BMA 15 - Kernow LMC

BMA calls for delay in roll-out of patient data sharing programme (GPDPR) for England

Today the BMA issued a press release calling on NHS Digital and the Government to delay the introduction of its new data extraction programme until patients and the public have had time to be aware of and understand it and are better able to choose to opt-out if they wish.

On the current timescale, patients have until 23 June to opt-out of their coded health data being extracted from GP systems by NHS Digital through daily extracts from 1 July, replacing the current GPES arrangements for planning and research purposes. Patients can continue to register Type-1 opt outs at any given point in time after this, however once the first extraction has commenced, this will not erase any data held by NHS Digital that has already been shared. We have met with NHS Digital to express our concern that this timeline is far too short and that they have not yet transparently and actively engaged the public in increasing awareness of the GPDPR (General Practice Data for Planning and Research) programme since its announcement in early May. Just last week we wrote a joint letter with the RCGP to NHS Digital urging for improved communication with the public.

In our press statement BMA GP committee executive team member and IT lead Dr Farah Jameel said, “Everyone deserves to know what happens to their healthcare data, and throughout our discussions with NHS Digital about this programme, we have stressed the importance of clear communication with the public. People need to fully understand what this programme means and crucially, how to opt-out of their data being shared, if this is what they want to do. However, recent weeks have shown that communication from NHS Digital to the public has been completely inadequate, causing confusion for patients and GPs alike. Family doctors have a duty to their patients, and have their best interest at heart – so are understandably hesitant to comply with something that patients may know nothing about and that they themselves do not fully understand, even if this is a legal requirement.

With less than four weeks until the programme gets fully underway it’s clear that the timeline needs a hard reset. NHS Digital and the Government must postpone the date of the first ‘extraction’ of data – scheduled for 1st July – until such time as the public are in full possession of the facts and are able to make a fully informed decision about what happens to their data. Unclear messaging and a complete failure to develop a wide ranging and far-reaching public engagement plan to communicate with the population, has resulted in a completely unrealistic expectation that GPs are left to communicate these complex changes. Rushing through such fundamental changes to confidential healthcare data, losing the confidence of the public and the profession, will severely undermine the programme and threaten any potential benefits it can bring to healthcare planning and research.

Drawing insights from health-related data is vital for health service planning, and is a crucial way to monitor public health, organise local services and look at population-level health needs. Whilst the BMA has been engaged during the development of this programme, our emphasis has always been on advocating on behalf of the profession and patients. We will 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.” The full statement can be found here. BBC News are reporting on this.

New PCSE GP pay and pensions portal (England)

Over the weekend, ahead of the 1 June launch of the new GP pay and pensions system, many GPs received automated emails from PCSE informing them that they had been given full access to the system. The emails gave access rights based on the recipient being a GP principal, a salaried GP, a locum and a portfolio GP. Unsurprisingly this created a lot of unnecessary confusion.

PCSE later sent an email to those recipients explaining that the allocation to all roles was to ensure that GPs can access all aspects of the new service, including historic pensions data. They added that the receipt of these emails did not mean that their status on the performers list had been changed.

Whilst the clarification was helpful, we were not informed of PCSE’s plan to send these emails. It has also become apparent that there are many GPs who have not yet received these emails. PCSE has told us that these GPs will receive a single email, in place of the four, by the end of this week.

GPs and practices should log on and confirm they have access to the system. The new system should give access to data that many GPs have not seen before. Navigating the system and becoming familiar with terminology is a challenge and some areas of the portal will only be relevant to certain types of GP.

Read the user guides and other resources for the new system here.

We expect there to be data gaps and PCSE say it has additional resources to meet the anticipated demand. Any issues should be raised with PCSE. Your pension data must be correct and complete, so do log on and check. The BMA will be monitoring both the pension and practice payment aspects very closely.

Deadline approaching for EU settlement scheme

The deadline of 30 June for applications to be made to the EUSS (EU settlement scheme) is rapidly approaching. If you are a doctor currently in the UK and arrived before 31 December 2020, you must apply before that date. It is free of charge, and by applying and being granted pre-settled or settled status, you will secure 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, have a permanent residence document or EEA biometric residence card, you still need to apply to the EUSS (or apply for British citizenship) by 30 June to secure your existing rights in the UK.

Check your immigration status here.

Apply now

GP partners and practice managers sought for research on locum doctors

Manchester University, funded by the Institute for Health Policy and Organisation, is conducting research exploring how temporary or locum doctors work in the NHS, what they do, how their work is organised, and what effects that might have on the quality and safety of healthcare for patients. They aim to find ways to improve the working arrangements for locum doctors.

Find out more information, including how to take part

NHS cervical screening management system to be introduced on 30 October

NHS Digital has been commissioned by NHSX to develop and implement a new IT system, which they say will be simpler and easier to use. It will replace the current call/recall IT system for cervical screening, which sits on the National Health Application and Infrastructure Services platform. As a first step in the transition to the new system, NHS Digital will be working closely with local IT teams and registration authorities for providers to ensure readiness. We will keep you updated on developments.

Mask Exemptions for airline passengers in relation to COVID-19

We have received some reports of airlines asking for medical evidence to support mask exemptions for passengers. Our response to these requests is that Government guidance clearly states that there is no requirement to have written evidence for an exemption for face covering rules and that people do not need to ask for proof from a doctor. We have stated in response to such queries that this is exactly the kind of activity that hardworking staff should not be distracted by while doing their utmost to care for ill patients, and practices are not obliged to undertake it.

Spirometry

NHS England have suggested that spirometry services should be restored. This guidance document comprises information from the Association for Respiratory Technology and Physiology (ARTP) and the Primary Care Respiratory Society (PCRS). It was developed from a task and finish group established by NHS England’s Clinical Policy.

Our guidance for spirometry in general practice remains unchanged. We believe this important diagnostic and monitoring tool should be properly commissioned and sufficient capacity should be made available for practices to be able to access this for their patients. NHS commissioners in many areas are failing to make this service fully available and must do more to support accurate diagnosis of both asthma and COPD. There is no contractual obligation for practices to do this themselves, and with the current infection protection and control restrictions still in place it is not practical for most practices to set aside treatment rooms to be able to complete this.

GP trainees committee regional elections 2021

Nominations for the BMA’s GP trainees committee in the below regions reopening from 12pm, Wednesday 2 June and will remain open 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.

Submit your nomination via the BMA’s election system.

Find out more about the GP trainees committee.

You need a BMA web account to take part in these elections. If you have any queries regarding the election process, contact elections@bma.org.uk

Media

I was interviewed this week for the BBC Radio 4 programme You and Yours talking about the problems caused by unsustainable GP workload pressures, answering questions from listeners about their experiences of accessing their GP practice. The programme can be listened to in full here.

The BMA's East Midland's council chair and member of the sessional GP committee, Dr Kalindi Tumurogoti, was interviewed on BBC Radio Northampton talking about why GP surgeries are busy and how in some cases, waiting rooms designed for 40 can only now have 10 patients in because of social distancing. He also said that GPs had continued to see those who needed a face-to-face appointment in person throughout the pandemic. You can listen to the full interview on BBC Northampton (scroll to 3:09 for the start and 3:11).

GP online reported a BMA press story that sessional GPs could leave the NHS if they are denied a real-terms pay rise this year. This follows previous surveys by the sessional GP committee showing significant numbers of salaried GPs in England did not receive last year’s pay award.

This week the Guardian featured an exclusive article highlighting that staff at UK GP surgeries were facing abuse and a ‘tsunami of demand’. I commented on how concerning this was, “There can never be an excuse for this kind of behaviour. Unfortunately, GPs and practice staff are very often at the receiving end of this frustration, when really it has originated as a result of many issues outside the control of the practice, such as lack of resourcing, chronic understaffing and years of underinvestment by the government.”

GP online reported on an analysis it had conducted showing that GP practices have delivered a third more clinical administrative work - including prescriptions and referral letters - and 8% more appointments in the past five weeks compared with the same period in 2019.

A survey conducted by BMA Scotland of 669 GPs found that 73.3% GPs reported struggling to cope with their workload, causing a negative impact on their physical and mental health. Two thirds of GPs (66.8%) admitted to their workload being unmanageable with 57% saying this had worsened over the pandemic. Dr Andrew Buist chair of the Scottish GP Committee, was also quoted in the press saying that it is well recognised we are facing a GP workforce crisis in Scotland – we simply do not have enough GPs to cope with an ageing population and increased need.

A BMA Scotland Survey showed that almost nine in 10 GPs in Scotland say they or their practice staff have suffered verbal or physical abuse in the last month.

The BMA issued a press release featuring Dr Alan Stout, NIGPC chair, talking about compensation rule changes and their significance for GPs. He highlighted that higher medical indemnity insurance rates threaten to unsettle GPs and possibly affect retention and recruitment.

The BMA has confirmed in an article in Pulse that practices are under no obligation to provide medical letters relating to whiplash injuries as it is not part of the core GP contract. New Government rules announced require whiplash claimants to provide medical evidence of their injuries. Northumberland LMC medical secretary Dr Jane Lothian said this change will ‘undoubtedly’ increase workload in general practice, adding ‘GPs would not be the right people to provide these detailed reports which can often escalate to quite complex claims’, adding ‘if it was me, I would leave it to people who are skilled in musculoskeletal issues’.

Also in an article in Pulse GPC England Executive member Dr Krishna Kasaraneni has said that says NHS must make carbon neutrality a reality. This follows the UK LMCs conference resolution to push the Government to commit to a carbon neutral general practice estate by 2030.

BMA COVID-19 guidance

Read our COVID 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:

The latest COVID-19 related statistics are available here.

Read the GP bulletin here.

Unsustainable, unsafe, and unfair: General Practice in crisis

Key Facts

Number of appointments in March 2021: 28,4 million

Number of appointments in March 2019: 24.6 million

March 2019 – 28697 fully qualified GPs*

March 2021 – 28096 (-2%) fully qualified GPs*

*Full time equivalent (FTE)

Full analysis of the latest GP workforce and activity data can be found on our GP pressures page.

GPs and practices are under unprecedented pressure, delivering a far greater number of consultations with almost 5 million more appointments in March than they did the month before, and nearly 3 million more than they did in the same month two years ago, long before the onset of the pandemic. This is not just due to the serious impact of the COVID-19 pandemic, but also the major scale of the NHS backlog with millions more waiting for treatment, combined with a falling numbers of GPs relative to the growing population, despite government pledges to address this. On top of this GPs and their teams are working incredibly hard to deliver the hugely impressive COVID vaccination programme quickly and effectively.

It is unsustainable, unsafe and unfair for GPs and their teams, whether in practices, urgent care services or other settings, to be working such excessive hours at an intensity that is increasingly at the expense of their own physical, mental, social and families’ health. This is putting patients at risk.

The first duty for GPs, as doctors and professionals, is to do no harm. GPs must, therefore, take all steps possible to deliver care that is safe for patients and protects their staff. With social distancing and infection protection and control measures still necessary, patients should only receive a face-to-face appointment if they need one, not simply because they demand one. Many surgeries have restricted and unventilated reception areas and are not yet safe for patients to walk-in without an assessment.

Practices are already working well beyond their safe limits and the impact of this on patient care has yet to be fully appreciated or recognised. GPs and their practices, as independent practitioners, with the support of GPC England and your LMC, should deliver care to their patients in the way they determine that best protects and cares for their population. They should not be disempowered by national guidance.

Most importantly, it is for practices to determine how best to manage and deliver their services and the best arrangements for appointments, based on their expert knowledge of their local community, and with regard to the need to maintain good infection, protection and control measures in place. Practices have the contractual freedom to do this in a manner determined by each practice, taking in to account their capacity and workload pressures, and using their best clinical judgement to interpret any guidance, and by doing so delivering a safe service to their patients and a sustainable working environment for their workforce.

As we have repeatedly stated throughout the pandemic, GPs must be trusted to lead and given the autonomy to look after their patients as they think best in their expert judgement. GPC England and BMA, as well as your local LMC, are here to support you in doing that.

The simple truth is that within the constraints of limited resources, dwindling workforce numbers and infection control measures it is not possible for practices to continue to deliver all that is expected of them. This is set against the context of rising infection levels and the spread of the B.1.617.2 variant in the UK, cases of which have risen by more than 160% in the past seven days. It is this clinical context that should determine the key priorities for General Practice in the coming days and weeks, not politically-driven or media-fuelled edicts.

GPs have always put the needs of their patients and communities first. It is important that that we continue to prioritise our resources to our sickest and most vulnerable patients, and that we do everything within our power to ensure they are kept safe.

Over the next few weeks, we will be producing a series of support and guidance resources to help you to:

define what unacceptable and dangerous workload looks like
push back against unacceptable workload demands and workload shift
work collaboratively at an ICS level to introduce an ‘OPEL alert’ system for use by practices supported by their LMC
deal with any abuse from patients.

Media

GP online report on our response to the SOP published last week. In response to this Farah Jameel, GPC England Executive team said: “Despite NHS England’s claims otherwise, this SOP fails to clarify how GPs are meant to offer face-to-face appointments to those patients who need them, while at the same time maintaining infection control and social distancing measures. In writing such an SOP, NHS England displays a critical lack of understanding of what the average GP surgery estate physically looks and feels like and how many patients it can safely accommodate at any given time.”

The Daily Telegraph (paywall) also quoted the Dr Jameel saying that GPs are 'incandescent with rage' after being asked to justify patient appointment numbers. She also said: "Practices have continued to see patients face-to-face throughout the pandemic. The proportion of in-person appointments recorded will obviously vary between practices – not least because no two practices are the same and because GPs are the best people to know their patient communities and provide care in the most appropriate way for them. Practices will feel very much like they are once again being reprimanded and asked to “explain themselves” for responding directly to their patients’ needs and providing care in the best way they can, given the immense pressures they are experiencing."

BBC News has published an article about the rising numbers of patients needing care and a shortage of GPs is threatening to overwhelm the system. I was quoted relation to recently updated SOP and the GPC England motion of no confidence in the NHS England leadership, where I said that doctors were left "angry, frustrated and disappointed" by the SOP letter, especially given the incredible contribution GPs have made to the vaccination programme. The article also includes an excellent interview with Dean Eggitt, Medical Secretary of Doncaster LMC and former member of GPC England, about GP practices in England facing 'tsunami of patients'.

I was interviewed on Talk Radio on Tuesday about the pressures facing general practice.

Today the Guardian reported on the crisis in general practice and abuse against practice staff. I said: “There can never be an excuse for this kind of behaviour. Unfortunately, GPs and practice staff are very often at the receiving end of this frustration, when really it has originated as a result of many issues outside the control of the practice, such as lack of resourcing, chronic understaffing and years of underinvestment by the government.” GP online, Practice in Management, and Mail online also reported on the crisis in general practice.

Urgent meeting held with ministers to seek action to address pressures in general practice

Yesterday, I, together with Chaand Nagpaul (BMA council chair) and Ben Molyneux (Sessional GPs committee chair), met with the Secretary of State for Health, Matt Hancock, and Parliamentary Under-Secretary of State for Primary Care, Jo Churchill where highlighted the huge concern of the profession about the current pressures facing general practice. This followed the motion passed by GPC England, calling for an urgent meeting with the Secretary of State.

We stressed the urgent need to support surgeries to reduce workload pressures and to deliver care and appointment arrangements in the way they knew their patients would benefit from. We called for an urgent end to national directives and criticism, and more help and understanding for practices trying to care for those patients who are now part of a huge NHS backlog, caused by the pandemic.

Although it is encouraging that senior members of the Government prioritised this urgent meeting following our request, it is only through swift and meaningful action by them, and from NHSEI, that we will be convinced that they are serious about tackling the crisis currently facing general practice. We will continue to work as hard as we can to ensure this happens. Read the full statement here

GPC Scotland survey

A GPC Scotland survey found that the COVID-19 pandemic has left GPs in Scotland at breaking point with unmanageable workloads and serious concerns about the level of support they will receive to care for patients as the NHS seeks to recover from the past 15 months. The survey also found that GPs and their practice staff are facing unacceptable abusive behaviour from members of the public – with 87.7% saying they or their staff have been subjected to verbal or physical abuse in the past month, and almost two thirds saying it has deteriorated since the beginning of the pandemic. As a result, around 70% of GPs surveyed said they are now more likely to take early retirement or leave the profession altogether. Read more in this statement by Andrew Buist, Chair of GPC Scotland.

This was extensively picked up by the media in Scotland, including STV, The Scotsman, The Times, The Daily Telegraph, Daily Mail, Daily Express, Metro, The Sun, and many regional papers and local radio stations.

RCGP statement on NHS pressures

We have been working closely with the RCGP on how to both highlight and tackle the workload pressures impacting general practice. As part of this they have published a statement saying that that NHS pressures are not just about hospitals, as GPs deliver record numbers of consultations. Professor Martin Marshall, RCGP Chair, said: “GPs and our teams are working flat out, delivering record numbers of consultations - almost 13 million in the last four weeks. This is in addition to their remarkable contribution to the COVID-19 vaccination programme, with 75% of vaccines currently being delivered in general practice alone.”

COVID-19 vaccination programme

Those aged 30 or over 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.

15-minute observation period (Pfizer)

We continue to question the necessity for the 15-minute observation period following a Pfizer vaccine, particularly for second or subsequent doses. MHRA have informed us that the evidence related to this is regularly reviewed by their Expert Working Group, but as yet no change has been made.

Vaccine data

Over 62 million doses of COVID-19 vaccines have now been delivered in the UK, and over 18 million have also received their second dose. The latest data show that over 32 million people in England have received their first dose, and 20 million their second dose.

Locum doctors in the NHS: understanding and improving the quality and safety of care

Manchester University, funded by the Institute for Health Policy and Organisation, is conducting a research project which is examining how temporary or locum doctors work in the NHS, what they do, how their work is organised, and what effects that might have on the quality and safety of healthcare for patients. Their aim is to help find ways to improve the working arrangements for locum doctors and the quality and safety of patient care they provide. For more information, including how to take part, see here

New PCSE GP Pay and Pensions portal (England)

The new PCSE GP Pay and Pensions portal is due to go live next week, on 1 June. PCSE has advised that via this new portal, practices and GPs working in general practice will be able to access a range of new services to help manage their payments and pensions administration online.

PCSE has written to all practices to ensure they have the correct details on file for the correct contact who will control the access within their practice to the new system. We have been assured that this work is complete but if a practice believes that they have not had this correspondence or they are unsure who their assigned contact is they should email pcse.user-registration@nhs.net Once the service is live, these ‘User Admins’ will then be able to log in to the portal and assign the roles to their practice staff. A suite of guidance for using the new system can be found on the PCSE website here.

The payments element of the new system should allow practices to submit payment claims, such as for premises or Locum cover, online. Monthly practice statements will also move to the portal from 1 June. These will only be available via this route.

Practices should find it easier to submit pension information such as an Estimate of GP and Non GP Provider NHS Pensionable Profits with the new system. Practices should also be able to provide updates on salary changes in real-time to ensure the correct pensions contributions are being deducted. Approving Locum A forms and other pensions administration work should also be easier.

Any GP who is a member of the NHS Pensions Scheme as a GP partner, salaried GP or locum GP will be able to access an improved service from PCSE to administer their pension account and access their pension records from 2014/15 onwards. Members will be able to do the following via PCSE online with the new service: Type 1 Annual Certificate of Pensionable Profit and Type 2 self-assessment forms; Estimates of Pensionable Profit/Pay form; Retirement, 24 hour retirement and death in service; GP Locum contributions; GP Solo contributions; opting members in or out of the NHS pension scheme; amending member’s Additional Voluntary Contribution (AVC). Further information can be found on the PCSE website

Members of the scheme are encouraged to log onto the new portal from 1 June 2021. To access this functionality you will need to have a verified PCSE Online account. If you don’t have an account, or have yet to verify your existing account, please contact the PCSE User Registration team at pcse.user-registration@nhs.net. If you already have an account but have forgotten your log in details you can set up a new password on the PCSE login page

£120m COVID expansion fund - fair shares allocation per STP (England)

NHSE/I has now published a fair shares allocation per STP for the £120 COVID expansion fund for 2021/22.

Following significant pressure from GPC England we secured additional £120m for general practices from April 2021 until 30 September 2021. Whilst the funding will be available to all practices it will be weighted towards those practices involved in the vaccination programme.

The funding will be allocated to systems, ringfenced exclusively for general practice, to support the expansion of capacity. Monthly allocations will be £30m in May, £20m in June and July and reach £10m in August and September.

Medical indemnity insurance rates in Northern Ireland

Alan Stout, Chair of Northern Ireland GPC, has written an article about the implications of the Damages (Return on Investment) Bill on general practice in Northern Ireland. NIGPC fully support for the purpose of this bill, and the principle of 100% compensation for claimants, but are concerned about the impact on general practice. GPs in Northern Ireland are the only doctors within the health and social care system who must provide and pay for their own indemnity insurance. The cost of this varies depending on a number of factors but can run to £12,000 per annum for a full-time equivalent GP. The cost of this indemnity insurance is, in part, dictated by the discount rate. When the rate is lower, indemnity costs are higher. It is clear from this bill that the indemnity rate has the potential to impact on indemnity costs for GPs in Northern Ireland. Read the full article here

GP Data for Planning and Research (England)

NHS Digital has published a Data Provision Notice (DPN) in order to begin extracting data as part of the GP Data for Planning and Research (GPDPR) programme, which is the successor to the GP Extract Service (GPES). Your IT supplier will be in touch separately with instructions on how to comply, as these vary by system. As this is a legal direction, responsibility for communicating these changes to the general public sits with NHS Digital and the Department of Health and Social Care. Should you wish to communicate it to your patients you may do so, but it is not an obligation.

These are the next steps that practices need to take:

Comply with DPN ;Update your Privacy notice ; Consider whether to proactively contact patients to inform them of what is changing; and register type 1 opt-outs in a timely fashion.
If patients register a Type 1 Opt-out, practices must process this. 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 and next step for GPs, is available here

A joint statement from BMA and RCGP can be found here

Final Seniority Factors for 2017/18 (England)
The Final Seniority Factors for 2017/18, for England, have now been published by NHS Digital.

NHSEI review of urgent and emergency care standards
Based on the responses to their consultation, NHS England and NHS Improvement (NHSEI) have announced on 26th May their intention to replace the four-hour A&E target by a bundle of new standards and an overall new approach to measuring performance in Urgent and Emergency Care (UEC) services. Any final proposals will however require government sign-off, which has not yet been given.

They are proposing to introduce 10 new standards which they say would provide system-wide information rather than focusing on one-part of the system. They argue that the current four-hour target focuses on only one part of a now much more complex range of urgent services for patients, including ambulance care, UTCs and NHS 111.

A summary of the proposed new metrics is available here.

Cameron Fund – 10 top tips for financial wellbeing
The Cameron Fund has had a difficult year in common with the rest of the world, but has continued to support our colleagues and families including those who have been affected by Covid. One of the objects of the Cameron Fund is the prevention of hardship and being aware of the financial pitfalls that can cause so much worry and stress to those who ask the Fund for help, they have produced: "10 Top Tips for Financial Wellbeing".

Health inequalities toolkit – call for examples
The BMA is producing a toolkit for frontline clinicians, including those in general practice, who feel frustrated by the health inequalities they see in their work, and who wish to do something about it.

The initiative is part of a project by BMA president Sir Harry Burns, who is making inequalities the focus of his one-year term in office. The BMA also published a paper in March recommending actions UK governments could take to mitigate the effect of the pandemic on health inequalities and the social determinants of health.

We would like to hear from those who have seen or participated in schemes to address health inequalities in their local area, and hope the final published toolkit will support clinicians to tackle health inequalities, either through direct action on behalf of their patients, through joint working with other local organisations, or indirectly through lobbying local, regional or national government.

Please send any examples of projects or initiatives you have seen in your local area to reduce health inequalities, by filling in this webform.

If you have any general feedback on what you would find useful in a toolkit, as a GP, please email Liv Clark at oclark@bma.org.uk

Media

The BBC reported on the case of Joy Stokes from Wiltshire, who sadly died from secondary breast cancer, after her husband says she struggled to receive a timely face-to-face appointment with her GP. Mark Sanford-Wood, GPC England Deputy Chair, spoke to BBC Radio Wiltshire (around 3hrs19) around the situation in general practice and reassuring the public that where face-to-face appointments are necessary practices are doing their utmost to fulfil them. He said that there needed to be a "proportionate" approach to increasing face-to-face appointments, noting that some people prefer remote consultations while for others in-person will always be more appropriate.

GPC member Russell Brown also spoke to BBC Radio Sussex (around 1hr40) about GP access.

NIGPC deputy chair Frances O’Hagan was interviewed on Talk Back (05:02) Yesterday about the roll-out of the covid vaccination programme to the over-18s cohort.

BBC Wales worked with Cymru Wales’ GPC Chair Phil White to create advice for people accessing GP appointments. The Q&A format is designed to inform patients how practices are operating across the country, the level of demand for services and what to expect when they make contact. This is part of the BMA’s work to demonstrate the significant rise in demand for GP services in Wales and to address media reports and public views about access to practices and face to face appointments.

Read the GP bulletin here.

Vote of no confidence in NHS England leadership

As lockdown measures are easing to various extents across the UK this week, and the BMA urging ‘utmost caution’, GPs in England are understandably angry after receiving the letter from NHSEI last week about face to face appointments and seeing walk-in patients in advance of an updated SOP whilst the Government’s guidelines still recommend social distancing in healthcare settings, and at the same time asking for second doses of COVID vaccinations to be brought forward, causing enormous pressure on general practice.

If it has not been evident to government, media or the public before now, it is now clear beyond doubt that general practice is under immense strain as a result of significant and unsustainable workload pressures and are delivering a far greater number of consultations (3m more) than they did at the same time two years ago, before the onset of the COVID-19 pandemic. This not only follows the serious impact of the pandemic and the hugely impressive involvement of GPs and their teams in delivering the COVID vaccination programme so quickly and effectively, but also the major scale of the NHS backlog and that GP recruitment and retention is still nowhere near at the levels we need and your government has pledged to address. Added to this, demand for our services has increased significantly through the use of additional means of communicating with patients through the growing use of online consultations.

As stated in my address to the UK LMC Conference last week, general practice has been through a hard and difficult time that has left many physically exhausted and mentally drained. It has tested every GP team and individual like never before. But it has shown the profession at its best. We have been there for our patients. We have not let them down. We have responded to this unprecedented situation and we have risen to and met the challenge. The hard work and dedication of so many people in general practice has saved countless lives and the nation owes you all a huge debt of gratitude.

The media headlines of recent days and the subsequent letter relating to the NHSE/I’s Standard Operating Procedures (published yesterday) understandably left many GPs and practice teams demoralised, angry and feeling that the immense workload pressures that practices are currently experiencing is not recognised or appreciated. Practices need help and support not condemnation and criticism. Note that this is guidance and not contractual. It is for practices to determine how they meet the reasonable needs of their patients.

We have already expressed our very deep concern to NHSE/I about the contents of their letter, and we have been candid about how it has been received by the profession.

We have also written to the Secretary of State for Health, Matt Hancock MP, calling for the Government to provide urgent support to general practice and clarity to practices and patients about the expectation to deliver more face-to-face appointments and enable walk-in patients whilst also maintaining safe waiting and reception areas, and asks for an urgent meeting to discuss this. This follows an urgent meeting I have already had this week to discuss the situation with Health Minister in England, Jo Churchill MP. The letter also outlines a number of changes which the Government must make if practices are to increase the number of face-to-face appointments. Read our press statement here.

As a result, in the GPC England meeting yesterday we discussed and passed an Emergency Motion of no confidence in the leadership of NHS England following its “tone deaf” letter to practices last week around face-to-face appointments, and longer-term failure to support, or recognise the efforts of, the profession over the last 14 months. The motion also demands an explanation from the Government as to why the letter was sent last week and an urgent meeting with the Secretary of State for Health and Social Care. As a result, the committee has now ceased all formal meetings with NHSE/I and this will continue until sufficient steps have been taken to give the committee confidence to justify a resumption in such meetings.

This motion sounds a much-needed warning bell, rung by GPs at the end of their tether, emotionally and physically exhausted by the past 14 months. The onus is now on NHS England and ministers to fix a broken system so that patients as well as doctors have a GP service that is fit for purpose in every way. Read my full statement

We are calling for an end to this management-by-directive approach which is not appropriate at this stage of the pandemic. To reiterate, such guidance is not contractual and it is for practices, as independent contractors, to determine how they meet the reasonable needs of their patients, and how they organise their appointment and access arrangements, including online consultations and triage, in the best way they can utilising their available capacity and expert knowledge of their local community.

Media

The story about the vote of no confidence was widely covered in the Telegraph, Mail Online, the print version of the Times, GP Online, and Pulse. It was also mentioned on BBC Radio 4 this morning, and across regional BBC stations such as BBC Merseyside. The Yorkshire Post also ran the story.

Our statement on the NHS England letter about the SOP published last week on returning to face-to-face consultations was covered by The Times (paywall), front page of the The Daily Telegraph (print), GP Online and Management in Practice. I was quoted saying: "We need to be very clear, GP practices have continued to see patients in person during the pandemic, but as with many other NHS services, the number of face-to-face appointments has understandably had to reduce to protect patients - particularly those at higher risk if exposed to such a potentially lethal virus – and to protect our staff." I was also interviewed on LBC News on Saturday on this subject where I said that it was vital that doctors had kept their patients safe throughout the pandemic without bringing them in unnecessarily to health settings.

The story about our letter to Matt Hancock was picked up by outlets including Pulse and the BMJ. In addition, Brian McGregor, GPC England member, was interviewed by BBC Humberside (around 9.30am) about the letter.

Mark Sanford-Wood, deputy chair of GPC England, spoke to BBC Spotlight about general practice pressures. He said that general practice in his area of Plymouth was close to collapse a few years ago, and that although it managed to recover, is still operating with severe workforce shortages - all in the midst of a global pandemic.

Summary of press and news: BMA reflects anger of the profession and calls for an urgent meeting and support for general practice (bma-mail.org.uk)

Online consultations – the contractual position

Before the pandemic, as part of the 2019 GP contract deal (paragraph 5.10 (i)) GPC England agreed that it would eventually become contractual for practices to offer online consultations during core hours. This agreement has not yet been added to the contract regulations, so is not currently a contractual requirement. However, GPCE also agreed that practices should offer online consultations as early as possible, provided that the necessary infrastructure is in place, but it would not become a requirement until it is entered into the contract regulations. It is therefore for practices to determine how best they use online consultation systems, including what hours they are available, and they should try to use them in such a way that helps with triage and workload management, enabling the delivery of a safer and more accessible service to all their patients.

COVID-19 vaccination programme

As of yesterday, 34 and 35-year-olds will receive texts inviting them to book a COVID vaccination via the national booking service, at an NHS vaccination centre, pharmacy or GP vaccination site.

COVID-19 vaccination: accelerating second doses for priority cohorts 1-9

Following the recommendation by JCVI that reducing the dosing interval to help protect the nation from the COVID-19 B1.617.2 variant, the Government has instructed that appointments for a second dose of a vaccine will be brought forward from 12 to 8 weeks for the remaining people in the top nine priority groups who have yet to receive their second dose. People should continue to attend their second dose appointments, and nobody needs to contact the NHS. The NHS will let those who should bring their appointment forward know, when they are able to do so.

Vaccination sites will receive an increase of the AstraZeneca vaccine to support with rescheduling second dose appointments.

The letter from NHSE/I promised additional financial support would be made available to vaccination centres to cover the administration costs of this activity and earlier this week we pushed for this to be made. We are pleased that NHSE/I has now published Further details on the support available for PCN-led sites, including CCGs and ICSs to bring in additional workforce where possible, and additional payment of £1,000 for PCN groupings for rescheduling second dose appointments on or after 25 May 2021. They have also updated their FAQs on providing second doses.

Updated Enhanced Service Specification

The Enhanced Service Specification for the COVID-19 vaccination programme 2020/21 has been updated to introduce a 3 month maximum period within which payment claims must be made, a change to restrict PCN groupings to using a single Point of Care system, as well as a change to permit the administration and payment claim of a single dose vaccine.

BMA media campaign ‘Spread the word, not the virus’

The BMA has launched a social media campaign to encourage a better uptake of COVID-19 vaccinations amongst communities from minority ethnic backgrounds.

Working with a group of influential social media creators, who have developed short video posts for Instagram, it is hoped that the campaign will pass on the message that everyone who can be, needs to be vaccinated so that the risk of infection and illness reduces and life can get back to normal. Find out more here.

Changes to National Booking Service (NBS) for pregnant women

The new NBS functionality will enable pregnant women to book appointments at a site that offers the Pfizer-BioNTech or Moderna vaccine following a series of screening questions. This is in line with JCVI guidance and the Green Book.

Every woman who is pregnant or thinks she might be, should be offered a discussion on the potential risks and benefits of vaccination with a clinician, so that she can make an informed choice about whether to receive it. Pregnant women will be able to have a conversation with a healthcare professional at their vaccination appointment or can speak to their maternity team or GP service.

Guidance for vaccination centres to ensure access to people with dependent children

We have welcomed guidance recently published to ensure that people are not turned away from vaccination centres because they attend with dependent children – and have called for it to be publicised more widely. We intervened after a junior doctor on maternity leave was refused entry at a hospital vaccination site because she was carrying her three-month-old baby. Details of the case can be read here.

Storage of Pfizer vaccine

Following reports by the European Medicines Agency that the approved storage period in a fridge for the Pfizer vaccine could be extended from days to weeks, the MHRA has approved new storage conditions for the vaccine, extending the length of time the thawed vaccine can be stored at normal fridge temperatures from 5 days to 31 days. NHSE/I has also published a letter about the change to shelf life of the Pfizer vaccine when stored in refrigerators at 2-8C. This change makes a big difference to the remaining vaccination campaign and potentially simplifies the giving of boosters at the same time as flu vaccines later in the year. However work still needs to be done on trying to reduce pack sizes. We have also questioned again the continued need for a 15 minute observation period after vaccination.

Vaccine data

Nearly 60 million doses of COVID-19 vaccines have now been delivered in the UK, and over 18 million have also received their second dose. The latest data show that over 31 million people in England have received their first dose, and 18 million their second dose.

Read more about the latest changes in our guidance about the COVID-19 vaccination programme.

COVID-19 data

The weekly summary of COVID-19 data, including information on the backlog of NHS work in each nation is available here.

NHS Standard Contract 2021/22 – New “interface” provision (England)

Following reports from GPs regarding inconsistent implementation of NHS Standard Contract requirements on secondary care providers relating to the interface with local primary care teams, the BMA has worked with NHS England on the introduction of a new provision in the contract to improve collaboration between clinical teams.

The new provision requires that secondary care providers work with their local commissioners to assess by the end of September, and annually thereafter, their compliance to the interface requirements of the contract. The commissioners and providers will have to agree an action plan to address any deficiencies identified by their assessment and ensure that this action plan is informed by discussion with and feedback from the relevant LMCs, and they also need to ensure that the action plan is adopted in public by their Governing bodies, and that progress on its implementation is shared with the relevant LMCs.

In addition to previous changes, this year there is an additional requirement which is set out in Sections 3.17 and 3.18 of the NHS Standard Contract:

“3.17 The Co-ordinating Commissioner (in consultation with the other Commissioners) and the Provider must jointly assess, by no later than 30 September 2021 (and annually thereafter), the effectiveness of their arrangements for managing the interface between the Services and local primary medical services, including the Provider’s compliance with SC6.7, SC8.2-5, SC11.5-7, SC11.9-10, SC11.12 and SC12.2 of this Contract.

3.18 Following the assessment undertaken under SC3.17, the Co-ordinating Commissioner and the Provider must then:

3.18.1 agree, at the earliest opportunity, an action plan to address any deficiencies their assessment identifies, ensuring that this action plan is informed by discussion with and feedback from the relevant Local Medical Committees;

3.18.2 arrange for the action plan to be approved in public by each of their Governing Bodies and to be shared with the relevant Local Medical Committees; and

3.18.3 in conjunction with the relevant Commissioners, implement the action plan diligently, keeping the relevant Local Medical Committees informed of progress with its implementation.”

GP Data for Planning and Research, legal direction (England)

On Wednesday 12 April, NHS Digital issued a Data Provision Notice (DPN) to all practices notifying them of their intention to begin extracting data as part of the GP Data for Planning and Research (GPDPR) programme. GPDPR is the successor to the GP Extract Service (GPES) and it is a legal requirement for practices to comply with the DPN. Your IT supplier will be in touch separately with instructions on how to comply as these vary by system.

These are the next steps that practices need to take include complying with DPN, update your Privacy notice, consider as a practice if you will proactively be contacting patients to inform them of what is changing and register type1 opt outs in a timely fashion

See also these key documents/links

Data Provision Notice (DPN)

Privacy statement

Patient information on GPDPR

Transparency notice

Type 1 opt-out form

Next steps for GPs

International Nurses Day

It was International Nurses Day earlier this week and we would like to acknowledge and pay tribute to the vital role of practices nurses and the many community nurses who work closely with practices on a day to day basis. As essential members of the general practice workforce we all benefit from their skills and expertise. I raised this in my speech to the LMC UK Conference, when I called for the investment necessary to be able to recruit and retain more practice nurses, as just as with GPs, as we have not seen the increase in their number in the way that we and our patients need.

On #NursesDay we celebrated and thanked our nursing colleagues for all that they do #NursesDay2021- read our tweet

New GP Pay and Pensions system (England)

The new GP Pay and Pensions system is due to become available to practices and GPs on 1 June. PCSE has this week written to LMCs with further information setting out some of its preparatory work and the support which will be available to users of the system.

Parliamentary elections 2021

I would like to congratulate Dr Ivan Camphor who was elected as a Wirral councillor and former GP Trainees Committee co-chair Sandesh Gulhane who was elected as a new MSP. In addition, Dr Onkar Sahota was re-elected on to the London Assembly as Ealing and Hillingdon representative. If you are aware of other GPs who were elected in local or national elections please let us know.

Mental health and awareness week 2021

It is the Mental Health Awareness Week this week, hosted by the mental health foundation.

The BMA now offers face-to-face counselling, in addition to our existing wellbeing services. For the next six months, you can access one-off support or, after triage, a structured course of up to six face-to-face counselling sessions, provided by the BMA’s existing accredited provider Health Assured, through a grant from the CHSA. Call 0330 123 1245 today or visit the website for more information.

Access the BMA’s COVID-19 wellbeing pages and the BMA wellbeing twitter page

GP Trainees Committee regional elections 2021

Nominations for the BMA’s GP Trainees Committee in the below regions in the UK are open until 12pm, 19 May. Seats are for a two-session term, 2021-23.

Eastern

East Midlands

Kent, Surrey & Susex

London North West

Mersey

North East

Northern Ireland

Peninsula

Scotland, North

Scotland, South East/East*

Thames Valley

Wales

West Midlands

Lancashire**

Scotland, West**

Severn**

*this seat is a by-election and is for a one-session term

**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. You need a BMA website account to take part in these elections. If you have any queries regarding the election process, please contact elections@bma.org.uk

EU settled status webinar

The Cavendish Coalition and the Home Office will be holding a webinar on Ensuring the settled status and right to work of social care and NHS staff on Wednesday 26 May, 12-1pm.

You can join this free webinar with colleagues from the Home Office to find out the latest on the EU settlement scheme, right to work for your EU nationals and next steps, as we fast approach the application deadline. Designed for recruitment leads and HR, you will hear best practice from social care and NHS organisations, in addition to a question-and-answer session. This will be relevant for employers of EU nationals, including GP practices or independent contractors. The webinar is free to join and if you wish to attend, please sign up here

Media

The Bournemouth Echo reported on the recent GP appointment figures showing increasing number of appointments in March. I commented: “Every day, more than a million patients in England had an appointment with their practices, whether this was the significant proportion seen face-to-face, on the phone, or, for a smaller number, via video call. This phenomenal amount and associated workload is before we consider the hundreds of thousands of other people being vaccinated via GP-led sites each day."

Iain Morrison, member Scottish GPC, has written an article in the Scotsman, calling for urgent support for Scottish GPs, who have been pushed close to breaking point.

Read the GP bulletin here.

BMA survey – GP workload pressures

The BMA has published its 13^th COVID-19 survey, which clearly demonstrates how the pandemic has had a great impact on GPs and practice staff in terms of workload, lack of breaks and leave, and an increasing number of staff leaving the NHS.

More than half of GPs (62.5%) surveyed say they are ‘very concerned’ their patients’ health will suffer due to the growing backlog of non-COVID care. The survey also reveals that 68% are either not very or not at all confident that their practice will be able to manage patient demand. GPs especially report that their non-COVID workload is higher than before the pandemic, and are less confident than their hospital colleagues that their practice and local health economy can manage this and actually clear the backlog within a year.

General practice, like much of the NHS, is currently facing unprecedented pressures as we battle to keep patients safe during the pandemic on top of a growing backlog of care.

The survey also shows that an increasing number of staff leaving the NHS, with:

36% of respondents from a primary care setting said they are more likely take early retirement in the next year while 22% of respondents from a primary care setting said they are more likely to leave the NHS for another career in the next year
55% of respondents from a primary care setting said they have changed their career plans because of workload, including the ability to take breaks/leave

No GP is a stranger to working long hours or seeing colleagues break down with stress, and as a result, many are now considering leaving the profession altogether in order to get the respite they so desperately need. Not only does this deprive the NHS of talented doctors, but it also hinders patient care, drives up waiting lists, and places extra pressure on those who decide to stay.

The BMA’s findings must act as a wake-up call to UK Government and treated with the upmost urgency. Without a functioning general practice system – the gatekeepers of the NHS – the entire health service teeters on a cliff edge.

I have written to Health Minister, Jo Churchill MP, to highlight the pressures GPs and their practice teams are under, and that despite this huge and growing workload, recent media focus has again misleadingly suggested that GP practices are not open to see patients. This is clearly not the case, as evidenced in the national appointment data published last week showing that there were 3 million more appointments (up 11%) in March this year, than the same time in 2019 prior to the pandemic.

Read the full results from the survey here

Follow us on the BMA GP twitter page: General Practice (@BMA_GP) / Twitter

Media

Following interviews for regional BBC last week on GP workload pressures this week I appeared on ITV's Calendar news (18.05) in their lead piece, which focused on the workload pressures in general practice and the looming workforce crisis, and referenced the latest BMA's tracker survey. I said that workforce problems long predated the pandemic: "The difficulty is replacing GPs who have left. That situation hasn't changed. We've been through the pandemic, we've done our best with the staff we've got and we're now hopefully coming out the other side, but we still have the same workforce issues as two years ago." My comments were also reported in a different ITV piece.

Pulse also reported on the BMA survey, and I commented that these findings ‘must act as a wake-up call to the UK Government’ and be treated with ‘the utmost urgency’. “General practice, like much of the NHS, is currently facing unprecedented pressures as we battle to keep patients safe during the pandemic on top of a growing backlog of care. Our calls must be listened to, and our workforce truly valued. This means giving GPs the respite they need and access to proper breaks to ensure no more feel forced to leave a career they’ve worked so hard to achieve.’

The BMJ reported on the workload pressures, GP Online, Healthcare Leader and Pulse reported on the finding that more than a third of GPs said they were now planning on retiring early, while Medscape and Personnel Today also carried articles on the survey.

Regional coverage of the latest GP appointments data - which showed an increase of 5 million appointments between February and March, in for instance the Stourbridge news, Greatest Hits Radio, Dorset Echo and the Bridport and Lyme Regis News. I commented: “figures underline the immense efforts that practices are going to providing care to their communities and the intense workload pressures that staff are under as we continue to respond to the pandemic alongside patients’ wider health needs."

The Westmoreland Gazette reported on a sharp increase in GP appointments in their region, to which I commented: ”Every day, more than a million patients in England had an appointment with their practices, whether this was the significant proportion seen face-to-face, on the phone, or, for a smaller number, via video call. This phenomenal amount and associated workload is before we consider the hundreds of thousands of other people being vaccinated via GP-led sites each day."

Workforce data and GP pressures

The latest GP workforce data report has been published yesterday, which shows that the overall number of FTE GPs has seen little growth since 2015, with the number of GP partners significantly decreasing in that time.

Between March 2020 to March 2021, the number of older, more experienced GP partners reduced by 546 doctors. Factoring in this decrease, the number of qualified GPs increased by 1541 (salaried and locum GPs only) in that time. Looking at this on a FTE basis (37.5 hours per week), the number of fully qualified FTE GPs only increased by 110.7 (to 28,096) over the past year.

The number of patients per practice is 22% higher than it was in 2015, but the GP workforce has not grown with this demand. As a result of this stasis, there are now just 0.46 fully qualified GPs per 1000 patients in England - down from 0.52 in 2015. This is significantly below the average number of physicians per 1000 patients in comparable OECD nations (3.5).

These figures clearly illustrate that in addition to the workload pressures practices are under, the GP workforce is decreasing steadily, while the patient numbers are increasing.

Read the BMA’s full analysis of the figures on the GP pressures page which has clear graphical analysis, with the chart resource pack here which can be posted as individual images as part of social media interactions. You can read the statement about it by the GPC Workforce lead and GPC England Executive team member, Krishna Kasaraneni.

The BMA's statement was covered by Pulse, Healthcare Leader and GP Online.

COVID-19 vaccination programme

JCVI announcement regarding AstraZeneca vaccine for people under 40

JCVI have today updated their advice for vaccination of those under 40. They have said ‘JCVI’s advice is based on the available data on the current epidemiology, benefit-risk profile by age, modelling predictions on future disease trends and the current forecast on vaccine supply. Given the risk (albeit extremely rare) of these adverse events associated with the AstraZeneca vaccine, the current control of COVID-19 in the UK, model predictions of the potential scale and timing of a future wave, and promising forecasts for the availability of vaccines in the UK, JCVI agreed its advice should be updated.

JCVI advises that, in addition to those aged under 30, unvaccinated adults aged 30 to 39 years who are not in a clinical priority group at higher risk of severe COVID-19 disease, should be preferentially offered an alternative to the AstraZeneca COVID-19 vaccine, where possible and only where no substantial delay or barrier in access to vaccination would arise. For those under 40 years who are of older age, male, obese (BMI above 30), from certain ethnic minority backgrounds or experiencing socio-economic deprivation, the risks of acquiring and/or suffering complications of COVID-19 are higher. Every effort should be made to remove barriers to accessing vaccination in those individuals.

For those aged 18 to 29 years the precautionary advice for a vaccine preference is stronger, reflecting a gradient in the benefit-risk balance with age.’

NHSE/I have issued guidance to GP practices relating to this change.

People aged over 40s are now eligible to receive the COVID-19 vaccination. Practice groups can invite these patients for their first vaccination if they have sufficient supplies alongside continuing with second vaccinations to those patients who are due to receive it.

NHSE/I will also be sending out text messages to remind people about the second dose if they haven’t received it or do not yet have an appointment at 91 days after the first dose. Patients can book at www.nhs.uk/covid-vaccination, by calling 119 or by contacting their GP practice, if that is how they booked their first dose.

Patients bringing babies or children to vaccination appointments

Following some reports of patients with young children being refused entry to vaccination centres, we raised this issue with NHSE/I who have confirmed that there should be equity of access to all patients. The have advised that reasonable adjustments can be made for parents with young babies or children, and should not be turned away, unless following a risk assessment by the senior clinician at the vaccination centre. Every effort should be made to ensure that individuals can receive their vaccine at their stated appointment time.

Following our intervention, they will ensure that all vaccination sites are aware of the guidance relating to patients bringing babies or children to their vaccination appointment, and that vaccination sites take a reasonable approach.

Oversupply of PPE to vaccination centres

NHSE/I originally sent replenishment PPE and non-vaccine specific consumables out to all vaccination sites on a weekly basis. However, after feedback from a number of regions they have now reduced the size of this replenishment, and each site has been given guidance around how they can pause or cancel non-vaccine deliveries if not required. In addition, they are also developing a methodology and system for all sites to become more in control of their supply of PPE and consumables.

Over 50 million doses of COVID vaccines have now been delivered in the UK, and 16 million have also received their second dose.

Read our guidance about the COVID-19 vaccination programme.

Media

The Independent reported on my comments that pregnant women are struggling to access coronavirus vaccinations nearly three weeks after the government made them eligible for the jab. Official guidelines say they should be offered Pfizer or Moderna, but the NHS National Booking Service says it does not have any information on how these can be accessed and directs women to their GP.

GPC Wales meeting

I, along with GPC England executive team member Farah Jameel, attended GPC Wales last week, on 29 March via MS Teams. In addition to the standing reports from the GPC Wales Executive team, the committee discussed the progress of the COVID-19 vaccination programme across Wales – with 74% of the Welsh adult population now having received a first dose; including the scale of practice participation in any booster campaign later on this year alongside the annual flu programme. The committee also received an update from Dr Malcolm Lewis, NHS Wales Shared Services Partnership, regarding the forthcoming mortality review process for primary care. Other topics covered include the process in primary care for the NHS Wales bonus payment as previously announced by the Minister for Health and Social Services, and the Locum Hub Wales system.

LMC UK Conference 2021

The 2021 UK LMC Conference will be held virtually next week on Tuesday 11 May and Wednesday 12 May.

We have emailed the representatives with all the necessary information, including how to log in to the virtual conference platform, and we would urge you to read the information in that email as soon as possible, ahead of the conference, to be fully aware of what is required to participate, and the deadlines involved.

The conference will be webcast live on the day via the events pages above or on this page. More information, including the Agenda, is available here (in the LMC UK Conference section)

Microsoft N365 licences will be allocated for Locum GPs

We are pleased to advise that as a result of work we have been doing through work across the BMA, the Royal College of GPs, and NHSX, the "apps for enterprise" Microsoft N365 licences will now be allocated for Locum GPs who are currently a member of the nationally managed NHS Mail Locum group for a period of 12 months. During this time, work will continue within NHSX and NHS Digital to find a sustainable long term solution. We expect the licences to be live over the coming weeks.

Central procurement for Pneumovax®23 from 1 June 2021

From 1 June 2021 the Pneumococcal Polysaccharide Vaccine (PPV 23) will be centrally procured. In line with other national immunisation programmes, Public Health England will supply this vaccine for the routine immunisation programme and immunisation of those with underlying medical conditions, rather than providers locally procuring the vaccine. The vaccine will be available to order from PHE’s ImmForm website. Read more here.

GP Trainees Committee regional elections 2021

Nominations for the BMA’s GP Trainees Committee in the below regions are now open until 12pm, 19 May. Seats are for a two-session term, 2021-23.

Eastern
East Midlands
Kent, Surrey & Sussex
London North West
Mersey
North East
Northern Ireland
Peninsula
Scotland, North
Thames Valley
Wales
West Midlands
Lancashire*
Scotland, West*
Severn*

*these seats are a by-election and are for a one-session term

To submit your nomination, please login to the BMA’s election system. You need a BMA website account to take part in these elections. For more information about the GP Trainees Committee please visit their webpage.

If you have any queries regarding the election process, please contact elections@bma.org.uk

Clare Wand Fund trustee elections (UK)

Nominations are open until 5pm Tuesday 11 May for three trustees to the Claire Wand Fund 2021-2024. Any registered medical practitioner who is, or has been, actively engaged in practice as a general medical practitioner in the UK under the NHS Acts is eligible for nomination by an LMC representative.

If you are interested in standing for election, please contact your LMC representative and complete the self-nomination process online via this link

You will be asked to specify your nominating LMC representative during the online self-nomination process. We also ask that the nominating LMC representative confirms the candidates name via email to elections@bma.org.uk. An LMC representative may make not more than one nomination. If you are unsure of your LMC representative please find the contact details of your LMC here.
To participate in these elections you must have a BMA web account, if you do not have one please click here to create one. Please follow the link to ‘request a temporary non-member account’ and email your temporary membership number to elections@bma.org.uk
To submit your nomination please visit https://elections.bma.org.uk/

Voting for these positions is only open to LMC UK conference reps and will conclude on 17 May.

Your chance to inform staff training in primary care
Health Education England and NHSE/I would like to hear from GPs, practice nurses, practice pharmacists, practice managers and administrative staff about their experiences of delivering remote triage (navigating patients to the right person at the right time), online, telephone and video consultations in general practice. Your input will be crucial in designing effective training to support all primary care staff and trainees to confidently work with these approaches. Virtual focus groups will be run in May-June 2021. If you would like to participate, or find out more about the study visit https://bit.ly/3dyYp19

Read the latest GP bulletin here.

GP appointment figures and workload pressures (England)

The latest GP appointment figures in England were published yesterday which show that practices delivered almost 5 million more appointments in March than they did the month before, and nearly 3 million more than they did in the same month two years ago, long before the onset of the pandemic.

These figures underline the immense efforts that practices are going to providing care to their communities and the intense workload pressures that staff are under as we continue to respond to the pandemic alongside patients’ wider health needs.

GPs and their teams are consistently telling us they’re busier now than they have ever been, and this data – which does not include a large proportion of the vaccine programme undertaken by practices, nor a vast amount of other daily tasks – backs this up.

Every day, more than a million patients in England had an appointment with their practices, whether this was the significant proportion seen face-to-face, on the phone, or via video call. With too few GPs and practice nurses, and a promise in 2015 of 5,000 extra family doctors within five years actually delivering a loss of almost 1,500 by September last year, individual doctors are taking on more and more as demand rises and the workforce diminishes.

So for GPs and many others in practices working 11 or 12-hour days, often leading heroic efforts to protect as many people as possible in their communities against a disease that has had such a devastating impact on all of us, it is heart-breaking and completely demoralising to hear accusations that general practice is not open and that patients are not being seen.

This narrative, categorically proven wrong by this data, is extremely damaging at a time when morale is already reaching rock bottom and many GPs, practice managers and others practice staff are reaching breaking point. With the ongoing use of telephone triage advised by NHSE/I , changes put in place for the protection of staff and patients alike due to the limits of the size of most practice reception areas - general practice is open, and staff need support, patience and understanding as they work harder than ever before. Read my full statement here

This was also reported by Pulse and GPonline

COVID-19 vaccination programme

As of today, people aged 40 and over are eligible to book an appointment via the NHS national booking service to receive the COVID-19 vaccination. Practice groups can invite these patients for their first vaccination if they have sufficient supplies alongside continuing with second vaccinations to those patients who are due to receive it.

Since the vaccination rollout began in December, over 34 million people in the UK have received their first dose, and 14 million have also received their second dose.

New photographs show the people behind the national vaccination effort

To mark the start of World Immunisation Week 2021, a series of photographs documenting the vaccination programme has been published by the Government. The photo montage comes as a new campaign begins urging under-50s to get the jab. Find out more here

Read more about the latest changes, including the arrangements for the second phase of the vaccination programme and what practices need to do, in our updated guidance page about the COVID-19 vaccination programme.

Weekly COVID-19 data

The BMA weekly COVID-19 data summary is available here.

Racism in primary care report

Humberside LMC have published a report following a survey in their area exploring the experience of racism in primary care. This is a challenging but important document and I am grateful for the LMC sharing it. The report is based on findings from a survey across all staff groups, and forms part of their wellbeing strategy. Further information can be obtained from Dr Zoe Norris, Wellbeing Lead for Humberside LMC, via zoe.norris1@nhs.net

LMC UK Conference 2021

The Agenda for the 2021 UK LMC Conference (to be held virtually on Tuesday 11 May and Wednesday 12 May and Thursday 13 May) has now been published, and we have emailed the representatives with all the necessary information.

We would urge representatives to read the information in that email as soon as possible, ahead of the conference, to be fully aware of what is required to participate, and the deadlines involved (e.g. 12 noon on 7 May for chosen motions, emergency motions etc).

Representatives will join via a virtual conference platform and we recommend that ahead of the conference you test your connection to the virtual platform, log in as soon as possible, and watch the short YouTube films that have been prepared for representatives on now to navigate the virtual conference platform.

We also suggest that all those scheduled to propose motions send a pre-record of their speech wherever possible, by Friday 7 May at 12 noon, to help in case of any connectivity challenges. These should be emailed to info.lmcconference@bma.org.uk, ideally using a MP4 format (video or audio).

Note that the deadline for registration of representatives has now passed, but the conference will be webcast live on the day.

More information, including the link for the webcast, will be published here

Sir Simon Stevens to stand down as NHS England chief executive

NHSE/I have announced that Sir Simon Stevens is to stand down at the end of July as NHS England chief executive. We have worked with Sir Simon and his team over the 7 years he has spent in this role and as a result have secured the landmark 5 year contract agreement with its significant funding increase, and more recently enabled GP practices to play a leading role in the successful delivery of the COVID vaccination programme. He has been a strong advocate for the vital role of General Practice within the NHS and we wish him all the best for the future.

Domestic Abuse Bill receives Royal Assent

This week saw the Domestic Abuse Bill receive Royal Assent to become the Domestic Abuse Act. This means the provisions in the Bill will come into law over the coming months, and probably before the Summer. The Bill contains a new measure which will prevent doctors from charging patients experiencing domestic abuse for letters to access legal aid. While BMA guidance has previously advised against charging for these letters, we continue to push for GPs to be removed from this legal aid process entirely – as we believe the current system disempowers victims and is unnecessary bureaucratic.

Serious Shortage Protocol for Estradot

A Serious Shortage Protocol (SSP) for Estradot® 75 microgram patches, was introduced yesterday. The prescriber will need to decide whether it is reasonable and appropriate to substitute the patient's prescribed order for the active SSP. The patient would also have to agree to the alternative supply for that dispensing month. Read the guidance on endorsement, prescription charges, remuneration and reimbursement, and Q&As here

Extension to the shingles immunisation programme (England)

Individuals become eligible for routine vaccination against shingles when they reach age 70, and all those aged up to and including 79, are now eligible to receive the vaccine until they reach age 80.

Individuals who are eligible for the shingles vaccination programme who turned 80 years during the pandemic and missed the opportunity to be vaccinated can now be vaccinated until 31 July. There are no contractual changes to this programme, the offer of vaccination is opportunistic or if requested for the catch-up cohort. GPs will continue to be reimbursed via the standard item of service fee, which should be claimed manually.

Launch of framework for suppliers of digital services to general practice (England)

The new Digital first online consultation and video consultation framework has been launched this week, which is intended to improve the standards of systems available for patients and practices. The new procurement framework means that PCNs working with commissioners can choose assured systems from a range of suppliers to better meet local needs.

The framework will allow products to be better tailored to user needs, including integrating online consultation systems with GP clinical systems and sending requests to other primary care services to reduce pressure on practices and navigate patients effectively.

Appraisal 2020 survey (England)

NHS England and Improvement is conducting a survey on Appraisal 2020. If you’ve used the new, streamlined format, which was introduced following our concerns about workload pressures and the impact on wellbeing during the pandemic, then your thoughts will be valuable to help develop the format and make appraisal more useful for all doctors. Everyone who has used the new format is encouraged to take part, especially if you’re a Responsible Officer. To take part please email lily.tomkins1@nhs.net who will share a survey link according to your designated body.

Global health leaders back BMA call for urgent action as COVID crisis in India worsens

The scenes we are witnessing in India, Brazil and other countries with rising cases of COVID-19 are deeply concerning and demonstrate how important it is to have a global approach to tackling the pandemic. Following the unanimous passing of an emergency motion, proposed by BMA council chair Chaand Nagpaul at last week’s virtual meeting of the World Medical Association in South Korea, the BMA has called on the UK Government to do more to support countries tackling a worsening COVID-19 crisis. Read the letter to the prime minister

Clare Wand Fund trustee elections (UK)

Nominations are now open for three trustees to the Claire Wand Fund 2021-2024. Any registered medical practitioner who is, or has been, actively engaged in practice as a general medical practitioner in the UK under the NHS Acts is eligible for nomination by an LMC representative.

If you are interested in standing for election, please contact your LMC representative and complete the self-nomination process online via this link. You will be asked to specify your nominating LMC representative during the online self-nomination process. We also ask that the nominating LMC representative confirms the candidates name via email to elections@bma.org.uk. An LMC representative may make not more than one nomination. If you are unsure of your LMC representative please find the contact details of your LMC here.

To participate in these elections you must have a BMA web account, if you do not have one please click here to create one. Please follow the link to ‘request a temporary non-member account’ and email your temporary membership number to elections@bma.org.uk. The deadline for nominations is 5pm Tuesday 11 May. To submit your nomination please visit https://elections.bma.org.uk/

Voting for these positions is only open to LMC UK conference representatives and will conclude on 17 May.

Media

I was interviewed by the Yorkshire Evening Post about the number of patients waiting more than 52 weeks for treatment, which in Leeds rose from 22 to more than 2,700 in just over a year. I said: "This is a sign of the massive impact the pandemic has had on the wider NHS. Staff at GP surgeries and hospitals have prioritised the huge number of patients coping with Covid-19. This has clearly left a number of other patients in this situation. It concerns clinicians at much as patients. We want to provide the best possible service to our patients and it is really frustrating to see these sort of delays."

A number of BMA spokespeople were interviewed on local BBC TV and radio stations, including David Wrigley (3hrs 37mins), Rob Barnett (5mins 20secs) Mary McCarthy (3hrs 5mins) and Christine Clayton (2hrs 9mins), about BMA's latest survey highlighting doctors' concerns over the growing backlog of care. GPC England member Rob Barnett said: "People can cope for a period of time, but if you have a painful hip, for example, that's not going to get better. That's only going to get worse. So, actually, conditions are going to progress, which means that when we actually come to deal with them, they are going to be even more difficult." ITV also reported about the BMA survey.

I was interviewed on Radio Humberside (from 2hrs 11mins) this morning, discussing the latest case rates in the area. I said: "Our focus is very much on the backlog of care that exists of people who would have had procedures over the last year that've been postponed. That's proving to be really tough for a workforce that's already tired and exhausted after such a difficult year, to now have to deal with large numbers of people on top of the routine work."

Northern Ireland GPC deputy chair Frances O’Hagan was interviewed on the BBC Evening Extra show (from 41mins) about figures showing only 56% of those who are eligible to take the Covid vaccine and under the age of 50 have chosen to take it. Dr O'Hagan said: "We are progressing through the age groups and a really rapid pace and the number of vaccines given has been fantastic in Northern Ireland. The under 50s have been rolled out relatively recently... and I would say to people it is a very good vaccine and it is very safe."

Krishna Kasaraneni, GPC England Executive team member was interviewed by the New York Times about social prescribing where he said: “It’s now part of normal practice. We use it for vulnerable older patients who live by themselves, for people with diabetes who are overweight, and we put them in touch with community groups that can help get them outside and exercising. I have young patients with other chronic conditions, people with mental health issues,” he said. “There are no age barriers, no limits on what social prescribing can support people with.”

Read the latest GP bulletin here.

COVID-19 vaccination programme

In his oral statement to Parliament this week, the Secretary of State for Health and Social Care, Matt Hancock MP, confirmed that plans are being made for COVID-19 vaccination boosters to be given later this year, to help protect against new variants. As we reported earlier this month, NHSE/I has committed to discuss delivery of COVID-19 boosters, and the impact on the flu campaign, with GPC England once further information is available. We are also awaiting the outcome of research in to the impact of giving COVID vaccinations and flu vaccinations at the same time.

Second vaccinations

The delivery of second vaccinations to patients continues to be progressing extremely well, with over 10 million patients now having received two COVID vaccinations. We continue to be assured by NHSE/I that all sites are receiving sufficient vaccine to ensure all patients receive their second vaccination as scheduled. Therefore, if any patient believes that they have missed or not received an appointment for a second dose by 12 weeks following their first dose, they should contact the vaccination site to book an appointment.

Guidance on AstraZeneca COVID-19 vaccine and very rare clotting disorders

MHRA and JCVI (Joint Committee on Vaccination and Immunisation) have published Frequently asked questions on the AstraZeneca COVID-19 vaccine and very rare clotting disorders, which advises that it is preferable for adults under 30 to be offered an alternative COVID-19 vaccine, if available.

Vaccinating during pregnancy

The JCVI has advised that pregnant women should be offered the COVID-19 vaccine at the same time as the rest of the population, based on their age and clinical risk group. Pregnant women should be offered the Pfizer-BioNTech or Moderna vaccines where available. Although there is no evidence to suggest that other vaccines are unsafe for pregnant women, more research is needed.

NHSE/I has published a letter with next steps and actions to take for vaccination sites.

Vaccine dose data

Over 44 million doses of the COVID-19 vaccination have been delivered in the UK, with 11 million now having received both doses. The latest data report shows that as of 22 April over 37 million doses have been given in England.

Weekly COVID-19 data

The BMA weekly COVID-19 data summary is available here.

PCV Hib MenC and Childhood 6 in 1 data collection for payment

A communication has been sent out from CQRS to commissioners regarding the automated data collection for PCV Hib MenC and Childhood 6 in 1. Due to a delay in the automated collection from the GP Clinical system, data for PCV Hib MenC and Childhood 6 in 1 will not be extracted until June 2021. To enable practices to claim for payment in respect of these services for April and May prior to this extract, GP practices will need to manually submit the data for these periods via CQRS.

The manual submission will need to be declared and approved within CQRS to generate a payment instruction to the payment systems. Where there has been no manual submission, the June automated extract will include April and May. If there has been a manual claim for April and May, the first automated extraction will be for June only.

Information and guidance documents for each of the available services can be found here

Details of these services, including the live collections timetable, can be found on the NHS Digital’s GP Collections website

Improving General Practice appointment data (GPAD) webinars and demos

Guidance for practices on standard national general practice appointment categories has been published to support the mapping of local appointment slots for these new categories. This follows from guidance published in August 2020 jointly GPC England and NHSE/I, which introduced an agreed definition of a general practice appointment. Recording all appointments in this way will help us to more clearly demonstrate the increased workload pressures and activity of general practice.

NHS Digital are hosting several webinars to supplement this guidance and the categorisation. There are also some short demonstrations that cover how best to carry out the national mapping exercise:

EMIS WEB users: GP Appointments Data (GPAD) - HowbeckHow2
TPP SystmOne users: GPAD Mapping - TPP Demo

Updated guidance for HGV medicals (UK)

Due to added pressures caused by the pandemic, a decision was taken by DVLA in April 2020 to waive the medical requirement for a D4 licence renewal application for those aged 45 and over. Applicants were instead issued with a single, one-year licence.

After talks with the DVLA, the BMA has agreed to aim to accommodate D4 medical appointments for working drivers to make sure that drivers are available to the transport industry. We would therefore encourage practices to enable working drivers to have this medical examination when necessary as much as public health guidelines and individual priorities allow. This excludes car driving licence renewals with small lorry (C1, C1E (107)) and minibus (D1 (101) and D1 (101,119)) entitlements issued before 1997 where these entitlements are used for driving large recreational vehicles rather than for working in the transport sector.

Further information and guidance on this can be found on the DVLA website.

DWP Forms

Further to a recent meeting GPC had with the DWP, they have agreed to supply copies of all relevant GP forms prior to their publication on the HCP pages of Gov.UK. Please see PDF copies of the available forms.

Maternal mental health

As a result of our 2020/21 contract negotiations, we secured additional funding to support a dedicated postnatal check-up for new mothers. The National Childbirth Trust has now found, in their one year follow up survey, that new mothers are not yet always being given the opportunity for this important review, particularly to have the chance to discuss their own mental health. Whilst this year has been very difficult, as practices plan for the coming year, we would encourage them to offer these dedicated appointments to all new mothers, and to do this at a different time from the regular baby health check.

New GP Pay and Pensions system

Following a number of delays it appears that the new GP Pay and Pensions system will become available to practices and GPs on 1 June 2021. PCSE has this week written to both LMCs and practices, advising on next steps and what practices will need to consider in preparation. GPs themselves are due to receive information and guidance on using the new system in the coming weeks.

BMA Scotland Health Hustings

BMA Scotland, in partnership with Holyrood Communications, held a health hustings event prior to the elections in May. Chaired by Holyrood journalist, Andrew Learmonth, on 19 April, with an introduction from Dr Lewis Morrison, the hustings featured contributions from Emma Harper, SNP; Jackie Baillie, Scottish Labour; Alex Cole-Hamilton, Scottish Liberal Democrats; Donald Cameron, Scottish Conservatives; and Alison Johnstone, Scottish Greens. You can watch the full event here

Media

The BMA contributed to the House of Lords report, Beyond Digital: Planning for a Hybrid World, which focuses on how the massive acceleration in the use of online services during the pandemic, and our ever-increasing reliance on digital technology, might have a long-term impact on aspects of life most crucial to our wellbeing: physical and mental health, social connection, education and quality of work. Dr Farah Jameel, GPC England executive team member, gave evidence to the committee and is quoted in the report, alongside BMA survey statistics about digital technology in health. The publication of the report, and our findings, were covered by Mail Online, Evening Standard and multiple regional titles.

On Wednesday I was interviewed on BBC Three Counties Radio about the potential for the continued use of telephone consultations to improve access after the pandemic.

Read the latest GP bulletin here.

COVID-19 vaccination programme

This week, as lockdown restrictions are beginning to ease in varying ways across the UK, those aged 45 and over in England are now eligible to book an appointment via the NHS national booking service to receive the COVID-19 vaccination. Practice groups can now invite these patients for their first vaccination if they have sufficient supplies alongside continuing with second vaccinations to those patients who are due to receive it.

This follows a statement published by the Joint Committee on Vaccination and Immunisation (JCVI) on phase 2 of the COVID-19 vaccination programme, which recommends that the most effective way to minimise hospitalisations and deaths is to continue to prioritise people by age.

GPC England and NHSE/I have agreed an extension to the existing enhanced service specification for practice sites to administer vaccinations to patients between the age of 18 and 50. The service specification arrangements for this second phase of the programme will mirror the arrangements for the first phase, and sites will still get the £12.58 item of service fee for each vaccine administered. Read more about the next phase of the vaccination programme here.

JCVI have also advised that individuals aged 18 to 49 years, in particular males in certain black, Asian or ethnic minority (BAME) communities, those with a BMI of 30 or more (obese/morbidly obese), and those experiencing socio-economic deprivation, should take up the offer of vaccination, as data has indicated that there is an increased risk of hospitalisation for this group.

In addition, the Moderna vaccine has begun to be delivered across more than 20 vaccination sites in England, following use in Scotland and Wales, for those aged 18-29 who are eligible, providing another alternative to the AstraZeneca vaccine in line with updated MHRA guidance last week.

Vaccinating during Ramadan

NHSE/I has published guidance on supporting COVID-19 vaccine uptake during the Islamic month of Ramadan which began on Monday 12 April 2021. The guidance aims to help vaccination sites build confidence, reduce barriers to access and support the uptake of the COVID-19 vaccine amongst Muslim communities during the month of Ramadan.

Vaccine dose data

Nearly 41 million COVID-19 vaccinations have now been delivered in the UK, and the latest data report shows that as of 15 April over 34 million doses have been given in England.

PRINCIPLE trial on COVID treatment

Following the publication of findings from the Oxford-led PRINCIPLE trial on inhaled budesonide as a potential COVID treatment, NHSE/I has issued the following advice which states:

Inhaled budesonide is not currently being recommended as standard of care but can be considered (off-label) on a case-by-case basis for symptomatic COVID-19 positive patients, aged 65 and over OR those aged 50 or over with co-morbidities, in line with the published Interim Position Statement. This Interim Position Statement clarifies that this includes co-morbidities that are 'consistent with a long-term health condition from the flu list’.

What is the background to this new Therapeutic Alert?

The PRINCIPLE trial reported a 3-day median benefit in self-reported recovery for patients with COVID-19 in the community setting who received inhaled budesonide. The impact on hospitalisation rates or mortality has not been established, but the evaluation is ongoing, so recommendations may change as more data become available. The current Therapeutic Alert is based on a decision by the Chief Medical Officer after consideration of the evidence.

What does this mean in practical terms?

There is no expectation that inhaled budesonide will be routinely prescribed for patients in the eligible cohorts with COVID-19. Advice to patients on the management of COVID-19 has not changed. However, as stated in the Therapeutic alert, prescribers may consider prescribing it to reduce symptoms in eligible cohorts who are being managed in the community. This would be on a case-by-case basis using a shared decision making approach.

Where a decision is made to prescribe, prescribers are asked to ensure that the patient understands how to use the inhaler properly. As patients will be self isolating, this may be via video link (see below).

Patients will need to ask a friend or relative to collect the inhaler. If this is not possible, they can access the NHS Volunteer Responders service. They will also be eligible for free delivery if other routes are not possible.

For pharmacists and dispensing doctors

Additional supplies of the Pulmicort 400 Turbohaler (AstraZeneca UK Ltd) are now available to be ordered as needed through business as usual routes from wholesalers.

Information for patients

Information for patients can be found here, including a link to videos explaining correct inhaler technique from Asthma UK.

Flu vaccination programme 21/22

We have now received confirmation from NHSEI that there will not be central procurement of flu vaccine for the coming year’s scheme, but the at-risk group will be extended as it was this year. Practices should therefore, where this is possible due to the late notice, take this into account when placing orders. The annual flu reimbursement letter was updated on 1 April. A copy of the latest version can be found here. The letter confirmed that those aged 50-64 year old will be included in the 21/22 flu programme and also confirmed the inclusion of a QIVr vaccine (Supemtek).

GP Career Support Hub

A new GP Career Support Hub has been launched this week on the Future NHS platform, containing all of the information GPs need to support them throughout their career.

The GP Career Support Hub is a central information point with resources to support GPs at all stages of their career - from newly qualified doctors to those approaching the end of their career. It provides information, guidance and support on career development, learning, mentoring, appraisals, career options/flexibility, wellbeing, pay and pensions to enable GPs to realise fulfilling, rewarding and exciting careers in general practice.

Call for swift action to remove GMC’s power to appeal tribunal decisions

Thirteen leading healthcare organisations, including the BMA and five royal colleges, are calling on the UK government to act to remove the General Medical Council’s power to appeal against decisions by medical practitioners’ tribunals. The government agreed in 2018 that the power, which duplicates similar powers held by the Professional Standards Authority (PSA), should be scrapped. Its abolition is included in draft legislation to reform the way healthcare professionals are regulated, on which the government is consulting. The healthcare bodies have told Matt Hancock, health and social care secretary for England, that the move is urgent and should be made now, by including it in the forthcoming health and social care bill.

Weekly COVID-19 data update

The BMA’s Health Policy team has started producing a weekly summary of key data on various aspects of the pandemic. The data is from external published sources (with links to the relevant data/study) and can be shared. The latest summary will be attached on Monday.

National e-Referral Service (e-RS) advice and guidance webinar (England)

To support mobilisation of advice and guidance (A&G) services as per the 2021/22 operational planning guidance, the NHSE/I is hosting a webinar for clinicians and system leaders about the National e-Referral Service on Tuesday 20th April 2021, 4.00pm-5.30pm.

The session will include an overview from NHS Digital on recent improvements that have been made to the NHS e-Referral Service A&G function, and will also share experience and learnings from clinicians working in primary and secondary care who have successfully implemented an A&G service, focusing on Cardiology, Gastroenterology and Urology.

If you would like to attend, please register here.

If you have any feedback with regard to the e-RS, generally speaking or regarding the A&G function specifically, please let the BMA Workforce and Innovation Team know via info.wi@bma.org.uk.

Elected BMA representatives from both primary and secondary sit on the monthly e-RS Optimisation & Improvement Clinical Council. We can therefore feed examples of both good and bad practice into this group and seek resolutions to both local and national issues and concerns.

GPC UK regional elections

The deadline for voting for seats to the General Practitioners Committee (GPC) UK in the Durham and Cleveland region is 12pm, Monday 19 April. To submit your vote please visit https://elections.bma.org.uk/

If you live or work in the Durham and Cleveland region and do not have access to the voting, please contact elections@bma.org.uk and the team will be able to assist.

If you do not have a BMA web account?

To vote in this election you must have a BMA web account, if you do not have one please click here to create one. Please follow the link to ‘request a temporary non-member account’ and email your temporary membership number to elections@bma.org.uk to get access to vote in this election.

If you have any queries regarding the election process, please contact elections@bma.org.uk.

Media

I was interviewed on Sky News on Monday 12 April (13.30pm) speaking about the latest on the delivery of covid vaccinations ahead of the over-45's being invited for their jab this week. When asked about the level of take up, I said: "Practices are continuing to work really hard to deliver the vaccination programme and the vast majority of people are coming forward. At the moment we are focusing primarily on the second doses. There is always potential that some people may not come to an appointment and there are more patients asking for information about side effects which they are happy to help with. We want to ensure patients understand that this is still a very effective and safe vaccine and it’s in their best interest to be protected from this deadly virus."

GP workload pressures

The headline story yesterday on BBC Look North (Yorkshire) was the workload pressure experienced by GP practices. I was interviewed for the lunchtime news and evening bulletin and highlighted the rise in workload as a result of dealing with significant pressures with insufficient workforce. I appeared on BBC Leeds at 7.05am and 8.05am on Thursday, and again at 5.15pm to discuss the current pressures facing general practice and the need for more long-term investment.

Easing of lockdown restrictions in England

Brian McGregor, GPC England member and chair of the BMA Yorkshire Regional Council, was interviewed on BBC Radio Humberside (from 2hrs 10mins on the easing of lockdown restrictions. Urging people to act with caution, Dr McGregor said: "It's important still just to remember there is still some infectious disease out there, all be it in smaller numbers, and to behave as if you are still trying to prevent the transmission of that disease."

Easing lockdown restrictions in Northern Ireland

Tom Black, Chair of NI Council, has released a statement ahead of the NI Executive’s announcement about exiting lockdown, expected later today, where he said: “We have seen that the rest of the UK has lifted restrictions, so today’s news will be very welcome to the Northern Ireland population. Unlike the rest of the UK we share a border with the Republic of Ireland and, as infection rates in the Derry and Strabane border area is currently showing us, greater coordination on public health measures is needed between the two jurisdictions to help minimise further outbreaks. He was interviewed on BBC Radio Foyle Breakfast (1:17:28) on exiting lockdown and the rising Covid-19 case numbers in the Derry and Strabane District Council area. NIGPC chair Alan Stout was interviewed on U105 news bulletins yesterday about the Executive’s approach to easing lockdown.

NHS pressures data

In response to NHS data on waiting lists in England, David Wrigley, BMA council deputy chair, said: “Today’s statistics are a stark reminder that, despite falling Covid-19 infection rates and the progress of the vaccination campaign, the health service remains in an incredibly precarious state.” Read the full BMA statement here. I was also interviewed on LBC radio about this last night where I said: "These figures have devastating consequences for people who are waiting for hospital procedures and they have a knock-on effect on community services because they need continued care from GP and nursing teams while they wait."

Read the latest GP bulletin here.

Read the latest Sessional GPs newsletter here.

HRH Prince Philip, Duke of Edinburgh

We are saddened to hear that HRH Prince Philip, Duke of Edinburgh, has died. He passed away peacefully this morning at Windsor Castle. The BMA has today passed on the organisation’s deepest condolences to Her Majesty the Queen and the Royal Family on the death of Prince Philip today. He was a dedicated public servant, and among his many other roles over the years kindly served as a past president of our association in 1959.

COVID-19 vaccination programme

MHRA/JCVI and EMA statements on AZ vaccine

MHRA, JCVI and EMA have all made announcements on serious thromboembolic events with concurrent thrombocytopenia associated with the use of the AstraZeneca COVID-19 vaccine. This includes a small number of life-threatening and fatal cases presenting as venous thrombosis, including unusual sites such as cerebral venous sinus thrombosis, splanchnic vein thrombosis, as well as arterial thrombosis, combined with thrombocytopenia that can rapidly progress. Multifocal venous and arterial thromboses have been reported in serious cases. The majority of the events occurred within the first 14 days following vaccination but have also been reported after this period. Risk factors have not been identified.

These serious, but rare, adverse events need to be seen in the context of over 4m COVID-19 infections since the start of the pandemic causing more than 120,000 deaths. Over 30m people have received their first dose of the COVID-19 vaccine since the start of the programme, which Public Health England (PHE) analysis indicates that the COVID-19 vaccination programme prevented 10,400 deaths in those aged 60 and older in England up to the end of March, an additional 4,300 since the previous update. Analysis of infection data since the introduction of the COVID-19 vaccines in the UK demonstrates that vaccination is highly effective and substantially reduces the risk of infection and severe COVID-19 disease.

JCVI is now recommending that 18- to 29-year-olds who do not have underlying health conditions putting them at increased risk of COVID-19 should be offered an alternative to the AZ vaccine where available. MHRA/JCVI confirmed that the risk/benefit of getting the vaccine is favourable for the vast majority of people, but more ‘finely balanced’ in younger people. The under-30s in the UK will be offered an alternative to the Oxford-AstraZeneca vaccine, where available (but stated that they were not advising a ‘stop’ for any age group). The deputy CMO has suggested that there will be minimal impact on the timing of the vaccination programme as a whole.

NHSE/I has issued advice to practices. The MHRA has produced guidance for patients and healthcare professionals. PHE has also published a leaflet that may be useful when communicating with patients. The BMA statement provides further information.

Easing of restrictions and testing

On 5 April the Government in England announced that from 12 April there will be a further easing of COVID restrictions after the prime minister confirmed the roadmap is on track. From 9 April everyone in England will be able to access free, regular, rapid COVID tests twice a week, including those without symptoms. Updates will be made to the NHS COVID-19 app in England to coincide with the universal testing offer. In response, the BMA said it is vital that the public is made aware of the limitation and accuracy of these tests. Recent research into lateral flow tests suggests they can pick up around half of the people with symptoms but significantly fewer of those who have asymptomatic COVID. Further, there is evidence of an even lower detection of positive cases if people carry out the tests themselves.

Confirmatory PCR testing has been reintroduced (from 1 April). Current guidance in England specifies that all individuals who receive a positive LFD test result are encouraged to take a follow-up PCR, whether the LFD test was assisted or self-reported. Contact tracing will begin immediately after a positive LFD result (eg without waiting for the result of follow-up PCR). The tracing process will be stopped and self-isolation notices rescinded where there is a negative follow-up PCR test result obtained within 72 hours of the LFD test result. This is intended to reduce the number of people self-isolating unnecessarily because of false positives from antigen LFD tests at low population prevalence.

Vaccine certificates

The Government confirmed that a COVID-19 status certification system will be developed over the coming months which could allow higher-risk settings to be opened up more safely and with more participants. Over the coming months, a system will be developed which will consider three factors: vaccination, a recent negative test, or natural immunity (determined on the basis of a positive test taken in the previous six months). Events pilots will take place from mid-April to trial the system. All pilots are checking COVID status, which will initially be through testing alone but in later pilots, vaccination and acquired immunity are expected to be alternative ways to demonstrate status.

GPC England has been discussing these proposals with the Government and NHS bodies to ensure there would be a minimal impact on GP practices, and this has been accepted. We need to avoid the expectation that people can secure evidence of vaccination or testing by obtaining a letter from their GP practice.

Weekly COVID-19 data update

Vaccine dose data

The latest data report shows that as of 8 April, over 31m doses of the COVID-19 vaccine have been given their first dose and over 37 milliondoses have been given in total.

Read more about the latest changes, including the delivery of second doses, added funding, and what practices need to do and the support available in our updated guidance page about the COVID-19 vaccination programme.

Vaccinations and immunisations guidance (England)

The BMA have now published guidance about the recent changes to the provision of routine vaccination and immunisation in general practice which come into place from 1 April 2021. The changes include:

The provision of V&I services becoming an essential service for all routine NHS-funded vaccinations with the exception of childhood and adult seasonal influenza and COVID-19 vaccinations.
The introduction of five core contractual standards to underpin the delivery of immunisation services.
A single item of service fee for all doses delivered in vaccination programmes funded through the GMS contract
The Childhood Immunisation DES with its 70% and 90% targets was retired on 31 March 2021 and a new V&I domain in the Quality and Outcomes Framework introduced for 2021/22.

Free COVID-19 PPE scheme extended until the end of March 2022

The Government is extending the provision of free COVID-19 PPE to health and social care providers until the end of March 2022. Following the previous announcement of free PPE provision until the end of June 2021, the scheme will now be extended to the end of March 2022 as the expectation of clinical experts is that usage will remain high throughout the next financial year. This will ensure that general practice can continue to access rigorously tested and high-quality PPE. Providers should continue to access COVID-19 PPE via their current distribution channels.

Access to vaccination for parents with children

We were made aware of an incident where a parent was prevented from brining their dependent children to their vaccination appointment at a hospital vaccination site. We took this up directly and after our intervention this matter has been addressed. They have published the following guidance:

“As we vaccinate the younger groups of patients, it may be the case that parents bring dependent children to their vaccination appointment. Colleagues are reminded that reasonable adjustments can be made for people in such circumstances, and every effort should be made to ensure that individuals can receive their vaccine at their stated appointment time.

Ultimately, the senior clinician on duty has the responsibility for patient safety and it is important that they are informed of any concerns that other colleagues may have about an individual, so that they can make a risk assessment at the time and that any necessary adjustments can be made.

Denying treatment/intervention, for any reason, is a clinical decision and it must be made by the most senior clinician on duty at the time. They will be able to assess the risks and make a clinical decision which will then be documented. All staff need to be aware of the need to escalate these situations to the senior clinician.

In the meantime, as a way of preparing for the younger cohorts, we are looking at ways of strengthening the guidance for parents at the point of booking. Patients booked in for vaccination are currently asked to attend on their own where possible to minimise the risk of COVID-19 infection. However, any individual is allowed to attend with another person, particularly if they need support, for example if they are in a wheelchair, are frail or have a learning disability. Parents with young babies or children need not be turned away, unless following a risk assessment by the senior clinician. They do need to be supported to receive the vaccine. As the cohorts move to younger populations, it is more likely that adjustments will need to be made to ensure no one is disadvantaged because they have dependents with them.”

The VC operational guidance has been updated to reference the above, along with the guidance for the National Booking Service including briefing notes for call handlers.

Flu vaccination 20/21 achievement and plans for 2021/22

On 1 April 2021, a letter from Professor Stephen Powis was published both commending the achievements of practices and developments made with regards to the NHS Annual Influenza Vaccination Programme during 2020/2021, referred to as ‘the most successful in the history of the programme’, especially considering the roll out took place during a pandemic, and outlining further details for the 21/22 programme in England. 81% of people aged 65 years and over were vaccinated and 52% of those under 65 years who are at clinical risk. This was a remarkable achievement and down to the hard work of many practices. The letter also outlines that practices should plan for the immunisation of 50-64 year olds again. We are seeking clarification on this as it has not been clearly stated before.

QOF 2020/21 year-end recalculation

An error has been identified with the QOF year-end calculations, which is related to additional point allocations for cervical screening and flu immunisation. This issue impacted the total number of available points, with the maximum value of 538 instead of the planned 567. The resolution has been identified, tested and validated. The resolution will be applied and the QOF calculation will be rerun overnight, with no action required from practices or commissioners today (7 April 2021).

It is expected that declarations and approvals can recommence on the morning of 8 April 2021. All previous declarations and approvals will be automatically reset within CQRS to support this. The CQRS team will issue further communications on the morning of 8 April to provide an update to commissioners.

The approval window for submission of payment requests to PCSE has been extended until close of play on Monday 12 April, allowing three working days for practice declaration and all commissioner approvals to be completed. This issue has not impacted PCN declarations or approvals, which can be actioned. Additional checks have been applied to validate the calculation of the PCN service, as previously communicated.

Improving GP appointment data

NHSE/I has published information aimed at improving the quality of GP appointment data. This is to ensure that published general practice appointment data fairly represents the appointment activity carried out across practices and general practice providers in England. This year’s PCN Investment and Impact Fund provides additional funding to support this through an indicator covering the mapping of appointment slot types to the new set of national appointment categories by all practices within the PCN. This should only require a short one-off exercise, mapping each slot type that the practice uses to one of the national categories. Practices should note that this only relates to appointments from 1 April 2021 onwards and shouldn’t require changes to wider processes or appointment books.

Salaried GPs vaccination reimbursement

We have received reports of salaried GPs being asked by practices to volunteer for vaccination on a goodwill basis with no payment or time off in lieu from their practice. While any clinician can volunteer to support vaccination clinics, funding models should not rely on this, and employees should never be coerced into doing so. GP practices are paid to administer COVID vaccinations and payment of staff is included in the costing of this funding. Salaried GPs should be fully remunerated for any vaccination shifts and should not feel pressured to take these on a goodwill basis.

Inspiring the female GP leaders of tomorrow

On March 25, the BMA held a hugely successful female GP leaders of tomorrow webinar chaired by Samira Anane (GPC education, training and workforce policy lead). More than 250 guests logged on to hear Nikki Kanani (medical director for primary care, NHS England), Margaret Ikpoh (RCGP council, associate director of primary care Hull Medical School), Farah Jameel (GPC England executive team and Camden LMC chair), Helena McKeown (BMA representative body chair) and Katie Bramall-Stainer (CEO Cambridgeshire LMCs, deputy chair UK LMC conference) discuss their personal leadership journeys, and share tips and advice. Please use this link to watch a recording of the event.

Delayed applications to New to practice partnership scheme (England)

NHSE/I have informed us that they have amended the deadline for the individuals that sent through applications. Their team will be working through all the applications submitted so far and have advised that due to the pressures caused by the pandemic this year they will still accept their application. They have advised that that they will be reverting back to the six months deadline for any further applications.

BMA moral distress survey (UK)

The BMA has launched a survey on moral distress, open to all UK doctors, including retired doctors, although it is not aimed at medical students. The survey will remain open until Sunday 11 April.

The survey asks about your understanding of moral distress and moral injury, whether you have come across these terms before or have experienced them. The impact of COVID-19 and potential solutions are also considered. The findings will be used to make recommendations and allow the BMA to help mitigate this problem throughout the UK’s medical workforce.

Take the survey, and read more about moral distress and how it impacts doctors, here.

BMA Scotland manifesto for the 2021 Scottish Parliament elections

BMA Scotland have published their manifesto for the 2021 Scottish Parliament elections. The proposals for the future of the NHS and crucially its staff, can be read here – and a shorter Pocket Edition here.

Key points include:

A call to put party politics aside and unite to depoliticise the debate around the NHS.
A national conversation on the future of the NHS, what it should provide and how it should be funded.
Transforming and improving how we measure performance in healthcare
A comprehensive and effective workforce plan
Finally tackling bullying and harassment in the NHS and improving workplace culture

The document also sets out a range of measures to help improve the working lives of doctors and help them feel valued once again. Read the BMA press release here.

GPC UK regional elections

The voting period for seats to the General Practitioners Committee (GPC) UK in the Durham and Cleveland region has reopened.

To submit your vote please visit https://elections.bma.org.uk/

If you live or work in the Durham and Cleveland region and do not have access to the voting, please contact elections@bma.org.uk and the team will be able to assist.

If you do not have a BMA web account?

The deadline for voting is 12pm, 19 April. If you have any queries regarding the election process, please contact elections@bma.org.uk.

Media

Dr Chaand Nagpaul, BMA council chair, spoke to Sky News following the announcement relating to the AstraZeneca vaccine saying: "The risk of blood clots has occurred in people with having had the first dose, but not a risk after the second dose, so the advice according to the regulator - according to the evidence - is that you should proceed to having your second dose and be properly protected from what is a deadly virus." I was interviewed on BBC York yesterday morning (around 7am), and Dr Rob Barnett, deputy chair of the north west regional council, spoke to BBC Merseyside (also around 7am). Dr Christine Clayton, south east coast regional council chair, appeared on BBC Sussex at 7.15am, and Dr George Rae, chair of the north east regional council, spoke to BBC Tees at 8.15am.

Read the latest GP bulletin here.

GMS/PMS regulations - pandemic amendments (England)

NHSE/I has confirmed that the temporary changes to the GP contract under the pandemic regulations which were due to lapse at the end of March have now been extended until 30 June 2021.

As with previously, this means a continued suspension of the Friends and Family Test requirement; a continued suspension of the requirement for individual patient consent for electronic repeat dispensing (eRD); and a continuation of the amendment to NHS 111 direct booking with sufficient slots available for NHS 111 to refer into a triage list; for most practices offering 1 per 3000 as per the pre-pandemic arrangement is likely to be sufficient but this can increase to 1 per 500 if demand requires.

Read more about what services practices should be providing, and what should be prioritised during the pandemic, in our COVID-19 toolkit for GP practices.

SFE and global sum calculation (England)

An official consolidated version of the SFE (Statement of Financial Entitlements) has been published for 2021. This updates the SFE from the last fully consolidated version from 2013 and includes the amendments made up to the current 2021/22 contract year. The global sum figure has now been finalised for 2021/22 (£96.78) and amended from early figures we shared as it now takes in to account the full impact of the final MPIG correction factor recycling. The global sum out-of-hours deduction will be 4.75% (£4.59).

DES directions and flu immunisations (England)

The DES (Directed Enhanced Service) Directions have also been published today. NHSE/I has decided not to include the revised Influenza Immunisation Scheme in this set of DES directions. This is due to the possibility of a COVID-19 booster programme running alongside the flu programme, and the need to look at potential operational considerations for providers. NHSE/I has made a commitment to discuss delivery of COVID-19 boosters and the impact on the flu campaign with GPC England once further information is available.

Note that practices should continue to plan to deliver the 2021/22 flu programme as per the letter from NHSE/I Medical Director Professor Steve Powis.

Network Contract DES 2021/22 and improving general practice appointment data (England)

NHSE/I has published a suite of documents to support the updatedNetwork Contract DES2021/22 from 1 April. These documents implement the changes set out in the NHSE/I letter of21 January 2021, and include a cover not outlining the key changes, the updated Network Contract DES specification and guidance, and other supporting guidance, including a set of FAQs.

They have also publishedguidance for practices on standard national general practice appointment categoriesto support the mapping of local appointment slots to these new categories. This follows joint NHSE/I and GPC England guidance published in August 2020, which introduced an agreed definition of general practice appointment.

There is also new guidance on PCNs implementing Investment and Impact Fund for their practices as per the requirements set out in the Network Contract DES.

Access all the guidance here

COVID-19 vaccination programme (England)

Vaccinations sites are encouraged to continue their efforts in maximising uptake in cohorts 1-9 during April, focusing on those in the lower cohorts first, which are yet to be vaccinated.

The JCVI is recommending that adults who are over 16 and living with adults who have weakened immune systems, such as those with blood cancer, HIV or those on immunosuppressive treatment including chemotherapy should be prioritised for the COVID-19 vaccine. NHSE/I has written to practices about the next steps, including a template letter practices can use to inform patients that their adult household contacts are eligible to have the COVID-19 vaccination, and also published operational guidance to vaccinate this cohort.

There will be very limited vaccine available for first doses in April and vaccination sites should now preferentially use spare vaccine from second dose clinics to give to other patients due a second dose, although they retain the clinical discretion to give it to others as a first dose, particularly those living with immunocompromised patients as set out in the letter from NHSE/I.

We are expecting a statement from JCVI shortly on details relating to the next phase of vaccination for groups 10-12.

Maximising vaccine uptake in underserved communities

NHSE/I has published a problem-solving framework to help maximise vaccine uptake in underserved communities, setting out best practice and practical guidance for implementing a range of interventions to ensure equitable access to COVID-19 vaccination and drive uptake.

Pinnacle now features reporting functionality

Pinnacle has now released reporting functionality in their platform. This move comes after lobbying from both GPC England and the Joint GP IT Committee, calling for a solution to support PCN-led vaccination sites with reporting. To support users with their service delivery Pinnacle have introduced several service reports that can now be accessed from the “Reports” tab. Only users with the “Site administrator – user management” permission will be able to see this tab. Please follow instructions sent out in LVS email. All requests for access to PID extracts will be subject to an approval from Pinnacle on behalf of NHS England. For further queries please contact the National Service Desk: Telephone: 0300 200 1000; Email: vaccineservicedesk@england.nhs.uk

Vaccine dose data

Nearly 31 million people in the UK have now received their first dose of the COVID-19 vaccine, and the latest data report shows that as of 31 March, nearly 29.5 million doses of the COVID-19 vaccine have been given in England.

Shielding for clinically extremely vulnerable to end (England)

As of yesterday, 1 April, clinically extremely vulnerable (CEV) people in England no longer need to shield. CEV patients are still advised to continue to take extra precautions to keep themselves safe, even after receiving both doses of the COVID-19 vaccine. Read the government guidance here

Practices are reminded to continue to add and remove patients, as appropriate, from the Shielded Patient List, as it may be necessary to identify this cohort in the future. Information on how to do so is available on the NHS Digital website.

Read our guidance for practices about arrangements for patients at high-risk of coronavirus.

The BMA also has guidance for doctors isolating and those in vulnerable groups

NHS Standard Contract 2021/22 – New “interface” provision (England)

The new provision published in the contract, requires that secondary care providers work with their local commissioners to assess by the end of September, and annually thereafter, their compliance to the interface requirements of the contract.

The commissioners and providers will also have to agree an action plan to address any deficiencies identified by their assessment and ensure that this action plan is informed by discussion with and feedback from the relevant LMCs.

Providers and commissioners will finally have to ensure that the action plan is adopted in public by their Governing bodies, and that progress on its implementation is shared with the relevant LMCs.

BMA summary: NHS Planning Guidance 2021/22 and NHS Mandate 2021/22 (England)

The BMA has produced a member summary of NHS England’s latest Planning Guidance for 2021/22, which sets out its expectations for NHS commissioners and providers in England over the coming year and for the recovery from Covid-19.

We have also responded to the publication of the planning guidance publicly here, and have welcomed the focus on staff wellbeing, recruitment and retention in the guidance, which echoes some of the priorities we set out in our recent paper Rest, recover, restore: Getting UK health services back on track.

The BMA has also called for a realistic approach to tackling the growing backlog of care given the scale of the challenge facing the NHS. Although it is positive that the planning guidance sets out relatively cautious timescales for increasing non-COVID care in the NHS over the coming six months, we’ve warned that offering financial incentives to raise activity levels could be counterproductive if this leads to healthcare workers being put under pressure to ramp up services too quickly.

Community pharmacy pandemic delivery service

You may be aware of the recent addition to the community pharmacy pandemic delivery service which allows pharmacy contractors and dispensing doctors to support the delivery of prescriptions to people who have been told to self-isolate by NHS Test and Trace.

Pharmacy contractors have reported that some people told to self-isolate, particularly the household contacts of COVID-19 positive patients, do not seem to be following the guidance and consequently are still presenting in pharmacies.

It is suggested all primary care providers flag the option to have prescriptions delivered when prescribing for COVID-19 positive patients, to try to ensure they stay away from all primary care premises.

BMA moral distress survey (UK)

The BMA has launched a survey on moral distress, open to all UK doctors, including retired doctors, although it is not aimed at medical students. The survey will remain open until Sunday 11 April.

Take the survey, and read more about moral distress and how it impacts doctors, here.

GPC UK regional elections

The voting period for seat to the General Practitioners Committee UK in the Durham and Cleveland region has reopened. To submit your vote please visit https://elections.bma.org.uk/

If you live or work in the Durham and Cleveland region and do not have access to the voting, please contact elections@bma.org.uk and the team will be able to assist.

If you do not have a BMA web account?

The deadline for voting is 12pm, 19 April.

If you have any queries regarding the election process, please contact elections@bma.org.uk.

Media

I was today interviewed on the BBC Radio 2 Jeremy Vine Programme (1.31m) on how vaccination sites use spare doses of vaccination at the end of a session.

I spoke to BBC Radio Leeds yesterday on the ending of the shielding arrangements in England and explained that throughout the pandemic, calls about mental health have increased. Listen here at 07:05.

GPs are working an average of 11 hours a day according to a workload survey by Pulse, which we was also covered by Mail Online, Daily Express and multiple regional outlets. In response to this I said: “As we move beyond the crisis stage of this winter wave, GPs will continue to face intense pressures and we must ensure all in the general practice workforce are given time to rest and re-charge before we get into the autumn which is already predicted to see increases in workload pressures. Not only will there be the annual flu programme alongside any further Covid vaccination boosters if they are thought to be necessary, we will also need to address the huge backlog of care while there is the potential for further spikes in coronavirus infections.”

Rob Barnett, GPC England member, was interviewed on BBC Radio Merseyside about how hard it's been for people shielding during the pandemic and their mental health might have been affected. Some of his patients have been 'stuck in flats' for a year, and people have been following the guidance to the letter. He stressed that it's really important that people maintain social-distancing and that, even though they are coming out of shielding, they must still comply with the current guidance.

Speaking to BBC News Online, Alan Stout, NIGPC chair, said he was concerned that the uptake of the Covid-19 vaccine will diminish as the roll out moves to the younger age groups. Dr Stout said that young men were the 'hardest to get for any health intervention'. He also appeared on Good Morning Ulster, allaying fears that the vaccine had any impact on fertility, saying that it was 'scientifically implausible' and urging people to have their vaccination, adding it was 'vital we get everyone vaccinated.'

Read the latest GP bulletin here

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