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SuffolkLMCNewsletterOct-Nov2022
Dates for your diary
Following valuable feedback from attendees at the recent Practice Managers Conference the LMC asked the Training Hub to explore putting on some follow-on in depth preparatory training for CQC inspections. We are pleased to report that this has now been set up for 7th & 12th December and the flyer and registration details are attached.
Link to November SNEE Training Hub newsletter here
Information, Guidance and News
Prescription Payment Errors:
The LMC would draw attention to the attached correspondence relating to significant errors made in relation to claims for dispensed items (including flu and other vaccines) dating back to April 2021. This affects both dispensing and non-dispensing practices and could amount to substantial sums for practices using ‘pooled list’ prescribing codes (these usually start with a ‘7’). To understand if or how you have been affected, it may help to compare year on year payments for high volume periods where the discrepancy may be more obvious.
At the time of writing the LMC is awaiting confirmation of the local escalation process and understand that a transitionary arrangement is in place up until end of March 2023 to allow practices to switch from pooled codes to GP Prescriber numbers.
These discrepancies appear to have arisen through PCSE’s system being unable to process claims with Pooled List IDs nor make adjustments for payments due, but rejected due to the pooled code. It is unclear why this was neither recognised nor corrected in a timely fashion.
Winter LES – Ipswich & East Suffolk:
The LMC would strongly encourage practices to review the requirements (either reviewing 10% of all care home patients through additional ward rounds and completing and reporting outcomes OR contacting 50% of COPD patients) of the recently released Winter LES against the funding available (£0.074 per registered patient equating to £892 for an average practice of 12,000 patients).
This LES was not agreed with the LMC and, in its truest contractual format, appears non-viable for most practices.
Population Health Management
PHM can be a useful tool for understanding and managing population health in a resource constrained environment. It may also offer opportunity to reduce or redirect primary care workload, but there are 2 aspects that require close inspection:
This is a specialist area requiring specific expertise. This advice and protection is provided to practices by the ICS DPO, Paul Cook and team, to whom specific queries and concerns should be directed. The LMC has asked Paul to write directly to partners of participating practices outlining their liabilities as they pertain to PHM setting out how such liabilities have been mitigated.
PHM has the potential to generate significant amounts of clinical work. It is not appropriate for the system to delegate work generated through PHM to primary care. The LMC and PHM programme agree that a core principle of PHM is that ‘whoever generates the work owns the work’. Practices and PCNs should adhere to this principle when assessing PHM projects and make the LMC office aware where this is not adhered to.
Private Interface & Prescribing
With increasing NHS waiting lists and an explosion in demand practices are likely to see a significant rise in the number of requests for prescribing of long-term medications arising out of consultations with private providers.
It is in this context that we would remind practices of the established policy (now adopted by the ICS and applicable across Suffolk) which makes it clear that taking over prescribing of amber medications (shared care) in this context is not advised. As a result, patients should be (a) if possible, warned of this issue when seeking private input for such conditions & (b) referred to NHS services (without prescribing in the meantime). The onus should be firmly placed back on the private provider to continue the prescription, with attendant monitoring, in the meantime.
This is predominately a clinical safety issue since the private providers, almost universally, do not provide care to the level required by the NHS shared care agreements and therefore leaves the primary care prescriber vulnerable.
Information for Practices in the East re: Datix/Interface Issues
Practices experiencing issues at the primary-secondary care interface (significant discharge medication errors, clinical governance concerns, etc) should email datix@esneft.nhs.uk with details and, where appropriate, copy a member of the LMC office into the correspondence.
These submissions, along with Datix reports generated by secondary care, will be investigated by the appropriate part of the system and the data reviewed at the ESNEFT:GP liaison meetings.
Wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support. Please take a moment to check in on your colleagues’ wellbeing and look out for each other.
Support comes in various forms, from the 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The Louise Tebboth Foundation is a charity that campaigns for the prevention of suicide and the mental wellbeing of doctors in England and Wales
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See the poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Visit the BMA’s dedicated wellbeing support services page for further information and resources.
Please also find attached the SNEE ‘Wellbeing Offer’ flyer.
Practitioner Health
The service is now open to everyone in any role working in primary care who is struggling to access confidential care and support. Previously this was only available to doctors, dentists and staff grade 8D or above in England, for self-referral.
Advice for managing long COVID with GP staff
While the symptoms may vary, and the diagnosis may be slow to be confirmed, long COVID is most likely to be categorised as a disability in employment terms. This means that, as an employer, you must take extra care in managing the employment relationship – not just managing the absences themselves but also in the day-to-day management of staff affected, to ensure employees are not suffering a detriment as a result of their condition. If decisions must be made about the termination of employment of any staff member, with a disability or not, as the employer you must be able to show that you have acted fairly and reasonably. Talk to your employment law advisors or for members the BMA’s Employment Advisory Service to get help and support with staff employment issues.
Crisis in general practice
The Health and Social Care Committee report: The future of general practice was published recently and the LMC strongly recommends reading. The report, which the BMA fed into by providing both written and oral evidence, highlights the crisis in general practice. It is known that patients benefit from continuity of care, with the quality, strength and consistency of their relationship with their family doctor having a significant impact on their health outcomes.
The report also reiterates that the punitive pensions taxation must urgently be addressed to tackle the chronic staff shortages in the NHS, asking the Government and NHS England to adopt the recommendations laid out in its workforce report, something that the BMA has long been calling for.
Read the full statement in response to the report, by Farah Jameel, chair of GPC England.
Letter from GP for travel with medication
Some airlines are advising travellers bringing medication in their hand luggage, that they should bring a letter from their medical practitioner confirming the type of medication and what it is for.
The BMA have raised this issue with the airline, who advised that if a passenger packs their medication in their hold luggage, they do not require any of their medical information. However, if a passenger seeks to carry their essential medication in their cabin luggage, and the form of the medication contravenes aviation regulations e.g., the use of sharps, liquids more than 100ml or oxygen cylinders, they require the passenger to produce confirmation from their healthcare practitioner that the medication is necessary to be carried as it may be required on board.
However, as the advice on their website is not clear on this point as it advises passengers to take their medication in their hand luggage, and it does not specify which sort of medication requires a letter, the BMA has written to the airline again asking for their webpage to be updated on this point.
Practices may choose to do this private work but are not obliged to do so. Practices should advise patients that they can print off their medical record from the NHS app, or alternatively, practices are able to charge for travel-related requests for information. See the guidance on the BMA website here
Accelerated citizen access to records
The BMA has undertaken a lot of work following the concerns about this roll out and previously advised practices about the options before them including asking the system supplier to delay the roll out by using a template letter which was provided. The template letter can be found in the BMA guidance to practices which urges for a delay to the rollout of the programme, as many practices are not currently in a position to activate it safely. There was also guidance on codes that can be added to the records.
The SoS announced earlier this month that the Citizens’ Access to Records programme would be going live. NHS Digital are currently suggesting the switch on will occur for all by November 30th and the BMA are challenging this as the major concerns have not yet been addressed. As a reminder you can inform your supplier to pause the roll out by using the template letter in this guidance and email it to your supplier.
In response to the announcement, the BMA issued a statement calling for clarity over the deployment of the programme and assurances that practices who do not yet feel ready, have ample time as they deem necessary to make preparations in order to ensure patients are protected.
BMA continue to have significant concerns over your role as a data controller being ignored, the redaction software not being fit for purpose, the risk to patients (especially ones in coercive relationships) and not to forget of course the workload involved at a time when there are already intolerable demands on practices day to day.
BMA is keen to ensure you are aware of this current guidance from NHS Digital:
Practices may still wish to send in the template letter even if you missed the deadline above. It is believed that additional support is needed for practices to implement this change and the recommendation is that practices follow the guidance and steps as set out.
Further update will follow next week with more information as this issue develops.
Health Education England training contract
It has been brought to GPC attention that training practices are being asked to sign a Health Education England training contract. As GPC England did not have input into the development of this contract, it is currently in the process of reviewing the contents. Practices who have not already signed and are unsure about doing so should either seek their own advice or hold off until you hear more guidance is received from GPC.
CQC clinical searches
The CQC developed a suite of clinical searches, initially in response to the pandemic, which are now routinely used when carrying out inspections of GP practices. They were designed to focus on areas of clinical importance. The majority of the searches focus on safe prescribing, monitoring of higher risk drugs, management of long-term conditions and identification of potential missed diagnoses. The searches can be found on the CQC website or via the LMC website CQC Resources – Suffolk Local Medical Committee (suffolklmc.co.uk)
Network Contract DES guidance – pay codes updated for 1st November
When NHS England published the October variation to the Network Contract DES (directed enhanced service), and associated guidance, there were a number of placeholders in the payments section of the guidance while they waited for new pay codes to be produced.
This reflected the transition from Calculating Quality Reporting Service (CQRS) and manual payments to automated payments via Primary Care Support England (PCSE) Online, as well as the short notice introduction of the new primary care network Capacity and Access Payment. The new automated pay codes are now in place and ready for use, in the updated guidance.
Punitive pensions tax rules
GPs should have received the recent newsletter from the BMA Pensions Committee providing an update on their continued lobbying of Government to fix punitive pension tax rules. If you haven’t already done so, we encourage you to take a look at the newsletter which is available to view here.
GMS and PMS requirement to pass on DDRB recommended uplifts
Practices with a GMS contract, or with a Suffolk PMS Agreement, have a contractual requirement to “ only offer employment to a general medical practitioner on terms which are no less favourable than those contained in the document entitled “Model terms and conditions of service for a salaried general practitioner employed by a GMS practice” published by the British Medical Association “.
The Model Terms states under clause 6 “Your salary will be increased by annual increments on [incremental date] each year and in accordance with the Government’s decision on the pay of general practitioners following the recommendation of the Doctors’ and Dentists’ Review Body”
Practices who have salaried GP employed under the terms of the model contract should offer the DDRB recommended 4.5% pay uplift as a minimum.
GPCE has lobbied for global sum to be uplifted to accommodate this increase for salaried GPs and other practice staff and will continue to do so. Read the BMA’s statement about the DDRB
Appointment data at practice level (GPAD)
We are aware the planned publication of Practice level appointment data is causing concern to practices. This will be included in the dashboard for ICBs, with access available to PCNs which will allow the data to be compared between practices.
The information being released is:
GPC have raised with NHS Digital/NHSE that this data is insufficient to draw any conclusions about what is being offered by individual practices. In particular, the reality that significant numbers of patients are seen by experienced clinicians that are not GPs, all of whom are aggregated in the data. They informed GPC that there would be caveats in the data making this explicit.
GPC have also discussed and NHSE have agreed that this data should not be used in a punitive way, but support of outliers should always be in consultation with LMCs. GPC have asked if this can be communicated clearly to ICB’s.
In terms of public access to this information a usable dashboard is planned for April 23, although the raw data in tabular form will be publicly available from next week. The BMA is ready to challenge any misreporting of this data in the media. As is known huge numbers of appointments are being delivered, and the significant data quality issues have been raised. This data does not allow comparisons to easily be made, although this may happen. To be clear there is no minimum number of appointments practices must provide as the manner in which practices deliver care is up to them. However there is existing guidance on safe working in General Practice and the BMA has also published guidance on workload control in General Practice.
https://www.england.nhs.uk/wp-content/uploads/2020/08/gpad-guidance.pdf
Hospital responsibility to issue sick notes
The LMC is keen to stop unnecessary workload coming to you from secondary care and would encourage colleagues to push back whenever possible to achieve a change in behaviour. Many appointments are taken up with patients requesting sick notes/ongoing sick notes when these could have more appropriately been provided by their hospital consultant. The 2010 DWP Statement of fitness for work guide: a guide for hospital doctors – GOV.UK which was updated in April 2022 contains the following statements:
“The role of hospital doctors in issuing the Statement of Fitness for Work:
Hospital doctors may need to provide all certification for social security and Statutory Sick Pay purposes for patients who are either incapable of work or who may be fit for work with support from their employer. The duty to provide a Med 3 rests with the doctor who at the time has clinical responsibility for the patient.
Hospital in-patients:
Form Med 10 should continue to be issued to cover any period that a patient is in hospital. On discharge from hospital the doctor who has clinical responsibility for the patient should provide them, if appropriate, with a Med 3 to cover a forward period. This is to avoid unnecessary referrals to GPs solely for the purpose of sickness certification.”
Many hospital doctors are still unaware that they should, if appropriate, issue Med 3 forms to patients in their care. Not issuing Med 3s denies patients the best care and leads to unnecessary duplication and extra work for GPs. In many cases it is the hospital doctor who is best placed to give advice on the impact of a patient’s health condition on their fitness for work.
Share widely with all your GPs and please contact the LMC if you need further clarification.
Firearms marker and flagging system
GPCE have been working with DHSC, Home Office, NHSD, and Police Chiefs Council to develop and roll out the firearms marker and flagging system following coroner instruction that this should be developed. The current flagging system was initiated in April 2022. Soon after switch-on it was identified that the flag was not working as planned in EMIS. EMIS flag was thus switched off. The flag has continued to be used in TPP SystmOne.
NHSD have worked with EMIS to redesign the flag for EMIS and this is now ready to be tested. The flag is also ready to be tested for Cegedim Vision. Joint GP IT Committee will test the system, but are looking for practitioners who use EMIS and Cegedim Vision who would be willing to work with NHSD to review the new flagging system. Let the LMC know if you would like to volunteer.
There is continuing concern that the flagging system is not working as anticipated in any of the systems, and GPC continue to work with NHSD to design a better, safer, and less intrusive flagging system.
GP Appraisals – withdrawal of the MAG/MAF form
Just a reminder to GPs that the MAG/MAF form will not be updated to the new appraisal format and will not be accepted beyond 31st March 2023.
PCSE issues – LMC escalation process
A system has been put in place for LMCs to be able to escalate issues encountered by practices/individual GPs in their dealings with PCSE. The process requires the practice to have raised an initial query with PCSE and obtained a CAS number. If the issue is not resolved at 40 days after raising the initial query, then the LMC can submit an escalation form to PCSE.
Essex LMC have been trialling the system and whilst a far from satisfactory process in terms of timescale and communication, it is nevertheless something additional that can be done to assist practices/individuals who are having difficulty getting their issues resolved with PCSE. Please do get in touch with us if you would like help.
LMC Buying Group
Just a reminder about the LMC Buying Group and potential savings that practices can make by registering – see LMC Buying Group – Suffolk Local Medical Committee (suffolklmc.co.uk) Membership entitles practices to discounts on products and services provided by the Buying Group’s suppliers. Membership is free and there is no obligation on practices to use all the suppliers. However, practices can potentially save money just by switching to Buying Group suppliers. To view the pricing and discounts on offer you need to log-in to the Members section of the Buying Group website.
Target Ovarian Cancer – resources
The early diagnosis team at Target Ovarian Cancer, have made available a number of free educational resources to increase awareness of ovarian cancer symptoms and the critical importance of early diagnosis.
Clinicians can sign up to our GP network and explore the free educational resources, which include:
eLearning training modules
Factsheets
There is also a wide range of practical and emotional support for patients, including a nurse-led support line, online community and information guides.
Practice Vacancies
Can be found on the LMC Website http://www.suffolklmc.co.uk/jobs
