GPC England Officer Team election
We are pleased to announce that David Wrigley has been elected to the GPC England Officer Team as deputy chair. He is a GP partner working in Carnforth, Lancashire and he is also an elected member of the BMA’s UK Council and, until his term finished in June earlier this year, was deputy chair of Council for five years, serving from 2016-17 and then again from 2018-22. He was also a former regional representative of GPC, and currently vice chair of Morecambe Bay LMC.
The GPC England Executive Team has now become the GPC England Officer Team (made up of a chair and three deputies). This brings the leadership structure of GPC England further in line with what is standard practice at the BMA and ensures parity of esteem between the Officer Team.
Read the full statement here and read more about GPC England here
GP workload and workforce
GP practices across the country continue to experience significant and growing strain with declining GP numbers, rising demand, struggles to recruit and retain staff and has knock-on effects for patients. GP numbers are falling, with little increase in the overall number of GPs since 2015, and a significant decline in the number of GP partners over that time.
As shown by the latest GP practice workforce data, published today, as of July 2022 we now have the equivalent of 1,857 fewer fully qualified full-time GPs compared to September 2015. This means that NHS has lost the equivalent of 51 full-time fully qualified GPs compared to the previous month (June 2022). This is despite the promises by the Government of an additional 6,000 GPs by 2024.
At the same time, the number of GP appointments remains high, with the July total of 26 million, of which 44.3% were same day appointments. Read more about the pressures in general practice here
General practice is under considerable strain and due to these pressures, GPs continue to leave the profession in larger numbers than ever before. We will continue to urge the Government to tackle the systemic pressures that contribute to burnout and worsening wellbeing among doctors, impress upon the need to support the workforce.
We encourage practices to control their workload to mitigate the impact of unsustainable demand and overworking. Our Safe working in general practice guidance enable practices to prioritise safe patient care within the present bounds of their contract with the NHS. We would encourage practices to consider these suggestions for controlling their workload to ensure safe patient care, and better staff wellbeing could make a significant difference in the coming weeks and months. Please also take a moment to check in on your colleagues’ wellbeing and look out for each other.
The BMA is here for you and offers a range of wellbeing and support services for doctors, and we encourage anybody who is feeling under strain to seek support. You can access one-off support or, after triage, a structured course of up to six face-to-face counselling sessions. Call 0330 123 1245 today or visit the website for more information.
For all other support, speak to a BMA adviser on 0300 123 1233 or email support@bma.org.uk
COVID Booster
Responding to the announcement of the autumn COVID-19 booster programme, Preeti Shukla, GPC clinical and prescribing policy lead, said:
“The new Moderna bivalent vaccine is great news in the fight against the Covid virus and will make an important addition to this autumn’s booster programme – a programme essential to preventing another outbreak in the winter.
“However, with the current well-documented pressures on GP practices and the reduction in the funding for delivery of these vaccines, we have serious concerns about the rollout. Payment to GPs for delivery of vaccines has dropped 20% since last year’s rollout while the costs for GP practices have only rocketed in the meantime. This vaccine will require freezing and refrigerating, an ever more expensive operation as energy costs rise. The new Moderna vaccine only strengthens the case for returning payments to last year’s level rather than trying to deliver a booster programme on the cheap.
“GP practices, while glad to hear of a new vaccine to add to their arsenal, will nevertheless be wondering if the numbers add up as they face a difficult autumn and winter.”
Read the statement: Autumn booster programme must not be delivered 'on the cheap'
New Flu Enhanced Service Specifications and Flu Collaboration Agreement
NHS England and NHS Improvement (NHSE/I) has now published the service specifications for 2022/23 flu childhood flu vaccination programmes.
As practices will be aware from the previous NHSE/I flu letters, practice staff are still not included within the cohorts for the programme. We have serious concerns about this as including practice staff within the eligible cohort would improve uptake, protect patients, and help maintain workforce.
We have repeatedly raised our concerns about this with NHSE/I, especially as practice staff were included in last year’s programme, and this is something that we are continuing to discuss with NHSE/I as a matter of urgency.
Government’s reported plan for GPs to prescribe heating bill discounts is 'beggars belief'
In response to the report that GPs would be asked by government to 'write prescriptions for money off energy bills', David Wrigley, GPC England deputy chair, said:
“We completely reject any suggestion that GPs do this work. They do not have the time or the skills to do the work of the welfare system. At a time when GPs are already overwhelmed with the greatest workforce crisis and are supporting patients on hospital waiting lists which are longer than ever, this addition to their workload would be totally unacceptable. It is beggars belief that government ministers think it is appropriate to suggest GPs undertake it. The government has not discussed this with us in any form - floating these sorts of proposals via the media is deeply unprofessional.” Read the full statement here
Social prescription trial on walking and cycling
The Government is introducing social prescriptions for walking, wheeling and cycling, as part of a new trial to improve mental and physical health and reduce disparities across the country. This is a step in the right direction for public health - physical activity is key to good physical and mental health and brings huge benefits to society and the environment.
But the impact will be minimal without a clear commitment to long-term funding and consideration of the wider context. Without properly addressing resources and the capacity of GPs, this approach risks frustrating doctors as well as the public. The initiative needs public health and primary care to have joined up policymaking and adequate funding, however, if prevention is to stay the course and deliver long-term health benefits, especially for the poorest.
Read more in this article by Penelope Toff, Chair of the BMA’s Public Health Medicine Committee
GP ‘bureaucracy busting concordat’
Earlier this week the Government published its GP ‘bureaucracy busting concordat’, which outlines seven principles to help reduce unnecessary bureaucracy and administrative burdens in general practice. Developed with input from the BMA, the concordat includes principles around medical evidence, certification and designing processes around ease of use for both GPs and patients.
GPC England deputy chair, Kieran Sharrock, said he was glad that DHSC and NHSE/I “recognise the potential of what empowering practices to take charge of their workload can do, and hope all Government departments sign up to this concordat and its seven principles - which the BMA helped develop - to ensure unnecessary bureaucracy in general practice can finally start to be relieved”.
PCNs – clarification on CQC registration
Following concerns and some confusion at local level regarding PCNs (Primary Care Networks) and CQC (Care Quality Commission) registration, the following clarification has been provided by CQC:
‘It is important to remember that only legal entities can register with CQC. If a provider is a collaborative, such as a PCN, and is not a legal entity then it cannot carry out regulated activities and therefore it cannot be registered with CQC. In a situation where a PCN is not a legal entity, and the constituent members are already registered with CQC for the delivery of regulated activities they provide as part of the network (including extended access) they will not need to register separately from the constituent practices, however it is advised that providers amend their statement of purpose to accurately reflect the additional roles they will assume as a participant member of a PCN.
In a situation where a new or currently unregistered provider organisation is formed as a legal entity AND the organisation will have ongoing direction and control of the delivery of regulated activities it would be required to register with CQC. If a PCN becomes a legal entity but does not directly control and deliver regulated activities (for example by supplying staff to assist constituent practices to deliver their regulated activities) there is no need to register with CQC. Please note that new applications for registration can take up to 10 weeks to process. The exact timeframe will depend upon the complexity of the application and the availability of key information requested by the registration inspector.’
In addition to this statement, GPC England officers and staff will be working with CQC to develop and publish responses to a range of FAQs addressing PCNs and registration.
Trust registration requirements
On 10 January 2020, the Fifth Money Laundering Directive (5MLD) was transposed into UK law. One objective of the 5MLD was to broaden the scope of trusts required to comply with and sign up to the Trust Register Service (TRS), which may apply to some GP surgeries depending on how they are structured.
Property-owning GP partners may be required to register, particularly where the names on the land registry entry do not match the names of the property-owning partners, or where there are more than five surgery-owning partners. Similarly, and depending on the precise wording of your Primary Care Network (PCN) agreement, monies held by one practice on behalf of a PCN could be construed as the formation of a trust and may trigger a registration requirement.
Unless exempt, 5MLD requires the express trusts to register with the TRS. HMRC has published guidance on what may constitute an express trust and instances where exemptions may apply.
If you are unsure whether you need to register with the TRS, it is important that you receive independent legal advice, as a failure to register may result in financial and criminal penalties. The deadline for registration is 1 September 2022.
Section 49 report guidance
Under section 49 of the Mental Capacity Act 2005 (the “MCA”), the Court of Protection (the “CoP”) may require NHS health bodies and local authorities to arrange for a report to be made for the purpose of considering any question relating to someone who may lack capacity. Producing a report is a complex process involving assessing the patient, reviewing notes, discussing with relevant professionals and compiling information. The amount of time required to review a long and complex set of medical records presented can be significant.
The definition of ‘NHS body’ does not include GP practices, even if their contractor CCGs/PCOs are. Therefore, practices cannot be directly ordered by the Court of Protection to produce a report under section 49.
Although it is possible for an NHS body (e.g. an NHS Trust) that had been ordered to arrange for a report to be made to request that someone else produce a report (under section 49(3)), e.g a GP - in doing so, the trust cannot compel a GP as an independent practitioner to do the work and if the GP agrees to do the work, he/she is entitled to be paid a rate agreeable to the GP.
Read more in this guidance by the BMA’s Medico Legal Committee
Research priority setting with the General Practice Workforce Survey
The School of Health Sciences, University of Surrey is conducting a short national survey to identify and prioritise a shortlist of service delivery challenges that require further research, as identified by the general practice workforce. Study findings will be used to ensure that future research seeks to address areas of unmet need, as determined by the workforce.
The survey asks three key questions from a workforce perspective: (1) what is working well in general practice; (2) where are the challenges; and (3) what needs fixing, as well as basic demographic information. The survey is open to all clinical and non clinical staff in UK General Practice. Take the 10 minute survey here (Deadline: 23 September 2022)
Best Practice Show, 12-13 October 2022, NEC Birmingham
GPC England will be at Best Practice Show, UK’s main event for the primary care and general practice community, on 12-13 October 2022. We will have a dedicated theatre, with a programme focussed on the most pressing issues facing general practice, including the future of general practice, working within ICSs, workload management, workforce management, primary care estates, and more.
Free for healthcare professionals, the conference provides up to 12 hours of CPD certified training, expertly tailored to meet the training requirements of healthcare professionals. Register here.
England Conference of LMCs 2022
A reminder that the closing date for the submission of all motions for the England Conference of LMCs 2022 is Thursday 8 September at midday. Guidance on how to submit motions can be found here and tips on how to write motions can be found here. If you require any additional guidance or assistance, please contact the team on info.lmcconference@bma.org.uk
GPC England committee pages and guidance for practices
Read more about the work of the GP Committee
Read practical guidance for GP practices
See the latest update on Twitter: @TheBMA / Twitter, @BMA_GP / Twitter @DrFJameel / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
| Read the latest GP bulletin (England) here |
| Have you got any information you would like to share via the GPC update to LMCs? Email us on info.lmcqueries@bma.org.uk. Deadline for submissions for the next issue is Monday, 5 September. |
GP Wellbeing
Last week we wrote to BMA members regarding the distressing news that Dr Gail Milligan, a GP at Camberley Health Centre in Surrey, took her own life, and to inform that on behalf of the BMA and the General Practitioners Committee, we have expressed our condolences to Dr Milligan’s family and her Practice.
We know Dr Milligan was, like so many of us, under intense pressure at work, as we struggle to meet what often feel like the impossible demands of the job. It’s clear that action by Government is the only way in which these systemic pressures can be relieved on a long-term basis. On behalf of the profession, we have long been urging government to tackle these issues that contribute to burnout and worsening wellbeing among doctors, be they GPs or otherwise, and we will continue to raise these issues. Last week we wrote to James Morris MP, the minister for primary care, urging him to take action, and we will continue to impress upon the government the need to support the workforce.
Here at the BMA, we want you all to know you have the support of your colleagues and your union. A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support. Please take a moment to check in on your colleagues’ wellbeing and look out for each other.
Support comes in various forms, from confidential counselling services to networking groups and wellbeing hubs with peers as well as the NHS’s Practitioner Health service and non-medical support services such as Samaritans.
Specialist services are also available, helping doctors with specific issues ranging from Covid and addiction to financial and legal assistance. Most services are free of charge and available to all doctors and medical students, not just BMA members. Please do not hesitate to reach out.
Please visit the BMA’s dedicated wellbeing support services page, speak to a BMA adviser on 0330 123 1245 or email support@bma.org.uk and for further information see our extended directory. We encourage you to access any, or all, of the forms support mentioned above, or encourage colleagues to do so, if you believe your or colleagues’ wellbeing is at risk.
Polio vaccine – London
As you will be aware, it was announced yesterday that all children between the ages of 1 and 9 in all London boroughs will be offered a polio vaccine booster. This has been recommended by the JCVI, following the discovering of polio in sewage in north and east London.
Prior to this announcement, the details regarding how this vaccine programme would be delivered had not been agreed. The involvement of GP practices in this programme was not discussed or agreed with either GPC England, Londonwide LMCs or Surrey and Sussex LMCs. We are currently having urgent conversations with NHSE/I to reach agreement on whether or not practices will be involved in the programme. As part of these discussions we have raised our concerns regarding capacity to deliver any part of the programme, and funding available for the work involved.
We have made clear our discontent with how this announcement was made prior to agreeing how this programme would be rolled out, especially as practices are already overburdened and do not have spare capacity. We will ensure you are updated when progress is made.
Pay Transparency update
In April 2022, amendments to the GP contract regulations were made that removed the requirement for individuals within scope of the general practice pay transparency provisions to make a self-declaration of their 2020/21 NHS earnings by 30 April 2022. Individuals within scope of the pay transparency provisions are not required to take any action in relation to their 2020/21 NHS earnings at this stage.
Pay transparency remains part of the current regulations, however DHSC has confirmed that commissioners should not enforce the requirement at this time.
Currently the individuals in scope of the regulations introduced in October 2021 will need to make a declaration of their 2021/2022 earnings in April 2023 as the provision remains in the GP contract. The latest position on Pay Transparency is available on the NHSE website: NHS England » General practice pay transparency
We continue to request further suspension of the requirement to declare earnings as we believe this is harmful to morale of the profession and could lead colleagues to reduce their working commitments or to retire. We also believe that it is inequitable to single out general practice for this requirement.
Changes to COVID-19 Vaccination ES (Phase 5)
Many of you raised significant concerns about recent amendments to the Enhanced Service for the COVID-19 vaccination programme, particularly in relation to the reduction of the item of service charge from £12.56 to £10.06, the removal of the care home administrative payment, and the decision to pass the cost of consumables (needles and needle disposal, cotton swabs etc) on to practices.
We wrote to Nikki Kanani (Medical Director of Primary Care, NHSE/I) and Amanda Doyle (Director of Primary and Community Care, NHSE/I) on 18 July to raise these concerns. We underlined the key role of, and enormous efforts made by, general practice in the rollout of the COVID-19 vaccination programme and highlighted that this amendment will effectively disincentivise practices from taking part – with severe risks to vaccine uptake and public health. We strongly urged NHSE to reverse its decision, and to extend the opt-in window to reflect these late changes. Finally, we emplored NHSE/I to adopt a collaborative approach on these crucial issues, noting that GPCE was not afforded a meaningful opportunity to negotiate these amendments.
On 3 August we heard back from Nikki Kanani and Caroline Temmink (Director of Operations and Delivery, CVP, NHSE/I). Whilst it included recognition that general practice has helped to save ‘an estimated 200,000 lives and 186,600 hospital admissions’ throughout the pandemic, the response also made it clear that NHSE was not willing to make any of the concessions we had requested to ensure that the Enhanced Service remains sustainable. Whilst this is a frustrating outcome, we will continue to make representations on this issue to NHSE/I. Despite NHSE/I’s assertions, the pandemic remains a public health an emergency and therefore requires us to operate on an emergency footing; decisions taken to reduce the strength of our COVID-19 vaccination programme must be vehemently challenged.
Patient Lists
NHSE/I has asked PCSE to recommence data quality checks on GP practice patients lists, this includes a reconciliation of practice patients lists. This work was paused during the COVID-19 pandemic but started again on Monday 1 August 2022. Copies of the communication circulated to practices can be found here: Patient list reconciliation and Patient list maintenance.
Although some targeted list reconciliation activity continue during the pandemic as essential groundwork for the decommissioning NHAIS, it was now been un-paused as a 3-year rolling cycle for all GP practices. The reconciliation checks the practice-held list with the NHAIS list held by PCSE. PCSE plan to start a new 12-month cycle, meaning a third of practice will be contacted over the next 12 months that have not previously had a reconciliation request.
We have raised our concern with NHSE/I that this is a bureaucratic burden for practices which will detract from practices’ capacity to provide patient care. We asked that the process be delayed until practices had their full complement of clinical and administrative workforce.
Whilst NHSE/I have acknowledged and considered the points raised, they have declined our request, stating that the process will only affect a small proportion of practices nationally and that there will never be an ideal time to restart the process.
GPC England Officer Team election
Following a recent decision at GPC England, the GPCE Executive Team (made up of a chair, a deputy and two executive team members) has become the GPC England Officer Team (made up of a chair and three deputies). This brings the leadership structure of GPC England further in line with what is standard practice at the BMA and ensures parity of esteem between the Officer Team. It will not impact the function of the Team.
There is a vacant position on the GPC England Officer Team. Following a recent decision at GPC England, this position shall be elected to ensure democratic accountability.
GPs who were members of the BMA were eligible to stand, and four candidates put themselves forward for the position. A husting between the candidates and the electorate, voting members of GPC England, was held on Tuesday, 9th August. Voting opened on Wednesday, 10th August and closes on Wednesday, 17th August. The result of the election will be announced following this.
If you have any questions about the election process, please email elections@bma.org.uk.
Best Practice Show, 12-13 October 2022, NEC Birmingham
This year the BMA and GPC England will be at Best Practice Show, UK’s number one event for the primary care and general practice community, at the NEC Birmingham on 12-13 October 2022.
Free for healthcare professionals, the conference programme will provide up to 12 hours of CPD certified training, expertly tailored to meet the training requirements of healthcare professionals, with clinical content closely following the GP curriculum spearheaded by the Royal College of General Practitioners.
The BMA and GPC England will have a dedicated theatre at the conference, with a programme focussed on the most pressing issues facing general practice, including the future of general practice, working within ICSs, workload management, workforce management (ARRS roles and multidisciplinary teams), primary care estates, and more.
The conference programme as a whole will address major policy topics impacting general practice, such as around access, health inequalities, digital innovation, and the GP contract. It was also cover range of clinical issues around areas such as cancer, dermatology, diabetes, gastroenterology, neurology, mental health, and cardiovascular disease. This year we’ll also have a renewed focus on women’s health and pain management as well as more content on immunisations.
If you are interested in attending, you can register here.
GPC England committee pages and guidance for practices
Read more about the work of the GP Committee
Read practical guidance for GP practices
See the latest update on Twitter: @TheBMA / Twitter, @BMA_GP / Twitter @DrFJameel / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
| Read the latest GP bulletin (England) here |
GPC England meeting update
GPC England met last week for the first time in the new session, and the meeting was opened by Dr Farah Jameel, GPC England Chair who welcomed the newly elected speaker, Dr Brian McGregor. Dr Jameel thanked Dr Zoe Greaves, the previous speaker, for her role as speaker over the past year, as well as the new members of GPC England. The Speaker congratulated Dr Samira Anan and Dr Bethan Roberts as the newly elected co-chairs of the Sessional GPs Committee, and Dr Euan Strachan-Orr as the outgoing Chair of the GP Trainees Committee.
Members passed the following resolution proposed by Dr Karthik Bhat and Dr Chandra Kanneganti:
“That this committee rejects the derisory and divisive pay award for 2022/23 announced by the Government, and gives the GPCE Executive team the mandate to immediately escalate discussions with BMA Council with a view to potential collective/industrial action on behalf of all GPs across England.”
Join the GPC England Officer Team
Following a recent decision at GPC England, the GPCE Executive Team (made up of a chair, a deputy and two executive team members) has become the GPC England Officer Team (made up of a chair and three deputies). This brings the leadership structure of GPC England further in line with what is standard practice at the BMA and ensures parity of esteem between the Officer Team. It will not impact the function of the Team.
There is a vacant position on the GPC England Officer Team. Following a recent decision at GPC England, this position shall be elected to ensure democratic accountability.
GPs who are members of the BMA are eligible to stand. The electorate are the voting members of GPC England.
Nominations are now open for this position and candidates should submit their nomination online via the BMA elections portal, accessible here.
To nominate themselves, candidates should submit a 500-word candidate statement. They should complete a conflict of interests form as part of their nomination.
There will also be a virtual husting on Tuesday 9 August which all candidates and the voting members of GPC England will be invited to attend. Candidates will be able to give a 5-minute speech during this husting.
Candidates may nominate themselves at elections.bma.org.uk . Nominations will remain open until 12pm Monday 8 August.
Further information about the role, including a role profile, the required time commitment, and the TCS are available upon request by emailing info.gpc@bma.org.uk.
If you have any questions about the election process, please email elections@bma.org.uk.
DDRB announcement
The recommendation from the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), and subsequent decision from Government published last week, was a 4.5% increase. This falls far below current levels of inflation, which are expected to reach 11% this year. In real terms, this amounts to the wages of overworked staff being cut by more than 6%.
Astonishingly, the increase excludes GP partners in England who are locked into a five-year contract deal agreed pre-pandemic in 2019. Consequently, there will be no funding increase to meet recommended pay awards for other staff. This decision occurred despite the DDRB clearly urging the Government to consider the impact of omitting those on multi-year deals from this year’s announcement, and stressing the “harm that may be caused to recruitment, retention and motivation by not acting”.
At a meeting of the GPCE (GP committee England) last week, members passed a resolution rejecting the pay award and committing BMA representatives to further discussions around next steps, including potential action short of industrial and industrial action itself.
For GPs who have spent the last two years pulling out all the stops to continue caring for their communities – often to the detriment of their own health and wellbeing – only to be left repeatedly unsupported and publicly admonished by Government and policymakers, this announcement only served to demoralise and devalue GPs ever further at a time when they are already feeling down and on the brink.
Without greater understanding and urgent support from Government, significant numbers of practices will fold and many patients will have no access at all to the care that they need. With spiralling costs, record demand and GP and staff workforce shortages across the board, we know practices across the country are already struggling to provide safe care. In what is fast becoming a consistently callous way, the Government has ploughed on regardless, actively choosing a path that compromises patient safety ever further. Doctors across the profession, and colleagues across the NHS, find it unfathomable just how completely out of touch this cabinet is. Given the experiences of those fighting an uphill battle on the ground, the message is being heard loud and clear – enough is enough.
Read my full statement here
Read all BMA statements about the announcement here
Workforce
The Health Foundation report on GP workforce projections was published last week, which shows that there is a GP shortage of at least 4,200 short as things stand, and set to rise steeply over the next decade.
Data has been released today to highlight the workforce and working patters and appointment numbers to help build a picture of the level of strain GP practices in England are under.
These are the headlines:
GP Workforce - June 2022
GP Appointments Booked – June 2022
Read further information related to GP Analysis >
Read the response from Dr Samira Anane, education, training and workforce policy lead
For more information, please contact Jenny Haigh, Senior Policy Advisor, jhaigh@bma.org.uk and Aarti Gokal, Policy Advice and Research Officer, agokal@bma.org.uk
GP patient survey
The GP Patient Survey (GPPS) report has now been published, which found that the proportion of patients having an overall 'good' experience of their GP practice has decreased by over 10 percentage points, dropping from 83% in 2021 to 72% in 2022. This further highlights the strain that general practice is under and the need for urgent action by the government to relieve the pressure on general practice.
Dr Farah Jameel, GP committee chair, said: "It's only right that patients expect and deserve high-quality, timely care whenever they interact with their GP practice, and we share their frustration when this doesn't happen. We too feel dissatisfied after years of under-investment, ever increasing workload, and a Government who has not been listening to us.
The fall in patient satisfaction with making an appointment is a stark reflection of the capacity shortfall that general practice is facing. General practice appointment bookings reached record highs over the winter of 2021, but we still lack enough doctors to safely meet demand. There has been a failure of successive Governments to recruit enough GPs, and crucially retain those we've already got, leading to those staff that remain being forced to plug the gaps in the service."
Read the full BMA statement in response here
Unagreed 2022/23 PCN DES requirements
At a recent GPC England (GPCE) and NHSE/I Operational Group meeting, NHSEI representatives confirmed that where PCNs and ICSs (integrated care systems) cannot agree on safe enhanced access arrangements for the new 2022/23 PCN DES requirements due to insufficient resourcing, GPCE can escalate this to NHSE/I to resolve with local commissioners.
They confirmed that they are committed to working with local and regional commissioners to do everything possible to help find an alternative safe solution. Subcontracting was one of the potential options pinpointed, although GPCE representatives highlighted at the time that that isn’t always a viable option for every locality/region. This was acknowledged as a problem for at least some areas.
NHSE/I representatives also confirmed there is no intention to penalise any PCN, or its constituent practices, that has not been / is not able to agree a safe solution with the ICS.
Subsequently, GPCE is seeking intelligence and examples from LMCs where PCNs and ICSs have not been able to agree so that they can be compiled as a body of evidence emphasising that, as originally outlined by GPCE earlier this year, the imposed additional PCN DES requirements are unworkable. This will then be escalated nationally for appropriate resolution. Please send information to info.lmcqueries@bma.org.uk. BMA staff may need to revert back to the LMC to ensure we have all relevant information and permissions before sharing with the primary care contracting team at NHSE/I.
Flu vaccines
The Department of Health has announced an extension of the cohorts for the 2022/23 flu programme to include 50–64-year-olds. Unlike in previous years, there will not be a central supply to cater for these extra patients, and instead NHSE/I will be looking at ‘local procurement’ routes.
There will be a phased introduction for the additional cohort, with 50–64-year-olds being eligible from October, when there is anticipated to be greater availability of vaccines for this group. Due to manufacturing processes and commissioning arrangements, some vaccines may only be available in limited quantities. Therefore, NHS England has recommended that orders are placed with more than one manufacturer to ensure providers receive sufficient stock.
We are continuing to discuss the practicalities of this with NHSE/I in order to minimise the disruption and additional workload that it may bring for practices
Read the NHSE/I flu vaccine reimbursement letter
Investigation of deaths in the community/Primary Care – Virtual Conference 28 September 2022
Healthcare Conference UK is holding a virtual conference on Investigation of deaths in the community/Primary Care providing practical guidance for investigating and learning from deaths in the community and primary care including learning from Covid-19, the extension of the Medical Examiner role to cover deaths occurring in the community, and the role of the GP in working with the Medical Examiner to learn from deaths and to identify constructive learning to improve care for patients. You will hear tips and advice for working with and involving families when a death occurs, implementing the new Patient Safety Incident Response Framework: learning from a primary care early adopter, and supporting staff following incidents that result in death. Access the full programme, speaker line-up and book here(a 20% Discount* is available with code hcuk20bmagp)
The Caldicott Guardian & Principles in Primary Care – Virtual Conference 4 November 2022
Healthcare Conference UK is holding a virtual conference on the National Caldicott Guardian in Primary Care. The conference will be chaired and has been produced in association with Christopher Fincken, past Chair and member of, The UK Caldicott Guardian Council, and will include national developments and local case studies in information sharing and the role of the Caldicott Guardian in Primary Care. The conference will bring current and aspiring Caldicott Guardians together to understand current issues and the national context, and to debate and discuss key issues and areas they are facing in practice. Access the full programme, speaker line-up and book here (a 20% Discount* is available with code hcuk20bmagp)
Best Practice Show, 12-13 October 2022, NEC Birmingham
This year the BMA and GPC England will be at Best Practice Show, UK’s number one event for the primary care and general practice community, at the NEC Birmingham on 12-13 October 2022.
Free for healthcare professionals, the conference programme will provide up to 12 hours of CPD certified training, expertly tailored to meet the training requirements of healthcare professionals, with clinical content closely following the GP curriculum spearheaded by the Royal College of General Practitioners.
The BMA and GPC England will have a dedicated theatre at the conference, with a programme focussed on the most pressing issues facing general practice, including the future of general practice, working within ICSs, workload management, workforce management (ARRS roles and multidisciplinary teams), primary care estates, and more.
The conference programme as a whole will address major policy topics impacting general practice, such as around access, health inequalities, digital innovation, and the GP contract. It was also cover range of clinical issues around areas such as cancer, dermatology, diabetes, gastroenterology, neurology, mental health, and cardiovascular disease. This year we’ll also have a renewed focus on women’s health and pain management as well as more content on immunisations.
If you are interested in attending, you can register here.
GPC England committee pages and guidance for practices
Read more about the work of the GP Committee
Read practical guidance for GP practices
See the latest update on Twitter: @TheBMA / Twitter, @BMA_GP / Twitter @DrFJameel / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
| Read the latest GP bulletin (England) here |
Rising covid cases and pressures on health services
The BMA is concerned about the rise in COVID-19 cases and hospitalisations in recent weeks, and the reports that the UK has now recorded 200,000 Covid-related deaths since the start of the pandemic, particularly in the context of the significant and rising pressures on NHS staff and services and the removal of special COVID leave for NHS staff. We have called on the government to reverse this deeply damaging decision (see the Guardian article here) and will continue to press for improved financial and wider support for everyone unable to work due to long Covid. We also support calls by the all-party parliamentary group for coronavirus for a compensation scheme for frontline workers.
The BMA has also called publicly for the UK government to do more to protect the NHS by bringing back mandatory mask-wearing for patients when they are in healthcare settings, ensuring regular testing for staff, and making sure that there is reliable access to appropriate PPE throughout the health service.
In the absence of clear government guidance, we have written to NHS Trusts this week reminding them of their legal duty under Health and Safety laws to undertake appropriate risk assessments and setting out the protective measures that individual Trusts can take to mitigate risks to healthcare staff and patients in healthcare settings. We would encourage LMCs to write a similar letter to ICSs, and we are looking at producing a template letter for LMCs to use.
We have also recently updated our guidance on risk assessments for GP practices emphasising that employers must continue to conduct risk assessments for those who come into contact with COVID-19 and take steps to mitigate risks identified.
We will continue to monitor the COVID-19 data and pressures on health and care services, to ensure we are in a good position to respond to the changing situation.
Alongside our COVID-19 specific activities, we continue to press for appropriate resourcing and staffing of the NHS to support staff and ensure the NHS is able to respond to the increasing pressures – please see our most recent press release here.
The BMA is also undertaking a COVID-19 review to ensure that lessons are learned and members’ voices heard, and the first three reports from this review have now been published.
New Sessional GPs co-chairs
Congratulations to Dr Bethan Roberts and Dr Samira Anane, elected as co-chairs of the BMA Sessional GPs committee, and to Dr Venothan Suri, who has been elected as deputy chair.
Read more about the sessional GPs committee
Rise in GP appointments
Recent ONS data show that UK services output grew in May 2022 with human health and social work activities growing by 2.1%, mainly because of a large rise in GP appointments, with 24 million in April 2022 jumping to 27.6 million in May.
These figures are yet another example of how hard GPs and their teams are working, but also why we desperately need more resource to close the workforce gap in primary care. This is not a sustainable way of working, and GPs desperately need more support if they’re going to be able to carry on providing this level of care. We don’t have enough GPs, and when taking on more work, they open themselves up to more stress, burn out, and exhaustion - potentially having to reduce their hours or leave the profession altogether, creating a viscous cycle of even fewer GPs, and ultimately threatens safe patient care.
Our new Health Secretary has the opportunity to put right the wrongs done to general practice, and the wider NHS, by giving it the appropriate funding and resources it so desperately needs to close the growing workforce gap and safely meet patient demand. All doctors want to do is give the best care they can, but without proper support, this is becoming increasingly hard to do.
Read the full statement by Dr Farah Jameel, chair of GPC England, here
Firearms marker in England
There will be a temporary pause on the digital firearms marker for practices using the EMIS system, effective from the evening of 14 July 2022 (today). The digital marker system on EMIS should be back up and running after a few weeks, and after it has been cleared through the JGPITC (Joint General Practitioners Information Technology Committee). This temporary pause is to address some issues that have been communicated by GPs and practices, and to enable testing of the accuracy and completeness of the flags that are currently popping up. The TPP system will continue to run during this time.
We hope to be in a position to provide an update on the digital marker next week.
Certifying fit notes
There is guidance and training available to support the new rules about who can certify fit notes. Employers and healthcare professionals should read the guidance that provides a summary of the knowledge, skills, and experience that healthcare professionals eligible to sign fit notes are expected to have before undertaking this task. Healthcare professionals eligible to certify fit notes should also complete the e-learning training programme which is freely accessible here.
Introduction of ICSs
As of 1 July, the 42 ICSs (Integrated Care Systems) across England have ‘gone live’ as statutory bodies, taking formal control over the planning, commissioning, and funding of NHS services across their footprints. Visit the BMA’s dedicated webpage to learn more about ICSs and what they mean for GPs and the NHS.
The move to statutory ICSs follows the enactment of the Health and Care Act (2022) and also marks the end of CCGs (Clinical Commissioning groups) which have been dissolved, with their powers, funding, and many of their staff transferring over to local ICSs.
GPC and the BMA continue to lobby ICSs on our core priorities, particularly on the need to enhance representation within ICSs for GPs, including positions on ICS boards for LMCs.
PCN DES opt out window
In light of the expressed will of LMC conference and GPCE motions, after having made clear to practices how they may withdraw from the PCN (primary care network) DES (directed enhanced service) in the last opt out window, a further opt out window was requested. This would have occurred prior to October 2022, the time at which EA (enhanced access) arrangements come into force, and would have allowed practices unable or unwilling to provide these additional hours to withdraw from the DES without endangering their core contracts.
NHSE (NHS England) considered and then declined our request, so there will be no additional opt out until April 2023, which is the standard annual window. The DES will therefore continue as published in year. If you have difficulties with EA or other aspects of the DES that cannot be resolved safely in collaboration with your local commissioner, please escalate to us (info.lmcqueries@bma.org.uk) so we can liaise with NHSE. They have recently emphasised their commitment to ensuring everything is done to support PCNs and commissioners to overcome resourcing hurdles. That said, we would encourage all practices to carefully consider the implications for continuing with the provisions of the PCN DES past April 2023 and will be developing a framework to support practices in their modelling and decision making in advance of this deadline.
Inclisiran
As you may be aware the BMA and RCGP have longstanding concerns regarding the roll out of Inclisiran within primary care. Following on from the publication of our joint position statement in December 2021, we have continued discussions with NHSE/I regarding the roll out of inclisiran, an injectable lipid lowering therapy, within primary care. We’ve now sent a further joint letter to NHSE/I on the topic, laying out our position and re-establishing our core concerns which were highlighted to us by our members. These concerns include the lack of long-term efficacy and effect on cardiovascular outcomes, lack of long-term safety data and the workload implications of managing and prescribing the drug in primary care. The updated position statement can be found on the RCGP website.
Pensions Committee – MP roundtable event and debate
On Wednesday 6 July the BMA Pensions Committee Officers held a MP roundtable event focusing on the impacts of pension taxation on the workforce and proposed solutions were discussed. The session was chaired by Dan Poulter MP, who is also an NHS psychiatrist, and attended by 12 MPs and 4 MP representatives.
The aim of the session was to highlight to MPs that pension taxation is a significant driver for doctors to take early retirement and reduce working, and that there is even more of a major cause for concern this year as a result of rapidly rising inflation. This relates to a discrepancy in the way pensions are revalued/dynamised and a disconnect between different measures of inflation used in the calculations. This affects career averaged revalued earnings pensions schemes and therefore as GPs have effectively always been in such a scheme, it is a much bigger issue for GP pensions than it is for hospital doctors. The Pensions Committee have developed a tool that you can use to model the impact of this “CPI disconnect” for your own personal circumstances. This outlines the issue in more detail and discusses the solutions that we are calling for.
As a next step, Dan Poulter MP has tabled a debate on Wednesday 13 July which will focus on the effect of the Finance Act 2004 on NHS pensions and the recruitment and retention of staff. The Pensions Committee will continue to do everything we can to address this and wider pensions issues, and will keep you updated.
National Standards of Healthcare Cleanliness 2021
We have recently been asked if the National Standards of Healthcare Cleanliness 2021 guidance is mandatory for general practice. We sought clarification on this from CQC last year and it was made clear that it will continue to regulate based on the actual regulations and the official code of practice. Its infection control mythbuster website page addresses this directly.
We also clarified the contractual position at that time, receiving confirmation that it was not a mandatory requirement. There has been no contractual change since then.
Medical Women Podcast
The Medical Women's Federation (MWF) launched a regular podcast earlier this year, to empower and support medical women in their careers. the largest body of women doctors in the UK and the voice of medical women on medical issues.
The season 1 finale features MWF President Elect Professor Scarlett McNally, who is an orthopaedic surgeon, speaking about her career, and she shares what she has learnt over the last few years of being both a doctor and a patient, and exciting things she is working on for the future. Listen to all podcasts here
BMA committee elections
Nominations to the following BMA committees are open:
The deadline for nominations is 12pm Friday 29July. To submit your nomination, please login to the BMA’s election system.
To participate in the election, you must be a BMA member and hold the relevant position for the specified seat. For more information about the committees and the positions available please visit the committee webpages linked above or visit the elections system to access the elections guide.
If you have any queries regarding the election process, please contact elections@bma.org.uk.
GPC England committee pages and guidance for practices
Read more about the work of the GP Committee
Read practical guidance for GP practices
See the latest update on Twitter: @TheBMA / Twitter, @BMA_GP / Twitter @DrFJameel / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
| Read the latest GP bulletin (England) here |
ARM 2022
The BMA’s Annual Representative Meeting (ARM) was held this week. As ever, the ARM has brought meaningful discussion, debate and strong representation on behalf of the medical profession. A motion calling on GPC England and the BMA to organise the withdrawal of GP practices from the PCNs by 2023, was passed. It’s clear from this result that there are ever-growing concerns about how well PCNs are actually working, and whether all practices can provide the safe, quality care they want to for their patients within the constraints of the current NHS-system as organised. GPC England will discuss how to enact this new policy at its next meeting in July.
In addition, other motions of relevance to general practice were debated on GP estates, doctors’ right to switch-off to be able to recuperate, and greater awareness of the prevalence of abuse towards healthcare staff.
Read the reports from the GPCs across the UK, including GPC England, here.
Read about the highlights and resolutions from the ARM here
Read the news stories from the ARM here
New BMA Council Chair
The BMA has elected Professor Philip Banfield as its next UK council chair. Professor Phil Banfield is an obstetrician, educator and academic based in north Wales. He is currently the chair of the BMA Welsh Consultants Committee, is the immediate past chair of the BMA Welsh Council and has been on UK Council since 2012. He lives in Wales, is married to a GP, and has a son who is also a GP.
Professor Banfield will serve a three-year term, providing overall leadership in developing and implementing the policies, objectives, and strategies of the BMA. He takes up his post with immediate effect. Read his statement here
Warning over GPs leaving NHS
In response to the Royal College of GP’s report ‘Fit for the Future’ and its warning that England could lose almost 19,000 GPs over the next five years, Dr Kieran Sharrock, GPC England deputy chair, said:
“This stark warning from the College is one that the Government can ill afford to ignore. The number of fully-qualified GPs is already plummeting, meaning each day more people are losing ‘their family doctor’, and such projections lay bare the potentially devastating impact for both the NHS and patients if politicians and policymakers fail to act.
The RCGP has laid out a number of areas that need urgent attention, many of which the BMA has raised continuously. Ministers must work with the profession and organisations such as the BMA and RCGP to come to workable solutions that protect general practice so that doctors and GP teams have the capacity to provide the standard of care that patients deserve.” Read the full statement
Rebuild General Practice: support the campaign
The Rebuild general practice campaign continues to tackle the crisis facing general practice. The campaign has been building awareness of the key issues in the media, with the public and with politicians. We need your support to amplify the message and make the campaign a success.
Parliamentary event
On 15 June, we hosted a drop-in event attended by 21 MPs to raise awareness of the challenges facing general practice. This was a real opportunity to influence policymakers, and we are pleased that so many MPs were able to join Drs Kieran Sharrock, Katie Bramall-Stainer, Rachel Ward, John Canning and Rob Barnett on the day. You can see coverage and photographs of the event on the Rebuild General Practice Twitter feed
Access to GP Services – House of Commons debate
Last Tuesday there was an opposition day debate in the House of Commons on access to GP Services and NHS Dentistry. During the debate a number of MPs, including Shadow Secretary of State, Wes Streeting raised concerns about demand for GP services outstripping the number of GPs. The BMA and our concerns were raised a number of times by MPs during the debate particularly in relation to GP abuse being a driving factor for those leaving the profession or retiring early, and the need to address sponsorship issues to support international trainee GPs to stay in UK. The wider debate included a range of topics such as pensions, retention, mental health support, wider general practice staff, community pharmacy, workforce planning and funding. Read the debate transcript in full here.
BMA calls for independent review of the GMC referral pathway
Following the GMC’s decision not challenge Dr Arora’s tribunal appeal and call for her one month suspension to be dropped by the High Court, the BMA has repeated its call for independent review of the GMC referral pathway. In response to this, Dr Chaand Nagpaul, chair of BMA council, said:
“The fact that the GMC has effectively overturned Dr Arora’s suspension shows that the current system is structurally disproportionate, with insufficient checks and balances, and is manifestly unjust. While this is the right response, it does not address the systemic flaws in the entire referral pathway to the GMC—ranging from the decision by an employer to refer, through to the decision to investigate, the process of investigation and finally the tribunal hearing.
This is precisely why the BMA is calling for a root and branch independent evaluation of the entire GMC referral pathway. The immediate safeguard of an external scrutiny panel is needed to assess each potential employer referral to ensure that it is fair and objective, and consider whether the issue could be more appropriately dealt with locally and swiftly. Nothing less will secure justice or fairness in medical regulation.” Read the BMA statement here
Fees calculator
A reminder about the BMA’s Fees calculator, which helps doctors decide how much to charge for their services based on their own circumstances. The Fees calculator uses your overheads to calculate a fee range for the time it takes to complete a piece of work. The calculations are specific to you, and you can see what rates you would need to charge to make sure your costs are covered. You can find out more about how the tool can help you save money and save time.
Letter from GP for travel with medication
It has been brought to our attention that some airlines are advising travellers bringing medication in their hand luggage, should bring a letter from their medical practitioner confirming the type of medication and what it is for.
We will raise this issue with the airline, but in the meantime, we would remind practices that patients can print off their medical record from the NHS app, or alternatively, practices are able to
charge for travel-related requests for information.
Fit note update
From 1 July, new legislation comes into force which allows nurses, occupational therapists, pharmacists, and physiotherapists to legally certify fit notes, in addition to doctors. To support this, the government has published guidance to help individuals and employers identify the knowledge, skills and experience required to certify fit notes. A new training package is also available and should be completed before taking up this task - this is freely accessible for all healthcare professionals. There is a rollout period from today where GP IT systems will be updated to reflect the change.
CVD enhanced service specification
NHS England have now published an updated enhanced service specification for the Covid 19 vaccination programme, alongside a covering letter. Practices should note that the programme from September will pay a reduced Item of Service fee of £10.06 per dose. As a result, we strongly recommend that practices review the impact that this funding reduction will have on their ability to undertake the enhanced service. Practices should also be aware that the deadline if they do decide to sign up for the service is 5pm on 14 July.
GP Trainees Committee elections
Please be advised that nominations in a by-election for London North West region for the GP Trainees Committee is open until Friday 8 July. Please submit your nominations here
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Committee of Medical Managers (CMM) elections
Nominations to the Committee of Medical Managers (CMM) are now open and doctors with recognised positions within the management structures of healthcare organisations, and who are BMA members, are eligible to stand for election. The deadline for nominations is 12pm Monday 11 July 2022. To submit your nomination, please login to the BMA’s election system. If you have any queries regarding the election process, please contact elections@bma.org.uk.
BMA Employer Advisory Service
As a membership benefit, the BMA provides an employer advice service for GP partners and your practice managers. With no expensive contracts, you can get tailored advice from the BMA’s specialist team of HR & employment advisersand regulatory knowledge, who can support you with HR & employment law case management, employment tribunal support, and much more. The service is available to BMA members - contact the BMA GP employer advisory service
GPC England committee pages and guidance for practices
Read more about the work of the GP Committee
Read practical guidance for GP practices
See the latest update on Twitter: @TheBMA / Twitter, @BMA_GP / Twitter @DrFJameel / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
| Read the latest GP bulletin (England) here |
Update on NHS Property Services (NHSPS) legal case
Since early 2020, the BMA has been supporting 5 GP practices in legal dispute with NHS Property Services (NHSPS) around inflated service charges. The case has been broken into two phases by the court: phase one to look into the principles of which services NHSPS can charge the practices for, and phase two to look into what the exact amounts of any charges will be. We have now received the judgment on phase one of the trial, and in determining which services practices are liable to pay, the court has decided in favour of NHSPS.
The complex judgment is 170 pages long, and gives some clarity to these practices about what services they are and are not obliged to pay for. The length of the judgment underlines the difficulties caused by the drastic change in approach by NHSPS to service charges that busy practices, working to provide care to patients under the most difficult circumstances, are being forced to navigate.
These proceedings were initially launched because NHSPS appeared to be increasing GP practices’ service charges in reliance on its Consolidated Charging Policy. However, in June 2020 NHSPS conceded that its charging policy did not impliedly vary these practices’ obligations retrospectively, and the recent judgment confirms that in none of the five practices’ cases was NHSPS’ charging policy incorporated into the terms of their tenancy.
GP practices’ service charge obligations can only be determined on a case-by-case basis. The judgment confirms that practices facing demands for fees that they do not understand should take a constructive approach, and seek their own advice to investigate what is and is not recoverable by way of service charges. This has always been our approach and we have consistently advised practices to do their own due diligence.
During these proceedings we have seen NHSPS’ claims for outstanding service charges revised vastly, in one case being reduced by as much as 34% (more than £178,000). This underlines the opacity of NHSPS’ methods for calculating charges. Had the BMA not supported the GP practices in this case to defend NHSPS’ claims for charges they could have overpaid hundreds of thousands of pounds to NHSPS, which NHSPS was unable to substantiate when required to do so.
The case is not over, with the next stage to determine how much these practices may owe, if indeed they received the services to the required standard or even at all. We are discussing our next steps with the legal team, and will provide further updates and guidance as they become available.
Risk assessment for practices
We have revised our guidance on COVID-19 risk assessment for practices, following the updated
NHSE/I national infection prevention and control (IPC) manual for England.
The IPC manual is clear about the need for local risk assessments for staff in contact with COVID-19, which is particularly important now that the requirement for social distancing and mask wearing is no longer obligatory. It is still the employer’s responsibility to ensure safe working for staff, and thus a risk assessment should still be carried out and appropriate mitigations.
People who come to GP practices are more likely to be ill or clinically vulnerable, so it’s vital that practices are able to exercise discretion to protect patients and staff. Especially in the context of rising abuse towards practice staff, people must be assured that if practices are asking them to continue wearing masks this is for the safety of everyone in the building.
The BMA will support practices and doctors who continue to ask patients and staff to wear face masks where they feel this is necessary.
GP abuse
A recent BMJ investigation found that the number of violent incidents at UK general practices recorded by police forces has almost doubled in the past five years.
In response to this, Dr Chaand Nagpaul, BMA council chair, said: “We fundamentally need the Government to be open and honest with the public that the real reason patients don't have the level of service they deserve is due to the fact we have severe shortages of GPs and a lack of capacity to meet record demand. We also need ministers to make clear to the public that there will be zero tolerance to abuse, violence and threats against GPs and their staff, and that swift action will be taken against any offenders.” Read the full BMA response
Download our poster against GP abuse
Rebuild General Practice: 3 ways to show your support
Help us build awareness of the crisis facing general practice. Your support to amplify the message will help make the campaign a success. Here are three ways to get involved.
Hundreds of GPs have already signed an open letter to our patients - showing them that GPs are on their side. To add your signature, simply email hello@rebuildgp.co.uk with your full name.
Follow and share content, news, and updates on the campaign Twitter page
Contact your LMCfor more information and to access campaign materials.
Accelerated access to patient records
We would like to update you on developments with regard to the provision of prospective access to patient records. This new service was due to go live at the end of 2021 but was delayed due to concerns from the profession. The Secretary of State has now confirmed a launch date of 1 November 2022.
The GP Committee’s IT Policy Group has been having weekly calls with NHS England and has participated in several workshops looking at clinical safety issues, redaction and guidance documents. We have worked with system suppliers and with safeguarding leads and we hope mitigations will be in place to address any ongoing safety concerns. We are also awaiting feedback from early adopter sites.
There are several steps that practices need to take between now and the launch date and we will provide guidance on this shortly.
Work is still ongoing and we are making all necessary representations, and continue to highlight the potential concerns of the profession. If you have any questions, you can contact us via info.gpc@bma.org.uk
Monkeypox
Whilst the risk of monkeypox infection remain low, the UK Health Security Agency (UKHSA) is asking people to be alert to any new rashes or lesions on any part of their body.
If you are concerned that a patient may have contracted the disease, use appropriate PPE, including mask and gloves. For confirmed cases of Monkeypox, UKHSA guidance states that FFP3 respirators should be used. Isolate the person whilst seeking advice on next steps from the local sexual health clinic for urgent advice or your local health protection team, and ensure the consultation room is cleaned appropriately afterwards based on UKHPA advice.
Monkeypox is now a designated a notifiable infectious disease under the Health Protection (Notification) Regulations 2010. This means all doctors in England are required to notify their local council or local Health Protection Team (HPT) if they suspect a patient has monkeypox.
We have raised concerns with NHS England that specific guidance for primary care has not been provided in relation to the latest outbreak of Monkeypox.
Further information is available on the UKHSA website.
Initial Health Assessment services in support of new arrivals from Ukraine
In order to support Ukrainian refugees arriving in England, NHSE/I is asking CCGs to commission Initial Health Assessment services in support of new arrivals from Ukraine. Whilst CCGs will be free to determine how best to undertake this, and who from, NHSE have developed an outline specification and a template Local Enhanced Service to support delivery by patients’ own registered GP practice when they register, should practices wish to sign up. Details this can be found on the NHS England website.
The DHSC has also published bilingual versions of the GMS1 registration form:
English / Ukrainian: https://www.gov.uk/government/publications/gms1.uk
English / Russian - https://www.gov.uk/government/publications/gms1.ru
Safe surgeries survey
Doctors of the World wants to hear from general practice staff to find better ways to support staff and patients to ensure that everyone can register with a GP. Part of this work will be used to evaluate the DOTW UK Safe Surgeries Initiative, a BMA-endorsed programme and toolkit that supports GP practices to become more accessible to socially excluded groups. Please complete a 5 minute survey by 20 June 2022.
If you’re interested in participating in a short, please contact Kerrie at k.stevenson@ucl.ac.uk
Fit Notes
From 1 July, new legislation will be enacted which will allow nurses, occupational therapists, pharmacists, and physiotherapists to legally certify fit notes, in addition to doctors who are currently the only profession able to do so.
Non-statutory guidance has been developed to help individuals identify if this task is within their scope of practice as well as a new training module which should be completed before taking up this task. These new products will be available from 1 July. There will be a rollout period from this date where GP IT systems will be updated to reflect the change.
One career, endless opportunities #Choose GP
Applications for 2022 GP specialty training open on 26 July – 16 August 2022. The GP National Recruitment Office has timelines and applicant guidance, or email gprecruitment@hee.nhs.uk to be put in touch with GPs and trainees who can help with local or general enquiries. Please forward this information to any doctors who may be thinking about career options.
LMC England conference 2022
The 2022 England LMC Conference will be a face-to-face conference at Friend's House in London on 24 and 25 November. The first day will be the annual conference, discussing the current issues facing English general practice. The second day will be a special conference to discuss a vision for English general practice, in light of a new contract in 2024.
More information will be circulated nearer the time about registration and motion submission, but it is likely that the deadline for motion submission will be the second week of September.
If you have any thoughts about conference format or how to enable a vision for the future, please email info.lmcconference@bma.org.uk.
BMA annual representative meeting 2022
The BMA’s annual representative s meeting (ARM) will be held on 27-29 June, and is a hybrid event this year, taking place online and in Brighton, with the theme ‘Fighting for our rights, fighting for our future’. Find out more about the event, agenda and elections
GPC ARM elections
We are seeking nominations for 10 seats on GPC UK for a one-session term. At least one seat will have their principal place of work in England, one in Northern Ireland, one in Scotland and one in Wales, and be elected by the RB as a whole. Find out what you can expect as a committee member
To stand in this election, you must be a BMA member and have a BMA online account.
Nominations will close at 10am on Monday, 27 June. Nominate yourself at elections.bma.org.uk
Voting will take place during the ARM on 27–29 June. Voting is open to delegates of the ARM only.
BMA Employer Advisory Service
As a membership benefit, the BMA provides an employer advice service for GP partners and your practice managers. With no expensive contracts, you can get tailored advice from the BMA’s specialist team of HR & employment advisersand regulatory knowledge, who can support you with:
– HR & employment law case management
– reviewing HR documentation and ensuring legal compliance
– employment tribunal support, and much more.
The service is available to BMA members - contact the BMA GP employer advisory service
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @TheBMA / Twitter, @BMA_GP / Twitter @DrFJameel / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Important information on the GP pension scheme – new CPI modeller
The recent soaring rate of inflation will have significant tax implications for some GPs’ pensions. This applies to those who are active members of the scheme contributing at any point of the current 2022/23 tax year, as you could have very large Annual Allowance charges, when such charges become due, depending on your accounting / pensions administration.
The BMA Pensions Committee have launched a new CPI modeller for the GP pension schemefor GPs to look at their pension growth in 2022/23 and 2023/24 tax years, and to explain the problems with poor design of the Annual Allowance and how it will interact with the 1995 / 2015 GP pension scheme, and Annual Allowance taxation. It is important that you urgently take steps to at least understand your position and the potential impact this may have on future Annual Allowance charges. Entering your own data and numbers in the tool will only take a few minutes and will enable you to see how this might affect you personally – for many members they may need to estimate the value of their current pension based on their most recently available pension savings statements, subsequent contribution history and pensionable earnings.
The Pensions Committee continue to lobby Government on this significant issue and encourage members to raise this with their local MPs, and help increase awareness with fellow GPs. Thanks to the Pensions Committee for their hard work on this, particularly the chair Vish Sharma, and the deputy co-chairs, Tony Goldstone and Krishan Aggarwal.
Fuller Stocktake report on the next steps for integrating primary care
Last week, NHSE/I published the ‘Fuller Stocktake report’ on the next steps for integrating primary care in England.
General practice’s strength and value lies in its ability to provide good quality care from within communities, offering continuity and reassurance for patients. It is therefore positive to see this report and the accompanying King’s Fund analysis recognise and champion the invaluable part that practices play in the health of their local areas, and why it is so vital that general practice is given a leading voice and role when it comes to overhauling health systems locally.
Throughout the pandemic, practices seized the opportunity they were given through increased flexibility to quickly adapt for the better under the most difficult circumstances, and it’s particularly positive that this report recognises that this autonomy is far more valuable in improving outcomes for patients than top-down directives and micro-management.
While the report highlights pockets where good collaboration is happening successfully already, we will continue to advocate on behalf of and call for more support for those areas that are struggling.
Read the full BMA statement here
Extending fit note certification
From 1 July, legislation is changing which will allow more healthcare professionals to certify fit notes to patients.
Working conditions of independent contractor GPs
GPC England met last week in our first face-to-face meeting since before the pandemic. In that meeting, the committee debated and passed a motion regarding the working conditions of independent contractor GPs. This motion reaffirms GPC England’s commitment to defending the independent contractor model, whilst highlighting the committee’s concerns about the pressures GP contractors are under, and its recognition of how undervalued they are by the current Government. Representatives also firmly believe the interests of independent contractors, and defence of the model, are also best served by one united committee for all GPs in England.
Commenting on the motion, I said:
“General practice has evolved over many years, changing to meet the needs of communities, but with the independent contractor model sustaining as the core on which it is built. We know that patients appear to benefit from continuity of care, with the quality, strength and consistency of their relationship with their family doctor having a significant impact on their health outcomes. All of this and more is possible through the independent contractor model.
The outcome of this motion reaffirms the committee’s wholehearted support and commitment to this model that allows for high-quality, cost effective and timely care, despite it being poorly valued by policymakers. And it further demonstrates how important it is that the profession stands together with strong representation for all GPs, regardless of career path, at a time when general practice and the whole of the NHS and care system are facing unprecedented challenges.
With the NHS undergoing significant reorganisation, it is vital that a strong, high quality general practice is able to thrive as part of the wider system and meet the needs of patients.”
GP workforce and appointment data
The latest GP data from NHS Digital once again shows a decline in GP numbers. Compared with this time a year ago, England has the equivalent of 396 fewer full-time, fully qualified GPs – having lost a further 26 in the most recent month alone. To this end, 1,622, fully-qualified full-time equivalent GPs have been lost from the workforce since 2015 (when the current collection method began). Meanwhile, the total appointments booked have reduced to 24.0 million in April 2022 from 29.7 million in the previous month – this is potentially due to there being fewer working weekdays in April compared to March.
Read our full analysis about pressures in general practice here and the full BMA press statement
Fees calculator
Doctors have undercharged for private and non-NHS fee-based work for years, effectively subsidising the system and taking the hit on their take-home pay. In response to this issue which was highlighted during ARM last year, we recently launched the Fees calculator and feedback has been extremely positive. Many doctors told us that they rarely reviewed their fees, some looked to their peers to gauge what to charge, and others used guidelines that were years out of date. The Fees calculator helps doctors decide how much to charge for their services based on their own circumstances. Find out more
The Fees calculator uses your overheads to calculate a fee range for the time it takes to complete a piece of work. The calculations are specific to you, and you can see what rates you would need to charge to make sure your costs are covered. You can find out more about how the tool can help you save money and save time.
Rebuild General Practice: support the campaign
The Rebuild general practice campaign continues to tackle the crisis facing general practice. The campaign has been building awareness of the key issues in the media, with the public and with politicians. We need your support to amplify the message and make the campaign a success.
Invite your MP to the parliamentary event
We are hosting a parliamentary drop-in event on Wednesday 15 June. The aim is to engage politicians from all parties, and raise awareness of the challenges facing general practice. This is a real opportunity to influence policymakers, and we are encouraging you to write to your MP and ask them to attend. Write to your MP
Have you signed the ‘Letter to my patients’?
The campaign is asking GPs across the nation to sign an open letter to our patients - showing them that GPs are on their side. Over 250 GPs have already signed. To add your signature, simply email hello@rebuildgp.co.uk with your full name. You can read the letter on the campaign website.
Monkeypox
An increasing number of monkeypox infections are being identified with some spread in the community.
Whilst the risk is currently low, an increase in numbers is expected, and the UK Health Security Agency (UKHSA) is asking people to be alert to any new rashes or lesions on any part of their body.
Although this advice applies to everyone, initial infections are currently mainly in urban areas with a particular focus on gay communities and men having sex with men. Practices should remain vigilant as anyone in close contact with a case, including household contacts, will be at risk.
If you are concerned that a patient may have contracted the disease, use appropriate PPE, including mask and gloves. Isolate the person whilst seeking advice on next steps from the local sexual health clinic for urgent advice or your local health protection team, and ensure the consultation room is cleaned appropriately afterwards based on UKHPA advice.
We have raised concerns with NHS England that specific guidance for primary care has not been provided.
If you have any specific concerns, please get in touch and we can raise these with UKHSA.
Read more, including guidance for healthcare professionals, on the UKHSA website.
Safe surgeries survey
Doctors of the World (DOTW) is working with UCL and the NHS to better understand issues facing underserved groups when accessing GP services. They want to hear from general practice staff (including reception staff, managers, clinical staff) to find better ways to support staff and patients to ensure that everyone can register with a GP. Part of this work will involve evaluating and redesigning the DOTW UK Safe Surgeries Initiative, a BMA-endorsed programme and toolkit that supports GP practices to become more accessible to socially excluded groups.
This project ‘Right to Care’ aims to identify barriers and facilitators to support socially excluded groups such as people experiencing homelessness, people with irregular or insecure immigration status, people who sell sex, and members of the Roma, Gypsy, and Traveller communities who may experience unique challenges to access primary care and to register with a GP.
GP staff perspectives will be highly valued and will help better support the needs of your GP practice and community. Please complete a 5 minute survey by 20 June 2022.
If you’re interested in participating in a short online interview, please contact Kerrie at
NHS Digital survey on the future of GP data sharing
Following discussions last year around the proposed GP Data for Research and Planning programme, and ultimately the indefinite delay to the programme. NHS Digital is now seeking views from the profession to shape their thinking in this area and more broadly in terms of data sharing across general practice. They have produced a 5-minute survey with a view to garnering feedback from all practice staff, so please forward on where appropriate. The survey will close on Friday 10 June 2022.
Primary care wellbeing survey
NHSE/I has commissioned the Institute of Employment Studies to carry out a survey of the wellbeing and resilience levels of staff in primary care. The findings provide valuable insight into the wellbeing of primary care staff and help national and regional teams to respond to the needs of the workforce.
The survey takes 10 minutes to complete, and will close at the end of June. Take the survey here
NHSE/I health and wellbeing support is available on the FutureNHS space. This includes a coaching programme, support for managing patients and promotional resources to share with teams.
Annual health checks to patients aged 14 years or over on the learning disabilities register
Under the LDHC (Learning Disability Health Check Scheme) DES, GP practices are required to offer an annual health check to each patient aged 14 years or over on the learning disabilities register. The requirements are set out in the DES Directions 2022. During the pandemic, NHSE/I advised GP practices that the LDHC could be undertaken with a blend of remote and in person appointments.
However, recent feedback of patient experience gather by NHSE/I has indicated a preference to return to face-to-face checks, so NHSE/I request that GP practices ensure at least part of the check is face to face unless there is a strong clinical and/or patient preference for not doing so. Where the LDHC has already been delivered virtually this financial year, this will still be counted. More information can be found here.
LMC UK conference 2022
The resolutions and election results from the 2022 UK LMC Conference held on 10-11 May have now been published: M10 2009-2010 (bma.org.uk)
BMA annual representative meeting 2022
27–29 June | The ARM is a hybrid event this year, taking place online and in Brighton, with the theme ‘Fighting for our rights, fighting for our future’. See the agenda and find out more
GPC ARM elections
We are seeking nominations for 10 seats on GPC UK for a one-session term. At least one seat will have their principal place of work in England, one in Northern Ireland, one in Scotland and one in Wales, and be elected by the RB as a whole. Find out what you can expect as a committee member
To stand in this election, you must be a BMA member and have a BMA online account.
Nominations will close at 10am on Monday, 27 June. Nominate yourself at elections.bma.org.uk
Voting will take place during the ARM on 27–29 June. Voting is open to delegates of the ARM only.
Read the latest GP bulletin (England) here
GPC England meeting update
GPC England met yesterday 19 May 2022 in their first face-to-face meeting since before the pandemic. Zoe Greaves, GPC England speaker, opened the meeting by welcoming back Farah Jameel, GPC England Chair, from her period of absence and thanked Kieran Sharrock (Deputy Chair), for his leadership and Richard Van Mellaerts (Executive Officer) for his support during this time.
In the morning, the committee received updates from the GPC England chair and Gareth Parry-Jones, BMA Head of Strategic Communications, regarding the ongoing Rebuilding General Practice campaign and the impact that it is having.
A brief presentation was given to help inspire thoughts and discussion on the committee’s future vision of General Practice. To feed in to this ongoing debate, in the afternoon, there were roundtable discussions where members got to share their different perspectives and experiences on behalf of constituents, and discuss ways to ensure GPCE can effectively secure better outcomes for the profession and patients.
The committee also debated and voted on a motion regarding the working conditions of independent contractor GPs. This motion was passed by the committee and reaffirmed GPC England’s commitment to defending the independent contractor model, whilst highlighting the committee’s concerns about the pressures that the model is currently under, and its undervalued nature by the government. The motion also contained a proposal for a separate committee for independent contractor GPs to be established. After a considered and rich debate, this part of the motion was not passed. The committee believed the interests of independent contractors, and defence of the model, were best served through representation by one united committee for all GPs in England.
Commenting on the motion GPC England Chair, Dr Farah Jameel, said:
“General practice has evolved over many years, changing to meet the needs of communities, but with the independent contractor model sustaining as the core on which it is built. We know that patients appear to benefit from continuity of care, with the quality, strength and consistency of their relationship with their family doctor having a significant impact on their health outcomes. All of this and more is possible through the independent contractor model.
The outcome of this motion reaffirms the committee’s wholehearted support and commitment to this model that allows for high-quality, cost effective and timely care, despite it being poorly valued by policymakers. And it further demonstrates how important it is that the profession stands together with strong representation for all GPs, regardless of career path, at a time when general practice and the whole of the NHS and care system are facing unprecedented challenges.
With the NHS undergoing significant reorganisation, it is vital that a strong, high quality general practice is able to thrive as part of the wider system and meet the needs of patients.”
LMC UK conference 2022
The 2022 UK LMC Conference took place last week - the first in-person UK LMC conference since the beginning of the COVID-19 pandemic and it ran very smoothly. The conference was adeptly chaired by Katie Bramall-Stainer and her deputy Matt Mayer. Our thanks go to them, the rest of the conference agenda committee, the GPC secretariat, including Dominic Norcliffe-Brown, Kathryn Reece and Karen Day, Caroline Eason from the BMA conference unit, as well as the numerous other members of BMA staff who provided support during the conference.
The conference was opened by Dr Phil White, chair of GPC UK, who congratulated the profession for all its hard work during the pandemic, including rolling out remote consultations and the vaccination programmes in record times. Dr White admonished the media and Westminster government for their unfounded attacks on general practice, particularly the false claim that GP practices had been closed during the pandemic. Furthermore, he congratulated the BMA and GPDF on the success rollout of the Rebuild GP media campaign, intended to combat these false narratives and promote an urgent workforce strategy and safe workloads for GPs. Read the GPC UK Chair’s speech
Of particular note, the conference voted through a motion calling on the national GPCs renegotiating the GMS contracts to include workload limits in order to protect patients and staff. With a dwindling, overstretched workforce, this motion gives our national committees the mandate to demand an end to endless unsafe demands on our GP services. Read the BMA’s safe working in general practice guidance.
The conference also urged the GPCs to negotiate a GP contract that incentivises continuity of care. In response, Dr Farah Jameel, GPC England Chair, said that “If continuity of care is to be rewarded and preserved, it will need to be measured and monitored and it will need new payment mechanisms. So we’ll need to spend some time thinking about these matters. We must reward continuity of care and it is right that we ask for it. We’ll need courage – from policymakers, from us and from parliamentarians.”
The resolutions will be published shortly on this page: Local medical committees
Rebuild General Practice: support the campaign
The Rebuild general practice campaign continues to tackle the crisis facing general practice. The campaign has been building awareness of the key issues in the media, with the public and with politicians. We need your support to amplify the message and make the campaign a success.
For more information on how to get involved and to access campaign materials, contact your LMC.
You can also follow and share content, news, and updates on the campaign Twitter page
Delayed contractual changes for deceased patient records
NHSE/I have confirmed that the contractual changes for the management of deceased patient records have yet to take effect. This is due to required legislative and system changes remaining outstanding and means that practices should continue printing and sending the full records to PCSE until NHSE/I notifies the profession otherwise. PCSE will also retain the obligation to process AHRA requests it receives directly until that time.
Medical exemption service
As of 12 May 2022 the domestic NHS COVID Pass is no longer available, and the medical exemptions service (119) will no longer accepts new applications from people who want to use the domestic NHS COVID Pass to prove they cannot be vaccinated for medical reasons.
The 119 service will continue running at a minimal level until 11 July, only accepting queries to the call centre and processing outstanding applications via GP assessments into the Summary Care Record application (SCRa). GPs will be required to continue processing applications until 11 July to comply with the amendments to GP regulations. Previously granted exemptions will continue to show throughout in the NHS Covid Pass under “view my records” except where they have expired due to time-limited grounds.
The NHS COVID Pass for international travel will continue to be available as normal. More information about medical exemptions can be found on gov.uk.
Navigating the GP sponsorship process webinar
The BMA has partnered with legal firm Magrath Sheldrick, who oversee our immigration advice service, to develop a webinar on navigating the GP sponsorship process. The webinar is aimed at GP employers and offers practical tips on how to navigate the current sponsorship process to recruit non-UK nationals and addresses frequently asked questions on the process itself. The link to the webinar is enclosed: www.magrath.co.uk/gp-practices-sponsor-licence-process/
If you have any questions, or would like to share your experiences of navigating the sponsorship process, please contact Caroline Strickland, Senior Policy Advisor, International Affairs (cstrickland@bma.org.uk).
More information about certificate of sponsorship is available on the BMA website
GP training needs reform: the status quo isn't working for anyone
A recent BMA survey has shown a shocking level of unacceptable behaviour towards trainees. Read more in this blog by Euan Strachan-Orr, chair of the BMA’s GP Trainees Committee.
Improvements to benefit eligibility at the end of life
On Monday 4 April 2022, eligibility for the Special Rules changed. This means that individuals can make a fast-tracked claim to two working age benefits if they have an estimated 12 months or less to live. To support people accessing these benefits and to find out more about the new process and medical evidence form, DWP have published this guidance.
GPC ARM elections
We are seeking nominations for 10 seats on GPC UK for a one-session term. At least one seat will have their principal place of work in England, one in Northern Ireland, one in Scotland and one in Wales, and be elected by the RB as a whole. Find out what you can expect as a committee member
To stand in this election, you must be a BMA member and have a BMA online account.
Nominations will close at 10am on Monday, 27 June. Nominate yourself at elections.bma.org.uk
Voting will take place during the ARM on 27–29 June. Voting is open to delegates of the ARM only.
Read the latest GP bulletin (England) here
By Dr Kieran Sharrock, Deputy Chair, GPC England
For clarity, I thought it would be useful to add some greater context to the position of GPCE exec around the Network Contract DES (PCN DES). We entered negotiations with NHSE in January 2022 with the intention of securing extra support and resource for practices to recognise the increasing workload and expenses. These requests were ignored by NHSE, and they subsequently published their changes to the contract without our agreement in late March 2022.
When NHSE published details of the contract changes and PCN DES, there were ambiguities that LMCs asked us to clarify after our contract webinars, and we wrote to NHSE outlining our position on these areas. Subsequently, NHSE gave verbal and written advice that LMCs will now be familiar with, removing local flexibilities, and clarifying the indivisibility of all parts of the PCN DES. GPCE communicated these points to practices and LMCs, through the newsletter and further webinars, and have produced several documents for practices to review, outlining the benefits and disadvantages of staying in the PCN DES, and those of leaving the DES.
The opt out window has now closed but our lobbying of NHSEI for greater flexibility and support continues unabated. We also plan for and ask that LMCs to lobby local and regional commissioners for local flexibility to ensure safe patient care within the workforce compliment practices have available to them. We will develop further guidance for practices on how to work within the constraints of the PCN DES in a way that is effective for practices and safe for patients, as further details emerge.
PCNs have until July to agree plans for extended access with their CCG, and GPCE have requested from NHSE/I that another opt-out window be opened so that practices who cannot agree a delivery model with their local commissioner, which is safe for both patients and the limited number of primary care staff we have, can withdraw from the DES.
Read more in our guidance about the contract changes to support practices in their decision making.
Practices should take into account safe working levels from both a workload/staffing and patient perspective, bearing in mind the BMA’s safe working guidance.
GP workforce and appointment data
The latest GP data releases on workforce and appointment bookings (both for March 2022) show that while appointments in England were up by 4 million, GP numbers continued to spiral downwards. Compared with this time a year ago, England has the equivalent of 369 fewer full-time, fully qualified GPs – having lost 30 in the most recent month alone. This means each day there is one less doctor for patients to see. On top of that, we have lost almost 1,600, fully-qualified, full-time equivalent GPs since 2015 (when the current collection method began). Read our analysis about pressures in general practice on our analysis webpage here and the full BMA statement here.
This trend, of demand rocketing while we haemorrhage doctors, is pushing the remaining staff to breaking point as they take on more and more each day, to a point which is not safe for them and certainly not safe for patients.
In addition, the March release of the appointments dataset includes for the first time statistics on: the duration of appointments, SDS role and the recorded national category, service setting and context type of the appointment. Further information can be found here.
As the appointment length metric refers to ‘work planned’ rather than ‘work done’, it will likely under-record the length of an appointment as the way in which appointment length is logged will vary by software system and from practice-to-practice, which means those appointments logged as only a few minutes may not accurately reflect the time taken to see a patient – let alone any follow up done by the GP. NHSD is aware of this issue and we are working with them to improve this metric.
What is your diagnosis for general practice? #RebuildGP
The Rebuild general practice campaign continues to tackle the crisis facing general practice. Last week, GPs from across Great Britain called for government support to recruit and retain doctors in general practice. Watch the film here.
The film was released alongside new data highlighting how workforce and workload pressures are impacting the mental health of GPs. This includes 84% of GPs have felt symptoms of anxiety, stress or depression because of their job in the last year.
There has been considerable interest from both national and regional media outlets, but we need your help to amplify the message and make the campaign a success. Show your support by sharing the video on social media and using the #RebuildGP. You can also follow and share content, news, and updates on the campaign Twitter page
GP abuse
A UK-wide survey by the Medical and Dental Defence Union of Scotland found that three out of four GPs reported facing increased patient abuse during the COVID-19 pandemic.
Although the pandemic has placed almost incomprehensible stress on the NHS, its staff and the general public and has caused pain and distress beyond anything we could have imagine - for doctors to be the brunt of violence and abuse in this way is wholly unacceptable. It is no surprise that GPs feel as undervalued as they do and are considering leaving the profession, as this report and multiple BMA surveys have shown.
This deeply disturbing trend must be addressed. The Government must not only be honest with the public about what general practice can achieve right now - given the chronic workforce shortages, backlog, and lack of resource - but also actually support the profession so that we can provide the kind of care we want to. Read the full BMA statement
General Practice Pay Transparency
We have continued to raise our concerns about earnings declarations for GPs with the Department of Health and Social Care (DHSC), and following confirmation that the implementation of general practice pay transparency would be delayed, amendments to the GP Contract Regulations have now come in to force to remove the requirement to make a self-declaration of 2020/21 NHS earnings by 30 April 2022. Individuals within scope of the pay transparency provisions therefore do not need to take any action, and commissioners should not seek to enforce this contractual requirement.
With GPs continuing to face such intense pressures, we have been clear that this policy was likely to be counter-productive. Although we are pleased that these plans are being delayed, we are disappointed that these amendments were ‘made with the expectation that this policy will resume at a later date’, and we will lobby for this requirement to declare earnings to continue to remain suspended for 2022/23 as well. Read our guidance on GP earnings.
Health and Care Bill becoming an Act
The Health and Care Bill for England has now received Royal Assent, meaning it is now an Act of Parliament. The BMA has said consistently that this is the wrong bill at the wrong time, which completely fails to address the main problems the NHS and our members are facing: too few resources, a crisis in social care and crucially, a huge shortfall of staff.
While we have seen some concessions from the Government – responding to our calls for greater protection from private providers influencing commissioning decisions via membership of NHS decision-making bodies, and safeguards to help prevent undue political interference in the running of local health and care services - we are dismayed that ministers have ultimately failed to listen to frontline workers and demonstrate its commitment to safely staff the NHS and care services.
As the Bill now becomes an Act the BMA will continue to campaign for a publicly funded, publicly provided and publicly accountable NHS that gets the investment it needs, is properly staffed and protects the health and wellbeing of its workers so they are able to provide the high quality and timely care that patients deserve.
You can find out more about the changes, what they mean for you and our work on the Bill here.
GPFR pilot
A new pilot is starting in May to trial a replacement to the existing GPFR (General Practice Factual Reports – also known as DS1500 or the PIP form), which GPs are asked to complete to support patients’ claims for Personal Independence Payment. The new form is designed to be quicker and easier for GPs to complete, whilst still capturing the information needed. The trial will run for six months and DWP hope that GPs will engage with it and provide any helpful feedback and comments they may have on the new form. During the pilot GPs may sometimes receive the existing GPFR and may sometimes receive the version being trialled.
LMC UK conference 2022
The Agenda for the 2022 UK LMC Conference, which takes place on 10 and 11 May in York, has now been published: uk-lmc-conference-agenda-22-april-2022-final.pdf (bma.org.uk)
The Conference will be webcast live - for more information see here: Local medical committees
Please send any queries to info.lmcconference@bma.org.uk
GPC ARM elections
We are seeking nominations for 10 seats on GPC UK for a one-session term. At least one seat will have their principal place of work in England, one in Northern Ireland, one in Scotland and one in Wales, and be elected by the RB as a whole. Find out what you can expect as a committee member
To stand in this election, you must be a BMA member and have a BMA online account.
Nominations will close at 10am on Monday, 27 June. Nominate yourself at elections.bma.org.uk
Voting will take place during the ARM on 27–29 June. Voting is open to delegates of the ARM only.
Read the latest GP bulletin (England) here
Read the latest sessional GPs Newsletter here
PCN DES
The updated PCN DES specification was published at the start of this month. Whilst GPC England continues to support the principle of the DES – independently contracted practices collaborating, alongside other local NHS providers, to provide services which are designed to support local communities – and given the realities of the unagreed contract changes brought in by NHSE/I for 2022/23, practices should be aware of their options relating to the DES.
We believe that the newly added demands within the PCN DES are a risk to patient and practice staff safety in terms of potentially unmanageable/unsafe workload and burnout. Worryingly, the recent GP Worklife Survey confirmed that GPs are overworking, with around 33% likely to quit direct patient care within the next five years. This rises to over 60% for GPs over 50, which is a worrying statistic given over 44% of the GP workforce is over 45.
Following the conclusion of the 2022/23 contract negotiations and the release of the DES specification, we sought further clarification from NHSE/I and proposed practical solutions that we felt would alleviate the concerns of the profession and any potentially negative impact from the unagreed changes. None of them were accepted.
With this in mind, practices will need to carefully consider the DES changes for 2022/23 and how this may impact them going forward. In particular, the incoming Enhanced Access requirements from October 2022 and the expanded service offer.
PCN DES opt out window
Practices who do not wish to continue participating in the PCN DES have until 30April 2022 as part of the current annual opt-out window, with additional 30-day windows following any in-year changes to the enhanced service specification. Practices must inform the local commissioner if this is their decision before the stated deadline. It’s important to note that opting out during a specified window is not a breach of contract.
Practices should take into account safe working levels from both a workload/staffing and patient perspective, bearing in mind the BMA’s safe working guidance.
Read more in our guidance about the contract changes to support practices in their decision making and next steps.
GP workforce data
The number of GPs in England has fallen every year since the Government first pledged to increase the family doctor workforce by 5,000, the health minister Maria Caulfield disclosed in a parliamentary answer. There were 29,364 full-time-equivalent GPs in post in September 2015, when the then health secretary, Jeremy Hunt, first promised to increase the total by 5,000 by 2020, however, it has now fallen to 27,920 as shown by the latest GP workforce data from NHS Digital.
These figures show that the lack of doctors in general practice is going from bad to worse for both GPs and patients, and patients are paying the price in the form of long waits for an appointment. Dr Kieran Sharrock, GPCE deputy chair, said:
“Despite repeated pledges from government to boost the workforce by thousands, it’s going completely the wrong way. As numbers fall, remaining GPs are forced to stretch themselves even more thinly, and this of course impacts access for patients and the safety of care provided.”
It’s time to rebuild general practice: support the campaign
The Rebuild general practice campaign continues to tackle the crisis facing general practice. The aim is to support GPs and their teams at an extremely challenging time to deliver the service that patients and staff deserve. Over the coming weeks, the campaign will build awareness of the key issues in the media, with the public and with politicians.
The campaign is calling for:
We need your support to make the campaign a success. For more information on how to get involved and to access campaign materials, contact your LMC.
You can also follow and share content, news, and updates on the campaign
Join our campaign for fair pay
Over the last two years doctors have worked tirelessly, with many putting their lives on the line to keep patients safe during the pandemic. With the NHS facing a backlog that will takes years to clear, in the face of severe staff shortages, these extraordinary pressures are set to continue.
Inflation is soaring and doctors are being driven out of the NHS by punitive pension tax rules. The BMA is now calling on the UK Government to award doctors a minimum pay rise of RPI plus 2% for doctors, including those working in public health services.
The BMA is urging that doctors in England write to their local MP asking for their support for our campaign. Using the BMA’s online tool, you can add your name to a template letter, that will be automatically sent to your local MP.
Infection Prevention Control in healthcare settings
The UKHSA has revised the Infection Prevention Control (IPC) guidance for healthcare workers, and now advises returning to pre-pandemic physical distancing in all healthcare settings, including primary care, and returning to pre-pandemic cleaning protocols outside of COVID-19 areas, with enhanced cleaning only required in areas where patients with suspected or known infection are being managed.
The guidance continues to recommend all healthcare organisations should undertake local risk assessments to ensure safe systems of work in the context of the wider impact of COVID-19 on health services. Practices should assess the risk to patients and staff using this guidance, and make decisions based on the needs and risks of everyone entering their practice building. Practices should also continue to triage patients and cohort people with respiratory illnesses. Read our guidance on risk assessments for practices
The guidance still advises that all patients, visitors and staff should continue to practise good hand and respiratory hygiene, including the continued use of face masks by staff and face masks / coverings by visitors and patients where clinically tolerated.
NHSE/I has published a letter setting out these changes
Read also the BMA’s briefing in response to the Government’s ‘Living with COVID-19’ strategy which sets out the plans for managing COVID-19 going forward.
Download our updated poster about using face coverings in practices.
Arrivals from Ukraine: advice for primary care
The UK government has published guidance Arrivals from Ukraine: advice for primary careto help primary care professionals assess and address the health needs of patients ordinarily resident in Ukraine who have arrived in the UK. Arrivals will usually be under the government visa schemes Ukraine Family Scheme and the Ukraine Sponsorship Scheme (Homes for Ukraine).
The guidance notes that it is important to adopt a trauma-informed approach that offers clear information and choice, supporting individuals to feel in control. Doctors of the World has produced the Safe Surgeries initiative (endorsed by the BMA) to tackle the barriers faced by many migrants in accessing healthcare, with GP registration being the first hurdle that this vulnerable group needs to overcome.
National flu immunisation programme 2022/23
UKHSA has published the annual National flu immunisation programme 2022/23 letter which sets out which groups are eligible for flu vaccination for the 2022/23 flu season.
NHSE/I will be publishing the specifications shortly, and have advised us that suppliers have committed to flexibilityif the reimbursement letter has impacted current orders. Therefore, if practices are having trouble amending orders, they should contact the contact the NHSE/I flu inbox phco.fluops@nhs.net.
LMC UK conference 2022
The Agenda for the 2022 UK LMC Conference, which takes place on 10 and 11 May in York, has now been published and is available here
The Conference will be webcast live - for more information see here: Local medical committees
Please send any queries to info.lmcconference@bma.org.uk
LMC UK Conference elections to GPC UK 2022-23
Please be advised that LMC UK Conference elections are open for seven members to the General Practice Committee (GPC) UK 2022-23. Nominations will close 12pm Tuesday 3 May 2022.
To nominate yourself, click here.
For six seats, any registered medical practitioner whose exclusive or predominant medical commitment is to providing personally or performing NHS primary medical services for at least two sessions a week, whether a member of the conference or not, is eligible for nomination. Please note that nominations need to be made/supported by LMC representatives, and a representative may not make/support more than one nomination
The seventh seat must be filled by an LMC representative who must never have sat on GPC UK and who is also a member of the conference and a registered medical practitioner whose exclusive or predominant medical commitment is to providing personally or performing NHS primary medical services for at least two sessions a week.
Please send any queries regarding the election process to elections@bma.org.uk
GP Trainees Committee - Elections Open
Elections are now open for the GP Trainees Committee for a two term session for seven constituencies. Nominations close at 12pm Thursday 5 May 2022, with the ballot from 12pm on Monday 9 May 2022 to 12pm on Monday 6 June 2022.
In addition, by-elections for a one-session term are also open in East Midlands, and Kent, Surrey & Sussex. Nominations for the by-elections are open until 12pm on Tuesday 3 May 2022, with the ballot from 12pm on Friday 6 May 2022 to 12pm on Friday 20 May 2022.
Full details about the GP Trainees Committee and election eligibility can be found here
Please send any queries regarding the election process to elections@bma.org.uk
LMCs – change of details
To keep our LMC contact information correct and up to date, could you please fill in this form, in particular if there are any changes to LMC personnel, addresses and other contact details. For any questions, please email Karen Day at kday@bma.org.uk
