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GP contract in England
Following the vote to accept the changes to the GP contract in England for 2020-21, we will be presenting the contract details to GPs and LMCs at a series of contract roadshow events across England over the coming month. The current list of events is available here.  In addition a number of LMCs have also arranged some local events.

The King’s Fund have produced a summary of the contract changes which can be read here.

As a result of further discussions we have had with NHSEI, they have sent a letter to commissioners about the PCN Additional Roles Reimbursement Scheme, which states "NHS England encourages commissioners to use unspent entitlement to enable PCNs to recruit now to any of the ten roles which will be included in the Additional Roles Reimbursement Scheme from 1 April 2020" and "commissioners are encouraged to reimburse any new appointments from 17 February at 100% of salary and employer ‘on-costs’, up to the maximum reimbursable amounts for each role, as set out in Table 1 of the GP contract update, with a view to these workforce roles then becoming eligible for reimbursement under the Additional Roles Reimbursement Scheme from 1 April 2020 without any change to their terms and conditions. Commissioners may also use this unspent funding to support PCN recruitment exercises. "

Special Conference of English LMCs

The deadline to register and submit motions for the special conference of English LMCs in London on 11 March, to discuss the outcome of negotiations and the contract agreement, has now passed.  The Agenda Committee will now work on preparing an agenda for the conference and publish it shortly.

LMC UK Conference 2020

A reminder that the deadline to submit motions for this year’s annual LMC UK conference (held on 6-7 May 2020 at York Barbican). Is noon, 24 February 2020. Please submit motions via this link

The deadline to register for the conference and dinner, should be done by no later than Friday 27 March, using this link:  https://events.bma.org.uk/uk-lmc-conference-2020/registration

Coronavirus (COVID-19) update

The containment of COVID-19 remains of major concern and we are monitoring the situation and will continue to disseminate information as it becomes available.

Our webpage is regularly updated with guidance and links to information from Public Health England, Health Protection Scotland, Public Health Wales and Public Health Agency (Northern Ireland), and the Department of Health and Social Care. Our webpage includes a link to the PHE guidance for primary care which was updated today, posters for practices and guidance by the RCGP (including practice action cards). The updated PHE guidance advises that the patient should be isolated and to call 111 directly, rather than there being an expectation that the GP does this. NHS England also distributed the attached briefing for primary care providers earlier this week.

I also wrote to the NHS England about coronavirus emergency planning, including the feasibility of an online booking suspension and procurement challenges such as the cost of supplies and equipment. We would encourage all practices to continue to follow current advice from PHE, and for anyone who suspects they might be at risk of having the virus, or has developed symptoms, to call NHS 111.

IR35 guidance for locum GPs
We have updated all our employment status (IR35) guidance into one easy-to-read document so that locum GPs have all the information they need to be confident in determining their employment status. Read more in a blog by Matt Mayer, deputy chair of the GP Sessional GP committee
 
Patients encouraged to get MMR vaccine after UK mumps outbreak
I was interviewed by LBC last Friday about the importance of MMR vaccines, following the news reports about a surge in mumps cases in the UK. I said that while the BMA is against mandatory vaccination, it’s essential that people are encouraged to get their jabs.

NHS 111 Data Sharing Agreements
We understand practices are still being approached by NHS111 providers to sign Data Sharing Agreements in order for NHS 111 staff to book GP appointments directly. Our advice stands that a DSA is not necessary for the purposes of assigning an appointment only as it does not require access to the patient’s medical record. 
 
NHS Digital and the Private Healthcare Information Network (PHIN) consultation
NHS Digital and the Private Healthcare Information Network (PHIN) have launched a consultation as part of the next phase of a programme to align private healthcare data with NHS recorded activity. The consultation sets out a series of changes to how data is recorded and managed across private and NHS care, along with a series of pilot projects, based upon feedback from a variety of stakeholders. The consultation, which has been launched following the publication of the Paterson Inquiry, is hosted on the NHS Digital Consultation Hub.

Pensions
The deadline to submit the NHS Pension Scheme end of year Type 1 medical practitioner (GP Provider) certificate or the Type 2 medical practitioner (salaried GP) self-assessment form for year 2018/19 is Saturday 29th February 2020. These need to be submitted to Primary Care Support England in accordance with the statutory NHS Pension Scheme Regulations. You can access all GP pension forms using this link
 
GP Online and Pensions Age reported that there are still concerns over the ongoing pensions crisis, in particular about how a stop-gap offer from NHS England to pay off pension tax bills for 2019/20 will apply to general practice. I responded that "the situation needs urgently addressing as it greatly impacts on GPs being able to manage not just their pension but their wider finances. It’s therefore understandable that, without this clarity, GPs will be hesitant to commit to extra work this year that could risk triggering significant annual allowance charges…we are therefore continuing to push NHS England and NHS Improvement to take the necessary urgent action to resolve this important issue."
 
GP streaming service in A&E 

Pulse reported that the government in England is planning to expand GP streaming services in A&E departments after claiming that it reduced pressure on urgent care services. Krishna Kasaraneni, GPC England executive lead for workforce, said: “One of the key solutions to addressing the pressures on access to services in the NHS is to invest in expanding the primary care teams in GP practices. With investment to increase the number of GPs and allied health care professionals, the care provided to patients in general practice will continue to improve. This, in turn, should then address some of the pressures on the NHS as a whole. There is no substitute for continuity of care and spreading the already stretched GP workforce even more thinly is likely to further fragment care.”

 
Paperwork and bureaucracy
GP online reported that that the government in England are planning to consult GPs in a review to ‘reduce the bureaucratic burden’ on practices, announced as part of the 2020 GP contract deal in England. In response to this I said: “Increased bureaucracy is a daily headache for GPs and practices, taking valuable time away from what family doctors and their teams do best – providing care to patients….we know GP workload is at an unsustainable level, and the BMA has long been campaigning against unnecessary admin in general practice, much of which centres around doctors being requested to produce reports or sign letters that shouldn’t need GP input or indeed the input from any healthcare professional…the pledge of a government review comes as a direct result of BMA pressure on this issue, and we will be informed by the profession as to what they want to see change so that doctors and practice teams are able to focus on treating patients.”
 

Childhood health briefing
The BMA has published the report Supporting a healthy childhood - The need for greater investment in services in Englandwhich highlights a serious lack of investment across a range of child services, leaving doctors concerned about the adverse impact on child health in England. The BMA is urging the Government to increase investment across the entirety of children’s health and social care services, and reverse local authority cuts to ensure children have a healthy start in life. 

Have your say - DWP survey for doctors involved in benefits process for the terminally ill (UK)
The Department for Work and Pensions is evaluating how the benefits system, including the DS1500 process, supports those nearing the end of their lives and desperately needs views from those doctors involved.  To have your say please complete this short survey.

GPC UK Regional elections
Elections for the following regions are now open and will close at noon, 16 March:

  • Gloucestershire and Avon
  • Leicestershire, Rutland and Northamptonshire

To submit your vote please go to: https://elections.bma.org.uk/

If you have any queries, please contact elections@bma.org.uk 

See the last GPC bulletin here

See the last Sessional GPs bulletin here

GPC England contract update
As you will be aware, last week, GPC England voted to accept the changes to the GP contract for 2020-21. Read more about the contract changes, including an update from me, here. We are now in the process of planning a number of GPCE roadshows to outline the agreement - more details will be announced shortly.

GP Online, Pulse and HSJ have covered the contract changes in detail. In addition P3 Pharmacy and Independent Community Pharmacist also reported on the contract changes. Practice business reported on the RCGP’s take on the new contract.

PCN conference 2020
Last Saturday, we held our second annual Primary Care Networks (PCN) 2020 Conference , this time in at the ICC in Birmingham. The event was very successful and provided a good opportunity for the almost 400 attendees to hear and talk about the new GP contract agreement and its impact on the future of PCNs for the years ahead. Read a summary here and my blog about it  here

At the conference, I also called for a rapid solution to the pension annual allowance tax issue, more work to address the gender pay gap in general practice and urgent funding to support practice premises and IT developments.  This was reported in GPonline

The BMA is continuing to provide a programme of support for the development of PCNs to ensure that this takes place in a way that supports GP practices and everyday GPs in their workload and provision of patient care.

Special Conference of English LMCs – 11 March

There will be a special conference of English LMCs on 11 March to discuss the outcome of negotiations and the contract agreement. The conference will take place at the Mermaid Theatre, London. The deadline to register to attend is Thursday 20 February, via this link

The deadline to submit motions is noon, Friday 21 February, via this link. Before you submit motions, please ensure you have read the 2020/21 contract agreement and that you submit motions using the suggested headings.

LMC UK Conference 2020

This year’s annual LMC UK conference will be held on Wednesday 6 and Thursday 7 May 2020 at York Barbican. UK LMCs have been sent an email earlier this week about registering for the conference and dinner, which should be done by no later than Friday 27 March, using this link

The deadline to submit motions for the LMC UK conference is noon, 24 February 2020, via this link [Please do not submit motions for the special conference of English LMCs using this link]

Coronavirus update

An email was sent out by the BMA yesterday to update members about COVID-19 (Wuhan novel coronavirus). The BMA has also updated its guidance  to reflect the latest Government guidance for health professionals. We are expecting further information for clinicians to be published shortly and will ensure our own guidance on the website reflects this. The main principle remains - to avoid pressures on primary care, ambulance services and emergency departments, and to direct patients to NHS111.  Read the Public Health England guidance here

Following concerns raised by practices and LMCs about patients accessing appointments via online system, without being triaged about the risk for having been infected, we have discussed with NHS England about practices being able to suspend online booking systems for appointments.  They have advised that currently, this would be local decision based on specific risks in the area e.g. in relation to confirmed cases and the adequacy of online booking messaging. In such situations practices should raise their concerns with the local commissioner through their LMC so that a risk assessment can be carried out and decision made. This issue was reported in the BMJ with comments by Peter Holden, BMA’s emergency preparedness lead.

Peter Holden was interviewed on Monday morning on Talk Radio (7.10am) and also by BBC News on Wednesday evening.  He also spoke to Sky News this morning, saying that it is crucial for the public to practice good personal hygiene, such as regular hand-washing. Pulse and Daily Mail reported on the issue of some NHS 111 call handlers failing to ask patient if they have travelled to the affected countries, and advising patient to see their GP. I spoke to BBC Radio York on Monday evening (about 5.45pm) and said that good personal hygiene is essential to stopping the spread of infection. BBC and Pulse reported on the GP practice in Brighton having closed after a staff member had been confirmed as infected by Covid-19.

We remain in regular contact with Public Health England, RCGP and other relevant stakeholders to highlight members’ concerns on a range of issues.

Regulations on Coronavirus (England)
The Secretary of State for Health and Social Care (England), Matt Hancock, has published new regulations declaring that the incidence or transmission of novel Coronavirus constitutes a serious and imminent threat to public health. The measures outlined in these regulations are considered as an effective means of delaying or preventing further transmission of the virus. Read their statement.

Mumps cases rising
BBC News and other media have reported today on the rise in the number of cases of mumps, reaching the highest level in England for a decade. I will be interviewed on LBC this evening about the importance of MMR vaccination.
 
Medicine supply notification: Salbutamol
Salbutamol 2mg/5mg syrup is out of stock until the end of February 2020. For patients with insufficient supplies, clinicians should consider prescribing an unlicensed import of salbutamol 2mg/5ml syrup or salbutamol 2mg or 4mg tablets.
 
GP pressures
In December 2019, 1.42 million more appointments occurred in general practice than in December 2018. This echoes the overall monthly trend towards increased appointments in general practice across England – over the entirety of the 2019 calendar year, 3.77 million more appointments occurred across England than in 2018. Whilst recognising the workload pressures the rise in the number of appointments reflects, this is a simplistic way of measuring activity in general practice and we believe practices should be supported to offer fewer but longer appointments to enable better quality consultations. Read more in our latest analysis of general practice data.

Reform report on practice premises
The think tank Reform has launched the report A primary care estate fit for the future, arguing for the need of greater focus and prioritisation of the primary care estate in the Government’s plans, calling for further investment into these services, better streamlining of existing funding and a new approach to funding digital initiatives in primary care. This reflects our position about the need for premises funding in our letter to the Chancellor calling for premises funding. We are continuing to lobby for urgent action on premises ahead of the UK Government’s Budget on 11 March.
 
IPPR report on new deal for primary care in England
The Institute for Public Policy Research has published a report entitled Realising the neighbourhood NHS: A new deal for primary care in England warning that scrapping the GP partnership model could be the key to delivering the extra 50m appointments and 6,000 GPs promised by the government. In response to this I said: “The partnership model is the ‘backbone of general practice’, allowing the practices the autonomy and independence to innovate. The changes brought in through primary care networks should, in time, improve the provision of care to patients – as this report highlights – without the need to change the entire model of general practice.” This was reported in GPonline.

GPC UK Regional elections

Nominations have reopened for Dyfed Powys and North Wales – and Hillingdon, Brent, Harrow, Ealing, Hammersmith and Hounslow regions. To submit a nomination please go to: https://elections.bma.org.uk/ by noon, 21 February.

Elections for the following regions will open at noon on Monday 17 February:

  • Gloucestershire and Avon
  • Leicestershire, Rutland and Northamptonshire

For more information, go to the ‘elections’ section on this page.

See the last GPC bulletin here


GPC England contract negotiations
GPC England met again yesterday following further contract negotiations with NHS England and NHS Improvement. The committee voted on and agreed to accept the changes to the GP contract for 2020-21, including funding to attract more doctors to take up partnership roles and expand the practice team seeing patients in surgeries. The main changes are:

  • The new value of Global Sum from 1st April will be £93.46.
  • The new value of a QOF point will be £194.83.
  • More roles added to the Additional Roles Reimbursement Scheme.
  • Between 2020/21 and 2023/24, the scheme will expand to 26,000 additional roles.
  • All roles to be reimbursed at 100%, freeing up the existing £1.50/head to contribute to management support for PCNs.
  • Funding entitlements increase from £257m to £430m next year and, in 2023/24, from £891m to £1,412m.
  • Extra investment will fund new GP training, recruitment and retention measures with £20,000 plus training support for every new partner.
  • Payment arrangements for vaccinations and immunisations to be reformed with an item of service fee for childhood vaccinations, beginning with MMR in 2020/21.
  • QOF to be updated.
  • PCN service specifications significantly reduced and improved.
  • Investment and Impact Fund introduced worth £40.5m in 2020/21.
  • Taken together, more funding available at practice level.

CCGs will be expected to provide LMCs with an annual report to enable them to monitor local investment in general practice.  There is also reference to the important role of LMCs throughout the agreement document. 

We will be planning a number of GPCE roadshows to outline the agreement, and the details of the contract agreement will also be discussed at the PCN conference tomorrow.

Following the announcement, I said "After months of challenging and tough negotiations we’re pleased to have secured this package of changes that have the potential to make a real difference to GPs, the practices they work in and the patients they treat. The significant investment in and focus on recruitment and retention, including payments to incentivise doctors to take up partnership roles and work in under-doctored areas, is a vote of confidence in the partnership model and a much-needed first step if we are to reverse the worrying trend of falling GP numbers that we have seen in recent years." Read my full statement here

 
Read more about the contract agreement on the BMA website.  Read NHS England’s press release here. It was reported by The Times, Pulse, HSJ and GP Online.

There will now be a special conference of English LMCs to discuss the outcome of negotiations and the contract agreement. The date will be confirmed shortly.

PCN conference 2020

The PCN conference will be held in tomorrow, 8 February, in Birmingham. It will provide an opportunity to hear from experts – including the HMRC – network with peers and seek professional advice on HR, insurance and the law. Those attending will also hear about the full details of the agreed contract changes.  There are now limited places available. Find out more here

NHSEI operational guidance 2020/21

The annual NHSEI operation guidance has now been published. There's a helpful mention of "funding invested by CCGs during 2019/20 in local service provision which will be duplicated through delivery of the new service requirements in the Primary Care Network Contract DES in 2020/21 should be reinvested within primary medical care."

MDDUS member vote on arrangements for historic liabilities
In September 2019, MDDUS entered into a transaction with DHSC in relation to its GP liabilities in England. It is important that arrangements for the management of existing liabilities remain clear – this was recognised during the contractual negotiations which set up the clinical negligence scheme for GPs (CNSGP). There is therefore acknowledgement from the GPC England that such arrangements are necessary as responsibilities for existing liabilities transfer. Information for MDDUS members is available here
 

Physician-assisted dying
The BMA has launched a survey of members on physician-assisted dying, following a vote at last year’s ARM to do so. Members will be asked whether they believe the BMA should support, oppose, or take a neutral stance on a change in the law to permit doctors to prescribe drugs for eligible patients to end their own life. They will also be asked about a stance to a change in the law to permit doctors to administer drugs with the intention of ending an eligible patient’s life. All BMA members will receive an email (BMAsurvey@kantar.com) from Kantar, the independent research agency, with a link to participate. Find out more at  www.bma.org.uk/pad and read the BMA statement here.

Coronavirus guidance

The BMA has published a web page highlighting key information and links to official guidance from government agencies on coronavirus, including how to handle queries from patients and how to manage patients who contact or attend GP practices.

We are aware that GP practices in England are being contacted by their CCGs, on behalf of NHSEI requesting information regarding practice preparation for coronavirus. Our advice remains that while there is no obligation to provide this information, unless the Secretary of State issues a direction, we would encourage practices to respond so that NHSEI and Public Health England are aware the national picture for preparations.

We remain in close contact with NHSEI and other stakeholder to ensure that any measures they put in place are supportive and do not place any overly onerous burden on GPs and their patients. Practice should continue to review your business continuity plans, infection prevention and control measures in addition to any

national guidance issued by UK health or public health agencies.

Following the reports of the two confirmed cases in York last week, Peter Holden, BMA's emergency preparedness lead for primary care, was interviewed by BBC Radio Derby (from 1hr20) and BBC Radio York, and I was interviewed on BBC Look North, BBC Radio Leeds and BBC Radio York. Peter was also interviewed on LBC on Wednesday 5 February (just after 11.30pm). 

GPC Wales update

GPC Wales met last week and discussed the Romney report with small breakout sessions to facilitate a more open and inclusive discussion. All feedback is to be discussed at the Welsh Council sub-group who will take forward as recommendations to UK Council.

Health Inspectorate Wales attended GPCW to present on their draft programme of work and strategic plan for 20/21 with national reviews being carried out on Mental Health Crisis care and Unscheduled care services.

The performance of the unscheduled and urgent care system in Wales was discussed in length. The committee were advised that the Health Minister has established an ambulance ministerial taskforce which will look at revising measures within the system with proposals for incentives/sanctions moving forward.
 

GPC UK Regional elections
The following regional reps have been successfully elected uncontested to the GPC UK committee:

  • Lewisham, Southwark & Lambeth/Bexley & Greenwich/Bromley – Penelope Jarrett
  • Cheshire/Mid Mersey – Ivan Camphor
  • Northumberland/Newcastle & N Tyneside/Gateshead & S Tyneside/Sunderland – Roger Ford
  • Glasgow & Clyde – John Ip
  • Wiltshire/Dorset – Andrew Purbrick
  • Buckinghamshire/Oxfordshire – Matt Mayer
  • Berkshire/North and East Hampshire – Simon Ruffle
  • Barnsley/Doncaster/Rotherham/Sheffield – Dean Eggitt
  • North Yorkshire/Bradford – Brian McGregor
  • North Staffordshire/South Staffordshire/Shropshire – Chandra Kanneganti
  • Sandwell/Walsall/Wolverhampton/Dudley – Uzma Ahmed

Nominations have reopened for the following regions, and will remain open until noon, 21 February.

  • Dyfed Powys and North Wales
  • Hillingdon, Brent, Harrow, Ealing, Hammersmith and Hounslow

To submit a nomination please go to: https://elections.bma.org.uk/

Elections will be held for the following regions:

  • Gloucestershire and Avon
  • Leicestershire, Rutland and Northamptonshire

Voting is due to open on 17/02/2020 at noon, reminder emails will be sent nearer the time. To take part in elections you must have a BMA website account. You do not need to be a BMA member to create a BMA website account click here.

If you have any questions about elections please email elections@bma.org.uk
 
COMAR 2020
The BMA’s annual conference for medical academics will be held at BMA House on Friday 15 May 2020.  The main theme will be doctors’ well-being.  Save the date, express your interest in attending to confunit@bma.org.uk and look out for further information on the BMA website.

Sandy Macara Memorial lecture
The BMA’s Public Health Medicine Committee (PHMC) has held a memorial address to honour the life and work of the former BMA Council Chair Sir Alexander Macara. In the commemoration address in 2013, the PHMC noted that ‘Sir Alexander was an absolutely extraordinary person’ who was deeply committed to the BMA and to Public Health. The event was hosted by Professor Kevin Fenton, PHMC chair, and there were also speeches from the CMO for Wales, Dr Frank Atherton and Professor Ronan Lyons from the Department of Public Health at Swansea University.  

The forthcoming Public Health Medicine Conference on 26 February will focus on climate change and inequalities. For further information email info.phmc@bma.org.uk

See the last GPC bulletin here

Brexit

As Britain prepares to leave the EU today, 31 January 2020, the BMA has released a statement saying that European doctors must continue to be welcome in the UK. Chaand Nagpaul, BMA council chair, said: “Freedom of movement has allowed talented doctors and other healthcare staff to travel, work and teach across Europe, letting those from the EU to both contribute to and learn from the NHS, while UK-trained clinicians have been able to share their skills in other European nations. Our message to our European colleagues – and indeed those around the world – is a clear one: you are welcome here.” Read the full statement here and the BMA work on Brexit here. This was reported on by GPonline,

The European Medicine’s Agency (EMA) has also published information about what this will mean for medicines during the transition period, including how to prevent shortages. Read more here.
 

Coronavirus

BMA emergency preparedness lead, Peter Holden, spoke to LBC on Saturday (just before 11am) about the coronavirus. He said that it’s understandable that people are worried, but that it’s important to have some perspective on the outbreak and that, compared to flu, general risk and fatalities remain low. He also spoke to talkRADIO on Tuesday morning (7.15am) about the latest developments in the spreading of the infection. Asked if the UK is prepared for its own outbreak, he said: "Yes, we're prepared, without in any way being complacent. We're as prepared as we can be because we don't know the precise size and shape of this beast yet.”

We are in regular dialogue with PHE and NHSEI on this developing situation, particularly following the news of two confirmed cases in York. We will keep practices informed as we can. Read the PHE guidance for primary care here and further information, including to the public, is available here.
 

GPC England contract negotiations
Following the vote not to accept the contract package on Thursday 16 January, GPC England have been in further negotiations with NHS England and NHS Improvement. There will a further meeting of GPC England on Thursday February 6 to discuss the outcome of negotiations. The content and agenda of the meeting is confidential. This was reported in GP Online and Pulse

 
Earlier this week, the GP contract negotiations and the concerns about the draft PCN DES specifications, were discussed in Parliament’s health questions with the Secretary of State for Health and Social Care, Matt Hancock MP. He replied to a question from Jonathan Ashworth, shadow health minister, about GPC England’s rejection of the contract package, and said “Of course, the negotiations with the BMA over the GP contract are always tough: they have been in every year in which they have taken place. The hon. Gentleman will understand why I want to get the best possible value for the money that the NHS spends, but I also want to see a successful conclusion to this negotiation, and we are working with the BMA to that end”.  Read the full transcript here
The story was covered by Pulse, GP Online and Healthcare Leader.

PCN Service specifications report
NHS England has released its response to the feedback from the PCN service specifications engagement exercise, which is published here. The revised service specifications are currently being negotiated as part of the GP contract negotiations.
 

PCN conference 2020

There are just a few days left to be able to book for the PCN conference on 8 February, as spaces are now limited. It will provide an opportunity to hear from experts – including the HMRC who are now confirmed to attend the event – network with your peers and seek professional advice on HR, insurance and the law. Those attending will also hear about the outcome of the GPC England meeting.  Find out more here and the updated agenda is available here

The GPDF has funded one seat for each LMC, which can be booked here; for any additional LMC seats please go through the standard booking form above.

Pensions tax charges
GPC England has written to NHS England about delays in GPs knowing whether they will face pension tax charges for 2017/18. The letter comes after it was revealed that more than 30,000 GPs had not been provided with a record of their pension contributions. I wrote: "If the delays alone were not enough cause for concern, the situation is being further exacerbated by current pension taxation policies and their management. As you know the BMA, is more widely calling for tax reform to address the punitive annual allowance and taper policies." This was covered by GPOnline and Pulse. BMA pensions committee chair, Dr Vishal Sharma, was also quoted in People Management and Pensions Age.

GP appointments data
NHS Digital has published their latest GP appointments data, in response to which I said: “These figures show the intense strain practices up and down the country are under, managing increased demand with a dwindling workforce. While the number of appointments delivered in practices has increased by more than 3 million in 2019, the latest figures show a drop of more than 300 full-time equivalent GPs in a year. So while the largest proportion of appointments are delivered on the day of booking, GPs are spreading themselves more thinly, not only risking their own health and wellbeing, but also meaning there are often long waits for patients to see their doctor.”
This was reported by GPonline and Pulse
 
NHS 'rapid response' teams (England)
Urgent community response teams will be rolled out at seven sites from April under a £14m joint NHS and local authority initiative that aims to provide support within two hours to help older people remain well at home and stay out of hospital. In response to this I said: “'Providing more support and treatment for patients at home by dedicated specialist teams visiting them rather than having to travel to hospital could help many patients and also reduce the pressure on currently overstretched services, both in hospitals and the community”. This was reported by GPonline, OnMedica and Pulse

Online booking forms (Scotland)
Andrew Cowie, deputy chair of Scottish GPC, was quoted in the Scotsman about patients using online forms to book GP appointments rather than calling the surgery. The story comes after a GP surgery in Scotland decided to stop patients phoning in for bookings with their doctor. He said: “GP practices need to design and implement systems for appointments and access based on their own local circumstances and the specific challenges faced by their patients. Clearly innovation and digital solutions have a role to play here, though that does need to be balanced against the need to ensure no-one – including those who are either less technologically literate, or aren’t able to access technology – is disadvantaged and unable to access services." This was also reported in Practice Business

LMC UK Conference 2020

As you are aware, the 2020 UK LMC Conference will be held on Wednesday 6 May and Thursday 7 May 2020 at the York Barbican, Paragon St, York YO10 4AH.

We emailed LMCs earlier this week that the database to submit motions is now open, and to use the suggested headings whenever possible. The final deadline for receipt of motions for the LMC Conference is noon 24 February 2020 and motions received after the deadline cannot be accepted.
 
Please confirm that all motions have been approved by the LMC members, and also please check that the motions are new, and are not already covered by existing conference policy (which can be checked on the policy database).  Please also note that the BMA provides a motions advisory service, where members can email for advice on facts/figures, information on existing policy, or for help with submitting motions correctly. Information about registering for the conference and dinner will be sent out shortly.

GPC UK Regional elections
A reminder that nominations for GPC UK regional representative close at 12pm Monday 3 February.
 

Nominees should be aware that the BMA is currently in the early stages of reviewing its governance structures, which may have some potential to impact on the length of terms of office and regional remits during a term of office. This may mean that the term of office that a representative is elected to may be less than the usual three years. Such a decision could be made part way through a representative’s term of office.

Please note that alongside each nomination, confirmation must be received from a representative of the candidate’s LMC that the candidate contributes to the voluntary levy. This confirmation is part of the candidate’s nomination and must be received by the nomination deadline for the completed nomination to be accepted.

It is the candidates responsibility to ask their LMC to do this on their behalf, confirmation emails can should be sent to elections@bma.org.uk.
 

For further information and to nominate yourself for a seat click here (elections section).

See the last GPC bulletin here

GPC England contract negotiations
Following the vote not to accept the contract package on 16 January, GPC England have been in further negotiations with NHS England and NHS Improvement.  There will now be a further meeting of GPC England on Thursday 6 February to discuss the outcome of negotiations.

This week the Guardian also reported on the wide concerns of NHSE/I’s proposals, and I commented that the previous draft service specifications were “unreasonable and completely unachievable”.

PCN conference 2020
The PCN Conference will be held on Saturday 8 February, at the ICC Birmingham. At this crucial time, not least following NHSE/I's consultation on draft service specifications, this is an important opportunity to share your views, raise concerns and highlight challenges directly with national policy makers, exchange experiences with peers, meet a career coach, and find answers to all your questions on legal, insurance and HR issues relating to PCNs. Find out more here

The GPDF has funded one seat for each LMC, which can be booked here; for any additional LMC seats please go through the standard booking form above.

Scottish GPC meeting update
The Scottish GP Committee met yesterday in Edinburgh where they received updates on contract implementation and negotiations including: premises sustainability loans FAQ and letter of comfort, the remote and rural working group report and rural flexibility options appraisal, data collection for phase 2, the MDT survey results, various letters from the Scottish Government relating the GMS National Oversight Group, and an update on the SLMC Conference motions.

There were general updates on information management and technology, sessional GP issues, GP training and various reports from external groups such as the Primary Care Prescribing/Dispensing Pathway. An update was also provided on pensions, a GP IT presentation by Jonathan Cameron as the deputy director for digital health and care at the Scottish Government, and the Daphne Romney Report into allegations of sexism and sexual harassment at the BMA was discussed.

Northern Ireland GPC meeting update
The first meeting of NIGPC came on the heels of the restoration of the Northern Ireland Assembly and appointment of a new health minister, Robin Swann, the first minister there has been in post for three years. There is no doubt about the extent of the challenge he will face with over 300,000 people in Northern Ireland waiting for a first appointment with a consultant and significant pressures facing practices.

The meeting considered a number of issues that need to be brought to the minister’s attention as a matter of urgency including indemnity, pensions and the roll out of MDTs. The meeting reviewed a paper on out of hours provision across Northern Ireland and discussed the best way to address the gaps in the service and ensure its stability. The meeting also had a presentation from Dr John Maxwell, an ED consultant in Belfast Trust and clinical lead and Alastair Campbell, Director of hospital services reform, DH who have been leading a review of urgent and emergency care in Northern Ireland; their full report will be available in March 2020. 

BMA briefing – Impact of pension taxation on the NHS 
As part of the BMA’s ongoing campaign to address the current pension taxation crisis impacting doctors across the country, we have produced a briefing paper which highlights the current situation, background to the issue and consideration of possible solutions. This includes an overview of the BMA’s preferred solution removing the annual allowance in defined benefit schemes, such as the NHS pension scheme. Read the briefing here

NHS pensions records
I have written to Sir Simon Stevens, chief executive of NHSE/I, about the need for urgent action to resolve pensions issues impacting GPs. This was illustrated well by a detailed article in The Times which reported on how three-quarters of GPs haven't been given up-to-date NHS pension statements and could get shock tax bills because they have not been given up-to-date pension statements from the NHS. In response to this, I said: “It is a disgrace that bureaucratic delays are preventing so many GPs from accessing vital pension statements. Quite simply, the body tasked with issuing these statements, the NHS Business Services Authority, is woefully under-resourced and unable to cope, while the involvement of Capita's Primary Care Services England, which has a history of failure, just makes matters worse.”

I am also seeking from NHSE/I full details of how GPs can benefit from the commitment made at the end of last year to cover annual allowance tax charges incurred in this financial year.

Coronavirus guidance for primary care
Public Health England has now published guidance for primary care to reduce the risk of spread of infection during and following consultation with a suspected case of the Coronavirus (WN-CoV). The main principles are:

  • identify potential cases as soon as possible
  • prevent potential transmission of infection to other patients and staff
  • avoid direct physical contact, including physical examination, and exposures to respiratory secretions
  • isolate the patient, obtain specialist advice and determine if the patient is at risk of WN-CoV infection, and inform the local Health Protection Team (HPT)

If WN-CoV infection is seen in the UK, it is most likely to occur in travellers that have recently returned from Wuhan city in China. All PHE’s coronavirus guidance is available here, information for travellers and HCPs on the NaTHNaC website and information for patients on the Patient website.

Peter Holden, GPC member, was interviewed on Sky News yesterday on the coronavirus outbreak in China. He was also quoted in London’s Evening Standard.

NHS England campaign materials
Practices in England should now have received the materials to support the NHS ‘Measles, Mumps and Rubella (MMR) – Help Us Help You, Get Protected’ campaign (also available on the PHE Campaign Resource Centre). This is final one of the six campaigns that practices are required to take part in as agreed in contract negotiations last year.

The other campaigns, materials for which practices have also been sent already, are:

  • NHS 111 (Help Us Help You - Know what to do)
  • Keep Antibiotics Working
  • GP Access (Help Us Help You – When you need it)
  • Pharmacy Advice (Help Us Help You – Before it gets worse)
  • NHS App

If you have not received materials for any of the above, please contact your local NHS England team

 
QOF Personalised Care Adjustments
Following the concerns raised by practices about the loss of opportunistic prompts following the roll out of the QOF changes in 2019, TPP have confirmed to NHS Digital that they will add a status flag to the patient record which will alert practices to the fact these patients may be missing QOF care as part of their roll out of v44 of the QOF business rules. This will be implemented in the next two weeks.

NHS Digital will explore whether additional functionality can be added to v45 of the QOF business rules to ensure that the two invitation PCA will only come into force at the end of the reporting period i.e. 31st March. 
 
New FP10 and prescriber endorsement
NHSE/I have published a new FP10 NHS prescription form with the new prescriber endorsement ‘FS’ for free supply of sexual health treatment – please see attached the guidance and toolkit. The new FP10 form is being rolled out at the end of January. Existing stocks of the old form already in the system, such as in GP practices and pharmacies, should be used up prior to use of the new form. Both forms will be accepted for processing during the transition to the new form.

The new prescriber endorsement will become live from 1 February 2020. Until the necessary changes have been made to prescribing systems, prescribers should revert to issuing paper prescriptions with 'FS' manually endorsed next to each item intended for the treatment of an STI. Where ‘FS’ has been added as a handwritten endorsement, for example, on a computer-generated form, this should be counter-signed in the usual way. Dispensing doctors will continue to use paper prescriptions with a handwritten endorsement. More information is available here.

Changes to gun licensing rules putting more pressure on GPs
Tom Yerburgh, deputy policy lead of the GPC clinical and prescribing group, was interviewed by BBC Radio Gloucestershire over changes to gun licensing rules in the area. The BBC reported how at the start of the year Gloucestershire police made it a requirement for anyone applying for a firearms certificate to first of all have a letter from their GP. Previously only people with a listed condition, such as depression, drug and alcohol abuse or dementia needed to apply. He said that the changes were putting an unfair burden on GPs, and "The question asks if there's any mental health issues that the patient has ever had which is an immense amount of work, going back volumes of records. There's confusion because the process has changed without us being able to advise or offer help to practices on what to do, the other thing is that every police force seems to do this process differently which is really confusing for practices on the edge of the county."
Listen to the full news item on here (from 2hours 10minutes).

Physician-assisted dying briefing
In February, for the first time, the BMA will be surveying our members to inform a debate at the annual representative meeting (ARM) on physician-assisted dying. To make sure you don’t miss out, please check that your contact details are up to date (including your preferred e-mail address) and that you have ‘opted-in’ to receive membership updates from the BMA. To find out more about what we’re doing and why, and to download the briefing pack before you take part, visit www.bma.org.uk/PAD.

DWP end of life survey (UK)
The Department of Work and Pension is undertaking an evaluation looking at how the benefits system supports those nearing the end of their lives, as part of this they have published a survey to collect information from clinicians on this issue. A similar change has already occurred in Scotland – this impacts on GPs and any hospital doctors involved in terminally ill patients.

The results from this survey will help support DWP in making decisions around how best to support claimants nearing the end of their life and provide valuable insight into how clinicians across the UK feel about the current system and where they think it can be improved. Take the survey here

Medicine supply update 
Please see attached the latest medicine supply update from the Department of Health and Social Care.

BMA MAPs (Medical associate professions) publications
The following two new papers relating to MAPs have been published on the BMA website:
Principles for effective working with medical associate professions outlines a range of principles that can help to improve the ways that doctors and MAPs (medical associate professions) work together and identifies possible solutions to some of the common problems that have arisen with the introduction of MAPs.

Medical associate professions in the UK provides key information about MAPs, including roles, regulation, and prescribing.
 
GPC UK Regional elections
Nominations for GPC UK regional representative are open until 12pm Monday 3 February. 

Nominees should be aware that the BMA is currently in the early stages of reviewing its governance structures, which may have some potential to impact on the length of terms of office and regional remits during a term of office. This may mean that the term of office that a representative is elected to may be less than the usual three years. Such a decision could be made part way through a representative’s term of office.

For further information and to nominate yourself for a seat click here (elections section). If you have any queries, please contact elections@bma.org.uk 

Public Health Conference 2020
Public Health Medicine Committee will be holding their Public Health conference on 26 February 2020 at the BMA House London. The underpinning theme of the conference will be ‘21st century public health’ and what that might mean for public health professionals. The conference will include keynote speakers on the issues of climate change and economic inequality. If you are interested in attending or for further information, please contact info.phmc@bma.org.uk   

See the last GPC bulletin here

See the last Sessional GP bulletin here

GPC England meeting and GP contract update

GPC England met yesterday where the majority of the day was spent discussing the GP contract negotiation proposals, including a package of proposed changes to the current contract. 

GPC England voted not to accept the proposed contract agreement with NHS England and NHS Improvement, condemned the draft Primary Care Networks service specifications and called for a Special Conference of English LMCs to allow GP to debate and consider the outcome of contract negotiations once they are concluded.

The feedback about the draft specifications issued by NHSEI has been overwhelmingly negative, with practices, PCN clinical directors, LMCs and local and national bodies all raising concerns about levels of workload involved and recruitment of additional staff, and together giving a clear message that these proposals were not achievable.

We have now returned to negotiations with NHSEI with a clear mandate to secure a deal that truly benefits and safeguards general practice, family doctors and their patients. We are planning an additional GPC England meeting in the next few weeks to consider the position. Read the full statement that we have issued here This was reported by in Pulse, and GP online. 
 

The GPCE executive and policy leads report, which was received by the committee, is attached. 

The next GPC UK meeting will take place on Thursday 19 March 2020 in Cardiff, Wales.

PCN surveys

The BMA has published a survey on Primary Care Networks this week, which was completed last year and before the draft PCN service specifications were published. Whilst at the time Clinical Directors believed they could make progress given the necessary resources, time and practical support the survey also found that workload has proven unmanageable for a significant proportion of those responding.  GPs wanted more support to help manage this workload and make PCNs work for general practice. The results came on the same day that the deadline for feedback on the  draft service specifications  ended. The survey findings echo much of the same serious concerns raised by the profession in recent weeks. 
 

A survey carried out by Pulse found that the vast a majority of GP partners (over 80%) will put of the network DES contract if NHS England's proposals for the service specifications remain unchanged. In response to this I said: “These survey findings show the drive and ambition of clinical directors, who want Primary Care Networks to both improve services for patients and begin to address some of the pressures that have been negatively impacting general practice for the last decade. However, it’s clear that PCNs cannot be expected to solve all problems facing the profession and the wider NHS – especially if concerns around present levels of workload are not heeded.” This was also reported by GP onlineTelegraph, Mail and GP online. The HSJ (paywall) also reported that NHS England was planning to drop two of the five services it wanted primary care networks to deliver in 2020-21, in response to criticism from GPs. 
 

PCN conference 2020
Following the events of recent weeks the PCN Conference on Saturday 8 February, at the ICC Birmingham, has become an even more important event. It will provide clinical directors and LMC colleagues with an opportunity to make your views heard about the challenges you are facing.  Whether it is the difficulty in recruitment, workload challenges, or the draft specifications released by NHSEI, this will be an opportunity to speak to national bodies and shape the direction of travel. At this crucial time for the future of PCNs and following the concerns many have about the draft DES specifications, this is an opportunity to discuss ways forward. You can read more here

The GPDF has funded one seat for each LMC, which can be booked here; for any additional LMC seats please go through the standard booking form above.

BMA secures significant High Court victory over unlawful pensions changes

The BMA has today secured victory in the High Court over controversial changes made by the Secretary of State for Health and Social Care to the NHS Pensions scheme in England and Wales.

In April 2019, the Government amended the NHS pension rules in order to grant the Secretary of State the power to suspend payment of pensions benefits to any doctor or NHS professional who had been charged with certain criminal offences but not yet convicted. These changes, which also did not include a right to appeal or a provision for the suspension of payments to be lifted automatically upon acquittal, were a total disregard of the principle that a person charged with a crime is presumed innocent until proven guilty. 

Despite concerns raised by the BMA before their implementation, the Government proceeded with their reforms leaving with the BMA with little choice but to take legal action to seek to force their reversal through a judicial review. 

Most, if not all, public sector pension schemes contain provisions for the suspension of a person’s benefits but only after the point of conviction. Yet, if the changes were to be allowed to subsist, NHS professionals would be the only public sector workers to have the threat of forfeiture of their pension hanging over them at any time from charge.

However, in a judgment handed down today, the High Court agreed with our argument that the new regulations breached Article 6 (right to a fair trial), Article 14 (protection from discrimination) and Article 1, Protocol 1 (right to peaceful enjoyment of property) of the European Convention on Human Rights (ECHR) and also breached the Public Sector Equality Duty (PSED) under the Equality Act (in failing to have regard to the equality implications of the changes).

This is a significant BMA victory not only for our members but for all doctors and their dependants and other NHS professionals in the NHS Pension Scheme in England and Wales.

In the judgment handed down the Hon. Mrs Justice Andrews described how the Government had drawn no distinction between someone charged with a crime and someone convicted of a crime despite the fundamental principle in law being that “every defendant to a criminal charge, however serious, and however compelling the evidence against him may appear, is presumed innocent until proved guilty to the criminal standard.”

This is of course not the only pensions related work the BMA is undertaking. Our campaign continues to convince the Government that removing the annual allowance, including the taper in defined benefit pensions schemes, is the only long-term solution to crisis caused by punitive pension taxation charges.

Yesterday we were clear that the latest proposal to raise the annual allowance threshold income to £150,000 would not “fix the fundamental problem of doctors being forced to limit the work they do to prevent being hit with significant charges on their pensions and many will still in effect be paying to go to work.” Read more about this issue and our response to The Times article here

Flu TIA coding error
NHS Digital has emailed practices about an error with the Seasonal Flu 2019/20 extraction where the codes for patients in under 65 at-risk groups with TIA were inadvertently removed from the business rules. This means that these patients are not being included in the payment extraction despite vaccines having been given and coded appropriately. It is anticipated that the number of missed payments will be low, as it is likely that most people will have other risk factors that are captured by the current business rules. There will be a single collection in April 2020 for payment in 2020/21. 

Practices will need to accept the service offer (as for any other service), when it is made available on CQRS. Practices are also encouraged to double check that all patients under 65 with TIA have been offered the flu vaccine this season. Read more in the attached document.

Premises claims against NHSPS
The BMA has proceeded to lodge claims with the High Court on behalf of five test claimant practices that are challenging the basis of their inflated service and facilities management charge demands from NHS Property Services. The action seeks to obtain a declaration that NHSPS’s ‘Consolidated Charging Policy’, which it has relied upon as the basis for its demands, does not form part of the tenancy agreements between the claimant practices and NHSPS, and as a result cannot be relied upon as a lawful basis for the inflated charges being demanded.

LMCs and practices are advised to continue to refer to the attached guidance issued by GPC in December 2019 regarding the action and advice relating to pressure to sign new lease agreements or other forms of agreement such as ‘rental agreement letters’.

GP pressures
GPs and practice teams are delivering an increasing number of appointments (28.5 million in November 2019) and providing care to a more complex patient population. This burden is being provided, with insufficient resource provision to match demand. In particular, the decreasing number of trained GPs (28,213 FTE in September 2019, a 1.2% decrease from September 2018) is impacting not only on GPs and other members of the practice team but also particularly patients who are having to wait longer than necessary for GP appointments. Whilst it is not possible with current data recording to know what proportion of patients are choosing to book ahead for planned appointments, in total 19.1% of appointments in November 2019 were preceded by a wait longer than two weeks.

The latest BMA analysis of GP data uncovers the trends behind these numbers, evaluating how general practice is faring in the face of increasing pressures across the health system.

Health and Social Care Network (HSCN) – Your future GP connectivity
NHS Digital has drafted the attached briefing about the Health and Social Care Network (HSCN), which is the replacement connectivity solution for healthcare to deliver modern digital care services. This will replace the old N3 network - also called the transition Network (TN). HSCN will provide several advantages to practices, such as faster connectivity at reduced prices, supporting initiatives such as Digital First; improved performance for primary care systems, including e-prescribing and simplified connectivity with third sector providers, for referrals and discharge notifications.

MMR campaign materials

Next week, NHSE/I will be sending posters and counter cards to all practices in England to support the NHS ‘Measles, Mumps and Rubella (MMR) – Help Us Help You, Get Protected’ campaign. These materials have been developed to support practices in encouraging their patients to get protected against measles, mumps and rubella, by getting the MMR vaccination. Posters and reception counter cards will be posted to GP practices for w/c 20 January 2020. A digital pack including these and further downloadable materials including social media content and digital screens will also be available on the Campaign Resource Centre

Corona Virus infection outbreak

A corona virus infection outbreak declared by the Chinese authorities, and Public Health England have distributed the attached document through their systems. With the upcoming Chinese New Year on 25 January, practices should be vigilant if patients present with recent history of travel to China/ close exposure to birds/ respiratory symptoms. GP action is limited to:

1. Call the ambulance service explaining your suspicions. The ambulance service has the responsibility to deal with the transfer and the destination hospital

2. Keep the patient in one room and turn off the air conditioning

Overseas doctors are vital to plug workforce shortages
The Sunday Mirror [paper version only] ran an article which warned that doctors from overseas trying to work in Britain are facing “too many bureaucratic barriers” despite severe shortages in general practice. In response to this I said: “The current recruitment crisis means we are heavily reliant on GPs coming here from overseas. The immigration and medical regulatory system still has far too many bureaucratic barriers. Streamlining the system must be a priority for politicians if we are to see a tangible improvement in numbers.”

Frail patients medicine reviews
The Guardian reported on an analysis of NHS Digital data carried out by the Pharmaceutical Journal, which showed that almost 75,000 severely frail, older people in England are missing out on vital medicine checks, putting them at risk of hospitalisation, falls and adverse drug reactions. In response to this I said these figures may say more about coding and recording, and “A clinician will review the medication when they see patients or a prescription is done, but may not necessarily code this”. Read the full article in the Guardian

GPC UK Regional elections
Nominations for GPC UK regional representative are now open, for more information see here.

Nominees should be aware that the BMA is currently in the early stages of reviewing its governance structures, which may have some potential to impact on the length of terms of office and regional remits during a term of office. The nominations close at 12pm Monday 3 February. For further information and to nominate yourself for a seat click here. If you have any queries, please contactelections@bma.org.uk 

See the last GPC bulletin here

PCN DES draft Service Specifications – summary for GPC and LMCs

The response to the NHS England and NHS Improvement draft PCN service specifications has been significant, with unprecedented numbers responding to this important survey. We are pleased that so many LMCs and PCNs have already submitted their responses to the service specification consultation. There is still time to send further feedback, including from the many LMCs and PCNs that have meetings in the next week.  We have produced the attached summary in table form which summarises what would be required, who from PCN workforce could deliver it, what the role of the community teams might be, and what the outcome measures are.

In response to these concerns I said: “General practice continues to be under a huge amount of pressure and we hear the concerns raised by the profession in recent weeks about these draft specifications, the workload implications and the need for a qualified workforce to deliver them, loud and clear.  While the content of negotiations is confidential, the profession should rest assured that we are listening to doctors on the ground, reviewing their feedback and this will form the basis of talks with NHS England to ensure that the specifications are fair and appropriate before they are agreed.” The BMA has reported it on this and commented on twitter, and it was also covered in PulseGP Online, and GP online

The HSJ (login required) have also commented today that “NHS England looks likely to row back quickly on its proposed requirements on GPs and primary care networks, after a deluge of strong opposition from GPs and others. Responding to criticism of the specifications which GPs would be asked to deliver as part of their PCN, NHSE director of primary care Nikita Kanani said: “The feedback is crucial and will absolutely be heard and reflected.”

Meeting with Health Minister

On Wednesday I met with Jo Churchill MP, the health minister with responsibility for primary care in England. We joined with Prof Martin Marshall, chair of RCGP, Nikki Kanani, Medical Director of Primary Care, NHSEI, Dr Rosie Benneyworth, CQC’s Chief Inspector of Primary Medical Services and a group of GPs from around the country.  It was a long and helpful meeting, providing a good opportunity to discuss with the health minister the key issues facing general practice and she was left in no doubt about the challenges we face and the support we needed from the new government. 

GP appointments wait

The Sunday Times (login required) reported that around 11 million patients waited more than three weeks for a GP appointment in England in the most recent four months for which statistics are available. The article referenced Boris Johnson's pledge, soon after becoming Prime Minister, in which he said that his "job is to make sure you don’t have to wait three weeks to see your GP". In response to this I said that these figures “come amid a backdrop of falling GP numbers because, despite their best efforts, many practices simply do not have the capacity to meet the ever-increasing demand” and that Boris Johnson’s promise to increase appointment numbers by recruiting more GPs “will require sustained investment and ensuring that it is easy to recruit overseas doctors”. The story was also reported by i NewsMailOnline and Pulse (log-in required).

NHS IT investment

The Department of Health and Social Care and NHSX have announced that they would be investing £40 million in updating NHS IT, beginning by focusing on speeding up login times by minimising multiple logins. In response to this, Chaand Nagpaul, BMA Council chair said that reducing multiple logins was a positive step, but that this would “not in itself address the overdue and urgent need to upgrade antiquated hardware and software in the NHS, and that we needed “to see an absolute commitment to interoperability so that different systems communicate with one another effectively, and we need to see a clear action plan of how this will be achieved”. This was reported by the BBC, the BMJ and the Times print edition.

GP earning figures

The Sun reported on figures which they said showed that over 160 GPs were paid more than £200,000 in 2017/18. In response to this I said that high earners are “more likely to be managing a business operation who are set up to manage multiple practices, rather than being on the front line of general practice seeing patients”. This was also reported by the Mail and Pulse.

Gender pay gap

The Institute for of Public Policy Research has published report which showed that women GPs earn an average of £40,000 a year less than their male colleagues. The IPPR argue that this is because of the existing GP partnership model and women being underrepresented amongst GP partners.  

In response to this, Farah Jameel, GPC England executive team member said: “The gender pay gap in this day and age is something that we as a society should be ashamed of, and we need to work harder to examine more closely and address the issues that lead to this in the medical profession. For many female doctors – many of whom will have family or caring responsibilities – working flexibly is the right thing for them, and salaried roles at present are able to provide a greater control over work-life balance. However, partnerships too can offer a great opportunity for flexible ways of working, which could be positive for the recruitment and retention of women, but action must first be taken to reduce the risks that put off GPs of all genders from currently taking on this role.”This was reported by the Independent

PCN conference 2020

At this crucial time for the future of PCNs, there is an important opportunity to join other PCN leaders and share best practice and build supportive relationships at the PCN Conference on Saturday 8 February, at the ICC Birmingham. It should be an interesting day and give people a flavour of how different PCNs, CCGs, LMCs across the country are doing things and giving PCNs ideas for the future and maybe how to do things differently for greater benefit. If you haven’t already signed up then you can do so here.

The GPDF has funded one seat for each LMC, which can be booked here; for any additional LMC seats please go through the standard booking form above.

CCG mergers guidance (England)

The BMA has produced new guidance on CCG mergers in England, to help GPs and LMCs get to grips with the changes taking place. This includes information on why, how, and when mergers are likely to take place, as well as advice on how to approach them, and examples of ways in which LMCs and grassroots GPs have influenced and shaped mergers in their areas. Read more here.

Online consultations toolkit

NHS England has published a toolkit to inform staff in practices and commissioning organisations who are implementing online consultation systems. There is a shortened version aimed at GPs and other practice staff, as well as a full version of the toolkit for those who are leading these projects. 

BMA mental health workforce report

The BMA published a mental health workforce report yesterday, which revealed that over half of respondents said they were too busy to provide the care they would like to be able to give, with 44% saying that they felt demoralised and the same number saying their workload was unmanageable. It also showed that around two in five GP appointments now involve mental health, while two in three GPs say the proportion of patients needing help with their mental health has increased in the last 12 months. Read more here. This was reported by  GP Online, and OnMedica.

RCGP (Royal College of GPs) Workforce Roadmap

The RCGP has launched a workforce roadmap, calling on the Government to take urgent action on the GP workforce with clear targets for expanding the entire general practice workforce, a commitment to increase GP training places to 4,000 in 2020/21 and to 5,000 soon after, and significant investment into initiatives to improve GP workload and retain existing GPs in the profession. This was reported by the BBC and I responded publicly in support of the RCGP’s recommendations.

Supply Disruption Alert for Phenytoin 100mg capsules

The Department of Health and Social Care has informed us that a supply disruption alert for phenytoin 100mg capsules has now been issued and can be found here.

GPC Regional elections

The nominations for the following GPC UK regional seats will open on Monday 13 January at 12pm:

  • Hillingdon/Brent & Harrow/Ealing, Hammersmith & Hounslow
  • Lewisham, Southwark & Lambeth/Bexley & Greenwich/Bromley
  • Cheshire/Mid Mersey
  • Northumberland/Newcastle & North Tyneside/Gateshead & South Tyneside/Sunderland
  • Glasgow & Clyde
  • Gloucestershire /Avon
  • Wiltshire/Dorset
  • Buckinghamshire/Oxfordshire 
  • Berkshire/North and East Hampshire
  • Barnsley/Doncaster/Rotherham/Sheffield 
  • Leicestershire & Rutland/Northamptonshire
  • North Yorkshire/Bradford
  • Dyfed Powys/North Wales
  • North Staffordshire/South Staffordshire/Shropshire
  • Sandwell/Walsall/Wolverhampton/Dudley

    Governance review

    Nominees should be aware that the BMA is currently in the early stages of reviewing its governance structures, which may have some potential to impact on the length of terms of office and regional remits during a term of office.

    The nominations close at 12pm Monday 3 February. For further information and to nominate yourself for a seat see here (in the elections tab). If you have any queries, please contact elections@bma.org.uk

Child Safeguarding Judicial Review
Following longstanding concerns about the failure of many areas to make proper payment to cover the costs to practices for work covered by collaborative arrangements, as I said at the LMC England Conference, the BMA launched an application for judicial review in Northamptonshire challenging the failure to make any financial provision for child safeguarding services provided by GPs. We have now been informed that our application for judicial review has been granted permission by the Administrative Court, which will be listed in the next few months. The focus now will be on collating mutual Counsel availability times to try to lock in a date which the parties can all do.

PCN Service Specifications survey

As I highlighted earlier this week, NHS England and NHS Improvement have published draft PCN service specifications and an accompanying survey asking for feedback. GPC England will engage with NHSEI in negotiations on the service specifications in the coming weeks and this will be influenced by the responses to the consultation. GPC England will be meeting on 16 January to discuss these proposals from NHSEI. We would therefore ask LMCs to circulate the link to the survey to local practices and clinical directors and to encourage as many as possible to make their views known as soon as they can.

NHSEI are also running a series of webinars where the outline service specifications will be discussed, on Wednesday 8 January 2020 at 12.00-1.30pm and Thursday 9 January 2020 at 10am-11.30am. Nikki Kanani, NHSE Medical Director for Primary Care, will also be hosting a #primarycarenetworks Twitter chat on 7 January 2020 at 20.00. In addition a webinar focusing on the community services elements of the Enhanced Health in Care Homes and Anticipatory Care service specifications, aimed at directors and chief executives of community health providers will be held on Tuesday 14 January 2020 – 3pm-4.30pm.

For community health providers, NHSEI plan to commission service requirements via the NHS Standard Contract. These requirements form part of the consultation on the Standard Contract, which will run from 19 December 2019 to 31 January 2020 and can be found here.
 
Primary Care Network conference
It is still possible to book to join a large number of PCN leaders at our second PCN Conference which will be on Saturday 8 February, at the ICC Birmingham. This will be an important opportunity to learn about what is happening in networks around England, share good examples and explore solutions to problems. Please see attached the outline programme which is also available on our PCN Support webpages https://pcn.bma.org.uk/

For more information and to get your early bird discount by 8 January see this page www.bma.org.uk/pcn-whats-next

PCN Service Specifications survey

NHS England and NHS Improvement have published draft PCN service specifications and an accompanying survey asking for feedback. GPC England will engage with NHSEI in negotiations on the service specifications in the coming weeks and this will be influenced by the responses to the consultation.  We would therefore ask LMCs to circulate the link to the survey to local practices and clinical directors and to encourage them to make their views known as soon as possible through a response.

NHSEI are also running a series of webinars where the outline service specifications will be discussed, on Wednesday 8 January 2020 – 12.00-1.30pm and Thursday 9 January 2020 - 10am-11.30am.  In addition a webinar focusing on the community services elements of the Enhanced Health in Care Homes and Anticipatory Care service specifications, aimed at directors and chief executives of community health providers will be held on Tuesday 14 January 2020 – 3pm-4.30pm.

For community health providers, NHSEI plan to commission service requirements via the NHS Standard Contract. These requirements form part of the consultation on the Standard Contract, which will run from 19 December 2019 to 31 January 2020 and can be found here.

GP shortages

Following the new Government's pledge to invest more into the NHS, the Times published a series of articles highlighting the workforce crisis in general practices. In response to this a letter I wrote to the Times was published, where I said: "Your important investigation (“One doctor for 11,000 patients in GP shortage”, Dec 21) underlines the crisis in general practice that my colleagues and I at the BMA have been vocal about for years. We do not have enough GPs to meet the needs of our growing population: many people are living with increasingly complex conditions. This inevitably means that some patients are waiting too long for an appointment, which is distressing for people who are ill and frustrating to practice staff, who want to provide the best care possible”.

I also spoke on LBC radio last week to discuss OECD research which found that Britain has the second lowest number of doctors per capita in Europe, after Poland, where I said:  "The number of doctors has not kept pace with the rising population or the complexity of our patients. It's been a really good thing that more people are living longer into their 80s and 90s, but that also means that they are more in need of healthcare, and so we need to grow our medical services - not just doctors, but nurses and others as well, to be able to support the growing needs of our patients. If we don't do that then we put added burden on clinicians and that's when they themselves become burned out and leave."

NHS investment
The Sunday Times (sign-up required) also reported on the letter from Chaand Nagpaul, BMA council chair, to the Prime Minister warning that the Government's NHS election pledges will not be enough to rescue it from crisis, and that there will still be a funding black hole of £6.2 billion a year by 2023-24. The story was also covered by Eastern EyeYahoo NewsNDTVBusiness StandardDevdiscourseOutlook India, and Medical Dialogues.

PHE to cut New Year anti-smoking campaign
I was interviewed by BBC 4 Radio’s World at One programme on Friday about the news that Public Health England will be cutting back on its New Year anti-smoking campaign due to a fall in Government funding. I highlighted the concern about these proposals and said: "We are seeing patients in our surgeries on a daily basis who still smoke; we try to provide advice and guidance to them but we need the help of Government, and we need the help of public health budgets." Listen to the full interview on BBC Radio 4’s World at One here (from  22mins in).

Influenza 2020/21 letter

NHS England and NHS Improvement has now published a letter based on the recommendations by Joint Committee on Vaccination and Immunisation (JCVI) which sets out the vaccines that should be offered to eligible people and the reimbursement guidance for 2020/21.

 
New Year’s honours

I would like to congratulate a number of GPs who we regularly work with who received honours in the Queen’s New Year’s honour list:

Dr Jonathan Leach, joint honorary secretary of the Royal College of General Practitioners, was awarded an OBE for services to general practice. Read more here.

Dr Victoria Tzortziou-Brown, joint honorary secretary of the RCGP, was also awarded an OBE for services to general practice. Read more here

Dr Henrietta Hughes, National Guardian for the NHS and General Practitioner, was awarded an OBE for services to the NHS.

Professor John Campbell, Professor in General Practice and Primary Care at Exeter University, was awarded an OBE for services to general practice.
 

Introductory meeting with England Chief Medical Officer Prof Christopher Whitty

Just before Christmas, I joined Chaand Nagpaul, BMA chair of council, in a meeting with the recently appointed England CMO Professor Christopher Whitty, who is also Chief Scientific Advisor for the Department of Health and Social Care. He is a practicing consultant physician in infectious diseases.

It was a good opportunity to discuss with Professor Whitty his thinking about the NHS and the medical profession.  He was particularly interested in the role of general practice within the NHS, and it was useful for me to be able to brief him on the realities facing GPs and how they can be better supported.

Medicine supply update

Please see attached the medicine supply update from the Department of Health and Social Care for December. There are also tier 2 shortages of clonidine 25mcg tablets and h2-antagonists (cimetidine, famotidine and nizatidine), and a supply disruption alert for ranitidine (all formulations) is available at SDA/2019/005-U2. A tier 3 supply disruption alert for Convulex capsules (valproic acid) was issued on 23 December and is available here.

Serious Shortage Protocol for haloperidol
The DHSC has issued a Serious Shortage Protocol (SSP) for haloperidol (Serenace®) 500 microgram capsules which took effect on 23 December 2019 with an expiry date of 23 March 2020. Where prescriptions are presented for the haloperidol 500microgram capsules, this SSP allows pharmacists to supply haloperidol 500microgram tablets. For more information see the SPS website.

RPS:  New competency framework for designated prescribing practitioners

The Royal Pharmaceutical Society (RPS) has published a Competency Framework for Designated Prescribing Practitioners for use by all the non-medical prescribing professions. The Framework supports individuals across all independent prescribing professions, training providers and universities to understand what competencies must be met to provide safe and effective prescribing supervision to independent prescribers.

Read the latest GPC newsletter here.

General election: Government pledges on NHS investment
I spoke to LBC on Sunday (just after 5pm) about the new Government's pledge to invest more into the NHS, where I said that the money promised is not enough, and that the Government must recognise that we have a growing, ageing population, which needs a stable health service to keep up with demand. I also mentioned the pensions issue and explained why this is deterring doctors from doing extra shifts in the NHS, or wanting to stay altogether. I also spoke to BBC York on Monday morning (interview starts about 2 hours in).

Dr Helena McKeown, chair of the BMA representative body, also spoke to BBC Wiltshire (7am) and BBC Humberside (9.15) on Monday, and said that now is the time for the Government to make a real difference on the frontline of the health service - something which was reiterated in our letter to Boris Johnson last Friday. She said the Conservative manifesto is 'promising, but not enough', and that she has concerns about attracting more healthcare professionals to the NHS.

BMA council chair Chaand Nagpaul has written to the prime minister calling for decisive action from the new Government to tackle NHS pressures and deliver real change for staff, patients and services. Read the letter 
 
BMA Legal action against NHS Property Services – Service and Facilities Management Charges
As you know, over the last three years many practices have seen significant increases in service charges and facilities management costs without prior agreement while some report being billed for services they are not receiving. This situation is placing unsustainable pressure on practices and is essentially diverting precious resources away from patient care. Furthermore, we know that this it is destabilising the future of practices as many young doctors are discouraged from becoming GP partners where this issue remains unresolved. The overall impact of this ongoing dispute is having a devastating effect on the profession.

The BMA has repeatedly pressed NHSPS to cease its inflated demands and to provide a proper explanation for the charges. Unfortunately, discussions and negotiations have reached a standstill. Consequently, the BMA wrote to NHSPS earlier this year, setting out why it believes NHSPS is acting unlawfully but received no acceptable response. Therefore, as you know I announced at the Annual Representative Meeting in Belfast in June this year that the BMA is now taking NHSPS to court. 

I attach a letter to you from Gaurav Gupta, GPC premises and practice finance lead, updating you further on progress.

CCG mergers guidance
Following the recent debate at LMC England Conference we are developing a “Focus on CCG mergers” guidance document outlining our work on CCG mergers which we will publish shortly. As outlined both by LMCs and in our letters to NHS England, mergers present a number of issues for practices, including the potential loss of local influence, continuity of funding and support, and understanding of the local population’s needs. We have also received a number of examples of mergers being carried out with poor quality and limited engagement with member practices.

We have raised each of these issues with NHS England and their most response  sets out their position on each. The response also includes a request for any examples of issues with mergers locally, which we may wish to highlight. Therefore please share with us any further examples and in doing tell us whether there been consultation with the LMC or BMA regional council and if so, is there support for the merger plans, whether you are aware of any support from local public (Healthwatch, patient groups, etc), and whether the relevant information including financial and service implication been provided with enough time to properly consider documentation ahead of votes? Please send any examples or feedback to tbramwell@bma.org.uk

Performers List Online Service
The new online Performers List service has now been launched by NHS England and is being managed by Capita (PCSE). Over the next few weeks GPs will be automatically registered on PCSE Online. You may have recently received an email from PCSE, with a link for you to verify your account. This is a legitimate email and we are recommending that you follow the link and verify your account – you will need to do this within 72 hours of receiving the link. If the link has expired you can use the ‘forgotten your login details’ button on the PCSE Online homepage.

If you have not received this email you will need to check that you have an email address registered with the GMC and/or that this is up to date. You can do this by logging into your GMC Online account and updating the ‘My details’ section, by emailing gmc@gmc-uk.org or by calling the GMC on 0161 923 6602.

The new online Performers List essentially is a move from a paper application to an online application and we have been involved in the development of the system.

There has been some concern regarding a tick box which asks for your permission for your details to be shared with your Local representative committee; this is your LMC.  Please do share your details as this will allow your LMC to contact you. Capita (PCSE) cannot share your details with anyone else.  

We would strongly recommend signing up to the new Performer’s list.

Practice e-declaration 
Following concerns raised by practices completing the e-declaration about including an email address, we raised this issue with NHSEI.  They have now modified the declaration so that practices can leave the data field relating to the email address blank. However, this only applies to those practices who have not yet submitted their form, it cannot be changed retrospectively.  Email addresses already submitted will not be published on NHS Choices. 

Influenza Season 2019-2020
A delay in the delivery of some influenza vaccines this year meant that the flu vaccination programme started later than usual; further supply constraints then occurred with the children’s nasal vaccine.  Although these issues are now resolved, vaccine uptake rates are around 5% lower than expected for this time of year for those in clinical risk groups under 65 years. Of particular concern is uptake for two and three year old children, which is around 8% lower than the same time point last year. The data suggests that practices are working hard to catch-up and we would like to thank all the GPs, practice nurses and other practice staff who support the programme. Unfortunately, however, we have already started to see early influenza activity in the community, particularly in the northern part of England.  School children have been particularly affected and several paediatric deaths have already been reported, as well ICU admissions.  The predominant strain causing cases this year appears to be well matched to this season’s influenza vaccine, and so we hope that practices will be able to continue these efforts to ensure as many children and younger adults are protected as possible.
 
Updated BMA handbook for salaried GPs
The sessional GP committee has just updated our salaried GP handbook which is written for salaried GPs and GP employers. It will also be of interest to those who are intending or about to become salaried GPs. It explains the legal entitlements of salaried GPs as employees and helps to ensure that salaried GPs are aware of their statutory and contractual rights. It also helps to prevent GP employers contravening the law unwittingly. In addition, it explains the national and local representation of salaried GPs, how to become a salaried GP and the work involved.

One of the aims of this handbook is to help ensure that all salaried GP members receive appropriate employment terms and conditions. It does this by setting out the legal entitlements that salaried GPs receive as employees, as well as the additional contractual benefits that are, or may be, available. It provides a comprehensive overview of the employment contracts available to salaried GPs and the effect of the various provisions of the model salaried GP contract. The handbook also provides guidance on negotiating improvements to salary and other
contractual provisions.

The handbook provides detailed guidance for salaried GPs. However, this cannot replace the expert and confidential advice on individual employment issues that salaried GPs should and can obtain. This is available as part of BMA membership by contacting the BMA.

Also, a specialised and invaluable benefit of BMA membership is the employment contract checking service that is offered. The BMA will review the employment offer letter and terms and conditions, and advise on any necessary improvements.

The handbook is a valuable tool for GP employers. It explains the statutory entitlements that a GP employer must provide to its salaried GPs in order not to fall foul of the law. It also highlights various contractual obligations, including those under the model salaried GP contract.

You can access the updated handbook here.
 
Pensions 
A special edition of the PCSE GP Bulletin had been published, which covers the End of Year Pension administration processes for 2020 and an update about Annual Benefit Statements (ABS). NHS Pensions has released the Type 1 Annual Certificate of Pensionable Profits and the Type 2 medical practitioner self-assessment form will be available very soon. In this bulletin we will help you understand what you need to do in order to prepare End of Year Pension administration in 2020.

NHS Pensions has confirmed that the following pension forms and associated guidance notes have now been published and are available to download from the NHS Pensions website here.

The following pension forms and associated guidance notes have now been published:

  • Type 1 GP and non-GP providers annual certificate of pensionable profits (partnership / single-hander) 2018/19
  • Type 2 medical practitioner amnesty form - for use when forms not already submitted from years 2009/10 to 2016/17

    Also available is: GP and non-GP providers annual certificate of pensionable profits (limited company) 2018/19

    Available very soon: 
  • Estimate of NHS pensionable profits / pay form 2020/2021

Type 2 medical practitioner self-assessment forms 2015/16, 2016/17, 2017/18 and 2018/2019

To read the full bulletin click here

GMC’s State of Medical Education and Practice annual report 
The GMC has published its State of Medical Education and Practice annual report. It notes that 45% of GPs reported working less than full time (61% female GPs compared with 26% male GPs), 36% have reduced their hours in the past year, and many are considering leaving the profession altogether (18% in the next year). Increasing workloads has resulted in two thirds of GPs working over their rostered daily hours with 19% taking stress related absence over the last year. 92% of GPs reported that they felt unable to provide sufficient levels of care at times while a quarter reported witnessing patient care being compromised. Despite this, the report also notes that around half of GPs are satisfied in their work, largely driven by a sense of fulfilment.

PCN conference
Join other PCN leaders and gain insight into what’s happening across England, share best practice and build supportive relationships at the PCN Conference on Saturday 8 February, at the ICC Birmingham. Learn more and get your early bird discount at www.bma.org.uk/pcn-whats-next

Social Prescribing webinar
The National Association of Link Workers is running a short webinar on 30 January for anyone interested in getting a bit more information about Social Prescriber Link Workers and their involvement in PCNs. LMCs and PCNs can register here.

Read the latest GPC newsletter here.

Read the latest Sessional GPs newsletter here.

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