Next steps for general practice in 2022
As we begin the New Year, with Omicron case rates continuing to rise alongside in extremis planning announcements of mini-Nightingales being erected in Hospital car parks, compounded by reports of testing capacity being compromised, many will be following the news and wondering, what does this mean for general practice? Or for that matter, whether anyone seems to understand the pressures we are facing.
Communication from the Department of Health and Social Care (DHSC) and its various bodies can be sparse, and unclear, so we would like to highlight some important immediate next steps that related to you and will need urgent local conversations. Many of you may already be deeply immersed in these local planning discussions.
Building on the updated joint BMA RCGP workload prioritisation guidance document published just before Christmas, practices should continue to prioritise care needs based on the local position you find yourself in. You are the clinicians dealing with the daily challenges. Please feel empowered to lead from the front and to not await formal guidance.
As the country becomes engulfed in a wave of Omicron infections, emphasis is likely to shift away from boosting, however the vaccination program will continue to expand. It is likely that General Practice will at least in the short term continue to play a pivotal role in supporting the vaccination effort, especially with our high risk and vulnerable patients, but there also needs to be long term strategy and planning in this respect. Alongside this priority, we are also expected to shift our focus to keeping the sickest and most vulnerable people safe. This will mean rapid access to COVID medicines for the highest risk, an emphasis on home monitoring and modifying our approach to changing care needs and priorities as they emerge.
It won’t have gone unnoticed that, the Prime Minister in his speech earlier this week talked about the rising hospital admissions when he talked about pressure in the NHS leaving us in General Practice as the forgotten soldier yet again. This was then further compounded by the Labour leader Sir Keir Starmer, saying “good luck to anyone trying to get a quick GP appointment”.
With over a million consultations a day, circa 7 million prescriptions a week in addition to everything else that we do, if General Practice was to fall over, a rough estimate tells us that at the very least 14 million patients would lose access to care in just one week. This is the impact that will ripple across the health care system and the sheer scale of care that you in General Practice provide.
I know that it is incredibly difficult out there right now, thank you again for all that you do.
Protecting yourself
We all know that we cannot provide care to our patients if we are ill.
Given that Omicron is readily transmissible in air and there is now enough evidence that there is community circulation - with the ONS estimating that one in 15 people in England had COVID-19 in the most recent week, we must take a more precautionary approach. And in the absence of readily available fit testing, there is a growing consensus that we should use non fit tested FFP2/3 masks as a default when seeing patients. A well-fitting FFP2/3 with a decent seal will provide better protection than a FRSM.
We continue to call for GPs to either have access to or reimbursement of associated costs of appropriate RPE, consequently I wrote to NHSE/I last week urging for provision of FFP2 masks as a default for all practices.
As a reminder, DHSC has advised that if a local risk assessment has been undertaken and primary care providers have been assessed as needing FFP3, the DHSC’s PPE portal should be contacted and they will arrange access to FFP3s. Staff will need to be fit tested.
Read the national COVID-19 IPC (infection prevention and control) guidance which has been updated in light of the rapid spread of the Omicron variant.
A useful thread explaining masks in more detail can be accessed here.
Please note this HSE report, which states: “Live viruses could be detected in the air behind all surgical masks tested. By contrast, properly fitted respirators could provide at least a 100-fold reduction.”
Reporting COVID-19 outbreaks and staffing pressures in General Practice
Whilst we do not have real time data from GP practices I know staffing has been really challenging for quite a while now and the recent surge in Omicron has meant staff absences have rocketed due to isolation or active infection. In reality this will have a devastating impact on GPs, their teams and patient care.
Please report any COVID-19 outbreaks to your commissioner if you feel that services may be compromised by staff absence due to the outbreak, as they have a duty to provide timely support to their contractors and should be working with you to put business continuity arrangements in place. The commissioner must inform the Regional Incident Coordination Centre without delay, and the Regional Team must notify the National Incident Coordination Centre. It is important that General Practice receives the attention and support it is due.
Please contact your LMC and keep us informed where practices are being treated unfairly or being put under any pressure via info.gpc@bma.org.uk
Self-isolation and access to PCR and lateral flow tests
The self-isolation advice for people with COVID-19 has changed, and it is now possible to end self-isolation after 7 days, following 2 negative lateral flow test (LFT) taken 24 hours apart.
The same advice also applies to Health Care Professionals, however, we continue to hear reports of lack of access to PCR and lateral flow tests, which is likely to be due to the rapid spread of the Omicron variant. It is crucial that the promised new supply of kits are offered to key workers such as health and social care staff as a priority. The Health Security Agency announced yesterday that from 11 January, people who receive positive lateral flow device test results for COVID-19 will be required to self-isolate immediately but won’t be required to take a confirmatory PCR test. Here is also a helpful link and flowchart that is being kept up-to-date.
Although the UK Health Security Agency has provided a contingency supply of LFTs from its prioritised stock for NHS health or social care staff, they are aware of the current supply issues and will provide additional contingency over the coming days.
For employing organisations to access LFT contingency supply for priority testing, if unable to access testing through other routes, please see the regional contact points in the attached document
Read the BMA statement here
Media
I was quoted in GPonlinesayingthat the government’s failure to secure a steady flow of tests for surgery staff was ‘further depleting’ the workforce, with many staying off work for longer than needed. She added that a lack of appropriate PPE was putting staff at increased risk of infection.
Combined paediatric and adult respiratory clinical assessment services hubs (RCAS)
Due to reduced mixing last winter, it is likely that population immunity to respiratory infections will have waned, and as a result this winter rates of respiratory infections will be higher than usual, with the very young, very old and those with pre-existing long-term conditions at greater risk of severe disease. This could impact on both primary care and hospital admissions, and could be affected by current and future outbreaks of COVID-19; NHSE/I has released guidance on setting up RCAS / COVID Hubs
We have written to NHSE/I asking for clarification of timeframes and support for the establishment of these services. It is unclear how such hubs will be staffed. Additionally, we recommend urgent risk assessments and access to fit testing to ensure appropriate protective equipment is in place. We would urge you to pursue local conversations in this regard.
NHSEI Guidance on assessment of COVID 19 patients in General Practice
With high numbers of symptomatic COVID patients, NHSEI has now released some guidance on assessment, monitoring and treatment of symptomatic patients in General Practice and 111, which you can find here. The guidance seeks to pick up the items below and explains them in more detail.
Pulse Oximetry @ Home, Covid Virtual Wards (CVW) and Hospital at Home
Pulse Oximetry @ Home
The COVID Oximetry @home pathway is a commissioned service and there is good evidence to support this model. The latest version of the National Standard Operating Procedure can be found here. Please engage in or initiate local conversations about what role you need to play regarding this and how you will be supported to deliver this priority.
Virtual Wards and Hospital @ Home
We have written to NHSE/I highlighting our concerns about the lack of capacity and support in the community to provide safe care for patients being discharged early or not being admitted. Please engage in or initiate local conversations regarding these proposals.
NHSE/I has published reference guidance on Supporting patients and bed capacity through virtual wards and COVID Oximetry @home and we are contributing to national discussions where possible.
New COVID-19 treatments
New treatments are available for highest-risk patients infected with COVID. These drugs have been shown to reduce hospitalisation and may reduce death and will be available for the highest risk patients.
Your role in this is to get eligible patients in contact with a covid medicines delivery unit (CMDU) when they are positive for COVID if this has not already been done by another service. Access to medicines could be lifesaving for this cohort of patients and time is of the essence. Read more here
Hospital discharge and support for general practice and community care
Having raised repeatedly our concerns about capacity constraints impacting patient safety in the community, we were disappointed to read the letter issued by NHSE/I on Preparing the NHS for the potential impact of the Omicron variant and other winter pressures. Disappointed because their priority to ‘maximise capacity across acute and community settings, enabling the maximum number of people to be discharged safely and quickly and supporting people in their own homes’ didn’t seem to provide any credible details on how additional capacity in the community was being created to cater for this new activity.
We have since written to NHSE/I formally to highlight our concerns about lacking capacity in the community.
We are particularly anxious about the wider impact on patients being discharged early into the community, given significant capacity constraints in all parts of the system and wholly inadequate support across both general practice and community care teams, to meet the ongoing care and treatment needs of patients.
We would urge you to progress conversations with local commissioners through your LMCs and plan together the necessary support that will need to be made available to meet patients’ needs. It is incredibly important that NHSE/I ensures that provisions designed to support one part of the system do not destabilise another.
We have created a template letter which practices and LMCs can send to their CCGs and NHSE/I locally requesting clarity on plans for RPE, CMDUs, and RCASs.
DHSC’s requirement for vaccination as a condition of employment
Unvaccinated individuals will need to have had their first dose by 3rd February, in order to have had their second dose by the 1 April 2022 deadline. NHSEI have released this guidance.
New Year’s Honours
We are pleased to so see so many GPs recognised in the New Year’s Honours list, including:
· Professor Helen Stokes-Lampard, the immediate past chair of the RCGP and current chair of the Academy of Medical Royal Colleges, and a GP in Staffordshire, was made a Dame.
· GP Professor Gregor Smith, CMO for Scotland, received a knighthood for services to public health.
· Professor Kamlesh Khunti, a GP in Leicester and professor of primary care diabetes and vascular medicine at the University of Leicester, received a CBE for services to health.
· Professor Tony Avery, professor of primary healthcare at the University of Nottingham, was awarded an OBE for services to general practice.
· Dr Grainne Doran, past chair of the RCGP in Northern Ireland and GP in County Down, received an OBE for services to general practice.
· Professor Simon Gregory, GP in Northampton and deputy medical director for primary and integrated care at Health Education England, received an MBE for services to general practice.
· Dr Adaeze Ifezulike, GP in Aberdeen, received an MBE for services to health inequalities in BAME communities in Scotland.
· Dr Iram Sattar, GP in London and trustee of the Muslim Women's Network UK and homeless charity The Passage, received an MBE for services to the health and wellbeing of vulnerable people
· Retired Sheffield GP Dr Amar Rughani, who wrote a book about leadership in primary care in 2020, received an MBE for services to general practice.
Read the latest GP bulletin (England) here: Looking ahead in 2022 | reporting staffing pressures | priority testing (bma-mail.org.uk)
Read my twitter page Dr Farah Jameel (@DrFJameel) / Twitter and General Practice (@BMA_GP) / Twitter
We would encourage LMCs to share this GPC update with GPs and practices.
Season’s greetings from GPC England executive team
2021 has been a year of enormous challenge and yet there is much for General Practice to be proud of. Over the last 12 months you have led the most ambitious vaccination program ever undertaken, delivered record numbers of appointments to patients in need, and been voted the most trusted profession in the world. You have done all of this with 1,139 fewer GPs than last year, substandard premises, closer scrutiny than any other profession, and an inadequate budget. You have done this with heart and soul, many a time putting your own health at risk in the face of extreme unknown adversity through a pandemic, you have done this because you care about people, because patients matter, because your communities matter to you.
For 2021, General Practice has given the nation the gift of life. You have saved lives, prolonged lives, and given quality to lives. You are tireless, ordinary people working in utterly extraordinary ways, and we are proud to be amongst you. But for many of you, this has taken its toll on you, you have questioned whether anyone is listening, whether anyone cares and who will take it upon them to make the day job possible once again.
We are resolute that 2022 will be better, and we know that this will be achieved by cohesive and robust representation, delivering you with the tools that you need to better look after patients. Because without you, there is no general practice, without you, patients will struggle to access care.
This will be our final newsletter of the year and we will write to you again in the new year. Over this festive period, please take time to look after yourself and those who you love. Afterall, there are no greater gifts than time, good health, and happiness. On behalf of the committee, we wish all those celebrating a very Happy Christmas. Thank you for all that you have achieved on behalf of general practice, and will continue to do. You are immensely valued.
GPC England Executive Team:
Farah Jameel (chair)
Dean Eggitt
Kieran Sharrock
Richards Van Mellaerts
NHS pressures and joint workload prioritisation guidance
The emergence of the COVID-19 Omicron variant, with ever increasing demand on healthcare services and rising numbers of staff sicknessrates has the potential to significantly impact the delivery of general practice.
Whilst GPs and their teams will do their best to continue to prioritise the care they offer alongside providing COVID-19 vaccines, patients will be understandably be concerned that some appointments will need to be postponed in order to ramp up the booster campaign.
Produced at the request of NHS England to help practices plan their participation in the booster programme, we at GPC England (GPCE) worked with the RCGP to update our joint workload prioritisation guide, to support clinicians working in general practice across England to prioritise clinical and non-clinical workload, and to support practices in their planning. Read the guidance
This follows the announcement of CQC Suspension last week and temporary changes to Fit notes and Certification to support general practice teams with workload and in supporting the vaccination campaign.
Media
Pulse and GP Online both reported on the Workload prioritisation document.
Infection prevention control guidance
The national COVID-19 infection prevention and control (IPC guidance) has been updated in light of the rapid spread of the Omicron variant.
While the IPC guidance should act as a further shield against harm - in general practice, as it currently stands, more clarity and support are needed to ensure its effectiveness. In particular section 2.1 which now advises: “Where an unacceptable risk of transmission remains, it may be necessary to consider the use of respiratory protective equipment (RPE) in clinical areas where suspected or confirmed COVID-19 patients are being managed.”
Given what we know to date about Omicron’s high rate of transmissibility, we have continued to call for GPs to have access to RPE where needed. We also continue to highlight that many GP premises lack space and necessary ventilation for suspected COVID-19 patients to be seen in an appropriate and safe setting. We have recommended for pathways to be urgently implemented for patients with COVID related symptoms, to be seen in an appropriate and safe setting, such as COVID Hubs.
The Department of Health and Social Care has subsequently confirmed that with regards to primary care access to FFP3, if a local risk assessment has been undertaken and primary care providers have been assessed as needing FFP3, the DHSC’s PPE portal should be contacted with the result of the risk assessment and they will arrange access to FFP3s. Staff would need to be fit tested to FFP3s before the PPE portal can give access to the appropriate masks to which staff have been fitted.
The World Health Organization has earlier today released a statement with recommendations on mask use by health workers providing care to patients with suspected or confirmed COVID-19, in light of the Omicron variant of concern. Chair of Council Dr Chaand Nagpaul is writing on behalf of the profession for access to RPE in all settings. The Government has also produced a poster about using face coverings in healthcare settings
To support doctors through the booster vaccination campaign, the BMA has called for infection control measures to be reintroduced in all healthcare settings, and for the Government to introduce robust infection control measures in the community, especially where people mix in indoor settings. Read the statement by the BMA Chair of Council.
Expression of thanks from the UK CMOs
The UK Chief Medical Officers (CMOs) have published a letter of thanks to the health profession:
“As 2021 draws to a close we mainly wanted to give an enormous thanks to all medical and wider health server staff. We have never been prouder to be members of the medical profession than over the last two grinding years.”
COVID-19 vaccination programme
Amendments to the Enhanced Service Specification for Phase 3
The updated Enhanced Service Specifications for Phase 3 of coronavirus vaccinations have now been published. The amendments include:
We had also suggested that NHSE/I made available a reference guide to summarise which vaccines can be given to which groups, and when patients become eligible for a second, third dose or booster, and NHSE/I has shared this chart (available on FutureNHS), which is updated weekly.
Second dose for 12-15 year olds
As part of the national mission to get people protected against the new Omicron variant, 12-15 year-olds are now eligible for their second COVID-19 vaccinations dose, if they had their first dose more than twelve weeks ago, in line with updated guidance from the JCVI published on 29 November.
Responding to vaccination data queries
The Vaccine Data Resolution Service (VDRS) aims to resolve missing or incorrect vaccination records for people vaccinated in England, Scotland or Wales who have a current NHS number and are registered with a GP practice in England. You can raise data quality issues directly with the VDRS team and you can direct your patients to access the service via 119. More information is available on FutureNHS.
Recording overseas vaccinations in the National Booking Service
Eligible people can now book a face-to-face appointment via the National Booking system at a selected vaccination centre to show evidence of MHRA-approved COVID-19 vaccinations administered abroad and have them recorded in the National Immunisation Management System (NIMS). Support is also provided through 119 to signpost the service, or to make bookings on behalf of users. More information is provided when the user books an appointment.
COVID-19 vaccine has been approved for use by children aged 5 to 11
The Pfizer BioNTech COVID-19 vaccine has been approved for use by children aged 5 to 11 by the Medicines and Healthcare products Regulatory Agency (MHRA), after finding it safe and effective.
Updates to the Network Contract DES
Following the letter of 3 December announcing changes to QOF and IIF and the temporary GP contract changes to support COVID-19 vaccination programme, NHSE/I has now updated the Network Contract DES
PCSE patient list validation requests
Following the issue being drawn to our attention, we asked NHSE/I to pause PCSE emails to practices requesting full patient list validation exercises. NHSE/I agreed to this and have instructed PCSE to stop sending them until the beginning of February, when the decision will be reviewed.
Further to this, we challenged the mention in these PCSE requests of a requirement to respond to the requests within five working days. NHSE/I agreed with us that the contractual requirement is actually 30 days. They will raise this with PCSE but, should the wording remain unchanged when these requests are resumed, we would advise practices that they can actually use the full 30 days.
Application window for 2019/20 Pensions Annual Allowance Charge Compensation Policy
The third GP application window for 2019/20 Pensions Annual Allowance Charge Compensation Policy applications is now open on the PCSE website 2019/20 Pensions Annual Allowance Charge Compensation Policy - Primary Care Support England. It closes on Friday 11 February 2022.
New annual leave guidance for employers of salaried GPs
This newly published guidance produced by the sessional GP committee provides advice to the employers of salaried GPs to ensure that the process for processing and allocating annual leave is fair, transparent and flexible. Read more here
Media
GP online reported on the BMA’s statement last week asking for government support for doctors through the booster campaign and concerns about staff shortages, in response to which I said: “ The reduction of some GP services or even temporary closure of surgeries due to staff sickness from COVID-19 is incredibly worrying and yet another reason why we need to see more measures from government to contain the spread of Omicron now.”
Read the BMA’s GP bulletin here.
Read the latest Sessional GPs newsletter here
Read my twitter page Dr Farah Jameel (@DrFJameel) / Twitter and General Practice (@BMA_GP) / Twitter
And just like that I am now one month into my role as chair of GPC England, how time has flown by in what feels like a flash, so I summarise below some of the key milestones in these past 4 weeks for you:
Week 1: LMC Conference, indicative ballot results
Week 2: Emerging Omicron Threat
Week 3: QOF and IIF suspension to support vaccination programme
Week 4: National Booster Mission, CQC Suspension, and temporary changes to Fit notes and Certification changes.
In my opening speech as chair, I said, it is essential that we work with the Government to begin to rebuild general practice, so that it can be there to care for our patients. And never could there be a truer time where our communities have needed us more. I know that you are all working at incredible pace and that the situation is very tense on the ground:
With a record NHS backlog and a growing volume of unmet acute need that general practice is shoring up;
· Significant shortage of hospital beds,
· More sicker patients being cared for in the community.
· No additional capacity to care for our sickest
· It all feels incredibly fraught and unsafe
These are pressures you are contending with in addition to incoming winter challenges and coming up to now almost two years of a pandemic, amid severe workforce shortages and now a new highly-transmissible variant meaning the roll out of the Booster vaccination is a national priority. I just don’t know what more any member of our team can do or for that matter the NHS, except that we will try to do our very best, we will continue to look after our communities, because that is who we are, we deeply care for our patients. But we must also look after ourselves.
In order to support practices, together with the RCGP, we are in the process of updating our joint workload prioritisation guidance, which will be published shortly.
There is no single ‘one size fits all’ blueprint for how practices should operate, or what measures should be taken to manage workload on a day to day basis. I know that you will be prioritising care in a way that meets your patients’ needs. Throughout the pandemic, following infection control guidelines will mean that you will have adopted relevant strategies and protocols to keep staff and patients safe. These will continue to need to be applied given what we know about rates of infection and route of spread. In the coming days, you and your teams will make difficult decisions about how you continue to provide timely care in a way that adds most clinical value and keeps patients, clinicians and staff as safe as possible from the risk of contracting COVID-19.
After a lot of work by many different departments across government, a number of temporary changes have been made in an attempt to support general practice teams through some of the paper work that we have to complete. These changes are unprecedented and are being taken in recognition of the extraordinary challenge general practice is facing to deliver the accelerated Covid-19 booster campaign.
· Fit notes (increased to 28 day self-certification)
· DVLA checks (suspended for all but essential workers – HGV and bus drivers)
· Firearms licenses (applicants asked to wait until after January to submit, except for urgent – ie needed for work commitments or imminent expiry)
· Prescription charge medical exemptions (suspend renewals, those due to expire will be extended for 6 months)
· COVID vaccine exemptions (timeframe for practice processing will be dropped so done to practice timeline)
I know that together, we will pull through this and we will continue to do our very best to look after our communities, our patients and each other. Here at GPC and the BMA, we will continue to do our best to support you through the coming months.
Thank you for everything that you are doing, through these difficult times.
GPC England executive team and new chair of GPC UK
I am delighted to announce that following a rigorous formal appointments process, I have now appointed Dr Dean Eggitt, Dr Kieran Sharrock and Dr Richard Van Mellaerts as new members of the BMA GPC England executive team, at such a pivotal time for our patients and the profession. In the coming weeks, they will be writing to you through the newsletter and will introduce themselves.
I am also pleased to announce that Dr Philip White, chair of GPC Wales, has been elected as the chair of GPC UK.
I know that with such experienced leaders supporting the work of our committees, I have every confidence that we will continue to represent GPs and their teams, and through them our patients, on the issues that matter most.
And it is now also time to say to goodbye. I want to take one final opportunity to thank the outgoing chair of both GPC England and GPC UK, Dr Richard Vautrey, as well as the outgoing executive team, Dr Mark Sanford-Wood and Dr Krishna Kasaraneni, for their many achievements, years of service and outstanding commitment to general practice, including through this unprecedented time of the pandemic. It has been an incredible opportunity to work alongside you and we together got a phenomenal amount of work done, you secured record levels of investment, a gamechanger indemnity package and a whole new workforce embedded in general practice.
I know that you will continue to be incredible advocates for the profession and your patients and I wish you the very best of luck for the future in all that you will go on to achieve.
Impact of COVID-19 omicron variant and vaccination deployment
The UK Covid Alert Level has now been increased to Level 4 due to a rapid increase in cases of the Omicron variant and the Prime Minister has launched an urgent appeal calling for people to get vaccinated.
NHSE/I has published guidance to prepare for the potential impact of the Omicron variant and other winter pressures, and the next steps for the vaccine deployment to ensure the successful ramp up of the COVID-19 vaccine programme.
Operational guidance was published on Wednesday on actions to take maximise capacity, and general practice teams (not only LVS sites) are asked to:
To support acceleration of the booster programme, the CQC are postponing all on-site inspection activity for the next three weeks with immediate effect - except in cases where there is evidence of risk to life, or the immediate risk of serious harm to people.
In addition, we have successfully lobbied for a temporary suspension of the 15 minute wait for the mRNA vaccine which has now been announced to allow for an increased amount of vaccinations to be carried out.
Supportive messages about the role of general practice
There have been numerous messages of support about general practice in the last few days:
1) Statement by the Prime Minister, Boris Johnson (12 December)commending “the extraordinary efforts of our NHS, including thousands of GPs and volunteer vaccinators”
“And I know the pressures on everyone in our NHS – from our GPs, doctors and nurses to our porters – all of whom have worked incredibly hard and we thank them for the amazing job they have done.“
2) The Secretary of State for Health and Social Care Sajid Javid appeared on Radio 4’s Today Programme talking about the role general practice would play in the Booster rollout. Discussing the need for workload prioritisation, he said: “When it comes to primary care for the next couple of weeks, our GPs will only be focusing on urgent needs and vaccinations, and it also means that non-urgent appointments in elective surgery may be postponed. For the next two-to-three weeks this is the new national mission. For the face to face appointments, the most important one you can have with any GP, is when you’re getting jabbed.”
3) Statement by Secretary of State for health and social care, Sajid Javid (13 December): “My hon. Friend is right to talk about how hard GPs have worked throughout the pandemic, and about the need to provide greater support. We expect and need them to help with this big new vaccination effort. There are already signs of many people showing that they understand the need for GPs to reprioritise over the next couple of weeks, which is important too.”
4) In a joint letter with RCGP, the UK CMO reiterated his appreciation and support, and acknowledged pressures: "We don’t underestimate the massive effort required nor the challenge of prioritising clinical care in an environment in which general practice’s contribution during the pandemic has not been appropriately recognised by some people. This will however be a time-limited effort- and one which is highly time sensitive. Only GPs can do this.”
COVID-19 vaccination programme
Item of Service fee for vaccinations
In light of the further vaccination effort required in response to the Omicron variant, NHSE/I has extended the Item of Service (IoS) fee to £20 per COVID-19 vaccination administered between 25 December 2021 to 3 January 2022 inclusive. This is to support vaccination sites to set up additional clinics during this period. The IoS fee will continue to be £20 per COVID-19 vaccination administered on Sundays in December 2021 and Sundays in January 2022 as previously announced. The ES and LES will shortly be updated to reflect this.
COVID-19 vaccination protocols and patient group directions
Updated national protocols and patient group directions and for the Comirnaty (Pfizer/Biotech) and
Spikevax COVID-19 (Moderna) COVID-19 vaccines have now been published, and are available here
Second phase for children and young people aged 12 to 15
Following the JCVI advice that all children and young people aged 12 to 15 years should be offered a second dose of the Pfizer-BioNTech COVID-19 vaccine at a minimum of 12 weeks, NHSE/I has published guidance on the second phase, setting out a hybrid model of delivery which includes both an in-school and out-of-school offer.
Vaccination as a condition for deployment in the healthcare sector
Last week, the Government published the outcome of their consultation on making vaccination a condition of deployment in the health and wider social care sector, advising that from 1 April 2022, only to deploy healthcare workers who have been vaccinated against COVID-19 to roles where they interact with patients and service users, to avoid preventable harm and protect patients in the NHS, protect colleagues in the NHS, and protect the NHS itself. Read the NHSE/I guidance
While the BMA has serious concerns about making vaccination mandatory, we’re pleased that the Government has, as we recommended, decided to delay the policy of mandatory vaccination for COVID-19 until spring next year. Read the full statement by the chair of BMA Council.
Exemptions from self-isolation of fully vaccinated staff members identified as a contact of a case
The UK Health Security agency has updated their guidance on COVID-19: management of staff and exposed patients or residents in health and social care settings.
Fully vaccinated GPs and practice staff no longer need to isolate for 10 days if they are a close contact of an Omicron Covid case.
The requirement has been replaced with a negative PCR and then daily LFT antigen tests for ten days, with isolation only on testing positive or developing symptoms, for those who are fully vaccinated.
Firearms licensing guidance
After extensive work, we have published guidance on the firearms licensing process, setting out the BMA position on firearms licensing and providing information to GPs on what to do when someone applies for a firearms licence, including responding to the police and conscientious objection.
The BMA has had significant involvement in the development of Home Office guidance for chief officers of police on firearms licensing that came into effect on 1 November 2021. We strongly support the Government’s overall message, that gun ownership is a privilege and not a right, and that firearms must be in the hands of only those who are deemed safe and responsible.
The 2021 statutory guidance and the arrangements for medical checks for applications reflects the BMA’s significant contribution to its development. Public safety is paramount for the Association and the guidance clearly sets the standards, clarifies the national process and provides a unified approach for doctors and police forces to follow.
Private provider requests for investigations under the NHS
Following some queries from LMCs about requests from private providers relating to investigation and/or treatment of one of the practice’s registered patients, we have produced new guidance, which includes a template letter to respond to private providers. If the GP is asked by a private provider to arrange investigations or tests, the results of which the GP would not be able to interpret and/or the GP does not feel clinically competent to manage the patient accordingly, then they should advise the patient and the provider that the services do not fall within NHS Primary medical services and to make alternative arrangements.
Prescription charge waiver for COVID-19 antivirals and therapeutic clinical trials
The Government has announced that, from 10 December 2021 until 31 March 2022, arrangements have been made under the NHS Regulations for antiviral medicines to be supplied to patients who have tested positive for COVID-19 and who are in the eligible cohorts of patients. Where the patients are not already eligible for free prescriptions, the antiviral medicines will be supplied free of charge.
The waiver will also apply to therapeutic treatments that are being made available through the NIHR funded HEAL-COVID clinical trial platform treating patients who have been hospitalised for COVID-19, for long-term effects and STIMULATE ICP treating community patients for long COVID. NHSE/I will be issuing guidance on the use of the waivers.
GMC State of Medical Education and Practice in the UK report
The GMC has published their State of Medical Education and Practice in the UK 2021 report, which shows that GPs are once again reporting much greater pressure than any other group, and that:
· On average, GPs described the workload on 76% of their days as ‘high intensity’, a significantly higher proportion than specialists (55% of days) and other doctors.
· The proportion of GPs struggling with their workload doubled in 2021, with more than half of GPs (54%) now falling into this group.
· GPs were the most likely to be at a high risk of burnout (32%), compared with specialists and other doctors, and fewer GPs took a leave of absence suggesting that some groups feel less able to take this action.
This data should ring alarm bells for policymakers and Government – not just about how severely over-stretched GPs and their teams are right now, but also on the impact this has on patients and the safety of care they can access. It emphasises what the profession has been saying for several years; that GPs and their teams have been working harder than ever before, and they did all they could to care for patients throughout the pandemic. Read my full comments in Pulse.
Read the BMA statement in response. The story was also covered in Management in Practice, London News Time and the Geriatric Medical Journal.
Read the BMA’s GP bulletin here.
Read my twitter page Dr Farah Jameel (@DrFJameel) / Twitter
Read General Practice (@BMA_GP) / Twitter
Temporary GP contract changes to support Winter pressures and the COVID-19 Vaccination program
Last Friday, following discussion with GPC, NHSE/I published a letter announcing changes to QOF and IIF and changes to the COVID vaccination DES. It has now provided further guidanceon these changes.
Given the announcement on QOF and IIF, we hope practices will be able to consider how they could support the national vaccination effort while continuing to clinically prioritise patients who need them. We recognise the significant unprecedented challenges you are all facing at present and know that you will do your best in the days and weeks to come, as you have been doing these past 20 months. Thank you for all that you are doing for your patients, for your communities. Read our press statement >
Secretary of state for health and social care Sajid Javid has written a letter to primary care, thanking staff for their efforts on the COVID vaccination programme.
Pandemic response – Plan B
It is important to reiterate that the current guidance on isolation and infection prevention and control remains in place. The main amendments include face masks becoming compulsory in most public indoor venues, other than hospitality, NHS Covid passes to be mandatory in specific setting, using a negative test or full vaccination via the NHS Covid Pass, vaccines and testing to remain the best line of defence and people are being asked to work from home if they can.
A reminder to colleagues of the recently updated infection prevention and control (IPC) guidance published by the UK Health Security Agency, issued jointly by the Department of Health and Social Care, NHS England and the devolved nations’ public health departments. It covers seasonal respiratory viruses and supersedes the previous COVID-19 specific guidance.
It recommended that face masks for staff and face masks/coverings for all patients and visitors should remain as an IPC measure within health and care settings over the winter period.
It also recommended that physical distancing should be at least 1 metre, increasing whenever feasible to 2 metres across all health and care setting, and that it should remain at 2 metres where patients with suspected or confirmed respiratory infection are being cared for or managed.
It is recommended that screening, triaging, and testing for SARS-CoV-2 continues over the winter period. Testing for other respiratory pathogens will depend on the health and care setting according to local / country-specific testing strategies / frameworks and data
This followed the specific recommendations for changes to IPC guidance in primary care published on October. The BMA have already stressed that 1 metre social distancing will be difficult for some smaller surgeries and as such there will still have to be a reduced capacity in some practices. The guidance strongly emphasises that local decisions and risk assessments will ultimately decide whether a face-to-face consultation is appropriate and where physical distancing can be safely reduced. It is therefore for practices to determine what arrangements they have in the surgery.
We are working with RCGP on updating our joint workload prioritisation document. https://www.bma.org.uk/media/4386/bma-rcgp-covid-workload-prioritisation-aug-2021.pdf
The BMA responded to the prime minister’s announcement on Wednesday 8 December that the Government will be implementing Plan B for dealing with COVID and the Omicron variant. Read more >
NHS COVID-19 vaccination programme
It was the one year anniversary on Wednesday for the NHS COVID-19 Vaccination program. Since its inception, GPs and their teams all over the country have played a pivotal role in rolling out at pace the most successful vaccination campaign to date. The NHS has delivered now over 100m doses in just 12 months, including 18m booster jabs. The lion’s share of this vaccination program has been delivered by General Practice, its been a massive undertaking at significant personal costs for many of you, a huge team effort delivered in partnership with your communities. In coming days and weeks many of you will continue to step up to the national priority of boosting this country through a surge of Omicron. Thank you for all that you have achieved and all that you will continue to do for your communities and for this nation.
To support you in this national effort, changes to the vaccination schedule now allow greater flexibility to move vaccines to individual practices.
Moving vaccines within a PCN grouping
Considering the need to rapidly expand capacity, the MHRA has expanded the circumstances in which the COVID-19 vaccine may be moved from a PCN Grouping’s designated site(s) to another location.
GP practices within a PCN Grouping may move COVID-19 vaccine from their Designated Site to collaborating individual GP practices within the PCN Grouping to increase the possibility of opportunistic administration of the vaccination to increase take up of the vaccine. Movement continues to be subject to:
The NHSE template Collaboration Agreement has now been updated to reflect these changes.
UK's most vulnerable people to receive life-saving COVID-19 treatments in the community
Thousands of the UK’s most vulnerable people will be among the first in the world to access life-saving, cutting-edge antiviral and antibody treatments from today, the government has announced.
A national study called PANORAMIC, run by the University of Oxford in close collaboration with GP hubs, has now launched and is recruiting around 10,000 UK patients at risk of serious illness from COVID-19 to have the opportunity to take the treatment molnupiravir at home after receiving a positive PCR test.
Those at highest risk who test positive for the virus – for example, people who are immunocompromised, cancer patients or those with Down’s syndrome – will also be able to access either molnupiravir or the novel monoclonal antibody Ronapreve outside of the study from 16 December 2021.
Supporting general practice
Read about how we are campaigning against abuse of GPs and their staff on our Support Your Surgery campaign page, which includes a number of resources that practices can use.
NHSE/I workforce staff survey development
The NHSE/I workforce team has commissioner Picker, an independent health and social care research charity, to develop a new questionnaire for the Primary Care Staff Survey Pilot. They are looking for volunteers (both clinical and non-clinical staff) to make sure the questionnaire is clear, easily understood and relevant to staff working in General Practice and Primary Care Networks. If you volunteer you will need to:
An interview will be arranged at time convenient to you, during one of the rounds detailed below.
Find out more here or contact volunteer@surveycoordination.com to register your interest.
New to Partnership Payment Scheme (N2PP)
This will be extended into the 2022/23 financial year and NHSE/I have now removed the requirement to apply within six months of commencing a partnership role. Following a review of the timeframe to apply for the scheme, and in acknowledgement of the challenges the deadline presented to busy new partners as well as the additional pressures created by the COVID-19 pandemic, NHSE/I has removed the six-month deadline, including for submitted applications that meet all other eligibility criteria. When the scheme comes to an end, there will be a cut-off deadline after the scheme closure date by which applications from eligible individuals must be submitted, and NHSE/I will give advance notice of this.
NHSE/I continues to encourage all individuals who have commenced in an equity share partnership on or after 1 April 2020 to submit their application as soon as they can after they become eligible. They are now reviewing all applicants this affects and updating their guidance to reflect the changes > Read NHSE/I’s primary care bulletin
Media
Changes to QOF and IIF
BMA GP committee chair Dr Farah Jameel made a number of comments in the media, following the announcement by NHSE/I last Friday that some contractual requirements on GP practices would be relaxed to allow increased capacity to deliver the COVID-19 vaccination campaign. In her BMA statement she said that there was a fine balance to be had between “the clear national priority to deliver booster vaccinations to as many people as possible with ensuring that people who need care and treatment from their GP practice and the wider NHS continue to receive it”. She was quoted in the Guardian, Daily Mail (print), i News, Pulse, BBC News and GP Online. On Saturday morning she appeared on BBC Radio 4’s Today programme (from 1hr14) and later on Times Radio (9 mins40). Her comments on the Today Programme received widespread further pick-up across the media, including the BBC.
Dr David Wrigley, BMA council deputy chair, appeared on Times Radio (from 2hrs38) and on the BBC News Channel on Saturday, with his comments picked up across BBC News bulletins throughout the day. I was also interviewed by ITV News on Friday evening on the same topic.
NHS on life support
The Spectator ran a piece on the NHS being on life support, which includes a line on GPs refusing to see patients (“Too many GPs are still refusing to see patients in person”). The BMA has published a letter in response from Dr Chaand Nagpaul, Chair of BMA Council.
COVID vaccines
Covid-19: General practice is at breaking point, warns BMA
The BMA featured in ITV News yesterday warning that general practice is at breaking point, with GPs under pressure to speed up the rollout of booster jabs alongside their usual clinical duties.
Dr Danielle McSeveney, BMA Yorkshire regional council deputy chair, said: "Some practices around the country have felt that they cannot continue to keep going with vaccinations at the rate they, that it is compromising their day-to-day care of patients and they just can't do it."
General practice: GPs will balance needs of patients alongside increased vaccination drive
The BMA featured in iNews yesterday discussing the need to balance the increased vaccination rollout with the needs of patients.
Dr Farah Jameel said: "We will continue to work with the Government to ensure GPs and practices are supported and enabled to effectively balance the needs of all our patients along with this increased vaccination drive.
"The ever-changing demands of the pandemic means that it is important to constantly assess the situation to ensure that practices are being best supported to cater to the most pressing needs of their patients and their communities at any given time."
GP pressures
The BMJ ran an article with GP leaders and the RCGP expressing serious concerns about the roll out of the new cholesterol lowering drug inclisiran in primary care.
London News Today ran an article highlighting staff shortages and recruitment schemes to get more staff.
The Northern Echo ran an article on the need for greater understanding from patients amid the additional workload and pressures resulting from the Covid-19 pandemic.
Pulse ran an article announcing that GPs are now contractually required to ‘offer and promote’ remote consultations during core hours, new NHS England guidance has confirmed.
Scotland
Dr Andrew Buist, chair of GPC Scotland was reported in the Scotsman – NHS Covid crisis: I worry about health service’s future and we need to be realistic about what it can do.
Northern Ireland
Northern Ireland: Continue to exercise caution by following Covid rules, says BMA
Dr Frances O’Hagan, deputy chair of the British Medical Association Northern Ireland GP Committee, appeared on UTV View from Stormont to discuss concerns over the Omicron variant (watch from 15:06).
Commenting on the Omicron variant, Dr O’Hagan said: “It is an evolving situation and until we know the facts we should be very careful. What we do know is Omicron is very infectious. We know that it can be transmitted very easily, but we haven’t got enough data yet on how severe the infection is.”
Dr O’Hagan reminded viewers to continue to wear masks, social distance, wash their hands and get the vaccine and booster jab when it is offered.
NHS pressures set to continue for months: GP
Dr Tom Black, Chair of BMA NI Council, a Derry GP says that the ‘relentless pressure’ exerted on the NHS since the start of the Covid pandemic is set to continue for months to come.
Read the BMA’s GP bulletin here.
Farewell to LMC colleagues
As our time on the executive team comes to an end, I want to take this opportunity to thank LMC colleagues for your support and camaraderie over the years. Richard Vautrey, Mark Sanford-Wood and I will be handing over to the new executive team in the next few days, and we wish you, the team and the profession well in these challenging times. It has been a privilege to represent you all these years and we hope the future is a positive one for General Practice.
Changes to QOF and IIF
NHSE/I published a letter today announcing changes to QOF and IIF and changes to the COVID vaccination DES. More detail and operational guidance on these changes will be forthcoming in days to come.
Given today’s announcement on QOF and IIF, I hope it will become possible for practices to consider how they may be able to support the national vaccination effort whilst continuing to clinically prioritise patients who need them. I recognise the significant unprecedented challenges you are all facing at present and know that you will do your best in the days and weeks to come, as you have been doing these past 20 months. Thank you for all that you are doing for your patients, for your communities. Read our press statement.
Secretary of State for Health and Social Care, Sajid Javid, has written a thank you letter to Primary Care, thanking them for their efforts on the COVID-19 Vaccination Program.
Additional funding for COVID vaccination programme – but more support is needed (England)
Following the identification of the COVID-19 omicron variant, the government have accepted JCVI advice to widen the age range for vaccine eligibility to include all 18-39 year olds and to shorten the time from last vaccination to booster to three months.
In addition, 12 to 15 year olds can now receive a second dose of the Pfizer-BioNTech COVID-19 vaccine, no sooner than 12 weeks after the first dose. Severely immunosuppressed individuals who have received three primary doses, should also be offered a booster dose.
To support the quicker and larger roll-out of boosters, NHSE/I announced earlier this week that there will be some additional funding to support PCN Groupings to step up capacity by:
· Increasing the Item of Service (IoS) fee for COVID-19 vaccinations to £15 from 1 December to 31 January (Mondays to Saturdays)
· Increasing IoS fee to £20 for vaccinations administered on Bank Holidays and Sundays from 1 December to 31 January
· Increasing the supplement for vaccination of housebound patients to £30 from £20 between 1 December and 31 December backdated to 16 September
Although we welcome additional funding being made available, we remain concerned about the high workload and lack of workforce capacity in general practice. Given today’s announcement on QOF and IIF, I hope it will become possible for practices to consider how they may be able to support the national vaccination effort.
At this critical time in the fight against COVID-19, GPs and their teams want to do all they can to protect and look after their communities, focusing on those most in need.
This means finely balancing the clear national priority to deliver booster vaccinations to as many people as possible with ensuring that people who need care and treatment from their GP practice and the wider NHS continue to receive it.
If practices physically do not have the staff or time to dedicate additional time to the vaccine programme because they are also focused on other contractually required work it will do little to help. With a finite number of staff and hours in the day there is a limit to what practices can safely do.
We hope that these changes, by removing some of the more bureaucratic and target-based requirements within practices’ contracts, will create capacity to step up delivery of the vaccination programme to quickly protect as many as possible from COVID-19. Read our press statement
Media
I spoke about this at length in the press, including in the Telegraph where I said: “What general practice needs right now, is to be trusted to lead their teams, delivering care to those who need it the most. We’re asking for a high-trust, low bureaucracy system.” I was also interviewed on BBC Radio 4's Today Programme (listen at 48m40s) and on BBC Radio 5 Live (listen at 2h55m) about the Covid booster campaign and pressures in general practice. This was also covered by MailOnline, Pulse, GPonline, the Times, the BBC (online), Daily Mail (also here and here), Pulse, and on BBC Radio London. The BMJ also ran an article about the need for extra staff in general practice and capacity to deliver accelerated booster programme.
Dr Brian McGregor, BMA Yorkshire regional council chair was interviewed on the topic on BBC Radio York (listen at 1h09m33s), and Dr George Rae, BMA North East regional council chair was interviewed on BBC Radio Tees (listen at 1h14m30s).
Pulse reported on my Tweets, where I said: ‘I have written to NHSE/I to offer the full support and force of general practice in the face of an evolving threat to the nation.’ It also reported on Tweets by former GPC chair, Dr Richard Vautrey, where he said that GPs ‘should be urgently freed up to focus on the patients who need them most’ and ‘step up delivery of [Covid vaccine] to quickly protect as many as possible from [Omicron]’.
New COVID-19 Omicron variant – new measures and booster programme extension
Following the reports of a new COVID-19 Omicron variant, last week the BMA called for mandatory mask-wearing and social distancing in indoor crowded spaces, and that public buildings, offices and hospitality venues have adequate ventilation to disperse the virus as much as possible.
The Prime Minister then announced that new targeted measures in England to prevent the spread of the new variant would be introduced on Tuesday 30 November, including mandatory mask wearing in shops and on public transport. The public was also encouraged to ensure they get vaccinated, to help protect themselves and others.
A CAS alert has been sent out to healthcare workers, with advice to continue to follow the national Infection prevention and control for seasonal respiratory infections in health and care settings for winter 2021 to 2022 guidance, wearing face masks for staff and face masks/coverings for all patients and visitors within health and care settings over the winter period.
It also recommends that physical distancing should be at least 1 metre, increasing whenever feasible to 2 metres across all health and care setting, and that it should remain at 2 metres where patients with suspected or confirmed respiratory infection are being cared for or managed. Read the BMA statement here
Media
Following the Prime Minister’s announcement of new infection control measures in response to the emergence of the new Omicron Covid variant, the BMA issued a statement calling for mandatory mask wearing to extend to all public indoor and enclosed spaces, which featured across media.
I was interviewed by Radio News Hub and featured on news bulletins across the country.
BMA report: Weathering the storm
The BMA published a report, Weathering the storm: vital actions to minimise pressure on UK health services this winter, last week.
The report outlines practical recommendations for stemming the winter crisis that health services across the UK are facing. These include calling on political leaders to have honest conversations with the public about the immediate challenges facing health services so that patients and the public alike have the best information possible about how to access safe and appropriate care
The report calls for urgent and immediate action by government and health service leaders and asks them to do more to:
1. Communicate honestly with patients and the public about health service pressures
2. Retain existing staff and maximise workforce capacity
3. Promote responsible public health policies to keep people safe and healthy and help manage demand on services
4. Direct resources to where they are needed most to manage health service demand
Access the report and read more here
Joint statement on Inclisiran
We have published a joint statement with the Royal College of GPs regarding the implementation of Inclisiran in primary care.
Although the BMA is supportive of innovation of new drugs, we have serious concerns about how this particularly drug is being introduced. In particular we have raised issues about where the long-term responsibility lies when prescribing this drugs, and the lack of clarity about where doctors and patients can turn if there are concerns or problems.
There is also an issue of capacity the lack of clear resources to support the additional work required and how the impact that introducing new treatment plans will have on teams that are already stretched to their limits. We have raised these concerns with NICE and NHSE/I.
This guidance aims to advise practices that may want to prescribe these drugs of our concerns and that they should only do so if they feel comfortable. Read the statement here
Integrated care systems – primary care (England)
The BMA continues to lobby on a range of issues relating to the Health and Care Bill, including strengthening the involvement of general practice, and the role of LMCs. As part of this we have co-signed a letter with other representative bodies for primary care, to Ministers and the Health and Care Bill Committee, asking for a commitment from Ministers in Committee that:
· The government honours its commitment for primary care to be represented and involved in decision-making at all levels of the Integrated Care Systems (ICS) including strategic decision-making forums through formalised roles for GPs, dentists, pharmacists, primary eye care and primary hearing care audiologists in Integrated Care Partnerships (ICPs)
· These roles are remunerated to ensure parity of availability and voice with NHS Trusts, NHS staff, social care and public health colleagues in strategic thinking and decision-making
· That existing statutory Local Representative Committees, such as LMCs, have the right put forward nominations for those roles
· Transparency and accountability - ICBs and ICPs to be under duty to explain in writing in public when they choose not to heed advice from local primary care bodies.
A briefing outlining what collectively we want government to do has also been sent to Ministers.
LMC England conference 2021 - resolutions
The resolutions and election results from the Annual Conference of England LMCs 2021, which was held last week, have now been published. Watch recordings of the event:
Day 1: https://bma.streameventlive.com/archive/246
Day 2: https://bma.streameventlive.com/archive/247
Read more about the event here: Local medical committees (bma.org.uk)
Media
There was coverage by Pulse and GPonline of a motion calling on the BMA to negotiate a new GP contract and coverage in GPonline of a motion asking for better primary care representation on ICS boards. There was also coverage in GPonline of a debate on GP wellbeing that saw delegates sharing harrowing personal accounts of attacks on staff in their surgeries.
Scottish LMC Conference 2021
The Scottish LMC conference was held today (virtually). Unfortunately I was unable to attend the day as originally planned. The conference was attended by the Cabinet Secretary for Health and Social Care Humza Yousaf. I understand that as one would expect, there was excellent debate, the day was expertly chaired by conference chair Dr Denise Mcfarlane. You can read Chair of SGPC Dr Andrew Buist conference speech. You can read the agenda here.
Sustainability payments for GP practices in Scotland
The Scottish Government has announced a £15 million sustainability payments for all GP practices in Scotland for 2021, with a further payment of £15m in 2022-23, following successful negotiations with Scottish GPC. The funding will need to be used to support:
· Extra internal GP sessions (including face-to-face appointments)
· Extra non-core hours
· Additional administrative time and practice manager time
· Additional practice nurse time
· Practice organised cover for PLT for reflection, learning and innovation
· External GP locum sessions
· Any other purpose connected with the provision of GP services
Read the blog about it by Chair of Scottish GPC, Dr Andrew Buist.
GPC Wales GP contract agreement 2021/22
GPC Wales has agreed changes to the GP contract for 2021/22 with Welsh Government and NHS Wales this week. The changes include:
· a 3% pay uplift for GPs and all practice staff1
· continued investment for the implementation of the ‘Access to In-hours GP Services’
· commitment to improve access to and from primary care
· in-year funding to alleviate winter pressures
· data legislative reform to de-risk general practice
· protected Learning Time and funding of Care Navigation Training
Supporting general practice
Read about how we are campaigning against abuse of GPs and their staff on our Support Your Surgery campaign page, which includes a number of resources that practices can use.
NHSE/I has now also published materials and guidance for use in primary care settings to encourage patients to treat NHS staff with respect.
Media
Indicative ballot
I was interviewed in The Times (also in print), where I said that the BMA wants to work with the government despite the threat of industrial action, and that: "There has been a breakdown in discussion and understanding. I know that solutions come from talking, even if you’re in conflict, they come from talking or respectful conversations that look to find solutions. I want to say I’m sorry that things are as bad as they are. But that is despite us trying hard to do our very best." I also called on the Health Secretary to find a way to "put a protective ring around" patients who needed urgent support this winter.
The BMJ reported on the Indicative Ballot, and the fact that it showed that over half of general practices in England would be willing to withdraw from primary care networks in response to the government’s “rescue package” for the profession.
GP pressures
GPC member Dr Gaurav Gupta featured on BBC South East as part of a special report on pressures in general practice (listen from 8:40). The story also featured on BBC Radio Kent (listen from 0:59).
Wales
Chair of GPC Wales, Dr Phil White, featured on BBC 1 Wales - Breakfast (listen from 5:35) and in news bulletins throughout the day highlighting the demands on general practice and warning that "something will have to give" if GPs are required to assist with the booster roll-out.
Scotland
BMA Scotland has welcomed the announcement by the First Minister, Nicola Sturgeon, of a £30 million fund to help GPs offer more appointments as part of a “significant down payment” of extra money for the Scottish NHS. This was reported by the National
Northern Ireland
NI GPC chair Dr Alan Stout joined a panel of experts on BBC The View to discuss the new omicron variant (listen from 9:56).
Read the BMA’s GP bulletin here.
Read my twitter page Dr Farah Jameel (@DrFJameel) / Twitter
Read General Practice (@BMA_GP) / Twitter
The Annual Conference of England LMCs was held today and yesterday (25-26 November).
At yesterday’s session there were a variety of debates, and motions were passed on the negative impact that inappropriate transfer of workload from secondary care to primary care; the use of ‘advice and guidance’ which cannot be mandated; GP representation in Integrated Care Systems; review of NHS 111; and sustainability and carbon neutrality in general practice.
This morning, the Conference passed motions on online consultations; PCN DES guidance, GP contract reforms; and the COVID vaccination programme. There was also a very powerful and moving themed debate on Wellbeing for those working in general practice – something that is the focus of our Support Your Surgery campaign, referenced again below.
In the afternoon of Friday, there was a closed section which closed to the media and which was not broadcast, to allow business to be debated without the constraints of a media spotlight. In the closed session, representatives discussed GPC England transparency; PCN DES; NHSE/I ‘access plan’; and accelerated patient access to medical records.
In her inaugural speech to conference, I was delighted to hear the newly elected chair of GPC England, Dr Farah Jameel, lay out her vision to the profession. Her appeal for the Government and GPs to work together to ‘build general practice back better’ was particularly apt, and I agree that we are at a crossroads for general practice in England.
I was also pleased to see highlighted the immense efforts of all GPs throughout the pandemic, including the hugely successful vaccination campaign, and the difficult truth that many family doctors have been left demoralised, broken and exhausted.
On Friday afternoon, conference also discussed the results of the indicative ballot of GP practices in England. As you know, this was launched by the BMA after the profession rejected the Government’s so-called winter ‘rescue package’ for general practice. The indicative ballot results showed that 84% of respondents said they would welcome non-compliance with COVID-19 exemption certificate requests, 80% said they would change the way they reported appointment data, and 58 % said they would support withdrawal from the PCN DES at the next opt-out period.
Read the press statement and full transcript of her speech.
I would like to say thank you to Shaba Nabi in her first year as Chair of Conference, and Elliot Singer, Deputy Chair of Conference, for their excellent chairing and handling of this virtual event. Thanks too to the agenda committee and staff teams who have made the event run as well as it has this year.
A list of resolutions and a recording of the event will be published on the BMA website next week. Read the Agenda and Supplementary Agenda.
Media
There was coverage in the Guardian about the mention of Industrial Action ballot in the speech by the GPC Chair. The story also featured in the Telegraph, GP Online, Pulse, and Yahoo News.
GP online reported on the speech by the GPC England Chair, Dr Farah Jameel.
Health Select Committee inquiry into the future of general practice
This week the Parliamentary Health and Social Care Committee (HSCC), chaired by former Health Secretary, Jeremy Hunt MP, has launched a timely inquiry into the future of general practice. The inquiry presents a key opportunity for the BMA to push our GP campaign asks, as well as to raise wider concerns and recommendations.
The BMA will submit a formal response, and you can share your views on review with us by emailing publicaffairs@bma.org.uk by the extended deadline of Wednesday 1 December, to support our response. Please do send across your thoughts so that we can represent the breadth of general practice perspectives to this important consultation.
Members of the public can also submit their comments directly to the inquiry by 14 December.
Supporting general practice against abuse
We continue to campaign against abuse of GPs and their staff with a number of resources available on Support Your Surgery campaign page, which can be used to explain to patients why practices need to work in the way they are doing in order to protect patients, and to make the best use of the available but limited workforce.
The resource package includes a support your surgery poster and GP abuse poster, a template letter to write to your local MP, and a template letter to share with local patient groups.
Our GP campaign factsheet can also be used to rebut the misinformation in the media and to proactively include in social media posts, letters to the local press or MPs.
Please continue to show your support by signing the Support Your Surgery petition to put pressure on the Government to support general practice.
You can also get involved in the #SupportYourSurgery social media discussion
Please do all you can to help us defend and support general practice at this critical time.
Your wellbeing
The BMA offers supportive wellbeing services which include face-to-face counselling. You can access one-off support or, after triage, a structured course of up to six face-to-face counselling sessions. Call 0330 123 1245 or visit the website for more information.
Updated infection control guidance (UK)
New infection prevention and control (IPC) guidance has now been published by the UK Health Security Agency, issued jointly by the Department of Health and Social Care, NHS England and the devolved nations’ public health departments. It covers seasonal respiratory viruses and supersedes the previous COVID-19 specific guidance.
It recommends that face masks for staff and face masks/coverings for all patients and visitors should remain as an IPC measure within health and care settings over the winter period.
It also recommends that physical distancing should be at least 1 metre, increasing whenever feasible to 2 metres across all health and care setting, and that it should remain at 2 metres where patients with suspected or confirmed respiratory infection are being cared for or managed.
This follows the specific recommendations for changes to IPC guidance in primary care published last month. The BMA have already stressed that 1 metre social distancing will be difficult for some smaller surgeries and as such there will still have to be a reduced capacity in some practices. The guidance strongly emphasises that local decisions and risk assessments will ultimately decide whether a face-to-face consultation is appropriate and where physical distancing can be safely reduced. It is therefore for practices to determine what arrangements they have in the surgery.
TPP Patient access to records
Following the announcement that patients registered with TPP practices would be granted access to their records from December 2021, BMA GPC England wrote to NHSX calling for a delay, citing clinical safety and workload issues. This week we received a response confirming that initial rollout will now be delayed until April 2022 with time given to work with NHSX to ensure that it happens safely and with minimal disruption. We will provide more information on any further changes as and when it is received.
GP appointment data
The GP appointment data for October have now been published, showing an increase in the number of GP appointments, including the number of those being seen face-to-face.
Last month practices in England delivered more than 4 million more appointments than they did in September, a total of 33.9 million in October, and more than 3 million more than they did in the same month pre-pandemic in 2019. Meanwhile the number of people being seen face-to-face continues to rise, which underlines how wrong suggestions are that practices are closed and not seeing patients in person.
What’s not picked up in these statistics though are the reams of other work that GPs and their colleagues do outside of consultations and at the same time we are continuing to lose GPs. Staff are exhausted and demoralised, and there are simply not enough hours in the day to provide safe, quality care to patients. Read the full statement here
Media
The BMA was featured in the Times and the Telegraph about the latest GP appointment data.
Updated PGD and national Protocols for COVID vaccination programme
Updates to the following PGDs and national protocols, for the COVID-19 vaccination programme in England, have been published:
National protocol for COVID-19 mRNA vaccine BNT162b2 (Pfizer/BioNTech)
National protocol for Comirnaty® COVID-19 mRNA vaccine
Patient group direction for Comirnaty® (Pfizer BioNTech)
Patient Group Direction for COVID-19 mRNA vaccine BNT162b2 (Pfizer/BioNTech)
New interactive ESA 113
The new interactive ESA 113 form, which healthcare professionals fill in if the Department of Work and Pensions (DWP) asks for information in connection with Employment and Support Allowance or Universal Credit, is now live on the gov.uk website
Application process for the GPC England Executive Team
Following the election of a new GPC England Chair last week, the call for applications for the three GPCE Executive Team posts from interested candidates is now open. Read the role profile.
We are inviting applications from all GPCE members and LMCs (local medical committees).
The deadline for applications is 2pm on Friday 3 December 2021 – submit your application to: info.gpc@bma.org.uk. Applications received after this time will not be accepted.
The current whole-time time commitment for GPCE Exec Team member is 2.5 days per week. This time commitment will depend on your personal circumstances / working preferences. A competitive remuneration package will be agreed commensurate with working hours. The arrangements will be covered by a contractor agreement between the contractor (Exec member) and the BMA.
Should you have any questions/queries about the application process or the Executive Team role, please contact the GPCE Secretariat via info.gpc@bma.org.uk.
Get the full details on the GPC England webpage
Media
New GPC England Chair
The Daily Telegraph reported on the appointment of Dr Farah Jameel, as the new GPC England Chair.
Backlog
The Guardian featured an article warning that a new Government plan to scrap tens of millions of hospital outpatient appointments could put patients at risk and add to the practice overload. In response to this, BMA council deputy chair Dr David Wrigley, said: "While it is important that immediate action is taken to tackle the largest ever backlog of care these short-term proposals by the health secretary have the potential to present significant challenges for patients and seek to worsen health disparities across the country." The story was also covered in Yahoo News and MSN News.
Northern Ireland
Dr Alan Stout, chair of GPC NI, was featured several outlets warning of extreme pressures on general practice in Northern Ireland, after Stormont's health committee heard a case of a patient who had called a GP practice 268 times without a response. Dr Stout said that this was unacceptable but that it was also a reflection of the pressure the system is under. This story featured in BBC Northern Ireland, UTV News and the Belfast Telegraph. Dr Stout also appeared on The Nolan Show (from 7.12) encouraging the public to come forward to get Covid booster vaccine).
Read the GP bulletin here.
Read the latest Sessional GPs newsletter here
New Chair of GPC England
I am delighted and honoured to have been elected to represent GPs as the new GPC England chair at a time of enormous challenge to the profession and I would like to thank the former chair, Dr Richard Vautrey for his dedication and commitment to this committee and all that he has achieved over the years for the profession. I would also like to take the opportunity to thank the rest of the Executive Team, who I have had the pleasure of working with over the past 4 years. Working through the pandemic as a team presented enormous challenges and I want to acknowledge their tireless efforts on behalf of the profession.
I am proud to represent grass-root colleagues, and in particular, to make history as the first woman to chair GPC England.
I don't underestimate the difficulties that lay ahead but we must recognise this as an opportunity to reset our relationship with Government and begin to rebuild general practice.
I want a fresh start for general practice and intend to use the next three years to work closely with general practice leaders, grassroots GPs, Local Medical Committees (LMCs) alongside other stakeholders. I intend to hear a range of diverse views and be innovative in navigating the stormy waters ahead. Together, we will seek to design and deliver a stable and sustainable general practice, fit to serve generations of patients to come.
I acknowledge some of the biggest issues the profession is currently facing - workload pressures, workforce shortages and funding depletion, and I will work with you to address these crucial issues.
I also know that the experiences for patients must improve, and how important it is to you, to be supported to provide the high quality, safe and equitable care you want to continue providing.
I promise to bring hope back into the profession.
Read the press statement, and General Practice (@BMA_GP) / Twitter
Media
This was reported by Pulse (also here), GPonline, BMJ, Healthcare Leader and the Times (print).
Report from GPC England meeting - 18 November 2021
I had the honour to attend my first GPC England meeting as Chair yesterday, after being elected into post that morning. In addition to thanking the former Chair, Dr Richard Vautrey, and team above, I would also like to thank Dr Chandra Kanneganti, who contested this election with me. I tweeted a picture of us just prior to the election to mark the day, when two overseas trained doctors contested the election for Chair of GPCE. This was a huge moment for me for many reasons and I want to thank him for his part in making history. Dr David Wrigley, Deputy Chair of Council, opened the meeting and chaired up until the election results were announced and also attended the remainder of the meeting. Dr Zoe Greaves, who has been elected the new speaker of the Committee, taking over from Dr Fay Wilson who had been the speaker for nearly 4 years, very ably fulfilled that role for the first time.
The main item of discussion following the election was the outcome of the indicative ballot, which closed earlier this week. The ballot asked what actions practices might be willing to take in response to the lack of support from Government and NHS England for general practice in the face of unprecedented pressures, which risk the quality and safety of care GPs are able to offer patients. These included withdrawing from the PCN DES, disrupting appointment data, refusing to provide COVID vaccination certification and refusing to declare earnings.
Following a thorough and engaging debate amongst committee members, GPCE is now considering the results in detail before deciding on next steps, which will be communicated to members in due course. There have been some questions on social media about why we have not released these results. I have explained our position above, in addition, I am day 1 in post, and commit to being completely open and transparent with you in as timely a way as possible. I promise to keep you updated, as I know that this is important to you.
GPCE also heard updates from:
· the Sessional GPs Committee Chair, Dr Ben Molyneux
· the GP Trainees Committee Chair, Dr Euan Strachan-Orr
· the GPC Gender Champion, Dr Rachel Ali
· the Chair of the LMC England Conference, Dr Shaba Nabi, about the Agenda for the Conference to be held next week 25-26 November.
At the end of the meeting, the Committee was divided into breakout groups to discuss the Health Select Committee inquiry into the future of general practice, where many useful points and suggestions were raised. The notes from these discussions will be collated and will form the initial basis of the BMA/GPCE response to the inquiry.
There were a number of strong debates throughout the day and given that this was my maiden meeting in the hot seat, I was so impressed with the tenor, tone and ethos. There were some slight IT hiccups but we got through it and kudos to Zoe and David for managing to chair through these hiccups. Well done to the committee for being so brilliant and my final thanks is to the staff for running the day so smoothly.
GP earnings declaration
With thanks to Richard and Chaand Nagpaul (Chair of council), who have continued to raise with the Department of Health and Social Care (DHSC) our serious concerns about earnings declarations for GPs. They had further discussions with them on Wednesday and they have now confirmed that they will delay both the submission and publication of earnings declarations until at least next Spring.
With GPs facing some of the most intense pressures many have ever experienced, we have been clear that this policy was likely to be counter-productive. Crucially, these changes could have caused disruption over the winter period – distracting from the immediate priorities facing practices and their patients.
We are pleased that the Secretary of State is delaying these plans, providing some breathing space for hard-working GPs. We will continue to lobby on this matter. Read our guidance on GP earnings.
Media
The story was covered by HSJ, and reported by Pulse, GP Online, Telegraph (also in print),
MailOnline (and here) and on BBC1 Cambridge.
Supporting general practice against abuse
The BMA continues to campaign against abuse of GPs and their staff with a number of resources available on Support Your Surgery campaign page, in order to get the changes that are so urgently needed to support general practice teams.
Please continue to show your support by signing the Support Your Surgery petition to put pressure on the Government to support general practice and use our resources to explain to patients why practices need to work in the way they are doing in order to protect patients from a rising incidence of COVID-19 and to make the best use of the available but limited workforce.
You can also get involved in the #SupportYourSurgery social media discussion by sharing your support across social media.
Please do all you can to help us defend and support general practice at this critical time.
Use our template letter to write to your local MP to outline the pressures being faced by GPs.
Share our template letter amongst your local patient groups.
Our GP campaign factsheet can also be used to rebut the misinformation in the media and to proactively include in social media posts, letters to the local press or MPs.
COVID-19 vaccinations
Booster vaccination for over 40s
The Joint Committee on Vaccination and Immunisation (JCVI) has advised this week that, all adults aged 40 to 49 years (cohort 10) should also be offered an mRNA COVID-19 Vaccine booster, 6 months after their second dose, irrespective of the vaccines given for the first and second doses.
Second doses for 16 and 17-year olds
The JCVI has also advised that all 16 to 17 year olds who are not in an at-risk group should be offered a second dose of the Pfizer vaccine. The second vaccine dose should be given 12 weeks or more following the first vaccine dose.
Note that for both of these group, it is on an opt-in bases, and provision to these groups won’t be required if PCN groups want to just continue with existing provision.
Read the guidance from NHSE/I on COVID-19 vaccination deployment for both groups.
COVID-19 vaccination for the housebound
NHSE/I has increased the supplementary fee detailed in the phase 3 general practice enhanced service specification to £20 per visit (increased from the current £10 supplementary fee) to a housebound patient for each vaccination dose given to a housebound patient, by PCN-led and CP-led LVS sites. This supplement is on top of the £12.58 Item of Service fee. This increased supplement will apply for COVID-19 vaccinations (booster and third primary dose only) administered to housebound people from 16 September 2021 until 5 December 2021.
Vaccination Data Resolution Service (VDRS)
The Vaccination Data Resolution Service (VDRS) has been established to resolve missing or incorrect vaccination records for people who are registered with a GP practice in England and who were vaccinated in England, Scotland or Wales. The primary aim of the VDRS is to ensure progression of the COVID-19 vaccination programme and ensure people’s records are correct and allow recommended doses of the vaccination to be booked and received, including booster doses.
As well as citizens being able to access the service via 119, a system has been established whereby sites can access the VDRS to support vaccination record entry and queries. This service should also be used by sites if a person presents for vaccination and has missing vaccination records relating to vaccine administered at sites elsewhere in England and requires sites to complete a form for the VDRS team to process.
For full information on how to access this service, please visit the VDRS page within the COVID vaccinations tech and data workspace on FutureNHS. Register here for a FuturesNHS account.
Health Select Committee inquiry into the future of general practice
This week the Parliamentary Health and Social Care Committee (HSCC), chaired by former Health Secretary, Jeremy Hunt MP, has launched a timely inquiry into the future of general practice. The inquiry presents a key opportunity for the BMA to push our GP campaign asks, as well as to raise wider concerns and recommendations. The BMA will submit a formal response, but members of the public can also submit their comments directly to the inquiry by 14 December.
Serious Shortage Protocol - atorvastatin 20mg chewable tablets (England and Wales)
Serious Shortage Protocol (SSP) for atorvastatin (Lipitor®) 20mg chewable tablets came into effect yesterday, 18 November in England and Wales. The SSP is currently scheduled to end on 12 January 2022. Read more on the NHS Business Services Authority’s SSP website.
Media
NHS pressures
The BMA was quoted in the media about patients having to wait hours for ambulances. Former GPC chair Dr Richard Vautrey was quoted in the Daily Mail, saying: "Some patients choose to go to their GP practice rather than call 999 and when the GP realises the situation, they take action and need ambulance staff to get there. Every second counts. There have been examples where practices have been giving oxygen to people while they wait for paramedics and have run out and have had to find further sources of oxygen." The story was also covered in the Express.
GP abuse
The Guardian interviewed Dr Richard Vautrey, who said that comments by Sajid Javid, Health Secretary, and senior NHS England officers, alongside negative coverage of GPs in some newspapers, had wrongly made the public think GPs were “hiding away” from patients, and exposed staff to abuse. He said: “We’ve gone from the clapping and support of the general public to the huge criticisms of, and unacceptable abuse that’s been levelled at, GPs and their teams both from certain sections of the media but also fuelled by government comments and NHS England comments, which have been completely unacceptable. Both the secretary of state and NHS England overtly supported the campaigning of some sections of the media. And that then fuelled the anti-GP rhetoric, not just nationally, but also locally.”
Northern Ireland
NIGPC chair Dr Alan Stout's interview about vaccine passports in Northern Ireland on BBC Good Morning Ulster (1:39:22) and BBC Nolan Show (12:40) was picked up today by the Belfast Telegraph.
NIGPC deputy chair Dr Frances O'Hagan was interviewed on BBC Evening Extra (22:12) and BBC The View (16:36) about Covid vaccine passports and booster jabs. NIC chair Dr Tom Black was quoted in today's News Letter in a piece about whether mandatory Covid vaccinations should be brought in for frontline health and social care staff. Read the GP bulletin here.
Indicative ballot of practices on potential action (England)
The indicative ballot of GP practices in England closes on 14 November. Please encourage practices to vote here
It is vital that we understand what actions members are prepared, willing and able to take in the future. Each of the potential actions the BMA may subsequently formally ballot on relate to the practice contract and therefore this is a practice level decision.
While the liability of any decision rests with the partnership, we strongly encourage practices to discuss the indicative ballot options with salaried and locum GP colleagues, practice managers and other members of the team working within the practice, since any future industrial action would affect all the workforce within the practice.
You can find full details of the ballot, including the questions we need you to answer and instructions on how to do so, on the BMA website.
GP earnings threshold (England)
Further to our advice last week regarding contractual requirement to ensure GPs earning over the earnings threshold (£150k) to declare their income, please see some further information below.
It is important to note that the new regulation applies to practices who have had their contracts varied to include the new rules, by the service of a 14 day contract variation notice. The legal advice we have received is that no practice has a contractual duty to comply with these new rules until it is served with a 14 day contract variation notice and the period of the notice has expired. Therefore, practices should check whether they have received a contract variation notice and the period of the notice has passed. If so, then you must comply with the new regulations. We understand that a number of GP practices have not received any such notice of variation and therefore the 12 November deadline would not apply.
Dispute
The BMA is in dispute over the pay declaration regulations in the contract. However, the act of being in dispute does not mean that individuals or practices are able to not comply with their contractual requirements without consequence, nor does it permit the BMA to induce/advise individuals or practices to not comply.
How to submit the pay declaration
While the regulations do not outline how the declaration should be made, NHSE/I has published guidance on this and created a process for it.
Regulation 94 of the GMS regulations requires the practice to “have regard to all relevant guidance issued by the Board, the Secretary of State or local authorities in respect of the exercise of their functions under the Act”.
Although practices would not be under a strict legal obligation to comply with NHSEI’s guidance, they are under an obligation to ‘have regard’ to it. This means that they must have in place a management structure which ensures that proper consideration is given to guidance before any relevant decisions are taken. A practice who chose not to comply with such guidance should be in a position to demonstrate that they had regard to the guidance before deciding not to comply. A practice should also be able to demonstrate why it has deviated from the guidance, and the reason should be rational and guided by the practice’s broader obligations under the contract. Otherwise, the Board could argue that adequate ‘regard’ had not be given and therefore take some sort of action.
Date of disclosure
According to the relevant regulations (27A paragraphs 3(a) and 4) which outline the disclosure date, the information must be received by 12 November 2021.
Note that declarations only apply to GP partners, GP subcontractors or locum GPs operating under the core contract and earning above the income threshold, and if they fail to declare their earnings, then the practice will be in breach of its core contract. It does not include salaried GPs and those who are employed by a contractor or sub-contractor. If the practice refuses to deliver a service that is required within the contract/regulations, the practice will be in breach of its core contract.
If the practice breaches its contract, the Commissioner can take action against the practice and the BMA cannot prevent them from doing this due to the inadequacy of trade union laws in protecting GP Partners.
Through the act of self-declaration, the individual will be consenting to publication. Individuals should therefore carefully consider the implications before self-declaration. We believe this policy provides no benefit to patients, but will potentially increase acts of aggression and abuse toward GPs and practices. It will be damaging to morale among the profession and wholly counterproductive in terms of the ability to recruit and retain GPs. We have already received reports of GPs reducing their hours to remain under the threshold which will therefore impact patient access to services at a critical time for the NHS. We believe the position the government and NHSEI have taken on this matter, singling out GPs alone rather than applying this requirement to all other healthcare professionals, is completely unacceptable. We will continue to do all we can to address this.
Read more about the consequences of taking this action or not here
We have also updated our guidance on income declaration with some further detailed FAQs including: Compliance with this new regulation, if/how it applies to salaried GPs, portfolio GPs, locums, subcontractors, how it might be policed/enforceable.
COVID-19 vaccination - condition of deployment for health and social care workers
The Government has announced that 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, under new measures announced this week.
Although the majority of NHS workers are already vaccinated (93% have had their first dose and 90% have had both doses) the government are urging the remainder to get vaccinated, to keep themselves and those they care for safe.
The requirements will come into force from 1 April 2022, subject to the passage of the regulations through Parliament, and there will be a 12-week grace period between the regulations being made and coming into force to allow those who have not yet been vaccinated to have both doses before the measures are introduced.
In response to this, Dr Chaand Nagpaul, BMA council chair, said: “While the BMA has serious concerns about making vaccination mandatory, we’re pleased that the Government has, as we recommended, decided to delay the policy of mandatory vaccination for Covid-19 until spring next year, and released both its workforce impact assessment and it’s equality impact assessment.” Read the full BMA press statement here
COVID-19 vaccination fee increase for the housebound
NHSEI have now agreed to increase the supplementary fee detailed in the phase 3 general practice enhanced service specification to £20 per visit (increased from the current £10 supplementary fee) to a housebound patient for each vaccination dose given to a housebound patient, by PCN-led and CP-led LVS sites. This supplement is on top of the £12.58 Item of Service fee. This increased supplement will apply for Covid-19 vaccinations (booster and third primary dose only) administered to housebound people from 16 September 2021 until 5 December 2021. On this basis, LVS sites should seek to maximise the number of boosters and third primary dose vaccinations given to eligible housebound patients by 5 December. From this date the standard £10 supplement will apply.
TPP access to records
As part of the accelerated access to records programme, patient access to records held in TPP SystmOne is planned to go live in December, with EMIS and Vision to follow in 2022. GPC continue to be engaged in discussions on this and on 8th November, we wrote to NHSX to outline concerns over the impact to patients and doctors of rolling out access to records in TPP practices in December. The letter expressed support for the aims of the broader programme but questioned the timing and whether the necessary infrastructure and support for practices was in place. We will communicate with practices as soon as we know more.
Antibiotic prescribing by GPs in England has fallen
Antibiotic Research UK has published an analysis of new antibiotic prescription data in England ahead of World Antimicrobial Awareness Week (WAAW), 18–24 November, and European Antibiotic Awareness Day (EAAD), 18 November. Key findings include:
Conference of Northern Ireland LMCs
The Agenda for the 2021 Conference of Northern Ireland LMCs to be held 13 November 2021 has now been published.
Curing the sickness in the system - understanding and eradicating bullying in the NHS – webinar
The BMA’s committee for medical managers (CMM) will be holding a webinar at 12.30-2pm on Thursday 18 November, looking at bullying in the NHS as a systemic issue. The following will be on the panel:
The webinar will be looking at the causes of bullying, the impact of it, and how to address this through a series of short talks and a Q&A. More information and registration can be found here
Media
Crisis in general practice / workforce
The Week reported on the crisis in general practice citing the shortage in GPs as one of the main reasons. A BMA spokesperson blamed poor “workforce planning” a “vicious cycle” of overwork and GP shortages.
GP online reported on the workforce data published last week and in response to this, Dr Krishna Kasaraneni, GPC England executive team workforce lead, said: “Since 2015, when ministers first began making promises about increasing GP numbers, England has lost the equivalent of more than 1,700 full-time, fully-qualified GPs. For those left, the average number of patients each GP is responsible for has increased by around 300 - or 15% - over the same period. Most notably, between September 2020 and the same month this year, more than 900 GP partners have quit or retired.
'While new doctors may be choosing general practice, this is not keeping up with the high numbers of GPs leaving or reducing their hours in the face of unsustainable, unsafe workloads and rising hostility against the profession.” He also appeared on Times radio (12min50s) to discuss GP workforce issues where he said that plans to force GPs to work in deprived areas will only backfire, and on BBC Sheffield to discuss local pressures.
NHS Pressures
I was quoted widely in the press overnight in the reports that some patients are having to wait hours in GP surgeries for ambulances. I said: "It leads the practices to manage said patients without the necessary equipment and expertise to do so. Some patients choose to go to their GP practice rather than call 999 and when the GP realises the situation, they take action and need ambulance staff to get there. Every second counts. There have been examples where practices have been giving oxygen to people while they wait for paramedics and have run out and have had to find further sources of oxygen."
The story was covered in the Guardian (also print), Daily Mail, on LBC, and in over a hundred
local and regional news outlets, and aggregators like yahoo! and AOL.
Northern Ireland
NIGPC chair Dr Alan Stout was interviewed on BBC Nolan Show (1:21:26) about Covid infection rates and mandatory vaccinations, and in the Belfast Telegraph about the knock-on effect of cancelled elective care operations on general practice and the growing tide of abuse directed towards primary care staff as health service pressures continue to grow. He was also quoted in a piece in Irish Legal News on personal injury discount rate.
Read the GP bulletin here.
Indicative ballot of practices on potential action
Further to the resolution passed in the recent emergency GPC England meeting rejecting the Government and NHSE/I ‘support plan’, we have this week launched an indicative ballot of all practices in England asking what actions practices might be prepared to take.
As these questions relate to the practice contract this ballot requires a practice level decision. We therefore request each practice provides ONE response to the ballot on behalf of the practice.
While the liability of any decision rests with the partnership, we strongly encourage practices to discuss the indicative ballot options with salaried and locum GP colleagues, practice managers and others working within the practice, since any future industrial action would affect all the workforce within the practice.
It is important that as many practices as possible submit their views in order to provide GPC England with the insight they need to make decisions on next steps. Each practice with a BMA member has a vote. The deadline to vote is 14 November. You can cast your vote here.
The ballot asks whether practices are prepared to take action in five key areas which are to:
Despite all attempts to work on a solution focused package backed by the profession and to put in place a plan that really would improve access, quality of care, free up time by reducing bureaucratic workload and enable practices to properly care for their patients over this expected difficult winter, the Government's ‘access and support plan’ has failed to address these and instead could create further bureaucracy and further demoralise the whole workforce across England.
At this time we must support one another and stand together. The BMA will do all in its power to back GPs.
Read more and access the ballot here.
Read our analysis of what the Government and NHSE/I package means for practices.
Media
Last Friday, the BMA issued a statement about our upcoming indicative ballot of GP practices, which was emailed to members on Monday. The story, and BMA's rejection of the Government's 'support package', was covered in the Mail Online, GPonline, Pulse (also here), Pulse (also here), GPonline, Medscape, Times and GPonline. The Guardian and i news also covered the story, in conjunction with the BMA’s comments regarding the Autumn budget.
GP earnings threshold
Due to the imposition of contract regulations in October 2021, it is now a contractual requirement to ensure GPs earning over the earnings threshold (£150k) to declare their income.
Declarations apply to GP partners, GP subcontractors or locum GPs operating under the core contract and earning above the income threshold, and if they fail to declare their earnings, then the practice will be in breach of its core contract. If the practice refuses to deliver a service that is required within the contract/regulations, the practice will be in breach of its core contract.
Individuals employed by the contractor or employed by a sub-contractor (including where a locum GP is engaged by a third party to provide services) are not within scope and so do not need to declare their earnings. Therefore, salaried GPs and those who are employed by a contractor or sub-contractor, which is a company, and the individual is not named on the contract or sub-contract, will not need to declare their earnings if above the threshold. Company directors are also not included unless they fall under the definition above.
If the practice breaches its contract, the Commissioner can take action against the practice and the BMA cannot prevent them from doing this due to the inadequacy of trade union laws in protecting GP Partners.
Through the act of self-declaration, the individual will be consenting to publication. Individuals should therefore carefully consider the implications before self-declaration. We believe this policy provides no benefit to patients, but will potentially increase acts of aggression and abuse toward GPs and practices. It will be damaging to morale among the profession and wholly counterproductive in terms of the ability to recruit and retain GPs. We have already received reports of GPs reducing their hours to remain under the threshold which will therefore impact patient access to services at a critical time for the NHS. We believe the position the government and NHSEI have taken on this matter, singling out GPs alone rather than applying this requirement to all other healthcare professionals, is completely unacceptable. We will continue to do all we can to address this.
Read more about the consequences of taking this action or not in our Indicative action supporting information
QC advice on holding undated PCN DES resignations
We have updated the briefing with advice from leading Queen’s Counsel on LMCs lawfully being able to hold undated PCN DES resignations, to include advice on whether it would be lawful for LMCs to encourage practices to submit undated letters of withdrawal from the PCN DES.
Response from the Secretary of State on the Government ‘access package’
Following the emergency GPC England meeting on 21 October we wrote to the Secretary of State for Health & Social Care to highlight the BMA’s concerns about the government’s GP access package. We outlined why the existing package had been rejected and was insufficient to meet the needs of patients or adequately support GPs and practice staff. We made it clear that the recent imposition of contract changes meant we consider that we are in dispute. We also stated that GPC England’s resolutions in relation to the access package meant the BMA would now be carrying out an indicative ballot of GP members.
This week we received a response from the Secretary of State who praised the work of general practice and outlined measures to address abuse of NHS workers. However he did not address our key concerns reading the lack of measures to reduce bureaucracy, resourcing premises and providing more support in an accessible way. We will continue to lobby the Secretary of State and Government to what is really needed for GPs and practices, as we progress with the indicative ballot.
GPC England chair stepping down
After being a member of the GPC negotiating/executive team for over 17 years, and chair for GPC England and GPC UK for 4 ½ years, I have decided it is time to step down when the committee meets for the first meeting of its delayed annual session on 18 November. With the need to begin planning for a new contract as we approach the fourth year of our current five-year agreement, it is now time for a new chair to take on this role and be given the opportunity to do this.
Being chair of the BMA’s GP committee has been the greatest privilege and honour. To be able to work on behalf of this great profession for so long has given me the opportunity to work with many extremely gifted and dedicated people and I want to thank them all for their help, support, and encouragement. Together we have achieved a lot including significantly increasing the investment for general practice after a time of austerity, including £2.8bn as part of the five year contract package, turning around the decline in GP pay, removing the burden of indemnity, improving the quality of care for patients with long-term conditions, enabling the recruitment of a growing multidisciplinary team to work with and support GPs - including pharmacists in practices - funding to help young partners and most recently supporting GPs and practices through and COVID-19 pandemic and enabling GPs to play a leading role in the hugely successful delivery of the COVID-19 vaccination programme. I’m proud of all we have accomplished.
I have been overwhelmed and humbled with the many messages I have received this week and I want to thank everyone for their kindness and thoughtfulness.
There is so much more to do, at such a critical time for the profession, and I wish my successor all the best in delivering that. Read my full statement here.
Media
The story was covered by Pulse, the Health Service Journal, Yorkshire Post and Yorkshire Evening Post (also in print), the Telegraph, Medscape, GPonline, the Times, and Healthcare Leader. Pulse also had an Editor’s blog.
Conference of England LMCs agenda
The Agenda for the 2021 Conference of England LMCs to be held 25 and 26 November 2021 has been published today. This is the fifth LMC England Conference, and we are pleased to continue building on the success of previous years in providing a focused space to debate important and pressing issues for GPs across England. It will be a fully virtual event. Read more here
Supporting general practice against abuse
The BMA continues to campaign against abuse of GPs and their staff with a number of resources available on Support Your Surgery campaign page, in order to get the changes that are so urgently needed to support general practice teams.
Please continue to show your support by signing the Support Your Surgery petition to put pressure on the Government to support general practice and use our resources to explain to patients why practices need to work in the way they are doing in order to protect patients from a rising incidence of COVID-19 and to make the best use of the available but limited workforce.
You can also get involved in the #SupportYourSurgery social media discussion by sharing your support across social media.
Please do all you can to help us defend and support general practice at this critical time.
Use our template letter to write to your local MP to outline the current pressures being faced by GPs across the country.
Share our template letter amongst your local patient groups.
Our GP campaign factsheet can also be used to rebut the misinformation in the media and to proactively include in social media posts, letters to the local press or MPs.
BMA Virtual GP parliamentary drop in event
As part of our GP campaign, we held a virtual parliamentary drop in event this week to address the scapegoating of general practice in the media and to provide MPs with the facts about how general practice is meeting the needs of its patients, and what more government must do to support GPs to meet the growing demands placed upon them.
The event which was attended by over 20 MPs and their staff from across the political parties included helpful discussions on overall access to general practice; what MPs could do to support practices in their local areas - including tackling abuse; what was missing from the access package; and how recent statistics showed that GPs are doing more than ever, despite receiving insufficient resource and support to meet this growing demand.
We will be following up with attending MPs in the coming days to ask them to further support our campaign both within parliament and within their local constituencies.
This was reported by Pulse
TPP access to records
As part of the accelerated access to records programme, practices will have seen communications about patient access to records held in TPP SystmOne is planned to go live in December, with EMIS and Vision to follow in 2022. GPC England has been engaged in discussions on this and have expressed significant concerns, including the timing of the launch during winter months, with anticipated unprecedented demand adding to patient safety risks that would result from a December rollout. We are seeking a pause to ensure the views of the profession are better represented and the programme delayed until there is appropriate time to work through our list of concerns.
New GP workforce data (England)
The latest GP workforce data in England for September show the continuing contraction of the General Practice workforce, which the Government’s clearly failed to acknowledge in its ‘rescue package’.
September’s data shows only a total increase of 42 FTE GPs compared to the previous month – which is an increase of 99 fully qualified GPs set against a loss of 57 trainees. This increase is clearly insufficient to cope with the current workload, with the enormous jump in GP appointments in the last month alone (up by 4.7 million, from 23.9 million to 28.6 million).
General practice is now the equivalent of 1,704 fewer fully qualified FTE GPs than 2015 levels. Over the last year (September 2020 to September 2021) general practice has lost 154 fully qualified GPs (a gain of 759 salaried and locum, set against a loss of 913 partners), and 282 fully qualified FTE GPs (430 FTE Partners set against a gain of 148 FTE Salaried).
Meanwhile, the number of patients continues to rise, which means the number of fully qualified GPs per 1,000 patients in England is likely to further fall soon (currently 0.45, compared to 0.52 in 2015)
Full analysis can be found on the BMA’s Pressures in General Practice webpage. Read our press statement.
The Eastern Eye reported on Sajid Javid’s statement to the health select committee when asked if the government was on track to implement the pledge of 6,000 GPs - “No. I’m not going to pretend that we’re on track when we are clearly not.” In response to this I said: “while the health secretary’s admission today is long overdue, it is absolutely not news to GPs and their colleagues working in surgeries across the country that have been decimated by workforce shortages. “The bottom line is we are haemorrhaging doctors in general practice. While more younger doctors may be choosing to enter general practice, even more experienced GPs are leaving the profession or reducing their hours to manage unsustainable workloads.” The Times and Healthcare Leader also reported on the fall in GP numbers.
Urgent workforce support required in Scotland
BMA Scotland has asked for urgent and renewed focus on recruitment and retention of GPs in Scotland, as it published a survey of practices which demonstrates the huge challenges being faced.
The survey shows in stark numbers the level of activity GPs are grappling with – which suggests well above 500,000 appointments were provided in one week at the start of October. On these figures, that is the equivalent of 10% of Scotland’s population consulting with general practice every single week. All practices which were surveyed stated they were carrying out face to face appointments every day. The Scotsman reported on this and quoted Dr Andrew Buist, chair of GPC Scotland.
NHS Confederation – an open letter to primary care
The chair of NHS Confederation, Lord Victor Adebowale, has written an open letter to everyone working in primary care. He says:
‘I want to say thank you on behalf of this organisation to everyone who works in primary care. You don’t need me to tell you how challenging the past 20 months have been. Primary care has met those challenges head-on, rapidly adapting to new ways of working and managing nearly 250 million appointments from January to August.
We know that primary care is a team sport. You have worked together across practices, primary care networks, primary care federations, at place level, and you are taking up the mantle as the drivers of system working too.’ Read the full letter here
BMA COVID-19 data analysis
The latest BMA COVID-19 data analysis is available here.
BMA Private Practice Committee 2021 elections – GP representative (UK)
Nominations for a GP representative to the BMA’s Private Practice Committee 2021 have opened and will remain open until 12pm Monday 8th November. Submit your nomination here
To submit your nomination please go to https://elections.bma.org.uk/
Do not provide and/or perform primary medical services under the National Health Service Act 2006 (and/or the equivalent legislation in the devolved nations) and who earn 75% or more of their income from private general medical practice and are engaged in private general medical practice to the extent of at least 20 hours per week. You have to be a BMA member to apply.
If you have any issues please contact the elections team elections@bma.org.uk
BMA Webinar - The Health and Care Bill
The BMA is holding a member webinar on the Health and Care Bill: What it means for you and what you can do about it – on Wednesday 17th November, 7-8pm.
The BMA believes that if this Bill is passed, it will usher in drastic changes to the NHS in England, impacting the working lives of doctors, and that urgent and significant changes must be made to it.
Register now to attend this event to learn more about the Bill and what you can do about it.
If you have any questions about the event, please contact tbramwell@bma.org.uk.
For further information about the Bill and the BMA’s work in this area, visit: www.bma.org.uk/hcb
Media
GP Appointment data
Responding to the latest set of GP appointment data in England which shows that the number of appointments have increased by 4.7million over the last month and face-to-face appointments have risen by over a quarter, I said: "The enormous jump in appointments in general practice in the last month, up by 4.7million, is a clear sign that GPs are working harder than ever to see as many patients as possible and clear the backlog. This is a testament to the dedication of GPs and practice staff who are going above and beyond to deliver care in exceptionally difficult circumstances, amid a persistent decline in the number of GPs2 and the implications of Covid safety measures on how care can be delivered." Read my full statement here.
This was also covered by Mail Online, The Express (print), Business Telegraph, Yahoo News and hundreds of regional outlets.
Changing face of General Practice
Over the past few weeks, the BMA media team has been working closely with the Financial Times (behind paywall) on a feature on the changing face of General Practice. Several members of GPC were interviewed for the feature including Dr Krishna Kasaraneni, Dr Ben Molyneux, Dr Euan Strachan-Orr, Dr Iain Kennedy, and Dr Christine Clayton. The article covers a number of themes, demonstrating some of the challenges of working in general practice.
Northern Ireland - booster rollouts, flu season and vaccine passports
NIGPC chair Dr Alan Stout was interviewed on BBC Nolan Show about delays to the Covid booster vaccine roll-out. Dr Stout was also interviewed in Friday’s Belfast Telegraph and Saturday’s Health and Life News about the arrival of flu cases in Northern Ireland hospitals. Comments made by NI Chair Dr Tom Black and NI GPC deputy chair Dr Frances O'Hagan earlier in the week about vaccine passports were included in a piece in the Irish News about a local coffee shop owner who compared vaccine passports to Troubles-era segregation. Both Dr Black and Dr Stout were also quoted in the Belfast Telegraph in a piece about pressures at the Royal Victoria Hospital's ED. Read the GP bulletin here.
BMA to undertake an indicative ballot of practices on potential action
Further to last week’s emergency GPC England meeting, the necessary preparations have been made and, next week, we will proceed with an indicative ballot of all practices in England.
Our condemnation of the DHSC (Department of Health and Social Care) and NHSEI plan stands, and we are now seeking the support of practices to demonstrate to Government and NHSEI that GPs and practices will not tolerate this unacceptable situation. We will give practices their say on further potential actions we can all take to persuade minsters and NHSEI to give practices the real support they require so that they can care for their patients as needed, not least over this expected very difficult winter period.
The BMA will now proceed to the indicative ballot of practices, which will open this Monday.
It will be based on the resolutions passed by GPCE last week and will include questions on further actions practices might be prepared to take, such as:
It is important to stress that these actions are not directed at patients, or the care they receive, but at Government and NHSEI.
The timescales are as follows:
Launch the indicative ballot with details for how to vote electronically (Monday 1st November)
Physical reminder letters reach GP partner members / practices (from 5th November)
The electronic ballot closes (13th / 14th November)
The ballot data is processed (15th / 16th November)
Results will be communicated to members (18th / 19th November).
The BMA is also preparing for a formal ballot of members on IA (industrial action), which for legal reasons could not have happened sooner than at least six weeks after the emergency GPCE meeting last week.
Moving to an indicative ballot of practices before a formal ballot of members on IA also means we not only get to gather the views of practices on the proposed forms of actions much more swiftly, but it also means we can keep pressure up nationally by using the result as further leverage in the interim.
General Practice is being pilloried and abused and together there is a need to fight back, protect and defend. This is an extremely difficult time for us all. We must support one another and stand together. This is not going to be easy, but the BMA will do all in its power to back GPs at this time.
Further information on the ballot will be shared with practices this Monday.
We are also rapidly developing additional workload management resources and guidance, which we will release in the coming days.
| As it is clear that neither the Government nor NHSE/I understands the scale of the crisis impacting general practice, or have provided the necessary measures to support the profession at this critical time, we would encourage practices to review our workload control in general practice paper. |
Read our statement following the GPCE vote rejecting the Government and NHSEI (NHS England and NHS Improvement) plan here
Our analysis of the Government and NHSE/I plan
Supporting general practice against abuse
The BMA continues to campaign against abuse of GPs and their staff with a number of resources available on Support Your Surgery campaign page, in order to get the changes that are so urgently needed to support general practice teams.
Please continue to show your support by signing the Support Your Surgery petition to put pressure on the Government to support general practice and use our resources to explain to patients why practices need to work in the way they are doing in order to protect patients from a rising incidence of COVID-19 and to make the best use of the available but limited workforce.
You can also get involved in the #SupportYourSurgery social media discussion by sharing your support across social media.
Please do all you can to help us defend and support general practice at this critical time.
The GPCE chair and BMA Patient Liaison Group chair have also recently written to a host of patient groups asking for their support. Please feel free to share the template letter amongst your local patient groups.
Use our template letter to write to your local MP to outline the current pressures being faced by GPs across the country.
Our GP campaign factsheet can be used to rebut the misinformation in the media and to proactively include in social media posts, letters to the local press or MPs.
Covid vaccination medical exemption certification
The government has introduced an exemption process for those who are unable to be vaccinated and/or tested for COVID-19 for medical reasons.
This guidance applies to England only.
BMA guidance on the Covid vaccination medical exemption certification process is available here.
Your wellbeing
The BMA is here for you and offers supportive wellbeing services which include face-to-face counselling. You can access one-off support or, after triage, a structured course of up to six face-to-face counselling sessions. Call 0330 123 1245 today or visit the website for more information.
For all other support, speak to a BMA adviser on 0300 123 1233 or email support@bma.org.uk
Read more about doctors’ wellbeing during the pandemic and on Twitter @TheBMA
BMA Webinar - The Health and Care Bill (England)
The BMA is holding a member webinar on the Health and Care Bill: What it means for you and what you can do about it – on Wednesday 17th November, 7-8pm.
The webinar will include:
The BMA believes that if this Bill is passed, it will usher in drastic changes to the NHS in England, impacting the working lives of doctors, and that urgent and significant changes must be made to it.
Therefore, we encourage all members to register now and attend this event to learn more about the Bill and what you can do about it.
If you have any questions about the event, please contact tbramwell@bma.org.uk.
For further information about the Bill and the BMA’s work in this area, visit: www.bma.org.uk/hcb
Research on providing annual health checks for autistic people (England)
UCL’s Centre for Research in Autism and Education (CRAE) is conducting a research project to understand the views of primary health care professionals on the value and feasibility of providing annual health checks for autistic people. By taking part, participants have the chance to shape policy recommendations and provide their opinions regarding the implementation of annual health checks for autistic people.
They are inviting GPs, nurses and other primary health care professionals in England who are involved in the implementation of other health checks (e.g., learning disability health checks, diabetes annual reviews etc) to take part in a short survey.
Participants do not require any expertise in autism. Find out more by contacting Jade at j.davies@ucl.ac.uk.
Read our COVID-19 toolkit for GPs and practices, which provides comprehensive guidance for practices to manage contractual issues and service provision during the coronavirus pandemic.
You can access all the BMA guidance on COVID-19, including ethical guidance, here
Media
Government / NHSEI plan for general practice
Council chair Dr Chaand Nagpaul was featured in the Guardian on Friday, expressing worries about the 'support package' announced by the health secretary, which could damage the relationship between GPs and their patients at a time when general practice staff are facing increasing levels of abuse.
West Midlands regional council deputy chair Dr Mary McCarthy was also quoted in the Shropshire Star talking about the pressures on general practice, saying that without adequate staffing levels and resources, "hardworking GPs and practice staff are becoming more and more limited by factors beyond their control".
The rejection of the GP support package continued to receive attention, with coverage found among others in Pulse (also here and here), the Daily Mail, and Nursing in Practice on Wednesday and on Thursday, in Pulse (also here and here) and the New Statesman.
Pressure on General Practice
North West regional council deputy chair Dr Rob Barnett was interviewed on BBC1's North West Tonight on Monday evening (item at 1m10s, Dr Barnett's interview at 5m54s) about GP pressures.
NI GP committee deputy chair Dr Frances O'Hagan was interviewed in the Belfast Telegraph and on The View from Stormont about the growing pressures on the health services. Dr O'Hagan's interview was picked up today by the:
GP online reported that the BMA demands honesty from the government and NHSE over GP workforce crisis. Doctors condemned the misleading claims from the government and NHSE that have downplayed the general practice workforce crisis and urged ministers to fix the GP shortage, rather than fix the data.
Pulse wrote an article on myth busting the rescue plan, outlining that demand outstrips supply, there are not enough GPs to provide what the government and patients are asking for.
The Financial Times wrote a piece about many GPs choosing part-time or locum posts to avoid burnout.
COVID Vaccine and Booster Programme
NIGPC deputy chair Dr Frances O'Hagan was interviewed on Sunday Politics programme (15:04) about Covid infection rates and pressures on the health service. Dr O'Hagan's interview was picked up by all other BBC News outlets, the Belfast Telegraph and today’s London Daily News. She was also interviewed on the Nolan Show (06:50).
NIGPC chair Dr Alan Stout was interviewed in the Belfast Telegraph about Covid certificates. Dr Stout was also interviewed on BBC Talkback about the current situation with vaccine uptake. The piece begins at 04:29 with his interview at 11:34.
NIC chair Dr Tom Black was interviewed on BBC Newsline last night about mandatory vaccinations for health and social care workers. Dr Black's interview beings at 17:27. He was also interviewed yesterday in the News Letter on the same subject.
Read the GP bulletin here.
Read the latest Sessional GPs newsletter here
