November/December 2019 Newsletter

Included in this edition:

  • CCG v Kafico DPO Services
  • Performer List – new PCSE online portal
  • Special Allocation Scheme
  • Data Sharing Agreements
  • Ear Syringing
  • PCNs – some common queries
  • Recent Court Case – collecting records
  • Safeguarding Training
  • Pensions tax payment for 2019/20
  • Private Consultants
  • Sleep Station
  • Registration of individuals leaving the secure residential estate (England)

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Information, Guidance and News

Key Matters reviewed by the Committee November:

  • GP IT
  • PCN update/developments
  • Sleep Station
  • Reduction in Health Visitor Services
  • AF Clinics
  • Minimum Wage implications for primary care resources
  • Population Health
  • Private Consultants/GP workload
  • Liaison with I&ES CCG/WS CCG
  • Liaison with STP
  • Liaison with WSFT & ESNEFT
  • Data Sharing Agreements 


CCG v Kafico DPO Services

The LMC had previously expressed some concerns about due diligence in the handover arrangements when practices wished to transfer to the CCG DPO service from the previous provider.  The CCG was able to provide appropriate reassurance around this and also agreed to reimburse the practice costs to the former provider during the 2-month notice period should that be now or at a future date.   

The LMC retained some concerns about the potential for conflicts of interest with a CCG led service, particularly where practices receive data sharing agreements associated with CCG led initiatives.  The LMC sought LMC Law’s advice on the matter.   Following Shanee Baker’s response the LMC has received sufficient level of reassurance that the arrangement should not present any major difficulties but LMC Law did wish to emphasise that it is the practice’s responsibility to cross check anything that they are signing up to. 

NB:  To assist in cross checking LMC Law have produced a Data Sharing Agreement checklist and this will be sent out to practices this week.


Performer List – new PCSE online portal 

This initiative from PCSE is due to go live from 2nd December.  We understand that practices by now will have received the email from PCSE with a link to set up the user account for the new online system.  PCSE will send a separate email to individual GPs so they can set up their access.  The email used will be the one that the GP has registered with the GMC.  

There are three ways to add or update a GMC email address:

  • Log into your GMC Online account & update this in the ‘My details’ section
  • Send an email to this is sent from your new email address you will be asked security questions to verify your identity)
  • Call the GMC on 0161 923 6602


Special Allocation Scheme

We recently reported to practices that the Special Allocation Scheme now operates on S1 GP module (Health Outreach APMS) and that this means that practices would be alerted should a patient present for registration.  

However, in the event a patient has been deemed fit for discharge from the scheme the SAS Provider (ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST) would ask the patient where they are planning to register and would provide a letter from the service that outlines the patient has completed successful rehabilitation on the scheme, to give to their new practice (this will also be attached to their record).  

The LMC view is that this system whilst a helpful step forward still falls short of the safety net provided by the previous system whereby the SAS patient list was circulated to all practices and we will continue to press for this to be reinstated.


Data Sharing Agreements

There is currently a lot of confusion about the various data sharing agreements in circulation for practices to sign.  The service to which these relate is not always clear or has changed and the LMC has therefore made formal request to the CCG for a summary document to be produced that will provide the necessary clarity and enable the LMC to ascertain its position on the suitability of the various documents and its recommendations to practices.  We will keep practices updated.


Ear Syringing

The contractual position around this continues to be a source of enquiry to the LMC and we understand some hospital departments are raising patient expectation that practices will perform the procedure.  The LMC continues to give the following guidance:

Ear syringing as a procedure is not a contractual requirement ie not part of essential services however the examination and assessment of patients who present with deafness is part of essential services.  As part of the deafness assessment practices may undertake ear syringing if they have the necessary equipment, a suitably trained individual to carry out the procedure but it is not a requirement under the contract.  

The NHS online patient information (see is very clear that GPs may not necessarily perform ear syringing.

Further research by the committee identified that ear syringing is high on the list of common reasons for litigation.

For completeness NICE in Recommendations | Hearing loss in adults: assessment and management | Guidance | NICE confirms in section 1.2.3 that primary care can consider ear irrigation if the practitioner has training/expertise in using the method and the correct equipment is available.  There is no obligation to purchase or maintain equipment in working order and no obligation to acquire training in order to do it.  If either of these is deficient there is an obligation NOT to perform the procedure.


PCNs – some common queries: 

ARRS Underspend

For 2019/20, in the event that a CCG forecasts an underspend on its Additional Roles Reimbursement Scheme funding (as a result of PCNs failing to draw down their full entitlement), NHS England have made it clear that CCGs should put in place local schemes to share that unused financial entitlement across the other PCNs in the area to enable them to carry out further recruitment – on the terms set out in the Network Contract DES and in this guidance – above their 2019/20 entitlement (with those further additional posts then attracting national funding via the Additional Roles Reimbursement Sum for 2020/21). For 2020/21 and beyond, GPC will seek to formalise this a little more and they are in discussions with NHS England about the introduction of a national system of entitlements for PCNs to claim unused Additional Roles Reimbursement Scheme funding from other PCNs’ unused entitlements within a CCG area.  

Consideration of inclusion of pharmacy technicians in PCNs

As per clause 1.21 of the contract reform agreement, GPC will continue to explore the opportunities for pharmacy technicians to work across PCNs.

ARRS from 2020

Each PCN’s Additional Roles Reimbursement Sum will use Contractor Weighted Population as at 1 January of the financial year preceding and be calculated as follows:

  • PCN’s weighted = PCN’s weighted population share/Total England weighted population

The Additional Roles Reimbursement Sum for any given year would be calculated as follows:

  • PCN’s Additional = PCN’s weighted population share X total national workforce funding Roles Reimbursement Sum
  • PCN Tax Implications

Andrew Burwood at Larking Gowen has advised the following:

The £1.50 per head belongs to the network and will form part of the network’s income and expenditure account which will have to be prepared on an annual basis.  Any profit generated within the network will be shared between the network members in accordance with the network agreement, and each partner will be taxed on their share of the profit achieved.  

Bearing in mind the set-up costs of each network, it is highly unlikely that networks will make much of a profit, if any, at all in year one, although of course it is possible…


Recent Court Case – collecting records

Practices will be aware of the recent SAR case and mode of availability of the records made by the practice.  This judgement has confirmed that practices can make records available for collection at the practice (ie rather than posting) if the recipient has agreed to this.   

The BMA FAQ on SARS is worth a read (FAQ is at foot of page) 


Safeguarding Training 

Practices will be aware the intercollegiate group changed their guidance on safeguarding requirements earlier this year to suggest that GPs, nurses and many practice staff should have level 3 safeguarding.  It made recommendations about the number of hours required for training and stipulated that some of this training needed to be face-to-face.  These onerous recommendations were concerning, particularly in relation to the impact on service delivery for general practice.

CQC and the network of Responsible Officers (ROs) use the intercollegiate guidelines as their benchmark for what they considered to be reasonable expectations of organisations and individuals, and so this raising of the bar was problematic.

The following action has taken place:

  1. GPC wrote to NHSE for clarification regarding the contractual situation, and they have replied to the effect that the contract does not directly stipulate the level of safeguarding training required. See letter here
  2. GPC have been in correspondence with the leaders of the RO network and they have agreed that the intercollegiate document is guidance only and that level 3 safeguarding should be an aspiration. It should certainly not be regarded as a pass/fail, and in any event that appraisal is not a summative process and that appraisers who take this kind of approach should be challenged.
  3. GPC agreed that appraisers are well poised to support doctors in terms of having a professional conversation with them about their CPD needs across their full scope of work, including safeguarding.  It is the doctor’s role to judge whether the level of CPD activity undertaken in an area is sufficient to maintain proficiency in that area.  Whilst the appraiser is in a position to review and, if necessary, challenge this, it is not the role of the appraiser to count whether time spent in CPD meets the level described in this or any other guidance.
  4. GPC also pressed the same point with CQC and was given a clear assurance that inspectors will regard the guidelines as aspirational. They will not fail practices who have coherent and reasonable safeguarding processes simply on the binary basis of these guidelines taken out of context.

The BMA have updated the practice training resource to reflect CQC and NHS England expectations on safeguarding training.  


Pensions tax payment for 2019/20

NHSE have announced plans for covering the costs of tax on the annual allowance for 2019/20.   NHSE have stated that the annual allowance tax charge for this financial year (for anyone that incurs it) will be covered via the scheme pays route and that when the individual retires and claims their pension, the NHS will pay to them the value of the tax charge for 2019/20 (including interest accrued), so covering the cost.

The BMA has responded to this proposal which can be found here.  The BMA is continuing to liaise on the details of how this will operate, as well as continuing to lobby for longer-term solutions, including proposals to get rid of the annual allowance altogether.

NHS England’s letter and FAQs are available here


Private Consultants

Following a few queries on this subject, the LMC wishes to advise that if a patient has chosen to pay for private healthcare because a) their treatment is not available on the NHS or b) they do not wish to be treated on the NHS, they are responsible for paying for all costs, including tests, and the private consultant is responsible for managing every aspect of their healthcare (unless the patient chooses to transfer back to the NHS at a later date to continue treatment).  For that reason, private consultants should not be asking GPs to arrange any tests that they deem necessary, and intend to use, to make a diagnosis and recommend a course of treatment with.


Sleep Station

The LMC has been notified that some practices have been approached by patients seeking referral to the Sleep Station  It is our understanding that some CCG areas have commissioned sleep management services (CBTi) from the organisation and that patients in those areas are able to gain ‘free’ access following referral by their GP.   We are not aware that this is the case in Suffolk.  The website can be misleading to patients on the availability of NHS referral.  


Registration of individuals leaving the secure residential estate (England)

In June 2019, NHSE issued information reminding CCGs and GPs of a GMS/PMS contractual change which means that people can now register with a GP practice prior to their release from the secure residential estate (such as prisons, young offender institutions, immigration removal centres and secure training centres).

The aim of this is to help these individuals maintain continuity of care, avoid unplanned emergency admissions to hospital, and support their rehabilitation.  NHS England has been advised by healthcare providers working within the secure residential estate, that not all GP practices are aware, and it has resulted in some issues with registering individuals prior to their release. 

Practices are advised to familiarise themselves with the process and update their procedures as set out here.  Any queries email 

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