November 2021 Newsletter

Included in this edition:

  • GP Input in the post CCG World
  • Omicron variant
  • Indicative ballot of practices on potential action  
  • GP earnings declaration
  • TPP access to records  
  • NHSEI project to re-issue consolidated provider contracts
  • Gender Identity Clinic – Prescribing Requests
  • Revisions to Firearms Licensing Process
  • New GP workforce data (England) 
  • COVID-19 vaccination – condition of deployment for health and social care workers 
  • Care Opinion
  • PNA Review – survey questionnaire for dispensing practices
  • Health Select Committee inquiry into the future of general practice
  • Updated infection control guidance (UK)
  • Practice Vacancies

Download Suffolk LMC Newsletter November 2021

GP Input in the post CCG World

CCGs and their responsibilities are due to be subsumed into a new NHS architecture from April 2022. 

Replacing CCGs are 3 new bodies:

  1. ICB (Integrated Care Board) – a small executive team overseeing ‘system’ function and which will encompassing core functions such as finance and estates. Primary Care commissioning will transfer from CCGs to the ICB.
  2. ICP (Integrated Care Partnership) – a wider board whose membership is likely to be a very broad range of health and social care providers.  The ICP will provide high level direction to the ICB.
  3. Alliances – 3 Alliances (East & West Suffolk alongside NE Essex) form the local bedrock of the ICS with a raft of delegated responsibilities.

The exact make-up of these bodies is yet to be finalised.

From a general practice perspective, it is imperative that primary care is adequately heard & represented at all levels of the new structure. Current thinking centres around 2 Primary Care posts on the ICB (1 Suffolk, 1 Essex; appointment via election) with proposals around Alliance and ICP largely unknown at the time of writing.

Omicron variant

Practices will have received the above CAS alert from MRHA outlining the designation of the new variant as a ‘variant of concern’ by the WHO.

Following the NHSEI Webinar Monday evening important communications can be expected in the next few days that will outline the actions that are proposed to control the spread of the new variant.  The government has already put in place enhanced precautions outlined here Coronavirus (COVID-19): guidance and support – GOV.UK (

The key theme from the webinar centred around a considerable ramping up of the covid booster campaign – boosters now to be offered to all those 18-39, second vaccinations for 12-15 year olds, and 3 monthly boosters instead of 6 months.  Some IOS fees for vaccinations are to be increased.  The PCN CD payments to be increased until the end of the year.  Other measures to support primary care to free up capacity are under consideration and GPC is campaigning, in particular, for suspension of QOF. 

More detail is due out imminently.  In the meantime, the following guidance has been put out by chair of GPC, Farah Jameel:

  • Reinforce, continue to use clinical decision making when seeing patients FTF.
  • Reduce / stop all non-essential contact (this should already be the case).
  • Wear masks: Hands, Face, Space.
  • Anyone with symptoms – reinforce need for PCR swab (best practice).
  • Anyone with history of travel as per press conference, confirm swab result and use clinical instinct & insight.
  • Big push on vaccination.

Indicative ballot of practices on potential action  

Last Friday afternoon, The LMC Conference discussed the results of the indicative ballot of GP practices in England. This was launched by the BMA after the profession rejected the Government’s so-called winter ‘rescue package’ for general practice.  The indicative ballot results showed that 84% of respondents said they would welcome non-compliance with COVID-19 exemption certificate requests, 80% said they would change the way they reported appointment data, and 58 % said they would support withdrawal from the PCN DES at the next opt-out period.

The next action will be to discuss a detailed version of the ballot results at a virtual event in January to steer the next steps.  Details of how to join the event will be communicated in due course. 

GP earnings declaration

With thanks to Richard Vautrey and Chaand Nagpaul (Chair of council), who continued to raise with the Department of Health and Social Care (DHSC) the serious concerns about earnings declarations for GPs.  They had further discussions with them on Wednesday and they have now confirmed that they will delay both the submission and publication of earnings declarations until at least next Spring.

GPC will continue to lobby on this matter. Read the guidance on GP earnings.

TPP access to records  

Following the announcement that patients registered with TPP practices would be granted access to their records from December 2021, BMA GPC England wrote to NHSX calling for a delay, citing clinical safety and workload issues.  Last week a response confirming that initial rollout will now be delayed until April 2022 with time given to work with NHSX to ensure that it happens safely and with minimal disruption. GPC will provide more information on any further changes as and when it is received.

NHSEI project to re-issue consolidated provider contracts

The LMC has been informed by NHSEI that together with Attain, they are about to embark on a project across the East of England region, to re-issue all provider contracts for Primary Medical and Ophthalmic contractors. The purpose of this exercise is to support the impending ICB Legislation by ensuring that NHSEI have accurate contractor information and have incorporated all the latest contract legislation, before the contracts are handed over to ICBs. 

The LMC has some concerns about this proposal and will be joining an engagement event with the project leaders shortly to learn more about what is proposed in preparation for the likely need for the LMC to seek legal opinion.   

Gender Identity Clinic – Prescribing Requests

The issue of prescribing hormones to patients seen by the new GIC service remains unsolved.  We would therefore like to gently remind practices of our previous advice (with associated pushback form) that the current arrangements around prescribing are wholly unsatisfactory.

Our concerns are mirrored by the SNEE ICS Area Prescribing Committee who have, recently, formally written to the commissioners.

Revisions to Firearms Licensing Process

Following revisions to the firearms licensing legislation we have had the following communication from Richard Kennett who is the Firearms Licensing Manager for the Norfolk & Suffolk Constabularies.

What has changed?

From 1 November the application form used by certificate applicants will contain a proforma which may be detached and given by the applicant to their GP or a qualified GMC registered doctor for completion.  This is to provide information to the police which will confirm whether or not the applicant is or has been diagnosed or treated for any relevant medical condition which could affect their ability to possess a firearm safely. The relevant medical conditions are listed on the proforma. An example of the application form and the proforma is attached for reference.

It is for the applicant to arrange for the medical information to be sent to the police either with the application itself or, alternatively, direct from the doctor. A significant change is that an application for a certificate will not be granted without such medical information.

It is matter for the GP whether they make a charge for providing the medical information check and as this is an additional service I would imagine most GP’s will need to make a charge.  Any fee charged will be between the applicant and the GP.

Where GP’s wish to send the proformas directly to us I would ask this is done by e-mail to either:

Patients who reside in Norfolk =

Patients who reside in Suffolk =

In the past some GP practices have chosen not to be involved in the old process for various reasons.  If this remains the case the patient has the option to go to a qualified GMC registered doctor to complete the proforma.  A number of private doctors do provide this service.  I would hope that the clarity  of the new guidance provides might allow GP’s or practices which have previously not  been able to assist in providing information might be able to reconsider their position.  

We still ask that GP’s who receive medical information proformas from their patients to place a firearm certificate marker on the medical record.  The purpose of having a marker on the medical record is to provide a reminder to the GP that they may need to notify the police if a person begins to suffer from a relevant medical condition, or a relevant condition worsens significantly, specifically when this may affect the person’s ability to possess a firearm safely.  The marker will be on the record during the validity of their firearm or shotgun certificate or registration as a firearms dealer. This is added to the patient’s record by the GP on a best endeavours basis, to reduce the risk that such relevant developments or changes are not reported to the police, which could endanger the certificate holder, members of his or her family, or the wider public.

I have attached an example of a new application form and the relevant sections of the new statutory guidance for information.  The full guidance can be viewed at GUIDANCE TO THE POLICE – FITNESS TO BE ENTRUSTED WITH A FIREARM (

The police may still send requests directly to GP for medical information during the life of a certificate in case where the certificate holder has come to police notice.  

We are in a period of change and are required to accept old application forms up until 1 December this year. This means for a few weeks we will continue to operate the old system for those old application forms received during the transition period.

New GP workforce data (England) 

The latest GP workforce data in England for September show the continuing contraction of the General Practice workforce, which the Government clearly failed to acknowledge in its ‘rescue package’.   September’s data shows only a total increase of 42 FTE GPs compared to the previous month – which is an increase of 99 fully qualified GPs set against a loss of 57 trainees.  This increase is clearly insufficient to cope with the current workload, with the enormous jump in GP appointments in the last month alone (up by 4.7 million, from 23.9 million to 28.6 million). 

General practice is now the equivalent of 1,704 fewer fully qualified FTE GPs than 2015 levels. Over the last year (September 2020 to September 2021) general practice has lost 154 fully qualified GPs (a gain of 759 salaried and locum, set against a loss of 913 partners), and 282 fully qualified FTE GPs (430 FTE Partners set against a gain of 148 FTE Salaried). 

Meanwhile, the number of patients continues to rise, which means the number of fully qualified GPs per 1,000 patients in England is likely to further fall soon (currently 0.45, compared to 0.52 in 2015) 

COVID-19 vaccination – condition of deployment for health and social care workers 

The Government has announced that health and social care workers who have face to face contact with patients, will need to provide evidence they have been fully vaccinated against COVID-19 in order to be deployed unless they are exempt, under new measures announced recently.   

Although the majority of NHS workers are already vaccinated (93% have had their first dose and 90% have had both doses) the government are urging the remainder to get vaccinated, to keep themselves and those they care for safe. 

The requirements will come into force from 1 April 2022, subject to the passage of the regulations through Parliament, and there will be a 12-week grace period between the regulations being made and coming into force to allow those who have not yet been vaccinated to have both doses before the measures are introduced.  

We understand that further guidance is going to be coming from NHS England and GPC will be getting expert HR and legal advice on the question of process and options to ensure that unfair dismissal claims are avoided. 

Care Opinion

Practices may be aware of the above organisation who publish feedback from service users of care organisations.  Some of the material appears to be copied over from NHS Choices.  They will usually send an email advising that a ‘story’ is to be published.  Until the story is published it will not be known whether this is of a positive or negative nature.   LMC Law have advised us that if it’s a negative story, then it could be actionable, but would question whether it would be worth pursuing in any event.’ 

If any practice has concerns about the content of what has been published please do get in touch so that we can obtain advice from LMC Law on whether any further action might be appropriate.

PNA Review – survey questionnaire for dispensing practices

The LMC would like to urge all dispensing practices to complete this questionnaire which you would have received via a Gateway recently:

What is this questionnaire about? 

As you may be aware, Suffolk County Council has a statutory duty to develop and publish a revised Pharmaceutical Needs Assessment (PNA) at least every three years. The next PNA will be published by October 2022. Work has been underway on the PNA for some time and I would like to update you on the process so far.   

A core Steering Group was established to lead the work. The Steering Group includes Local Medical Committee (LMC) representation.  Information is being collated on the population and health needs of each of the localities in Suffolk. Alongside that, information is being collated on the pharmaceutical services that are currently available. 
The conclusions will start to be drawn leading to the draft PNA for consultation being completed by summer 2022. All dispensing doctor contractors will be asked to comment as part of the consultation. 

To help us form a clearer picture of the services available to patients living in the more rural parts of the Health and Wellbeing Board area who may have problems accessing services, please can you answer the following questions by 17th December 2021 at the latest, so that the information can be incorporated into the needs assessment.

Who should complete the questionnaire?
This questionnaire should be completed by the Dispensing Doctor / Practice Manager. The responses should be about the dispensary. If your practice offers dispensing services from several branch surgeries, please complete a return for each dispensing site. 
If you do not wish to answer a question for any reason, then leave it blank.  

Please complete this questionnaire by 17th December 2021

Please click here to complete the survey.

Health Select Committee inquiry into the future of general practice

This week the Parliamentary Health and Social Care Committee (HSCC), chaired by former Health Secretary, Jeremy Hunt MP, has launched a timely inquiry into the future of general practice. The inquiry presents a key opportunity for the BMA to push our GP campaign asks, as well as to raise wider concerns and recommendations.

The BMA will submit a formal response, and you can share your views on review by emailing by the extended deadline of Wednesday 1 December, to support our response. Please do send across your thoughts so that we can represent the breadth of general practice perspectives to this important consultation.  Members of the public can also submit their comments directly to the inquiry by 14 December.

Updated infection control guidance (UK)

New infection prevention and control (IPC) guidance has now been published by the UK Health Security Agency.  It covers seasonal respiratory viruses and supersedes the previous COVID-19 specific guidance.

It recommends that face masks for staff and face masks/coverings for all patients and visitors should remain as an IPC measure within health and care settings over the winter period.  It also recommends that physical distancing should be at least 1 metre, increasing whenever feasible to 2 metres across all health and care setting, and that it should remain at 2 metres where patients with suspected or confirmed respiratory infection are being cared for or managed.

This follows the specific recommendations for changes to IPC guidance in primary care published last month. The BMA have already stressed that 1 metre social distancing will be difficult for some smaller surgeries and as such there will still have to be a reduced capacity in some practices. The guidance strongly emphasises that local decisions and risk assessments will ultimately decide whether a face-to-face consultation is appropriate and where physical distancing can be safely reduced.  It is therefore for practices to determine what arrangements they have in the surgery.

Practice Vacancies

Can be found on the LMC Website

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