BMA survey reveals worrying levels of abuse against doctors and staff
A BMA survey of doctors in England, Wales and Northern Ireland, published earlier this week, showed that more than half of GPs responding have faced recent verbal abuse from patients, or those close to them. The survey was widely reported in national and local media, including in this powerful piece in the Guardian, and key findings include:
COVID vaccination programme data
Three quarters of UK adults have now received both doses of a COVID-19 vaccine and the data shows that two doses provide over 90% protection against hospitalisation from the Delta variant, which is the dominant strain in the UK. I commented about the amazing achievement of general practice teams and many others vaccinating so many so quickly here
Self-isolation removed for close contacts of those who are fully vaccinated (England)
From Monday 16 August, people who have had two COVID vaccinations or aged under 18 will no longer be legally required to self-isolate if they are identified as a close contact of a positive COVID-19 case. With 75% of people having received both doses of the vaccine, the majority of adults will no longer need to self-isolate if they are contacts. Read more here
NHSE/I has distributed a system letter on how the government’s changes to the requirements to self-isolate following a positive COVID-19 contact will impact staff and students working in the NHS.
The letter can be found here.
The weekly BMA COVID-19 data analysis is attached.
Mandatory requirement for vaccinations to enter care homes (England)
DHSC has published guidance on new regulations which make COVID-19 vaccination a requirement for NHS staff entering care homes in England. This includes all staff in NHS commissioned services going into care homes. The last date for a care home worker to get their first vaccination in time to be fully protected is 16 September as the regulations requiring two vaccinations will come into force on 11 November. Booster doses are not currently covered by the regulations but may be added in the future. There are only a limited number of exemptions, and we are currently discussing this with DHSC.
Becton Dickinson blood specimen collection supply disruption
NHSE/I has 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 as it could have an impact on regular tests for 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.
COVID-19 pandemic recovery workload prioritisation guidance
As the COVID-19 restrictions are easing across the UK, and despite the success of the vaccination programme, the workload pressures caused by the pandemic remain at record levels.
The UK is currently moving through a third wave of infections, driven by the delta variant, leading to large numbers of COVID-19 cases, albeit often less severe than in previous waves, many of whom are managed by GPs and their teams. General practice not only continues to deliver the vaccination programme, but also provides routine acute and long-term care to patients and supports large numbers of individuals who are awaiting specialist assessment or treatment.
In light of these workload pressures, GPC England and RCGP have updated our joint COVID-19 Pandemic Recovery Workload Prioritisation Guidance for GP practices.
We urge commissioners to understand that there is significant variation in local capacity in general practice - subject to local circumstances, COVID-19 prevalence, and staffing levels – and that it is for practices to determine how they meet the reasonable needs of their patients.
Clinicians should continue to review and reprioritise workload, using clinical judgement and reflecting both patient need and local circumstances (e.g. staffing levels, local disease prevalence and patient demographics). Commissioners should also continue to limit or suspend additional expectations of practices, such as local enhanced services. However, with the withdrawal of the national Standard Operating Procedure (SOP) for general practice, following our intervention last month, the RCGP and GPC have amended our own national guidance. We will though be keeping the situation under close scrutiny and the winter approaches.
Read more in our updated section on service provision in our COVID-19 toolkit for GP practices
GPC Scotland update and blog
Congratulations to Dr Andrew Buist who last week was confirmed as Chair of the BMA’s Scottish GP Committee for a further three-year term. Read his blog where he updates on the COVID-19 situation in Scotland, the implementation of the 2018 GMS contract, including their refreshed Memorandum of Understanding that describes the process for transfer of services from general practice to Health Board responsibility.
BMA Annual Representative Meeting 2021
The agenda for the 2021 ARM has been published. The ARM takes place virtually on 13 and 14 September. A dedicated ARM website had also been launched where you will find information on elections, events and a blog from Dr Latifa Patel, Acting representative body chair.
BMA Infection control guidance
The BMA has updated its guidance on reducing risk in healthcare settings following the easing of restrictions on 19 July, to reflect the fact that COVID-19 is still circulating in the community, and the need to continue to reduce the risk of infection in healthcare settings.
The report sets out a number of measures that need to be taken by employers and government to reduce the risk of infection in all healthcare settings, including, adequate workplace and individual staff risk assessments; providing staff facilities that support infection control; a greater focus on ventilation in healthcare environments; the provision of safe and sufficient PPE; and reporting and investigation of COVID-19 cases suspected to have arisen from work.
The government’s infection control guidance for healthcare settings still applies following the lifting of the restrictions and as confirmed by the government, healthcare settings should maintain face coverings among other IPC measures. Download our poster for practices to display, about the continued use of face coverings for healthcare settings, 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, Primary Care Networks and clinical directors across the UK. Get the latest updates and best practices to power up your practice and patients through social prescribing – find out more here https://nalwevents.org/
There are 20 free tickets available for BMA members – first come first served - via this link
Media
England
After the secretary of state for health and social care in England, Sajid Javid, confirmed that pending final advice from experts, the booster Covid vaccines would be given at the same time as flu jabs, my comments were played on dozens of local and national radio stations saying the booster campaign is added pressure on general practice, but one that is really important to deliver.
Pulse reported on GPC England’s forthcoming supporting general practice campaign -materials and tools to help practices explain to their patients the pressures general practice is facing. I commented: “Even before the pandemic, surgeries were struggling with staff shortages, outdated and small premises and a lack of resources, and now they are facing spiralling demand and managing a record backlog of care, on top of delivering an historic vaccine rollout. The BMA regularly provides guidance, support and materials to practices to help them navigate these pressures – and helping the public understand the challenges faced by their local surgery, and the impact that this may have on their experience, as well as where the responsibility lies for addressing these issues, is one area in which we are committed to assist GPs and their teams – and we will provide members with more information in due course.”
Dr George Rae, BMA North East regional chair, was interviewed on BBC Radio Tees (2h1m40s into replay) about reducing NHS pressures in the North East. He reminded listeners that the pandemic is not over and wearing a mask is not a big ask.
Wales
Dr Phil White, GPC Chair for BMA Cymru Wales contributed to a BBC Wales article regarding the change in access to GP services in Wales as a consequence of COVID-19. The story includes a balance of opinion from patients and GPs on how patients are accessing GP appointments, i.e. through telephone, video conference or face to face and the reasons behind this. Dr White said: "It is a complete misconception to suggest that surgeries have been closed. Appointments have always been honoured whether through video, telephone consultations or face-to-face where clinically necessary. Face-to-face consultations are gradually increasing but with Covid measures in place including PPE and room cleaning, each face-to-face consultation can take twice as long and so offering a range of consultations can help us to try to meet the growing need for our services whilst keeping the most vulnerable safe." The article is available to read in full at BBC Wales News.
Northern Ireland
NIGPC chair Dr Alan Stout discussed COVID vaccine hesitancy in an article in the Belfast Telegraph (behind paywall).
Read the GP bulletin here.
Seasonal Influenza Vaccination Programme 2021/22 enhanced service specifications
Following the publication of the annual flu letter on 17 July 2021, NHSEI has published the two Enhanced Service Specifications for the Seasonal Influenza Vaccination Programme 2021/22. Practices are encouraged to opt in to the seasonal flu vaccination programme by Monday 16 August.
The service specifications are practice-based and similar to the 2020/21 flu service specification, except they now allow practices to vaccinate certain non-registered patients, including care home staff, in line with the current COVID-19 enhanced service. They may, though, be modified subject to any further JCVI advice or government policy. The enhanced services would be offered to all GP practices providing essential services and would not be capable of amendment by CCGs.
It is important to note that we are still awaiting the outcome of clinical trials which will help to determine which vaccine general practice will be using. This could clearly have a significant impact on the practicalities of programme delivery, so it is important that practices are given this information as soon as possible.
Public Health England has updated its guidance to explain to patients how they can help to protect themselves and their children against flu this winter.
Vaccines for 16- and 17-year-olds
The JCVI has confirmed that 16- and 17-year-olds will be offered a COVID vaccine. NHSEI have amended the enhanced service specification accordingly to incorporate 16- and 17-year-olds into cohort 12, and published a letter outlining details. The updated COVID-19 enhanced service specification for phases 1 and 2 and the enhanced service specification for phase 3 now include the new eligible patients. Practices delivering COVID-19 vaccinations under the phases 1 and 2 arrangements can start vaccinating eligible children and younger people immediately subject to meeting the requirements of the ES.
The revised enhanced service specifications clarify that the Clinical Negligence Scheme for General Practice (CNSGP) will provide clinical negligence indemnity cover for all staff engaged by a GP practice under the CNSGP Regulations. Cover under CNSGP is not restricted to a GP practice’s registered patients so would apply to the provision of any NHS COVID-19 vaccinations by a GP practice to a person, including where they are not on the registered list of that GP practice.
We are aware of a number of GP groups having problems sourcing, securing and/or funding venues for the booster programme, particularly when previous venues are no longer available. If practices/PCN groupings are having difficulties finding venues, they should raise this with their local commissioner in the first instance. It is expected that PCN groupings will, where possible, use existing premises within their collaborating GP practices’ control. If any other NHS estate is used the costs should be covered by the commissioner (NHSE) via the CCG.
Workforce data concerns
The latest quarterly GP workforce data has been published by NHS Digital. However changes have been made to the way this information is produced, and we have raised concerns that it is now misleading and fails to accurately reflect the staffing shortages that we, and thousands of doctors across England, know we are facing in primary care – and have been for at least a decade. The methodology NHS Digital is now using no longer includes estimated data to accommodate for the small proportion of practices that upload no or only partial workforce figures each quarter. As a result, this makes it look like the decrease in the GP workforce is less than the reality shown across previous datasets.
We can’t make improvements without understanding the extent of the problem, which is why NHS Digital must be allowed to revert to its original methodology as a matter of urgency. We’re already losing talented, experienced GPs to the workforce crisis; attempting to gaslight them into believing it’s not real is only going to drive more away.
The story was covered in Pulse and GPOnline
COVID-19 vaccine dashboard
NHS Digital has developed the GP COVID-19 vaccine dashboard to enable general practices and PCN-led local vaccination services to view the uptake of COVID vaccines of their registered patients. This dashboard is now live and can be accessed via NHS Futures.
The platform aims to enable staff at GP practices to view and understand uptake for all patients registered to practices. Access is controlled by NHS smartcard and is subject to an organisation and role code B0360 being available for relevant organisations on a user’s smart card. The dashboard provides contact information for registered patients who are eligible for the vaccine and have not received their first dose, and those whose second dose is pending or overdue.
It is an optional tool to help practices to support patients in the vaccination rollout in local communities.
New NHS England chief executive
Last week we highlighted that the new chief executive of NHS England and Improvement would be Amanda Pritchard. We were pleased to see that her first visit as chief executive was to a GP-led vaccination centre in Reigate, and during the visit she expressed her thanks and appreciation to primary care and general practice staff for playing their part in the incredibly successful COVID-19 vaccination programme, with now almost 90% of adults having had at least one vaccination and more than 32m having both.
We have approached Ms Pritchard to welcome her appointment and will be using all opportunities with her arrival in post to reset our relationship with NHS England in such a way that GPs can see tangible evidence of both understanding and support for them and the teams they work with, at this critical time of workload pressure and workforce exhaustion.
NHS COVID-19 app updated to notify fewer contacts to isolate
The Department of Health and Social Care issued a press release urging the public to continue using the NHS COVID-19 app as changes had been made which would result in fewer close contacts being advised to self-isolate. Please see an explanation of the risk algorithm of the NHS COVID-19 app here.
Weekly COVID-19 data
The BMA's weekly analysis of Covid-19 data is available here.
Changes in visa sponsorship for trainee GPs
The BMA has written to the minister responsible for workforce, Helen Whately MP, to ensure adequate support is being given to international GP trainees on completion of training to find employment with a licensed sponsor. We are asking that the DHSC work with the Home Office to take action to ensure a long-term solution is found to support future cohorts of doctors.
Fit notes
Now that many coronavirus regulations are being relaxed, practices are reminded that DWP Medical Certificates should normally be issued only following evidence of a related consultation with the patient.
Appraisal payments
Following our submission to the DDRB, and the recommendation of a 3% uplift for GP appraiser pay and trainers grants being accepted by government, NHSE/I has confirmed the standard appraisal fee will be uplifted by 3% and applied from 1 April 2021. It is anticipated that the September 2021 payment will reflect the new recalculated fee and include back payments for appraisals undertaken and paid. It is positive that the award has been applied to this area as GP appraisers had been severely affected during the pandemic, with many appraisals being paused.
Practices call for more PCN funding, support and autonomy
The NHS Confederation PCN Network has published a new report, PCNs: Two Years On, which highlights how PCNs have risen to the challenges and demands of COVID-19, galvanising their communities to deliver the most successful vaccination programme in the history of the health service.
It has reinforced BMA messages about the impact of the huge workload pressures on general practice and the scale of the challenge from the nearly 5.3m people who are now awaiting elective treatment, with the pandemic having led to increased and more complex demands on all NHS services.
Improving the NWRS (National Workforce Reporting Service)
NHS Digital has improved the way they collect primary care workforce data making the new NWRS is easier to use, and as simple and efficient as possible to help minimise the burden placed upon practices and primary care networks.
From July, users should access the new NWRS via the Strategic Data Collection Service (SDCS) - using the same login you use to complete other data collections, such as the General Practice Annual Electronic Self-Declaration (eDEC). Visit the SDCS Data Submission site to check that you have access to the new system. If you have never used SDCS, you will need to register for an account.
It is important to understand staff capacity in the health service - this information helps shape GPC England’s negotiating strategy and how investment, training and resource is directed across the primary care workforce. It is therefore critical that the information you submit to NHS Digital about your staff is accurate and complete. Provision of workforce data is also a contractual requirement for practices and PCNs as it is crucial for understanding changing capacity across the primary care workforce.
To find out more about the changes to the NWRS, Practice and PCN Managers can join one of NHS Digital’s webinars which are running twice weekly until end of August.
GP payments and pensions system update
As we approach the end of the second month of its use, we continue to see an unacceptably high level of issues being raised about the new online portal. We continue to liaise with PCSE several times a week but the progress is frustratingly slow. The survey for GPs in England to provide their experiences of the new system will remain open until 13 August. If you haven’t already, we would urge you to please fill out the survey so that we have further evidence of the full extent of the issues and can hold PCSE to account. Note that this survey is not a forum for individual issues – please raise these with PCSE directly.
We know that practices are the biggest users of the portal and we are aware of the many issues they are facing. Our intention is to release a survey of practices in England at the start of September which we hope to use as a ‘snapshot’ of progress after three months of its use. There will be further information on this in the coming weeks but, again, the purpose is to help us hold PCSE accountable for their performance. Please be assured that practice use of the portal continues to be central to the work we are doing on this issue.
There has been continued coverage of this issue in Pulse.
New president of RCGP
Congratulations to BMA council member Professor Dame Clare Gerada who has been named as the next president of the RCGP. We look forward to working with her and the RCGP more widely on key issues impacting on general practice.
Media
Northern Ireland
Northern Ireland GPC NI Council Dr Tom Black was mentioned in the Derry Journal about a previous motion to Derry City and Strabane District Council on levels of public access to GPs. Tom was also interviewed on today’s Good Morning Ulster (1:47:00) and BBC Radio Foyle’s Breakfast Show (1:41:59) about vaccine uptake among young people and roll-out to 16-17 year olds.
Dr Black's interview on the BBC Nolan Show (51:42) earlier this week about vaccine passports for hospitality was also picked up by yesterday’s Good Morning Ulster (06:25).
Northern Ireland GPC Chair Dr Alan Stout was interviewed, along with Dr Michael McKenna NIGPC members in the Belfast Telegraph about the high volume of requests to GP practices for medicines that can be bought over counter. Dr Stout was also interviewed on the Nolan Show (39:05), about the current trajectory of infection numbers and the effects of this on frontline HSC services.
Dr Stout was interviewed on the BBC Nolan Show (starts at 1:05:49) about the extension of Covid vaccines to 16 and 17 year olds and whether vaccinations should be incentivised for young people to improve uptake levels. Dr Stout was also interviewed on BBC Talkback on the topic of Vaccine passports for hospitality becoming inevitable in Northern Ireland, The piece begins at 04:21 with Dr Stout’s interviews at 11:28.
Northern Ireland GPC deputy Frances O’Hagan, was interviewed on Good Morning Ulster (1:16:01). about vaccination numbers and rising covid cases, this was also picked up by the Belfast Telegraph and BBC News.
Scotland
BMA’s Scottish GP Committee chair Dr Andrew Buist was quoted in the daily record the committee were very concerned about what appears to be a significant pension contribution issue affecting many GPs.
England
Dr Dean Eggitt, CEO of Doncaster LMC, invited a journalist to spend a day shadowing him in his surgery to witness GP pressures first-hand. The story is featured in the Daily Mail. Dean is quoted saying that the truth is we don’t have enough clinicians to deal with the number of patients who need to be seen. We’ll try what the Government suggest, but only because we don’t have another solution.’
In the coming weeks the BMA will be sending to practices materials and tools they need to explain to their patients the pressures general practice is facing.
I was interviewed on BBC Radio Leeds (08.11, 2h11min in), reminding the public that young people can have serious symptoms COVID-19, whilst discussing vaccination rates in the Leeds area, uptake in the younger population and the upcoming booster campaign.
I was quoted in Management in Practice and Pulse, describing how practices are under ‘immense pressure’ as they continue to see patients while playing a leading role in the vaccination programme. The latest dataset from NHS Digital published on 29 July, showed that practices in England booked 3.5 million more appointments in June that next month, delivering 15 million face to face appointments in June.
Read the GP bulletin here.
We were all shocked and saddened to hear of the death of Professor Kailash Chand OBE, a former member of GPCUK, LMC medical secretary and deputy chair of BMA council. He was a hugely influential NHS campaigner and prolific writer of articles making the case for general practice and the wider NHS. For much of his career, he worked as a GP in Tameside in Greater Manchester. Kailash was first elected to BMA council in 2006 and served as deputy council chair from 2012 to 2016. He was also elected to the BMA board in 2020.
Kailash was named GP of the year by the Royal College of General Practitioners in 2009 and was recognised for his services to the NHS with an OBE in 2010. He recently featured on the BBC documentary Our NHS: A Hidden History,describing how nurses, doctors and health workers from overseas transformed the NHS despite hostility and discrimination. Kailash was a role model, mentor and friend for many and will be a great loss. We wish to offer our sincere condolences to his family at this difficult time.
New NHS England chief executive
The new chief executive officer of NHS England and Improvement will be Amanda Pritchard. She is currently the chief operating officer at NHSE/I and was previously chief executive of Guy's and St Thomas' NHS Foundation Trust after beginning her NHS career as a graduate management trainee in 1997. She is the first woman in the health service’s history to hold this post, which she will take up on 1st August.
As I previously highlighted, Amanda Pritchard recently publicly praised GPs and their teams and acknowledged the work we are doing saying: 'a really big thank you to primary care – working well beyond pre-pandemic activity – (they are) really really working at an astonishing rate'.
We’ve welcomed her appointment and hope this provides an opportunity to reset our relationship with NHS England in such a way that GPs can see tangible evidence of both understanding and support for them and the teams they work with at this critical time of workload pressure and workforce exhaustion. We believe that a strong and supported general practice is the core foundation on which the wider issues facing the NHS can be dealt with and it’s vital that NHSE/I under this new leadership do all they can to address the fundamental issues we all face.
Read the BMA response to the announcement.
GP appointment data demonstrates workload pressure
The latest GP appointment data for June has been released. The data shows a 3.5m increase in the number of appointments provided during June this year compared to June 2019 (26.7m compared to 23.2m), with an additional 4m COVID vaccination appointments delivered on top of that. Taken together the total number of appointments during June was approximately 31.1m.
The appointment figures continue to demonstrate the immense pressures that GPs and practice teams are under with the ever-increasing workload generated by the pandemic and NHS backlog. Figures like these have become all too familiar but to see them in the summer when the workforce should normally be able to take time out to rest and recharge after such a difficult year is very concerning. We will be highlighting to the new incoming NHSE/I chief executive that there is a critical need to alleviate the severe pressure GPs and their teams are under.
Supporting general practice campaign
In the coming weeks, we will be sending to practices materials and tools they need to explain to their patients the pressures general practice is facing. The monthly appointment data clearly shows the need for this as we all experience unprecedented pressures which are increasingly hard to deal with. There is no evidence that these pressures are going to lessen in the coming months as we face what many are predicting to be a very difficult winter.
RCGP report echoes BMA call to tackle general practice pressures
The RCGP has published a report reinforcing many of the key public messages regularly made by the BMA in recent months including that general practice is now ‘at breaking point’. It proposed a five-point recovery plan to prevent GPs and other members of the practice team from burning out and ensure patients can continue to receive the care they need, well into the future. The RCGP described the pressures within general practice as unsustainable and said that they must be urgently addressed as we move beyond the ‘emergency’ pandemic period. During this time, GPs have to deal with the aftermath of COVID in their local communities, including long COVID, and the additional mental and physical health problems it is causing in patients of all ages.
They call for much more work to be done by the Government on recruitment and retention of GPs and the wider workforce. There is an urgent need for investment in premises so staff have space to work safely while providing care for patients. In addition, workload pressures must be reduced, including the removal of unnecessary bureaucracy, and GPs need to have a strong voice in the new ICS arrangements. We would agree that all these goals must be delivered to see a real change in the crisis we currently face.
Chief Midwife urges pregnant women to get NHS Covid Jab
Professor Jacqueline Dunkley-Bent, Chief Midwifery Officer for England, has written to midwives and GP practices stressing the need to encourage pregnant women to be vaccinated to protect them and their baby. England’s top midwife is urging expectant mums to get the Covid-19 vaccine after new data shows the overwhelming majority of pregnant women hospitalised with the virus have not had a jab. The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives have both recommended vaccination as one of the best defences for pregnant women against severe COVID-19 infection.
GP payments and pensions system update
As we approach the end of the second month of its use, we continue to see an unacceptably high level of issues being raised about the new online portal. We continue to liaise with PCSE several times a week but the progress is frustratingly slow. The survey for GPs in England to provide their experiences of the new system will remain open until 13 August. If you haven’t already, we would urge you to please fill out the survey so that we have further evidence of the full extent of the issues and can hold PCSE to account. Note that this survey is not a forum for individual issues – please raise these with PCSE directly.
We know that practices are the biggest users of the portal and we are aware of the many issues they are facing. Our intention is to release a survey of practices in England at the start of September which we hope to use as a ‘snapshot’ of progress after three months of its use. There will be further information on this in the coming weeks but, again, the purpose is to help us hold PCSE accountable for their performance. Please be assured that practice use of the portal continues to be central to the work we are doing on this issue.
There has been continued coverage of this issue in Pulse.
Guidance to support GP practices obtain a sponsorship licence
The BMA and NHS England and NHS Improvement have published guidance to support GP practices obtain a sponsorship licence to recruit a GP from outside of the UK or a UK medical graduate switching from a Tier 4 visa. After hearing from GP practices, it will address the questions that are often raised and is designed to support GP practices to complete the online registration process and identify the right documents to send to the Home Office. Please note this does not replace the official Home Office guidance.
You can access the guidance on the following link
Improving the NWRS (National Workforce Reporting Service)
NHS Digital has improved the way they collect primary care workforce data making the new NWRS is easier to use, and as simple and efficient as possible to help minimise the burden placed upon practices and primary care networks.
From July, users should access the new NWRS via the Strategic Data Collection Service (SDCS) - using the same login you use to complete other data collections, such as the General Practice Annual Electronic Self-Declaration (eDEC). Visit the SDCS Data Submission site to check that you have access to the new system. If you have never used SDCS, you will need to register for an account.
It is important to understand staff capacity in the health service - this information helps shape GPC’s negotiating strategy and how investment, training and resource is directed across the primary care workforce. It is therefore critical that the information you submit to NHS Digital about your staff is accurate and complete. Provision of workforce data is also a contractual requirement for practices and PCNs as it is crucial for understanding changing capacity across the primary care workforce.
To find out more about the changes to the NWRS, Practice and PCN Managers can join one of NHS Digital’s webinars which are running twice weekly until end of August.
Media
Northern Ireland
Northern Ireland GPC Chair Dr Alan Stout was interviewed on BBC Good Morning Ulster on Monday about how vaccinated healthcare staff should not be exempt from self-isolating, in a bid to cope with staff shortages. The piece starts at 1:36:59 with Dr Stout’s interview at 1:37:24. His comments were then picked up by the Newsletter, Q Radio News and BBC News online. BMA Northern Ireland was mentioned in a piece in The Irish News on the same subject.
England
The latest annual National Training Survey report, published by the General Medical Council (27 July), found that as many as a third (33%) of trainee doctors felt burnt out to a high or very high degree because of their work. Efforts to increase the number of GPs in general practice could be undermined with the new report highlighting increasing levels of burnout among GP trainees. I commented that it is incredibly concerning that GP trainers were increasingly likely to suffer from burnout and emotional exhaustion. There was a need for a renewed effort to protect staff’s wellbeing, while providing practices with the resources they need to meet the growing list of demands they face.
There was continued coverage in GP online of the Government announcement in England on pay and the impact on GP partners. GPC England exec team member Dr Krishna Kasaraneni commented that 'The government has said that practices will not be given additional funding on top of the 2.1% for staff already allocated for this year. This means GP partners could be faced with deciding between service cuts or being able to pay the full amount to salaried GPs. It is therefore not acceptable and disingenuous to speak of an uplift while refusing to provide the necessary funding. The government has completely and shamefully ignored the incredible response made by GP partners and their teams during the pandemic, suggesting that this year's pay award was to recognise the role played by other NHS workers. This will further damage GP morale and demonstrates that the government does not value general practice as it should. Liverpool LMC medical secretary Dr Rob Barnett commented that the pay award was a 'kick in the teeth' for practices that had delivered the vast majority of COVID-19 vaccinations and endured a significant rise in workload through the pandemic.
Dr Brian McGregor talked to BBC Radio York about falling Covid-19 cases. Interviewed on BBC Radio York (starts at 07.10) he said that one of the reasons case numbers appear to be dropping, is because people are deciding not to be tested as they don't want to have to self-isolate. He went on to say that with schools now on holiday, many asymptomatic cases will no longer be picked up. He also said that people in hospital with Covid tended to be those who were younger and unvaccinated and he urged listeners to have their vaccine as soon as possible, saying that vaccinations are the best protection against this illness.
Read the GP bulletin here.
DDRB pay uplift
The BMA is hugely disappointed by the Government’s announced 3% pay uplift for doctors. As we have come to expect from this Government, this announcement is not all that it seems. For salaried GPs, a 3% uplift is more than the 1% the Government recommended at the beginning of the year and is the highest uplift they have received in many years. However, 3% does not compensate for the years of pay erosion experienced by all doctors. Moreover, the government has said that practices in England will not be given additional funding on top of the 2.1% for staff already allocated for this year which means GP partners could be faced with deciding between service cuts or being able to pay the full amount to salaried GPs. It is therefore not acceptable and disingenuous to speak of an uplift while refusing to provide the necessary funding. We have made our grave concerns known directly to the Secretary of State for Health and Social Care.
In their evidence DHSC highlighted the ‘vital role’ that general practice had played in the pandemic response and the DDRB underlined the critical importance of general practice and primary care more generally. In acknowledging the contribution of all doctors in the pandemic response, the DDRB also urged ministers to consider additional recognition for groups outside of their remit for this year, including GP contractors. Salaried GPs were roundly praised for their work throughout the pandemic and their adaptation to ensure the continued success in their role, including the utilisation of technology. It is worth also noting the announcement that GP trainer grants will increase from £8,584 to £8,842 and GP appraiser fees will increase from £543 to £559. These will be backdated to 1 April 2021.
What's clear is the government in England have completely and shamefully ignored the incredible response made by GP partners and their teams during the pandemic, suggesting that this year's pay award was to recognise the role played by other NHS workers. This will further damage GP morale and demonstrates that the Government does not value general practice as it should. The Government chose to ignore the DDRB’s clear statement that pay awards needed to be appropriately funded in order to avoid ‘a negative impact on service provision’.
Read more in my joint blog with the Sessional GPs committee chair Ben Molyneux about what this means for GPs.
Read the BMA statement here
Easing of COVID restrictions and infection control (England)
As of this week, from 19 July, the COVID-19 restrictions in England have been eased in line with the government’s roadmap.
Following this announcement, NHSE/I has published a letter that confirms that the existing COVID-19 Infection Protection and Control guidance continues to apply in healthcare settings, and that contractors will continue to have NHSE/I’s support in enforcing the IPC guidance.
The following provisions will continue under the Pandemic Regulations until 30 September 2021:
The Government has announced that double vaccinated frontline NHS and social care staff who have been told to self-isolate will now be permitted to return to work ahead of the self-isolation period - if there is a risk that staff absence would lead to potential patient harm, and following the completion of a local risk assessment and a number of safeguards are implemented.
It is regrettable that, through Government decision-making, inconsistent and confusing public messaging and policy, we are in the position we are now in, with soaring case numbers and hugely increased pressures on the healthcare system. Government’s approach to loosening restrictions means many healthcare staff are now having to isolate at a time when pressure on the service is increasing, and practices are finding it incredibly difficult to deliver a service with very limited staffing.
We know that local medical committees will be discussing with relevant organisations in their area, including the director of public health, how this can be safely and appropriately implemented. Practices are reminded that this is voluntary and should only be used in exceptional circumstances. Any staff who decline to return should not be adversely impacted financially and there should also be a focus on better provision of remote working alternatives wherever possible.
Maintaining staffing levels when many have to self-isolate is having a big impact on some practices so there does need to be some sensible local flexibility in the way this is applied across an area, and practices need quick answers when seeking to apply it.
Read the NHSE/I guidance for allowing essential frontline staff to return to work.
Read the BMA’s response to the staff isolation exemptions
GPDPR delay – joint statement and letter to GPs
The Parliamentary Under Secretary of State for Health, Jo Churchill, has written to all GPs in England, setting out plans for the next steps for the GPDPR (GP Data for Planning and Research) programme and extending the timeframe indefinitely beyond 1st September.
The BMA and RCGP (Royal College of General Practitioners) have been closely involved in discussions over the steps that are necessary before any data collection can commence under GPDPR, and welcome the commitments made in these latest plans.
We have always recognised the crucial role that GP data has to play in research and planning which can improve public health but have made it clear that it is important for patients and the public that this data is only made available for appropriate purposes, and in a secure and trusted manner and with minimal administrative burden on the profession.
Read our full joint statement here
Read the press statement by Farah Jameel, GPC England executive team IT lead, here
The BMA's response to the Government's announcement delaying the start of the data sharing programme was referenced in a number of articles on The Register, Digital Health, Healthcare Leader and Medscape.
COVID-19 vaccination programme
Vaccinating children
The Joint Committee on Vaccination and Immunisation (JCVI) has advised that children at increased risk of serious COVID-19 are to be offered the Pfizer-BioNTech vaccine, including children aged 12 to 15 with severe neurodisabilities, Down’s syndrome, immunosuppression and multiple or severe learning disabilities.
The JCVI also recommends that children and young people aged 12 to 17 who live with an immunosuppressed person should be offered the vaccine, to protect those at higher risk of serious disease from COVID-19, and who may not generate a full immune response to vaccination.
The BMA welcomed this new guidance and have encouraged NHSE/I to be clear that people should not contact their GP for information practices do not have. Read the BMA statement
NHSE/I has now published a letter advising that children and young people (aged 12-17) with underlying health conditions, or who are household contacts of persons (adults or children) who are immunosuppressed, should be offered COVID-19 vaccination, following the JCVI statement earlier this week. The letter advises that children are offered a first dose vaccination before returning to school in September, and it is therefore expected that first dose vaccinations for eligible children aged 12-15 to be operational from w/c 23 August at the latest with invitations issued in advance.
The letter also advises that, ’18 years’ in the existing national protocol and PGD can be interpreted as including 17 year olds within 3 months of their 18th birthday, where this is necessary to support high vaccine uptake. Children aged 12-15 in the groups specified by JCVI can only be vaccinated using a PSD until the documents are updated.
Annual flu vaccination letter
The annual national flu immunisation programme 2021 to 2022 letter has now been published. This year, the eligible cohort from the start of the programme includes those aged 50 and over and the letter states that, as trials are still ongoing to ascertain whether co-administration of COVID-19 and influenza vaccines will be permissible, practices should continue planning for influenza vaccination as usual, with further advice to be issued should co-administration with COVID-19 vaccination be recommended.
As we pointed out last week following the publication of the Enhanced Service Specification for phase 3 of the COVID-19 vaccination programme, community delivery of both COVID-19 and flu vaccinations is essential to the success of the programme and it is vital that local systems support practices to do this where the nature of the COVID vaccination used allows.
Meetings with ministers and MPs
I met with the Parliamentary Under Secretary of State for Health, Jo Churchill, this week to discuss a range of issues. I raised my serious concern about the DDRB award, the lack of recognition for the role GP partners have played during the pandemic and the need for funding to support the implementation of the award for sessional GPs. I also raised our concerns about on-going workload pressures and the impact this was having on the workforce, with the potential for further PCN service specifications planned by NHSEI in the autumn, which would add significant additional pressure to practices at what was already likely to be a time of unprecedented activity given rising infection rates would be coupled with winter-related illness and a double vaccination programme.
Last week, I met with former Health Secretary and Current Health and Social Care Committee Chair, Jeremy Hunt MP. The focus of the meeting was also workforce pressures, in particular the need to manage patient expectations; better support the health and wellbeing of those working in primary care; improving workforce planning and promoting better approaches to recruitment and retention. During the meeting I asked the parliamentary committee to support increasing resource available for premises and improving access to community diagnostics, and also renewed our support for the committee’s lobbying to ensure independent workforce planning was adopted as a statutory responsibility in legislation.
I have also this week met with Alex Norris MP, Shadow Minister of State for Prevention, Public Health and Primary Care in Labour’s health team, again to highlight the workload and workforce pressures in general practice, and the unacceptable abuse directed at many working in general practice with the need for greater support. We also discussed the changes that needed to be made to the Health Bill and the need for premises investment to both improve infection control but also to provide space for expanding practice teams.
GP Payments and pensions system provided by PCSE
We, along with the Institute of General Practice Management, wrote to NHS England last month to raise our concerns about the new system and demand urgent action to ensure that GPs and practices are able to use the system as intended. We have now received the attached response which maintains the line that the issues we raised are merely expected ‘teething problems’. PCSE are gradually putting ‘fixes’ in place for many of these issues, most of which we would consider to be solutions to problems that would not have arisen if user testing had been more thorough.
We continue to engage with PCSE in pursuit of solutions to outstanding issues as well as relevant data to allow us to measure performance. We will continue to do so for as long as is necessary. In addition to the survey for GPs currently running (see below) we are looking to survey practices in England in early September to capture their experiences of using the system in August, the third month of its use. Both surveys will be invaluable in helping us to hold PCSE to account.
Tell us your views on the new PCSE pensions portal
If you are a GP working primarily in England, please fill out our survey on the new system so that we have further evidence of the full extent of the issues and can hold PCSE to account. Note that this survey is not a forum for individual issues – please raise these with PCSE directly.
Vaccines and undocumented migrants – safe surgeries toolkit
There have been some reports of undocumented migrants not being registered by GP practices, despite the requirement on GP surgeries to register all patients (if open to new patients).
We would therefore like to encourage practices to use the Safe Surgeries toolkit developed by Doctors of the World (DOTW), which is an accessible presentation of existing DHSC guidance and supports clinical and non-clinical NHS staff to promote inclusive care through GP registration. Notably, it aims to address specific barriers to primary care faced by vulnerable, un/under-documented migrants by ensuring that GP practices are aware of all relevant guidance and rules. This includes, for example, that patients should not be turned away if they lack a proof of ID, address, or immigration status.
We continue to work with DOTW to encourage GPs and practices to consider and adopt the recommendations set out in the toolkit, particularly as it is now more important than ever that patients are registered with a GP. GP registration will likely mitigate the effects of the pandemic on health inequalities by improving equitable access to care and ensuring that marginalised and excluded communities are not missed in the COVID-19 vaccine roll-out.
DOTW also offer FREE training to clinical and non-clinical NHS staff that aims to improve awareness of migrant entitlements to NHS care and enables staff to better advocate for their patients.
GPC England executive team member and workforce lead Krishna Kasaraneni was interviewed on Channel 4 News about this last week, where he highlighted that everybody is entitled to free general practice services at the point of need, regardless of immigration status or ability to produce documentation. This is in line with contractual requirements. Read the BMA and DOTW joint letter to support practices to remove barriers for this group of vulnerable patients.
Delegation of NHS England commissioning functions to integrated care systems from April 2022
NHSE/I has written to ICS (integrated care system) leads and CCGs to outline their plans to delegate some of NHSE/I’s direct commissioning functions to integrated care boards within each ICS as soon as operationally feasible from April 2022. The letter outlines that subject to the will of Parliament relating to the Health and Care Bill, NHSE/I's expectation is that from April 2022 ICBs will assume delegated responsibility for primary medical services currently delegated to all CCGs (and continuing to exclude Section 7A Public Health functions).
Are you considering applying for a GP sponsorship licence to employ non-UK nationals?
If so we are keen to hear from you as well as those who started the process to apply for a licence, but dropped out because of difficulties with the application process.
The Home Office introduced a new sponsorship system last October, in preparation for the introduction of the new immigration system which came into force in January 2021. The new system is designed to alleviate many of the complexities of the old system and it is hoped the new application process will support employers to apply for a sponsorship licence with relative ease.
As detailed in the updated guidance, employers can now apply online.
The Home Office wish to survey small businesses, including GP practices considering applying to get a sense as to their perceptions of the process. If you have any insights into the sponsorship process that you wish to share, please contact Caroline Strickland, Senior Policy Advisor in International Affairs on the following email CStrickland@bma.org.uk
Media
GP Online reported on our calls for NHSE/I to publish the ES specification for flu, and I commented: “Practices need to have all the information about different areas of work this winter, so they are able to make informed decisions about what is possible and begin planning. Therefore, NHS England should publish the flu specifications as soon as possible, giving practices as much time as they need to consider them alongside the booster programme. As we have already made clear to government, any other additional demands on GP workload must be delayed given the current crisis, and therefore NHS England must also think carefully before introducing any further service specifications in the coming months, in the context of rising COVID-19 cases and the challenges winter will bring.”
Andrew Buist, chair of the GPC Scotland, has published an article calling for urgent support for primary care in Scotland, about the continued workload demands the service faces.
Chair of NI GPC Alan Stout was interviewed on BBC Talkback (at 18:09) about the vaccination roll-out to at-risk children and young people over 12. Dr Stout was also interviewed on U105 Frank Mitchell show about vaccine passports.
Read the GP bulletin here.
Update on GPC England resolution
At the last GPC England meeting in May, the committee passed a vote of no confidence in the senior leadership of NHS England and Improvement. Among other things, the motion also instructed the GPC England executive team to cease all formal meetings with NHSEI until such time a motion could be brought back to the committee recommending that NHSEI had taken sufficient steps to restore the confidence in its leadership. This is an instruction we have followed. Yesterday, GPC England met again to discuss progress and the direction we may wish to go next.
In the eight weeks since our last meeting we have seen some positive signs and change in tone from both the Department of Health and Social Care and NHSEI, including from senior NHSEI executive directors, with public thanks and recognition of the pressures currently facing general practice, while communications have taken on a more factual tone.
But while we acknowledge and welcome these positive signs, and in particular the recognition of the important role that general practice has played throughout the pandemic as well as the pressures GPs and the whole of general practice is currently experiencing, kind words have not yet always been followed by the actions we’d like to see. In recent weeks we’ve seen flawed and overly bureaucratic enhanced services announced and activity targets introduced when the profession is on its knees. Most recently, the specifications for the Covid booster programme ignored calls from frontline GPs to be given more clinically appropriate flexibility and support in enabling practices to deliver the programme in a way that best benefited their communities.
So, despite some signs of progress, after discussion at yesterday’s meeting, a recommendation was not brought to return to formal meetings with NHSEI at this point.
We must be clear, however, that this is not a situation that we want to continue and we recognise that getting to a place where we are able to negotiate effectively on behalf of the profession with an NHSEI that clearly demonstrates that it understands and acts on the needs of general practice is in the best interests for everyone, not least our patients.
England has a new Health Secretary and in the coming weeks NHSEI will have a new chief executive, and these appointments provide an important opportunity for both the Government and NHSEI to demonstrate their clear commitment to general practice, that we hope could potentially pave the way for beginning to engage on fresh terms.
GPC England continues to discuss how we may proceed and we will keep you informed of developments in due course.
Shocking workforce crisis exposed by BMA report
The BMA published Medical staffing in England: a defining moment for doctors and patients early this week. The figures indicate that there are 1,307 (4.4%) fewer fully qualified FTE GPs than in September 2015, whilst the number of patients per GP practice is 22% higher than it was in 2015, so the GP workforce has not expanded with this rise in patient need. As a result of this, there are now just 0.46 fully qualified GPs per 1,000 patients in England - down from 0.52 in 2015.
There is an urgent retention issue with GP partners with numbers continuing to fall. It is clear that workload pressures are having a material impact as, based on the data trends, fully qualified GPs generally want to better control their workload and work-life balance. There is also a clear trend towards salaried and sessional GP roles and more portfolio and LTFT (less than full-time) working, which is the case for GP trainees as well.
The Government is clearly failing to get anywhere near its 2020 commitment of an additional 6000 doctors in general practice by 2024, as we only anticipate getting around 3,380 additional fully qualified FTE GPs (not factoring in any existing GPs reducing their hours or leaving the profession in that time). This also still falls short of the Centre for Workforce Intelligence’s 2014 prediction model of the worst-case scenario for the GP workforce in 2024.
To tackle the workforce crisis we are calling for urgent and sustained action, including:
Supporting general practice and latest appointment data
We all know that GPs and their teams across the country are under enormous pressures. NHS Digital has published the latest statistics for GP appointments which show that over 8.5 million vaccines appointments were delivered via general practice in England in May, on top of 23.5 million ‘regular’ appointments, again demonstrating the level of demand that practices continue to meet. These figures, taken together with the results of the national GP patient survey released last week, shows the reality of our experience, that practices are delivering hundreds of millions of appointments and as a result of our hard work the vast majority of patients are pleased with the care delivered by their general practice team.
In our letter to the former health secretary Matt Hancock, we made clear that the Government needs to do more to support general practice, not talk it down. Our message to the new Secretary of State for Health and Social Care, Sajid Javid, is the same – GPs and their staff are angry, frustrated and disappointed by this treatment. In our letter to him, we raised our concerns about the way the Government's emergency regulations have led to a command and control way of working which at times has restricted practices rather than empowered them, and asked for him to bring an end to this micromanagement of general practice from both government and NHSE/I when the restrictions are lifted on 19 July. We have also called for urgent action to reduce workload pressures through recruiting and retaining more GPs and practice nurses, and to address the premises issues that serious limit our work.
As well as our lobbying efforts, we also want to do as much as we can to support practices in England with the tools they need to explain to their patients the pressures that general practice is facing. We will be releasing more information in the coming weeks on the BMA website and in communication directly to practices.
Easing of COVID restrictions and face coverings
A BMA survey released ahead of the Government's announcement confirming the easing of the restrictions on 19 July, found that a vast majority of doctors who were asked said they were in favour of keeping rules around face coverings and social distancing.
91% of doctors surveyed believe masks should continue to be worn in healthcare settings - where practical – and 86% say the same for social care settings. 90% of those surveyed wanted to see masks remaining mandatory on public transport, and a majority thinks face coverings should continue to be worn in shops, in hospitality and workplaces, like offices.
BMA council chair Dr Chaand Nagpaul said: "Doctors are clear in their desire to protect the public’s health and our NHS by proven measures to control spread of this deadly virus. They want to see the legal requirement for wearing of face coverings retained not just in enclosed public spaces but also for patients and visitors and staff in hospitals and GP surgeries as well as social care settings."
The BMA has also co-signed a letter with the Royal Pharmaceutical Society and other stakeholders, to the Prime Minister, calling for the continued use of face masks in healthcare settings.
NHSEI have now made a statement that the government’s infection control guidance for healthcare settings has not changed, and so will continue to apply following the lifting of restrictions next week, and healthcare settings should therefore maintain face coverings among other IPC measures.
We have produced a poster that practices can display about the continued use of face coverings for healthcare settings – download it here
See more information and guidance on PPE for practices in our COVID-19 GP toolkit, and general guidance on PPE for doctors here
Face coverings in healthcare settings in England
While NHS England clarified that IPC guidance in GP practices would remain in place, I commented: "It is essential that this is communicated clearly and widely so that everyone understands what to expect when entering surgeries, hospitals and other health and care premises, and why these measures are necessary to protect us all and to effectively get on top of this pandemic".
The story was covered in Pulse and GPOnline.
The Guardian reported that PHE made clear on Tuesday that its infection prevention control (IPC) guidance is to remain in place after 19 July, meaning the current situation on mask-wearing in health and care settings will continue. This is following pressure from the BMA and other health organisations on the government for clarity on the status of face coverings in hospitals and GP surgeries when legal requirements on mask-wearing will be lifted.
Face coverings in healthcare settings in Wales
The Welsh Government have announced that masks will remain mandatory in healthcare settings and public transport. BMA Cymru Wales welcomed the news, and David Bailey, Chair of BMA Wales, was interviewed on BBC Radio Wales (22 mins in) where he said: "We’re happy with the Welsh Government’s decision, as we’ve been calling to keep face masks mandatory in healthcare settings for a while now. We’re also pleased to see the decision extend to public transport and the reasons are very similar. You can’t ventilate terribly well, you can’t socially distance, and people who are more vulnerable to the virus don’t have any choice but to use those healthcare settings or indeed to use public transport so yes we’re very happy". He was also interviewed on ITV Wales
Face coverings in healthcare settings in Scotland
First Minister Nicola Sturgeon has said that mandatory precautions like the mandatory wearing of face coverings and guidance on ventilation and hand hygiene would remain in place "for some time" in Scotland, even following the move to level zero of Covid restrictions on 19 July.
Face coverings in healthcare settings in NI
Some rules could be relaxed on 26 July, subject to 22 July approval. From 26 July, face coverings will no longer be compulsory in places of worship or for students in school classrooms in the new term, but will remain mandatory on public transport and in shops and hospitality venues.
COVID-19 vaccination programme (England)
NHSE/I published the Enhanced Service Specification for phase 3 of the COVID-19 vaccination programme and other assorted documents yesterday.
It is very disappointing that NHSE/I are not listening sufficiently to practices and have not done more to enable local groups to safely transfer vaccines delivered to PCN sites on to member practice sites should they choose to do so. Yet at the same time we have seen vaccine safely delivered in care homes, through buses, pop-up sites and smaller pharmacies. Moreover, earlier in the pandemic vaccine has been provided to practices to deliver to their patients elsewhere in the UK. We will continue to challenge this unnecessary restriction which could lead to poorer uptake.
Local community delivery of both COVID-19 and flu vaccination is essential to the success of this programme and it's vital that local systems support practices to do this. Read ourstatement in response to the publication of the ES documents. This was reported by GP Online and Pulse.
I was quoted in the BMJ, and Healthcare Leader about the BMA's disappointment at NHS England's decision not to allow individual GP practices to organise and administer covid-19 vaccination boosters this autumn.
The BMA’s weekly COVID-19 data analysis is available here.
Health and Care Bill briefing for general practice
Following the introduction of the Government’s Health and Care Bill to the House of Commons last week, GPC and the BMA have produced a briefing outlining the key implications and potential impacts of the new legislation on GPs and General Practice. This covers key changes including the transfer of powers from CCGs to ICSs, GP voice within ICSs, and changes to funding flows.
Ahead of the Bill’s Second Reading this Wednesday, BMA Council also voted to express the BMA’s opposition to the Bill as presented to Parliament, arguing that it is the wrong time to be reorganising the NHS, fails to address chronic workforce shortages or to protect the NHS from further outsourcing and encroachment of large corporate companies in healthcare, and significantly dilutes public accountability. The BMA is also concerned about the wide-ranging excessive powers the Bill would confer on the Health Secretary.
The story was covered by the Independent, Open Democracy, Nursing Times, Pulse, GP Online and Health Business UK
Further information on the Bill and the BMA’s work this is available on a dedicated webpage.
Medical examiners roll out (England and Wales)
On Tuesday, 8 June, the UK Government formally announced the roll out of the medical examiner system into primary care in England and Wales, although medical examiners have already been in place in Scotland and in acute settings in England and Wales. Many have expressed deep concern about the impact this could have on an already overstretched, underfunded, primary care system. Complicating matters was that at the time of the announcement, there was no statutory instruments in place for the roll out.
The recently published Health and Care Bill will, if enacted, see dramatic changes for the NHS in England, and the BMA has issued a press response to the publication of the Bill, highlighting our concerns. The BMA’s Professional Fees Committee are making representations on behalf of the BMA to both the National Medical Examiner’s (NME) and the UK Government to express our concerns over the medical examiner system roll out into primary care.
Survey about CQC inspections and their effect on ethnic minority GPs
BAPIO GP forum is seeking views of GPs and GP Practices effected by CQC inspections, particularly from ethnic minority GPs or practices owned and/or led by ethnic minority GPs. This will help inform the discussions with CQC on issues facing ethnic minority GPs and the practices they work in. Please feed in your views here. If you have any questions, please contact Kalindi Tumurugoti (Kalindi.Tumurugoti@nhs.net)
GPC England meeting report
GPC England met on 15 July 2021 where much of the meeting was spent discussing what actions had been taken following the resolution from the May GPC England meeting, the results of which are outlined above. The committee also had updates on and discussed phase 3 of the COVID vaccination programme and winter flu vaccination programme, the implementation of GP Data for Planning and Research (GPDPR), and implications for primary care of the NHS Bill.
This was the last meeting of the session and several members of the committee will be leaving the committee after the BMA ARM in September. Julie-Anne Birch, Siobhan Brennan, Mark Corcoran, Lynn Hryhorskyj (Chair, GP Trainee Committee), Bob Morley, and Simon Parkinson were all thanked for their contribution and support to the committee and the profession over the years. Their wise counsel and input into our work will be missed.
This will also Fay Wilson’s last meeting as Speaker for the committee and she was thanked for the fulfilling this new role so well.
The GPC England Executive and Policy lead update is available here.
Elections for BMA’s specialist and professional committees
Voting for the Specialist and Professional Committee elections has now opened for seats on the following committees:
The deadline for voting is 12pm Thursday 22 July 2021.
Nominations for seats on these committees have reopened until 12pm on Thursday 22 July 2021.
To submit your nomination or vote, please login to the BMA’s election system. To vote or stand in the election, you must hold the relevant position for the specified seat.
If you have any queries regarding the election process, please contact elections@bma.org.uk.
One career, endless opportunities #Choose GP
Final applications for 2021 GP specialty training will open on 27 July – 18 August 2021. Please ‘like’ and follow the #Choose GPFacebook and Instagram page to keep up to date with news and views, and forward this information to any doctors who may be thinking about career options. The GP National Recruitment Office (GPNRO) website has more guidance and we have a number of GPs and trainees who can help with enquiries. Email Daryl gprecruitment@hee.nhs.uk to be put in touch.
Media
Pulse reported that GPs have been threatened with legal action by patients who object to being asked to wear a face covering in their practice. Mark Sanford-Wood, GPC England Deputy Chair, said: “We have received a number of reports of practices being threatened with actions under the Equalities Act from solicitors representing people who have objected to being asked to wear a face covering to attend their surgery. It is difficult to see how such claims for financial redress could be justified under the Act and that they have the appearance of attempting to coerce GPs into breaking public health safeguards and therefore putting themselves, their staff and other patients at risk. These actions have the appearance of using the Equalities Act for a purpose for which it was clearly not intended and are a direct threat to reasonable public health measures designed to save lives.”
GPC England executive team member Krishna Kasaraneni was interviewed on Channel 4 News on a programme regarding the barriers undocumented migrants face when trying to access Covid vaccines. He said everybody is entitled to free general practice services at the point of need, regardless of immigration status.
BMA Scotland expressed concerns around the workload of GPs as growing numbers of long Covid patients add to the pressures on general practice. Patricia Moultrie, deputy chair of Scottish GPC, said: "General practices are in a very difficult place workload-wise, and we are very anxious about what the future weeks and months hold. It does look as though long Covid is going to be an illness that’s going to be managed in the community, and it’s good that fewer people are being admitted to hospital. But looking at the numbers that we’re seeing, we are very concerned about the workload that is going to be sitting in the community with the pandemic."
The story was in The National, The Courier, STV, Aberdeen Evening Express, Herald Scotland, The Scottish Sun, and a number of other publications.
BMA Northern Ireland council chair Tom Black was mentioned in a piece in the Sunday Independent Ireland about the rising rates of covid infection rates in border areas. NIGPC chair Alan Stout was interviewed by Belfast Telegraph for a piece about inappropriate phone calls to under pressure GP surgeries in Northern Ireland.
Read the GP bulletin here.
Patient survey results
The annual GP patient survey results were published yesterday, and with 83% of patients rating their overall experience of general practice as good, an increase on the previous year, this is testament to just how hard GPs and their teams have, and continue to, work in order to provide care to their patients and communities. To see an increase in overall patient satisfaction despite the really challenging year the entire NHS has faced - is incredibly positive. Such excellent feedback from patients about all members of the practice team will also lift morale amongst an exhausted workforce who have clearly gone the extra mile and beyond for their patients. These results also clearly show how out of touch with the real views of patients NHSE/I’s damaging and demoralising letter earlier this year was.
GPs and their teams have been providing this good patient care all while playing a crucial role in the delivery of the COVID-19 vaccination programme and dealing with the consequences of a massive NHS care backlog, resulting in record appointment numbers being delivered. However, if we are to continue to meet the increasingly complex needs of our communities – delivering flu vaccine programmes, COVID-19 booster programmes, supporting growing numbers of patients with long COVID and managing an increasing number of appointments - then general practice needs more staff, more resources and better premises. It is the only way to avoid a potentially irreversible crisis in general practice and instead to build further on this feedback from patients.
Health and Care Bill
The Government has introduced the Health and Care Bill this week, which will deliver significant health reforms in England. These include making ICSs (integrated Care Systems) statutory bodies, dissolving CCGs and transferring their responsibilities, staff and powers to ICSs, formally merging NHS England and NHS Improvement, removing Section 75 of the 2012 Health and Social Care Act and mandated competitive tendering, and conferring new powers over the NHS to the Secretary of State.
Responding to the publication, the BMA raised concern over the timing of the bill given the huge pressures facing the health and care system as a result of the pandemic, as well as highlighting critical areas where we believe the bill needs to be amended and strengthened to protect the NHS from unnecessary private sector involvement and establish a healthcare system that is collaborative and fit for the future.
The BMA will continue to lobby to ensure the Bill addresses our concerns and that reform is in the best interests patients and doctors, and supports the NHS to be a publicly-funded provider to care for the health needs of our population. We have been working to shape the guidance that will underpin the Bill the in practice, including through our response to NHSE’s consultation on the new provider selection regime and feeding into the newly published ICS Design Framework. We have also been clear on the critical role LMCs should play in the new arrangements. We have produced a member briefing on that framework, including our immediate reaction to it.
You can find out more about our work around the Bill and key calls here, and read our detailed analysis of the bill here.
The story was covered by GP Online, Pulse, and Pharma Times.
COVID-19 booster vaccine and flu vaccine programmes
Following the guidance published by JCVI last week about the COVID-19 booster programme, and the subsequent guidance from NHSE/I guidance on COVID-19 vaccinations, we remain seriously concerned that this may be interpreted as a cap on general practice involvement in the flu vaccination campaign this winter or that practices will be limited in their ability to provide this to their patients as they would normally do because of overly restrictive arrangements set by NHSEI.
GP practices are already preparing for this winter’s flu campaign, as they do every year, and will be keen to continue to play a pivotal role in protecting their patients against COVID-19 with booster jabs alongside this. GP practices have shown, for many years through the annual flu programme and recently through the COVID vaccination programme, that general practice through its place in the community is best placed to provide effective and efficient vaccination programmes to the population of England. Many patients and members of the public expect such a service to be widely available from their local GP practice. We believe delivering the flu vaccination and COVID-19 booster vaccination programme concomitantly through general practice is the best way forward and that most practices will want and expect to deliver them.
As Phase 3 begins, practices must be able to administer COVID booster jabs during the same appointment as flu vaccines within their own practice buildings if they wish – which has not always been possible for COVID vaccines, with many practices who wanted to continue to provide COVID-19 vaccination to their patients being prevented by NHSE/I from doing so. We believe patients want to be vaccinated at their local practice as they are used to for their flu jabs each year. In addition, working at practice level can reduce the bureaucracy for staff, limiting the impact on other GP services that are also important. It is also vital that existing resources are retained for additional staff who support the programme.
If we are to ‘learn to live with’ COVID-19 in the long-term and vaccinations are to become routine, practices need to be trusted and empowered to build on their expertise, proven track record and knowledge of their communities to lead the way in ensuring the public is protected.
We are therefore calling on the Government and NHSE/I to support practices and PCNs in delivering Phase 3, not just through appropriate funding, but also through the ongoing workforce support provided during phase 1 and 2, through managing workload (including the continued suspension of PCN service specifications), and improvements to IT systems.
Praise for the NHS and general practice
Responding to the announcement that Her Majesty the Queen has awarded the George Cross to the NHS to acknowledge its remarkable efforts throughout the pandemic and contribution over the last 73 years of service since the birth of the NHS, BMA council chair Dr Chaand Nagpaul said:
“This is a worthy honour for all NHS staff who have worked tirelessly throughout the pandemic to protect the health of the nation, providing care to hundreds of thousands suffering with illness and have also saved the lives of so many. The fight against Covid has been largely down to their enormous contribution, and with many putting their own health at risk as they cared of patients with a deadly and infectious illness, and with sadly several hundred losing their lives from the virus. It is only right that they should be recognised for their brave and dedicated commitment.” Read the full BMA statement here
NHSE/I has published a video this week marking the birthday of the NHS, to thank general practice and primary care teams for our phenomenal hard work and dedication. This follows the praise and acknowledgement of the significant activity and related workload pressures in general practice by NHSEI executive directors in a recent NHSE/I board meeting.
Easing of COVID restrictions
Ahead of the Prime Minister’s announcement earlier this week to end the COVID-19 restrictions in England on 19 July, including mandatory wearing of face coverings and social distancing, the BMA urged Government not to ‘throw progress away’ and to keep some Covid-safe measures, such as the requirement to wear a mask in enclosed public spaces.
The BMA expressed serious concern that the government has decided to ease all mitigations, despite the Chief Medical Officer speaking about the alarming rise in cases, doubling of hospitalisations and certainty of more deaths. We are also concerned that there is no update on what restrictions should be in place in healthcare settings after this date and the BMA is seeking information for members to use going forward. As a result, the BMA will be producing guidance to support those working in practices, community healthcare and hospital settings and will issue this as soon as possible. Read the BMA statement on the response here
New guidance for health and social care providers on CQC's monitoring approach
The CQC has published newguidance for health and social care providers on their monitoring approach.
The BMA is seriously concerned about CQC's new approach to monitoring practices and have raised this with them directly. Practices will understandably be anxious about the implications, not least when they are struggling with record demand and significant workload pressures. Whilst CQC has a legal responsibility to inspect health care providers and ensure the safety of services to patients, it has been doing this throughout the pandemic through its Emergency Support Framework. We have called for a continuation of this ESF approach which is much more proportionate and have misgivings about a move towards greater inspection numbers linked to a risk stratification approach that is new and not widely trialled.
PCSE pay and pension system update
We continue to work hard at challenging the considerable shortcomings of the new portal. We are aware of the many unacceptable issues being faced by practices and GPs but it is of critical importance that users log these with PCSE to ensure that we can hold them accountable. We know that those interactions are also causing frustration and we are applying pressure for improvements and greater transparency around their customer service work. We would advise practices to keep a record of the issues they are raising with PCSE and the length of time taken to get resolutions.
Regular and ongoing meetings have led to a considerable number of ‘fixes’ to the system but there are many more outstanding. This will take time, but we are committed to ensuring a much improved service for the profession to use. NHSE/I and PCSE have assured us that the current run of global sum payments is going well but we are keeping a particularly close eye on this.
The BMA’s Pensions committee will soon be sending out a survey to GPs, to capture their experiences of using the new system. There will be more details on this next week, but we continue to encourage GPs to log on to the system to check the accuracy of their records. A similar survey will go to practices in the coming month. We have yet to receive a response to the letter to NHSE/I setting out our concerns.
COVID-19 vaccination programme
Acceleration of second doses for all cohorts
The government has published guidance advising that appointments of a second dose of the COVID-19 vaccine should be brought forward from 12 to eight weeks for the remaining people in all cohorts who have yet to receive their second dose, to ensure everyone has the strongest possible protection from the Delta variant of the virus at the earliest opportunity possible. Read the NHSE/I letter here
Vaccine data
Nearly 80 million doses of COVID-19 vaccines have now been delivered in the UK, and 34 million people have also received their second dose.
The BMA weekly COVID-19 data report is available here.
Education and training tariff guidance and prices for 2021 to 2022 financial year
The Department of Health and Social Care and Health Education England (HEE) have published the
Education and training tariff guidance and prices for 2021 to 2022 financial year. The guidance provides further information in support of the education and training (ET) tariff payment process for the 2021 to 2022 financial year, with medical placements in GP practices listed as an exclusion (see section 5.12-514). Read more here
Delay in roll-out of patient data sharing programme (GPDPR)
Following extensive lobbying by the BMA and RCGP, Government announced a delay to the rollout of GPDPR, with full rollout now expected on 1 September rather than 1 July. BMA is now engaged in discussions with NHS Digital and other stakeholders to ensure no additional burden is placed on GPs to facilitate the implementation of this programme, and that patients are properly informed about it. We have been lobbying MPs on this issue.
In view of the extension to date of the first extraction, we will keep you informed on all next steps that practices will need to take as we approach this deadline. Read our full statement about the announcement to delay here
Review of the England Medical Performers List Regulations (England)
The Department of Health and Social Care has commissioned NHSE/I to review the England Medical Performers List Regulations in the context of the wider regulatory landscape in operation across England. This review has the potential to identify where regulatory requirements can be streamlined and simplified, while maintaining the high professional standards that ensure patient safety.
This questionnaire aims to gather information from stakeholders about their views of the existing regulatory landscape for GPs in England and thoughts on how this landscape might be transformed. The feedback will contribute to the content of a series of focus group discussions and inform an options appraisal that will be shared with the DHSC during autumn 2021. Take the survey here
ARM elections – GPC UK
GPC UK is the only body that represents all GPs in the UK. It takes an interest in all matters concerning the professional lives of GPs, in addition to negotiating national terms and conditions. We are currently seeking nominations from GP members to join the committee. Nominations close at 10am, 13 September. Submit your nomination here
To participate in the election, you must hold the relevant position for the specified seat and be a BMA member. You must also be a delegate of the ARM (annual representative meeting) to vote.
Elections for BMA’s specialist and professional committees
Voting for the Specialist and Professional Committee elections has now opened for seats on the following committees:
The deadline for voting is 12pm Thursday 22 July 2021.
Nominations for seats on these committees have reopened until 12pm on Thursday 22 July 2021.
To submit your nomination or vote, please login to the BMA’s election system. To vote or stand in the election, you must hold the relevant position for the specified seat.
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Calling all pharmacists: your chance to inform staff training in primary care
Health Education England and NHSE/I would like to hear from pharmacists about their experiences of remote triage, care navigation, online and video consultations in general practice. Your input will allow us to design effective training to support all primary care staff and trainees to confidently work with these approaches. If you would like to be interviewed, please contact Frances Brown at Nightingale Research, francesbrown@nightingaledesignresearch.com by 14 July. To find out more about the study visit https://bit.ly/3dyYp19. For any questions about the project contact the Digital First Primary Care team: england.digitalfirstprimarycare@nhs.net
One career, endless opportunities #Choose GP
Final applications for 2021 GP specialty training will open on 27 July – 18 August 2021. Please ‘like’ and follow the #Choose GPFacebook and Instagram page to keep up to date with news and views, and forward this information to any doctors who may be thinking about career options. The GP National Recruitment Office (GPNRO) website has more guidance and we have a number of GPs and trainees who can help with enquiries. Email Daryl gprecruitment@hee.nhs.uk to be put in touch.
Media
Following comments made by Seb James, CEO of Boots, that primary care had 'more or less disappeared during the pandemic' we challenged this by saying: “These comments are unfair and undermine the work of all primary care workers. Since March 2020, GP staff in England have delivered over 173 million face to face appointments. Thanks need to be given to all frontline staff and healthcare workers for their efforts throughout this pandemic.” Our comment was covered by The Times (print), Chemist and Druggist, and Pulse
Read the GP bulletin here.
New Secretary of State for Health and Social Care
Following the resignation of Matt Hancock MP last week, Sajid Javid MP has been appointed Secretary of State for Health.
Dr Chaand Nagpaul, BMA chair of council, commented: "Sajid Javid has a huge and urgent task ahead. He must ensure completing the roll-out of the adult vaccination programme at rapid pace to control spiralling infection rates. He must also put forward a credible plan to tackle a backlog of care of unprecedented scale whilst at the same time rebuilding the trust of doctors and the wider healthcare workforce.
Frontline doctors and other staff have gone above and beyond time and time again over the course of the last 18 months, with many suffering from burnout and mental ill health as a result. The new Secretary of State must show he understands this challenge and must also be willing to listen to the voice of the frontline on the government's plans for sweeping changes in the running of the NHS in the upcoming Health and Care Bill.”
Read the full BMA statement here
Dr Nagpaul has since had a discussion with the secretary of state, in which Sajid Javid specifically asked that his thanks be passed on to GPs and their teams for their work in the vaccination programme.
Extension of the pandemic regulations (England)
The new Secretary of State for Health has announced that the three pandemic regulations 2020 relating to general practice have been extended to 30 September 2021.
We are concerned about the implications of DHSC's extension of the pandemic regulations, which includes three particular elements of eRD, Friends and Family Test and NHS111, and have told them this. The experience of general practice in England has been that these regulations have led to a command and control approach by NHSE/I through their various letters, guidance and SOPs ,and most recently with the latest NHSE/I target to increase appointment numbers outlined in their board paper on NHS metrics for 2021/22 at a time when general practice is already overwhelmed. These directives provide less flexibility and whilst we have been clear that they are only guidance they have led to many practices feeling that they must operate in a specific way.
As we've recently and repeatedly highlighted the government and NHSE/I are failing abysmally to deliver on another government commitment of an increase in 6000 GPs and if they were really serious about both improving the workforce's wellbeing and improving quality of care for patients they'd be setting this as the metric for general practice not the narrow and misguided focus on appointment numbers.
This is their target not ours, and whilst including the appointments done by the additional PCN-related workforce will mean this is delivered, what we all know is needed is for individual workload pressures to be reduced, and rather than suggesting we all work harder the goal should be for GPs to do fewer not more appointments. We've described the importance of this in our previous workload paper.
We have therefore called on the Secretary of State to direct NHSE/I to end their restrictive and prescriptive direction of the profession and allow general practice to return to the way it operated in line with existing contracts, and support GPs and practices to provide the care they know their patients need.
Given the current state of general practice, with workload and appointments being at an all-time high, the impact of the ongoing respiratory epidemic across the country, alongside rising COVID cases, NHS care backlog and other patients who have not come forward during the pandemic now coming forward, we would again advise practices that it is for them to determine how they meet the reasonable needs of their patients in line with their contract.
COVID-19 vaccination programme
JCVI and NHSE/I guidance on COVID-19 booster vaccine programme
The JCVI (Joint Committee on Vaccination and Immunisation) issued interim guidance yesterday advising that any potential COVID-19 booster programme should be offered in 2 stages from September, starting with those most vulnerable, including care home residents, people over 70, frontline health and social care workers, clinically extremely vulnerable adults and those who are immunosuppressed.
Having so effectively led the COVID-19 vaccination campaign, and with their proven track record of delivering flu jabs every year, GPs and their teams must be enabled to play a pivotal role in the booster programme, delivering both vaccinations directly to local communities from their practices.
Following the guidance issued by JCVI on the need for a COVID-19 booster programme alongside the annual flu vaccination programme, NHSE/I have now issued guidance on COVID-19 Vaccination Autumn / Winter (Phase 3) planning. It highlights that local systems should prepare to deliver booster doses of COVID-19 vaccine to the individuals outlined in the JCVI interim guidance between 6 September and 17 December 2021 (15 weeks), as quickly and safely as possible in two stages using supply available to us over that period. It suggests doing this through community pharmacy, vaccination centres and general practice but suggests that whilst practices delivered the majority of vaccines in phase 1, in phase 3 local plans should be for a minimum of 40% of COVID-19 booster vaccination through general practice and a maximum of 75%.
We are seriously concerned that this may be interpreted as a cap on general practice involvement in the winter vaccination campaign and, whilst historically local pharmacies have played a role in delivering flu vaccinations, we believe that most practices will, as part of their annual planning, be already making plans for the delivery of flu vaccination as usual this winter. It's imperative therefore that local systems and NHSE/I enable local practices that want to take part in this programme to receive sufficient COVID vaccination in order to provide this to their patients and do not place barriers in the way of them doing this. Furthermore, adding an additional 1000 community pharmacy sites in the run-up to September should not be done in such a way as to undermine practice involvement in this crucial phase of the pandemic. Read our full statement here
Second doses (England)
Further to the letter from NHSE/I dated 15 June setting out that second doses of the COVID-19 vaccine should be brought forward from 12 to 8 weeks for the remaining people who have not yet had their second dose vaccination, those who have not had one after 70 days will be contacted and encouraged to arrange an appointment as soon as possible. Vaccination sites have also been told not to give second vaccinations earlier than 8 weeks.
Chapter 14 of the Green Book has been amended to reflect this advising that for all COVID-19 vaccines there is evidence of better immune response and/or protection where longer intervals between doses are used, and that JCVI recommends an interval of 8 to 12 weeks between doses of all the available COVID-19 vaccines.
Vaccine data
Nearly 78 million doses of COVID-19 vaccines have now been delivered in the UK, and 33 million people have also received their second dose.
The BMA weekly data analysis is available here.
ICS framework document (England)
NHS England’s ICS Design Framework, sets out how ICSs are expected to develop in the coming years and to prepare for statutory status, in line with the Government’s Health and Care White Paper. The framework includes key detail around the roles and responsibilities ICSs are set to take on ahead of April 2022 – including managing NHS funding, commissioning, and co-ordinating services. The framework will shape how GP and primary care services are planned and organised, as well as the role clinicians take in delivering system transformation. So, it is essential that all doctors – and GPs in particular – are aware of and engaged in this process.
General practice will have a seat on the ICS board but must also be fully involved in local place-based integrated care partnership arrangements. The framework says that “Primary care should be represented and involved in decision-making at all levels of the ICS, including strategic decision-making forums at place and system level”. LMCs will play a crucial role in this and it’s vital that discussions are taking place now to ensure the voice of general practice is heard. Our summary provides a comprehensive overview of the key details of the framework to help support this.
Praise for general practice
Despite our continued concerns as outlined above, we were pleased to hear praise of GPs, and acknowledgement of the significant activity and related workload pressures in general practice, from senior executive directors of NHSEI attending the NHSE/I board meeting last week, when they specifically praised the role of GPs and their teams over the last year.
NHSE/I’s Chief Operating Officer Amanda Pritchard said: "really big thank you to primary care - working well beyond pre-pandemic activity – (they are) really really working at an astonishing rate".
The National Director for Primary Care, Community Services and Strategy Ian Dodge also said: "In general practice it has never been busier, our colleagues in general practice have been working incredibly hard and not just with the vaccination programme.” He added that PCN recruitment was ahead of schedule with 9100 FTEs additional staff employed so far and that “we need all the capacity we can get in general practice”. He also highlighted that “despite the busyness of general practice, there has been a huge recognition of the critical importance of providing better healthcare to people with learning disabilities and despite all the other pressures the goal of 67% annual health checks was exceeded by achieving 73.5%. That is a testimony that general practice has also wanted to focus on these priority areas that do not always receive the same headline attention."
Home delivery of medicines and appliances during the COVID-19 outbreak
The Medicines Delivery Service for self-isolating patients was commissioned from community pharmacies and dispensing doctors in March 2020 and commissioned until 30 June 2021. The DHSC has now announced the medicine delivery service will be extended until 30 September 2021
Read the letter on home delivery of medicines and appliances during the COVID-19 outbreak, which 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 extended from 1 July 2021 to 30 September 2021 for anyone living in England who has been notified by NHS Test and Trace to self-isolate.
NICE shared decision making guideline
NICE has published a new shared decision making guideline, which aims to help people using healthcare services feel more confident in discussing care and treatment options with their healthcare teams.
NICE has collaborated with NHSE/I to develop a standards framework to determine whether the quality of shared decision-making support tools, including patient decision aids, is sufficient. In addition to this, as part of a package of resources to accompany the shared decision making guideline, NICE has worked Keele University to develop a learning package, aimed at healthcare professionals, to help with implementing these recommendations.
You can find out more about the guideline, standards framework and learning package here
One career, endless opportunities #Choose GP
Final applications for 2021 GP specialty training, opens on the 27 July – 18 August 2021. Please ‘like’ and follow the #Choose GPFacebook and Instagram page to keep up to date with news and views. Please forward this information to any doctors who may be thinking about career options. The GP National Recruitment Office (GPNRO) website is the place to go for more guidance or we have a number of GPs and trainees who can help with local or general enquiries. Email Daryl gprecruitment@hee.nhs.uk to be put in touch.
Specialist and Professional Committee elections
The deadline for nominations for the Specialist and Professional Committee elections for the following committees is 12pm Wednesday 7 July 2021:
For more information about the roles please visit the committee webpages linked above.
To participate in any of the elections, you must hold the relevant position for the specified seat. You must also register for a BMA web account to use the online election system.
To submit your nomination in any of the above elections please login to the BMA’s election system.
If you have any queries regarding the election process, please contact elections@bma.org.uk.
BMA COVID-19 guidance
Read our COVID-19 toolkit for GPs and practices, which provides comprehensive guidance for practices to manage contractual issues and service provision during the coronavirus pandemic.
You can access all the BMA guidance on COVID-19, including ethical guidance, here
GPC UK and GPC England committee pages
Read more about the work and priorities of GPCUK and GPC England in the newly updated committee pages, which also includes surveys undertaken, membership of the committee, meeting dates and a link to the GP practices page. You can also follow us on twitter
Media
I was interviewed on BBC Radio York (from 03.10) where I said that the rise in COVID cases in North Yorkshire is concerning but that we were not seeing the rapid rise in hospitalisations and death which was good, but that everybody who is eligible must take up the offer of a vaccine.
Pulse reported on the figures in published in recent NHS board papers showing that PCNs in England have recruited more than 9,000 clinical staff under the Additional Roles Reimbursement Scheme (ARRS) so far, representing around a third of the target 26,000 ARRS staff expected to be hired by 2024. Krishna Kasaraneni, GPC England Executive team workforce lead commented: “The 9,100 staff recruited via the ARRS will make a difference to primary care. However, general practice is currently under enormous pressure with demands of Covid, the vaccination programme and a growing backlog of care to contend with. While ARRS staff are very beneficial, much more needs to be done to boost the GP workforce itself who are struggling under the weight of current workloads.”
I commented on the Government's plan for a COVID vaccine booster rollout from September calling on the Government to “listen to practices when they outline the support they need” for any future vaccination rollout. I also said “Practices are under intense pressure and they must be given support and the flexibility to take part in the booster campaign in a way that works best for their patients.” The story was covered by BBC, ITV, Daily Mail, Mail Online, and Pulse.
BBC Look North (Yorkshire) interviewed practice staff about the increased abuse they were experiencing from patients and Dr Brian McGregor, GPCE member and chair of BMA Yorkshire council, commented on the pressures practices were under.
A news report about long COVID from BBC Wales highlights the concerns of patients with the condition who are calling for specialist long Covid assessment centres to be established in Wales similar to those set up in England. Both the chair of GPC Wales, Phil White, and the chair of BMA Wales Council, David Bailey, were interviewed and agree that “a multi-disciplinary approach” outside of general practice is needed particularly for patients with the more acute symptoms that are very specific to COVID-19 such as prolonged respiratory difficulties, cardiac concerns and blood clots.
The story was covered on BBC Wales, BBC Wales online, and BBC Radio Wales (1hr, 7 mins).
A news report on Newyddion news bulletin on S4C was covered by BBC Wales online and BBC Radio Cymru (at 1h6min). BMA Cymru Wales provided background on the story as well as data from a recent survey of GPs which showed that 30% of GPs in Wales are looking to reduce their working hours or retire early - with 40% considering doing so in the next year. Phil White, chair of GPC Wales provided an overview from GPs across Wales in both Welsh language broadcasts to support this picture which shows gaps in the workforce in some parts of Wales.
Read the GP bulletin here.
New PCSE pay and pension system update (England)
We have grown increasingly concerned about the volume of issues being raised about the new online portal for pay and pensions. The issues are wide-ranging and involve both historical migrated data and current data. We are aware of some of this data being incorrect, some of it being missing and still more just being unclear to users. It is affecting GPs’ pension data in many instances, locum and solo performers being particularly affected, and there have also been early issues with some payment runs to practices. PCSE assures us that all of this is being addressed urgently but we need to see more evidence that this is happening.
We, along with the Institute of General Practice Management, have written to the Chief Commercial Officer of NHS England to raise our concerns and demand urgent action to ensure that GPs and practices are able to use the system as intended as we approach a critical time for many users.
GP engagement with the new system remains low according to the data we have seen, so we would urge GPs to log in and check their records as a priority and to inform PCSE of any errors. We would also ask all system users to make use of PCSE’s guidance materials. We understand that a significant number of calls and emails to PCSE are being answered with information from the guidance.
Meetings with Health Minister, Jo Churchill (England)
We met with health minister, Jo Churchill, this week to follow up the points raised in our previous meeting with the Secretary of State for Health and Social Care and following his recent letter, where we called on the Minister to bring an end to SOPs, and the NHSE/I approach to overly prescriptive management of general practice. We also asked for improved direct messaging to patients and pushed for the PCN service specifications planned for October to be delayed until April 2022 at the earliest in order to reduce additional workload burden for practices during the autumn and winter when we are likely to be facing a rise in respiratory illness alongside the need to focus on flu/COVID-19 vaccinations and support patients impacted by the on-going NHS care backlog.
We raised the need to maximise ARRS recruitment this year, to maintain the options for flexible working and the issue of practice premises, including the need for more space, not least for PCN recruited staff to work from. We also discussed the need for the government to do more to inform the public about the pressures the whole NHS was under and for them to encourage people not to take out their frustration on frontline staff, particularly by abusing reception staff.
Following a joint GPC England/DDA (Dispensing Doctors Association) letter to Jo Churchill MP about a range of dispensing issues, I joined Dr Richard West, the chair of the DDA, for a meeting with the health minister to discuss how these issues could be addressed. We highlighted the need to enable dispensing practices to use the electronic prescribing system, to address the issues relating to rurality that adversely impact many dispensing practices and called for improvements to the arrangements for drug reimbursement.
Meeting with the Minister for COVID Vaccine Deployment, Nadhim Zahawi (England)
I met with Vaccines Minister, Nadhim Zahawi this week to discuss the COVID booster vaccine and the flu vaccine preparations. The Minister opened the meeting by thanking GPs for their work and recognising the success of the COVID vaccine programme. He outlined that work is underway to roll out a booster campaign, but that questions remain and the final decision will be made by the JCVI. Operational guidance will be coming out shortly to enable practices to opt in to phase 3 of the programme.
I outlined the need to base the programme as much as practically possible on the historically successful annual local delivery of flu vaccination, which is effectively “business as usual“ for practices and pharmacies. We also discussed the need to support practices and not to add additional burdens during what is likely to be a challenging winter, and called for IT improvements, including how the NHS app could be used to record wider vaccine provision to enable patients to be empowered to check their own vaccine history.
Exemptions for care workers
Following a public consultation, it was recently announced by the Government that, from October, people working in care homes will need to be fully vaccinated against COVID-19.
This will impact those who visit care homes, including GPs and community teams. The government has said that a small number of people would be exempt and whilst they have indicated that individuals may be directed to their GP to provide evidence for their exemption, we do not believe this should be the approach.
We believe a better approach would be for local authorities to receive support in commissioning a dedicated service to assess exemption requests that does not require GP involvement, as is the case in many areas for disabled parking badge and that the Government should support local authorities with this. This would lead to a consistent approach as well as reducing a further workload burden for practices. Should the government continue to suggest GP practices should do this, we believe this will require practices to refer to a secondary care service to do the necessary assessment as many of these patients will be receiving specialist care.
The government also plans to launch a further public consultation on whether or not to extend this to include all those employed in health and care settings. Read the BMA’s response to the announcement on a consultation on mandatory COVID-19 vaccinations for healthcare workers.
COVID-19 vaccination programme
Vaccine cohorts
All adults aged 18 and over (cohort 12) in England are eligible for the COVID-19 vaccines and will be receiving texts inviting them to book a vaccination via the national booking service, at an NHS vaccination centre, pharmacy or GP vaccination site. This weekend many sites will be offering the opportunity to attend a centre without an appointment for vaccination.
In Scotland, people aged 30 and over can get their vaccine, and in some parts of Glasgow people aged 18 and over can also get the first vaccine.
In Wales, people aged 18 and over can get the vaccine as of last week.
In Northern Ireland, people aged 18 and over can book online or call 0300 200 7813.
Vaccine supply
While the limited supplies of the Moderna vaccine have always been directed to mass vaccination sites, in recent weeks some areas have reported seeing a significant reduction in the volume of Pfizer vaccine available and supplies are not meeting demand from those still to be vaccinated. This means some people waiting weeks for their first-dose appointment at a time when we need as many as possible to be protected as quickly as possible.
While the Government insists that the UK is on track to offer a first dose to all adults by its own 19 July deadline, we need honesty and transparency about what supplies are available nationally. This is especially urgent given the need to stem the spread of the Delta variant by vaccinating as many people as quickly as possible.
FAQs to support general practice and students in higher education institutions
NHSE/I has published FAQs to support general practice and higher education institutions, which advises that although in general, patients should return to the place they had their first dose to have their second dose, students in higher education are able to receive their second dose in a different location to their first dose if they have relocated. The National Booking Service has an option to book or re-arrange the second vaccination appointment at a different location to the first appointment.
The guidance also advises on what the options are for student who had their first dose in Wales, Scotland or Northern Ireland, but is in England at the time of their second dose. If a person has received a first dose of COVID-19 vaccine overseas with a vaccine that is also available in the UK, they should receive the same vaccine for their second dose. If the vaccine they received for their first dose is not available in the UK, the most similar alternative should be offered.
Vaccine data
75.5 million doses of COVID-19 vaccines have now been delivered in the UK, and nearly 32 million have also received their second dose.
The weekly BMA summary of COVID-19 data is available here.
Department of Health and Social Care draft data strategy
The Department of Health and Social Care has published their draft data strategy this week, setting out their plans to harness the potential of data in health and care.
When used effectively, ethically and legally, data can play a pivotal role in improving the health of the population, whether this is for planning, research or for direct patient care. Everyone has a right to know what is happening with their healthcare data, however, as we have seen in recent weeks with the pausing of the GPDPR roll-out what happens when these issues are not communicated properly, and patients are not given an opportunity to take part in such important discussions.
Therefore, the Government and NHSX must follow through with commitments to engage fully with both the public and the profession, addressing any concerns they may have about this strategy and specifically proposals around sharing data more widely than for direct care.
We will be considering the draft strategy in detail and responding formally on behalf of our members and their patients in due course. Read our full statement in response by Farah Jameel, GPC England Executive team IT lead, here
This was reported by the BBC, Mail Online, Pulse, and Yahoo News. The BMA's concerns were also mentioned on Newsnight on Tuesday.
Delay in roll-out of patient data sharing programme (GPDPR)
Following extensive lobbying by the BMA and RCGP, Government announced a delay to the rollout of GPDPR, which amounts to two months with full rollout now expected on 1 September rather than 1 July.
BMA is now engaged in discussions with NHS Digital and other stakeholders to ensure no additional burden is placed on GPs to facilitate the implementation of this programme, and have been lobbying MPs on this issue.
In view of the extension to date of the first extraction, we will keep you informed on all next steps that practices will need to take as we approach this deadline. In the interim, you may wish to consider as a practice whether to proactively contact patents to inform them of what is changing. Read our full statement about the announcement to delay here
If patients register a Type 1 Opt-out, practices must process this in a timely fashion. Codes for opt-out can be found here and are copied below for ease
Opt-out - Dissent code
9Nu0 (827241000000103 |Dissent from secondary use of general practitioner patient identifiable data (finding)|)
Opt-in - Dissent withdrawal code
9Nu1 (827261000000102 |Dissent withdrawn for secondary use of general practitioner patient identifiable data (finding)|)]
Further information, including a transparency notice, is available here
This was reported by the Eastern Eye.
Cervical screening adverse incident (Scotland and England)
In December 2020, a national health service board in Scotland conducted its annual invasive cervical cancers audit and discovered that a very small number of women had developed cervical cancer after being wrongly excluded from the screening programme following a hysterectomy that was carried out more than 20 years ago. The Scottish Government have apologised for this cervical screening incident in Scotland, but it is now clear that a small number of those affected now live in England (currently believed to be 19 individuals).
NHSE/I will be contacting the respective practices for those patients today (via regional screening leads) to ask them to notify the patients identified that they’re impacted by the incident and provide advice on the appropriate next steps e.g. follow up appointment in colposcopy. They’ll be providing supporting materials to those practices, including a patient letter, based on the NHS Scotland response.
BMA Scottish GP Committee/ Scottish LMC Update – June 2021
The attached document from Scottish GPC includes updates on their latest SGPC meeting; negotiations and contracts; workload and wellbeing; COVID-19 Recovery and Remobilisation; Information Management and Technology; LMC update.
Enhanced shared parental leave system for salaried GPs (UK)
The new enhanced shared parental leave system for salaried GPs has been launched across the UK and will allow for up to 50 weeks of the 52 weeks maternity leave to be shared between the parents. Eligible parents are also able to share up to 37 weeks of statutory shared parental pay (equivalent of statutory maternity pay). The ESPL system will be offered by employers at GMS and some PMS practices. Employees may request for this new form of leave to be included in their contracts, in line with provisions for junior doctors and agenda for change staff. This change to a more flexible form of leave supports the BMA’s commitment to address the gender pay gap. Find out more about enhanced shared parental leave entitlements and read the updated Salaried GPs handbook
Contact your MP about punitive pension tax
The BMA will begin its campaign addressing the taxation issues within the NHS Pension Scheme with a Parliamentary briefing event on 1 July. We are looking to gather support and attendance from MPs from all parties and nations to address this vital issue. BMA members are encouraged to support this event by tweeting their MP to highlight the event directly to them. Please join us and invite your MP along to the event by using our template form
Do you hold a GP sponsorship licence?
If so, we are keen to hear from you. Whether you already hold a sponsorship licence or are considering getting one to employ non-UK nationals, we really want to know how you found the application process and any barriers that you faced.
The Home Office introduced a new sponsorship system last October, in preparation for the introduction of the new immigration system which came into force in January 2021. The new system is designed to alleviate many of the complexities of the old system and it is hoped the new application process will support employers to apply for a sponsorship licence with relative ease. As detailed in the updated guidance, employers can now apply online.
The Home Office wish to survey small businesses, including GP practices to get a sense as to any barriers in the system. If you have any insights into the sponsorship process that you wish to share, please contact Caroline Strickland, Senior Policy Advisor in BMA’s International Affairs on the following email CStrickland@bma.org.uk
ARM 2021
This year's annual representative meeting, which is taking place on 13 and 14 September, will be held fully virtually as last year.
Following the ballot of LMC UK conference members who registered their interest in attending the BMA ARM, we still have some ARM seats remaining. You need to a BMA member and provide your BMA number. If you would like to register your interest in attending can you please email Karen Day at KDay@BMA.org.uk
RCGP report on relationship-based care
The RCGP has published a new report 'The power of relationships: what is relationship-based care and why is it important?', which sets out what is meant by relationship-based care – “care in which the processes and outcomes of care are enhanced by a high quality relationship between doctor and patient” - what the evidence tells us about its benefits for patients, GPs and the wider healthcare system, and why relationship-based care needs to be reinvigorated.
Deadline for THE EU SETTLEMENT Scheme – 30 June
The deadline for applications to be made to the EU Settlement Scheme (EUSS) is 30 June 2021. If you are a doctor currently in the UK and arrived before the 31 December 2020, you must apply by 30 June. It is free of charge, and in applying and being granted pre-settled or settled status, you will have secured your rights to continue living and working in the UK.
An application must also be made for every eligible child within your family. If you and your family members have lived in the UK for many years or have a permanent residence document or EEA Biometric Residence Card (BRC), you still need to apply to the EUSS (or apply for British citizenship) to secure your existing rights in the UK. Apply on GOV.UK and check your immigration status here.
Specialist and Professional Committee elections
Nominations for the Specialist and Professional Committee elections are now open for the following committees:
The deadline for nominations is 12pm Wednesday 7 July 2021. For more information about the roles please visit the committee webpages linked above.
To participate in any of the elections, you must hold the relevant position for the specified seat. You must also register for a BMA web account to use the online election system.
To submit your nomination in any of the above elections please login to the BMA’s election system.
If you have any queries regarding the election process, please contact elections@bma.org.uk.
BMA COVID-19 guidance
Read our COVID-19 toolkit for GPs and practices, which provides comprehensive guidance for practices to manage contractual issues and service provision during the coronavirus pandemic.
You can access all the BMA guidance on COVID-19, including ethical guidance, here
GPC UK and GPC England committee pages
Read more about the work and priorities of GPCUK and GPC England in the newly updated committee pages, which also includes surveys undertaken, membership of the committee, meeting dates and a link to the GP practices page. You can also follow us on twitter
Media
I was interviewed by BBC Radio York this week about whether children should be offered covid-19 vaccination, following an increase in outbreaks in schools.
NIGPC member Michael McKenna was interviewed on Good Morning Ulster programme (2:24:00) about how GPs are involved in claims for Personal Independence Payments (PIP). A recent Public Services Ombudsman report found that too many people were unfairly turned down for PIP claims and, in many cases, evidence submitted by medical professionals in support of these claims were only considered at a later stage during appeal hearings.
NIC chair Tom Black’s interview on RTÉ Radio One Morning Ireland show about the prevalence of the Delta variant in the north west border area of Ireland was picked up by RTÉ online news, Irish Examiner and Irish Times.
Read the GP bulletin here.
Read the latest Sessional GPs newsletter here
GP appointment data (England)
The GP appointment data for April in England was published yesterday, with revised data so that it now also includes COVID vaccinations delivered via general practices. The figures for April 2021 (23.8 million) are very similar to those in April 2019 (23.85 million), but with an additional 7.5 million appointments for COVID-19 vaccinations.
There were also more appointments being seen within the same or next day (13.1m vs 11.8m), and within a week (18.2m vs 16.2m), compared to April 2019 as well despite the additional workload from the COVID vaccination programme.
This highlights the immense pressures that GPs and their teams continue to operate under, as they battle to provide care to their communities alongside the ever-increasing workload generated by the pandemic and associated backlog of patients needing care.
It is testament to general practice that in April, the majority of appointments were done the same day as booking. The number of consultations taking place after a two-to-seven day wait is going up, which is a sign that practices are responding appropriately to the needs of their patients who want to wait for a specific timed appointment, often face-to-face. However, it could also be an indicator that practices are struggling to meet same day requests, and illustrates the serious toll that increased patient demand is having on surgeries across the country, and how much harder it is for GPs to give patients the timely care they need. Read our full statement here and on our twitter page. This was reported by Pulse,
Time to end NHSE/I directive letters
In our recent letter to the Secretary of State for Health and Social Care in England and our follow up urgent meeting with him, we stated a need to see an end to directive letters from NHSE/I, and instead allow practices and other GP services to provide patient care in the most appropriate manner, meeting the reasonable needs of their patients and based on their knowledge of their local communities.
It is therefore positive to see affirmation that we are starting to be heard. We have now received a reply from the Secretary of State, in which he ‘thanked all general practice staff for the incredible work we have been doing since the start of the pandemic to deliver essential care and support to all patients’, acknowledged the pressures the profession is facing and also confirmed the intention to ‘move away’ from the use of SOPs as ’we transition further out of the pandemic.’ This was further reiterated by NHSE/I in their bulletin issued on 15.6.21 which says their current approach is a temporary one not a permanent fixture and that when the government is finally able to move to Step 4 of its easing of lockdown plan, now potentially in July, the need for SOPs could end. They were also clear that SOPs are only guidance, not contractual documents, something we have made clear to practices.
In addition, in a recent interview in Pulse, Nadhim Zahawi MP, the vaccines minister in England, talked about the ‘tireless dedication’ of everyone in Primary Care involved in the vaccination programme, recognising how much pressure it had placed the profession under.
These are all small but positive steps in the right direction but there is clearly much more that they need to do.
Long-covid and weight management enhanced services (England)
NHSEI have published two new enhanced services, relating to long-Covid and weight management. In addition, and following our lobbying, they have also confirmed a further welcome extension to pay the full sessional payment to PCN clinical directors, recognising the significant workload they have been carrying.
Whilst the additional support for practices to help care for patients with long-Covid has some merit, it does not recognise the need for support for those in the general practice workforce who need access to occupational health services, or practices that need financial support to enable them to better help colleagues on prolonged sick leave. This must still be addressed if we are to reduce the loss of much needed members of our workforce.
The weight management enhanced service will present practices with additional work at a time when practices are already stretched to the limit. We also have concerns that this service specification is overly bureaucratic, further micromanages clinical consultations, is clinically flawed and demonstrates a lack of trust in GPs and their teams to do what is best for patients. Furthermore, it is not clear that local weight management services have the necessary capacity to respond to increased referrals. This could have been an opportunity for NHSE/I to demonstrate their commitment to be less directive and for government to take much more meaningful steps to address the underlying factors that lead to obesity, but they have failed to do that. You can read our press statement on this. GP online reported on our concerns about this enhanced service.
Workload crisis
As all of us who work in general practice are only too well aware, our profession is in crisis. We are faced by a profound workload crisis which has been in the making for years. While GPC England will continue to campaign at a national level for the resources and workforce levels which primary care needs not only to flourish but simply to survive, it is now abundantly clear that we cannot wait for others to resolve this.
However, GPs as independent practitioners are innovators and have the ability to manage their practice in the way they think best meets the needs of their patients, and as we have demonstrated during the COVID-19 pandemic, and through our delivery of the largest vaccine programme in the history of our nation’s healthcare, that when GPs are trusted to lead they can do incredible things.
Simply put, the response from GPs and their teams to COVID-19 is compelling evidence of what can be done when practices are afforded the trust, autonomy, flexibility and freedom to act as the leaders of the profession in their local communities, acting in the best interests of their patients.
To help GPs to push back against the unmanageable and inappropriate workload demands which we are faced with, GPC England previously published Workload control guidance.
The information in this guide will arm practice managers and GP partners with a range of practical tools to reduce your practice's workload. The benefits of implementing this strategy include helping to define what unacceptable and dangerous workload looks like, improved GP morale and wellbeing, locality working with CCGs and practices providing support, and integrated primary care systems giving general practice a stronger voice.
This guide will help you to agree quantitative limits to individual safe practice for GPs. Appropriate limits on workload will depend on the unique circumstances of each practice and the preferences of each individual GP, as well as the complexity of care being provided. There will also be variation in the amount of spinoff work depending on the complexity of the case mix and also on the contractual status of the doctor.
SGPC meeting -17 June
I attended the Scottish GP Committee (SGPC) meeting yesterday, 17 June 2021 and heard updates on development of transitionary services; progress of the memorandum of understanding refresh; results of the workload and wellbeing survey and the expanded multidisciplinary team survey which has recently been disseminated to GP practices as well as notification of the upcoming elections for all office bearer SGPC posts.
The committee again discussed local rollout of the Redesign of Urgent Care work, the future of COVID-19 community pathways and received various reports from the Sessional GP committee and GP Trainee committee. SGPC also heard updates on premises, IT, GP Wellbeing, medical appraisal and pensions.
PCN handbook (England)
The new PCN handbook for 2021/22 has now been published and is available on the BMA website. The handbook has been updated to include the changes agreed as part of the 2021/22 GP contract, including additional ARRS workforce and new PCN service specifications, as well as other operational aspects. The full service specification setting out the requirements of the PCN DES for 2021/22, as well as further guidance, is also available from NHS England.
Long COVID NHS plan for 2021/22 (England)
NHSE/I has this week published a Long COVID plan for 2021/22 which outlines the 10 key next steps to be taken to support those suffering from long COVID. The plan is underpinned by a £100million investment, £30million of which will go towards the enhanced service, highlighted above, for general practice to support patients with long COVID. The remaining £70million will be used to expand other NHS long COVID services and establish 15 new ‘paediatric hubs’ to coordinate care for children and young people who are suffering from the condition. These hubs will have specialists who can directly treat the children and young people, advise GPs or others caring for them or refer them into other specialist services and clinics. The plan, which builds on the five-point plan for long COVID support outlined by NHSE/I last year, also highlights the need for equity of access, outcomes and experience in long COVID support.
However, we remain concerned about the need for more help for members of the workforce with long COVID and for practices that need to support them, and continue to call for the government to provide a compensation scheme to support healthcare staff and their families who are living with long COVID.
COVID-19 vaccination programme
Acceleration of second doses for cohort 10 and plans for inviting the remainder of cohort 12
NHSE/I has published a letter advising that appointments for a second dose of the COVID-19 vaccine will be brought forward from 12 to 8 weeks for the remaining people in cohort 10 (40-49 year olds) who have yet to receive their second dose.
The letter also includes an update on inviting the remainder of cohort 12 (18-24 year olds) to book their COVID-19 vaccinations, availability of support to meet challenges to system capacity and information about a webinar to discuss the new developments.
People aged 18 and over in England are now eligible and will be invited to book their vaccination appointments through the National Booking Service or by calling 119. It is expected that all adults in England will shortly be eligible to book an appointment. However, we do have concerns that the limitations on availability of Pfizer and Moderna vaccination will mean many young adults will have to wait a number of weeks before being able to get this much needed protection.
In Scotland, people aged 30 and over can get their vaccine, and in some parts of Glasgow people aged 18 and over can also get the first vaccine. In Wales, people aged 18 and over can get the vaccine as if this week. In Northern Ireland, people aged 18 and over can book online or call 0300 200 7813.
Funding and support for COVID-19 vaccination sites (England)
The NHSE/I document on funding and support available for PCN and Community Pharmacy-led COVID-19 vaccination sites published last week, asked CCGs to seek to minimise any burden associated with locally commissioned services where these do not support COVID-19 vaccination and COVID-19 related activities.
Vaccine data
Nearly 73 million doses of COVID-19 vaccines have now been delivered in the UK, and over 30 million have also received their second dose. Over 70% of all doses have been delivered by general practice teams. It is through the hard work and dedication of GPs and their staff that the UK is emerging from the restrictions imposed by the coronavirus crisis.
Read our guidance page about the COVID-19 vaccination programme.
Delay in roll-out of patient data sharing programme (GPDPR) - England
It was announced in the Parliamentary health questions last week that the planned roll-out of the GP Data for Planning and Research (GPDPR) in England would be delayed by two months, from 1 July to 1 September 2021.
This follows extensive engagement by BMA and RCGP with NHS Digital and with the health minister, calling on NHS Digital and the Government to delay the introduction of their new data programme until patients and the public have had time to be aware of and understand the programme and choose to opt-out if they wish.
Along with the RCGP we have made it abundantly clear to both the Government and NHS Digital that this programme needed to be delayed to allow for a proper in-depth public information campaign to give the public a chance to make an informed decision about whether they want their data collected as part of the new GP data extraction programme. We knew there was insufficient time until the first extraction to allow for the public and patients to have a proper understanding of what the programme was intended for and to give enough time to make fully informed choices on whether they should opt-out or not. It is clear that previous communications from NHS Digital on this programme had been either inadequate or non-existent.
While we understand that data sharing plays a key role in planning and research as well as developing treatments, we also know that the crux of the GP-patient relationship relies on trust, transparency and honesty, and therefore allowing the public and patients to make fully informed decisions is paramount.
It is important that the Government now takes full responsibility for ensuring that there is an adequate public engagement ahead of the roll out so that all patients across England can make an informed choice.
Following the announcement, we have had exploratory meetings with NHS digital to consider next steps, and will continue to work with them, to ensure that there are appropriate safeguards in place as to how the data collected is used, and that the views of the profession are represented in all discussions pertaining to patient data.
Read our full statement about the announcement to delay here
New PCSE pay and pension system update
PCSE’s new pay and pension system was launched on 1 June and we have been contacted by concerned practices and GPs about the disparities in information and the difficulty in finding the relevant information on the system. We would urge all GPs to log on and check their details and data. Any errors or issues identified should be raised with PCSE at the earliest opportunity. We have been informed of the following which is very concerning:
NHS Digital has published their response to their consultation on the proposed changes to the annual complaints collection (K041b) and the plan for its reintroduction. These changes were initiated by the GP bureaucracy review NHS Digital paused the collection of the 2019/20 KO14B form, from general and dental practices, but have now confirmed that collections will resume from the 9 August to capture complaints recorded in 2020/21. The NHSD response sets out:
Deadline for THE EU SETTLEMENT Scheme – 30 June
The deadline for applications to be made to the EU Settlement Scheme (EUSS) is 30 June 2021.
If you are a doctor currently in the UK and arrived before the 31 December 2020, you must apply by 30 June. It is free of charge, and in applying and being granted pre-settled or settled status, you will have secured your rights to continue living and working in the UK.
In addition, an application must be made for every eligible child within your family. If you and your family members have lived in the UK for many years or have a permanent residence document or EEA Biometric Residence Card (BRC), you still need to apply to the EUSS (or apply for British citizenship) to secure your existing rights in the UK. Apply on GOV.UK and check your immigration status here.
Seats for the ARM
Following the ballot of LMC UK conference members who registered their interest in attending the BMA ARM which will take place on Monday 13 and Tuesday 14 September 2021, we still have some ARM seats remaining. You need to a BMA member and provide your BMA number. If you would like to register your interest in attending can you please email Karen Day at KDay@BMA.org.uk
Specialist and Professional Committee elections
Nominations for the Specialist and Professional Committee elections are now open for the following committees:
The deadline for nominations is 12pm Wednesday 7 July 2021. For more information about the roles please visit the committee webpages linked above.
To participate in any of the elections, you must hold the relevant position for the specified seat. You must also register for a BMA web account to use the online election system if you do not already have one.
To submit your nomination in any of the above elections please login to the BMA’s election system.
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Read our COVID-19 toolkit for GPs and practices, which provides comprehensive guidance for practices to manage contractual issues and service provision during the coronavirus pandemic. There is also guidance on the following topics:
You can access all the BMA guidance on COVID-19, including ethical guidance, here
GPC UK and GPC England committee pages
Read more about the work and priorities of GPCUK and GPC England in the newly updated committee pages, which also includes surveys undertaken, membership of the committee, meeting dates and a link to the GP practices page.
You can also follow us on twitter: General Practice (@BMA_GP) / Twitter
Media
I was quoted in two articles in the print version of the Yorkshire Post on Monday - one about the impending Government announcement on lockdown, and the other about accessing GP appointments. On lockdown, which was their front page story, I said: "It is imperative that we follow the data. That's what the Government has said all along and what they must do. We have to recognise that we are in a critical stage of the pandemic where the Delta variant is increasing." In a piece on GP appointments, I said there was "anger, frustration and disappointment felt by tens of thousands of GPs about the cavalier ways in which they have been treated and badly let down by the Government and NHS England", following a NHSE letter to practices directing GPs to resume face-to-face appointments. You can read our full press release on this issue here.
Last week I was also interviewed on both BBC Look North (Yorkshire), along with GPC England member Dr Brian McGregor, and ITV Calendar News about GP workload pressures.
NIGPC deputy chair Frances O’Hagan was interviewed on Sunday’s BBC NI Sunday Politics show (01:13) about the spread of Delta variant in Northern Ireland and the country’s waiting list crisis. Dr O'Hagan's interview was subsequently picked up by BBC News NI, yesterday’s BBC Ulster and Foyle radio news bulletins, and the Belfast Telegraph.
The Register reported on NHS Digital's decision to delay the deadline to opt out of the General Practice Data for Planning and Research (GPDPR). In response to this, Farah Jameel, GPC England executive team IT lead said: "The public needs a clear deadline by which they can opt out, alongside clear instructions on how to do this if they so wish. We have been urging the government and NHS Digital to consider making the process of opting out simpler, and in effect remove any additional burden [that] large volumes of Type 1 opt-outs could place on already under-pressure general practice. We urge NHS Digital to clarify this with both the public and practices. NHS Digital must also make clear to patients what will happen to their data if they do not opt out before the deadline, and how long this data will be stored for, as well an explanation as to why it cannot be retrospectively deleted should patients subsequently decide to opt out."
GPC England member Brian McGregor was quoted in York Press about patients demanding face-to-face appointments, where he said: “The biggest and most significant worry for many people in the healthcare profession is that with this increased demand we have, it is almost impossible to allow us to give that greater care to people lost in that huge sea of demand – that tsunami of everyone trying to get access to general practice – and we do not want the situation where vulnerable individuals will deteriorate while we're dealing with things that could have been dealt with in other ways.” He was also interviewed mon BBC Radio Humberside (from 2h10min) to discuss the delayed to the proposed lockdown easing on 21 June, as well as how doctors are feeling right now.
Read the GP bulletin here.
Delay in roll-out of patient data sharing programme (GPDPR)
It was announced in the Parliamentary health questions earlier this week that the planned roll-out of the GP Data for Planning and Research (GPDPR) would be delayed by two months, from 1 July to 1 September 2021.
This follows extensive engagement by BMA and RCGP with NHS Digital and a direct meeting with the health minister, calling on NHS Digital and the Government to delay the introduction of their new data programme until patients and the public have had time to be aware of and understand the programme and choose to opt-out if they wish.
Along with the RCGP we made it abundantly clear to both the Government and NHS Digital that this programme needed to be delayed to allow for a proper in-depth public information campaign to give the public a chance to make an informed decision about whether they want their data collected as part of the new GP data extraction programme. We knew there was insufficient time until the first extraction to allow for the public and patients to have a proper understanding of what the programme was intended for and to give enough time to make fully informed choices on whether they should opt-out or not. Is clear that previous communications from NHS Digital on this programme had been either inadequate or non-existent.
While we understand that data sharing plays a key role in planning and research as well as developing treatments, we also know that the crux of the GP-patient relationship relies on trust, transparency and honesty, and therefore allowing the public and patients to make fully informed decisions is paramount.
It is important that the Government now takes full responsibility for ensuring that there is an adequate public engagement ahead of the roll out so that all patients across England can make an informed choice. We will also continue to hold NHS Digital to account, to ensure that there are appropriate safeguards in place as to how the data collected is used, and that the views of the profession are represented in all discussions pertaining to patient data.
Read our full statement about the announcement to delay here
Find out more on the BMA twitter page
Media
Last Friday the BMA called for a delay in the implementation of a new programme that will see patient data shared from GP practice systems with NHS Digital, from where it will be made available for planning and research purposes. The General Practices Data for Planning and Research (GPDPR) programme was announced in early May, but we said NHS Digital has not adequately communicated with the public about it and how they can opt out if they want to. Currently the timeline for opt-outs is 23 June before the data is first extracted on 1 July. Read the full press release here. This was covered by The Times (print), Pulse, The Register, the Standard, onMedica, Tech Register and across regional titles. Our concerns were also reflected in pieces on BBC online, BBC online and the Guardian. On Monday morning the Labour party echoed our calls in asking for delay. This was covered by the Guardian, the Daily Mail and across regional titles.
The BMA's role in the Government's subsequent decision to delay was reported over 500 media outlines have reported on it including BBC Radio News bulletins throughout the day, BBC News Online, The Standard, The National, PA and National Health Executive. Several quoted Farah Jameel, GPC England executive team member, and our press release
COVID-19 vaccination programme
COVID-19 Vaccine Enhanced Service specification
The COVID-19 Vaccine Enhanced Service specification has been updated to include the following amendments:
1. Introduction of a 3 month-maximum period for payment claims.
From the beginning of June, the deadline for practices claiming payments for COVID-19 vaccinations will be 3 calendar months following the calendar month in which the vaccination was administered, to ensure good financial governance.
2. Restriction for PCN groupings to use a single Point of Care system.
To minimise the risk of duplicate payments resulting from a PCN grouping entering vaccination events on two Point of Care systems simultaneously, PCN groupings can now only use a single Point of Care system within a single calendar month to enter new vaccination events (except for changes to existing events or during the transition period to the new Point of Care system).
3. A change to permit the administration and payment claim of a single dose vaccine
With the introduction of new vaccines that can be given as a single dose, the specifications have been amended to allow the administration and payment claim of a single dose vaccine.
Vaccine cohorts
Those aged 25 or over (within cohort 12) are now eligible for the COVID-19 vaccines and will be receiving texts inviting them to book a vaccination via the national booking service, at an NHS vaccination centre, pharmacy or GP vaccination site. Sites should also continue to work through vaccination of cohort 11 who are yet to receive their first dose.
COVID-19 vaccination: accelerating second doses for priority cohorts 1-9
In addition, sites should continue to bring forward the appointments for a second dose of a vaccine from 12 to 8 weeks for the remaining people in the top nine priority groups who have yet to receive their second dose.
Funding and support for COVID-19 vaccination sites
NHSE/I has published a document outlining the funding and support available for PCN and Community Pharmacy-led COVID-19 vaccination sites. This includes an additional £20 million to ICS/STPs to support primary care providers to draw down additional staff to help deliver the COVID-19 vaccination programme between 16 June and 14 July 2021.
Vaccine data
Nearly 70 million doses of COVID-19 vaccines have now been delivered in the UK, and nearly 29 million have also received their second dose. Over 70% of all doses have been delivered by general practice teams. It is through the hard work and dedication of GPs and their staff that the UK is emerging from the restrictions imposed by the coronavirus crisis.
Read our guidance page about the COVID-19 vaccination programme.
Extending the medical examiner into primary care
The National Medical Examiner (NME) and other parties this week published a letter announcing the extension of the medical examiner (ME) scrutiny to non-acute settings. The new ME system is likely to be enabled through primary legislation (the Coroners and Justice Act 2009) and is due to be implemented across England and Wales through statutory instrument.
Due to the multinational aspect of the roll-out, the BMA’s Professional Fees Committee (PFC), which retains negotiations in all four nations, have been involved in the discussions on how to best implement the new arrangements with the aim of minimising both the financial and operational impacts upon GPs and their practices. There have been two small trials of the ME system in primary care in Gloucestershire and the results are not yet published.
The letter presents a significant shift in the pace of implementation in primary care. The BMA is looking to analyse any secondary legislation which may underpin the new ME system. PFC has contacted the National Medical Examiner to clarify the plans and exact legal status of his letter.
The PFC will keep members updated on this developing issue.
New PCSE pay and pension system update
PCSE’s new pay and pension system was launched on 1 June and 3,500 GPs have logged onto the system so far. We would urge all GPs to log on and check their details and data ahead of the any need to use it. Any errors or issues identified should be raised with PCSE at the earliest opportunity.
We have been made aware post-launch that PCSE don’t have contact details for approximately 6,000 GPs. They assure us that they are working on solutions for this but we would advise any GP who haven’t received one or more emails from PCSE since 30 May giving access to the system contact pcse.user-registration@nhs.net in the first instance.
In the same period around 2,500 practices have logged on to the system and allocated roles to their own users. We would encourage all practices to do this and ensure that all details and data are correct at the earliest opportunity, reporting any issues to PCSE.
We have been meeting with PCSE almost daily since launch and have raised myriad of issues relating to missing and incorrect data along with poor usability. We are concerned about the volume of these issues but have been assured that they are all being addressed. We will continue to monitor and pursue the progress of this and other remedial work over the coming weeks.
We will continue to update members and LMCs on a weekly basis.
PCSE have posted user guidance for practices and GPs on their website. We would encourage users to make use of them.
GP registration for un/under-documented migrants (England)
GPC England would encourage practices to use the Safe Surgeries toolkit developed by Doctors of the World (DOTW). The toolkit - endorsed by RCGP and RCN - is an accessible presentation of existing DHSC and NHSE guidance and supports clinical and non-clinical NHS staff to promote inclusive care through GP registration. Notably, it aims to address specific barriers to primary care faced by vulnerable, un/under-documented migrants by ensuring that GP practices are aware of all relevant guidance and rules. This includes, for example, that patients should not be turned away if they lack a proof of ID, address, or immigration status.
GPs and practices are encouraged to consider and adopt the recommendations set out in the toolkit, particularly as it is now more important than ever that patients are registered with a GP. GP registration will likely mitigate the effects of the pandemic on health inequalities by improving equitable access to care and ensuring that marginalised and excluded communities are not missed in the COVID-19 vaccine roll-out.
DOTW also offer FREE training to clinical and non-clinical NHS staff that aims to improve awareness of migrant entitlements to NHS care and enables staff to better advocate for their patients.
PCN funding (England)
GPC England has had some concerns from practices about payments for IIF for 2020/21. NHSE/I has informed us that this is in progress and calculations of achievement will be available for declaration within CQRS on or around 11 June, with PCN declaration required by 24 June, and payments being made before 31 July.
We have also received some concerns about local funding being removed where it was invested in services similar to the PCN DES services previously. The Update to the GP contract agreement 2020/21 – 2023/24 stated “all funding previously invested by CCGs in LES/LIS arrangements which are now delivered through the DES must be reinvested within primary medical care” and primarily to bolster the PCN funding. This is a principle for the duration of the GP contract period (so until April 2024), not just for 2020/21, so any PCN/practices/LMCs experience difficulties with this funding should remind their CCG of this requirement.
Pension guidance for retired doctors - reminder
From 25 March 2020, due to the COVID-19 pandemic, the UK government’s emergency legislation temporarily suspended some of the regulations governing the administration of NHS pensions, allowing doctors who have recently retired from the NHS to return to work, and for retired doctors who had already returned to work, to increase their commitments without affecting their pension benefits.
These measures include the temporary suspension of the 16-hour rule when members of the NHS Pension Scheme take retirement.
Following the end of the COVID-19 outbreak, a six-month notice period will be given to staff and employers at the end of which the suspended regulations will take effect again. Staff and employers will therefore have six months’ notice to readjust their working patterns, where necessary.
Read more in the NHSBSA guidance on the rules currently on hold
Fall in prescription items dispensed (England)
The number of prescription items dispensed in England during 2020-21 fell by almost 2 %, the annual Prescription Cost Analysis shows. This equates to a decrease of 21.5 million items, compared to 2019-20, taking total dispensing volume to 1.11 billion. However, the cost of the prescription items (each item on a prescription) dispensed in the community in England during 2020-21 rose – by 3.49 % (£324m) to £9.61 billion. This is the second consecutive year that the cost of items dispensed in England has increased following three consecutive years of decreases between 2015/16 and 2018/19. Read more on the Dispensing Doctors Association website.
Deadline for THE EU SETTLEMENT Scheme – 30 June
The deadline for applications to be made to the EU Settlement Scheme (EUSS) is 30 June 2021.
If you are a doctor currently in the UK and arrived before the 31 December 2020, you must apply by 30 June. It is free of charge, and in applying and being granted pre-settled or settled status, you will have secured your rights to continue living and working in the UK.
In addition, an application must be made for every eligible child within your family. If you and your family members have lived in the UK for many years or have a permanent residence document or EEA Biometric Residence Card (BRC), you still need to apply to the EUSS (or apply for British citizenship) to secure your existing rights in the UK.
Apply on GOV.UK and check your immigration status here.
GP Trainees Committee regional elections 2021
Nominations for the BMA’s GP Trainee Committee in the below regions have reopened until 12pm 16 June. Seats are for a two-session term, 2021-23.
- Eastern
- Scotland, North
- Scotland, South East/East
- Lancashire*
- Scotland, West*
- *these seats are a by-election and are for a one-session term only
To submit your nomination, please login to the BMA’s election system. See further information about accessing the system below.
Specialist and Professional Committee elections
Nominations for the Specialist and Professional Committee elections are now open for the following committees:
The deadline for nominations is 12pm Wednesday 7 July 2021. For more information about the roles please visit the committee webpages linked above.
To participate in any of the elections, you must hold the relevant position for the specified seat. You must also register for a BMA web account to use the online election system if you do not already have one.
To submit your nomination in any of the above elections please login to the BMA’s election system.
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Media
Pulse reported on an increase in abuse of practices staff, believed to be a direct result of NHS England’s face-to-face order. Krishna Kasaraneni, GPC England Executive team member, was quoted: “Unfortunately, condemnation from NHS England and certain sections of the media have fed a dangerous narrative and created confusion among patients about the way general practice is operating. The frustration felt by patients is often shared by GPs themselves and it is completely unacceptable for people to take this out on hardworking practice staff, who are doing their absolute best to try to meet the needs of all patients when they contact the practice. Abusive language and even more seriously, threats of physical violence, can never be justified, and it has a severe impact on staff’s mental health and wellbeing. No one should expect to come to work and be abused.”
Pulse reported on the 10th biannual GP Worklife Survey (conducted between November 2019 and March 2020) which showed that GPs were working on average two hours per week less in 2019 than two years before. In response to this, Samira Anane, GPC workforce policy lead, said the figures on GP intentions to leave the profession are alarming but will certainly not come as a surprise to many GPs. She said: “This desire is largely driven by unsustainable workload and the impact this has on doctors’ own wellbeing. GPs desperately need support from Government and policymakers as they face the most challenging time of their careers – with, as this study suggests, even younger doctors being pushed to the brink. This research was carried out before the pandemic, and it is likely that the experiences that GPs have gone through over the last year has changed their outlook further.”
Read the GP bulletin here.
The latest Covid-19 statistics are available here.
