November 2020 Newsletter

Included in this edition:

  • Key matters reviewed by the committee in November
  • PCNs Training Needs
  • Practice Manager Webinars coming up
  • Communication from Jo Churchill
  • Covid Vaccination Programme Guidance
  • Additional Funding Support for Covid Vaccination Programme
  • Covid Vaccination Programme – IT capability
  • Latest Guidance for Extremely Vulnerable Patients
  • Guidance for GPs – isolating or in vulnerable groups
  • Medicines Home Delivery Service
  • Temporary Approval to Suspend the need for signatures on prescriptions
  • Workload prioritisation during Covid 19 pandemic
  • PCR Covid Testing
  • Extension to the Flu Programme Announced
  • Flu Vaccine recommendations for 2021-22
  • Think 111 First
  • Community Pharmacy Consultation Service
  • PCN Clinical Director Survey
  • Letter to CQC on Supporting General Practice
  • CQC Fees – no change for 2021-22
  • Gender Dysphoria
  • Parental Leave Webinar and Workshop
  • GMC Update Guidance – Decision Making and Consent
  • Aerosolshield

Download Word Doc Version >


Information, Guidance and News

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 


Forthcoming Practice Manager Webinars 

MOT4U (wellbeing) Bluegreen Coaching 2.12.20 @ 10.30am

Practice Finance Larking Gowen 15.12.20 @ 11 am

Sharing Challenges & Finding Solutions The Development People 13.1.21 @12 noon

HR Update LMC Law late Jan 21 TBC


Communication from Jo Churchill

Jo Churchill, health minister in England with responsibility for primary care, has asked that the letter of thanks here is shared with constituents. 


COVID-19 vaccination programme guidance (England) 

PCNs who have been successful in their applications to provide a site for Covid vaccinations will receive a copy of this template letter  Note the letter says it is not expected that practices will be required to deliver vaccinations in the week commencing 30th November.   Given that the PGD, the online training and the IT capability is not yet available and that the increasing indication is that the first available vaccines will be going to the acute trusts for staff, a commencement date for PCN participation continues to be very uncertain.  Note 10 days’ notice will be given of the delivery of vaccine.

The specification for the COVID-19 vaccination programme is expected to be published towards the end of the week commencing 23rd November.  Note from the above template letter that practices will be expected to sign up to the ES within 7 days of release of the specification.  

BMA have updated the newly published guidance about the CVP to explain the specific characteristics for two of the potential vaccines that are likely to be supplied in the UK and how practices can prepare for this. There is also a clarification that the latest information on the vaccines suggests that patients do not need to be observed following administration of the vaccine, but patients must not drive for 15 minutes after.  

A new section has been added about how practices can utilise the resources and contractual flexibilities provided, including the use of PCN staff, extended access services and using QOF and local enhanced services income protection to enable workload prioritisation.  The LMC has raised this with the CCGs and the LMC is currently awaiting a response detailing the measures that the CCG plan to put in place to support practices to deliver the Covid vaccination programme.  

Practices may be interested in Dr Vautrey’s blog about GPs taking lead role in defeating the virus which can be read here 


Additional Funding support for delivering Covid Vaccination 

The template letter for successful PCN vaccination sites sets out the following:

CCGs will agree with PCN groupings the one-off costs of setup which will be met by the NHS from an agreed mobilisation date, applying a value for money test. Up to £20m has initially been made available to systems to meet these expenses

The LMC has been in discussion with the CCGs on other measures such as the repurposing of other enhanced services so that practices are able to prioritise the delivery of the programme.  The CCG has not yet advised of their proposals. 


Covid Vaccination Programme – IT capability

TPP and EMIS are unlikely to be compliant by 1st December in terms of recording the vaccinations and then reporting nationally.  There is also consideration being given to the need for bar scanning the vials. 

STPs/ICS are being asked to use one of 4 platforms one of which is Pharmoutcomes – this records the vaccination and the information then goes to the patients practice and also to the national database. 


Latest Guidance for Clinically Extremely Vulnerable patients

Following the announcement of a second lockdown from 5 November, the Government has updated their guidance for people who are clinically extremely vulnerable (CEV) alongside the new national restrictions.

NHSEI has written to practices to inform them of the new arrangements and although shielding is not being reintroduced as before, two additional groups have been added (adults with stage 5 chronic kidney disease and adults with Down’s syndrome).

Patients who are on the shielding list will receive notification directly from government about what they should do. The letter to the patients will also state that a copy of the letter is sufficient to give to an employer as evidence for Statutory Sick Pay purposes should that be required. Patients in this situation should therefore not need a fit note issuing by the practice.


Guidance for doctors who are isolating and those in vulnerable groups 

With new national restrictions in place, the Government is advising people who are clinically extremely vulnerable to work from home. The BMA has now published some FAQs explain what this means for doctors in that group, or who live with someone who is. See guidance >


Medicines home delivery service (England) 

The Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service have been commissioned for those identified as clinically extremely vulnerable on the shielded patient list for the national lockdown period in England, which means that all pharmacies and dispensing doctors in England will again be required to ensure patients on the Shielded Patient List receive their medicines at home.  Read more in this letter to pharmacies and dispensing doctors and in the service specifications 


Temporary approval to suspend the need for signatures on prescriptions (England) 

The Secretary of State for Health and Social Care has approved a temporary measure in England to help limit the transmission of coronavirus by suspending the need for patients to sign prescriptions until 31 March 2021, to avoid cross contamination and help minimise the handling of paperwork when collecting medicines.  

Patients are still required to either pay the relevant charge or prove their eligibility for an exemption from charges. Where patients are exempt from charges, the dispensing contractor will mark the form on the patient’s behalf to confirm the patient’s entitlement to exemption and, where applicable, to confirm that the patient’s evidence of eligibility has not been seen. Read more here  


Workload prioritisation during COVID-19 pandemic

In response to the COVID-19 pandemic, and rising workload pressures the GPC have prepared joint guidance with the Royal College of GPs to help practices prioritise the clinical and non-clinical workload in general practice. 

On entering the second national lockdown the pressures on health and social care services are growing.  GPs and their teams must be supported and enabled to provide care that best serves the needs of their patient population, in a way that adds most clinical value and keeps patients, clinicians and staff safe from the risk of contracting COVID-19.  

Whatever steps are taken to manage workload, the message must remain clear however that general practice remains open and that patients will be seen face to face where it is clinically appropriate to do so. 


PCR COVID testing

NHSE/I announced in a recent primary care bulletin that NHS Test and Trace is making PCR COVID testing available on a voluntary basis for self-administration, following a number of pilots in practices over recent weeks. This will be a supplementary option for practices and does not replace any of the existing routes to access testing. Members of the public will continue to be directed to regional testing centres or home testing kits in the first instance.  

The tests will be part of the Pillar 2 process and can be offered to patients attending the practice when the GP feels that a test would be appropriate and there would be difficulties for them to access the standard routes for testing.  The tests can also be used for GP staff and symptomatic household members. 

GPC raised concerns with NHSE/I that this could lead to patients contacting practices for tests inappropriately rather than using the current drive in or postal routes and as a result there will be no media launch of this initiative.  Further information is available here 


Extension to the Flu Programme Announced

Adults aged 50-64 will be able to get their free flu vaccine from 1 December in the next phase of this year’s expanded flu vaccination programme from either the GP or pharmacy. GPs, Trusts and Pharmacists can order additional stock to vaccinate this new group from the centrally secured government supply of over 7 million vaccines. 

Flu vaccine uptake is reported to be higher in all vulnerable groups except pregnant women compared to this time last year. Provisional data published by PHE on Thursday 20 November suggests 72.9% of those aged 65 and over, 45.0% of 2 year olds and 46.8% of 3 year olds have had their vaccine.

Flu Vaccine recommendations for 2021-22 – see link below 


Think 111 First

Mandated to ‘go live’ on 1st December, the principle aim of this scheme is to reduce ‘unheralded’ A&E attendances. We have repeatedly raised concerns that this pathway has significant potential to divert work to practices &, in response, have been shown local modelling suggesting between 8 – 16 patients per day, spread across the ICS, will be sent to in hours primary care via this route. 

Participation in the scheme is mandatory, but it is worth noting that:

GP practices are asked to make sufficient slots available for NHS 111 to refer into; they should assess the use of the slots each day and adjust the number to meet demand. This could be fewer than 1 appointment per 500 registered patients 


Community Pharmacy Consultation Service

From 1st November 2020, the NHS Community Pharmacist Consultation Service (CPCS) was extended across England to include referrals from general practices as well as from NHS 111.  See toolkit here  

Discussions will be taking place locally with relevant parties on establishing a robust referral process, with the necessary support available for both practice staff and pharmacies. Once this has been established it is likely that some early adopter practices will be sought who are willing to test the process before further roll out.  Given the current priorities and pressures it is not expected that the service will be fully functional at scale until well into the New Year.


PCN Clinical Director Survey

The BMA has launched the second edition of its annual survey of PCN Clinical Directors. In order to understand the situation on the frontline PCN Clinical Directors are being asked for their unique insights into the recruitment of the new workforce, the delivery of services throughout the pandemic and the future of PCNs.   The responses to the survey will contribute to supporting the long-term development of PCNs and help inform the BMA for its annual negotiations with NHS England.  Survey takes around 15 mins to complete. 

Link to the survey:   


Letter to CQC on supporting general practice during a period of unprecedented pressure 

GPC wrote to the CQC again urging them to immediately halt all non-essential inspections and practice monitoring to allow GPs and their teams, currently under immense pressure, to focus on the job at hand during the pandemic.  

Disappointingly, the CQC are not prepared to change their transitional regulatory approach, although it has confirmed that it will only inspect based on risk – i.e. where there are serious concerns around safety and quality of care.  As a result GPC has now written to Matt Hancock calling again for an immediate suspension of all CQC inspections and reviews of general practice, other than those required for serious safety issues. This should be for the duration of the pandemic and to enable practices to focus on other priorities, not least the COVID-19 vaccination programme.  


CQC Fees – No Change in 2021/2022 

The CQC fees scheme will not change in 2021/22. This means that, for most providers, their fees will remain the same as in 2019/20 and 2020/21, providing their registration or size does not change. The fees for General Practice remain fully reimbursable.  You can find the fees scheme, guidance and calculator at    


Gender Dysphoria

As you will be aware there is no gender dysphoria service in Suffolk and patients often endure long waits for assessment and treatment (including prescriptions for hormone treatment) at a tertiary centre.  Unfortunately, this is a commonplace experience for relatively large numbers of patients in this region.  

Given these circumstances local General Practitioners are often placed in an invidious situation where they are asked to prescribe and monitor treatments that sit outside their competency.  Unless the practitioner has specialist skills, this practice is unsafe and exposes the practitioner to medicolegal and other professional risks. The below extract is taken from NHSE & GMC documentation relating to prescribing responsibilities in primary and specialist care:  

NHSE “GPs must be clinically competent to provide necessary medicines in order to provide the most appropriate level of care to the patient.” 

 GMC Guidance on Prescribing: “You are responsible for the prescriptions that you sign. You must only prescribe drugs when you have adequate knowledge of your patient’s health. And you must be satisfied that the drugs serve your patient’s need.” 

 “Good medical practice says that you must recognise and work within the limits of your competence” 

Suffolk LMC, and the BMA as a whole, are quite clear that: 

(a) The absence of a specialist service, or the presence of a long wait times for secondary/tertiary services, this does not mean that GPs must prescribe outside their competency.  Furthermore, most primary care practitioners do not have the skillset to offer the other forms of support that should sit alongside prescriptions for hormone treatment in this context. 

 (b) The responsibility for providing a service to patients with gender dysphoria sits with NHSE who directly commission this service. Complaints relating to difficulties obtaining timely and appropriate treatment, in the context of patients who have been referred to the service by their GP, should therefore be directed to NHSE rather than the practice.


Parental leave webinar and workshop 

The BMA have published guidance for GPs on parental leave and will be hosting a webinar and workshop for more in depth guidance on these issues:  

2 December from 12.30pm – 2.00pm – Webinar‘GP Maternity and Parental leave Guide: launch and introduction to the guide’. Register here 

9 December from 12.30pm – 2.30pm – Workshop – ‘GP maternity’. Register here 

If you would like to submit questions in advance to be covered at either session, please contact Christopher Scott via


GMC – updated guidance ‘Decision making and Consent’

See updated guidance applicable from 9th November 2020 


AEROSOLSHIELD – GP Invention makes Resus Covid-Safe 

Created in the opening weeks of the pandemic by Dr. Lydia and Matthew Campbell-Hill and a like-minded team of experts from across the medical, business and technology disciplines, the AerosolShield is now being used by NHS teams across the country as a protective measure to help stop the spread of contagions produced by aerosol generating procedures and ensure staff feel secure whilst providing lifesaving care and assistance. 

Click here for more information about the AerosolShield to reduce Covid risk around resuscitation.  

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