October 2021 Newsletter

Included in this edition:

  • BMA to undertake an indicative ballot of practices on potential action – Update from BMA
  • Workload control in general practice
  • GP declaration of earnings guidance
  • Medical Exemption Certificate for Covid Vaccination
  • WSH AAU contact number
  • Dispensing Fee Cut
  • Infection control recommendations for primary care
  • Domestic Abuse Act 2021
  • GP Support Hub – DBS message
  • Healthwatch Report
  • Pass on to GP Trainees
  • Practice Vacancies

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BMA to undertake an indicative ballot of practices on potential action – Update from BMA

Further to the emergency GPC England meeting, the necessary preparations have been made and  BMA will proceed with an indicative ballot of all practices in England. 

Our condemnation of the DHSC (Department of Health and Social Care) and NHSEI plan stands, and we are now seeking the support of practices to demonstrate to Government and NHSEI that GPs and practices will not tolerate this unacceptable situation.  We will give practices their say on further potential actions we can all take to persuade minsters and NHSEI to give practices the real support they require so that they can care for their patients as needed, not least over this expected very difficult winter period. 

The BMA will now proceed to the indicative ballot of practices, which will open this Monday.  

It will be based on the resolutions passed by GPCE last week and will include questions on further actions practices might be prepared to take, such as: 

  • participating in a coordinated and continuous withdrawal from the PCN DES at the next opt-out period 
  • disengaging, on a continuous basis, from the PCN DES before the next opt-out period 
  • not complying, on a continuous basis, with the contractual requirement to ensure GPs earning over the earnings threshold declare their income or to provide COVID vaccination exemption certificates 
  • participate in a coordinated and continuous change to your appointment book, so as to impact the quality of the nationally reported appointment dataset. 

It is important to stress that these actions are not directed at patients, or the care they receive, but at Government and NHSEI. 


The timescales are as follows: 

Launch the indicative ballot with details for how to vote electronically (Monday 1st November

Physical reminder letters reach GP partner members / practices (from 5th November

The electronic ballot closes (13th / 14th November)

The ballot data is processed (15th / 16th November

Results will be communicated to members (18th / 19th November). 


The BMA is also preparing for a formal ballot of members on IA (industrial action), which for legal reasons could not have happened sooner than at least six weeks after the emergency GPCE meeting last week. 

Moving to an indicative ballot of practices before a formal ballot of members on IA also means we not only get to gather the views of practices on the proposed forms of actions much more swiftly, but it also means we can keep pressure up nationally by using the result as further leverage in the interim. 

General Practice is being pilloried and abused and together there is a need to fight back, protect and defend. This is an extremely difficult time for us all. We must support one another and stand together. This is not going to be easy, but the BMA will do all in its power to back GPs at this time. 

Further information on the ballot will be shared with practices on Monday 1st November. 

We are also rapidly developing additional workload management resources and guidance, which we will release in the coming days. 

As it is clear that neither the Government nor NHSE/I understands the scale of the crisis impacting general practice, or have provided the necessary measures to support the profession at this critical time, we would encourage practices to review our workload control in general practice paper

Read BMA statement following the GPCE vote rejecting the Government and NHSEI (NHS England and NHS Improvement) plan here    Our analysis of the Government and NHSE/I plan  


Workload control in general practice 

It is clear neither the government nor NHSE/I show they understand the scale of the crisis impacting general practice and have not provided the necessary measures to support the profession at this critical time.  We would encourage practices to look again at the Workload Control in General Practice paper.  

In addition to the actions highlighted above, GPC England also resolved that practices should be encouraged to take actions to prioritise higher quality of care that delivers a safer service to patients and protects the wellbeing of the workforce.  Practices should not feel pressured to return to a traditional 10-minute treadmill of face to face consultations, that are neither good for patients nor clinicians. Instead, they should:   

  • Offer patients consultations that are 15 minutes or more 
  • Apply to close the practice list in order to focus on the needs of existing patients (where safety issues are applicable)
  • Stop all non-GMS work to give priority to GMS care 
  • Reject all shifted work from secondary care that has not been properly commissioned 
  • Don’t accept additional NHS 111 referrals above the contractual 1 per 3000 patients 
  • Stop unnecessary cost based prescribing audits in order to focus on quality care 
  • Decline to do additional extended access sessions in order to focus on the core work of the practice 


GP declaration of earnings guidance 

Ahead of the Government’s GP pay transparency deadline of 12 November, which was introduced on 1 October, when the GMS and PMS Regulations were amended to require some GPs to self-declare their earnings, GPC have now published guidance on what this means for GPs.  

GPC has already made clear the significant concerns about the compelling GPs to publicly declare their NHS earnings over a certain threshold, especially in the current climate of threat, aggression and violence towards GPs. This will be damaging to morale among the profession, could lead to an increase in abuse targeted at individual GPs and will be wholly counterproductive in terms of the ability to recruit and retain GPs.  There have already been reports of GPs already reducing their hours to remain under the threshold. 

The BMA will be issuing an indicative ballot to members for industrial action over the Government’s decision to impose this and other measures on GPs. In the meantime, until GPC have issued further information, practices may wish to hold off submitting information until at least the deadline date of 12th November.  

Larking Gowen have prepared a blog on the subject which practices may find useful https://www.larking-gowen.co.uk/insights/blog-201920-declaration-of-gp-earnings/


Medical Exemption Certificate for Covid Vaccination

A systematic medical exemptions process was introduced 30 September, to ensure that those who, for medical reasons, should not be vaccinated (and/or be tested) for COVID-19 are not disadvantaged across certification use cases. 

Given the need for clinical judgement and access to patient records, the Department of Health and Social Care are asking GPs, secondary care clinicians and midwives to assess applications. Steps have been taken to ensure this does not impact workload (eg. no appointment required, pre-screening process).   A fee of £44 is payable for the assessment.

Read the guidance detailing the process, clinical criteria and payment mechanisms (for GPs).  Clinical grounds for exemption can be viewed in the green book chapter 14a (page 28) COVID-19: the green book, chapter 14a – GOV.UK (www.gov.uk).  See also COVID-19 medical exemptions: proving you are unable to get vaccinated – GOV.UK (www.gov.uk)

Practices will be aware that this is one of the measures included in the BMA indicative ballot.  In the meantime, and pending further BMA advice, the requirement is included in the contract regulations and as such the LMC cannot advise or encourage practices to withhold the service as this would be a breach of contract.  


WSH AAU contact number

We are advised that West Suffolk Hospital has a dedicated AAU GP Referral direct phone number –07812 679273


Dispensing Fee Cut

GPC England and the DDA asked NHS England to intervene to change the fee scale.  As calculated (correctly under an agreed formula) it took account of a 14% increase in volume triggered by the Covid pandemic and the first lockdown.   This has resulted the steep reduction in fees, which will be partially abated next April.

It is not just dispensing doctors who are affected by this fee cut.  The scale also includes non-dispensing GPs who claim for Personally Administered items, including vaccines. There is on average a 35 pence per item decrease in dispensing fees.

In view of the financial detriment to practices and the promise not to disadvantage because of Covid, the DDA have asked all of their members to write to their MPs as per their template letter and have asked LMCs to share with all practices locally.


Infection control recommendations for primary care  

The UK Health Security Agency today has published recommendations for changes to Infection Prevention and Control Guidance (IPC) in primary care following previous recommendations which focussed on changes in elective care. 

The main amendment is the reduction of the 2 metre social distancing rule to 1 metre, highlighting the need for appropriate mitigation. The BMA has already made the point that even 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 and buildings. The guidance strongly emphasises that local decisions and local risk assessments will ultimately govern judgements such whether a face-to-face consultation is appropriate and where physical distancing can be safely reduced, which is welcomed. It is therefore for practices to determine what arrangements they have in the surgery. The full guidance will be published shortly. Read more about the UKHSA review into IPC guidance 


Domestic Abuse Act 2021

The Government’s new Domestic Abuse Act came into being on 1/10/21.  Of direct relevance to GPs is Section 80, which sets out the government stance on Prohibition on charging for the provision of medical evidence of domestic abuse. Read the full section here: https://www.legislation.gov.uk/ukpga/2021/17/section/80


GP Support Hub – DBS message

Disclosure and Barring Service “DBS” checks is something often overlooked through extended periods out of work for things like career break, due to ill health, care responsibilities or simply through becoming a newly qualified GP as a necessary part of the process.  Most GP Practices as employers take care of DBS checks in-house.  However, if you fall into the category of those not linked directly to a current medical practice this can be a hurdle to securing employment.  The GP Support Hub exists to support in the recruitment and retention of GPs based in Suffolk or North East Essex and can be contacted to provide administrative support with DBS checks via info@thegphub.org 


Healthwatch Report

For anyone who hasn’t seen this https://healthwatchsuffolk.co.uk/news/it-left-me-wondering-why-i-do-the-job-local-practices-speak-out-about-abuse-from-patients/ 


Pass on to GP Trainees

The GP trainee committee would be extremely grateful if you could highlight to all GP trainees you are in contact with, regardless of location in the UK and regardless of BMA membership status, that GPTC have just launched a survey.  The link is: https://www.research.net/r/GPTsurvey2021

The survey has been designed over the past year with input from the representatives and staff from all four nations and representatives. We are gathering information about multiple aspects of training/working, the impact of COVID and future career plans.

The survey will remain open for three weeks, closing on 13rd November. We feel that data from this survey will be pivotal in directing our future work and building our lobbying positions, so we are hoping for as high a response rate as possible.


Practice Vacancies >

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