May/June 2022 Newsletter

Included in this edition:

  • Dates for your diary
  • Important information on the GP pension scheme – new CPI modeller
  • Fuller Stocktake report on the next steps for integrating primary care
  • Dental Cases
  • Secondary Care Interface
  • Inclisiran
  • AAA Screening
  • Extending fit note certification
  • Working conditions of independent contractor GPs
  • Access to online records update
  • GP workforce and appointment data
  • Fees calculator
  • Monkeypox
  • Delayed contractual changes for deceased patient records
  • Unacceptable behaviour from patients – useful document
  • GPFR pilot
  • IPC guidance – updated
  • Staff – Covid Risk Assessments
  • DVLA – medical licencing
  • Practice Vacancies

Dates for your diary

A series of online seminars by LMC Law

Thursday 23rd June midday to 2pm:  PCN Structures, workforce and Incorporation
Wednesday 27th July midday to 2pm:              Mergers and Takeovers

Pension Seminars (Larking Gowen) 6th & 7th July 6.30-7.30 (link below)

nhs pension | Larking Gowen | Chartered Accountants | Norfolk, Suffolk, Essex (

Practice Managers Conference           27th September 2022 at Wherstead Park

Information, Guidance and News

Important information on the GP pension scheme – new CPI modeller

The recent soaring rate of inflation will have significant tax implications for some GPs’ pensions. This applies to those who are active members of the scheme contributing at any point of the current 2022/23 tax year, as you could have very large Annual Allowance charges, when such charges become due, depending on your accounting / pensions administration. 

The BMA Pensions Committee have launched a new CPI modeller for the GP pension scheme for GPs to look at their pension growth in 2022/23 and 2023/24 tax years, and to explain the problems with poor design of the Annual Allowance and how it will interact with the 1995 / 2015 GP pension scheme, and Annual Allowance taxation. It is important that you urgently take steps to at least understand your position and the potential impact this may have on future Annual Allowance charges. Entering your own data and numbers in the tool will only take a few minutes and will enable you to see how this might affect you personally – for many members they may need to estimate the value of their current pension based on their most recently available pension savings statements, subsequent contribution history and pensionable earnings.

The Pensions Committee of GPC continue to lobby Government on this significant issue and encourage members to raise this with their local MPs, and help increase awareness with fellow GPs.

Fuller Stocktake report on the next steps for integrating primary care

At the beginning of June NHSE/I published the ‘Fuller Stocktake report’ on the next steps for integrating primary care in England.

GPC has commented the following:

General practice’s strength and value lies in its ability to provide good quality care from within communities, offering continuity and reassurance for patients. It is therefore positive to see this report and the accompanying King’s Fund analysis recognise and champion the invaluable part that practices play in the health of their local areas, and why it is so vital that general practice is given a leading voice and role when it comes to overhauling health systems locally.

Throughout the pandemic, practices seized the opportunity they were given through increased flexibility to quickly adapt for the better under the most difficult circumstances, and it’s particularly positive that this report recognises that this autonomy is far more valuable in improving outcomes for patients than top-down directives and micro-management.

While the report highlights pockets where good collaboration is happening successfully already, we will continue to advocate on behalf of and call for more support for those areas that are struggling.

Read the full BMA statement here

Dental Cases

Practitioners are reminded that treatment of dental cases should be undertaken by individuals with the relevant competencies. The recent CKS/NICE update on primary care management in certain dental scenarios appears to unhelpfully confuse matters and clinicians should refer to BMA guidance on the matter.

Secondary Care Interface

It is anticipated that a central email address will be made available shortly to both primary & secondary (ESNEFT) care to report interface issues. This is a bi-directional process allowing both primary care in the East of the county alongside ESNEFT clinicians, including A&E, to raise issues in a non-confrontational way and represents a more productive way to identify systemic issues of relevance to all parties. The data collected will form the basis of discussions at regular GP:ESNEFT liaison meetings.

Practices in the West should continue to report such issues directly to the LMC for review and action.


A reminder to all practices that requests to prescribe or administer Inclisiran should be referred back to the initiating clinician and reference made to the relevant ‘holding’ statement of SNEE ICS Area Prescribing Committee.  Issues around incorrect reimbursement calculations, unfunded SC administration costs and financial jeopardy (if the practice is not recognised in the correct fashion by the supplier, AAH, then it will be invoiced at secondary (around £2000) rather than primary care (£45) cost) remain unresolved.

AAA Screening

 Practices in West Suffolk may have received requests for review of patient lists in relation to AAA screening and, a national request for coding reviews of diabetic eye screening patients.  It is the LMCs opinion that the responsibility and funding for recalling patients to screening programmes sits entirely with individual programmes and not with practices.

In line with this the LMC has responded to the local AAA programme, on behalf of all West Suffolk practices, declining the unfunded reviews and has raised concerns around the timescales and work involved in diabetic eye screening coding verification.

Extending fit note certification

From 1 July, legislation is changing which will allow more healthcare professionals to certify fit notes to patients.

  • Currently only doctors can legally certify fit notes. DWP are now changing the legislation which will allow a further four professions to do this. These professions are nurses, occupational therapists, physiotherapists, and pharmacists.
  • Not everybody working within these professions should issue fit notes. Professionals should be working in a suitable environment and have the necessary skills and training to have work and health conversations with patients.  This task needs to be within their professional ‘scope of practice’, therefore new guidance and training has been developed which will help professionals to identify if this task is suitable for them.
  • This legislation change applies across England, Scotland, and Wales.
  • This change follows legislation changes in April which removed the need for fit notes to be signed in ink. This change made it possible for doctors to certify fit notes digitally and also for patients to receive their fit note via digital channels (where GP IT systems support this).

 Working conditions of independent contractor GPs

GPC England met earlier this month in the first face-to-face meeting since before the pandemic. In that meeting, the committee debated and passed a motion regarding the working conditions of independent contractor GPs.  This motion reaffirms GPC England’s commitment to defending the independent contractor model, whilst highlighting the committee’s concerns about the pressures GP contractors are under, and its recognition of how undervalued they are by the current Government.  Representatives also firmly believe the interests of independent contractors, and defence of the model, are also best served by one united committee for all GPs in England.

Commenting on the motion, chair Farah JameeI said:

General practice has evolved over many years, changing to meet the needs of communities, but with the independent contractor model sustaining as the core on which it is built. We know that patients appear to benefit from continuity of care, with the quality, strength and consistency of their relationship with their family doctor having a significant impact on their health outcomes. All of this and more is possible through the independent contractor model. 

The outcome of this motion reaffirms the committee’s wholehearted support and commitment to this model that allows for high-quality, cost effective and timely care, despite it being poorly valued by policymakers. And it further demonstrates how important it is that the profession stands together with strong representation for all GPs, regardless of career path, at a time when general practice and the whole of the NHS and care system are facing unprecedented challenges.

With the NHS undergoing significant reorganisation, it is vital that a strong, high quality general practice is able to thrive as part of the wider system and meet the needs of patients.”

Access to online records update

The following update has just been received from GPC:

We would like to update you on developments with regard to the provision of prospective access to patient records. This new service was due to go live at the end of 2021 but was delayed due to concerns from the profession. The Secretary of State has now confirmed a launch date of 1 November 2022.

The GP Committee’s IT Policy Group has been having weekly calls with NHS England and has participated in several workshops looking at clinical safety issues, redaction and guidance documents. We have worked with system suppliers and with safeguarding leads and we hope mitigations will be in place to address any ongoing safety concerns. We are also awaiting feedback from early adopter sites.

There are several steps that practices need to take between now and the launch date and we will provide guidance on this shortly.

Work is still ongoing and we are making all necessary representations, and continue to highlight the potential concerns of the profession.

It remains to be seen whether the significant concerns that have been raised previously about the risks associated with the roll out of this programme have been adequately addressed.

GP workforce and appointment data

The latest GP data from NHS Digital once again shows a decline in GP numbers. Compared with this time a year ago, England has the equivalent of 396 fewer full-time, fully qualified GPs – having lost a further 26 in the most recent month alone. To this end, 1,622, fully-qualified full-time equivalent GPs have been lost from the workforce since 2015 (when the current collection method began). Meanwhile, the total appointments booked have reduced to 24.0 million in April 2022 from 29.7 million in the previous month – this is potentially due to there being fewer working weekdays in April compared to March.

Read the full analysis about pressures in general practice here and the full BMA press statement

Fees calculator

Doctors have undercharged for private and non-NHS fee-based work for years, effectively subsidising the system and taking the hit on their take-home pay.  In response to this issue which was highlighted during ARM last year,  BMA have recently launched the Fees calculator and feedback has been extremely positive. Many doctors have said that they rarely reviewed their fees, some looked to their peers to gauge what to charge, and others used guidelines that were years out of date. The Fees calculator helps doctors decide how much to charge for their services based on their own circumstances. Find out more

The Fees calculator uses your overheads to calculate a fee range for the time it takes to complete a piece of work. The calculations are specific to you, and you can see what rates you would need to charge to make sure your costs are covered. You can find out more about how the tool can help you save money and save time.

Access to the fees calculator is unfortunately restricted to BMA members currently..


An increasing number of monkeypox infections are being identified with some spread in the community.

Whilst the risk is currently low, an increase in numbers is expected, and the UK Health Security Agency (UKHSA) is asking people to be alert to any new rashes or lesions on any part of their body.

Although this advice applies to everyone, initial infections are currently mainly in urban areas with a particular focus on gay communities and men having sex with men.  Practices should remain vigilant as anyone in close contact with a case, including household contacts, will be at risk.

If you are concerned that a patient may have contracted the disease, use appropriate PPE, including mask and gloves. Isolate the person whilst seeking advice on next steps from the local sexual health clinic for urgent advice or your local health protection team, and ensure the consultation room is cleaned appropriately afterwards based on UKHPA advice

GPC have raised concerns with NHS England that specific guidance for primary care has not been provided.

Read more, including guidance for healthcare professionals, on the UKHSA website.

Delayed contractual changes for deceased patient records

NHSE/I have confirmed that the contractual changes for the management of deceased patient records have yet to take effect.  This is due to required legislative and system changes remaining outstanding and means that practices should continue printing and sending the full records to PCSE until NHSE/I notifies the profession otherwise.  PCSE will also retain the obligation to process AHRA requests it receives directly until that time.

Unacceptable behaviour from patients – useful document

The following has the useful template letters to use in the unfortunate scenario of needing to issue a warning to a patient.


GPFR pilot

A new pilot is starting in May to trial a replacement to the existing GPFR (General Practice Factual Reports – also known as DS1500 or the PIP form), which GPs are asked to complete to support patients’ claims for Personal Independence Payment. The new form is designed to be quicker and easier for GPs to complete, whilst still capturing the information needed.  The trial will run for six months and DWP hope that GPs will engage with it and provide any helpful feedback and comments they may have on the new form. During the pilot GPs may sometimes receive the existing GPFR and may sometimes receive the version being trialled.

IPC guidance – updated

Top line summary of points:

  • Patients should be able to be accompanied to appointments if they wish
  • Health and care staff should wear facemasks in untriaged settings where patients might have COVID19
  • Masking where known patients with immunosuppression
  • Health and care staff in general do not need to wear face masks in nonclinical areas e.g. offices unless personal preference
  • Patients with respiratory symptoms should wear a facemask or covering if tolerated or offered one on arrival
  • Other patients not required to wear a facemask unless personal preference
  • People accompanying patients not routinely required to wear a face mask unless personal preference

Further updates will be shared as they become available.

Staff – Covid Risk Assessments

Note this document has recently been updated  Risk assessments for staff | NHS Employers

DVLA – medical licencing

Following the confusion around the current process for assessing fitness to drive whilst the DVLA deals with its backlog of applications the LMC has asked GPC to provide clarification for constituents on exactly what the expectations are from GPs.  Our current understanding is that GPs should not be making an assessment, ie giving their opinion, on fitness to drive but merely advising where there are clear indications that the patient is NOT fit to drive.  To clarify this work is non-contractual and therefore a fee is payable if GPs wish to undertake.

The LMC will report back in due course.

Practice Vacancies

Can be found on the LMC Website


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