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
Rebuild general practice campaign
General Practice is in crisis and patient safety is at risk. The BMA, working in partnership with the GPDF, recently launched the Rebuild General Practice campaign to tackle these issues.
The aim of the campaign is to support GPs and their teams, at an extremely challenging time, in delivering the general practice service that patients and staff deserve.
The campaign is calling for:
It is vital that we build as much support for the campaign as possible. You can find more information on the campaign website > and follow the campaign Twitter account >
To launch the campaign, I gave a keynote speech to outline the impact on patients that the workforce crisis is having: Video: Why we need a bigger GP workforce (rebuildgp.co.uk)
Read more about the launch event on the BMA website
For more information on how to get involved and to access campaign materials, contact your LMC
British Social Attitudes Survey
An analysis by the King's Fund and the Nuffield Trust Public of the British Social Attitudes Survey has shown the lowest NHS satisfaction rating in 25 years, and more people (41%) are now dissatisfied with the NHS than satisfied. In response to these findings I said:
“We really understand how difficult it has been for patients and we’re so sorry that they are feeling dissatisfied with general practice. We too feel dissatisfied after years of under-investment, ever increasing bureaucracy and a government who has not been listening to us. We’ve been saying for years that general practice needs investment, we need more GPs and we need more help to see as many patients as possible in a way which meets their needs.
“It's clear that there are patients who would have wanted more face-to-face appointments than we have been able to offer, given the restrictions of the pandemic and the need to keep everyone safe from infection. More face-to-face appointments are now available but we’re still struggling to keep up with demand as we simply don’t have enough doctors to see everyone safely. Now is the time for proper investment in general practice to give patients the best service we can and to ensure that GPs are given all the support they need to rebuild their practices, now and for the future.”
Read the BMA’s response to the survey here
Changes to COVID-19 testing for health and social care staff
The BMA has welcomed that the changes to COVID-19 testing announced last week, advises that healthcare workers should continue to test twice a week, whether or not they have symptoms, and that Ministers have abandoned plans to scrap testing for healthcare workers altogether from 1 April.
Lateral flow tests will continue to be available through the gov.uk portal for NHS staff working in a patient-facing role, who are symptomatic. NHS England is working with UKHSA to determine how routine asymptomatic testing should be stepped down in line with any decrease in prevalence rates.
However, restricting testing to those in patient-facing roles ignores the reality of working life. Staff in patient-facing roles or otherwise, are not segregated, and therefore can easily spread infection between each other. By artificially making this distinction we also risk pushing up staff absence rates which are already impacting on services and patient care.
Read the BMA statement in response here
The Infection Prevention Control (IPC) guidance for healthcare workers remain in place and face masks should continue be worn by staff and patients in health care settings.
Download our updated poster about using face coverings in practices.
GP contract and safe working guidance
General practice is in under increasing pressure, and we have recently published a safe working guide to enable practices to prioritise safe patient care, within the present bounds of the GMS contract. We have now added some videos to our resources directing practices to the safest way to continue deliver patient care.
Following the announcement of the GP contract changes for 2022/23, which came into effect from 1 April, we have now published an explainer video explaining what this will mean for practices.
Read also our guidance about the contract changes to support practices in their decision making and next steps.
All the 2022/23 contractual documentation have now been published on the NHSE/I website
Death certification and cremation forms
The Coronavirus Act 2020, which introduced easements to death certification processes and cremation forms during the pandemic, was repealed on 24 March 2022.
The following provisions are continuing:
The following emergency provisions are changing with the expiry of the Act:
The Cremation Regulations (2008) does not state any time frame in which a doctor has to have attended the deceased before or after death to complete Form 4. If a doctor completes Form 4 without having seen the deceased before or after death, the Medical Referee will make a decision about whether or not a cremation should take place.
Read more on the BMA’s website about these changes.
Gender dysphoria guidance
We have updated our guidance on managing patients with gender dysphoria, to include some advice in relation to Gender Identity Clinics asking GPs to review patients who had already been referred to the GIC, due to long waiting time.
Our guidance also explains the role of GPs managing patients with gender identity problems, including questions relating to patient records, confidentiality, prescribing and monitoring responsibilities.
Alongside the updated guidance, we have also published a statement about the need for NHS England to commission gender identity services in England.
We would also recommend that the guidance is read in conjunction with the BMA guidance on Inclusive care of trans and non-binary patients, which explains first steps and best practice in providing a supportive service to transgender, trans and non-binary patients, including patients who present with gender incongruence and/or dysphoria.
Health and Social Care Bill
Important changes to the Health and Care Bill by the House of Lords were put to MPs last week for their approval. The BMA briefed MPs in advance of the debate, and provided members with tools to contact their constituency MP directly about the importance of upholding measures around accountability for safe staffing and more.
Whilst MPs successfully used a free vote to make telemedicine abortion a permanent service in England, the Government’s majority sabotaged crucial improvements to the Bill on workforce and service configurations – more on this can be read about in our reaction on the night.
On the Bill's return to the House of Lords this week, however, with our support, Peers have pushed back and voted to add the workforce reporting duty back into the Bill in a slightly amended form. We have welcomed this outcome and will be doing all we can to urge MPs not to overturn it again when it is put to them for consideration later in April, including urging members to keep contacting their MP (email or tweet) about the importance of tackling unsafe staffing in legislation.
NHS and Social Care Coronavirus Life Assurance Scheme
We have been informed by NHS Pensions of their decision to wind down the NHS and Social Care Coronavirus Life Assurance Scheme (CLAS), due to the decrease of deaths of NHS and social care staff, and the success of the coronavirus vaccine programme, from the end of 31 March 2022.
There will be a further 12-month window to 31 March 2023 to allow families time to bring forward outstanding claims in respect of deaths which occurred whilst the scheme was open.
Any LMCs or practices who know of a health worker who has sadly died, should direct families affected to this scheme.
Improvements to benefit eligibility at the end of life
From Monday 4 April 2022, eligibility for the Special Rules is changing. These currently apply to people who have 6 months or less to live and will now apply to people who have 12 months or less to live.
From 4 April, two working-age benefits will be impacted by this change. To support people accessing these benefits and to find out more about the new process and medical evidence form, DWP have published this guidance.
DWP change to fit note – from 6 April 2022
On 6 April DWP changed regulations so that fit notes do not require a signature in ink to authorise them. Instead, a new template is being delivered that is authorised by the name of the doctor being included in the form. This means fit notes can be completed, authorised and sent digitally from 6 April. The main points:
Read more about these changes on Gov.uk
LMC UK Conference 2022
The 2022 UK LMC Conference will take place 10 and 11 May and will be held face to face in York at the Barbican Centre. LMCs are reminded to complete the registration form by no later than Friday 8 April 2022. Please note that we would be unable to fulfil registration requests beyond that date.
If you have any queries, please contact us at: info.lmcconference@bma.org.uk
Read the latest GP bulletin (England) here
Rebuild general practice campaign launch
GPs and their teams faced an extremely challenging time during the COVID-19 pandemic. At the same time, general practice in England continues to face a worsening workforce crisis. BMA research published last year showed that the NHS has lost nearly 2,000 full-time equivalent GPs in England since 2015.
In response, working in partnership, the BMA and GPDF have launched the Rebuild General Practicecampaign. To launch the campaign, Dr Kieran Sharrock, GPC England Deputy Chair, gave a keynote speech earlier this week at the King’s Fund, where he was joined by Jeremy Hunt MP, to outline the impact on patients that the workforce crisis is having.
You can read more about the launch event on the BMA website
To coincide with the launch, the campaign released the findings of a survey of GPs in England, Wales, and Scotland, which showed that:
It is vital that we build as much support for the campaign as possible. You can find more information on the campaign website >
You can also follow and share content, news and updates on the campaign Twitter account >
For more information on how to get involved and to access campaign materials, contact your LMC
Future of general practice - Health Select Committee evidence
Dr Kieran Sharrock gave oral evidence on the future of general practice to the Health and Social Care Committee last week, where he told of the ongoing criticism and general negativity about GPs and general practice must end if the NHS wants to retain the doctors we have and recruit more.
He said: "One in five GPs has been the butt of abuse as a result of the recent campaign against general practice. Dialling down the rhetoric against general practice is really important if you want to retain and recruit GPs.
"We have to be honest with the public about what general practice is delivering now, not what it should be delivering - clearly a 10 or 20-year plan is needed for that, including a workforce plan – but at the moment we can't provide the care to the level we want to. We need the Government to support us and say, 'This is what your GP can do at the moment because of the rise in demand, the huge backlog and the loss of staff.'"
Read the BMA press statement and get a snapshot of the session on the BMA’s GP twitter account
Dr Sharrock also met with Shadow Minister for Primary Care and Patient Safety, Feryal Clark MP. This week where he outlined the key aims of the BMA and GPDF’s joint campaign to restore general practice. They discussed the impact of the ever growing workload, and falling numbers of GPs on both the health of doctors and patient safety. In addition, they also discussed how these critical issues could be addressed through better workforce planning, reductions in bureaucracy and increased resources, alongside an honest public facing campaign explaining these pressures and outlining how NHS services and access, have changed following the pandemic.
GP contract changes guidance
Following the announcement of the GP contract changes for 2022/23, which will come into effect from 1 April, we have now published an explainer video explaining what this will mean for practices.
Read also our guidance about the contract changes to support practices in their decision making and next steps.
Safe working guidance
General practice is in under increasing pressure, and we have recently published a safe working guide to enable practices to prioritise safe patient care, within the present bounds of the GMS contract.
We have now added some videos to the resources section directing practices to the safest way to continue deliver patient care, including one on redirecting patients to the safest part of the system.
Correction
We have updated our Safe working guidance to correct some data we had extrapolated from figures in ‘At Your Service (published by the Policy Exchange) to clarify that is 37 patients per day that GPs are seeing on average.
Health foundation report on access to general practice
The Health Foundation and NHSE/I have published an analysis on access to patient preferences when accessing GP services, which suggests that while not suitable for everyone or all conditions, in many cases patients themselves will often prefer and indeed request a remote consultation.
Despite the fact that General Practice continued to provide high quality care throughout the pandemic and in line with national guidance in place to keep patients and staff safe, leading to a rise in remote consultations, this evolution in how we provide care attracted significant criticism.
Going forward it’s crucial that patient choice, clinical need, and staff and practice capacity are at the centre of decisions around how people can interact with their surgery, rather than pressure from politicians or the press. Read the full BMA statement here
GP to patient ratio
Recent NHS Digital data has shown that patient ratios vary widely across England, from 41,000 patients per GP at a practice in Coventry and Warwickshire, to just 96 at a Shropshire, Telford and Wrekin surgery.
This data shows worryingly large disparities in GP to patient ratios across the country and it is wholly unacceptable that patients should have to experience such variations in access to care.
The Government has failed to address the longstanding recruitment and retention issues in general practice and we now have a unsafe situation where fewer GPs are being tasked with the responsibility of caring for significantly more patients.
The Government should therefore provide urgent and substantial support to enable high quality care.
New policy for applications to the Performers Lists
NHSE/I has published a new policy for applications to the Medical Performers List (MPL), which introduces a number of changes including the removal of duplicated checks, introduction of more nuanced support tailored to the specific needs of the performer, and confirmation that performers are able to increase or decrease their scope of work whilst on the MPL.
It is hoped by NHSE/I and the BMA that the new policy will bring positive changes for GPs in England. It is anticipated that it will allow a quicker application process due to the reduced documentary evidence required, and that the majority of applicants will be able to be included on the list with an education and/or clinical support plan and a probationary flag. These applicants will not require consideration by a Performers List Decision Panel. Read more here.
If you have any questionsor feedback on implementation of the new policy please contactinfo.ret@bma.org.uk
MCCD and death certification
Many of our members have been in touch regarding queries around seeing a body, and a recent email about having ‘seen’ or ‘attended’ a body for the issuance of an MCCD.
Please note, to complete an MCCD there is no legal requirement to have “seen” a deceased patient in the 28 days before or after death, however, if a deceased patient has not been seen in the 28 days before or after death, the registrar will automatically refer this to the coroner.’
Infection Prevention Control in healthcare settings
Although the COVID restrictions have been lifted in England, the Infection Prevention Control (IPC) guidance for healthcare workers remain in place and still advises that face masks should continue be worn by staff and patients in health care settings.
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.
Friends and Family Test
The requirement to submit Friends and Family Test (FFT) data was temporarily suspended in March 2020 to allow resources to be freed up for prioritisation during the pandemic.
The requirement that practices report to commissioners about the FFT returns will now be reintroduced into the GP Contract from 1April 2022. To allow practices time to get fully up to speed, practices will only be required to submit data from Q2 in 22/23 onwards and commissioners will be made aware of this.
Practices will need to implement the new FFT guidance, and the key requirements for practices are:
GP and LMC Representation in ICSs
Ensuring a strong voice for General Practice within ICSs (Integrated Care Systems) remains a key priority for GPC and the BMA, particularly as the Health and Care Bill nears the end of its passage through Parliament and the development of ICSs as statutory bodies gathers pace.
The BMA has been campaigning, both independently and as part of a wider coalition, for ICSs to include a strong voice for GPs. This includes specific asks to ensure enhanced representation on ICBs (Integrated Care Boards) – the element of the ICS responsible for NHS funding and commissioning – beyond the single GP representative set out in the Bill, as well as ensuring LMCs have a recognised voice throughout ICSs.
ICBs are also beginning to establish how their GP representatives will be selected and whether additional positions for GPs, or other representative functions such as GP advisory boards, will be established. GPC are monitoring this situation closely, working with Regional Councils and BMA policy teams. Find more information on the BMA’s work on the Health and Care Bill and ICSs.
Emergency GMC registration to end in September
The UK government has announced that the temporary emergency GMC registration they introduced to support the pandemic response, will close on 30 September 2022. The GMC will shortly be in contact with doctors who still hold this type of registration to outline their options and to thank them for holding this type of registration during such a challenging period. The options are likely to include retaining temporary emergency registration until the 30th September deadline, asking the GMC to remove it, or applying to restore their routine registration and licence to practise.
Read more about temporary registration on the GMC website
Flu orders
Following the recent publication of the guidance for the 2022/23 flu programme, we are aware that some practices may have based their orders on last year’s expanded cohorts and be experiencing difficulties in amending them. We have raised this with NHS England who have assured us that they have received commitments from manufacturers to being flexible if the reimbursement letter impacted existing orders. If manufacturers are refusing to be provide this flexibility, practices should contact the NHS England flu inbox (phco.fluops@nhs.net) with the specifics and they will assist.
Fit Notes
In July 2021, the Government outlined plans to deliver fit note improvements including:
We are expecting further detail of these changes from the DWP over the coming weeks to enable awareness of and preparation for them and will update members accordingly.
GPC regional elections
The voting period is open for seats to the GPC in the following regions:
To submit your vote for any of the above seats please visit https://elections.bma.org.uk/
To vote in this election you must have a BMA web account, if you do not have one please click here to create one. Please follow the link to ‘request a temporary non-member account’ and email your temporary membership number to elections@bma.org.uk to get access to vote in this election.
The deadline for voting 12pm on Thursday 7 of April.
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Read more about the GPC and elections here
Sessionals GPs committee regional elections
The Sessional GPs committee is currently seeking regional representatives to join its committee, which has 16 elected members. If elected, candidates will take up their seats on the committee in July 2022 and will serve for three BMA sessions, from 2022-2025. You must be a BMA member to nominate in this election.
To submit your nomination please visit https://elections.bma.org.uk/
The deadline is noon Tuesday 29 March 2022.
If you have any questions about the elections please email elections@bma.org.uk
LMC UK Conference 2022
The 2022 UK LMC Conference will take place 10 and 11 May and will be held face to face in York at the Barbican Centre. LMCs are reminded to complete the registration form by no later than Friday 8 April 2022. Please note that we would be unable to fulfil registration requests beyond that date.
Read more about the conference, how to register and to submit motions on the BMA website
If you have any queries, please contact us at: info.lmcconference@bma.org.uk
Read the latest GP bulletin (England) here
GP contract negotiations and future of general practice
As you will probably be aware, despite negotiations between GPC England and NHS England about amendments to the five year contract deal agreed in 2019, NHS England announced last week that the contract amendments will come into effect from 1 April, without an agreement or endorsement by the BMA.
We are bitterly disappointed with these changes to the GP contract, which fail to help patients and support practices at this critical time.
The negotiations reached a stalemate in mid-February when it became clear that NHS England would not be offering an update that would impact meaningfully on patient care, nor provide the support desperately required for general practice as it faces unprecedented pressures and pandemic recovery, despite GPC England suggesting a number of solutions to address some of these pressures, enabling practices to support patients.
Read the full BMA statement here and our response to misleading comments about our involvement in the contract changes.
GP contract 22/23 – guidance for practices
Read our guidance about the contract changes to support practices in their decision making and next steps.
Safe working in general practice
General practice is in crisis, with increasing patient need and demand, coupled with a shrinking and exhausted workforce, as well as a vast backlog of care following from the COVID-19 pandemic, exerting greater pressure on a system already at breaking point.
As a result of these challenges, GPCE has published a safe working guide to enable practices to prioritise safe patient care, within the present bounds of the GMS contract. Present resource in general practice is finite, though we must continue to deliver high quality, safe care to our patients. As a result of resource decisions by practices, it may be the case that some patients will regrettably wait longer to access GP care for their non-urgent problems, or are directed to another more appropriate provider.
Meeting with Secretary of State and NHS health care reforms
This week Dr Farah Jameel, GPC England Chair, attended a meeting with Sajid Javid MP, Secretary of State for Health and Social Care, alongside BMA Chair of Council, Dr Chaand Nagpaul. The meeting was an opportunity for the Secretary of State to outline the key themes from his ‘Road to Recovery Speech’, which he delivered the following day. The BMA response to that speech can be viewed here.
The meeting was also an opportunity for us to raise the case for general practice. In particular we outlined the continued and growing pressures facing the general practice workforce, and also reflected on the mood of the profession in response to the contract announcement from NHSE/I – outlining what further measures we have been calling for.
Policy Exchange report on the future of general practice
We were pleased to see that the recent Policy Exchange report of future of general practice, supported by the Secretary of State, recognises the importance of what GPs and their teams do for their communities, and understands that there are some deep-seated problems that need to be urgently addressed, and begins to articulate some ways to make general practice services sustainable for the future. The BMA will be providing a more detailed critique of this report in the coming weeks. Read the BMA statement in response.
GPCE executive team changes
On the 28th February, I (Dr Dean Eggitt) announced my resignation from the GPC England executive team and I expect to leave the role on 12 April. The following is an extract of my resignation letter, that I wanted to share with the profession.
“It is with great regret that I submit my resignation as a GPC England executive officer.
I applied for this post with the aim of working on the refresh and reset that Dr Farah Jameel set out on her appointment as Chair, and I was excited to witness the historic democratic election of the first female Chair of GPCE.
I was honoured to have been given the once-in-a-lifetime opportunity to represent our nation as a part of her team.
Sadly, the role is not compatible with my desire to have a normal family life. So, I must resign.
I thank you all for your support. I wish you all good health and happiness.”
In response to the announcement, Dr Farah Jameel, Chair of GPC England, said:
“Dr Eggitt has been a dedicated and enthusiastic member of the Executive and I thank him for his commitment and the ideas he has brought during his tenure. I am sorry to see him go and wish him well for the future. We will, in due course, be setting out the process the BMA will follow to appoint his successor.”
Data on the pressures facing general practice
Pressures on general practice such as workforce shortages are still as severe as ever, and is evident in the latest data from NHS Digital for the GP workforce in January which shows that there is now the equivalent of 1,608 fewer fully qualified full time GPs than in 2015. This is in addition to the average number of patients each GP is responsible for having increased by around 300 since 2015.
The Institute for Government has produced a performance tracker for general practice for 2021, which draws together data from various sources on the state of general practice and the challenges facing it in the context of the pandemic. It also addresses some of the challenges to recovery and provides estimates for projected demand, concluding that the largest concern for general practice is the need to increase staff numbers.
The Health Foundation’s webpage on understanding activity in general practice has more up to date figures and in particular provides detailed explanations of the scope, quality and detail of GP appointments data, to show what appointment data can or can’t tell us.
The BMA’s own webpage on pressures in general practice data analysis includes key figures on workforce and appointments that are updated each month, alongside what the BMA has been calling for, for general practice.
BMA successfully challenges threatening letters from solicitors
A number of solicitors have been threatening doctors with legal action if the doctor does not provide COVID-19 exemption for the solicitor’s clients. The BMA’s Medico Legal Committee (MLC) has written to the Solicitor’s Regulation Authority (SRA), and has been assured that solicitors should not be “writing in offensive, threatening or intimidatory ways. And we also do not expect solicitors to pursue matters which they know have no legal merit.”
If doctors receive intimidating letters, please advise your Medical Defence Organisation (MDO) and share a copy with us at info.gpc@bma.org.uk so that the MLC may pursue further via the SRA.
Furthermore the GPC and the MLC have met with the COVID-19 Exemptions Team at the Department of Health and Social Care (DHSC). We understand that further guidance on COVID-19 exemptions will be published and this will clarify the role of doctors in providing exemption certificates, make it clear what conditions do and do not warrant an exemption, and reiterate that there is no appeal. We have asked for departmental support that any legal action is against the policy, and thus the DHSC, and not the GP/surgery. Both committees hope to see a swift and satisfactory conclusion to this matter.
NHSPS service charges dispute update - trial dates
The BMA is supporting five test claimant GP practices who have received demands from NHS Property Services (NHSPS) to pay inflated service charges based on its “full cost recovery” approach, outlined in NHSPS’ Consolidated Charging Policy (‘the Policy’). These court proceedings were brought against NHSPS for a declaration that the Policy does not form part of their tenancy and therefore NHSPS cannot base their charges on it.
The trial will begin on 17 March 2022 and will be concluded no later than 5 April 2022.
The Lawyer magazine has selected the caseasone of the top 20 cases to watch in 2022.The case was pursued because of its national significance and has required a huge amount of time and effort from everyone involved, and it is good to see this being recognised. This is a good example of a grassroots issue that is being supported by the BMA at considerable risk and costs. Irrespective of the final outcome this case shows that the BMA is prepared to support doctors in difficult circumstances. Read the statement from our legal team at Capital Law.
Kings Fund report on Additional Roles Reimbursement Scheme (ARRS)
The King’s Fund has published a major report on the ARRS, which focuses on four roles — social prescribing link workers; first contact physiotherapists; paramedics and pharmacists — to examine the issues related to the implementation of these roles, looking at the experiences of working in these roles and of the people managing them.
The report found a lack of shared understanding about the purpose or potential contribution of the roles, combined with an overall ambiguity about what multidisciplinary working would mean for GPs. It also found that successful implementation of the scheme requires extensive cultural, organisational and leadership development skills that are not easily accessible to PCNs.
Guidance for 2022/23 seasonal flu vaccination programme
NHS England has published guidance on the recommended vaccines and eligible cohorts for the 2022/23 seasonal flu vaccination programme.
The guidance highlights that in 2022/23, the NHS flu vaccination programme will only be offered to patient groups eligible in line with pre-pandemic recommendations. This means that 50-64 year olds, and frontline health and social care workers will not be included in the national programme for the coming year. Practices will therefore need to revert to their previous occupational health arrangements for the vaccination of practice staff.
Mandatory vaccinations for healthcare staff to be revoked
The proposed requirement of mandatory vaccinations for health and social care staff, which was supposed to come into force in England on 1 April, will be revoked on 15 March 2022.
If you have been affected by this issue, please contact the BMA’s employment advisers.
LMC UK Conference 2022
The 2022 UK LMC Conference will take place 10 and 11 May and will be held face to face in York at the Barbican Centre. LMCs are reminded to complete the registration form by no later than Friday 8 April 2022. Please note that we would be unable to fulfil registration requests beyond that date.
We aim to publish the final Agenda on the BMA website on 22 April 2022, and it will also be emailed directly to those who have registered and LMCs as soon as it is available.
Read more about the conference, how to register and to submit motions on the BMA websiteIf you have any queries, please contact us at: info.lmcconference@bma.org.uk
Read the latest GP bulletin (England) here
GPC England – information and guidance
Read more about the work of the GPC England
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @DrFJameel / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
From now on our updates will be published fortnightly.
Update on 2022/23 GP contract negotiations
Given the time of year, we are aware that colleagues are wondering about the 22/23 Contract. 2022/23 will be the fourth year of the five-year framework for GP contract reform agreed in 2019.
Negotiations are ongoing and remain confidential till they have concluded.
The GPC England executive team have been meeting with NHSE/I frequently since early January 2022 to negotiate changes to the contract that reflect the current day pressures.
There is still no agreement with NHSE/I however negotiations are still ongoing, and we will leave no stone un-turned in trying to find an agreed way forward.
Whilst the details of ongoing negotiations remain confidential for now; the following matters are in the public domain:
It is our intention to meet with Local Medical Committees (LMCs) and GPs over the coming months to seek your views on a model of general practice which is fit for the future, that will enable us to care of our patients safely.
Lifting COVID restrictions and infection control
As of today, 24 February, as part of the Government’s ‘Living with COVID-19’ plan, the COVID restrictions have been lifted in England, including the requirement to isolate after testing positive.
The BMA has voiced concerns that living with COVID doesn't mean ignoring its continued harm to many, and that scrapping all restrictions and allowing the infection to spread in an unmonitored and unfettered manner would be damaging to the health of millions.
We are also concerned that removing the protections in healthcare settings that currently exist, such as mask wearing, would be wrong and we have raised this with NHSE/I, who has confirmed that the Infection Prevention Control (IPC) guidance for healthcare workers will not be changing and still advises that face masks should continue be worn by staff and patients in health care settings.
NHSE/I has published a letter to healthcare providers to update in light of the Living with COVID plan which confirms that there are no changes to IPC measures, and which also advises that healthcare staff who have tested positive for COVID-19, or who have symptoms of, should not attend work until they have had two negative LFD test results taken 24 hours apart, no earlier than day 5 after their initial positive test.
We have requested urgent communications to the public about IPC expectations for public in healthcare settings.
COVID-19 vaccination programme
COVID-19 vaccination for all 5-11 year olds
Following the latest JCVI guidance on vaccinations for all 5-11 year olds, NHSE/I has published guidance on the actions to take to begin administering vaccinations to 5-11 year-olds from the beginning of April.
We also understand that the COVID-19 vaccination enhanced service specification will be extended and is being updated to align with the JCVI guidance as well as the next steps guidance (below), and will be published shortly.
Next steps for vaccination programme
NHSE/I has sent out a letter setting out the next steps of the vaccination programme asking local systems to plan for the April to September period, advising that general practice should focus on delivery of core/routine services to patients, and that it is likely that PCN sites will ‘hibernate’ over that period whilst being prepared to stand back up if there is a surge. Provision of COVID vaccinations over that period will be through mass vaccination sites and pharmacies, although in limited circumstances, where appropriate and agreed with local systems, PCN sites might still be utilised. Read more in the planning parameters document.
The letter also announced that a second booster programme will commence in Autumn 2022, which will be limited to over 75s, care home residents and severely immuno-compromised - it will not include health and care staff. The NHSE/I letter also requests local systems about preference for delivery of the further booster programme from September.
We will continue to engage with NHSE/I on this over the spring and summer.
GP pressures
Dr Farah Jameel, chair of GPC England, has published a letter in the Daily Mail responding to the article 'What really lies behind the national crisis in GPs?'.
Dr Jameel said: "While we understand the frustration of patients who have had difficulty getting appointments, the root cause lies in chronic workforce shortages and a lack of proper investment. Without a workable plan to increase staffing, freeing up the staff we have to care for patients based on clinical need and directing investment to where it's needed most, we will see no relief from the current crisis engulfing the NHS."
Read more about NHS pressures in our NHS under pressure hub, including GP workforce and pressures on our GP analysis page
Check your NHS pension scheme protection
If you have maintained enhanced protection under the 1995 or 2008 sections, be aware this will be lost when you transition to the 2015 scheme on 1 April 2022. Members should consider opting out of the NHS pension if they want to retain the enhanced or fixed protection and do so by 31 March 2022 – it is important that you ensure that PCSE effects this promptly. Read more
NHS Elective Recovery Plan
The BMA’s comprehensive summary and analysis of the new NHS Elective Recovery Plan has now been published. The recovery plan sets out a range of ambitions, policies, and programmes targeted at reducing the elective care backlog in England over the next three years.
GPC England has encouraged NHSE/I to develop a support package so general practices can deliver recovery and deal with the backlog in long-term conditions. Our briefing analyses the key details of the plan – read it here
Patient access to records
GPC England recognises the immense pressure that enabling access to records in such a short timeframe would put on GPs. We secured a delay to the original launch date and continue to work with other stakeholders to seek a resolution to ongoing concerns. As it stands the requisite infrastructure and guidance is not yet in place to enable this to launch in an effective fashion. We have concerns that without this and without an adequate public education campaign, the launch of the programme will likely drive traffic to GPs from patients unable to access aspects of their record or confused about what they find, ultimately creating more harm than good due to increased demands on GPs time.
Fuller stocktake
Professor Claire Fuller has been asked to lead a wide-ranging national stocktake of how primary care can best be supported within the emergent Integrated Care Systems (ICSs) to meet the health needs of people in their local areas. We would encourage LMCs and GP practices to take the opportunity to input into this review. You can do this by adding comments and ideas to the Stocktake Crowdicity page
New to partnership scheme
Following the article in Pulse which revealed that more than 1,300 GPs have benefited from the new to partnership payments, I commented: “The New to Partnership scheme was part of NHSE/I and DHSC's commitment to the partnership model and we are glad that it is being taken up in such numbers. While we think progress has been encouraging, it can do better and we are keen to ensure this scheme encourages GPs to become partners.”
Ordering DWP leaflets
A new contract for Managed Print Services with HH Global Associates Ltd (HHG) started on 21 February 2022, which provides the supply of items to DWP’s external customers / partners, such as the MATB1 maternity certificate, Med 3s and Med 10s for health care professionals. Read more on GOV.UK
LMC Secretaries Conference 2022 – registration deadline 25 February
Information has been sent out to register for the LMC Secretaries Conference 10 March 2022. The event will take place at Friends’ House, on Euston Road opposite Euston Station. An online application form for nominations is available here, with a closing date of 25 February 2022. Please contact the GPC office at info.lmcconference@bma.org.uk with any queries you have about the LMC Secretaries Conference.
LMC UK Conference 2022
The 2022 UK LMC Conference will take place on 10 and 11 May and will be held face to face in York at the Barbican Centre (unless government advice mandates that we cannot, in which case it will be held remotely).
The deadline to submit motions is noon 2 March 2022, via thislink
LMCs are asked to complete the registration form by the following link no later than Friday 8 April 2022 Registration site - UK conference of LMCs 2022 (bma.org.uk). Please note that we would be unable to fulfil registration requests beyond that date.
We aim to publish the final Agenda on the BMA website on 22 April 2022, and it will also be emailed directly to those who have registered and LMCs as soon as it is available.
Read more about the conference, how to register and to submit motions on the BMA website
Key GPC contacts for any queries and information:
General queries: info.lmcconference@bma.org.uk
Karen Day kday@bma.org.uk (Registering reps, conference attendees, motions, general admin)
Kathryn Reece kreece@bma.org.uk (Registering reps, conference attendees, motions, general admin).
GPC regional elections
Nominations are open for seats to the General Practitioners Committee (GPC) in the following regions:
All standard seats are for a three-year term, 2022-25 sessions, subject to governance structure review. You must be a BMA member to stand in this election.
Please note that in previous years there was a requirement that only GPs who paid the voluntary levy could nominate themselves for election. That requirement has now been removed.
To submit your nomination for any of the above seats please visit https://elections.bma.org.uk/
The deadline for all nominations is 12pm Monday 7th March.
If you have any queries regarding the election process, please contact elections@bma.org.uk
Read our comprehensive guide for elected members, which includes a role profile.
Read more about the GPC and elections here
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk
Welsh GP Contract 2021/22
The Welsh Government, NHS Wales and GPC Wales agreed the Welsh GP contract for 2021/2022 in November 2021. Subsequent to the completion of formal negotiations a GMS Contract Implementation Group was established to take forward the agreed outcomes and facilitate their implementation into the GMS contract. This group has now concluded its work and all contractual guidance is available online, this includes the GPC Wales Focus On document.
During this protracted period of negotiations, GPC Wales fought hard to ensure the best deal possible for GPs in Wales. We are pleased that hard-working practice staff are finally able to receive a pay uplift, however, we have stated throughout negotiations that it is inappropriate to link the DDRB’s recommended pay award to wider contractual change. This is a clear point of principle for us as an Association and we are deeply frustrated that the Welsh Government has taken this approach.
Read the latest GP bulletin (England) here
Read the Sessional GPs newsletter here
GPC England – information and guidance
Read more about the work of the GPC England
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @DrFJameel / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
From now on our updates will be published fortnightly.
Calls on Government to begin negotiations for revised fit-for-purpose GP contract
In an extraordinary meeting today, where GPC England discussed the2022-23 proposals from NHS England for this year’s GP contract changes, the committee called on the Government to commence negotiations for the next GP contract, and to provide support for practices in meeting the ongoing demands placed on them in the wake of the pandemic.
During 2018, the BMA negotiated a five-year contract deal for general practice in England, with an agreement reached with NHS England in January 2019. Since then, details on implementation and additional amendments to the agreement have been negotiated annually.
However, as the deal was reached long before the arrival of the COVID-19 pandemic and all the additional and unprecedented challenges it has brought for practices, the committee is calling on the Government to enter negotiations with GPCE for a refreshed, fit-for-purpose contract so that practices can ably take care of patients, and adequately respond to the needs of general practice going forward.
We also called for immediate support for practices in managing the record backlog in the communities, so as to safely care for our patients and laid out our intention to begin plans for a profession-wide consultation on the future of General Practice. Read our statement here
Vaccination as a condition of deployment (VCOD) - what are your responsibilities now?
The Secretary of State for Health, Sajid Javid, announced last week that healthcare workers will not require COVID vaccination as a condition of deployment, which the BMA has welcomed due to the policy’s potentially devastating impact on workforce numbers.
However, there is still as professional responsibility for health and social care staff to be vaccinated. It is also a requirement for employers to ensure that employees are protected from infection. Non-vaccinated people should therefore be identified and their role should be risk assessed to identify whether or not they should be redeployed into a non-patient-facing role.
Each case will be different depending on the level of risk, the potential other mitigations, the reasons for not getting vaccinated, and the practice set-up. Read more in the BMA guidance on risk assessments, in particular the sections ‘After the risk assessment’ and ‘The approach in primary and secondary care’.
The BMA Employers Advisory Service will be able to advise practices as employers on an individual basis.
We recently published guidance for GPs and practices which includes a flowchart for practices dealing with vaccine hesitant staff. Note that this guidance is on hold following the announcement and further guidance will be available once the latest regulations are confirmed.
Infection prevention control and risk assessments
GPC England and the BMA’s Occupational Medicine Committee have now published guidance on risk assessments for practices to advise that employers should carry out risk assessments and provide mitigations to reduce risk of contracting COVID.
This follows our abbreviated guidance for practices on COVID-19 Infection Prevention and Control published in January, which includes a template letter to CCGs requesting support with getting RPE supply.
GP workforce data
The latest GP workforce figures (from December 2021) have now been published. Following extensive lobbying by the BMA, the data once again include full estimates of the GP workforce (NHS Digital initially removed these estimates in August 2021). There have been several methodological changes since the estimates were last included so figures have been revised back to the start of collection in 2015. The data in this release and future releases is therefore not comparable to previous figures.
Data for December shows a decrease of the equivalent of 188 full time fully qualified GPs over the last year since December 2020. We now have the equivalent of 1,516 fewer fully qualified full time GPs than in 2015.
On a headcount basis, over the last year from December 2020 to December 2021 we have lost 454 GP Partners and gained 305 salaried GPs.
It is also worth noting that despite reductions in the fully qualified GP workforce, the average number of patients each GP is responsible for has increased by around 300 – or 15% - since 2015.
Read more about NHS pressures in our NHS under pressure hub, including GP workforce and pressures on our GP analysis page
2019/20 Pensions Annual Allowance Charge Compensation Policy
The application window for 2019/20 Pensions Annual Allowance Charge Compensation Policy applications is coming to an end and any GP with an annual allowance charge for 2019/20 needs to submit their employer sign off to PCSE by 11 February 2022 (albeit late applications will be processed if you have not received your information to submit this, or if your information changes post McCloud).
The Scheme Pays application needs to be in with NHSBSA by the hard deadline of 31 March 2022 (late applications will not be accepted, where you have still have not received your information we advise submitting an application with a nominal amount which can be amended at a later date, again another window will open for this if your AA position changes after McCloud).
Read more about the Pensions Annual Allowance Charge Compensation Policy on the PCSE website.
The BMA’s advice on annual allowance is available here
Read more about the McCloud judgement here
Pension tax seminars
NHSE/I are hosting a number of pension seminars in February for GPs aged 50 and over to address pensions and pension tax. There are 25 places available at each seminar, and slots will be offered on a first come, first served basis – book here
New to Partnership Payment Scheme Evaluation
NHSE/I are evaluating the structure and impact of the New to Partnership Payment Scheme to understand better how it is viewed by GPs, whether it has made a positive impact, either for you as new partners or in recruiting new partners to your practice. If you have received this grant payment and would be willing to share your experience and feedback, please get in touch by emailing england.newtopartnershipenquiries@nhs.net
GPC regional elections
Nominations are open for seats to the General Practitioners Committee (GPC) in the following regions:
All standard seats are for a three-year term, 2022-25 sessions, subject to governance structure review.
You must be a BMA member to stand in this election.
Please note that in previous years there was a requirement that only GPs who paid the voluntary levy could nominate themselves for election. That requirement has now been removed.
To submit your nomination for any of the above seats please visit https://elections.bma.org.uk/
The deadline for all nominations is 12pm Monday 7th March.
If you have any queries regarding the election process, please contact elections@bma.org.uk
Read our comprehensive guide for elected members, which includes a role profile.
Read more about the GPC and elections here
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk
LMC Secretaries Conference 2022 – registering
Information has been sent out to register for the LMC Secretaries Conference 10 March 2022. The event will take place at Friends’ House, on Euston Road opposite Euston Station. An online application form for nominations is available here, with a closing date of 25 February 2022. Please contact the GPC office at info.lmcconference@bma.org.uk with any queries you have about the LMC Secretaries Conference.
GPC England – information and guidance
Read more about the work of the GPC England and practical guidance for GP practices
See the latest update on 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 today, 20 January 2022. Zoe Greaves (GPC England speaker) opened the meeting by welcoming Farah Jameel, in her second meeting as GPC England chair, and introduced the new Executive Team members Kieran Sharrock (Deputy Chair), Dean Eggitt (Executive Officer), and Richard Van Mellaerts (Executive Officer) who were appointed in December 2021.
GPCE heard updates from:
Lena Levy, Head of BMA’s Public Health & Healthcare Delivery team, provided an update on mandatory vaccinations and confirmed BMA wide guidance has been published this week. FAQs for GP practices will also be published shortly.
The Committee also received an introduction from the BMA President Professor Neena Modi who gave an update on the President’s project.
There were also updates on proposed next steps following the results of last year’s indicative ballot on industrial action, work on setting GPCE England’s new strategic priorities and from the BMA Strategic Communications Team on the ongoing national GP Campaign.
The Committee received an oral update from Devina Maru, FMLM National Medical Director’s Clinical Fellow, Medical Woman’s Federation Representative to GPC, on the future of General Practice. Members then divided into breakout groups to discuss how the Committee could contribute to the development of a policy document on the future of general practice.
In the afternoon the Committee debated a motion on proposed changes to the BMA Conflicts of Interest policy.
The Committee then debated the GPC UK review proposal paper following opening remarks from the GPCE chair and a brief introduction from the chair of the review task and finish group, Mark Sanford-Wood. It was noted that all four national GPCs would be discussing this in their January meetings, with the Sessional GPs and GP Trainees committees, who do not have scheduled meetings this month, reviewing the proposals and feeding back electronically. A further debate and vote on the proposals will take place at the next GPC UK meeting on 24th March, with an aim to have the new GPC UK function and remit in place for the 2022/23 session.
Mandatory vaccinations FAQs for GPs and practices
Given the impact the requirement for COVID vaccinations as a condition of employment in the health and social care sector will have for GPs and practices as contractors, providers and employers, we are developing a set of FAQs which will address redeployment, termination and implications for practices, which will include answers to:
This will be published next week and will sit alongside wider BMA guidance published earlier this week. Both sets of guidance should be read in conjunction with each other.
We will add to the guidance as more questions are asked and more information becomes available.
NHSE/I has also released guidance for employers.
Extension of free PPE to the health and care sector
The government has extended the central, free provision of all items of COVID-19 PPE to the health and care sector, including primary care, by up to one year to March 2023 or until the infection prevention and control (IPC) guidance on PPE usage for COVID-19 is either withdrawn or significantly amended.
The recently updated UK Health Security Agency guidance on infection control states that “an FFP3 respirator (or equivalent), must be worn by staff when caring for patients with a suspected or confirmed infection spread by the airborne route (during the infectious period)”.
The Department of Health and Social Care (DHSC) has advised in its response to the consultation on provision of PPE to the health and social care sector, that practices can use the DHSC PPE portal to access PPE free of charge.
NHSE/I has confirmed that this includes FFP3 respirators, and that CCGs have been informed that where risk assessments have shown it to be necessary that fit-testing should also be provided by the CCG.
Face coverings in practice premises
On 19 January the Prime Minister announced that face masks will no longer be mandated, though people are still advised to wear coverings in enclosed or crowded spaces and when meeting strangers.
IPC guidance for health settings has not changed and states "Universal masking with face coverings or surgical masks (Type II or IIR) to prevent the transmission of SARS-CoV-2 and other respiratory infectious agents in health and care settings, as a source control measure, should continue to be applied for all staff, patients, and visitors"
Furthermore, practices should carry out risk assessments of their environments and assess what level of respiratory protective equipment should be worn by different groups in various settings. Health and Safety law makes it your responsibility to protect staff and other patients based upon these risk assessments, thus making mask wearing a legal requirement if your risk assessment suggests masks should be worn.
If challenged by patients not wanting to wear a mask you can advise the about the IPC guidance and your risk assessments and inform the patient that "the law imposes on me the duty to expect you to wear a mask, and on you the duty to wear one in these premises"
Download our poster about using face coverings in practices.
Access all our patient resources for practices on our Support Your Surgery page
Guidance on COVID-19 Infection Prevention and Control for GP practices
Last week we published guidance for GP practices on COVID-19 Infection Prevention and Control, to help practices reduce the risk and pressures on their staff. The guidance also includes a template letter to CCGs requesting support with getting RPE supply.
The BMA Occupational Medicine Committee is also drafting guidance for workplaces to advise that employers should carry out risk assessments and provide mitigations to reduce risk of contracting COVID. This guidance will be published in full shortly.
COVID-19 self-isolation can end after 5 full days following 2 negative LFD tests
From Monday 17 January, people with COVID-19 in England can end their self-isolation after 5 days, as long as they test negative on day 5 and day 6 with LFD tests. The health service is experiencing disruption from widespread absences due to the rapid spread of Omicron but healthcare workers do not want to risk infecting colleagues and patients - many of whom are clinically vulnerable. So they can only return to work safely after a shorter period of isolation and two negative lateral flow tests if they have access to high-grade masks, and many are finding that this is still not the case.
Read the BMA statement
Read the NHSE/I guidance on isolation for NHS staff
COVID-19 vaccinations programme
Vaccinating 12-17 year olds at risk
NHSE/I has published operational guidance following JCVI advice on booster vaccination of eligible 12 - 17 year olds and household contacts of immunosuppressed people. Vaccinations sites can now begin to invite eligible 12-17 year olds for their booster vaccinations.
Extending the post-thaw expiry date of specific batches of Comirnaty® (30 microgram/dose)
After discussions with Pfizer Inc. and the Medicines and Healthcare products Regulatory Agency (MHRA), certain post-thaw expiry dates of unpunctured and undamaged Comirnaty (30mcg/dose) vials in batches detailed in this NHSE/I letter may be extended from 31 days to 45 days.
Updated PGD and National Protocol for Spikevax (Moderna)
An updated PGD and National Protocol for Spikevax (formerly COVID-19 Vaccine Moderna) V05.00 have now been published.
Global vaccine equity
The BMA is a leading voice calling for urgent action to ensure an equitable distribution of vaccines globally. This is not only a moral imperative – as we have seen all too clearly with the emergence of the Omicron variant, failure to achieve high levels of vaccine coverage anywhere puts lives at risk everywhere.
We have twice written to the Prime Minister urging the UK to lead by example and do more to help poorer countries vaccinate their populations and we published a joint statement with other unions and royal colleges in December expressing our deep concern at the ongoing inequity in access to COVID-19 vaccines globally.
We are also supporting the #VaccinatetheWorld campaign launched by a group of grassroots health care professionals, including one of our GP members, Dr David Attwood, and senior leaders as a New Year’s resolution for the UK. The campaign calls on doctors and the public to sign a petition and write a letter to their MPs (template provided). If you have a few moment, please consider supporting this important action.
National Standards of Healthcare Cleanliness 2021
Members and practices have been asking if the implementation of the National Standard of Healthcare Cleanliness is mandatory in Primary Care. NHSEI have confirmed that, while contractors must have regard to NHSEI guidance, it is not a mandatory requirement.
CQC acknowledge in their advice on Infection prevention and control in General Practice that it will continue to regulate in line with its own regulations and the existing Code of Practice.
Medicines Supply Tool
The Department of Health and Social Care and NHSE/I have now launched an online Medicines Supply Tool, which provides up to date information about medicine supply issues. To access the Medicines Supply Tool you will need to register with the SPS (Specialist Pharmacy Service) website.
LMCs – change of details
To keep our LMC contact information correct and up to date, if there are any changes to LMC personnel, addresses and other contact details, please can you email Karen Day with the changes at kday@bma.org.uk
Media
Pressures in general practice
Dr Farah Jameel, Chair of GPC England, appeared on a special ITV Tonight episode 'When can I see my GP?' last week, which examined why patients are struggling to get GP appointments, the impact this is having on the wider NHS and what the solution might be. Dr Farah Jameel said: "It's a perfect storm. People are tired, working long hours, managing a whole variety of complexity and illness and not seeing an end in sight. We don't feel valued and so the workforce is leaving."
Pulse reported that COVID pressures are forcing GPs to provide urgent-only services in two areas and featured a BMA survey which revealed that almost 70% of GPs have seen staff shortages affect patient care. Dr Jameel commented that: “These survey findings highlight the sheer scale of impact that the latest surge in COVID-19 infections has had on practices, the workforce and their very ability to provide patients with the care they need.”
CQC report into ethnic minority-led GP practices’ experiences of CQC regulation
Responding to the publication of the CQC’s research into ethnic minority-led GP practices’ experiences of CQC regulation, Dr Jameel, said: "It is an important piece of work that underlines and recognises not only the poor experiences of, and challenges faced by, ethnic minority GPs during inspection processes, but also wider systemic factors that disproportionately impact this valuable group of doctors and their patients. These are all areas the BMA has been consistently raising for years.” This was reported by in Pulse, GP Online Management in Practice and London News Today.
Read the latest GP bulletin (England) here
See the latest updates on twitter Dr Farah Jameel (@DrFJameel) / Twitter and General Practice (@BMA_GP) / Twitter
Respiratory Protective Equipment, risk assessments, and provision of respirators
Omicron is more transmissible than previous variants of COVID-19 which increase the risk of general practice workforce contacting the disease. To reduce this risk BMA Occupational Medicine Committee is drafting guidance for workplaces to advise that employers should carry out risk assessments and provide mitigations to reduce risk of contracting COVID. This guidance will be published in full shortly.
In the meantime an abbreviated guideline has been developed by GPC England for GP practices to use, which includes a template letter to CCGs requesting support with getting RPE supply.
We continue to call for GPs to either have access to or reimbursement of associated costs of appropriate RPE and have urged NHSE/I to provide FFP2 masks as a default for all practices, and for availability for FFP3 and fit testing where appropriate.
Impact of Omicron on service provision and workforce
The BMA carried out a snapshot survey last week, which showed that around two-thirds of doctors responding said that the recent spread of Omicron is causing a dramatic slowdown in the provision of non-urgent medical care, leaving millions of patients in untold suffering as a result.
It also showed that nine in ten said clinical colleagues had to take sick leave or self-isolate within the same period, and that less than half of doctors said they could always access lateral flow tests, which are required to return to work as quickly as possible. This illustrates how the recent surge in Omicron has meant an increase in staff absences due to isolation or active infection, which will have a devastating impact on GPs, their teams and patient care.
Last week the BMA also responded to the Health Select Committee report 'Clearing the backlog caused by the pandemic', urging the Government to listen in order to end the staffing crisis. Dr David Wrigley, BMA deputy council chair, said:
“This wide-ranging and detailed report clearly lays out what a gargantuan challenge the NHS faces. The biggest barrier to tackling the backlog caused by the pandemic is a severe staffing crisis and our calls for improved workforce planning have thankfully been heard. It’s now time for the Government to listen too. Read the BMA statement
BMA survey
Pulse reported on the BMA survey and one in 5 doctors now self isolating
Requirement for COVID-19 vaccination as a condition of employment
In November, the Department of Health and Social Care announced the requirement for COVID vaccinations as a condition of employment in the health and social care sector. Health and social care workers who have face-to-face contact with patients, will need to provide evidence they have been fully vaccinated against COVID-19 in order to be deployed unless they are exempt. Unvaccinated individuals will need to have had their first dose by 3 February, in order to have had their second dose by the 1 April 2022 deadline.
This will have implications for general practice above those felt in other branches of practice. General practices are both contractor and provider which complicates the issue. Practices typically do not have the physical space to separate unvaccinated workforce into non-clinical areas.
NHSE/I has published guidance to support providers in preparing and planning for when the regulations (which are still subject to parliamentary passage) are introduced. Note that this is not a NHSE/I-led commissioning requirement but a legal one related to CQC registration and the regulations.
Practices are already straining with workforce shortages and enforcing this is going to an added burden. Practices will need to identify who has not received the vaccination and have discussions regarding their ongoing role. NHSE/I guidance advises, “as independent employers, primary care providers may wish to seek individual legal advice.”
We are developing a set of FAQs which will address redeployment, termination and implications for practices, including answers to:
We are hoping to release the guidance before the end of the month, but much of it will depend on the wording of the legislation itself, which we have not yet seen. We will add to the guidance as more questions are asked and more information becomes available.
The Royal College of Nursing has also produced a COVID-19 workplace risk assessment toolkit which may also be helpful.
Confirmatory PCR tests temporarily suspended for positive lateral flow test results
Following the announcement by the Health Security Agency last week that asymptomatic people who receive positive lateral flow device test results for COVID-19 now won’t be required to take a confirmatory PCR test, NHSE/I has published guidance on the implications for the NHS and advice for practices for actions to take:
Note that anyone who develops one of the three main COVID-19 symptoms are still required to take a PCR test, and self-isolate if they get a positive test result.
Read our simple flowchart about whether staff need to self isolate
Capacity constraints in general practice
We continue to raise our concerns about capacity constraints impacting patient safety in the community, and have written to NHSE/I formally to highlight our concerns about this, awaiting their response. We are particularly anxious about the wider impact on patients being discharged early into the community, without adequate support across general practice and community care teams.
We would urge practices and LMCs to progress conversations with local commissioners and plan together the necessary support that will need to be made available to meet patients’ needs. To enable this, we published a template letter to request clarity on plans for RPE, CMDUs, and RCASs.
COVID-19 vaccination programme
A Patient Group Direction (PGD) and national protocol have now been published for Comirnaty30micrograms/dose COVID-19 mRNA vaccine V06.00
Guidance on assessment of COVID-19 patients in General Practice
With high numbers of symptomatic COVID patients, NHSE/I has now released some guidance on assessment, monitoring and treatment of symptomatic patients in General Practice and 111. The guidance seeks to explain the COVID Oximetry @home pathway, Covid Virtual Wards and Hospital @ Home in more detail.
NHSE/I has also published guidance on Supporting patients and bed capacity through virtual wards and COVID Oximetry @home and we continue to contribute to national discussions where possible.
2022/23 priorities and operational planning guidance
NHSE/I has also published guidance on priorities and operational planning for 2022/23, based on a scenario where COVID-19 returns to a low level and the NHS make significant progress in restoring services and reducing the COVID backlogs in the first part of the year. The guidance includes future funding arrangements.
GP contracts and variation notices
The model contracts and contract variation notices have now been published, including the general practice pay transparency obligations. But as previous communicated, the Secretary of State for Health and Social Care has confirmed the implementation of general practice pay transparency will be delayed until at least Spring 2022. Read our guidance on declaring earnings
Medicines Supply Tool
The Department of Health and Social Care and NHSE/I have now launched an online Medicines Supply Tool, which provides up to date information about medicine supply issues. To access the Medicines Supply Tool you will need to register with the SPS (Specialist Pharmacy Service) website.
GP practice sponsorship process
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. Access the webinar
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).
LMCs – change of details
To keep our LMC contact information correct and up to date, if there are any changes to LMC personnel, addresses and other contact details, please can you email Karen Day with the changes at kday@bma.org.uk
Media
Workforce
The BMA featured in the BMJ on Friday warning that the Government's manifesto pledge to boost NHS staffing numbers is set to be broken. There were 35 991 full time equivalent (FTE) GPs working in England (from a head count of 45 303 doctors) at the end of November last year, NHS Digital reported. This represented a drop of 127 doctors from the FTE number at the end of October 2021 and a fall of 153 from a head count of 45 456.
I was quoted saying: "Since September 2015, when the government first pledged to recruit an additional 5000 GPs, England has lost the equivalent of more than 1750 full time, fully qualified family doctors, with more than 300 being lost in the last year alone. This means the remaining GPs are now on average caring for 2222 patients: this is around 300 more than they were in 2015 and is significantly more than GPs in similar countries. For years GPs have been stretching themselves more thinly as the workforce crisis deepens. In November, practices in England booked a record 34.6 million appointments. Doing more with fewer staff is not safe and not sustainable."
Read the latest GP bulletin (England) here
Read the latest NI GP bulletin (23 December) here
Read the latest GPC Wales bulletin (1 December) here
See the latest updates on twitter Dr Farah Jameel (@DrFJameel) / Twitter and General Practice (@BMA_GP) / Twitter
