Overwhelming rejection of government’s ‘rescue package’
As you will have seen from our message yesterday, GPC England has unanimously rejected the Government’s ‘rescue plan’ which fundamentally failed to address the ongoing crisis in general practice. The committee called for GPs and LMCs to disengage in its implementation in line with the overwhelming view that you voiced to us in a snap poll last weekend. By this we mean they should not comply with the ‘rescue plan’ – which would mean spending more time on bureaucratic process, and complying with target driven leagues tables to ‘name and shame’ GPs. We are also taking steps towards industrial action over the Government’s decision to impose plans on GP earnings declarations and forcing GPs to be involved in the Covid vaccination exemption process.
We believe that Sajid Javid, the Secretary of State for Health and Social Care, ignored GPs expertise and experience when he laid out his bully’s charter and that patient care will suffer as a result, and are now calling on the Government to withdraw their plan and work with us to introduce a new contract which ensures general practice is properly funded, with safer workload and reduced bureaucracy, and ultimately provides better care and services for patients and vastly improved working conditions for doctors and their teams.
Read more about the response of GPCE and the actions that we are taking
Read our statement here
Workload control in general practice
As it is clear neither the government nor NHSE/I show they understand 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 look again at our Workload Control in General Practice paper.
In addition to the actions highlighted above, GPC England also resolved that practices should be encouraged to take actions to prioritise higher quality of care that delivers a safer service to our patients and protects the wellbeing of our workforce. Practices should not feel pressured to return to a traditional 10 minute treadmill of face to face consultations, that are neither good for patients nor clinicians. Instead, they should:
We will provide more guidance in the coming days on what practices could do if NHSE/I and government fail to take the action needed to properly support general practice.
Analysis of NHSE/I ‘rescue package’
Following our initial response last week to the NHSEI/government’s ‘rescue package’ – we have done some rapid analysis of each element of the package that shows just how many sticks there are. Our analysis shows what the package really means for general practice and highlight that it consists mainly of things NHSE/I and/or government has already stated or things that are already the case, and are clear that the few positives are completely outweighed by the impact of the negatives (often packaged as positives). We hope this will help explain just how damaging the package is and dispel any suggestion that this provides the necessary support for general practice.
All health systems have been told they must develop and submit a plan, by Thursday 28 October, assured by the ICS board. We believe CCGs and ICS managers should resist this punitive and damaging approach, and we know that many want instead work to support not punish practices.
We have also updated our General Practice factsheet showing the facts and figures of the crisis.
These are also available on our Support your Surgery campaign page
GP declaration of earnings guidance
Ahead of the Government’s GP pay transparency deadline of 12 November, which were introduced on 1 October, when the GMS and PMS Regulations were amended to require some GPs to self-declare their earnings, we have now published guidance on what this means for GPs.
We have already made clear our significant concerns about the compelling GPs to publicly declare their NHS earnings over a certain threshold, especially in the current climate of threat, aggression and violence towards GPs. This will be damaging to morale among the profession, could lead to an increase in abuse targeted at individual GPs and will be wholly counterproductive in terms of the ability to recruit and retain GPs. We have received reports of GPs already reducing their hours to remain under the threshold. GPs need to consider carefully the implications before making a self declaration.
As GPC England did not agree to this amendment to the regulations, we consider these to have been imposed on the profession and in breach of the original agreement. In addition, GPCE has resolved that it will seek support from BMA council to formally ballot members for industrial action over the Government’s decision to impose this solely on GPs
Supporting general practice against abuse
The BMA continues to campaign against abuse of GPs and their staff with our Support Your Surgery campaign to get the changes that are so urgently needed to support general practice teams.
The latest resource added to the campaign page is a zero-tolerance poster to show that assault on practice staff, threatening or abusive behaviour or damage to property will not be tolerated.
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.
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 vaccinations
Next steps for vaccinations of 12 to 15 year olds
NHSE/I has published a letter setting out the next steps in the deployment of COVID vaccinations for 12-15 year olds, with vaccinations now being offered via the National Booking Service and mass vaccination sites (rather than PCNs) to support the school based programme.
In a few areas where there isn’t good geographic coverage, there may be a small number of PCNs who are asked to take part. This would utilise the Enhanced Service amendment which has already been agreed and would only be on the agreement of both the commissioner and the PCN. The majority of PCNs will not be expected to be vaccinating this group but to continue to focus on boosters, the at-risk 12-15s and third doses for the severely immunosuppressed.
Government COVID antiviral strategy
On Wednesday the Government announced plans to roll out new anti-viral drugs via clinical trials over the coming winter months, with a view to deploying more widely in summer 2022. Trials have found the twice-daily tablet molnupiravir (Merck) cut the risk of hospital admission or death by about half- 480,000 courses have been secured.
A further 250,000 courses of PF-07321332/ritonavir (Pfizer) have also been secured, which is currently undergoing clinical trials with three Phase Two and Phase Three trials looking at the clinical effectiveness of the treatment currently underway.
The drugs reduce the severity of symptoms and speed up recovery time for those who test positive. The two new drugs are yet to be approved by the Medicines and Healthcare products Regulatory Agency.
COVID-19 medical exemptions
A systematic medical exemptions process was introduced on 30 September, to ensure that those who, for medical reasons, should not be vaccinated (and/or be tested) for COVID-19 are not disadvantaged across certification use cases.
Given the need for clinical judgement and access to patient records, the Department of Health and Social Care have set up a system using 119 to initially assess patients and may then ask GPs, secondary care clinicians or midwives, depending on who is involved in the person’s care, to assess applications. Steps have been taken to limit the number of applications reaching clinicians (e.g. no appointment required, pre-screening process).
Read the guidance detailing the process and clinical criteria and payment mechanisms (for GPs).
PCN survey
Please complete our PCN survey to tell us about the issues you are facing and how the pandemic has affected your work. Your responses will provide us with insights to share among PCNs. It is open to all clinical directors of PCNs across England and closes on 27 October. Take the survey >
Management of IBS in primary care - survey
King’s College London are currently carrying out research that aims to capture how Irritable Bowel Syndrome (IBS) is diagnosed in clinical practice by GPs and the dietary advice provided to patients with IBS. If you would like to participate in this short survey (no longer than 5-8 minutes) click here
GPC UK election
Voting for a representative for Nottinghamshire and Derbyshire in the GPC UK election is now open.
To submit your vote please go to https://elections.bma.org.uk/
Voting will close on 25 October at midday.
You will need a BMA web account to access the election, if you do not have one you can register for access via the ‘I want temporary access to the website’ option available here. Once you register for an account you will be given an ID number which you will need to share with the elections team to enable them to give you access.
If you have any issues please contact the elections team elections@bma.org.uk
GP Trainee Regional Elections
Nominations for the reopened elections for GP Trainees Regional Elections 2021 opened on Wednesday 20th October at midday and remain open until 3rd November at midday. Below are the seats open for nomination.
If you would like to submit a nomination, please go to https://elections.bma.org.uk/.
If you have any questions about the elections please email elections@bma.org.uk
Media
Rescue package
I told Mail Online that GPs are 'deeply unhappy' about Government's plans to improve NHS access for patients and support GPs. When the 'rescue package' was announced last week, I said that the plans will not reduce the burden that practices carry and free up any more time for doctors to see more patients. I was also quoted in the Yorkshire Post where I said that preoccupation with face-to-face consultations is disappointing and that minsters should listen to GPs, adding that what was needed was "a more intelligent conversation about the variety of appointments that patients need."
Speaking on BBC Cornwall (starting at 07:13).GPC England deputy chair Dr Mark Sanford-Wood said: "There are not enough GPs, we're all working ourselves into the ground and if we have to see all patients face-to-face, the numbers of appointments will drastically reduce." He also said: "The Government has thrown GPs under the bus, diverting the blame for shortages in numbers to GPs who are burned out and exhausted as we're down by about 8,000 in total." His quotes also featured in South West local media outlets, like the Plymouth Herald (also in print) and Western Morning News.
GPC England executive team member Dr Krishna Kasaraneni was interviewed on local BBC Radio stations, and a letter from GPC England executive member Dr Farah Jameel was also printed in the Yorkshire Post (and print).
Dr George Rae, BMA North East regional council chair, was quoted in the print edition of the Sunday Sun (Newcastle upon Tyne) saying that GPs were preparing to 'hang up their stethoscopes and leave the profession altogether'.
Dr Chaand Nagpaul, BMA council chair, was quoted in the Daily Telegraph (print) and online, saying that forcing GPs to see patients face-to-face was 'discrimination and harassment' explaining that no other parts of the NHS were blamed via league tables for workforce shortages. The story has also been covered by Eastern Eye, who quoted Dr Chaand about another element of the plans - to rank surgeries based on performance. He was also quoted in the Guardian saying that the rescue package would leave GPs open to more abuse.
Other coverage on this topic with BMA commentary includes The Chester Standard, Express explaining the shortage of GPs, Mail Online (also in print) about the crisis facing the NHS, the Times (also in print), Daily Mirror (also in print), Daily Mail (also here), Daily Telegraph (print), Daily Express (also in print), Medscape, GPOnline, Pulse (also here), GB News, over a hundred regional press, Express Digest, and on local BBC radio stations.
Vote to reject the ‘rescue package’ and BMA action
The story was featured in Sky News, Guardian (also here, and here, also print front page), Daily Mail (also here, also in print), Daily Mirror (in print), Daily Star (in print), Telegraph (also in print), Sun (also in print), Times, LBC, GPOnline, Pulse, Medscape, and hundreds of local and regional media outlets, and has been discussed in most news bulletins for TV and radio stations across the country since last night. I was interviewed on LBC and Times Radio.
NHS pressures
The BMJ reported onEngland’s chief medical adviser, Chris Whitty, speaking at the RCGP conference last week, saying that the NHS will have an “exceptionally difficult” winter, whether there is another covid-19 surge or a slump. He was due to speak after the health and social care secretary for England, Sajid Javid, who pulled out of attending at the last minute. Dr Farah Jameel, GPC England executive team member, was also quoted “The fact that Sajid Javid failed to keep his promise to address doctors at the RCGP conference tells you everything we need to know about this health secretary. He is running scared of speaking to the profession face to face because he knows his plan is, in reality, no plan at all. The secretary of state had the perfect opportunity today to stand up and defend his so called ‘rescue package’ and hear at first hand what GPs thought of it. But ducking out of the conference shows he wasn’t willing or, in reality, able to defend the indefensible.”
Rejection of call for Plan B measures
The BMA's response was featured widely across the media after the Health Secretary rejected calls for plan B measures to be put in place, despite predicting that infections could reach unprecedented levels, in a press conference on Wednesday. Council chair Dr Chaand Nagpaul was interviewed on BBC News, Sky News, BBC Breakfast (clip at 1m45s in replay, highlights here and here), BBC News at 9 (at 8m54 on replay), and ITV's Good Morning Britain (first item in replay). Council deputy chair and GP, Dr David Wrigley, was interviewed on LBC and Yorkshire regional chair and GP Dr Brian McGregor was interviewed on BBC Radio Humberside (at 2h in replay) on the same topic. I was interviewed by BBC Radio Leeds.
COVID vaccine and booster roll-out
I spoke to BBC York (around 8.09am) on Tuesday about the Covid vaccine and booster rollouts.
I said that practices are limited by when they are able to give the booster and flu jabs and that practices are working hard to mitigate any delays to the rollout and are trying to see as many patients as quickly as possible. I was also interviewed on the BBC Richard Stead Breakfast show about COVID vaccinations.
Access to face to face GP appointments and the UK GP recruitment crisis
Dr Iain Kennedy, GPC UK and SGPC member, appeared on Channel 4 News Wednesday at 7-8 pm to talk about access to face to face GP appointments and the UK GP recruitment crisis.
Read the GP bulletin here.
Government’s ‘rescue package’ out of touch with GP crisis
After weeks of promising an ‘emergency package’ to rescue general practice, we are hugely dismayed that whilst additional funding of £250m has been promised, the Government’s so called ‘rescue package’ as a whole offers very little and shows a Government completely out of touch with the scale of the crisis on the ground.
GPs and their teams will now be facing the worst winter for decades, and as a result, patients’ care will suffer. Appointments will be harder to book, waiting times will get longer, more of the profession could leave and GPs will struggle to cope.
It is also disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments. While in-person consultations are a key feature of general practice and absolutely necessary for some patients, the pandemic has proven that in many other cases, phone or video appointments are entirely appropriate and appreciated by patients, and a crude focus on percentages or targets is completely unhelpful.
Throughout our lobbying of ministers and NHS England in recent weeks, the BMA has been clear that without a concerted effort to reduce bureaucracy, admin and red tape in practices, patient access and care was at risk.
We had four simple asks – and only increased sentencing for assaulting healthcare workers has been fully answered, but is meaningless if the Government refuses to address the crisis fuelling such abuse. The Secretary of State has started to address a second, by talking more positively about general practice at times but he needs to do much more by way of action to publicly support the profession. Sadly the tone of arrogance and dissonance within the document sends quite the opposite message, not one of thanks to the profession. I made our serious concerns about this when I meet him this week.
These proposals will only confirm the profession's belief that ministers and NHS England fail to understand the dire state of general practice – or that they, not hardworking GPs, are to blame. It is truly frightening that we have a government so ignorant to the needs of such a core part of the NHS. GPs want to improve the care we offer to our patients, but this package will not enable us to do that as we had hoped. There can be no doubt that this lack of action at such a critical time will force many GPs to hang up their stethoscopes and leave the profession for the last time.
Read my full statement
Analysis of NHSE/I package
Following our initial response to the NHSEI/government package – we have done some rapid analysis of each element of the package that shows just how many sticks there are. Our analysis shows what the package really means for general practice and highlight that it consists mainly of things NHSE/I and/or government has already stated or things that are already the case, and are clear that the few positives are completely outweighed by the impact of the negatives (often packaged as positives). We hope this will help explain just how damaging the package is and dispel any suggestion that this provides the necessary support for general practice. We have also updated our General Practice factsheet showing the facts and figures of the crisis. These are also available on the BMA website
GPC England/LMC virtual listening event 21 October 7-8pm (England)
Following recent events and the Government’s so called ‘rescue package’ for general practice published yesterday, the GPC England Executive Team will be holding a listening event via Microsoft Teams this coming Thursday 21 October from 7-8pm. We want to hear the views and ideas from LMCs around the country to help shape how GPC England responds.
There is no need to register, but please note that there is a limit of 300 people attending, so entry to the Teams meeting will be permitted on a first come first served basis.
GPCE Exec Team members are also looking to attend regional LMC events following this emergency session and will send more information about that in a separate email direct to LMCs.
We will be emailing a link to the Teams meeting early next week.
Your wellbeing
When we are working so hard to do our best for our patients, the daily torrent of abuse and vitriol directed at GPs and their teams, both in the national media and from patients and the public, is having a major impact on the morale and mental well-being of many of us. With the long awaited emergency support package failing to offer the hope needed that there will be meaningful support for the winter ahead, rather than more targets and performance management, it’s important that we our best to care for one another.
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.
Workload Control in General Practice
As it is clear neither the government nor NHSEI show they understand the scale of the crisis impacting general practice, or have come forward with the necessary measures to support the profession at this critical time, we would encourage practices to look again at our Workload Control in General Practice paper. Practices should not feel pressured to return to a traditional 10 minute treadmill of face to face consultations, that are neither good for patients nor clinicians, but instead adopt arrangements that allow for longer but fewer consultations, and which delivers a higher quality of care and a safer service to our patients.
Infection control recommendations for primary care
The UK Health Security Agency today has published recommendations for changes to Infection Prevention and Control Guidance (IPC) in primary care following previous recommendations which focussed on changes in elective care.
The main amendment is the reduction of the 2 metre social distancing rule to 1 metre, highlighting the need for appropriate mitigation. The BMA has already made the point that even 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 and buildings. The guidance strongly emphasises that local decisions and local risk assessments will ultimately govern judgements such whether a face-to-face consultation is appropriate and where physical distancing can be safely reduced, which we welcome. It is therefore for practices to determine what arrangements they have in the surgery. The full guidance will be published shortly. Read more about the UKHSA review into IPC guidance
New GP workforce data
The latest GP workforce data for August show the continuing contraction of the General Practice workforce, something that the Government’s failed to acknowledge in its ‘rescue package’, although many media reports, including BBC reports yesterday, have started to helpfully focus on this important issue.
While an increase of around 1,700 GP trainees since the previous month is a positive addition, General Practice is now 1,803 fully qualified full-time equivalent (FTE) GPs short of 2015 levels. Over the past year alone General Practice has lost 380 fully qualified FTE GPs, which equates to a net loss of 307 fully qualified individual GPs (a gain of 611 salaried and locum GPs, with a loss of 918 partners).
The number of primary care nurses and direct patient care staff has also dropped over the past year, and marginal increases in the number of admin and non-clinical staff are not enough to cope with increasing administrative and bureaucratic burden.
Meanwhile, the number of patients continues to grow equating to more pressure on remaining GPs as the number of fully qualified GPs per 1,000 patients in England have fallen). This, combined with the latest GP appointment data, which showed that the total number of appointments delivered by general practice remains higher than pre-pandemic levels and the fact that appointments delivered face-to-face has risen to 57.7%, clearly illustrates that the profession is working harder than ever.
Full analysis can be found on the BMA’s Pressures in General Practice webpage.
Supporting general practice against abuse
The BMA continues to campaign against abuse of GPs and their staff with our Support Your Surgery campaign to get the changes that are so urgently needed to support general practice teams.
The latest resource added to the campaign page is a zero-tolerance poster to show that assault on practice staff, threatening or abusive behaviour or damage to property will not be tolerated.
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 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.
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. Please share with us replies you may receive from your MP.
Joint statement condemning abuse of healthcare staff
BMA has co-signed a joint statement condemning abuse of health and care staff, together with the Academy of Medical Royal Colleges, NHS Employers, NHS Confederation, Royal College of Midwives, Royal College of Nursing and UNISON.
We ask the Government and media to 'be honest and transparent with the public about the pressures facing health and care services and that this is going to have direct implications for patients and their carers. This means making clear that the problems are systemic and that blaming and abusing individual staff members is never acceptable behaviour.'
This statement was reported in the Guardian, BusinessFast, BusinessMayor, Yahoo! and MSN. We were also mentioned in a Pulse article about a branch surgery of a Staffordshire GP practice that was forced to close down for two days last week, related to staff receiving verbal patient abuse.
Following the Guardian article BMA council chair Dr Chaand Nagpaul was interviewed on LBC.
COVID-19 Vaccinations
Local Vaccination Services SOP update
An update to the Local Vaccination Services SOP has been published, including updates relating to Phase 3, and the vaccination of eligible children and young people. It is relevant to PCN-led vaccination sites and community pharmacy-led vaccination sites participating in phases 1, 2 and / or 3 of the vaccination programme.
Light touch assurance process on third doses of Moderna for immunosuppressed patients
NHSE/I has also published a light touch assurance process on the identification and invitation by GP practices of severely immunosuppressed patients eligible for a third dose as part of their primary course of vaccination. We would encourage practices to identify and invite these vulnerable patients, by noon Friday 15 Oct. Read more here
COVID-19 Vaccination PGD and national protocol
A revised Spikevax (formerly COVID-19 vaccine Moderna) PGD and national protocol for England have now been published here
Flu vaccination guidance on accessing centrally supplied flu stock
DHSC have published guidance for general practice and community pharmacy, outlining the process for accessing centrally supplied flu vaccines for this season.
In order to achieve higher vaccine uptake rates compared to last year, DHSC has secured an additional supply of influenza vaccines, which will be for available from early November, for practices and community pharmacies to top up local supplies and where it is most needed.
Practices should determine if there is a need for further flu vaccines by assessing current uptake rates in eligible cohorts, and will be able to place orders for this stock from 18 October.
Health inequalities toolkit
The presidential project of last year’s BMA president Sir Harry Burns culminated in a health inequalities conference this week to launch the BMA’s health inequalities toolkit. The toolkit brings together ideas of projects for colleagues across the UK and across medical specialties to try, should they wish to do something to tackle the growing health inequalities felt in this country.
The toolkit is intended to support clinicians and medical students, and that the Government should take responsibility for reducing health inequalities, rather than put that responsibility on clinicians.
If you are involved in a project that seeks to address health inequalities that you would like to share with colleagues, please email info.phh@bma.org.uk to request a submission form.
PCN Clinical Director survey
Please complete our PCN survey to tell us how things are going and how the pandemic has affected your work. Your responses will provide us with insights to share among PCNs and help us negotiate with NHSE/I. It is open to all clinical directors of PCNs across England and closes on 27 October.
GPC UK election
Voting for a representative for Nottinghamshire and Derbyshire in the GPC UK election is now open.
To submit your vote please go to https://elections.bma.org.uk/
Voting will close on 25 October at midday.
You will need a BMA web account to access the election, if you do not have one you can register for access via the ‘I want temporary access to the website’ option available here. Once you register for an account you will be given an ID number which you will need to share with the elections team to enable them to give you access.
If you have any issues please contact the elections team elections@bma.org.uk
Media
Government ‘rescue package’
I was interviewed on ITV News (from 18m20s), BBC Breakfast and other BBC News bulletins, on BBC London (1:07:30 into replay), and talkRADIO (7min into the 07.00-07.30 segment).
GPC England executive team member Dr Krishna Kasaraneni was interviewed on ITV Calendar, Sky News (3.30pm), and on BBC Radios: Three Counties (4pm), Nottingham (4.08pm), Wiltshire (at 2h17m), Cambridgeshire (at 2h24m30s), Newcastle (4.30pm), Solent (at 2h40m), Humberside (at 2h46m) and Cumbria (at 2h52m45s); and on LBC (5pm).
GPC deputy chair Dr Mark Sanford-Wood appeared on Channel 5 News (5 and 6 pm), BBC Radio Dorset (7.25am), BBC Radio Hampshire (7.55am), BBC Radio Solent (at 2h25m40s) and BBC Radio Devon (at 3h10m).
GPC England exec team member Dr Farah Jameel appeared on the BBC's News at Six and News at Ten (all BBC TV channels - item at 1m30s, interview at 4m40s), and GB News last night, as well as Bloomberg radio this morning (11am).
In addition, GPC member and BMA north-west regional chair Dr Rob Barnett appeared on BBC Radio Merseyside (3h11m in replay, in a package played on BBC Radio News at Six and News at Ten (first item in the replay, Dr Barnet's interview at 2m35s), and in a TV package in the BBC's News at Six (4m into replay). North East regional council chair Dr George Rae was interviewed on BBC Radio Tees (replay at 3h43) and LBC as well as commercial radio stations in the north of England.
GP trainees committee chair Dr Euan Strachan-Orr was interviewed on BBC Radio 1 Newsbeat (12.45 pm - first item in the replay). BMA east midlands regional council deputy chair Dr Kalindi Tumurogoti on BBC Radio Leicester (7.05am), West Pennine LMC chair Dr Amir Hannan was interviewed on BBC Radio Manchester (3h10m20s into replay), and Norfolk & Waveney LMC chair Dr Tim Morton was interviewed on ITV Anglia (3m50s into replay).
The story and our views also received widespread coverage on ITV News, BBC News (Online), BBC and commercial radio news bulletins, LBC (online and on air) in the Guardian, the i, Financial Times, Daily Express (also in print), Pulse, GPOnline, and MSN. Some outlets focused on the 'league tables' of face-to-face appointments that would be published as a result of the new measures. This could be found in Sky News, the Times, Telegraph, Daily Mail, Daily Mirror, Independent, Head Topics, commercial radio stations across the country, Yorkshire Post, and Yahoo!
Many chose to cover what the plan includes and why the BMA criticised it, like the Guardian (also here, and here also both in print), ITV News, BBC News, the Telegraph, Times Radio, Medscape, the Express, Pulse (also here, here and here), Healthcare Leader, Nursing in Practice, Healthcare & Protection, Head Topics, BusinessFast, regional coverage including the Yorkshire Post (also in print) and Eastern Daily Press (also in print).
NI package of support for general practice
A statement issued by NIGPC chair Alan Stout in response to the announcement of a £5.5m support package for general practice in Northern Ireland this winter was carried across multiple news outlets: BBC News Northern Ireland, all BBC Radio Ulster news bulletins, Belfast Telegraph, Belfast Newsletter, Irish News, BelfastLive and Q Radio News. Dr Stout was also interviewed on the U105 Frank Mitchell Show about the introduction of a league table for GP practices in England and possible implications for Northern Ireland primary care. The interview was carried across yesterday’s U105 news bulletins.
Pressures in general practice
There were reports about pressures in general practice after an analysis by House of Commons
Library staff for the Liberal Democrats showed there was disparity across the country in the average number of patients per GP. In response to this I said: "These figures clearly highlight the serious pressure that is being placed upon general practice at present, as the shortage of GPs alongside a large increase in demand means that many practices are struggling." I was also interviewed on BBC Leeds about winter pressures and vaccinations.
GPC deputy chair Dr Mark Sanford-Wood was on BBC Radio Somerset (2h10m into replay), also discussing the pressures on general practice and their impact on doctors, and again on BBC Radio Somerset (1m45s), saying: "We are in the middle of a state of emergency in general practice."
The Daily Mail (also in print) and Times also reported on the health secretary's plan to reduce paperwork for GPs in order to facilitate more face to face appointments. The BMA was quoted, saying surgeries are overloaded and understaffed.
Workforce data
Sky News analysis showed the number of GPs has been decreasing while the demand is above pre-pandemic levels. In response to this, Dr Krishna Kasaraneni, said: "The shortage of GPs has both a huge impact on the remaining colleagues, whose workload increases, but crucially it has an effect on the care practices are able to offer". The Sunday Times reported on the impact of workforce shortages with a piece from a Glasgow GP quoting the BMA's calculations on the numbers of GPs per patient in the UK.
After certain sections of the media suggested the "average GP is now working a three-day week", the BMA responded to set the record straight, and highlight the workforce shortages in general practice. I said: "The very notion of a 'part-time' GP is often anything but. The data used in this article actually shows that the average hours worked by a GP in England is around 40 hours per week – the same as most full-time jobs.” I was also interviewed on Times Radio (12m30s), saying the data is a recognition that the pattern of general practice is changing, and there are huge pressures on general practice - and by the time you count 'part-time' GPs' hours, they are equivalent to what one would call full-time.
This was also covered in GPOnline, Pulse, Express Digest, the Daily Mail and Telegraph, Yahoo!, AOL and many regional outlets. There was also further coverage about the disparity in GP numbers per patients across the country, with articles in inews, the Independent, Daily Mirror, Metro, Eminetra and the Canary. And dozens of regional and local media also covered the issue looking at the numbers for their own area.
Read the GP bulletin here.
Survey on General Practice response to the current crisis
We highlighted last week the current pressures in general practice, the media and government pressure to increase face-to-face consultations (despite current government guidance), and the increase in abuse and aggression toward GPs and practice staff. We also outlined our call on the government for support and protection for practices, and that we had held discussions with DHSC and NHSE/I.
While we await their firm proposals for a package of support, we want to know what you might be prepared to do if the package is not adequate.
We therefore sent an email on Wednesday asking for views on what GPs may do next and what they are prepared to do if there is no satisfactory response. We would be grateful if LMCs could also add to the push now to raise awareness in order to inform us of the strength of feeling within the profession and the measures that people might be prepared to take.
The survey includes a range of possible actions, and asks for any further actions you might consider that are not specifically asked. But this is not a ballot – it is important that we understand what action you would like to see and what action you would personally be willing to take.
If you haven’t already filled the survey out - please do complete it if you haven’t already and encourage your colleagues to do so as well.
The survey will close at 9am on Wednesday 13th October 2021.
Media
The Telegraph reported on our survey asking for views on what GPs may do next and what they are prepared to do if there is no satisfactory response. A BMA spokesman said: "This is a critical time for the profession and it is important that members have their say on the current state of general practice. As the BMA frequently does, we are asking members for their views in this confidential survey for internal use while we continue to pursue positive engagement with NHS England and the Government. To be clear, this is not a ballot." Pulse also reported on the GP support package.
Support your surgery campaign
In light of the current reports of a rise in GP abuse, both by some patients and media, the BMA continue to campaign in defence of GPs and their staff with our Support Your Surgery campaign to get the changes that are so urgently needed to support general practice teams.
We have now added a zero-tolerance poster to show that assault on practice staff, threatening or abusive behaviour or damage to property will not be tolerated.
Please also continue to show your support by signing the Support Your Surgery petition and sharing it with colleagues, friends, and families to put pressure on the Government to support general practice.
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.
We are asking members to use our template letter to write to your local MP to outline the current pressures being faced by GPs across the country.
We have also produced a GP campaign factsheet that 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.
Letter of thanks to GPs in Scotland
Earlier this week, Scottish GPC sent a joint letter with the Scottish Secretary for Health and Social Care, thanking GPs and recognising the difficult situation general practice are in:
“We absolutely reject this and condemn the increasing abuse that has been directed towards General Practice staff at what already is a difficult time for all health and social care workers. This is completely unacceptable.”
We would urge the UK Government to follow suit, to show their support for GPs in England.
GP Pay Transparency – NHSE/I Guidance
The statutory instrument to amend the GMS and PMS Regulations affecting pay transparency has been laid before Parliament and will come into force on 1 October 2021. NHSE/I has now published guidance on how the regulation will work in practice, which is available here.
We have made clear our significant concerns about the change compelling GPs to publicly declare NHS earnings above £150,000 especially in the current climate of threat, aggression and violence towards GPs. We believe this will be hugely damaging to morale among the profession and wholly counterproductive in terms of the ability to recruit and retain GPs. If this comes into force, it will have been imposed on the profession in breach of the original agreement and GPC England has not agreed to them being introduced in the absence of similar requirements across all providers of various primary care services.
This was reported by GPonline, where GPC chair, Dr Richard Vautrey, said that pay transparency was agreed as part of the five-year contract deal 'on the clear understanding that GPs were not being singled out but that the government would also require other professions such as pharmacists and dentists to publish NHS earnings above a certain figure too'.
GP appointment data
The GP appointment data for August has been published, showing that the total number of appointments delivered by general practice in August (25.5 million) remains higher than pre-pandemic levels (23.3 million in August 2019). The percentage of appointments delivered face-to-face has also risen to 57.7%, while the percentage of appointments delivered remotely (by telephone and video consultations) has fallen.
There are 1,904 fewer fully qualified full-time GPs than there were in 2015 despite government promises for 6,000 more. We are almost 8,000 GPs short. In the face of a huge backlog or care in hospitals as well as communities, these figures show that GPs are working harder than ever and dealing with even more patients than before the pandemic. Read our full statement
COVID-19 Vaccination PGD and national protocol (England)
A revised Spikevax (formerly COVID-19 vaccine Moderna) PGD and national protocol for England have now been published – access here
Mitigating the effect of dispensing fees cut
GPC England and the DDA asked NHS England to intervene to change the fee scale. As calculated (correctly under an agreed formula) it took account of a 14% increase in volume triggered by the Covid pandemic and the first lockdown. This has caused the steep reduction in fees, which will be partially abated next April.
It is not just dispensing doctors who are affected by this fee cut. The scale also includes non-dispensing GPs who claim for Personally Administered items, including vaccines. There is on average a 35 pence per item decrease in dispensing fees.
The DDA have asked all of their members to write to their MPs as per their template letter and we encourage LMCs to share this with practices locally.
GPC UK election
Voting for a representative for Nottinghamshire and Derbyshire in the GPC UK election is now open.
To submit your vote please go to https://elections.bma.org.uk/
Voting will close on 25 October at midday.
You will need a BMA web account to access the election, if you do not have one you can register for access via the ‘I want temporary access to the website’ option available here. Once you register for an account you will be given an ID number which you will need to share with the elections team to enable them to give you access.
If you have any issues please contact the elections team elections@bma.org.uk
Media
Abuse
There’s a supportive article in the Observer around the abuse of GPs and practice staff.
Pulse reported on attacks in the media against GPs and their survey of GPs found that 50% think a return to pre-pandemic levels of face-to-face appointments is not possible, citing problems around infection control and increased demand throughout the pandemic. Dr Richard Vautrey, GPC chair, was quoted saying the recent meeting with the Secretary of State, Sajid Javid, was used to call for ‘clear public backing for GPs’ acknowledging ‘the huge pressure they are under’, urgent investment in primary care to ‘remove unnecessary bureaucracy’ and a Government commitment to work with the BMA on ‘a national campaign to stop the abuse of NHS staff’.
The Mail reported that MP Tim Farron has written to the health secretary Sajid Javid challenging him to publicly support GPs and their staff in the wake of a ‘worrying rise’ in abuse from members of the public.
There have been a few more positive media coverage - an article in Pulse covered the negative articles recently directed at GPs, and another discussed the results of the media regulator ruling about the Telegraph columns from Alison Pearson. A third Pulse article covered the news that Deputy Prime Minister Dominic Raab admitted that GP appointments 'have returned to pre-pandemic levels'.
The Daily Mail also reported that Sajid Javid said at a fringe event at the Conservative party conference that remote consultations had a 'role' in healthcare and that 'it continues because - I don't think this is surprising at all - that you find a lot of people that actually prefer it.'
Northern Ireland
Northern Ireland GPC chair Dr Alan Stout was interviewed in Friday’s Belfast Newsletter about threats made against the Northern Ireland Health Minister.
Read the GP bulletin here.
Tackling abuse and aggression towards GPs
As you will be aware, over the last few months, reports of patient abuse and aggression toward GPs and practice staff have increased, coinciding with very high levels of pressures in general practice.
At the same time, patients and the media are calling on general practice to increase face-to-face appointments, whilst government infection control guidance remains for practices to ensure social distancing and make use of remote consultations to protect patients and staff, when we know that most practices are providing a balance of remote triage, telephone, digital and face-to-face appointments based on their assessment of patient need.
Richard met with the Secretary of State, Sajid Javid, last week and called on the government to enable and support general practice over the coming winter. At that meeting we made it crystal clear how unacceptable the increasing abuse against GPs and the general practice workforce is, fuelled by a damaging and demoralising misinformation campaign in some parts of the media, as well as comments from politicians.
Following that meeting we have written to the Secretary of State again to outline our key asks tosupport andto protect practices against abuse, which include:
· Providing clear public backing for GPs, recognising the huge pressure they are under
· Invest urgently in primary care and remove unnecessary bureaucracy
· Support increased sentencing for those who assault healthcare workers
· Commitment to work with the BMA on a national campaign to stop abuse of the NHS staff
In the last few days we have had discussions both with officials from the Department of Health and Social Care and NHSE/I on these key asks, but we are clear that there remains an urgency to deliver them. They have confirmed they will return to us next week with some firm proposals for a package of support for General Practice focused on quickly tackling abuse / aggression, low morale and unmanageable workload.
Consultant support for GPs
The BMA consultants committee are showing its support in their statement published today, unequivocally condemning the unacceptable abuse against hardworking and dedicated GPs and the general practice workforce – read the statement here. We wholeheartedly welcome this support from our consultant colleagues.
The BMA continue to campaign in defence of GPs and their staff with our Support Your Surgery campaign to get the backing of patients to make the changes to primary care that are so urgently needed.
Please continue to show your support by signing the Support Your Surgery petition and sharing it with colleagues, friends, and families. It's important to get as many signatures as possible to put pressure on the Government to support general practice.
We have produced a GP campaign factsheet that can be used to rebut the misinformation being published in the media and to proactively include in social media posts, letters to the local press or MPs. Please do all you can to help us defend and support general practice at this critical time.
You can also get involved in the #SupportYourSurgery social media discussion. Many GPs and patients are sharing their support for each other and practices across social media. This will help us reach as many people with the campaign as possible.
Following increasing instances of GPs being scapegoated by the media and rising instances of abuse against GPs and their staff, we are asking members to use our template letter to write to your local MP to outline the current pressures being faced by GPs across the country.
COVID-19 vaccinations
Boosters for health care staff
Health and social care workers can now book their COVID-19 vaccination boosters through the National Booking Service or by calling 119.
Booster vaccinations can be administered no earlier than six months after completion of the primary vaccine course.
Medical exemptions
A systematic medical exemptions process is being introduced today, 30 September, to ensure that those who, for medical reasons, should not be vaccinated (and/or be tested) for COVID-19 are not disadvantaged across certification use cases.
Given the need for clinical judgement and access to patient records, the Department of Health and Social Care are asking GPs, secondary care clinicians and midwives to assess applications. Steps have been taken to ensure this does not impact workload (e.g. no appointment required, pre-screening process).
Read the guidance detailing the process and clinical criteria and payment mechanisms (for GPs).
Vaccine Data Resolution Service (VDRS)
The Vaccine Data Resolution Service (VDRS), established by NHSE/I and NHS Digital, aims to resolve missing or incorrect vaccination records for people vaccinated in England who have a current NHS number and are registered with a GP practice in England.
A pilot of outbound calls was launched on 3 August to patients identified as having a second dose but where no first dose is showing on the national immunisation database (NIMS). This service continues to operate. An inbound service accessed has also been launched, and referrals to the VDRS can be made via any of the services accessed via 119.
Note that119 and VDRS call agents will not provide clinical advice and cannot assist with queries related to vaccinations received overseas. If the query relates to personal information that is incorrect on the patient record (e.g. name, address), these will still need to be resolved by their GP practice. If a member of the public believes they have missing or incorrect COVID-19 vaccination data, they should be advised to call 119.
Flu vaccinations for primary care contractors and frontline staff
The Enhanced Service Specification for Seasonal influenza vaccination programme 2021/22 has now been published. We have been lobbying for many years for GPs and practice employees to be included within specification for the annual flu programme and for practices to be able to claim an item of service fee for giving flu vaccinations to their staff.
We are therefore pleased that we have now been able to secure agreement with NHSE/I to the inclusion of all frontline practice staff in the Enhanced Service. All practice staff with patient contact, including both medical and administrative staff, will now be eligible to receive a flu vaccination from employing practice or the practice at which they are registered as a patient, and practices will receive an item of service fee for their provision. As in previous years locum GPs will also continue to be eligible for a free vaccination. The provision of flu vaccination to all target groups will therefore be covered under CNSGP.
NHSE/I has also published guidance (available on the Future NHS platform) on the process for recording flu vaccinations administered to patients not registered with a practice.
GP Recruitment Campaign 2021 (England)
HEE (Health Education England) has just begun campaign activity to raise awareness of Round 1 GP specialty training applications, scheduled to open Thursday 4 November – Wednesday 1 December for an August 2022 start. GPC has been working in partnership with HEE since September 2015 and GP trainee numbers have increased by 36% during that period - from 5,026 to 6,855 in July 2021.
Whilst continuing to signpost doctors who might be thinking about a career as a GP to the GPNRO website pages, HEE is keen not to simply rely solely on social media or online content, and would like to hear innovative ideas and thoughts about how to reach more doctors via gprecruitment@hee.nhs.uk
Thank you to all those that have come forward and volunteered to help create lots of new content to populate the new Choose GP Instagram page, which complements the Facebook community.
NHS 111 Booking into general practice
During the pandemic a temporary change was made to the requirement for practices to make available to NHS 111 one appointment per 3000 registered patients to one appointment per 500 registered patients. This temporary change will stop at the end of September 2021 and the contractual requirement will revert to 1:3000.
Medicines Delivery Service extension (England)
An extension of the medicines delivery service has been announced by NHSE/I. The announcement letter explains that to help provide support to people who have been notified of the need to self-isolate by NHS Test and Trace, the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service will be commissioned from 1 October 2021 to 31 March 2022 (inclusive) for anyone living in England who has been notified by NHS Test and Trace to self-isolate.
GPC UK elections
Voting is now open for a representative for Hampshire and Isle of Wight in the GPC UK by-election.
Submit your vote here. Voting closes on 7 October at midday.
Nominations are open for the following seats:
You must be a BMA member to stand in this election.
Submit your nomination here. The deadline for nominations is midday on 7 October.
You will need a BMA web account to access the election, if you do not have one you can register for access via the ‘I want temporary access to the website’ option, after which you will be given an ID number which you will need to share with the elections team to enable them to give you access.
Media
Following the meeting with the Secretary of State last week, The Daily Telegraph, Pulse and GP online carried our comments, with Dr Vautrey saying: "The Secretary of State must confront the reality of unsustainable workload pressures, poor premises, the impact of the care backlog and secondary care work transfer to general practice and we urged him to trust practices to deliver services to patients without the rigidity, bureaucracy and burden of QOF or unnecessary CQC inspections." It was also reported by the BMJ
Wearing face masks in healthcare settings
Pulse reported that GPs around the UK are urging patients to continue wearing face masks when visiting practices to reduce the risk of spreading COVID-19. GPC England members Dr Brian Balmer, Dr Jackie Applebee, as well as Dr Phil White, chair of GPC Wales, and Dr Andrew Cowie, deputy chair of Scottish GPC were all quoted.
Data shows more GP appointments than pre-pandemic levels
The Independent, Daily Mail, Daily Express, Sun, Times, ITV, Pulse, National World, over two hundred local and regional press outlets, Yahoo! MSN and AOL all picked up our press release on appointment data and the fact that, despite having less staff, practices continue to do more work now than before the pandemic.
ARRS funding needs to be “as flexible as possible”
GP Online reported on GPC’s warning that millions of pounds in unspent 'additional roles' recruitment funding must not be lost to general practice.
Issues continuing with PCSE pensions portal
GP Online carried GPC comments on the GP pay impact as late pension deductions leave practices facing cashflow problem.
Fuel crisis
The BMA issued a press release this week in response to reports about fuel shortages around the country which calls for healthcare workers to be prioritised for fuel due to the impact this may have on their ability to carry out their work. I did a pre-recorded an interview with ITV News, shown on the lunch time news on Tuesday, and I also featured on LBC live and BBC London live at 16.40.
Wales
Dr Phil White, Chair of GPC Wales, has outlined the pressures in general practice in Wales, calling for greater funding needed to ensure patient support. Read his statement here
Read the GP bulletin here.
Read the latest sessional GPs newsletter here
Tackling abuse and meeting with the Secretary of State for Health and Social Care
In recent weeks, GPs and their practice teams have been subjected to a systematic and cruel smear campaign by sections of the media, this has directly resulted in rising incidences of abuse and aggression being experienced by general practice. This has left many in the profession feeling totally demoralised and under siege.
We want to be clear - general practice has continued to see patients throughout the pandemic, in July alone 27 million appointments were delivered by general practice, the majority of which were face-to-face. This is testament to the true integrity, grit and determination of GPs and their practice teams. We will not let false narratives go unchallenged.
Following a horrific act of aggression against a practice last Friday, we wrote to Sajid Javid earlier this week demanding an urgent meeting and summit to discuss the unacceptable level of abuse being levelled against GPs and their staff, and have called for a comprehensive national violence reduction strategy, and as a result of our pressure, I met with him face to face yesterday.
It was a robust and frank meeting in which I highlighted the serious damage to morale the current anti-GP rhetoric was having on the whole profession, the fear that many on the GP frontline had and that this must stop. I raised the need for urgent action to challenge abuse against GPs and their staff, and support for the whole general practice workforce and called for legislative change to better protect the workforce. I stressed the need for Government to explain to the public why healthcare workers are still working within the constraints of infection, protection and control measures, that large numbers of face-to-face consultations were taking place every day and that clinicians would always see their patients when it was necessary to do so. We also discussed the value of telephone consultations as part of a mix of access offers - something that is increasingly appreciated by many patients who now receive more timely appointments as a result but whose voices are not being heard in the toxicity of media reporting.
I also raised the essential need longer-term premises development so we have the space to offer access to the increasing multidisciplinary team that is developing in many practices, in addition to being a safer place for patients with the on-going pandemic. I focused on the need to address the unsustainable workload pressures, the impact of the care backlog and secondary care work transfer to general practice and urged him to trust practices to deliver services to patients with long-term conditions without the rigidity, bureaucracy and burden of QOF or unnecessary CQC inspections. We also called for far more action to enable practices to expand their workforce and for government to deliver on their own commitment of 6000 more GPs. But most importantly I focussed on the need to acknowledge, thank and value the GP workforce who have gone above and beyond over the course of the pandemic from being pivotal in delivering the COVID vaccination program to continuing to keep seeing patients throughout the course of the pandemic.
We now demand that the Government take immediate action to tackle the abuse against GPs and their practice staff, which is having a serious impact on the wellbeing and morale of the profession and provides both immediate and long term support to practices at this critical time.
Read our statement following the meeting.
Read our message to the profession, including resources for practices how to remove violent patients from your practice list.
Dealing with abuse of practice staff on social media from patients
We have developed guidance how to protect yourself from online abuse and the steps GP practices can take against patients who leave abusive comments on social media or websites. It outlines what to do first, how to report content to the provider and what criminal and civil actions are possible.
On top of what the BMA has been doing, other GPs are making it clear the pressures they’re under.
NHS Confederation is also showing their support in their statement ‘Standing with primary care’ where they ‘stand unwaveringly in support of the vital contribution of our primary care members’.
Following increasing instances of GPs being scapegoated by the media and rising instances of abuse against GPs and their staff, we are asking members to use our template letter to write to your local MP to outline the current pressures being faced by GPs across the country.
Media intrusion
We are aware that with the intense national media vilification of General Practice some journalists are approaching local practices directly for comment. There is no obligation to respond to the media. If practices would like guidance about a specific situation they can reach the BMA media team at Media Office MediaOffice@bma.org.uk. We are also concerned that some publications will send photographers to practices looking for photos designed to support their narrative of primary care being hard to access. The Editor’s Code of Conduct which guides the practice of press organisations in the UK says that journalists should identify themselves when asked to do so and that no journalists should operate on healthcare property without permission, this applies to photographers as well. So if practice staff see a possible photographer who is not welcome then the best advice is to ask them to identify themselves and then ask them to leave.
Media
Reported on by Chronicle live, The Daily Telegraph (print and online), Express (print and online), Yahoo news, Nursing Standard, Mail Online, and in multiple regional titles including London Economic, Evening Standard, BasildonEcho, LancsLive, Management in Practice, on LBC, Shields Gazette (print), Sunderland Echo (print), BirminghamLive, the Express, Daily Mail, Pulse, Pulse, the Clinical Services Journal, GM Journal, Nursing in Practice, and on local radio stations.
Support your surgery campaign
The BMA has been campaigning consistently and vociferously in defence of GPs and their staff over the summer with our Support Your Surgery campaign to get the backing of patients to make the changes to primary care that are so urgently needed and to help them understand why we still need to work in the way we have been doing, primarily to protect them from infection.
Please continue to show your support by signing the Support Your Surgery petition and sharing it with colleagues, friends, and families. The petition is just one element of the campaign but is a way of putting pressure on the Government to properly support general practice.
We have produced a GP campaign factsheet that can be used to rebut the misinformation being published in the media and to proactively include in social media posts, letters to the local press or MPs. Please do all you can to help us defend and support general practice at this critical time.
You can also get involved in the #SupportYourSurgery social media discussion. Many GPs and patients are sharing their support for each other and practices across social media. This will help us reach as many people with the campaign as possible.
GPC UK meeting update
GPC UK met yesterday in its first meeting of the new session and where new members were welcomed to the committee for the year ahead.
The main item of discussion was the recent shocking rise in cases of abuse and aggression being directed at GPs and practice teams, fuelled by false narratives put forward by sections of media. The committee discussed the actions urgently needed to tackle the abuse against GPs and their staff and to support the. I also updated the committee on plans to meet with the Secretary of State for Health yesterday afternoon, more of which is reported in the next item.
The committee discussed further campaigning planned by the BMA in defence of GPs and their practices following on from the Support Your Surgery campaign. Work on the actions that can be taken next both nationally and by individual practices is happening at pace over the coming weeks.
GPCUK also discussed the following key items:
The GPC Uk update is available here and policy lead update is available here.
Support for GPs
We were pleased to have some recognition from the Deputy Prime Minister, Dominic Raab, who thanked GPs in answer to a question by Robert Largan MP to get GPs to see patients face-to-face. Mr Largan said GPs have done a brilliant job and are working long hours in challenging circumstance, but many constituents have raised concerns about seeing their GP face-to-face.
Mr Raab paid tribute to GPs by saying “I join him in thanking GPs for the heroic job they have done in seeing us through the pandemic” and also said appointments have returned to pre pandemic levels.
COVID vaccinations
Phase 3 and booster vaccinations (England)
The roll out of the COVID booster vaccination programme has started this week, for the eligible cohorts (aged 50 and over, health and social care workers, and those clinically extremely vulnerable aged 16 and over).
Those who have had their second vaccine at least six months ago are eligible, and in line with JCVI advice, people should receive either one dose of the Pfizer vaccine or half a dose of the Moderna vaccine, which means for some people their booster dose may be different from the vaccines they had for their first and second dose. People could also be offered a booster dose of the Oxford/AstraZeneca vaccine if they cannot have the Pfizer/BioNTech or Moderna vaccine.
Updated Patient Group Directions and national protocols for use in England for Pfizer BioNTech Covid-19 Vaccine BNT162b2 and Comirnaty have been published.
Overprescribing report
The national overprescribing report was published yesterday by the Department of Health and Social Care. The key recommendations from the review are:
Although we agree with the overall aim and recommendations, and are pleased to see the growing number of practices that now have pharmacists working in them and increasingly making a difference both in terms of quality care and workload reduction - something we lobbied hard for - this report omits to understand that the cost of achieving change is enormous, with a service so overstretched with targets demands and a dwindling tired workforce in all health service sectors.
It also fails to highlight how difficult it can be to access alternative services, with long waiting times and limited interventions, leaving GPs with lack of support for their patients with acute and often complex needs. It is also regrettable that international comparators and any lessons learned from overseas haven’t been incorporated into the report.
The good work that general practice does do in managing multiple co-morbidities and complexity, having to make complex decisions in partnership with patients within a very resource poor environment, should be acknowledged.
End of the shielding programme and closure of the Shielded Patient List (SPL)
We have updated our webpage on shielding following the Government announcement that the shielding programme has now ended and patients will no longer be advised to shield.
Pension deductions by PCSE
We are aware that around 2,000 practices did not have pension deductions taken for one or more GPs from June through August. PCSE inform us that the majority will have the deductions in total taken from payments to practices during this month’s payment runs. The deductions will be taken from the first payment processed by PCSE during the month, be that global sum or any other payment. Where the deduction total is greater than this payment the balance will be taken from the next payment during this month.
PCSE tell us that they have communicated this to affected practices but we are keen that this is understood. They have advised us that practices will also receive a separate statement with details of the pensions deductions being taken and that it will be important that practices compare both statements to ensure they have the full view of payments in vs the deductions.
GPC UK elections
Voting is now open for the following GPC UK by-election: Representative for Hampshire and Isle of Wight
Submit your vote here. Voting closes on 7 October at midday. You will need a BMA web account to access the election, if you do not have one you can register for access via the ‘I want temporary access to the website’ option available here. Once you register for an account you will be given an ID number which you will need to share with the elections team to enable them to give you access.
If you have any issues please contact the elections team elections@bma.org.uk
LMC UK conference agenda committee elections
The results from the LMC UK conference agenda committee elections have now been confirmed, and are as follows:
Bethan Roberts (Wales & member of GPC UK)
Alastair Taylor (Scotland)
Paul Evans
Shaba Nabi
Rachel McMahon
Elliott Singer
Ursula Brennan (Northern Ireland)
GP Trainees committee chair
Congratulations to Dr Euan Strachan-Orr who has been elected as the new chair of the GP Trainees committee. Thanks too to Dr Lynn Hryhorskyj for all the work she has done for GP trainees during her time as chair.
Media
GP pressures
Following BMA media work there were two items last night on ITV regarding the pressures on general practice. ITV national news looked at the reality of GPs' experience, featuring an interview with Dr Ehsan Alkizwini at his surgery in North London, as well as an interview with Dr Farah Jameel, GPC England executive, discussing the wider picture. Dr Jameel said: "Are GPs closed? Absolutely not. Are they seeing patients face to face? Yes. However, complexity has increased, workload has increased. There is a significant backlog and the significant numbers of patients who need to be seen or who need access to their GPs has risen." Read about it in this BMA tweet
There was also a regional coverage on ITV West Country, with an interview with Dr Shaba Nabi, GPC England member, at her surgery in Bristol. Dr Nabi said: "At my end of the spectrum, at the more senior end of the spectrum - are leaving in their droves, they're retiring early, because the job has become too pressured, so we need to make the job better. I think it's important that the public know the truth, and the truth is that we're a system under pressure, huge pressure. And scapegoating general practice is not the answer to that problem. I just want people's understanding, nothing else. I don't want claps, I don't want cards, I just want a bit of understanding from the public that we're all humans first, and we're all patients first as well."
The Daily Mail reported on GP pressures and quoted from my interview with Radio 4 Today programme where I said: “The pressures on services are incredible but we recognise that there aren't enough GPs, there aren't enough nurses. To resolve that we need the Secretary of State, we need the Government, to act to do what they promised – which is to recruit 6,000 more GPs, to invest in our premises, to invest in our staff and our service – and by doing that we will get a better service for our patients.” My comments on Radio 4 were also covered by the Daily Telegraph (print) and Mail Online. GP Online reported that Kernow LMC were raising concerns that practices in Cornwall are dealing with an unmanageable workload and it feared that they would not have the resources or resilience to handle any additional pressure in the coming month.
Face-to-face appointments
We have sent a strong rebuttal to the Daily Mail in response to their article alleging that lack of face-to-face GP appointments 'caused stillbirths to spike 88%' in England during pandemic, which they have chosen not to publish but is attached.
GB News (BBC1 Wales) reported on the issue of face-to- face appointments, and the continued Daily Mail campaign, echoed in the Sun.
Scotland
Dr Andrew Buist, chair Scottish GPC, wrote a piece for the Herald regarding the support needed by general practice. He said: "Knocking us when we are doing our best will damage morale, and risks harming workforce retention, only making things worse. We need to continue the hybrid model of patient access with telephone and face-to-face appointments and we need to be trusted to do our jobs and prioritise our capacity to those who need us most."
In an article in Herald Scotland, Dr Iain Kennedy, a GP and medical director for Highland LMC, warned that face-to-face appointments will have to be rationed permanently to ensure that the most urgent patients are prioritised amid staff shortages and surging workloads. He said there would be "no going back to business as usual" and that telephone triage of patients "is here to stay".
Northern Ireland
NIGPC chair Dr Alan Stout was interviewed on BBC Breakfast Show about pressures on HSC (interview begins at 1:14:31), in Irish News about booster jabs, and on BBC Nolan Show about the vaccination of healthcare workers (interview begins at 20:20). Dr Stout was also mentioned in Irish News, in an article by Sinn Fein vice president Michelle O’Neill, about the importance of vaccination.
Wales
BMA Cymru Wales has written to the Welsh Health Minister demanding an urgent intervention from following a rapid deterioration of the service in recent weeks in Wales. Dr Phil White, Chair of GPC Wales, said: “Within the last six weeks the situation has escalated to a point where the Welsh Ambulance Service is having to refuse to attend emergency requests from the public and clinicians alike. It is astonishing that we’ve reached this point. After repeatedly raising concerns over the last few years that the situation was worsening, we are sadly seeing our fears borne out. If action is not taken immediately to resolve this situation then patients will die, there’s no doubt about it.”
Flu vaccine delays
I was interviewed on BBC Radio Humberside (starting 2h09) about flu vaccine logistical issues. I said: "This is really difficult for practices. They're trying their best to provide a good service to their patients and they're under huge workload pressure at the moment. And not just GPs, but practice receptionists, practice managers and many others working in the practice. They're trying to provide a good service but these are just added difficulties and added frustrations."
Read the GP bulletin here.
#Support Your Surgery campaign
At a time when so many are criticising general practice, we would encourage you to continue to use the resources and tools available on the Support Your Surgery campaign page to get the support of our patients to make the changes we urgently need to see.
The need for the campaign was clearly demonstrated this week as Sajid Javid, Secretary of State for Health and Social Care, showed how out of touch he is with the state of general practice through the comments he made in parliament. We would therefore encourage patients and the profession to sign our petition calling on Government to provide the resourcing need so we can increase the number of GPs and other support staff in England.
This is one of the ways to address the concerns we share with our patients and to reduce the workload pressures we currently experience – and morethan 10,000 people have now signed our petition - please show your support and sign it here
A paper version of the petition is also available to use in practices, and which could be used for the large number of patients attending surgeries, including in forthcoming vaccination sessions. Once completed, these can be emailed back toinfo.gpc@bma.org.uk.
You can also show your support for the campaign by adding a ‘Support Your Surgery’ Twibbon or Twitter banner, or Facebook banner, to your social media profiles.
Letter to Secretary of State
Following our joint letter with RCGP, NHS Confederation and the Institute of General Practice Management (IGPM) sent last week, we have again written to the Secretary of State, Sajid Javid, to address the inflammatory comments he made in Parliament regarding increasing face-to-face GP appointments and that they were working with the BMA about this.
We pointed out that although GPs would like to be able to do this, the simple truth is that we need far more than just words to do so, and we need to remember “a return to how things were before the pandemic” would mean a return to a profession at breaking point, too few GPs, practice nurses, support staff, inadequate premises and longer waiting times to obtain an appointment for patients.
We have again called for urgent action from government to tackle these fundamental issues including an immediate suspension of QOF, not least following the impact of the blood bottle shortage and the ongoing workload pressures and restrictions practices are experiencing. Read our statement in response to Sajid Javid’s comments
Media
This was reported by the Independent, Medscape, Pulse, GP Online, GP online and dozens of local and regional outlets including the Yorkshire Post (also front page in print), as well as MSN.
GP survey - deadline extended (England, Wales, Northern Ireland)
Please complete our survey to tell us about the issues affecting you most, including your workload, recruitment and your future career plans.
This is an important survey and will support our negotiations and lobbying, and is a crucial important part of our GP campaign. Your responses will also help us better understand the issues affecting GPs and ensure we are representing the profession effectively.
The survey is now open until 22 Septemberand will only take around 10-15 minutes to complete.
COVID vaccinations
COVID vaccinations for 12-15 year olds
The UK CMOs have now advised that the additional likely benefits of reducing educational disruption provide sufficient extra advantage in addition to the marginal advantage at an individual level identified by the JCVI, and therefore recommend on public health grounds to extend the offer of vaccination with a first dose of Pfizer-BioNTech vaccine to all children aged 12 to 15.
The Enhanced Service Specifications have been updated to include the expanded “at risk” group for 12-15 year olds, which means that practices will be covered by indemnity and can start vaccinating this group.
The Collaboration Agreement which has been approved by MHRA for phase 3 of the vaccination programme has been updated. Practice vaccination groups are required to have a Collaboration Agreement, although not required to use the template.
Healthy school-aged children aged 12 to 15 will primarily receive their COVID-19 vaccination in their school, and practices will only be involved in the vaccination this group where the commissioner requests, with the agreement of the practice, and in collaboration with the school-aged immunisation service. GP vaccination sites should not therefore proactively vaccinate this group unless they been requested to do so. Read the guidance from NHSE/I here
Booster vaccines
We welcome that the JCVI has now confirmed that booster vaccines should be offered to those more at risk from serious disease, and who were vaccinated during Phase 1 of the vaccine programme (priority groups 1 to 9). The booster vaccine dose should be offered no earlier than 6 months after completion of the primary vaccine course, in the same order as during Phase 1. We would anticipate that many GP practices will want to co-administer these boosters with flu vaccination and we expect local teams to facilitate this. There is also a need for government and NHSE/I to do far more to support practices, not only in the delivery of this important programme for our patients, but also to address the wider workload pressures practices are experiencing, something which is only likely to increase as the winter progresses.
NHSE/I have announced a further increase to the funding for PCN clinical directors from October to March 2022 although this will be from 0.25WTE to 0.75WTE rather than the higher 1WTE payment made previously. Whilst it is necessary to recognise the significant work clinical directors and those working with them are currently doing, it is disappointing that this has been reduced rather than increased further as is really needed. The updated Phase 3 specification has now been published.
We have also written to the MHRA asking for clarification with regards to the continued recommendation for a 15-minute observation period following provision of the Pfizer-BioNTech ‘Comirnaty’ vaccine for COVID-19. We highlighted that this causes a particular problem for GP practices participating in the vaccination programme as many practice premises lack the facilities or space to safely undertake the required 15-minute observation period following provision. We would encourage LMCs and practices to also write to MHRA (info@mhra.gov.uk) to address this issue.
Media
The Guardian reported on the COVID vaccinations for 12-15 year olds and the booster campaign, and the article mentioned our advice in the bulletin that GP vaccination sites should not proactively vaccinate this group unless they been requested to do so.
Recording overseas vaccinations
We continue to raise the issue of recording overseas vaccinations on practices’ IT systems, a technical solution for recording on the NHS immunisation management service (NIMS) is still being worked up but not yet ready to roll out.
In the meantime, NHS Digital has advised that vaccination sites should follow the guidance from Public Health England (see pages 13 and the table on page 34-35), relating to vaccines given abroad, in terms of which vaccine should be given in England depending on which was given abroad.
If someone has had their first dose outside of the UK, they should be directed to a walk-in clinic which administers the same brand of vaccine they have had for their first dose, or a GP practice (especially if they have had a brand of vaccine not available in the UK) to arrange their second dose. Patients should be told that at this time, only vaccines delivered in the UK will count towards UK COVID-19 certification and that the NHS is working on a solution.
If a patient registered with a GP in England informs you that they have had a vaccination overseas, you may choose to record the details in the usual clinical notes section of the patient’s GP record. Overseas vaccinations should not be added to the Pinnacle (Outcomes4Health) point of care system as this will result in incorrect GP payments.
Blood bottle supply update
NHSE/I has sent a letter to practices updating on the supply disruption of BD blood bottles. The availability of alternative products and improvement in BD’s production capabilities, alongside the efforts of NHS staff to manage use, mean that the supply situation is no longer as constrained as it was. However, the issue has not yet been completely resolved.
The letter advises that testing activity in primary and community care, in line with the best practice guidance, can resume, stocks permitting from 17 September. Practices are advised to work through any backlog of tests over a period of at least eight weeks, prioritising as required, in order to spread out demand for tubes. All organisations are asked to regularly review their stock holding and upcoming planned care requirements and aim not to re-stock to more than one week’s worth of tubes based on demand from June and July 2021.
Blood tests in hospital will still be more limited and we have asked NHSE/I to send messaging to hospitals to stop them shifting blood test requests to general practice.
COVID-19 Response: Autumn and Winter Plan 2021
The BMA has produced a short briefing regarding the Government’s Winter Plan, outlining the main points expressed in the Secretary of State’s speech and the Prime Minister’s press conference.
Read the BMA press statement which reflects our position on how we believe the Government should approach this period of time
End of the shielding programme and closure of the Shielded Patient List (SPL)
The Government has announced that the shielding programme has now ended and patients will no longer be advised to shield. The Shielded Patient List will also be closed, and NHS Digital will retain the capability to identify high-risk patients in the future. Relevant patients will be written to inform them of this change and that support still available. Practice do not need to inform patients themselves, and any future changes to the COVID-19 risk status for patients will no longer be captured on the national list.
Health inequalities and climate change
This week we wrote to the President of the UN COP26 Climate Conference, Rt Hon. Alok Sharma MP, to highlight our concerns about health inequalities and climate change. We made a number of recommendations to the Minister including the action government could take to support general practice to become carbon neutral, implementing a practice of return and recycling for medicines such as inhalers and for resources to meet the needs of practices in areas suffering from high levels of deprivation.
ARM update
The BMA’s Annual Representative Meeting was held earlier this week, where the Council chair Chaand Nagpaul’s speech highlighted the pressures GPs are under, and that GPs and primary care teams have worked incessantly 7 days a week in vaccination centres while practices at the same time continued to provide essential services to their patients. He pointed out that it’s therefore soul destroying for GPs to be publicly vilified for not being able to operate normally and that it was a failure of leadership by the NHS not to defend GPs. He said “what we needed was for ministers and NHS leaders to visibly congratulate and thank GPs and primary care teams for their heroic efforts in saving tens-of-thousands of lives.” Read the resolutions here and listen to my report to the ARM
A motion was passed at the ARM, which stated that ‘primary care did not shut during the pandemic, but appropriately changed working practices to protect both patients and staff, continuing to see patients face to face where this was necessary’ and called on ‘the BMA to demand NHS England cease and desist from negative briefings suggesting otherwise’.
This was reported on by Pulse
Changes to the COVID-19 test kit distribution service
From 4 October, an amended COVID-19 test kit distribution service will begin from and as part of the changes, people will be asked to register on www.gov.uk or via 119 for a collect code to pick up test kits. More information is available from the Service Specification on the NHS BSA website.
NHS-Galleri cancer test trial
The NHS has launched a trial of a new blood test that can detect more than 50 types of cancer before symptoms appear. The participants, are aged 50-77 and asymptomatic of cancer, are identified and invited through NHS DigiTrials to register their interest in being part of the study. Those who consent will be invited up to a mobile screening unit to give a blood sample.
The NHS Galleri test trial checks for the earliest signs of cancer in the blood and only those who have a positive Galleri test will be referred by the study team to a 2WW clinic based on the predicted cancer signal origin. Hence, any GP involvement in this study is only if participants choose to contact them at any point in the trial process. A few GP practices have, in addition, volunteered to undertake trial recruitment from their lists and are liaising with the study team.
Supportive call from WHO for investment in primary care post COVID
Attached is a statement by the WHO Regional Committee for Europe, about reinventing primary health care in the post-COVID-19 era, which calls for more investment in primary care.
Survey of practices' experiences of using PCSE payments and pensions portal in August (England)
We are extending the closing date of our joint survey (with the Institute of General Practice Management), for practices to learn of their experiences of using the PCSE payments and pensions portal, until Tuesday 21 September. We would be grateful if you could share the survey with your practices if you haven’t already done so. Take the survey
GPC UK by-election
We have now opened nominations for the following GPC by-elections:
If you would like to submit a nomination, please go to https://elections.bma.org.uk/.
Nominations will close on midday on Wednesday 22 September. If you have any questions about the elections please email elections@bma.org.uk
Sessional GPs webinar – contracts
A webinar will be held on 21 September, 6.30-8pm, about key contract issues for sessional GPs, including what to look out for when reading a new contract, common pitfalls to avoid and what support is available from the BMA. There will also be an update on NHS 111 contracts. Register your place here
Social Prescribing Link Worker Day Conference
The National Association of Link Workers will be hosting a virtual Social Prescribing Link Worker Day Conference on 8 October 2021, with the theme of The Creative Disruptors Reducing Inequalities & Powering Up Integrated Care, to celebrate and showcase Social Prescribing Link Workers’ impact and role in creatively disrupting inequalities and powering up integrated care. This event is open to GPs, social prescribing link workers, community health and social care industry leaders, PCNs and clinical directors. There are 20 free tickets available for BMA members – first come first served - via this link
Media
GP pressures and staff abuse
Dr Farah Jameel, GPC England executive team member, wrote a piece for the Independent about her experience of abuse as a GP, which was then also picked up on MSN and Yahoo!.
I was quoted on BBC Radio 2, Radio 4 and Radio 5 Live, saying general practice went into the pandemic with too few doctors and inadequate spaces, and that the Government had to invest as the profession was on its last legs. This came after the Guardian reported on the struggles of primary care, quoting Prof Martin Marshall, chair of the RCGP. The BMJ carried an article around GPs being blamed for government failures in primary care, and Pulse covered the story of GPs struggling to give 'safe care' due to 'Government failings'. I was on BBC Radio York on Monday, warning that the NHS is heading into a very difficult winter and again this morning explaining why GP practice needed to continue to limit the number of people in practice waiting rooms which had an impact on the number of face to face appointments that could be offered.
The Guardian wrote a piece in defence of the GPs and the pressures they are under, and the abuse and criticism they are facing.
Dr Chaand Nagpaul also mentioned the scale of the backlog as he gave evidence to MPs around the Health and Social Care Bill currently being debated in parliament - this was covered in Pulse.
There was also further coverage on the letter sent to health secretary Sajid Javid by the BMA, RCGP, NHS Confederation and IGPM, expressing concerns with the lack of support from the Government around the abuse towards General Practice. The story was covered by Pulse and GP Online.
BMA concerns on the NHS backlog and the workforce shortages in the health service were also quoted in London Economic, and Tribune Mag.
I was interviewed today on BBC Radio 4's Today programme (at 1h36m47s into replay), where I highlighted the how the ongoing infection protection measures and size of many waiting rooms limited the number of face to face appointments that could be provided as practices continued to work to protect their patients and also spoke about the workload and workforce pressures, saying: "GPs and practices share the frustrations of our patients. We started the pandemic with too few GPs, too few nurses, too few support staff and we're in a worse situation rather than a better situation now."
Dr Krishna Kasaraneni, GPC England executive team member, was part of coverage on ITV News Calendar (6min into replay) was shown alongside a package around GP pressures. He said: "I think what we need is a joint effort both from the profession and from the public to call on the Government to change things in general practice, to invest in general practice, both in people and premises so that we can start looking after patients in the way that they deserve."
The BMA's concerns around workforce shortages and abuse were also mentioned in regional media like the Hull Daily Mail, Nottingham Post (print), and on BBC Humberside.
Northern Ireland
NIGPC chair Dr Alan Stout was interviewed in the Belfast Telegraph and Irish News about Covid jabs for over-12s and booster jabs for over-50s. He was also interviewed by Ulster Star, BBC Radio Ulster news bulletins (00:25) and Newsletter about pressures.
Read the GP bulletin here.
Supporting general practice and challenging abuse – letter to the Secretary of State
I have written a joint letter to the Secretary of State for Health and Social Care, Sajid Javid, to express our grave concern with the lack of central support, or clear public challenge by government, of increasing instances of abuse being directed towards those working in general practice and the misinformation about how they are delivering their services for patients.
We share patients’ frustrations when they face long delays for an appointment or long waiting times to get through to their surgery, but we are all on the same side and all want to ensure high-quality care is delivered when needed. However, practices are facing an increasing amount of abuse, as highlighted in a recent BMA survey, whilst working tirelessly throughout the pandemic.
The importance of tackling the increased abuse directed against GP practices was also highlighted in a statement in the NHSE/I primary bulletin yesterday, which followed a meeting in which we stressed the importance of this. They said: “Everyone has the right to be safe at work, and we want to reiterate in the strongest possible terms that violence and aggression towards NHS staff is totally unacceptable. Staff facing abuse will always have our support and that of their local system. We are also working with partner organisations to develop practical support for primary care employers and employees.” We now expect them to act on this.
This situation is not acceptable and we have therefore called for the Government to publicly support and defend dedicated GPs and primary care staff against this onslaught of misinformation and abuse promoted by the media. It is essential that patient care is protected by looking after the hardworking primary care teams who provide care.
We believe that there must be accurate, timely and regular communications from the government to the public, which reflect the realities of the situation and what is being done to address the challenges facing the NHS, and particularly relating to general practice.
GP pressures and abuse in the media
The BMA’s communications department continue to support us and the profession by pushing back against attacks against general practice in some sections of the media. Most recently I had a letter published in the Spectator, responding to an editorial last week entitled ‘It’s time for NHS GPs to stop hiding behind their telephones’. A subscription is required to access the letter, but I highlighted how millions of in-person appointments had been delivered by practices during the pandemic, while noting the absurdity of comparing the re-opening of pubs and nightclubs with the situation in general practice. I said: “How many nightclubs force very sick people, many of them elderly and living with a number of long-term illnesses, into a confined space at the same time?” I underlined how unfair it was to lay the blame for the current crisis at the door of dedicated individual GPs, and how in doing so would have a lasting impact on staff morale, recruitment and retention, and ultimately, the doctor-patient relationship.
There was also a piece in the Express in defence of GPs, some local coverage around workforce shortages in the Northumberland Gazette and Keighley News (both print). A piece in Pulse covered the abuse faced by GPs, while a Pulse survey of 1,000 GPs showed 8 in 10 say a return to pre-pandemic levels of face-to-face appointments is not necessary. NIGPC deputy chair Dr Frances O'Hagan was interviewed on ITV View from Stormont about HSC pressures. The piece begins at 02:22 with Dr O'Hagan's interview starting at 02:44. The BMJ has written an article about GP abuse, entitled Has abuse become the norm for NHS staff?
GP survey - help us to help you (England, Wales, Northern Ireland)
We know how tough it is for many GPs - that's why we want to hear directly about your experiences working as a GP. Please complete our survey to tell us about the issues affecting you most, including your workload, recruitment and your future career plans.
This is an important survey and will support our negotiations and lobbying, and is a crucial important part of our GP campaign. Your responses will also help us better understand the issues affecting GPs and ensure we are representing the profession effectively.
The survey is open until 20 September and will take around 10-15 minutes to complete
Support Your Surgery campaign
Our Support Your Surgerycampaign provides GP practices with the tools to both manage expectations and to provide patients with the reality of issues facing general practice.
We now have a suite of resource materials available on the Support Your Surgery campaign page including Support Your Surgery poster, as well as a poster and twitter versions explaining why practices are having to work differently during the pandemic.
We are strongly encouraging patients and the profession to sign our petition calling on Government to provide the resourcing need so we can increase the number of GPs in England – please show your support and sign it here. A paper version of the petition is also available to use in practices, and which could be used for the large number of patients attending surgeries, including in forthcoming vaccination sessions. Once completed, these can be emailed back to info.gpc@bma.org.uk.
You can also show your support for the campaign by adding a ‘Support Your Surgery’ Twibbon or Twitter banner, and Facebook banner to your social media profiles.
At a time when so many are criticising general practice, we would encourage you to use this campaign to gain the support of our patients to make the changes we urgently need to see. We would ask that you continue to support the campaign in the coming weeks. (@BMA_GP) / Twitter
Government imposes pay transparency regulations (England)
The Department of Health and Social Care have this week published regulations which will require GPs and their staff with NHS earnings of £150,000 and over in 2019/20 to declare these through national arrangements. This information will then be published by NHS Digital as part of the government's pay transparency agenda. In the 2019 contract negotiations, government and NHSE/I insisted on the inclusion of new pay transparency arrangements for higher earners as part of the overall package but it was also agreed that this should not solely relate to general practice but would be progressed for all those working in the NHS.
While the Government has now published regulations for general practice, to ensure GPs and their staff will have to declare their earnings over certain limits, there are at present no similar proposals for pharmacists, optometrists, dentists, consultants or other doctors in the NHS, anywhere else in the UK. As such the Government and NHSE/I have chosen to single out general practice in England and have breached the 2019/20 agreement. We have not agreed the change. However, health ministers have instead decided to impose this on the profession.
The 2019 agreement that was reached in principle did not take into the account the significant changes that have happened since, including the effect of the pandemic that has seen many GPs being willing to work longer hours and do more sessions to cope with the demand, and more recently the increased levels of abuse suffered by GPs and their teams. We strongly believe that these imposed changes risk dedicated hardworking doctors being subjected to abuse and that they will worsen the current workforce crisis if GPs seek to reduce their working commitments. It could also make it harder to recruit doctors to fill out-of-hours sessions and thereby have an impact on A&E pressures. Ultimately patients will be impacted by these unacceptable changes. We have made it clear that the government will be responsible for the consequences of this.
GPC England meeting with NHSE/I
We have this week held our first formal meeting with NHSE/I since May, following agreement by the committee last week that we should do so. It was an opportunity to convey the significant strength of feeling and anger of the committee and profession about the current low morale of the profession, the workload and demand pressures, and the impact of abuse from patients and media. We described specific examples of the impact this was having on GPs and others and how it was leading to some thinking about leaving the profession. We also clearly articulated that NHSE/I, DHSC and government were not sufficiently supportive of the profession, whether through funding, through policy/contract initiatives or through explicit public statements of support and this must urgently change.
We stated that, first and foremost, the profession needs a public and repeated show of support for GPs and practices from NHS England, DHSC and wider Government, including defending the profession when criticised and a more proactive and reactive approach to counter the negative media coverage, as well as strong public statements about the unacceptability of any aggression toward GPs or practice staff. Following the meeting, NHSE/I issued a statement as highlighted above.
We pressed for rapid and significant actions to address the current situation, including an immediate suspension of QOF with income protection, not least with the ongoing blood bottle shortage but also in expectation of significant pressures with rising covid-19 cases in the coming winter, support for practices against complaints, renewed efforts to recruit and retain GPs, and an emphasis on practices rather than PCNs, highlighting the professions strength of feeling that PCNs are not the panacea for all primary care ills and cannot be the only avenue for services and funding for general practice. We made it clear that PCNs were established to build on and support their member practices as a response to rising workload, so we must develop, support and fund practices as the foundations for not only their networks but the rest of the NHS. We have also called for more ongoing support for managing the impact of the pandemic and the backlog of patients both in general practice and secondary care.
We reiterated our significant concerns with the decision to impose the declarations of earnings provisions into the GP contract, despite our protestations to NHSE/I and DHSC and without the involvement of other healthcare professionals as was agreed in 2019, and we called out the unacceptable way it was enacted. We also called for a delay to the implementation of the PCN access arrangements, so that they can be appropriately negotiated and considered by the Committee, and so that practices and PCNs are able to prepare for the implementation. The immediate priority must be resolving the current pressures for GPs and practices before spending time looking ahead to next year, not least as we face what many predict to be the worst winter for a generation.
We also insisted that the government must fund the additional employers National Insurance contributions planned for next April so that this did not fall as an added burden on to practices. NHSE/I highlighted the wording included in the Government statement that it intends to compensate departments and other public sector employers in England, including practices, at the Spending Review for the increased cost of the Levy. We have asked for NHSE/Is assurance that this will be implemented ASAP.
NHS Digital GP workforce data releases switch to monthly from quarterly (England)
The latest quarterly GP workforce data for England was released by NHS Digital yesterday. As reported last month, the methodology NHSD now used no longer includes estimated data to accommodate for the small proportion of practices that have historically uploaded no or partial workforce data.
For July 2021, the new way of collecting data suggests that the fully-qualified full-time equivalent GP workforce has shrunk by 253 since June 2021 and 616 since September 2015 respectively. In reality, when reinstating previous historical estimates, fully-qualified FTE GP numbers have actually shrunk by 1,904 and GP partner numbers have also decreased by 18% since 2015
We remain in dialogue with NHSD and GPCE representatives strongly raised their objection to the methodology change during our last meeting together in August. Changing the baseline now is only going to exacerbate the GP workforce crisis because we need to know where we started from in order to make positive improvements. NHSD counterparts committed to consider reinstating the estimates and to working with GPCE to find a workable solution going forward.
Delays in influenza vaccines
Last week, Seqirus has informed practices that due to road freight challenges, there would be a delay to scheduled delivery of influenza vaccine by one to two weeks. Our concerns about the impact of this on practices and patients were widely covered in the media in recent days. However, whilst supplies are belatedly arriving in surgeries, they still have the workload of rebooking clinics previously cancelled. Read the press release here
Media
I spoke to Sky News about flu jab delays – access the tweet about it here. Dr Farah Jameel, GPC England executive team member, was interviewed on BBC Look East (7min in). The Hereford Times reported on the issue as GPs in Hereford had to cancel appointments following delivery delays.
LMC role in Integrated care systems (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:
A briefing outlining what collectively we want government to do has also been sent to Ministers. Yesterday, BMA council chair, Dr Chaand Nagpaul, provided oral evidence to the Public Bill Committee on the Health & Care Bill, alongside Sara Gorton (Unison, Head of Health).
Advice and Guidance – statement from GPC England
GPC England has drafted the following statement relating toAdvice and Guidance (A&G), following a query from an LMC who had been invited to sign up to a local scheme to use Advice and Guidance before making referrals.
Advice and Guidance (A&G) is defined as non-face-to-face activity delivered by consultant-led service, which provides primary care with continued access to specialist clinical advice, enabling a patient’s care to be managed in the most appropriate setting, strengthening shared decision making and avoiding unnecessary outpatient activity.
Advice and Guidance as a service needs to be clearly defined in its role and what it is trying to achieve. When used to support and enhance professional interaction between GP and specialist it can be a helpful tool and a good adjunct to the normal referral arrangements, reducing waiting time, preventing delays to care. It should provide GPs with quick and relevant advice and guidance from a consultant.
Whilst A&G can be helpful as an option when it is clinically appropriate, we would be concerned about any scheme that compelled its use prior to onward referral for further specialist assessment. This could result in unnecessary and avoidable delays to care, it will result in additional unresourced transferred workload in primary care, and thereby impact the care of others, but could also theoretically result in greater medicolegal risk if GPs became responsible for patients and treatments they did not have the competence to deal with appropriately.
If A&G is being used as part of referral management or waiting list initiative by acute trusts or commissioners, it must be adequately resourced and appropriately commissioned with the wider implications for general practice clearly assessed. Local medical committees must be involved in these discussions. Unfunded transfer of workload into general practice is unacceptable as this does not only add further burden to an already overstretched service, but also has the potential to worsen access to general practice services for all patients.
It should always be voluntary for practices to take part in schemes such as this and the principle should be similar to shared care agreements, in that the clinician must feel able and competent to carry out any recommended investigations and ongoing management as advised, they should be aware that they will carry clinical responsibility for the patient until seen by secondary care.
Practices should never be put in the position of having a financial incentive not to refer a patient, which goes against GMC responsibilities (78. You must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients) and the GMS contract regulations:
17.5 (b) making available such treatment or further investigation as is necessary and appropriate, including the referral of the patient for other services under the Act and liaison with other health care professionals involved in the patient’s treatment and care.
GPC UK by-election
We have now opened nominations for the following GPC by-elections:
If you would like to submit a nomination, please go to https://elections.bma.org.uk/.
Nominations will close on midday on Wednesday 22 September. If you have any questions about the elections please email elections@bma.org.uk
Survey of practices' experiences of using PCSE payments and pensions portal in August (England)
A reminder to please fill in our joint survey (with the Institute of General Practice Management), for practices and practice managers to learn of their experiences of using the PCSE payments and pensions portal during August specifically. We are also keen to know about your experiences of contacting PCSE for support around issues raised around the portal since it came into use on 1 June.
We know how incredibly busy practices are but completing the survey should take no longer than 10 minutes and will be invaluable in helping us hold PCSE and NHSE accountable for the portal’s performance. The survey will remain open until Friday 17 September.
ARM 2021
The BMA’s Annual Representatives Meeting (ARM) will be held on Monday 13th and Tuesday 14th September, as a virtual meeting. Representatives will come together for policy-making debates on issues including pay, pensions, the health and care bill, climate change and physician-assisted dying. You can follow a live webcast of the meeting and add your views on Twitter, using #ARM2021.
Listen to my report to the ARM, in which I say: “The bullies, the critics, those who carped from the side lines and those who did so little to help and support a dedicated but overstretched workforce should all hang their heads in shame.” – or read the transcript >
Hear more from representative body acting chair Latifa Patel >
A series of scientific lectures includes ‘Obesity: causes and consequences’ and ‘The alcohol pandemic: before and after COVID-19’. Find out more and register >
Sessional GPs webinar – contracts
A webinar will be held on 21 September, 6.30-8pm, about key contract issues for sessional GPs, including what to look out for when reading a new contract, common pitfalls to avoid and what support is available from the BMA. There will also be an update on NHS 111 contracts. Questions can be submitted in advance and there will also be an opportunity to ask questions during the event. Register your place here
BMA clinical academic trainees conference 2021
Academic trainees: join us for an exciting evening event on Wednesday 13 October 2021, 6.30 – 8.30 pm, which aims to help you make the most of your academic training and develop your career. You’ll hear from Dr Sarah Alderson, clinical associate professor in primary care at the University of Leeds, who’ll be sharing tips for building an academic career and talking through her own career journey. Professor Fiona Denney, professor of business education at Brunel University London, will speak about developing leadership in academia. You’ll also have the opportunity to hear from a range of other knowledgeable speakers and to join breakout discussions on getting published, wellbeing and writing successful grant applications. Find out more and book your place.
Media
Face-to-face appointments
There was more press activity around face-to-face appointments in general practice over the weekend. Pulse covered GPs' frustrations at the attacks from a section of the press, as well as a debate on in-person appointments. The Health Secretary reportedly said that practices must provide face-to-face appointments, prompting coverage in the Telegraph (also in print), Daily Mail (also in print). I said: "GPs share and understand the frustration of patients who are struggling to be seen at their practice, but blaming individual GPs is unfair – and making hardworking family doctors scapegoats for years of Government failings is completely unacceptable."
Wastage of AZ vaccine
The Telegraph (replicated on Yahoo!) reported on the loss of of 800,000 doses of AstraZeneca vaccine across the UK, set to be thrown away having reached expiry date. I was quoted saying, "Vaccines are a precious resource and the key weapon in keeping Covid at bay and coming out of the pandemic, so as we’ve always said, wastage should be avoided at all costs. Practices and vaccine sites have throughout the campaign been doing their utmost to reach all eligible patients and improve take-up, but with national guidance changing around the use of AstraZeneca in younger groups it’sunsurprising that some places will have doses left over. It was therefore incredibly concerning to learn last month that where this had happened the excess jabs were not being picked up and redistributed where they were needed - despite sites doing everything right by notifying authorities when they had leftover stock. The Government should be putting into action plans to use any excess vaccines elsewhere; it’s indefensible if such an extraordinary number of doses have been left to expire and be thrown away."
GPC England
GP online and Medscape reported on the GPC England vote last week to resume holding formal meetings with NHSE/I.
UK GP training
The BMA has been mentioned across the Portuguese media after responding to claims by the country’s minister for Science, Technology and Higher Education that GP training in the UK is less demanding than for other medical specialities. In a statement, Dr Samira Anane, GPC policy lead for education, training and workforce, said: "It’s completely inaccurate to describe GP training in the UK as less demanding than for other medical specialties, which does a severe disservice to our highly-skilled family doctors working in practices across the country." Read the full statement here.
Read the GP bulletin here.
GPC England meeting
GPC England held an additional meeting yesterday to discuss events since we last met in July, relating to the motion of no confidence in NHSE/I's executive directors passed by GPCE in May and which led to a cessation of formal meetings with NHSE/I.
I reported to the committee that since July I have had a constructive meeting with the newly appointed chief executive of NHSE/I, Amanda Pritchard, and following that we received a letter from Ian Dodge, National Director for Primary Care, Community Service and Strategy at NHSE/I, emphasising the value they placed on the relationship with the committee and making a commitment to work with GPCE to address workload and workforce issues impacting general practice. They subsequently made changes to the planned October contract implementation, which we had been calling for, including reducing and delaying further PCN specifications and Investment and Impact Fund expectations, modified how IIF money would be invested, as well as producing an additional £43m for GPs and practice staff involved in PCN management. They have also issued flu vaccination specifications which continue to be practice-based. In addition, the Standard Operating Procedure for General Practice has been withdrawn, again as we called for. Last week we have also launched our Support Your Surgery campaign and major GP survey, and vigorously responded to unacceptable media articles. I also shared with the committee that we had received representation from a number of LMCs encouraging us to restore dialogue with NHSE/I.
Whilst many members expressed the view that the committee should hold formal meetings with NHSE/I in order to both make clear our serious concerns face-to-face, but also to resolve the many issues facing the profession at this time, others were strongly of the opinion that we had not yet seen sufficient steps taken by NHSE/I to do this. I recognise the strength of feelings expressed during the debate by committee members and I can give my assurance that these views are very much being taken on board. Clearly, we had an incredibly important issue to discuss but even though some committee members disagreed, we all have the best interests of members, general practice, and our patients at heart. There was though an overwhelming concern and consensus that neither government nor NHSE/I were doing anything like enough to counter the unacceptable media attacks on GPs in recent weeks, or to truly recognise and resolve the workload pressures GPs and practices were currently experiencing.
The committee has now voted on the resolution that ‘GPC England agrees to resume formal meetings with NHS England and NHS Improvement’ with 59% supporting this and 39% opposing it.
As a result, we will now meet with NHSE/I, but to be clear, and reflecting the views of the committee, this cannot be "business as usual". We must see far more evidence of action by the new NHSE/I leadership to address the serious situation we now see in practices and other services that GPs work in, and we will do all that we can to hold them and government to account. Not least, we expect both government and NHSE/I to promote and defend those working in primary care, most urgently in the face of the sustained attacks on our members within certain sections of the media.
One way of helping us to do this is to get as much backing as we can to our Support Your Surgery campaign, and I hope you can promote this locally as much as possible, for it's by working together that we will achieve the outcomes we all want to see.
We have issued a press statement and add a link to that shortly.
#Support Your Surgery – GPC England campaign
Following the launch of our Support Your Surgerycampaign last week, more than 5,600 people have now signed our petition asking GPs and the public to support our call on Government to provide the resourcing need so we can increase the number of GPs in England.
We have added some more resource materials to the Support Your Surgery campaign page, including a downloadable version of the petition for use in practices. Once completed, these can be emailed back to info.gpc@bma.org.uk.
We have produced a poster and twitter versions explaining why practices are having to work differently during the pandemic.
You can also show your support for the campaign by adding a ‘Support Your Surgery’ Twibbon, Twitter banner, linked in banner, or Facebook banner to your social media profiles.
Physical posters have now also been dispatched to more than 5,800 practices in England. It would be a great help once they are received if you could send any photographs on the posters on display to us so we can use them as part of the campaign to encourage more people to do the same.
At a time when so many are criticising general practice we would encourage you to use this campaign to gain the support of our patients to make the changes we urgently need to see. I would ask that you continue to support the campaign in the coming weeks.
General Practice (@BMA_GP) / Twitter - #supportyoursurgery
Media
Denton MP Andrew Gwynne wrote a column referring to the BMA's Support Your Surgery campaign, and stating the blame for GP waiting times lies with Government, not hardworking health professionals.
GP survey - help us to help you (England, Wales, Northern Ireland)
We know how tough it is for many GPs at the moment, that's why we want to hear directly about your experiences working as a GP. Please complete our survey to tell us about the issues affecting you most, including your workload, recruitment and your future career plans. The survey is primarily aimed at fully qualified GPs who are currently working. We will be running a survey for GP trainees separately later in the year.
This is an important survey and will support our negotiations and lobbying, and is a crucial important part of our GP campaign and the results will help to support this. Your responses will also help us better understand the issues affecting GPs and ensure we are representing the profession effectively.
The survey is open until 20 September and will take around 10-15 minutes to complete
BMA Scottish GP Committee/ Scottish LMC Update – September 2021
Please find attached an update from GPC Scotland, including a summary of their most recent committee meeting, update on negotiation issues and contracts, and Finance (Pensions, Pay Announcement and GP Uplift 2021-22). It also includes an update for LMCs.
Blood bottle shortages
The shortages of Becton Dickinson blood test tubes across GP surgeries and hospitals are now severe, and the BMA has raised concerns that if the NHS does not reduce the amount being used in the coming days, even the most clinically important blood tests may be at risk.
The BMA has now written to the Health and Social Care Secretary Sajid Javid calling for urgent action from ministers to address the shortages outlining the key areas that require urgent attention:
We urgently need the government to do much more to provide patients with detailed, easily accessible information about the situation so that practices are not blamed for something they have no control over.
The NHSE/I published guidance last week about the impact of the national shortage, after we raised concerns about the impact this is already having on the ability of practices to complete QOF and other national and local contractually. The guidance advises practices not do any routine blood tests, until the situation has been resolved, and until then, urgent blood investigations can still be done as supplies allow (the national indemnity scheme, CNSGP, will cover this situation).
Media
Deputy Chair of BMA Council, Dr David Wrigley appeared on BBC News Channel and on Times Radio (at 45m25s on replay) on Sunday, while GPC England executive member Dr Farah Jameel was interviewed on BBC Breakfast.
The BMA's statements were covered widely in the press including the BBC, ITV news (all local TV channels and STV), Daily Mail, iNews (also in print), Express, Telegraph (also in print), Sunday Mirror (print), LBC, talkRADIO, Times Radio, Politico, National World, Pulse the Spectator, Express Informer, City A.M., Press From, This Is Money, BBC, Mail Online, Daily Mirror (print), GP Online, Press From, Eminetra, Sky News, the i, South Wales Argus, GP Online, Pulse and across over a hundred and fifty regional press outlets including the Evening Standard Yorkshire Post (print) and Eastern Daily Press, and on MSN, Yahoo! and AOL.
Delays in influenza vaccines
Seqirus has informed practices that due to road freight challenges, there will be a delay to scheduled delivery of influenza vaccine by one to two weeks. Practices have been asked not to book any flu clinics until they have received a Delivery Note email from Seqirus.
In response to this I commented: “This issue is likely to affect a significant proportion of practices, and have a serious impact on both practice workloads and patients. Many practices will have spent the last few days and weeks meticulously planning for their flu vaccination programme, inviting and booking patients in for their jabs, only now to have to contact them all again to cancel or reschedule appointments. This causes a huge increase in staff’s already unsustainable workloads, and inconvenience and unneeded anxiety for patients who will be keen to be protected ahead of winter. This is on top of the chaos already being caused by the shortage of blood test bottles, which is leaving hardworking doctors and practice teams bearing the brunt of understandable frustrations from patients when the problem is well outside of their control.
That this appears to be stemming from similar issues around freight capacity and transportation is incredibly concerning, and we must ask the Government exactly what it is doing to address this. It is not acceptable for government to be leaving these issue to NHS management when NHS management have no levers to resolve them, ministers must act.”
COVID vaccinations
Updated advice from the Joint Committee on Vaccination and Immunisation (JCVI) on vaccination of children aged 12 to 15.
JCVI have today issued further guidance relating to vaccinating childrenJCVI statement on COVID-19 vaccination of children aged 12 to 15 years: 3 September 2021 The committee is of the opinion that the benefits from vaccination are marginally greater than the potential known harms but acknowledges that there is considerable uncertainty regarding the magnitude of the potential harms. The margin of benefit, based primarily on a health perspective, is considered too small to support advice on a universal programme of vaccination of otherwise healthy 12 to 15-year-old children at this time. It has suggested the government may wish to seek further views on the wider societal and educational impacts from the chief medical officers of the 4 nations, with representation from JCVI in these subsequent discussions.
JCVI advice on third dose vaccination for severely immunosuppressed
The JCVI has advised that a third vaccine dose of the COVID-19 vaccination should be offered to people over 12 who were severely immunosuppressed at the time of their first or second dose, including those with leukaemia, advanced HIV and recent organ transplants, as they may not mount a full response to vaccination and therefore may be less protected than the wider population. This is in addition to any booster they may need in the future.
We are still waiting for JCVI to make a decision on whether, when and to whom booster doses should be given. Practices need this information as soon as possible as they prepare to start their annual flu campaign
Survey of practices' experiences of using PCSE payments and pensions portal in August (England)
We continue to challenge PCSE to ensure that their pay and pensions portal in England is fit for use by both GPs and practices. The portal has now been in use for three months and we are looking to gauge how effective the various ‘fixes’ put in place by PCSE to correct what they have described as ‘teething issues’.
We are now at a critical time where PCSE and NHSE/I will be looking to end the transformation process and return to ‘business as usual’. We need to be confident that the many significant issues around payments to practices which blighted the first couple of months of the portal’s use are largely behind us. To this end, we are launching a joint survey, with the Institute of General Practice Management, for practices and practice managers to learn of their experiences of using the system during August specifically. We are also keen to know about their experiences of contacting PCSE for support around issues raised around the portal since it came into use on 1 June.
We would be hugely grateful if you would share the survey with your practices and encourage them to respond. We know how incredibly busy practices are but completing the survey should take no longer than 10 minutes and will be invaluable in helping us hold PCSE and NHSE accountable for the portal’s performance. The survey will remain open until Friday 17 September.
Sessional GPs webinar – contracts
A webinar will be held on 21 September, 6.30-8pm, about key contract issues for sessional GPs, including what to look out for when reading a new contract, common pitfalls to avoid and what support is available from the BMA. There will also be an update on NHS 111 contracts. Questions can be submitted in advance and there will also be an opportunity to ask questions during the event. Register your place here
Integrated Care Boards guidance
NHSE/I has published some additional resources in supporting system leaders to establish integrated care boards (ICBs) which are broadly centred around effective partnership working within ICSs. The documents are:
Guidance on the development of place-based partnerships as part of statutory ICSs
ICS implementation guidance on effective clinical and care professional leadership
ICS implementation guidance on working with people and communities
NHS X has also published: ICS ‘What Good Looks Like’ Framework (Digital & Data)
Media
Face-to-face appointments
The BMA is continuing to defend GPs as press interest continues into the numbers of face-to-face appointments provided in general practice, and into the amount GPs are being paid for remote appointments. On Friday afternoon and on Monday evening, I was interviewed on LBC regarding the numbers of face-to-face appointments, saying the UK has one of the lowest headcounts of GPs in Europe and the government needs to invest in primary care.
GP pressures (England)
I was featured in the Yorkshire Post (also in print) and the front page of the Yorkshire Evening Post (twice, also both in print), discussing pressures on general practice and the local numbers for Leeds where each GP team is dealing on average with 9,663 patients as of the end of June. I said: "The NHS entered the pandemic on the backfoot, desperately underfunded and short on staff - things that, despite repeated calls from the BMA both during and before Covid-19, haven't improved and make delivering the high-quality care our communities deserve increasingly difficult. GPs have done everything they can to improve pressures in their own surgeries, but we can’t make the changes we and our patients want to see without urgent Government intervention to retain and expand our workforce, and give practices the funding they desperately need."
GP pressures Northern Ireland
Dr Alan Stout, chair of the GPC Northern Ireland, was quoted in the Newsletter alongside Dr Laurence Dorman from the RCGP NI, saying that general practice was also under intense pressure with around 200,000 patients per week seeking care. Both doctors said GPs were relying on remote consultations and, whilst acknowledging some patients are frustrated with the arrangements both highlighted the benefits of that approach. Read the full article here
Dr Stout was also interviewed in News Letter about Northern Ireland GPs’ planned roll-out of the Covid booster.
Workforce crisis
On Monday a letter published in the Times (also in print) from GPC workforce policy lead Dr Samira Anane, responded to an unacceptable piece from James Kirkup, which said that cutting GP pay was the way to solve the GP staffing crisis. You can read the full unedited letter on our website and social media response on our Twitter. This was also reported on by Pulse
The BMA also responded to a Daily Mail article on Monday that misrepresented the reality facing GP practices, and BMA was quoted in this piece from i news regarding Covid rules remaining in healthcare settings. The BMA was quoted further around the workforce crisis in general practice as articles in local press covered the stories of overseas GPs feeling 'unwelcome' after Brexit.
GPDPR - NHS data sharing plan
The Eastern Eye reported on the NHS data sharing plan GPDPR, where Dr Farah Jameel, GPC England executive team lead for IT, said that she believes that when used effectively, ethically and legally, data can play a pivotal role in improving the nation’s health through planning, research or for direct patient care. She said: “When patients interact with the NHS, they expect that the right staff have access to the necessary information about them, so they get the treatment they need, regardless of whether this is at their GP practice, in a hospital or elsewhere. When this doesn’t happen, it’s frustrating for both patients and clinicians. The situation we have at present needs improving, to facilitate better data-sharing between settings. Everyone has a right to know what is happening with their healthcare data, what is being shared for wider purposes than just their own care, and who has access to it – as well as to have the final say on whether to share it or not.”
Read the GP bulletin here.
#Support Your Surgery – GPC England campaign
We have launched the BMA campaign Support Your Surgerythis week. We are all acutely aware and feeling the pressure of the unfair criticism being levelled at general practice in the news and across social media due to the necessary restrictions that COVID-19 has brought about, and the subsequent abuse that GPs have received, which the BMA has been highlighting through features in The Doctor magazine and evidenced in our latest survey results.
To counter these perceptions and to force the Government to act to do more to support general practice, our new campaign provides GP practices with the tools, such as poster and social media graphics, to manage expectations and to provide patients with the reality of issues facing general practice.
Alongside this, we have also launched a new petition asking GPs and the public to support our call on Government to provide the resourcing need so we can increase the number of GPs in England. 3501 people have added their name in just the three days since we launched but we need as many as we can from both members of the profession and from the public.
It is important that we are upfront with patients, so they understand the reality that we are all facing and the underlying reasons for this, and that, despite the easing of lockdown, the pressures experienced by general practice and the rest of the NHS are unlikely to ease soon. We have therefore developed this campaign with insight from not just GPs, but also patient representatives and the wider public.
We have written to the profession to outline the details of the campaign and have produced various resources that GPs can use in their surgeries including posters, and social media graphics, available on our Support Your Surgery campaign page. Physical posters have now also been dispatched to more than 5,800 practices in England. It would be a great help once they are received if you could send any photographs of the posters on display to us so we can use them as part of the campaign to encourage more people to do the same.
For those who would prefer it, there is now a downloadable version of the petition for use in practices. Signing this would also clearly demonstrate that many patients are being seen in surgeries and show how wrong those who criticise us are. Once completed, these can be emailed back to info.gpc@bma.org.uk. We have also added QR codes to email signature graphics and a Twibbon is now available for use on social media (this has to be downloaded from the third-party site; the link is on the campaign page).
I would ask that you do all you can to support this important campaign.
Read our press release here and our Twitter page. Join the conversation on social media using the hashtag #supportyoursurgery
Media
The campaign has already received widespread media coverage. I was interviewed on GB News and LBC on Tuesday and again on today, and the story was covered widely cross the press. Coverage could be found in the Telegraph, Mail Online, GPOnline, Pulse, i news article, in the news on LBC, BBC Radio stations, Medscape, GBNews, on BBC Merseyside, and in over a hundred local and regional press outlets, as well as MSN and Yahoo!. I was quoted in the Yorkshire Post and Dr George Rae, GP and chair of the BMA's North East regional council, was on BBC radio Tees (3h18m into this replay).
Challenging media critics
A letter I sent to the Daily Telegraph was published yesterday in response to an unacceptable and demoralising column by Allison Pearson. This was just the latest in a series of damaging articles which seriously misrepresent the reality of what hardworking GPs and their teams are doing to care for an protect their patients. I said: “It was with despair and anger that I read the column in yesterday’s Telegraph. To suggest that family doctors have seen their work-life balance improve during the pandemic and attempt to justify the abuse directed at them and their colleagues serves no good purpose. Since March 2020, there have been nearly 370 million patient appointments in England – 200 million of which were in-person – at the same time as GPs and their teams moving heaven and earth to lead the Covid vaccination campaign. Meanwhile, the number of patients per practice is 22% higher than it was six years ago, leading GPs to report working an average of 11-hour days. These are not figures that show a better work-life balance for the family doctor.” Read the full letter in our press release. I was also interviewed on this on LBC radio.
Blood bottle shortages
England
NHSE/I have issued further guidance yesterday about the impact of the national shortage of BD test tubes. This follows the serious concerns we have been raising with them, not least the impact this is already having on the ability of practices to complete QOF and other national and local contractually related blood tests and the concern that practices will be held liable for any clinical untoward incidents that occur as a result of delayed tests and investigation. We also called on them to step up public information to ensure patients are informed of this shortage and practices are not blamed by patients for this situation.
Their new guidance now tells practices that this situation could continue until 17 September and until then they should not do any routine blood tests. Urgent blood investigations can still be done as supplies allow. The national indemnity scheme, CNSGP, will cover this situation. National communications to patients will also be delivered.
This is clearly a serious situation that will have major implications for practices and patients. We are continuing to demand that practices are provided with more support, that the impact on QOF and the practice workforce, not least phlebotomists, is not just recognised but fully mitigated as it's not acceptable to add to our already heavy workload burden by creating an even bigger backlog to deal with.
The BMA issued a press release earlier this week, where Dr David Wrigley, deputy chair of council said: "The BMA has raised the impact this could have on regular tests for NHS Health checks, the monitoring of quality of care, and medication reviews. It would also be unreasonable to ask healthcare staff to simply delay these tests until a later date – not only for the sake of our patients, but also the entire system, which is already tackling an enormous backlog of care.” The story was covered in GPOnline (twice), Pulse, Health & Protection, BBC News, Head Topics, Eminetra, Politico, Medscape, Pharmafile, BBC Radio channels, some local press - as well as Yahoo! and MSN.
Dr Farah Jameel, GPCE executive member, shared her experience with BBC News of having "difficult conversations" with patients about rationing the vials "among the very sickest". Dr Lucy-Jane Davies, chair of BMA South West regional council, was interviewed about the issue on BBC Bristol (02:30:15 on the replay).
Joint letter (Wales)
GPC Wales and the Welsh government have agreed the attached letter about blood bottle shortages, which was sent to practices last week and BMA Cymru Wales has issued the following press statement. Dr David Bailey, BMA Cymru Wales Chair, and Dr Phil White, GPC Wales Chair, were interviewed by BBC Wales, ITV Wales, and BBC Radio Cymru, where they expressed their concerns. Wales online and BBC Wales has run the story online. Dr White’s interview is also available at BBC Radio Cymru (9 mins in) where he also responded to the rising cases of COVID in Wales and new research that shows efficacy of the AstraZeneca vaccine starts to wane after six months.
Primary Care Networks – plans for 2021/22 and 2022/23 (England)
Following the letter from NHSE/I we received last week, which acknowledged the pressures facing the profession, NHSE/I has published guidance outlining the changes to, and support for, practices working in PCNs as part of the wider GP contract agreement. The key points are:
Practices will be auto enrolled into the revised PCN DES, but with an option to opt-out for one month from 1 October – which is what GPC England had previously stipulated should happen when there are any changes to the PCN DES and which NHSE/I has chosen to implement.
These changes are further evidence that NHSE/I has begun to listen to the BMA by pushing back these service specifications, as we called for, and delivered an additional £43m to support those GPs and practice managers who are working hard with their local practices in PCN leadership and management roles. However we still have concerns about some of the IIF indicators and the approach of micromanaging practices and PCNs in this way.
Following recent pronouncements about its gratitude to general practice and its recognition of just how hard GPs and their colleagues are working, it is now a positive sign that this change in tone is beginning to be backed up with more tangible action. Of course, even with these specifications deferred, this winter will still be incredibly difficult for all working in general practice, and we need assurances that individual practices, as well as PCNs, will be given all of the support, flexibility and resources needed to care for their communities in the coming months. The story was covered in Pulse, and GPOnline.
GP survey - help us to help you (England, Wales, Northern Ireland)
We have launched a major survey as we want to hear about your experiences working as a GP in England, Northern Ireland or Wales. Please complete our survey as soon as you can to tell us about the issues affecting you most, including your workload, recruitment and your future career plans. The survey is primarily aimed at fully qualified GPs who are currently working. We will be running a survey for GP trainees separately later in the year.
This is an important survey and will support our negotiations and lobbying and is a key part of our #Support Your Surgery campaign and the results will help to support this. Your responses will also help us better understand the issues affecting GPs and ensure we are representing the profession effectively.
The survey is open until 20 September and will take around 10-15 minutes to complete.
Backlog of fitness to drive assessments
When combined with the backlog of, primarily car, driving licence holders who need ‘fitness to drive’ assessments for their applications, the BMA estimates the total number of patients requiring medical assessments for licence applications to be over 200,000 - rising by thousands each month.
At present standard driving licence holders are advised to request fitness to drive assessments from their GP, but there is also the option of going to any registered medical practitioner. However, they will not have access to the full lifelong medical history of a patient.
Because of these concerns, BMA has written to the Department of Transport calling for the Government to guarantee a ‘safety-first’ approach for plans to manage backlog and expressing “concerns that this style of self-reporting is neither sensible nor safe”.
BMA Professional Fees Committee chair, Dr Peter Holden, commented that GPs and their teams are “gravely concerned” about the potential impact on road safety that this process of bypassing individual’s own GP practices may have. Read the full statement here
Media
Dr Holden was interviewed on BBC (2h23m in) and Times Radio Drive (1h38m25s in). Dr Mark Sanford-Wood, GPC England deputy chair, was interviewed on LBC and BBC 5 Live. The story was also published covered by The Times, Sky News Online, the Mail Online, GPOnline, Independent, the Express (twice), Pulse, Morning Star, and in dozens of local and regionalpress and radio outlets - including the Yorkshire Post.
Vaccinations for NHS staff entering care homes
New government regulations come into force on 11 November 2021, requiring all CQC regulated care home staff to refuse entry to anybody who cannot prove that they have had two doses of COVID-19 vaccine, or that they are exempt.
NHSE/I has issued a letter and FAQs on how this will be delivered operationally. All providers delivering NHS-funded services into a care home will need to have actively supported staff to have their first COVID-19 vaccine by 16 September 2021 and to carry out proactive workforce planning to ensure that only staff who are vaccinated, or exempt, are deployed to enter a care home from 11 November. The FAQs, which will be updated on a regular basis, should be read alongside DHSC operational guidance.
Appraisal fees (England)
NHSE/I has confirmed that the appraisal fee in 2020-21 was £530 (i.e. the 2020 uplift of 2.8% applied to the 2019 fee of £515) and the 2021-22 appraisal fee is £546 (i.e. the 2021 uplift of 3% applied to the 2020 fee of £530). There is a discrepancy with the fees quoted by the DDRB, which we have drawn to their attention and asked them to correct.
NHSE/I is in the process of calculating and paying arrears for appraisals in the current financial year but this process in not complete yet, so GP appraisers will not yet have seen the uplift in any fees since April.
Sessional GPs webinar – contracts
A webinar will be held on 21 September, 6.30-8pm, about key contract issues for sessional GPs, including what to look out for when reading a new contract, common pitfalls to avoid and what support is available from the BMA. There will also be an update on NHS 111 contracts. Questions can be submitted in advance and there will also be an opportunity to ask questions during the event. Register your place here
New Community Pharmacy Contract and Hypertension Case Finding
The contract changes for Community Pharmacy for 2021/22 were announced this week. Starting in October 2021, or as soon as possible thereafter, it is expected that Hypertension Case-Finding Service as an advanced service will be introduced to support the NHS Long Term Plan ambitions for prevention of cardiovascular disease. This service will have two stages. The first is identifying people at risk of hypertension and offering them blood pressure monitoring (clinic check). The second stage, where clinically indicated, is offering ambulatory blood pressure monitoring (ABPM). The blood pressure test results will then be shared with the patient’s GP to then inform a potential diagnosis of hypertension. This scheme therefore links to the PCN service specifications, highlighted above. The details of the contract are available here
Survey of GP practices' experiences of using the PCSE payments and pensions portal in August
We are very much aware of the unacceptable level of problems that practices have faced when using the new online portal since 1 June. We have challenged PCSE throughout on these and continue to work towards a system that does what is required.
We will be launching a survey on 2 September, aimed at capturing the experiences of practice staff’s use of the portal through August. The purpose will be to measure the progress of solutions to the big issues that those staff have been facing. There will also be a section on resolution times for issues practices have raised with PCSE since the launch of the portal in June.
We will include a link to the survey next week and we would encourage you to share this with your practice managers for them to respond to.
Standards for health and care records.
The Professional Records Standards Body (PRSB) has been commissioned by NHSE/I to develop standards that will enable key information about a person with diabetes to be shared between them, their carer and professionals to support self-management and to enable the best care to be delivered by those supporting them. There will be wide consultation between 20th-30th September 2021 to ensure views from professionals and service users across the UK are considered. If you would like to be involved please contact info@theprsb.org for joining information.
Media
Survey on GP abuse
The results of a BMA survey around the abuse faced by doctors were quoted again in the press and an article in the Independent discussed the abuse faced by GP surgeries as systems overwhelmed with demand struggle to cope, and a false perception by patients that GPs are closed lead to frustration directed at staff. The story was also picked up by the Mirror, Nottingham Post, Hampshire Chronicle, Eminetra and Yahoo!. The Telegraph also mentioned the BMA in their story on patient's frustration at the lack of availability for face-to-face appointments.
Vaccine Wastage
i news highlighted that 100,000 doses of the Oxford/AstraZeneca vaccine are set to be disposed of at the end of the month when they expire with GPs across England furious they have not been transported abroad to developing countries. In the article I commented that “Vaccines are a precious resource and the key weapon in keeping Covid at bay and coming out of the pandemic, so as we’ve always said, wastage should be avoided at all costs. Practices and vaccine sites have throughout the campaign been doing their utmost to reach all eligible patients and improve take-up, but with national guidance changing around the use of AstraZeneca in younger groups it’s unsurprising that some places will have doses left over. It’s incredibly concerning therefore to learn that where this is the case the excess jabs are not being picked up and redistributed where they’re needed, despite sites doing everything right and notifying NHS England when they have leftover stock. The Government should be putting into action plans to use any excess vaccines elsewhere; it’s indefensible if they’re left to expire and be thrown away.”
Northern Ireland
NIGPC chair Dr Alan Stout was interviewed on the Nolan Show (09.00) about the continued reluctance to take the Covid vaccine amongst some sections of the population. Last Friday, Dr Stout was interviewed on the Frank Mitchell Show about vaccine uptake, and he was also interviewed by Pulse about the removal of pregabalin from drugs being prescribed by GPs for the treatment of neuropathic pain. Its removal follows a 'significant increase' in deaths related to the drug.
NIGPC deputy chair Dr Frances O'Hagan was interviewed on BBC Evening Extra programme (11.36) about the continuing high case rate in Northern Ireland, and last Friday's case rate was the highest ever recorded since the pandemic began. The interview was picked up by the Belfast Telegraph in its reporting of the death of a woman from Covid shortly after she gave birth.
NIGPC member Dr Brendan O'Hare was interviewed on Friday's BBC Radio Foyle Breakfast show (22:46) about rising Covid rates in Fermanagh.
Scotland
In Scotland GPs have insisted the future of general practice should be a mixture of remote and face-to-face consultations, as the Scottish Government promised a return to in-person appointments as part of its £1 billion recovery plan. In the Scotsman BMA Scotland chair Dr Lewis Morrison said the plan rightly also focuses on primary care – and what support is in place for GPs. However, we need to be clear that GPs, as with clinicians in other parts of the healthcare system, are having to manage overwhelming demand and ensure patient and staff safety. In that context, they are already seeing patients face to face where appropriate and we must continue to allow those careful judgements to be made. We didn’t have enough GPs before the pandemic, and workload from Covid illness in the community, which is currently rising rapidly, falls on GPs both in and out of hours. We have to be careful of not making an already difficult situation worse. A 10 per cent increase in capacity would be unrealistic without the staff to do it.
Read the GP bulletin here.
Supporting General Practice - letter from NHS England
We have received a letter from Ian Dodge, National Director for Primary Care, Community Service and Strategy at NHS England and NHS Improvement (NHSE/I). This follows the meeting I had with Amanda Pritchard, the newly appointed NHSE/I chief executive, last week, and which was one of the first face to face meetings with any professional representative she had had since taking up her new role.
The letter acknowledges the pressures facing the profession, recognises its contributions and in doing so demonstrates a change of tone. It shows the steps NHSE/I is taking to rebuild relations with GPC England.
We are expecting NHSE/I to shortly publish further information on the service specifications and IIF with a focus primarily on 2022/23. As the letter suggests, they have heard our call to delay as much as possible of this until April 2022 at the earliest, whilst also continuing to invest the planned additional £150m for 2021/22. Our comments on this was reported on by Pulse.
Support Your Surgery campaign
In the next few days we plan to launch our latest campaign – Support Your Surgery. This follows the unfair criticism that has been levelled at general practice in the news and across social media over the last few months due to the way practices have had to work during the pandemic because of the necessary infection, protection and control measures. All too often this has resulted in GPs and their team members receiving abuse, as we have highlighted in The Doctor magazine and through our widely reported latest survey results.
To counter these perceptions and to put pressure on the Government to act to do more to support general practice, the campaign will provide practices with resources to help patients understand the reality of the issues facing general practice and to encourage them to join us in lobbying for the changes needed to address them.
Earnings and expenses report 2019/20 (UK)
NHS Digital has published the GP earnings and expenses figures for 2019/20. This is a UK report and provides details of both average earnings and expenses for contractor and salaried GPs in each of the four nations. However, as practice contracts now vary so much between nations, this annual report no longer produces any combined UK data. There were also significant factors in each of the nations in 2019/20 that impacted the outcomes and make interpretation and comparison more difficult, for instance in England it was the first year of the five year contract package with the introduction of the widely welcomed new Clinical Negligence Scheme for General Practice, and in Northern Ireland some payments were delayed from the previous year. For reference, the DDRB recommendation for 2019/20 was for a 2.5% pay increase.
Overall the figures suggest that years of repeated, real-terms pay cuts for GPs are slowly reversing for both salaried GPs and GP contractors. They also highlight the rising expenses in running practices, with in England the expenses to earnings ratio (the proportion of gross earnings taken up by expenses), at a record high of almost 70%. This indicates how much GP contractors need to invest in their practices to maintain services for their patients.
My comments were covered in the Daily Mail (print), Mail Online, Pulse and MSN.
COVID-19 Vaccination programme
Vaccinating 12-15 year olds with underlying health conditions
Following the advice from the JCVI that those aged 12–15 years with specific underlying health conditions that put them at risk of severe COVID-19 should be offered two doses of the Pfizer vaccine with an interval of eight weeks between doses, NHSE/I has published a letter outlining the actions practices should take to help identify eligible 12-15 year olds (cohort 13) to ensure they are offered a COVID-19 vaccination appointment by 23 August 2021.
The letter includes a template letter for practices as well as a link to updated FAQs on Vaccinating children and young people
Vaccinating 16-17 year olds by 23 August
The government has now also announced that all young people aged 16 to 17 in England should be offered a first dose of a COVID-19 vaccine by Monday 23 August to give them protection before returning to school. Read the NHSE/I letter which outlines details of the amended enhanced service specifications to incorporate 16 and 17 year olds into cohort 12.
Spikevax vaccine (formerly COVID-19 Vaccine Moderna) for 12- to 17-year-olds
The Medicines and Healthcare products Regulatory Agency (MHRA) has confirmed that the Spikevax vaccine (formerly COVID-19 Vaccine Moderna) is safe and effective to use for 12- to 17-year-olds, thereby extending the current UK approval (currently authorised for over 18s).
New and updated COVID-19 National Protocols
The following new or updated COVID-19 national protocols and PGDs have been published:
The updated PfizerBioNtech mRNA vaccine BNT162b2 National Protocol v04.00
The new Comirnaty COVID-19 mRNA vaccine National Protocol v01.00
The updated PfizerBioNtech mRNA vaccine BNT162b2 PGD (v04.00)
NHSE/I will also be publishing the new Comirnaty PGD v01.00 shortly.
The weekly BMA COVID-19 data analysis is available here. This will be produced fortnightly in the future.
Becton Dickinson blood specimen collection supply disruption
Last week NHSE/I issued urgent guidance on recommended actions following an alert by Becton Dickinson to a global shortage of products from their Blood Specimen Collection Portfolio, which is expected to last a significant period of time. They advise that, other than in exceptional circumstances, vitamin D testing should be stopped, retesting and monitoring intervals should be extended when clinically safe to do so and that routine screening for pre-diabetes and dyslipidaemia, allergy testing and routine infertility testing should be deferred until a resolution to the supply problem. We have raised this issue with the NHSEI primary care team and are seeking assurances that this will not impact tests required for contractual areas such as NHS health checks, QOF and drug monitoring. It would be unreasonable for practices to delay tests and then be expected to catch-up later, so adding to the current care backlog.
NHS Supply Chain has issued a Customer Notice which details the products impacted and the measures they have put in place. Practices that secure these products from Primary Care Support England (PCSE) should continue to order in this way. GP practices that do not usually order from PCSE can also order via their process.
Updated PHE guidance on NHS staff self-isolation and return to work following COVID-19 contact
As of 16 August 2021 the government has changed the requirements to self-isolate following a positive COVID-19 contact, and PHE has updated its guidance on how this changed will impact NHS staff and students working in the NHS
Fully vaccinated staff and students who are identified as a contact of a positive COVID-19 case will no longer be expected to isolate and will be expected to return to work, after a number of safeguards have been implemented, such as a negative PCR test prior to returning.
It’s important to remember that the updated guidance applies only to people who have the infection but are not showing symptoms. Anyone who develops symptoms should still self-isolate and end isolation only following a negative PCR test.
Read the BMA statement in response, by Dr Penelope Toff (BMA public health medicine committee co-chair) here
HEE is looking to the future for the health and social care workforce (England)
HEE has been commissioned by the Department of Health and Social Care to work with partners and review long term strategic trends for the health and social care workforce. The Long-Term Strategic Framework for Health and Social Care Workforce Planning will review, renew and update HEE’s Framework 15, last published in 2014, to help ensure we have the right numbers, skills, values and behaviours to deliver world leading clinical services and continued high standards of patient care.
The BMA will make a submission, but HEE also wants to hear from as many stakeholders and partners as possible, including people who need care and support, service users, patients, carers, members of the workforce, as well as students and trainees.
They have launched a ‘Call for Evidence’ which is live until the 6 September - please do complete the survey and have your say if you have capacity to do so.
BMA Annual Representatives Meeting
The ARM (Annual Representatives Meeting) agenda, Build back together: supporting our members, supporting our NHS, has now been published. The ARM takes place virtually on 13 and 14 September and is the BMA’s largest policy making event. We have also launched ARM 2021 on our website, and you will find information on elections, events and more online, as well as a blog from Dr Latifa Patel, Acting representative body chair.
NHS e-RS five minute Referral Assessment Survey (RAS) survey (England)
Currently, when patients are referred through non-A&G (advice & guidance) pathways in e-RS (e-Referral Service), a provider can either accept a referral (without advice) or return the referral (with advice / comment). However, a 5-minute survey has been launched to evaluate the potential benefit of enhancing e-RS RAS (Referral Assessment Services) – the non-A&G referral pathway – to allow providers to accept a patient referral and simultaneously provide comments or advice to the referrer to support patient care while the patient waits for their outpatient appointment.
There have been >750 responses already but a strong clinical voice would be really beneficial. The survey closing date is Monday 23rd August. Dr Carolyn Charman, NHSE/I e-Referrals Secondary Care Clinical Lead, appreciates that it is August and not an ideal time for a survey but thanks you in advance for your support in completing the survey and sharing it with colleagues.
The survey is live in e-RS as an alert – see this link for further information. Please do not hesitate to feedback via email (enquiries.ers@nhs.net) even after the survey closes if you have any comments.
Media
GP abuse survey
The BMA survey last week on the abuse experienced by GPs and others in the workforce, which showed that more than half of GPs responding have faced recent verbal abuse from patients, continued to receive media coverage, including in Pulse and Southern Daily Echo.
Northern Ireland
BMA Northern Ireland has released a statement on behalf of NIGPC chair Dr Alan Stout and NICC deputy chair David Farren appealing to people to wear a mask when in a healthcare setting unless there is a valid reason for not wearing one. The statement was covered by BBC News online, UTV News, News Letter, Belfast Telegraph, Irish Daily Mail (print), Daily Mirror, RTÉ News, Irish Times, Irish Examiner and Q Radio News. On Friday Dr Stout was interviewed on BBC Talk Back (interview starts at 09:1) about visiting restrictions to patients healthcare settings.
BJGP paper on health inequalities in England
The BJGP has published a paper which found that GP shortages in poorer areas could widen health inequalities. In response to this I said: “This research not only highlights the severity of the workforce crisis facing primary care, but also the dire consequences it’s having on deprived communities across the country – each one made up of real people, unable to get the timely care that they need. Government cannot afford to ignore this any longer; especially in the context of Covid-19, which has created an unprecedented NHS care backlog. Without safe staffing levels to overcome it, there will be further detriment to the wellbeing of both staff and patients long into the future.” The comments were covered in Medscape, GB News, Mail Online, LBC, Wales online and multiple regional titles.
Pulse reported on the blood specimen collection supply disruption, and GPCE member Dr Chandra Kanneganti commented that central communications must go out to patients to prevent them from blaming GPs for their cancelled appointments. He said that while it is ‘too early to say’ whether there have already been incidents in his area, practices cancelling routine blood tests are facing questions from patients wanting an explanation. GPCE members Dr Elliot Singer and Dr Peter Holden also commented in the article.
Read the GP bulletin here.
Read the latest Sessional GPs newsletter here
