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Topics covered:
Shared Care Agreements;
Inclisiran;
Accessing LMC Help & Support;
e-Dec and Practices having to declare compliance with Pay Transparency requirement;
Dental Issues;
Claiming flu and COVID vaccination reimbursement;
Mental Health ‘Interface’ Issues – NSFT Liaison Forum
CNSGP Indemnity guidance for General Practice – consulting patients abroad;
Niche GP Initiative
GPC England meeting update;
General Practice pressures and data;
Accelerated Access to Records Programme update;
Physician Associates;
Seasonal Vaccination Update;
Navigating GP Premises Service Charges;
GP trainees committee renames itself the GP registrars committee;
NHS Suicide Postvention Guidance for staff;
Wellbeing resources
PDF version – Suffolk LMC Newsletter – November 2023
Shared Care Agreements
Cinacalcet/Amiodarone (East) – The LMC would suggest that the entirely unfunded addition of Cinacalcet to the growing list of shared care medications has crossed the ‘line of reasonableness’ and we would strongly encourage Suffolk practices not to enter into new arrangements for prescribing this drug at this juncture and to consider their position in relation to existing SCAs for Cinacalcet. East Suffolk practices may also wish to review their approach to Amiodarone (also recently added to the same list) in a similar manner.
There is no fair mechanism currently in operation that reimburses practices for the
work/responsibility involved in this arrangement and, by resisting this particular item of workload
shift, we hope to reinforce our core message that such a mechanism needs to be found with a degree of urgency and, in the interim, that no new shared care agreements should be operationalised.
Inclisiran
The Collaborative Lipids Funding (CLF) Inclisiran Pilot, supported by the GP federation, has
experienced some delays due to challenges in the ICS governance process. However, the LMC is
informed that the process is within the final stages and that, according to the ICS, the chosen
delivery agent (GP Fed) will be soon be in a position to reaching out to their member practices to
provide details on the funding and logistics of delivering the pilot program. This initiative aims to
offer Inclisiran to the top 10 most at-risk eligible patients in each practice, facilitating the system to
gain experience with this injectable therapy.
Suffolk LMC advice, in line with national BMA & RCGP advice, remains that Inclisiran (a black triangle
drug) is best delivered, at first, by a larger scale service with a degree of specialist oversight. It
should also be noted that this is not a self-administered (subcutaneous) medication and that there is
no funding to create capacity for the aforementioned intervention at practice level.
Accessing LMC Help & Support
The LMC office is undergoing a period of transition with back office support moving to the Suffolk GP
Federation. We anticipate that this will create additional capacity for core LMC work and is part of a
bigger piece of work seeking to optimise the LMC.
As part of this transition, we would encourage any new queries or questions to be sent to
support@suffolklmc.co.uk.
e-Dec and Practices having to declare compliance with Pay Transparency requirement
The deadline for returning the e-Dec is 1st December. We are informed that GPC intend to publish
guidance to all practices next week and therefore, for practices with concerns, we would suggest
waiting for the national steer before submission.
Office Opening Hours
The LMC is currently operating with a (very !) reduced headcount and will therefore be operating a reduced service between Xmas and New Year (office open on 28th Dec). We look forward to welcoming Aimee Longfoot to the team in mid January and have a live advert for a Medical Officer.
Dental Issues
Recent cases in Suffolk have illustrated the fact that callers via 111 may be directed to general
practice as a provider of last resort for dental issues; this is not codified in the pathways used by the
system, but the modus operandi, when no appropriate dental cover is available, appears to be that
practices will be asked to intervene.
Extract from dialogue with PPG:
Patients who are unwell (eg fever, dental red flags etc) may be signposted to their own GP if the
patient has already tried local dental practices and ED, but this will always be caveated with the
patient being told that the GP surgery may not be able to help and this is very much a last resort
after exhausting all other options. Patients would be told to call 111 back if the GP is unable to
help.
Further confusion is introduced by recent changes to the NICE guidance on dental treatment by non-specialists.
Suffolk LMC is clear that GPs and other primary care staff must act within their scope of competency
and are therefore, as above, are entitled to redirect patients back to 111/A&E where this applies.
It is also clear that primary care should not be placed, by inadequacies in the system, in situations
where the temptation, by virtue of trying to help a distressed patient, is to do practice unsafely.
Claiming flu and COVID vaccination reimbursement
EMIS practices using, as per the NHSE co-administration guidance in operation prior to 23 October,
Pinnacle/non GP systems to record flu and COVID vaccinations should be aware that a separate
submission (to claim dispensing costs for ‘flu) is likely to be required in addition to that submitted via
Pinnacle.
Mental Health ‘Interface’ Issues – NSFT Liaison Forum
Practices will, no doubt, be aware that the difficulties at the interface of NSFT and primary care in
Suffolk have proved tricky to resolve over the years. It is hoped that the establishment of an
NSFT:Primary Care liaison (Suffolk LMC representing practices) may move us towards resolving
granular issues such as medical cover for eating disorder patients, ECGs and the legion of prescribing
responsibility issues amongst others.
In light of this new forum, the LMC office would like to be made aware – via email to support@suffolklmc.co.uk – of practical issues experienced by teams in Suffolk relating to this
interface. This is particularly the case where the issue appears to be a systemic or governance
problem rather than individual clinicians.
CNSGP Indemnity guidance for General Practice – consulting patients abroad
Practitioners should be aware that CNSGP (the NHS Indemnity Scheme) does not cover legal action
brought in other jurisdictions and therefore practitioners should be wary of consulting NHS patients
who are currently abroad.
Niche GP Initiative
The GP support hub have identified 14 GPs who are able to work in niche roles (as per below) and
are available to practices. It is a matter for practices & the individual ‘niche GP’ to agree a pay rate.
LARC; Cardiology x2; Dermatology x3; Learning Disabilities; Baby checks; Remote consulting x2;
Medical admin; Frailty; Lifestyle medicine in the elderly & proactive care of the elderly and
teaching/education
Further info and contact at https://gpsupporthub.org.uk/niche-gp/
BMA GPC Update
GPC England meeting update
At last week’s GPC England meeting, we set out a vision for general practice which will further be
refined and influenced by the upcoming England Conference of LMCs, and the national survey of the
profession – being announced the same day. This survey is to be of all GPs, not just BMA members.
Our aspiration is that we survey annually each summer, in time for feedback to be ready ahead of
the annual contract negotiation round.
Our vision needs to be rooted in common ground with our patients, and common sense with our
commissioners. It will be framed ‘before’ and ‘after’ the 2024 general election. NHS England and the
Department of Health and Social Care have already committed to very little change for the 2024/25
contract, but the financial envelope to fund practices has not expanded for 5 years despite
population, demand and inflationary rises. We need to push for greatest flexibility, lowest
bureaucracy and highest trust to best guarantee practice sustainability.
Once we have fed in your opinion as GPs on the ground across the country, we will be sharing our
thoughts with stakeholders of influence, e.g. colleagues at the RCGP and RCN; think tanks; and most
importantly of all, patient groups before publishing next Spring in time to influence party manifestos
and make protecting general practice a key ’doorstep conversation’ on the election campaign trails.
We need to better the figures released last week by the Institute for Government which
demonstrated how “GP numbers have flatlined, while the hospital doctor workforce has
burgeoned”; The Economist data which demonstrated the 4% productivity rise in general practice
post-pandemic compared with circa 10% drop in the acute sector; the NHS waiting list across
England and its driving factors when Trusts were put on captivated budgets and how GPs can
likewise reflect on how Trusts chose the speed of their own hamster wheels – this is the foundation
of the BMA’s safe working guidance. But we know you would like more evidence, and more
examples of how to embed this in your practices. We shall be working on these together with
resources for you to share with your PPGs in due course.
Look out for the survey towards the end of the month – this is your opportunity to place your voice
at the heart of your future.
General Practice pressures and data
The latest GP workforce data showed that, the net outcome of those newly-qualified GPs joining the
workforce in England this August, and those retiring, resulted in a net gain of a mere 56 more fulltime
equivalent (FTE) GPs by September. Noting the longer-term trend, compared with September
2015, there are still over 2,000 fewer FTE fully qualified GPs. The NHS Long Term Workforce
Plan projects a shortfall of 15,000 qualified full-time equivalent GPs by 2036/37 without further
policy action. That action cannot come soon enough.
Being a GP can be the best job in the world, but we need the Government to recognise the value and
importance of investment and support for our profession, so that we can safely look after our
patients, and effectively meet growing demand.
A single full-time GP is now responsible for an average of 2,300 patients. If we are 6000 GPs short as
the Government have accepted, this is the equivalent of millions of patients without access to their
GP. No wonder services feel so stretched, and no wonder patients perceive the keen loss of “their”
family doctor. Click here for more infographics and data on General Practice.
Accelerated Access to Records Programme update
GPC England has a new webpage with guidance for practices on how they can provide prospective
access to their patients’ GP-held medical records safely, where all our resources are available.
Legally, GPs must act in the interests of their patients. As data controllers, they must see to mitigate
data protection risks. Practices are required to carry out a Data Protection Impact Assessment (DPIA)
exploring the risks and any possible mitigations as part of the implementation of this programme.
GPC England is supportive of patients having access to their records so long as this is safe for
patients and safe for GPs. We continue to put forward the case for making access to records on an
opt-in basis.
If you have any examples of where your practice or patients are being put at risk as a result of the
programme, please email us on info.gpc@bma.org.uk
Access our template DPIA and other resources on our updated guidance page
Read also: GPs urged to adopt opt-in approach to online patient record access (bma.org.uk)
Physician Associates
At the GPC England meeting we also passed an emergency motion tabled, expressing concern over
the increasing trend of Physician Associates (PAs) where erroneously used to replace GPs, and to
protect patients by ensuring appropriate processes and regulations are in place. This follows
a statement by UEMO (European Union of GPs/Family Doctors) supporting GPs in the UK over our
concerns.
The BMA recognises the vital role that multidisciplinary teams play in General Practice, but patients
need to know and understand what each healthcare professional can and cannot do, and where
their expertise is relevant. There have been some recent examples suggesting a potential blurring of
lines between doctors and non-medically qualified professionals, leading patients to think they’ve
seen a GP – when they haven’t.
PAs are not doctors, they are not regulated, and they cannot prescribe. The distinction between GPs
as expert medical generalists, and PAs, must be protected. PAs cannot be used as a substitute for
GPs, or in place of a GP when supervising GPs in training.
The GP workforce crisis is a result of the failure of Government to plan for the recruitment and
retention of GPs. Only by valuing and investing in the recruitment and retention of GPs will the
experience and care of patients improve. While PAs may help reduce general practice workload in
some well-defined cases and pathways, it should not come at the expense of patient safety.
Read my full statement here
Seasonal Vaccination Update
The Co-administration template is now available as of 23 October, and this should be now available
to all sites who are using the system. NHSE have advised that the delays to the co-administration
template came about due to the accelerated timelines of the programme. “Pinnacle had to prioritise
their workload to ensure that rapid development of POC systems could be achieved. Our digital
colleagues worked with Pinnacle to introduce it as soon as possible, recognising that it is a very
important functionality for sites.”
The additional financial support, which came to an end on 31 October, was put in place to support
programme acceleration (i.e. to administer as many Covid-19 vaccinations before the end of
October) and to recognise the additional administrative, organisation and delivery costs associated
with that ask. The UKHSA and DHSC are responsible for monitoring the epidemiology and advising
NHS England where further steps need to be taken in response to emerging Covid-19 variants. They
have been monitoring the situation, and do not regard additional measures as necessary at this
stage. Therefore, at this point in time, there are no plans to extend the additional financial support.
However, it appears that patients are coming forward less quickly this Autumn compared with last.
The UKHSA’s uptake reports are available here.
Regarding staff vaccination for flu, provision is an employer responsibility and not provided under
the NHS flu programme. Frontline primary care staff are not eligible for a free NHS flu vaccination
and therefore are not included in the Annual Flu Letter cohorts, but they do appear in the enhanced
service spec because the decision was taken last year to include frontline primary care staff in the
spec to allow for cover under the Clinical Negligence Scheme for General Practice, as provision of flu
vaccinations to these staff is an employer responsibility.
Navigating GP Premises Service Charges
In 2022, the cases of Valley View & Others v NHS Property Services (which were supported by the
BMA) considered five different scenarios where service charges (charged by landlord NHS Property
Services) were disputed.
Service charges usually arise where the GP practice doesn’t own the premises and the landlord
provides repair and maintenance. Here, NHS Property Service’s default position was to charge
pursuant to its Charging Policy.
However, the Court concluded that the Charging Policy doesn’t override the terms of the tenancy
agreement. While these cases don’t set a universal precedent, there are useful points that may
assist GP practices in resolving disputes or pushing back on service charges raised.
The sums initially demanded by NHSPS in the cases of Valley View & Others were significantly higher
than what was ultimately paid by the practices. The BMA successfully assisted the five practices in
the cases to significantly reduce service charge claims, with one practice agreeing to a reduction of
more than 80%.
BMA Law has a team of legal professionals specialising in healthcare related law and can advise GP
practices in respect of service charge issues. To discuss NHSPS service charges and other related
matters please BMA Law on 0300 123 2014 or email info@bmalaw.co.uk
GP trainees committee renames itself the GP registrars committee
The BMA’s GP trainees committee has now officially changed its name to the GP registrars
committee.
The decision to change the committee name was made to reduce confusion for patients as it better
reflects their roles as fully qualified doctors, and it is a step to regaining the professional respect that
all GP registrars deserve.
You can read more about how the GP registrars committee is working toward regaining their
professional identity in this blog by the GP registrars committee chair, Dr Malinga Ratwatte.
NHS Suicide Postvention Guidance for staff
The University of Surrey, Keele University, and the University of Birmingham have developed
postvention guidance for NHS services on how to support staff after the death by suicide of a
colleague. The Social Partnership Forum Workforce Interest Group, of which the BMA is a member,
have been asked to circulate the executive summary and full report for your information.
Wellbeing resources
We continue to encourage practices to focus on their own team’s wellbeing and take time to reflect
on what can be done to protect it (this will also meet the requirements of QOF quality improvement
project on staff wellbeing). We have produced a document which includes some tools for improving
workload and safe working. A range of wellbeing and support services are also available to doctors,
from the BMA’s counselling and peer support services, NHS practitioner health
service, Samaritans and Doctors in Distress. See also our poster with 10 tips to help maintain and
support wellbeing.
