondary care when appropriate. It is expected that further NHS guidance will be published shortly advising secondary care to accept and hold clinical responsibility for GP referrals.
Following discussions at the May committee meeting, concern was expressed that it was essential that the hospital take the clinical responsibility for patients that have been referred/triaged and are being held in a ‘waiting list’ situation pending the hospital being able to offer an out-patient appointment. The committee also heard that the situation at Addenbrookes appears to be problematic in that referrals are currently not being accepted. The LMC will follow up with the CCGs.
Practices should note that the hospitals have issued the following referral guides:
WSHFT have issued this document: WSHFT referral pathway guide during Covid and WSHFT Update to Primary Care 15.5.20
ESNEFT have issued this document: ESNEFT referral pathway guide
The DHSC have published guidance on safe verification of death procedures (outside hospitals) during the COVID-19 emergency period. This guidance sits alongside the wider BMA guidance on death verification, death certification and cremation which can be seen on the BMA website
The BMA has worked jointly with the RCGP to produce guidance on verifying death remotely Guidance for Remote Verification of Expected Death Out of Hospital
The LMC has been liaising with the Suffolk Coroner during the pandemic phase and had previously asserted that death verification must be carried out by a suitably trained health professional although there now appears to be a level of acceptance from the Coroner that the circumstances of the pandemic situation must allow for flexibility. The coroner has registered his concerns about remote verification of death and has made it clear, given the difficulties for GPs to attend, that his preference for verification of is by a death verification service.
The coroner has already set up a service for the verification of unexpected deaths which is accessed via 111 or 999. This is a Suffolk-wide mobile unit run by Suffolk Constabulary Service manned by police officers and supported by the Coroner.
The I&ESCCG and WSCCG have set up a Suffolk-wide (except Waveney) verification of expected death service and this is currently operating at phase 1 level (ie the numbers are not high enough to need a mobile unit). The service is co-ordinated by the Suffolk GP Federation and verification is usually done by the nearest trained community health professional (from the Covid team) or by a SGPF clinician. GPs can access this service (if not wishing to undertake the death verification) through the Suffolk GP Federation Clinical Hub.
Essex EQUIP offer a Death Verification training course. This course is now live via the Essex EQUIP website. This is the link to book:
https://www.essexequip.co.uk/events/online-verification-death-level-3-cpd-course/
Until 31st July 2020 this is offered to GP practice staff at a discounted rate of £18.00 – please use discount code ELMCEOEDV20 when booking to access the £6 discount. For more details contact. Details can be shared with care home managers who can also benefit from the discounted rate until 31st July 2020.
Catherine Greene at Essex EQUIP: catherinegreene@essexequip.co.uk
Practices will be aware that these forms can, as a result of the Coronavirus Act, be completed and submitted electronically to funeral directors or direct to the Crematorium. Provided they are sent from the GPs own email address then a signature is not required on the form. See relevant section 14 from the Guidance for Crematorium Managers here
Following LMC discussions with the CCGs it has been agreed that GPs will no longer be required to sign drug charts for District Nurses – although still a requirement for controlled drugs. Particular care is needed when issuing prescriptions that the intentions with the medication are very clear – particularly for syringe drivers. The LMC is hopeful that this change will be permanent and remain in force post pandemic.
Following BMA pressure, the DHSC has now published the new SOP for EOLC medicine reuse in care homes and hospices. The guidance sets out criteria for when and how a medicine can be ‘reused’ in these settings.
The NHSEI preparedness letter highlighted that practices must now make a minimum of 1 appointment per 500 patients available for direct booking from NHS 111 through the CCAS clinical triage service – replacing the previous requirement to make 1 in 3000 appointments available for NHS111. CCAS has been established to help reduce the pressure on practices by providing direct support for patients with suspected COVID-19. Patients directly booked by NHS 111 will not be given a specific appointment time but added to a practice list as these are not ‘traditional’ appointments. Practices should then deal with these patients based on their priority and need.
The LMC is aware of the request made by the Health Visitors for GPs to weigh babies when seen for the 8-week vaccinations. The LMC has discussed this transfer of workload request with the Health Visiting Lead at the LA. They have emphasised that weighing the baby is entirely optional and clarified that referrals to the health visiting service can continue to be made in the normal way for any concerns picked up at the 8 week vaccination appointment.
The government has announced the temporary removal of the routine DV medical for bus and lorry drivers. Under the new scheme, drivers will be able to receive a temporary 1-year licence, providing they do not have any medical conditions that affect their driving and their current licence expires in 2020, and they do not have to provide further medical evidence. Read full details here.
The LMC is aware that practices are receiving a lot of enquiries from concerned parents about the forthcoming return to school for some children. We have prepared a template letter which can be copied/adapted to use to respond to parents. The letter can accessed from the Covid ‘local advice’ section of the website or downloaded here
(credit to South Staffordshire LMC)
Following the recent NHSEI statement given in the Primary Care Bulletin of 30th April 2020 (pasted below) regarding pay arrangements for shielding employees – see below – the LMC has liaised with the CCGs to ask whether practices would therefore be able to claim backfill costs for the shielded employee as a Covid expense. Both CCGs have confirmed their wish to be supportive and that claims will be assessed on a ‘case by case’ basis taking into account factors such as the nature of the role/workload of the absent employee and whether this could be absorbed by other staff members.
Given our commitments to maintain GP practice income during the outbreak (as per out letter dated 19 March 2020), GP practice staff who are shielding because they are at highest clinical risk from Covid-19, should continue to receive full pay. They should also be encouraged and supported to work remotely where they are able to do so, in light of the home working solutions we are facilitating.
Practices may find the Safety Assessment and Decision Aid (SAAD) risk score tool useful. It has been developed by a group of frontline BAME GPs and Practice Managers following the death of Greater Manchester GP Dr Saad Al-Dubbaisir from Covid 19 in the hope his memory will live on in the use of the Safety Assessment and Decision Aid tool. The guidance is readily usable whether partners, salaried doctors, locums, nurses, trainees, reception staff, secretaries, practice managers et al and could also be used by community and hospital staff too
LMC Law have provided the following guidance on staff planning holidays abroad
If staff choose to go abroad in the knowledge that they will need to quarantine for 2 weeks on return then (in the absence of any government guidance to the contrary) they would unfortunately need to factor this in and it would probably have to take that as annual leave.
It may be that as they are having to forcibly quarantine there might be an argument that they are entitled to SSP, but as stated, no guidance has yet been issued and until this changes we would have to give the advice based on normal employment rules
