COVID-19 one year on
This week marks one year since the first UK lockdown was introduced in order to combat the spread of COVID-19 and the fight back, with the help of the vaccination roll-out, is gathering speed. It is though concerning that national daily case numbers have stopped falling and in some areas are rising again. There is clearly some way to go in dealing with the pandemic.
The vaccination effort started only a few short months ago, and more than half of the adult population in the UK have already received at least one dose of the vaccine. It is an incredible achievement to have reached such a significant milestone so quickly. Thank you to all involved in this vitally important task which has been achieved whilst at the same time managing many other workload pressures.
Practices across the nation have been working together in groups, often in PCNs (primary care networks) to deliver the vaccination programme locally. Ever since we started, we have been vaccinating people come rain or shine. Even when snowstorms tried to put a spoke in the wheel, armies of volunteers rallied with shovels, clearing snow in car parks and enabling people to get to their appointments.
The vaccine roll-out demonstrates the value of general practice. GPs, by the very nature of their contractual arrangements, are incredibly adaptive, flexible and responsive to new situations. They understand their patients and their communities. If you give practices the necessary resources and the flexibility to get on with it, that’s what we will do. And that is exactly what has happened.
Read the full article here
Support for CCGs in addressing vaccine inequalities (England)
In February, £4.2 million of funding was allocated to STPs to be used across CCGs to support and enable locally led community engagement in all areas with health inequalities. NHSE/I has now pledged an additional £3 million of funding to support further local activity in addressing local vaccine inequalities. From 26 March, regions are invited to submit funding applications for their CCGs. Read more here
COVID-19 vaccination programme (England)
As we reported last week, although vaccination supplies are increasing this week, there will be a reduction of supply of COVID-19 vaccinations from next week for about four weeks due to reductions in national inbound vaccines supply. We are told that this should not impact the delivery of second doses. Vaccinations sites are encouraged to continue their efforts in maximising uptake in cohorts 1-9 which are yet to be vaccinated.
We are expecting a statement from JCVI shortly on details relating to the next phase of vaccination for groups 10-12.
Frequently Asked Questions for second doses
NHSE/I has published some FAQs to help answer some questions relating to second doses of the COVID-19 vaccination, including location of second doses, interval period and consent.
Quality Assurance Framework and SOP for lateral flow devices for COVID-19 vaccination sites
NHSE/I has published a Quality Assurance Framework for COVID-19 vaccination sites, to use as a tool aligned to the operating frameworks and standard operating procedures underpinning the delivery models for these settings.
NHSE/I has also published a Standard Operating Procedure (SOP) for usage of lateral flow devices for asymptomatic NHS staff testing at vaccination sites.
COVID-19 vaccines and pregnancy
There has been some confusion around the eligibility of pregnant women for the COVID-19 vaccine. While it is not currently available to all pregnant women, those who are at high risk of exposure to the virus, including health and care workers, or with high risk medical conditions are eligible. This includes women diagnosed with gestational diabetes in pregnancy or those with a BMI of more than 40 at their antenatal booking appointment.
The benefits and risks of COVID-19 vaccination in pregnancy should be discussed on an individual basis. The discussion should include acknowledgement that, while there is no known risk associated with giving other non-live vaccines to pregnant women, there are no specific data as yet about the safety of COVID-19 vaccination in pregnancy. More information including FAQs and a decision aid are available from the RCOG website.
In addition, the National Clinical Director for Maternity and Women’s Health, and the Chief Midwifery Officer, have published a letter setting out actions for maternity services to identify and invite pregnant women for vaccination, and enabling them to make an informed choice about receiving it.
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.
Vaccine dose data
Nearly 29 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 25 March nearly 27 million doses of the COVID-19 vaccine have been given in England.
Weekly COVID-19 data update
The BMA’s Health Policy team is now 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 is attached with the Monday pdf.
Medical assessments for prospective foster carer and adopters
This week, we have published a joint statement with the Royal College of GPs, to support GPs in considering requests for medicals for prospective adopters and foster carers. These assessments play an important role in safeguarding vulnerable children and are the final requirement for many families across the country.
NHS Operational Planning and Contracting Guidance 2021/22 (England)
NHSE/I has published the NHS Operational Planning and Contracting Guidance for 2021/22, setting out the priorities for the year ahead, to restore services, meet new care demands and reduce the care back logs caused by the pandemic, whilst supporting staff recovery.
One of the priorities is expanding primary care capacity, which will largely be done through the increased ARRS allocation, and a renewed focus on recruiting and retaining an additional 6000 GPs.
Investment in General Practice report and data quality statement 2015/16-2019/20 (England)
NHSE/I has published the annual Investment in General Practice Report 2015/16-2019/20, Data quality statement and GP investment. This shows the level of investment in 2019/20 compared with previous years. The increased funding received by general practice in England is in a greater proportion compared to other sectors in the NHS and is as a direct result of our 5 year contract agreement.
Annual allowance voluntary scheme pays 2018/19 deadline extension
In a previous newsletter we provided information on the annual allowance repayment scheme, which was introduced in England and Wales. The scheme guarantees any annual allowance tax charge in 2019/20, for eligible clinicians will be compensated for at the time of retirement. The deadline for submitting an application form for the scheme for GPs who have or who are planning to retire by 31 March 2021, has been extended to 31 March 2021. For detailed advice on the scheme, please click here.
Scottish GPC meeting update
The BMA Scottish GP Committee (SGPC) met yesterday, 25 March, and discussed the needs of general practice as it recovers from the pandemic and the changes introduced as a result of the pandemic which should be retained.
The committee also discussed the latest progress on the development of transitionary services and the next steps for the Memorandum of Understanding, as well as the redesign of urgent care across LMC areas, and the ongoing impact of Covid on general practice, including the ongoing vaccination programme and future of the community pathway.
The committee received various reports from the GP Sessional committee and GP Trainee committee. SGPC also heard updates on premises, IT, GP wellbeing, medical appraisal and pensions.
BMA report on impact of COVID-19 on health inequalities
The BMA has launched a report, ‘Mitigating the impact of Covid-19 on health inequalities’, outlining a range of measures for Governments across the UK to ensure that those who have been most impacted by COVID-19 are protected in the immediate and longer term.
The report highlights concerns that the unacceptable inequalities that existed before the pandemic will only worsen for families who have been pushed into poverty, and disadvantaged communities that face further hardship due to job losses and COVID-19’s socio-economic impact.
The BMA wants to work towards addressing the underlying inequalities which lead to unacceptable and avoidable differences in life expectancy, as well as quality of life across all communities. Read more and read the report here
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.
Training needs of LMC officers GPDF have developed a project to help identify the support and training needs of LMC officers. Details of the project are available here and they would also welcome the completion of this survey. There are 23 questions separated into four sections and it should take no longer than ten minutes to complete.
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?
To vote in this election you must have a BMA web account, if you do not have one please click here to create one. Please follow the link to ‘request a temporary non-member account’ and email your temporary membership number to elections@bma.org.uk to get access to vote in this election. The deadline for voting is 12pm, 19 April.
If you have any queries regarding the election process, please contact elections@bma.org.uk.
GPC election results
The voting for the following GPC UK regions has now closed. Congratulations to all the successful candidates and thank you to all those who took part in this year’s election.
Contested
Norfolk, Suffolk, Great Yarmouth & Waveney - Ian Hume
Enfield & Haringey, Camden & Islington, Barnet, Kensington & Chelsea, Westminster - Farah Jameel
Merton, Sutton & Wandsworth, Kingston & Richmond –Richard Van Mellaerts
Salford & Trafford, Manchester, Stockport - Samira Anane
Forth Valley, Fife, Lothian, Tayside - Stuart Blake
E Sussex, W Sussex - Russell Brown
Gwent, Bro Taf, Morgannwg - David Bailey
Herefordshire, Worcs, Warks, Coventry - Sarah Matthews
Barnsley, Doncaster, Rotherham, Sheffield representative (by-election) - Clare Bannon
Uncontested
Sefton, Liverpool, Wirral - Robert Barnett
Grampian, Highland, Orkney, Shetland, Western Isles - Iain Kennedy
Somerset, N & E Devon - Mark Sanford-Wood
Birmingham, Solihull - Gavin Ralston
Northern Ireland – Alan Stout
Prison GP representative - Wayne Sturley
Media
Healthwatch England report on GP access
Healthwatch England has published a report showing that some people were struggling to access their GP and that only 54% of appointments over the past year have been face-to-face. Their key recommendation was for NHS England to commission a full review of GP access arrangements as part of the COVID-19 recovery plans. Responding to the report, I said: “We’re acutely aware that remote appointments don’t work for everyone, as this report highlights, but it’s important to dispel the myth that patients without access to the internet have in some way been abandoned and simply cannot access their GP. The vast majority of initial contact with patients was made through phone calls, and practices will always see patients face-to-face when clinically necessary.” This was reported by the Evening Standard and GP online.
Vaccine rollout
I appeared on Sky News last Friday talking about the success of the vaccine rollout and how the whole of the NHS should be incredibly proud of the work they have done. I appeared on the programme to reassure people that although there were some supply delays patients 'could be' assured that they will still be contacted to invite them to have the vaccine at the appropriate time.
I was also interviewed on BBC 5 Live (1 hour and 5 mins in) about the vaccine rollout, where I talked about the hard work of healthcare staff and about some of the challenges that they have faced.
Read the latest GP bulletin here
£120m additional funding for general practice (England)
Following significant pressure from GPC England we have now secured an additional £120m for general practices from April. Whilst the funding will be available to all practices it will be weighted towards those practices involved in the vaccination programme.
The extension of the General Practice Covid Capacity Expansion Fund will be from 1 April to 30 September 2021. £120 million of revenue funding will be allocated to systems, ringfenced exclusively for general practice, to support the expansion of capacity until the end of September. Monthly allocations will be £30m in April and May, £20m in each of June and July and reach £10m in August and September.
Please share this letter widely to help practices consider their options about their involvement in the vaccination programme phase 2.
COVID-19 vaccination programme (England)
People over 50 (JCVI cohort 9) are now being invited to book an appointment via the National Booking Service to receive a COVID vaccination. Practices groups should continue to focus on vaccinating patients in the lower cohorts first, in particular those with underlying health conditions (cohort 6).
If some practices within the local vaccination group want to continue delivering vaccinations to group 10-12 but others do not, the group should discuss with their local vaccination leads how this can be managed with modified supplies to enable some continuation in the programme.
Reduction of vaccine supply in April
NHSE/I published a letter yesterday setting out the next steps on uptake and supply of the COVID vaccinations, over the next six weeks. Although vaccination supplies are increasing this week and next, there will be a reduction of supply from the week beginning 29 March for about four weeks due to reductions in national inbound vaccines supply. The letter also encourages vaccinations sites to continue their efforts in maximising uptake in cohorts 1-9.
Deadline to opt out of second phase of the CVP
As we reported last week, we have agreed amendments to the CVP Enhanced Service Specification, including an extension to allow practice sites to administer vaccinations to patients between the age of 18 and 50. Existing practice sites will be able to opt-out of delivering the second phase of the vaccination programme.
Following significant lobbying based on concerns from practices, we have secured an extension to the previous deadline for practices to inform their commissioner of their intention to opt-out of this second phase of the programme. If necessary, practices now have a few more days, and if necessary beyond the weekend,to decide whether to opt out of the second phase.
Practice that wish to vaccinate cohorts 10-12 should advise their local commissioner how many vaccinations they could administer each week, to ensure local capacity is in place. There will continue to be a choice of provider for the local populations and no expectation that practices or PCN grouping has to deliver vaccinations to its entire population in cohorts 10-12.
PCN grouping could also amend its Collaboration Agreement if individual practices within that PCN grouping wanted to increase or decrease their involvement in the administration of vaccinations to cohorts 10-12.
Additional workforce remains in place to support practice site to deliver the vaccination service, and local commissioners are encouraged to consider their approach to local service commissioning and take appropriate steps to release capacity to support with COVID-19 vaccinations.
Read more about the latest changes, including the delivery of phase 2 of the programme, and what practices need to do and the support available in our updated guidance page about the COVID-19 vaccination programme.
MHRA confirms that people should continue to receive the AstraZeneca vaccine
The MHRA made a statement yesterday confirming that the available evidence does not suggest that venous thromboembolism is caused by COVID-19 Vaccine AstraZeneca. This follows a detailed review of report cases as well as data from hospital admissions and GP records. The MHRA’s advice remains that the benefits of the vaccines against COVID-19 continue to outweigh any risks and that the public should continue to get their vaccine when invited to do so.
Vaccine dose data
Over 25 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 18 March 23.2 million doses of the COVID-19 vaccine have been given in England.
Ongoing support for general practice
We have continued to encourage NHSE/I to maintain the vital ongoing support for practices from April onward, with a renewed call for ongoing income protection for QOF, DESs/LESs and other contract elements. We are pleased therefore, as highlighted above, to have today secured the continuation of funding (£30m per month since November 2020) to support practices to continue with their pandemic response.
Without these protections and support, many practices are telling us they may no longer be able to deliver the vaccination programme, let alone take on the second phase (for patients in cohorts 10-12).
We also believe CCGs should maintain income protection arrangements for local enhanced service and other local schemes. This is crucially important to enable practices to continue with the successful delivery of this nationally important vaccination programme.
We therefore hope that CCGs will do all they can to support practices in this way for the coming months.
Shielding for clinically extremely vulnerable to end
It has been announced that clinically extremely vulnerable (CEV) people in England will no longer need to shield from 1 April 2021.
The Department of Health and Social Care are writing to CEV patients informing them of this and that they can begin to follow the national restrictions alongside the rest of the population. However, the letter does advise to continue to take extra precautions to keep themselves safe, even after they receive both doses of the COVID-19 vaccine.
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.
VAT removal for primary care
We have written a letter to the Financial Secretary to the Treasury, Jesse Norman MP, about VAT removal for primary care, following the consultation on VAT and the Public Sector: Reform to VAT refund rules published last year.
We called on the Financial Secretary, whose ministerial portfolio includes VAT, to make costs for patient facing services exempt for practices and PCNs, and we also emphasised that this approach would allow practices and Primary Care Networks to use the 20% VAT normally spent on hiring practice staff to instead directly support patient services.
GPC UK meeting
GPCUK met yesterday morning where we had updates from each of the four nations on COVID related work and also contractual issues, and also from the Sessional GPs Committee and Trainees Committee. There was a presentation from the Chair of the Pensions Committee, Vishal Sharma, and Deputy Chair Krishan Aggarwal, about life time allowance and other current pension issues affecting doctors. We hope that elements of their very successful webinars will shortly be available on the BMA website.
The BMA’s President, Sir Harry Burns, gave a very interesting presentation about his project looking at how doctors can take local action to reduce health inequalities. This is something we will be working on in the coming months.
Bruce Hughes, Representation policy lead, gave an update about proposals to set up a task and finish group to review future of GPC UK, and proposals to widen the electorate for elections from GPC UK to include Sessional GP Committee members. The committee voted and agreed to the proposal to set up a task and finish group, and also to widening the electorate for elections from GPC UK to other bodies.
GPC England meeting
GPC England met in on Thursday afternoon, where I highlighted that we had written to NHSE/I regarding the need for ongoing support for general practice. I also gave an update on the contract negotiations in England, and about the agreed amendments to the Covid Vaccination Programme Enhanced Service Specification, including an extension to allow practice sites to administer vaccinations to patients between the age of 18 and 50.
There was a valuable and important discussion on the Integrated Care Systems (ICS)/White Paper proposals, and the BMA health policy team introduced a briefing paper about the proposals.
Ben Molyneux, Chair of the Sessional GPs Committee, outlined the enhanced shared parental leave offering to salaried GPs. The committee welcomed and voted to accept these proposals.
Sarah Westerbeek, Sessional GPs committee member, introduced a paper on the gender pay gap for general practice which set our proposals on how practices can be supported to publish gender pay gap information.
General Medical Services (GMS) Ready Reckoner 2021/22 (England)
We have been working with NHSE/I on the production of a ready reckoner which has now been published and is intended to provide an indication of the changes in income streams that may affect a GMS practice and primary care network (PCN) from 1 April 2021.
Implementing the 2021/22 GP contract changes to personal medical services and alternative provider medical services contracts (England)
NHSE/I have published this document which sets out the approach to the funding changes that we will apply to Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts. Commissioners will update local PMS and APMS contracts as soon as possible, applying the funding changes identified in this guidance with effect from 1 April 2021.
Overworked doctors must be allowed to rest and recover so we can keep patients safe, BMA warns
Doctors must be allowed to rest and recuperate from the exhaustion of working throughout the pandemic if we want to have safe patient care in the future.
In a new report, Rest, recover, restore: Getting UK health services back on track, the BMA argues that the pandemic has left the health service running on empty, with staff burnt out, disillusioned, and even considering leaving the NHS as a result of the intense pressures and stress of the past year. The report points out that pushing doctors to ‘get the NHS back to normal’, without giving them the respite and support they need, will not only result in increasingly high absence rates and staff reducing their hours, but also threaten patient care and safety.
Against a backdrop of current workforce shortages, patient demand outstripping staffing levels, and tens of thousands of clinical and non-clinical vacancies in hospitals and a shortage of GPs, the need for a strong and healthy workforce is obvious. As a result, the BMA has set out a series of recommendations to UK Governments to ensure that services resume safely for both staff and patients, including:
1. All Governments and system leaders across the UK to have an honest conversation with the public about the need for a realistic approach to restoring non-Covid care, and support for systems to tackle the backlog.
2. Health, safety, and mental wellbeing of the workforce to remain a top priority.
3. Additional resourcing to help tackle the backlog.
4. Measures to expand system capacity.
5. Measures to expand the workforce and retain existing staff.
The report and press statement can be found here.
Welsh health and social care staff to receive one-off payment
The Welsh Government has announced that a one-off bonus payment of £735 will be made to all health and social care staff in Wales,to recognise their extraordinary contribution during the COVID-19 pandemic. In response to thisBMA Cymru Wales chair Dr David Bailey said: “We welcome this gesture as an acknowledgement of the hard work and dedication demonstrated by doctors and other NHS workers in Wales who have been stretched to the very limits during the COVID-19 pandemic. We are pleased to see their tireless commitment has been recognised.”
Read the full press statement here
Wales easing out of lockdown
Wales started easing out of lockdown on 13 March, with the stay-at-home restrictions being replaced by a new interim stay local rule. Most of these actions follow the BMA’s Taking a cautious approach for easing lockdown document, and feedback from the Minister indicated that opening early years (under 7) had gone well, with very low positive results among teachers.
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 is attached.
Medicine Delivery Service (England)
A Community Pharmacy Home Delivery Service during the COVID-19 outbreak was originally commissioned throughout England from community pharmacies (and a similar service from dispensing doctors) on 10 April 2020 to ensure delivery of medicines to eligible patients who should not present in the pharmacy. This service may continue to be commissioned as necessary nationally or for patients living in local outbreak areas. Read more here, including the revised Service Specifications.
NHS Digital Research Session Request – NWRS (National Workforce Reporting System) (England)
NHS Digital is currently carrying out research focused on improving the NWRS and wishes to engage with users to understand current experiences and potential opportunities. The workforce data GP practices and PCNs share via the NWRS is absolutely essential to ensuring there is an accurate national primary care workforce picture, prudent workforce planning can take place and General Practice can ultimately recruit sufficient and safe levels of staffing. NHS Digital staff would like to speak to people who use NWRS in both practices and Primary Care Networks.
Participants would be asked to join a Microsoft Teams meeting for 30-60 minutes and tell NHS Digital colleagues about your job, work practices and what that entails in relation to NWRS. They would also find it helpful if you could share your screen, and talk them through how you use NWRS and comment on some design ideas they have.
There will be two NHS Digital staff on the call with you: a User Researcher and a Designer. They are ready to speak to willing participants now, so we urge willing GP practice and PCN staff to get in touch and assist NHS Digital with this vital research via Katherine.tyte@nhs.net
LMC UK Conference – change of date
As we reported last week, due to the oversight which allowed us to schedule UK LMC conference on Eid, the conference has now been re-scheduled from 12-13 May to 11-12 May, with the closing of conference at mid-afternoon on 12 May, to hopefully further minimise impact on Eid celebrations.
In careful collaboration with BMA staff from across several teams we have looked at a number of potential other options and dates, and this seems to be the best course open to us. As this is a virtual conference, it might seem relatively easy to reschedule to a different date. However due to the complication involved in organising these sorts of large scale events, not least the availability of key staff and contractors, and clashes with other events, this is not as straightforward as it might first seem.
We know that this is a far from perfect solution (e.g. with many colleagues fasting during the conference), but in the hope that it will have the least impact on the plans already made to attend, and will also impact on colleagues’ Eid celebrations as little as possible.
The deadline for registrations remains the 26 March 2021 via this link
If you need to change the names of any of your attendees can you please email Karen Day at kday@bma.org.uk rather than reregistering.
BMA’s Annual representative meeting 2021
The BMA has confirmed that this year’s ARM (annual representative meeting) will take place Monday 13 and Tuesday 14 September. Find out more about this year’s conference
Senior female GPs Leadership webinar
In celebration of International Women's Day this month, we are pleased to present senior female GP leaders, talking about their leadership and career journeys, in a webinar to be held 7– 8.30pm on Thursday 25 March.
A lack of females in senior medical leadership positions is recognised as one of the underlying factors contributing to the gender pay gap, and this latest webinar forms part of a series of work from the GPC education, training and workforce policy group. Speakers include:
Dr Samira Anane (GPC Education, Training & Workforce Policy Lead)
Dr Nikki Kanani (Medical Director for Primary Care, NHSE/I)
Dr Helena McKeown (Chair of the BMA’s Representative Body)
Dr Farah Jameel (GPC England Executive Team, GPC Negotiator and Chair Camden LMC)
Dr Margaret Ikpoh (RCGP Council, Associate Director of Primary Care Hull Medical School)
Dr Katie Bramall-Stainer (CEO Cambs LMCs, Deputy Chair UK LMC Conference, BMA Council)
Click here to sign up
Please submit advance questions for the Q&A session to Cscott@bma.org.uk
Media
Today I have done interviews for Sky News and BBC Look North on the continued successful roll-out of the vaccination programme.
GP online reported on the vaccination plans for cohorts 10-12, and I commented that I thought most practices would choose to remain involved in vaccinating these cohorts. However, I added that a longer opt-out window would have been preferable after practices were given just a week to decide.
I was interviewed on BBC Radio Leeds (from 1hr 5mins) about the NHS backlog. I said: "It’s really important that we give our hospitals and community services the necessary resources not just to cope with the Covid crisis but also to cope with the crisis of the backlog of care that’s built up over the last 12 months."
Chair of GPC Wales, Phil White, appeared on BBC Radio Cymru to discuss the Oxford-AstraZeneca vaccine, where he explained the importance of vaccination in the pandemic and the fact that medical bodies have deemed the vaccine safe for use. The full Welsh language interview is available at BBC Radio Cymru (12 mins).
GPC member Brian McGregor was interviewed on BBC Radio York (from 2hrs 11mins) about the decision of several European countries to pause the rollout of the AstraZeneca vaccine over links to blood clots. He said: “There's still no link definitively to the vaccine. It may well be the case there has been other things going on and other reasons for [patients developing clots]. But there is no confirmed link between the blood clots in the vaccine as yet.”
GPC member Peter Holden was interviewed on BBC Radio Derby (2hrs 15mins) on delays to vaccine supplies. Reassuring patients that there were sufficient doses available to mean no vaccine appointments should be cancelled he said: "It is a big nuisance but not a disaster. GPs are very used to flexing to daily demand... as soon as we can see [the vaccine] in the country we can start going again." Speaking about the easing of lockdown he said: "We've said it's got to be driven by data, not dates. The issue is data on infections, hospital occupancy and in ITU - not the number of people who have been vaccinated."
Northern Ireland GPC chair Alan Stout was interviewed on the Nolan Show (5:39), UTV Live and BBC Newsline (2:45) about concerns over covid vaccination supplies. He said: "We know we're going to get bumps along the road and this is not going to be the only bump in the road and the key thing is we work through this and we get our priorities right and we get the planning and communications right."
Read the latest GP bulletin here
Read the latest Sessional GPs newsletter here
COVID-19 vaccination programme (England)
Amended COVID-19 Vaccination Programme specification
We have now agreed amendments to the CVP Enhanced Service Specification, including an extension to allow practice sites to administer vaccinations to patients between the age of 18 and 50, which are not currently covered in the ES. Existing practice sites will be able to opt-out of delivering the second phase of the vaccination programme if they want to do so.
Practices will need to inform the Commissioner of their intention to opt-out of this second phase of the programme, by 23.59 on Friday, 19 March, 2021 (but sooner if possible). This is to enable them to be ready to move on to the next phase of the vaccination programme as soon as it is announced.
There are three main criteria, which practices will need to fulfil before they can be approved to deliver this second phase:
Practices will need to carefully consider these three criteria when deciding whether they are prepared to undertake this second phase, and also decide what “business as usual” looks like for them, bearing in mind the ongoing pandemic and their experience over the last year. Sites will continue to receive the £12.58 item of service fee for each vaccine administered.
NHSE/I is also offering for PCN groupings to express interest in trialling use of the national booking system (to replace their own booking systems) – sites should carefully consider the conditions of signing up for this.
We have agreed with NHSEI that the new PCN Services and additional IIF indicators (above what was included last year) will not be introduced before October 2021 and importantly we have secured continuation of the additional payments for PCN clinical directors for a further quarter.
We have also agreed a change to the full ES Specification that practices will use the national naming conventions for coding appointments for vaccinations.
Read more about the amendments and the role of PCN LVS sites in Phase 2 of the COVID-19 vaccination programme here
Vaccinating cohort 8
This week, people aged 55-59 (JCVI cohort 8) are being invited to book an appointment via the National Booking Service, to receive a COVID vaccination. Practice groups should continue to focus on vaccinating patients in cohorts 6 and 7 first.
As set out in the NHSE/I letter on the next steps and key priorities for vaccine deployment plans published last week, from 11 March, vaccine supply will increase substantially and be sustained at a higher level for several weeks. Therefore, as from next week, vaccination sites are being asked to deliver around twice the level of the limited vaccine supply available this week.
Other guidance
NHSE/I has published a Standard Operating Procedure (SOP), to help identify and enable carers to be invited quickly for vaccination, as well as making provision for those unpaid carers who may not already be known to the health and social care system to come forward.
NHSE/I has also published a position statement on vaccinating people registered with a GP in Wales in COVID-19 vaccination sites in England
Vaccine dose data
The latest data report shows that as of 10 March 20.5 million doses of the COVID-18 vaccine have been given in England.
Read our guidance on the COVID-19 vaccination programme which includes information about what is expected of practices and the support available to enable practices to prioritise vaccine delivery.
Guidance for QOF payments
We have now published guidance about QOF payments for 2020/21. Due to the pandemic, these payments will be calculated differently to normal. Some indicators are based on achievement, some are awarded in full and some will be income protected.
Income protection is based on achievement in previous years but uprated for the 2020/21 QOF point value, prevalence and list size adjustment. Therefore, it is not the case that practices will have a floor for payments equal to payments in previous years – it will be a different calculation.
Read the NHSE/I letter and QOF guidance for 2021/22 here
The Department of Health and Social Care has published the amended QOF SFE for 2020/21.
Vaccination and Immunisation guidance
NHSE/I has published a letter confirming the changes to the provision of routine vaccination and immunisation (V&I) in general practice from 1 April 2021, which includes:
Workload prioritisation
We would like to remind practices about our joint guidance with RCGP on workload prioritisation for primary care, which sets out what practices should consider doing are in a national lockdown.
Our guidance references the need for local conversations about approach to local enhanced services taking into account pandemic state.
As with the national agreement to delay implementation of PCN service specifications and new IIF indicators, it is important that LMCs and CCGs agree the continuation of local income protection arrangements whilst the pandemic and vaccination programme continues.
Locum income support
The recent budget announcement included an extension of the Self-Employment Income Support Scheme (SEISS) to provide self-employed individuals with a grant (up to a total of £7,500) to cover lost earnings due to COVID-19 through February, March and April of this year. If you’ve been operating as a locum during this time and have seen your income impacted by the pandemic you may be eligible for this grant.
Applications will open in April. To check your eligibility, the full list of criteria and details on how to apply is available on the gov.uk website
Everyday sexism survey
On Monday, we celebrated International Women’s Day and its theme this year of ‘choose to challenge’. The BMA has launched a new survey which aims to tackle sexism in medicine by exploring what doctors have experienced or witnessed. Sexism, sexist practices, gender bias and discrimination have a negative impact on the whole workforce. The results of the survey will be used to support the BMA’s work in creating a fair and inclusive culture which gives doctors and medical students equal access to opportunities, free from prejudice and discrimination. Doctors of all genders are invited to complete this survey. Read more in Dr Chelcie Jewitt’s blog
The latest BMA tracker survey showing gender disparity
We are already aware that gender inequality exists in medicine and the latest BMA survey found that 27% of women and 23% of men had undertaken additional hours of work over and above their contractual requirement as part of the response to COVID within the last month.
In addition, 44% of women and 35% of male doctors responding to the survey considered themselves to be currently suffering from depression, anxiety, stress, burnout, emotional distress, or other mental health conditions relating to or made worse by their work or study, compared with 31% of women and 25% of men in the survey in April 2020.
While an increase in levels of burnout and emotional distress are to be expected for all doctors, the disparity between the sexes is marked and growing. Read more here
Senior female GPs Leadership webinar
In celebration of International Women's Day this month, we are pleased to present senior female GP leaders, talking about their leadership and career journeys, in a webinar to be held 7– 8.30pm on Thursday 25 March.
A lack of females in senior medical leadership positions is recognised as one of the underlying factors contributing to the gender pay gap, and this latest webinar forms part of a series of work from the GPC education, training and workforce policy group.
There will be advice, insights and inspirational stories shared to help guide and motivate the future leaders of tomorrow of all genders, as well as an opportunity to submit questions as part of the Q&A panel discussion. Speakers include:
Dr Samira Anane (GPC Education, Training & Workforce Policy Lead)
Dr Nikki Kanani (Medical Director for Primary Care, NHS England and NHS Improvement)
Dr Helena McKeown (Chair of the Representative Body of the BMA)
Dr Farah Jameel (GPC England Executive Team, GPC Negotiator and Chair Camden LMC)
Dr Margaret Ikpoh (RCGP Council, Associate Director of Primary Care Hull Medical School)
Dr Katie Bramall-Stainer (CEO Cambs LMCs, Deputy Chair UK LMC Conference, BMA Council)
Click here to sign up
Please submit advance questions to Cscott@bma.org.uk
BMA briefs peers ahead of committee stage of Domestic Abuse Bill
The BMA has briefed peers ahead of two amendments at committee stage of the Domestic Abuse Bill. The amendments 66c and 71 if voted for will prevent GP practices from charging for template forms used by victims to access legal aid. While the BMA’s guidance currently advises against charging for these forms – we do not believe that these amendments address the root cause of the problem.
Instead we have called on peers to empower victims of domestic abuse by removing the need for medical evidence when applying for legal aid entirely. Moreover, if evidence from a third party to obtain legal aid is required this should be obtained from others who may be better placed to provide this rather than GP practices.
We will keep you updated on the progress of the Bill.
NHS Pension scheme webinar for sessional GPs and locums
The BMA’s Sessional GPs Committee recently held a webinar about navigating through the NHS Pension scheme, to guide through the process and highlight the key things you need to know and do.
You can now watch the webinar here to learn about Locum A and B forms, Type 2 forms, how to access PCSE, how to raise complaints and how to raise escalations amongst other key topics. We also provide practical advice to guide you through the process.
The BMA’s Pensions committee also held four webinars last month about the unlawful age discrimination that resulted when transitional protection was offered to older but not younger members when the 2015 NHS pension scheme was introduced. Guidance about this will be published in due course. Read more about pensions here
School absence note requests
The Department for Education (DfE) has published operational guidance for reopening schools reminding schools they should not encourage parents to request unnecessary medical evidence i.e. doctors’ notes from their GP when their child is absent from school due to illness.
Parents can use other evidence such as prescriptions, appointment cards, text/email appointment confirmations, and input from GPs should only be sought for complex health needs or persistent absence issues.
The guidance also confirms the procedure for clinically extremely vulnerable children, and for those absent from school due to COVID-19 and self-isolation.
Patients ordering PCR tests without symptoms
Patients are now able to order a PCR test without having any symptoms, and the COVID-19 PCR test booking webpage includes an additional reason for getting a test, to make it easier for patients to book a test when recommended by a GP.
This aims to support patients in accessing testing where they have been instructed to by a GP, no matter what their symptoms are. No referral is required to book a test under this option.
Covid-19 Assisted Lateral Flow Device test results to GP records
Positive assisted lateral flow device (LFD) test results will shortly be sent to GP records, including historic results (assisted refers to LFD test results being interpreted and reported by a trained operative at a test site).
This does not apply to unassisted LFD tests which are self-administered, interpreted and reported by the individual, such as LFD tests that primary care staff are regularly undertaking twice weekly. Negative and void assisted LFD tests and all unassisted tests will not be flowed to GP records.
There is no action for practices following receipt of these LFD results and no need for GP practices to report them to PHE as a notifiable disease.
Discharge Medicines Service
The Discharge Medicines Service (DMS) became a new essential service within the Community Pharmacy Contractual Framework (CPCF) on 15 February 2021. NHS Trusts are now able to refer patients who would benefit from extra guidance around new prescribed medicines for provision of the DMS at their community pharmacy.
Read more about its introduction and implications for general practice, in a briefing by the PSNC (Pharmaceutical Services Negotiating Committee)
LMC UK Conference – change of date
Due to an unfortunate oversight which has allowed us to schedule UK LMC conference to clash with Eid al-Fitr on 13 May this year, the chair and agenda committee of Conference have decided that in these circumstances it is, of course, right to reschedule conference and will announce a new date as soon as possible. We are sorry for the inconvenience this may cause.
Note that registrations remain open while they are rescheduling the conference https://events.bma.org.uk/uk-lmc-conference-2021/registration/Site/Register.
If you have any queries please email info.lmcconference@bma.org.uk
Managing environmental impact of prescribing webinar
The BMA’s Committee of Medical Managers has organised a series of online events this year. The first webinar looks at How medical leaders can manage the environmental impact of their prescribing, and will be held on Tuesday 16 March 2021, 6.30pm - 8.00pm
For further details, please click here
This webinar is free to attend, but please note that registration is essential
GPC UK regional elections
The voting period is open until 12pm Friday 19 March for seats to GPC UK in the following regions:
GPC England Executive team
I am pleased to announce that following a recruitment process, Mark Sanford-Wood, Farah Jameel and Krishna Kasaraneni have been reappointed to the GPC England Executive Team. As I previously reported, this would normally have taken place following my re-election last year but had to be delayed. Thank you to all involved in enabling the recruitment and appointment process to take place at this time.
Media
GP online reported on the Governments reform plans which should increase flexibility for commissioners, with statutory control over GP services shifting to regions to help break what are currently separate funding silos for different NHS services. In response to this I said that NHS England and the government must not renege on funding agreements made in the NHS long-term plan, and I called for ‘transparency over spending decisions’ and 'fair representation’ for NHS providers impacted by decisions made under the reformed model.
Northern Ireland Council Chair Dr Tom Black was interviewed on RTÉ Radio One Morning Ireland programme about the covid vaccination programme in Northern Ireland. He said that slow supply of the vaccine had been frustrating but the rollout was going in the 'right direction'. Dr Black was also interviewed on The Tonight Show on Virgin Media about the NI Covid vaccination programme.
Read the latest GP bulletin here
Government budget 2021
The Chancellor Rishi Sunak gave his budget speech on 3 March. We were disappointed that no significant funding announcements for the NHS were made. This was a missed opportunity to announce extra support for the NHS and its workforce in this difficult time. Read the BMA briefing and analysis on key announcements.
The Chancellor also outlined the freezing of the lifetime allowance for pensions – in a move that will disproportionately affect doctors. This comes as a new BMA survey, responded to by more than 7,000 doctors, reveals that 72% of doctors would be likely to leave the NHS earlier and 61% would be likely to work fewer hours or part-time if the freezing of the lifetime allowance was put in place. Read more here
Letter to Chancellor about funding in general practice
In a joint letter with the RCGP to the Chancellor, we said that the funding currently available is spread very thinly and urged the Government to use the Budget to invest in general practice. The letter also said: “While vaccination of the first nine priority cohorts is not expected to be completed until at least Easter and the Government’s aim is now to vaccinate every adult over the age of 18 by the end of July, the clinical director funding and the £150 million/£30m per month Covid Capacity Fund are currently only available up to the end of March, and are spread very thinly for multiple purposes.” This was reported by Pulse.
Government evidence to DDRB (UK)
The Government and Department of Health and Social Care has published their evidence to the DDRB, which suggests a pay uplift of 1% for those within the remit. Responding to this, the Chair of Council, Dr Chaand Nagpaul said, “This is a total dereliction of the Government’s moral duty and obligation to a workforce that is keeping the NHS on its feet and patients alive.” The full statement can be read here.
The BMA has already submitted it’s evidence to the DDRB, including for UK salaried GPs, all GPs in NI, Scotland and Wales. We have not made a submission for GP partners in England and there as there is already a practice funding agreement in place for England which enables a pay uplift of 2.1%.
COVID-19 vaccination programme (England)
Vaccinating cohort 7 and Phase 2 of vaccination programme
This week, people aged 60-64 (JCVI cohort 7) are being invited to book an appointment to receive a COVID vaccination. Practice groups should though continue to focus on vaccinating patients in the bigger cohort 6 group. People are being invited to be vaccinated in order of risk, which increases with age. JCVI has also published a statement advising that during Phase 2 of the COVID-19 vaccination programme will be age-based, and proceeding once those in the current cohorts 1-9 have been offered vaccinations, to next invite all those aged 40 to 49 years, followed by all those aged 30 to 39 years, and then finally all those aged 18 to 29 years.
Vaccination deployment
NHSE/I has published a letter setting out the next steps and key priorities for vaccine deployment plans for weeks beginning 8 and 15 March. These include actions for immediate review, such as ensuring maximum penetration and uptake within the JCVI cohorts, second dose planning and delivery and preparations for vaccination in line with increased supply. All future second dose deliveries will be made 11 weeks after the corresponding first dose, and so practices should now start to book second dose appointments when making first dose bookings.
The letter confirms that from 11 March, vaccine supply will increase substantially and be sustained at a higher level for several weeks. Therefore, from the week of 15 March vaccination sites are being asked to deliver around twice the level of the limited vaccine supply available this week and next.
Improving social staff vaccination rates
NHSE/I has also published a letter about improving social care staff vaccination rates and completion of outstanding first dose vaccinations in older adult care, which asks care providers to work with local partners to ensure social care staff vaccination rates increase further. The letter confirms that the £10 supplement in addition to the Item of Service fee for vaccinations administered to residents and/or staff in older adult care home settings has been extended beyond the end of January. This means that any first doses administered in February onwards will also attract the supplement, as will corresponding second doses.
NHS number and COVID vaccinations
NHSE/I has this week sent a reminder to vaccination sites, that no patient, including NHS staff, require an NHS number or GP registration to receive a vaccination and should never be denied one on this basis, either in person when presenting for a vaccine, or through design of booking systems. Vaccination sites are being asked to ensure this is not the case within their organisation.
If a patient has not been issued with an NHS number, then providers should vaccinate now, record locally via a paper system and ensure that the vaccination event is recorded on Pinnacle at a later date. NHSE/I is working to agree a longer-term solution, but providers should not wait for this before vaccinating. Providers will be advised once a solution is in place so they can transfer the vaccination record on to Pinnacle and be paid for these vaccinations in the next payment period.
Read our guidance on the COVID-19 vaccination programme which includes information about what is expected of practices and the support available to enable practices to prioritise vaccine delivery.
Vaccine dose data
This week, we are celebrating another milestone - over 20 million people in the UK have received their first dose of the COVID-19 vaccine, and the latest data report shows that as of 5 March nearly 19 million doses have been given in England.
Health Secretary’s message of thanks to GPs on pandemic effort
We are pleased to see that the Secretary of State for Health and Social Care, Matt Hancock MP, has again expressed his thanks to all those in general practice (via the RCGP website) who have been involved in the COVID vaccination programme and who have continued to deliver dedicated care throughout the pandemic.
Recruiting and maintaining your vaccination workforce
The BMA, NHSE/I and the RCGP have developed the Vaccination workforce top tips guide for use by practices, PCNs and LMCs. This can be used in conjunction with the BMA’s own online guidance for former NHS doctors willing to support the vaccination workforce and recruiting retired and former NHS doctors back into fully licenced clinical practice.
Please note that, although there are national initiatives to bring back staff (NHS England and Improvement) and recruit the vaccination programme workforce (NHS Professionals), willing former NHS GPs and doctors of any age can also approach local practices / PCNs / LMCs directly to offer their services. This can either be as fully licensed doctors, which requires going through the formal return to practise process, or as registered healthcare practitioners or clinical supervisors in the vaccination workforce. For any questions, queries or concerns about bringing staff back into the workforce, please do contact the BMA for advice and support in undertaking recruitment or overcoming any issues you may encounter.
Flu vaccination orders and reimbursement
We are aware that prior to the publication of the flu letter for the 2021/22 programme, some practices had already placed orders for QIVe vaccines for their 18-64 year old cohort, and are now struggling to change their orders to QIVc as set out in the flu letter. NHS England and NHS Improvement have now confirmed that, given that QIVe is still recommended for the 18-64 at risk cohort, practices should feel confident that they will be reimbursed for any QIVe administered to this group over the 21/22 season if unable to change their orders. If any LMCs become aware of difficulties with reimbursement then please contact info.lmcqueries@bma.org.uk
NHSBSA has also published information for practices administering flu vaccines, about claiming for reimbursement, completing end of season 2020/21 flu vaccine declaration, and guidance around NHSBSA’s post payment verification process.
Contract webinar 2021/22 recordings (England)
The recordings of the recent GP contract 2021/22 update webinars are now available on the BMA website, including question and answer sessions.
Amended QOF SFE 2020/21 (England)
The Department of Health and Social Care has now published the amended QOF SFE for 2020/21. The QOF guidance will be published next week.
Welsh GMS Contract - Relaxation of Access standards
Following a sustained campaign over a number of months, GPC Wales met with Welsh Government officials last week and negotiated a relaxation relating to the Welsh GMS contract in-hours Access standards. (The Access Standard domain is part of the Quality Assurance and Improvement Framework [QAIF], and incentivises practices to meet the Access Standards set by the Minister for Health & Social Services)
GPC Wales received confirmation this week that the Access standards call answering target will be paid at last year’s achievement, and the whole system will be rolled over until April 2022. Read more in this email sent to Welsh GPs and in a statement by Chair of GPC Wales, Phil White.
Northern Ireland’s plan for exiting lockdown
The Northern Ireland’s pathway for exiting lockdown has now been published. In response to this, BMANI has warned that the approach should be co-ordinated between north and south and Tom Black, Chair of NI BMA Council, cautioned divergence between Dublin and Belfast could ravage Border areas as people flock from one side to the other. He said: “They should co-ordinate non-essential retail and should definitely co-ordinate hospitality and personal services, because there would be concerns people will move across the Border to venues that are open”. NIGPC chair, Dr Alan Stout, was interviewed on the Nolan Show (40:38) about the NI exit plan for lockdown, and comments from this interview were subsequently picked up by the Belfast Telegraph.
LMC Secretaries conference 2021
I was pleased to attend the LMC Secretaries Conference, held virtually yesterday, where I gave an update on the importance of a 4-nation united profession. We received updates from the Cameron Fund and GPDF, heard a range of perspectives of the impact of COVID-19 on General Practice in the UK, and a presentation on how LMCs can engage with the integrated care agenda. Thanks to all those who organised the conference.
New to Partnership Payment - Physician Associates
As of 1 March, the New to Partnership Payment Scheme has been expanded to include Physician Associates. Although there is currently a delay in launching the regulation of this profession, the additional scheme criteria in place is that for those on the Physician Associate Voluntary Register at the time of application, registration with their professional body will be required at a later date once this is in place. In line with the current eligible professions, applications to the scheme can be made via the online portal.
The guidance has been updated, and more information including FAQs is available on the Future NHS platform (GP career support hub).
This addition brings this group of healthcare workers in to the scheme alongside others who are nationally regulated. However we also believe that many practices want to and would benefit from making their practice manager a partner in the practice, and so we continue to push for practice managers to be involved in this scheme.
Remote fit notes - please remember to sign them
DWP has asked us to remind GPs that as per previously agreed guidance they will accept fit notes that are printed, signed, scanned and be mailed to patients. This advice has also been given to employers, who should also be accepting signed, scanned and emailed fit notes. However, DWP is receiving a significant number of unsigned fit notes which they cannot accept and this results in inconvenience for both patients and GPs. We would therefore remind GPs that fit notes must be signed.
Read more in the Service Provision section of the COVID-19 toolkit for practices.
Senior female GPs Leadership webinar
In celebration of International Women's Day on Monday 8 March, we are pleased to present senior female GP leaders, talking about their leadership and career journeys, in a webinar to be held 7– 8.30pm on Thursday 25 March.
A lack of females in senior medical leadership positions is recognised as one of the underlying factors contributing to the gender pay gap, and this latest webinar forms part of a series of work from the GPC education, training and workforce policy group.
There will be advice, insights and inspirational stories shared to help guide and motivate the future leaders of tomorrow of all genders, as well as an opportunity to submit questions as part of the Q&A panel discussion. Speakers include:
Dr Samira Anane (GPC Education, Training & Workforce Policy Lead)
Dr Nikki Kanani (Medical Director for Primary Care, NHS England and NHS Improvement)
Dr Helena McKeown (Chair of the Representative Body of the BMA)
Dr Farah Jameel (GPC England Executive Team, GPC Negotiator and Chair Camden LMC)
Dr Margaret Ikpoh (RCGP Council, Associate Director of Primary Care Hull Medical School)
Dr Katie Bramall-Stainer (CEO Cambridgeshire LMCs, BMA Deputy Chair UK LMC Conference, BMA Council member)
Click here to sign up
Please submit advance questions to Cscott@bma.org.uk
GP Retention Scheme webinar
You can now view a video of our recent GP Retention Scheme webinar, where you will learn about how the GP Retention Scheme works for both employees and employers, and tackles some common misconceptions about the scheme. Access a recording of the webinar here
GPC UK regional elections
The voting period is open for seats to GPC UK in the following regions:
The nomination period for the Durham/Cleveland region has reopened until 12pm Friday 19 March.
To submit your nomination please visit https://elections.bma.org.uk/
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Read more on the BMA website
Please share as widely as possible through your networks where applicable
Media
Pulse reported on the Government’s plans for a COVID-19 revaccination campaign, to which I commented: ‘If it was found necessary as we understand more about Covid and the requirement to provide protection to our patients, then it’s quite possible that we may need further boosters in the future and general practice would be the best place to deliver that.
BMA Northern Ireland Council Chair Tom Black was interviewed in the News Letter about the need for a near-elimination strategy to tackle the pandemic and in the Belfast Telegraph about the contrasting vaccine programmes between Northern Ireland and the Republic of Ireland. He was also interviewed on the RTÉ Radio One News at One about the vaccine roll-out in Northern Ireland. NIGPC chair Alan Stout took part in a panel discussion on BBC Radio Ulster Talk Back about the Covid vaccination programme.
Responding to the Welsh Government’s announcement that the introduction of a target for GP practices to answer 90% of phone calls within two minutes has been delayed, BMA Cymru Wales said it was "pleased" the target had been "rolled over for another year due to concerns raised about the impact of the pandemic". White, chair of GPC Wales said: "Given the unprecedented pressures on general practice and the wider NHS - including delivering the largest vaccination campaign in history - now is not the time to introduce major contractual changes. This was reported by the BBC
Read the latest GP bulletin here
Lockdown restrictions loosening (England)
Ahead of the announcement by the Prime Minister this week of a four-step end to the lockdown in England, the BMA published a paper setting out the principles and policy ideas which it believes should inform a sensible and safety-first approach to easing the current lockdown.
The BMA warned the Government to take ‘cautious approach’ to lifting lockdown restrictions as otherwise the NHS will be overwhelmed. Easing restrictions must be connected with measurable metrics and targets on virus circulation. Read more here
Although England is still in a national lockdown, as of 8 March, some of the rules will be changing, such as all pupils returning to school. More details can be found in the Government’s COVID-19 Response - Spring 2021, which sets out the roadmap out of the current lockdown and explains how the restrictions will be lifted over time.
Read the BMA’s response to the PM’s announcement here
Review of COVID restrictions in Wales
The Welsh Government has reviewed the coronavirus restrictions in Wales, and from 22 February, children aged three to seven will begin a phased returned to schools, and some vocational learners on courses that require practical learning will return to college. From 20 February, four people from two different households are able to meet outdoors for socially distanced local exercise.
In response to this, David Bailey, BMA Welsh Council chair, was included in a Powys County Times article on the importance of moving slowly when restrictions are lifted, urging a “continued cautious approach”. He said: “Whilst there are hugely encouraging signs that we’re successfully tackling the virus with lower case rates and with the progress made on the vaccine rollout, we must continue to move slowly and be vigilant particularly with the threat of new variants. If we can contain the spread of new variants now, there is less opportunity for them to create a new wave of cases which may also make the current vaccine less effective."
Scotland’s route out of lockdown
First Minister Nicola Sturgeon announced this week that the reopening of Scotland's economy (including shops, bars, restaurants, gyms and hairdressers) - is expected to start in the last week of April. There would be a progressive easing of restrictions before then, with four people from two households allowed to meet outdoors from 15 March. Early learning and Primary year 1-3 returned to school this week, and all primary and more secondary school pupils could also be returning from 15 March. The government hopes to lift the stay at home restrictions on 5 April. Read more here
Lockdown restriction in Northern Ireland
In NI there will be a gradual return of schools and a review of restrictions in March. Following the PM’s announcement about a four-stage plan to lift Covid-19 restrictions in England, Northern Ireland’s deputy First Minister Michelle O’Neill cautioned the public not to expect a rapid exit from lockdown, insisting the route back to normality will be slow and steady. The Northern Ireland’s plan for exiting lockdown will be outlined in the Assembly next week.
Contract webinar 2021/22 (England)
We held two well-received webinars this week, setting out the updates to the 2021/22 contract. 573 people attended across the two events.
The presentation slideshow is available here and the recordings of the webinars will be available on the BMA website next week. We will include a link to the recordings in next week’s newsletter.
COVID-19 vaccination programme (England)
NHSE/I has sent a letter setting out the additional steps being taken to support the vaccination of cohort 6 - adult carers and individuals added to the shielded patient list - as a result of the COVID-19 Population Risk Assessment tool (QCovid). The letter also includes information on the availability of the national booking system for these groups.
This follows the letters to people identified as high risk by COVID-19 Population Risk Assessment Model – under 70 years of age which was sent out last week. We have since raised concerns with the Department of Health and Social Care about the impact this letter has had on some patients who have subsequently contacted their practice seeking more information. Although the letter clearly states, on our insistence, that patients do not need to contact their GP about the letter, many anxious patients are still clearly doing so, so we have asked whether modifications can be made to any future letters sent.
COVID-19 Clinical Risk Assessment Tool (QCovid)
A new online tool that can help clinicians better understand how at-risk a person may being admitted to hospital or dying as a result of being infected with coronavirus is now available. The COVID-19 Clinical Risk Assessment Tool is powered by QCovid®, a coronavirus risk prediction model created by the University of Oxford.
Clinicians can use the tool to risk assess individual patients or review those added to the Shielded Patient List (SPL) as part of the COVID-19 Population Risk Assessment.There is though no requirement or expectation for practices to validate the latest update to the shielding list following the application of the QCovid tool.
There are some instructions for individuals and organisations to follow before using the tool, including the requirement for a Data Protection Impact Assessment (DPIA) and privacy notice in place that covers the tool’s use. A template DPIA and privacy notice have been provided to support you to do this.
Following concerns about the inclusion of some codes relating to gestational diabetes, NHS Digital has published specific guidance on gestational diabetes on their COVID-19 Population Risk Assessment page. This page also has a lot of detail about the development of the risk assessment tool and it has information about how patients can get more information if the page does not answer their questions (email risk.strat.spl@nhs.net). The RCGP has also developed a flow chart to support GPs when considering risk for patients with a history of gestational diabetes.
Vaccinating people with a learning disability
As we know, multimorbidity is very common for those with a learning disability and we would therefore encourage all practices to contact all people on their learning disability practice register and offer an early appointment for vaccination.
Vaccinating people with Severe Mental Illness (SMI)
As people with SMI people face reduced life expectancy of 15-20 years when compared to the general population and have also been disproportionately impacted by the coronavirus pandemic, this group is also included in cohort 6 prioritisation list. Note that the Green Book defines SMI as schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment, and also includes people with an eating disorder and those with a diagnosis of ‘personality disorder’.
Tailored invitation letters for local vaccination sites to invite these groups are available on the FutureNHS platform.
Vaccination patients who are HIV positive
People living with HIV, at all stages of infection, should be offered the vaccination due to the associated immunosuppression, and are as such part of cohort 6. Most of these patients will be invited for vaccination by their GP, however, for the small proportion who has declined sharing their HIV status with their GP, HIV clinics should encourage and support these patients to share their HIV status with their GP.
Vaccinating those aged under 18
As the AstraZeneca (AZ) vaccine is not licensed for use in those under the age of 18 – if any young staff members or volunteers (aged 16-17) present to a vaccination centre for vaccination, they should be referred to their GP or local hospital hub where they can access the Pfizer vaccine which is authorised for this age group. If the Pfizer vaccine is unavailable, JCVI have recommended that the AZ vaccine can be used as an alternative in those aged 16-17 years. This is outside the license and must therefore be done under a PSD and cannot be done under a PGD or National Protocol.
Vaccination cohort 5
Patients in cohort 5 (people aged 65 and over) have received a letter from the national booking system stating that they are now eligible for vaccination, with information about how to book into a mass vaccination site or a pharmacy. The letter also states that if the patient wishes to be vaccinated by their GP then they should wait to be contacted by their practice. Practices, however, have been told to prioritise patients in cohort 6.
To be clear, if practices vaccinate anyone in cohort 5 they will receive payment. However the priority for practices should be those in cohort 6, which is a much bigger group, but once practices are in an appropriate position having completed cohort 6 they could contact patients in cohort 5 to invite them for their vaccination if they have not already received it. In order to manage patient expectations and to prevent additional patient enquiries, practices may wish to contact their patients in cohort 5 to inform them that they will be contacting them in the near future to give them the opportunity to receive their vaccination locally if that is their preference.
We expect people in cohort 7 to shortly receive similar letters, and the same points with respect to cohort 5 apply to 7.
NHSE/I has this week published a letter on Supporting CCGs to address vaccine inequalities, which describes further action to enable and locally deliver community activity and engagement to support COVID-19 vaccination access and uptake, building on the vaccine uptake strategy.
NHSE/I has also published guidance on Further opportunities for PCN and Community Pharmacy vaccination sites to partner with community venues to deliver temporary vaccination clinics.
Read our guidance on the COVID-19 vaccination programme which includes information about what is expected of practices and the support available to enable practices to prioritise vaccine delivery.
Studies on COVID-19 vaccine efficacy
Three new studies about COVID-19 vaccine efficacy have been published, as summarised below:
EAVE II Study (Pfizer and Oxford/AstraZeneca vaccines)
The EAVE II study looked at the efficacy of the single dose regimen of both the Pfizer and the Oxford/AstraZeneca vaccines at reducing hospitalisations from COVID-19 over a number of timeframes, post vaccination. Hospitalisations are defined as an individual who is hospitalised with COVID-19 as the principle reason for hospitalisation within 28 days of a positive PCR test. The paper found that the vaccines have an 85% (Pfzier) and a 94% (Oxford/AZ) efficacy at reducing hospitalisations after one dose, respectively – although this varied over different time periods post-vaccination.
PHE monitoring of the early impact and effectiveness of COVID-19 vaccination (Pfizer) in England
Public Health England has published their initial findings from the rollout of the Pfizer COVID-19 vaccine, assessing the impact the vaccine has had on across relevant metrics such as infection, hospitalisations and deaths. For over 80s one dose of the Pfizer vaccine is 57% effective at reducing incidence of symptomatic COVID-19, and this rises to 88% after two doses. It also showed that mortality was reduced by just over 50% if the patients became infected. When cases do occur among elderly groups, vaccinated over 80s are half as likely to die or be hospitalised from COVID-19 as their unvaccinated counterparts.
PHE SIREN study of efficacy rate of Pfizer vaccine among healthcare workers
Public Health England has also published the SIREN study which looks at efficacy rate of the Pfzier vaccine at preventing both symptomatic and asymptomatic COVID-19 among healthcare workers under 65 years of age.
The study found that effectiveness against infection was 70% after one dose which rose to 85% after two doses. However, partially vaccinated patients who can still get COVID (the 30%) are more likely to produce vaccine resistant variants and there is still significant risk of nosocomial infection with the doctors acting as vectors.
These are encouraging findings as this is among the first real world data that suggests the vaccine will likely reduce onward transmission.
Updated BMA COVID risk assessment tool
The BMA has updated our risk assessment tool (PDF). This can help you to quantify your biological risk and should be used to facilitate your work-based risk assessment. It does not replace the need for a comprehensive risk assessment that employers must undertake in addressing the risks posed by COVID-19. Read our full guidance >
Circular on long COVID for GP partners and their staff (Scotland)
The Scottish Government has sent out a circular on for GP partners and practice staff who have contracted COVID. This looks to replicate the arrangements in place for NHS employees through a combination of SFE and advance funding. Note that the circular states (in para 5) that advance funding will be “supplemented as necessary” to cover costs.
Annual allowance repayment scheme 2019/20 (England and Wales)
The annual allowance repayment scheme, which was introduced in England and Wales following BMA lobbying, guarantees that any annual allowance tax charge for eligible clinicians will be compensated for at the time of retirement. Under the scheme, if an eligible clinician who is a member of the NHS England and Wales pension scheme incurs an annual allowance tax charge, they must elect to pay this through scheme pays - and you must not pay this tax bill using cash.
GPs retiring by 31 March 2021 who are eligible to apply for the 2019/20 Pensions Annual Allowance Charge Compensation Policy can submit their application form via PCSE until 21 March 2021. Application windows for other GPs will open after the mandatory scheme pays election deadline for 2019/20 closes on 31 July 2021. To qualify for the policy you must first submit a scheme pays election (SPE2) form for 2019/20 to NHSBSA.
Find details about how the scheme and how to apply >
Pulse workload survey
Pulse magazine will be launching a one-day snapshot workload survey on Monday 1 March, when they are asking practices to take a couple of minutes to log information about their day spent in practice. This is a repeat of a similar survey that they launched two years ago, which found GPs were working on average an 11-hour day, with 41 daily contacts.
The survey will be available to fill in on Pulse’s website on Monday, and you can read an article that I wrote discussing how the pandemic has exacerbated existing workload pressures.
Medicine Delivery Service
Following the announcement last week for Clinically Extremely Vulnerable (CEV) patients to continue to self-isolate, NHSE/I will continue to commission the Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service until 31 March 2021.
NHSE/I has sent a letter to Dispensing Doctors and community pharmacies setting out the details. The Service Specification has also been updated to make it more generic so that it can be applied in other situations moving forwards e.g. if a therapeutic agent for Covid suitable for supply in Primary Care is identified.Read more on the NHSE/I webpage for community pharmacy
GPC UK regional elections
The voting period is now open for seats to GPC UK in the following regions:
Media
GP Online reported that the BMA has warned that without significant investment in GP premises, many practices 'simply don't have space' to accommodate new staff. I commented: "The government has committed to expanding general practice by 27,000 staff by 2024, to meet the growing demand from patients. Achieving this goal is not just about recruiting those new members of the team, which has started in earnest, but having the space for them to provide those services to their patients. At present practices simply don’t have that space. If the government is to live up to its commitment, then it must invest significantly in general practice premises and expand practices to house the 27,000 new members of the workforce. Without this, practices cannot fully recruit, and patients will ultimately be let down by another government commitment that is unfulfilled."
Healthcareleader reported on the announcement that GPs should now invite all patients on the learning disability register for Covid vaccination as part of priority group six. In response to this I said that the JCVI’s decision to prioritise patients with learning disabilities was ‘the right one’ and ‘vital’.
I added: “The Government must also ensure that everything is done to encourage patients with learning disabilities to come forward for their vaccine, with appropriately tailored communications and information so that they have equitable access to the necessary care.”
Phil White, Chair of GPC Wales, was featured on the BBC discussing GP call-answering targets that have been maintained over COVID-19. He said the GP committee had "petitioned strongly" that the target should be "suspended, referencing the increasing telephone traffic in and out of practices due to the Covid pandemic workload, the practice administration of the Covid vaccination programme and the reintroduction of shielding. He added "Unfortunately, Welsh Government are wedded to the standard and despite our persuasive argument have rejected our request to suspend this indicator".
NI GPC deputy chair, Frances O’Hagan, was interviewed on BBC Evening Extra (1:26:02) about the Prime Minister’s roadmap plan out of lockdown.
Read the latest GP bulletin here
COVID-19 vaccination programme (England)
Last weekend we passed the first milestone for the COVID vaccination programme with over 15 million of the most vulnerable patients in the UK getting their first dose of vaccine, which is a remarkable achievement. The latest data report also show that as of 18 February a total of 16.4 million doses have been given in England.
This has been achieved due to the considerable efforts of everyone involved in the general practice vaccination programme, for which I would like to give my heartfelt thanks. As such, I have written to thank everybody who has been involved in the vaccination programme and who have worked so hard to achieve this so quickly. However, as we all know this is just the start and GPs, our teams and may others will continue to do all we can to protect people as quickly as we can.
Read the BMA statement about the vaccine milestone, by the BMA’s Chair of Council, and an opinion piece by the Deputy Chair of BMA Council, David Wrigley, comparing the vaccination roll out with the test and trace system, and commending those who have been involved in the vaccination programme.
The Prime Minister has thanked those involved in reaching the significant milestone – watch the video here. Sir Simon Stevens, the chief executive of NHSE/I, has also praised the extraordinary efforts of GPs, nurses, pharmacists and volunteers as the COVID vaccination campaign enters a new phase.
Vaccinating cohorts 5 and 6
Practice sites are now already vaccinating an expanded group of clinically extremely vulnerable (CEV) people (cohort 6) and many will also be vaccinating those in those in cohort 5 (people aged 65 and over) who have chosen to receive their vaccination locally.
The NHSE/I letter Vaccination of JCVI cohorts 5-6 and additional funding for vaccination in residential settings outlines the next stage of the vaccination programme. It also contains information about an additional payment of £10 on top of the Item of Service fee for vaccinations given to all those in residential settings, such as care homes for people with learning disabilities or mental health problems, or hostel/hotel accommodation for the homeless, where it would not be possible for these patients to attend vaccination sites.
Vaccination sites are initially being asked to focus on the expanded group of cohort 6, which now includes those who will have been identified as at higher risk from COVID-19 using a new population risk assessment tool (Q-COVID) and if they are not already on the Shielding List they will be automatically added, so there is no need for practices to do anything. You can read the NHSE/I letter to GPs about this cohort and how they should be prioritised for vaccination and how they will be added to the Shielded Patient List. We have raised concerns with the Department of Health and Social Care about the impact this letter has had on some patients who have subsequently contacted their practice seeking more information. NHSD has also published specific guidance on gestational diabetes COVID-19 Population Risk Assessment - NHS Digital under the metabolic, renal and liver conditions tab.
JCVI priority Cohort 6 includes ‘all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality’. This also includes those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. Cohort 6 is further defined in the newly updated Green Book Chapter 14a as “Adults aged 16 to 65 years in an at-risk group”.
Those in cohort 5 (those aged 65-69) will receive an invitation from the national booking service (NBS) to attend a local vaccination centre or community pharmacy setting. PCN sites may though still vaccinate patients in this cohort and be paid for doing so should a patient request an appointment.
Read the BMA statement on the inclusion of 1.7 million patients on the shielding list following the development on the new risk assessment model (Q-COVID)
National pool of Steward Volunteers
A national pool of Steward Volunteers is available to support non-clinical tasks at vaccination sites, including PCN and community pharmacy sites. These are ready-to-use, unpaid volunteers who are managed, trained and paid expenses by the NHS volunteer responders programme. Steward Volunteers can undertake any tasks which support the smooth running of vaccination sites and would not normally be filled by paid staff. These include managing queues, greeting and directing people, monitoring numbers and overseeing social distancing measures. Primary care sites can access these volunteers by request via their lead employer and volunteers will be provided free of charge to local sites. The maximum shift length is six hours. Read more here.
COVID vaccination for healthcare workers
To support healthcare workers and community based social care workers in priority group 2 to receive their COVID vaccination, you now have the option to book your vaccination appointments in a vaccination centre or community pharmacy through the NHS COVID-19 vaccination booking service.
You should try booking online first but if this is not possible, you can phone 119 free of charge, 7am to 11pm, seven days a week. As part of the booking process, eligible staff need to self-declare that they are a health or social care worker. You will be able to book this way for a limited period, until 28 February. At your appointment, you will be asked to verbally declare that you are a health or social care worker, the type of role/work you do and the name of your employer/ locum agency. You should also bring ID/proof of employment such as a staff ID badge, a recent payslip or recent letter/email from your employer (dated within the last three months) or a letter of confirmation of locum status from your locum agency.
If you are a self-employed locum, some evidence of being paid for the provision of frontline, patient-facing services, along with photo ID, should be provided.
Read our guidance on the COVID-19 vaccination programme which includes information about what is expected of practices and the support available to enable practices to prioritise vaccine delivery.
Contract agreement 2021/22 and webinars
Following the recent contract agreement for 2021/22, we will be holding two contract virtual roadshows/webinars next week on the following dates:
24th February – 19.30-20.30
25th February – 12.30-13.30
Register here
A recording of the webinar will be available on the BMA website after the event.
Please note that we have now confirmed the various contract values for 2021/22 as follows:
Global sum will increase by £3.82 (4.1%) to £97.28
QOF point value will increase by £6.33 (3.3%) to £201.16
Out of hours adjustment will increase by £0.14 (3.0%) to £4.59
Retired doctors – return to practice to support the pandemic effort (England)
Given the intensity of current workload pressures and the mounting backlog of care exacerbated by COVID-19 in the NHS, the BMA has recently updated its online guidance for doctors considering or wishing to return to clinical practice in the short, medium or long term, and for those wishing to specifically support the vaccination programme. This follows consultation with NHSE/I and NHS Professionals.
The NHS is still seeking registered healthcare workers and clinical supervisors for the programme. Doctors can either return to work through the national routes, e.g. NHS Professionals vaccination programme recruitment drive or the GP refresher scheme, or they can approach local employers, e.g. GP practices, primary care networks or their local Integrated Care System lead (usually a hospital / trust).
The BMA would be glad to hear from and support members or LMCs who know of application issues or delays, as we can work with stakeholders to overcome them as swiftly as possible.
BMA briefing on White Paper on NHS reform and Integrated Care Systems
The BMA has produced a new member briefing on the UK Government’s White Paper on NHS reform - Integration and Innovation: working together to improve health and social care for all – published last week, which sets out a range of proposals that would see dramatic changes for the NHS in England.
The briefing provides a summary of those changes, the BMA’s initial analysis of them, and outlines how the BMA is working to influence the proposed legislation on behalf of members.
The BMA also issued a press response to the publication of the White Paper, highlighting the unfortunate timing of the proposals and saying clinicians must be front and centre in plans for NHS reform.
NHSPS - service charges dispute (England)
The BMA supported five GP practices to bring a legal challenge against NHSPS try to clarify the legal basis for NHSPS’s dramatic increases in how service charges are calculated. The BMA now continues to support the same practices to defend legal proceedings brought against them by NHSPS in response to their claims. It is extremely concerning that NHSPS- a company owned by the Department of Health and Social Care- are pursuing this course at a time when frontline doctors are facing a national health crisis.
Through the legal action, NHSPS have admitted that they cannot rely on the Charging Policy in isolation as a legal basis to increase charges- as we have said all along. As set out in a letter to practices, the BMA now recommends that GP practices facing similar demands for increased service charges that have not been explained to these five practices should insist that NHSPS provide a full explanation of the legal and factual basis on which their charges have been increased. To assist practices, we have prepared a template letter for you to amend as appropriate and send to NHSPS
Protection for Healthcare workers
The BMA has co-signed a coalition letter to the Prime Minister today, which escalates our concerns about protection for healthcare workers – asking for a more precautionary approach. This follows our letter in January to PHE and associated comms, as well as work we have done with others to-date, including the RCN, the AGP Alliance, and the Shadow Health Secretary. The BMA also sent recommendations directly to Trusts in England.
The press release for the letter has been flagged by the BBC.
Lung cancer campaign launch (England)
Public Health England has launched the next phase of the ‘Help Us, Help You’ campaign, urging people to come forward and seek advice if they are worried about possible symptoms. This new stage of the campaign focuses on lung cancer, with the aim of raising awareness about its key symptom – a cough that lasts for three weeks or more. It is hoped that this will encourage those most likely to get lung cancer and who have this symptom, but do not have COVID-19, to contact their GP practice, reminding the public that cancer remains a priority and that the NHS is here to see them safely.
"A cough for three weeks or more that isn’t COVID-19 could be a sign of cancer. Contact your GP practice. However, if you’ve got a new, continuous cough, contact Test & Trace. #HelpUsHelpYou"
A campaign toolkit and posters are available free of charge on the Public Health England (PHE) Campaign Resource Centre.
Primary care in Scotland report
This week, the Scottish Parliament’s Health and Sport Committee published its report into primary care in Scotland. The report followed evidence gathering from the general public and committee sessions with key stakeholders, including the BMA. While the report did contain some useful recommendations around improved IT and expansion of multi-disciplinary teams, many GPs were left frustrated and angry by the suggestion that GP surgeries were only open between 9-5pm – and that longer surgery opening hours would solve long standing problems with primary care.
Dr Andrew Buist – Chair of SGPC – set out our concerns with the report in his latest blog – which you can read here. In this, Andrew describes how he believes “the careless and frankly inaccurate depiction of GPs only being available from 9-5 will have left many feeling dispirited and undervalued”. Addressing the 9am-5pm point, he says “GPs core hours are from 8am-6pm – when surgeries are open, and GPs are available. As I saw one GP tweet – the news that we only open from 9am-5pm will come as a surprise to our families, who wave us off to work before 8am and welcome us back after 6pm. Indeed, a great number of GPs regularly have to stay on beyond 6pm in order to complete paperwork, referrals and phone calls”.
This report will now be considered by Parliament, and the Scottish Government will respond – throughout this process BMA Scotland will continue to represent GPs interests and push back against inaccurate representations of the pressures and demands they are under.
NHS Discharge Medicines Service (England)
The NHS Discharge Medicines Service (DMS) launched this week and is available in all community pharmacies in England. The service has been established to ensure better communication of changes to a patient’s medication following discharge, with NHS trusts referring appropriate patients. It is hoped that this will improve outcomes, prevent harm and reduce readmissions.
NHSE/I has published some resources for the DMS, including guidance, a cross sector toolkit and training and assessment materials to support clinical teams across community pharmacies, PCNs and hospitals to deliver the service.
The DMS does not replace the role of general practice in managing patients’ medicines on discharge. The cross sector toolkit includes a checklist for general practices and PCN pharmacy teams, which sets out how to work collaboratively, and provides examples of where the community pharmacy may require information, support and clinical expertise from practices.
Online fit note research help
The DWP is currently developing and improving the current fit note/sicknote uploading system for patients. They would like to give GPs the opportunity to have their say on what they like and don’t like in terms of the whole fit note/sicknote process. This will then allow the DWP to make some changes before the system goes Live at the end of March 2021.
Once the system goes live it will be difficult to implement further changes down the line. Hence, now is the time to speak out. Take the survey here – it will only take about 10 minutes to complete.
GP Retention Scheme Webinar
We will be holding a webinar on the GP Retention Scheme on Thursday 25 February from 7pm – 8.15pm, where we will be looking at how the GP Retention Scheme works for both employees and employers, tackling some of the common misconceptions about the scheme and hearing from GPs who are currently on the scheme. Speakers include:
The session will be of interest to GPs who are considering applying to join the scheme or who would like to know more about it, GP employers and practice managers who would be interested in employing a retained GP and existing Retained GPs who have questions about the scheme or would like to hear some perspectives from other retained GPs and employers.
The webinar will be recorded and will be made available to view on the BMA website during the following week. There will a Q&A session at the end and you can submit any questions in advance to cscott@bma.org.uk. Click here to sign up.
The BMA has also produced information on addressing misconceptions on the GP retention scheme. You can access the information here.
Recruitment of GPC England Executive Team members 2021
As you are aware, the GPC England Executive team is made up of an elected chair and three appointed members. A maximum of one non-GPC member (who could also be a non-doctor) could be included within that membership. Responsibility for the appointment of these three members lies with the GPC England chair working with senior BMA staff and with external expert advice.
Terms of office for the executive team are aligned with the GPC England chair’s term of office and end in summer 2023; there is no limit to the number of terms of office for executive team members. These are senior roles in which post holders will be accountable for leading, developing and representing the views of GPC (England) on all policy matters affecting GPs working in England, and will work with the rest of the team taking forward negotiations on all aspects of GP contracts in England.
Under normal circumstances the process to appoint the GPC England Executive team would have commenced with the election of the chair of GPC England in July 2020 and ended with appointments by the end of the year. However, due to the postponement of the BMA ARM (which marks the end of one BMA session and beginning of the next session) as a result of the COVID pandemic, I was not re-elected chair of GPC England until October 2020. In consultation with senior BMA staff a decision was taken to undertake the appointment process when interviews and assessments could take place in person. However it is now increasingly clear that meetings in person will not be a possibility for some time to come. We have therefore decided not to delay this further and to open the process now.
The roles require an experienced professional, with extensive experience of influencing policy or negotiating contracts/terms and conditions, either for independent GP contractors or on behalf of employees or employers. Candidates should be confident communicators, able to demonstrate evidence of leading and motivating teams, as well as possessing personal resilience and significant influencing skills. A detailed role profile is available here.
A remuneration and support package will be available commensurate with these requirements. Applications are now invited for three members of the GPC England Executive team. This notification is being sent to current members of GPC and circulated to LMCs.
In order to apply, candidates should submit their CV and covering letter, together with their answers to the following three questions (the answer to each question should not exceed 400 words):
1. How do your skills and experience meet the GPC England executive team role profile?
2. What do you think are the main challenges facing the GPC England executive team over the next 12 months, and how would you deal with these?
3. Explain what you think the role of the GPC England Executive is in improving equality, diversity and inclusion for GPs and improve the working culture in primary care?
Applications should be sent to Richard Pursand (rpursand@bma.org.uk) by 26 February 2021.
GPC UK regional elections
The voting period is now open for seats to the General Practitioners Committee (GPC) UK in the following regions:
The nomination period for the Durham/Cleveland region will be reopening from 12pm today, 19 February to 12pm Friday 19 March. To submit your nomination please visit https://elections.bma.org.uk/
If you have any queries regarding the election process, please contact elections@bma.org.uk. Read more on the BMA website. Please share as widely as possible through your networks where applicable.
COVID-19 media
On Monday I spoke to Radio Leeds (here at 1hr 7min) about successfully delivering 15 million vaccinations. On Tuesday I was interviewed on BBC Radio 4’s The World at One (here at 27 mins) about the inviting priority groups, including those with learning disability, for vaccination.
Long Covid
Yesterday, the BMA joined with 65 MPs and 7 Peers from 7 parties in a call for a compensation scheme for healthcare workers suffering with long-Covid. 65 MPs and 7 peers signed a letter to the Prime Minister urging the Government to launch a compensation scheme for frontline and key workers living with Covid-19. The story ran as an exclusive on BBC Breakfast yesterday morning, and RB chair Dr Helena McKeown was interviewed live – with clips used on the BBC throughout the day. The story was then additionally reported by BBC News online, the Mirror, the Daily Mail, the Guardian and across regional outlets. BMA deputy council chair Dr David Wrigley was interviewed on the BBC News Channel and the appeared on various BBC regional radio stations’ drivetime shows, including BBC Bristol, Berkshire, Lancashire and Cumbria. Dr Christine Clayton, BMA south east coast regional council chair, appeared on BBC Radio Kent.
Vaccine rollout (Wales)
BMA Welsh council chair David Bailey was featured in a BBC Wales story celebrating Wales as the first UK nation to hit the February Covid-19 vaccination target. Dr Bailey said: "People are really making an effort to make the thing go as smoothly as possible, and it is a credit to the Welsh public, as well as everyone who has actually been delivering the vaccine, because it has gone smoothly and everyone has been trying to do their part."
Northern Ireland
Chair of BMA’s Northern Ireland Council, Tom Black, was interviewed on the RTÉ Radio One Today with Claire Byrne Show about the differences in the covid vaccine rollout north and south of the border. NIGPC chair, Alan Stout, was quoted in Belfast Live in a piece about the launch of a new interactive map showing where in Northern Ireland you can access GP-led counselling services. The map was launched by the ‘Participation and the Practice of Rights’ organisation.
Read the latest GP bulletin here
Read the latest sessional GPs newsletter here
COVID-19 vaccination programme (England)
Earlier this week, eligible patients (70 or over) who have not yet heard from their practice or received a letter and have not yet taken up a vaccine offer, were invited to contact the online booking service, call 119 or contact their GP practice directly. This aims to catch patients who may have been missed by or not responded to previous communications.
While the focus continues to be to vaccinate JCVI groups 1-4 this week if this is complete vaccination sites are permitted to offer appointments to people in cohort 5 and 6 instead of risking wastage.
Practices have also been asked to contact their clinically extremely vulnerable patients, who are shielding, to ensure they have been offered the vaccine.
Vaccination of frontline health and social care workers
Protecting frontline health and social care workers from COVID-19 remains a priority, something that the BMA has been lobbying on, and NHSE/I has written to commissioners this week asking for reassurance that the offer of a vaccination frontline health and social care workers, as priority cohorts, has been fulfilled.
Practices are encouraged to liaise with local system partners to ensure that any staff who have not yet been offered a vaccine are offered one, including any locum GPs they are in regular contact with, as soon as practically possible.
Social care workers are now able to, for a limited period until 28 February, to self-book a vaccination at a vaccination centre or community pharmacy led local vaccination service online
Transport of Astra Zeneca vaccine to GP practices within the PCN Grouping
The NHSE/I has confirmed that the SPS SOP (Standard Operating Procedure) has been updated to make clear that the Astra Zeneca COVID-19 vaccine does not need to be used immediately after being transported within the PCN grouping. The SOP states:
1.1.2. The vaccine should be used as soon as it is received or immediately put in a refrigerator to be administered as soon as possible thereafter. This has been defined as meaning within 24 hours or over the following days.
Freeing up practices to support COVID-19 vaccination
NHSE/I has written to practices and commissioners providing further measures on freeing up practices to support COVID-19 vaccinations, following their letter of 7 January 2021. The letter sets out the arrangements for additional funding for PCN clinical directors, and income protection arrangements for the Minor Surgery DES and QOF (Quality and Outcomes Framework).
Vaccine hesitancy
Surveys have shown stark differences by ethnic group in attitudes to COVID vaccines, and a quarter of younger women fear it would affect fertility. The BMA has published guidance and resources on how to communicate with different groups about the vaccine.
The British Fertility Society and Association of Reproductive and Clinical Scientists has also published some COVID-19 Vaccines FAQs to help address some of the vaccine hesitancy relating to fertility.
Read our guidance on the COVID-19 vaccination programme which includes information about what is expected of practices and the support available to enable practices to prioritise vaccine delivery.
Vaccine dose data (UK and England)
Over 13,5 million people in the UK have received their first dose, and almost 525,000 have received their second dose. The latest data report show that as of 12 February a total of 12,3 million doses in total have been given in England.
In the 10 weeks since vaccinations against coronavirus began in the UK, a first dose has been given to more than 11.8 million people in England, more than 715,900 people in Wales, more than 1.1 million in Scotland and more than 373,400 in Northern Ireland. This is an incredible achievement and thank you to all those that have made this possible.
Thank you from the Prime Minister
In his daily statement on the Coronavirus on 10 February, we were pleased to see the Prime Minister thanking all those involved in delivering COVID vaccines in local GP sites, such as Alwoodley Medical Centre in Leeds:
“And I want to thank all of those involved for their heroic efforts: the doctors, nurses, military medics, local authorities, transport planners, warehouse operatives, delivery drivers, countless volunteers, often working through the night or even digging out snowed-in vaccination centres, like the community effort at Alwoodley Medical Centre in Leeds last Saturday so GPs, nurses and their teams could deliver 1,200 doses that day.”
Watch the clip here (24mins 46 seconds in)
Government White Paper on NHS reform and Integrated Care Systems (England)
The Government has now published ‘Integration and Innovation: working together to improve health and social care for all' – its white paper on new plans to reform the NHS, including proposals to make ICSs statutory and make major changes to way services are procured.
Chaand Nagpaul, Chair of BMA council, has released a strong statement on the white paper, stressing the need for clinicians to be at the heart of any changes. The BMA will be producing a summary of the white paper for members shortly. In January, the BMA submitted a comprehensive response to NHS England’s legislative proposals, on which the Government’s plans have been based, highlighting the importance of ensuring proper clinical, GP, and LMC representation.
The proposals set out that GPs will be one of the few required members of the ICS leadership, and that there will be a lot of flexibility around how place level (former CCG) working is organised and works, so there is a key role for LMCs to engage in that to help shape it.
Contract agreement 2021/22 webinar (England)
Following the recent contract agreement for 2021/22, we will be holding two contract virtual roadshows/webinars on the following dates:
24th February – 19.30-20.30
25th February – 12.30-13.30
Register here
A recording of the webinar will be available on the BMA website after the event.
Assessments carried out for detention under the mental health to take place in person (England)
Following a ruling in case bought by Devon Partnership NHS Trust against the Secretary of State, NHS England has issued directions to all mental health providers not to carry out any assessments for the purposes of determining whether or not an individual should be detained under the act remotely (by any medium). This applies to all members of a medical team involved in the decision and should be considered as the overriding guidance until further notice. This was reported by the Guardian
Amendments to European Health Insurance Cards (EHICs) and S1 forms (UK) Regulations
There have been some minor amendments to the GMS and PMS regulations relating to European Health Insurance Cards (EHICs) and S1 forms, to allow for reciprocal healthcare arrangements with EU member states.
The change has been made via the Reciprocal and Cross-Border Healthcare (Amendment etc.) (EU Exit) Regulations 2020 which support the process of EU exit. The amendments are within the contract regulations that govern information relating to overseas visitors (GMS regulation 74F and PMS regulation 67F) – where, if patients choose to provide EHIC, S1 or PRC details on registration, then GPs must forward those details to NHS Digital or NHS BSA.
The new wording allows for the possibility that, on registration, patients may in future submit other (unnamed) documents which are equivalent to EHICs or S1s, which could be required as part of a “listed healthcare arrangement” between the UK and an EU/EEA country (or the EU). However, at present, the UK government has not agreed any listed healthcare arrangements which establish EHIC or S1 equivalent documents, so for now there is no possibility of patients submitting them.
LMC UK Conference 2021 – submitting motions and registering
The deadline for submitting motions to the LMC UK conference (to be held virtually on 12 and 13 May) is midday Friday 19 February 2021. The deadline to register for the conference is Friday 26 March 2021. More information will be provided nearer the time on how to access the virtual conference, and will be added to the LMC page on the BMA website. For further information please email info.lmcconference@bma.org.uk
GP Retention Scheme Webinar
A webinar on the GP Retention Scheme will be taking place on Thursday 25 February from 7pm – 8.15pm. We will be looking at how the GP Retention Scheme works for both employees and employers, tackling some of the common misconceptions about the scheme and hearing from GPs who are currently on the scheme. Speakers include:
Samira Anane, chair (GP and GPC policy lead for Education, training and workforce)
Naureen Bhatti (Health Education England)
Katie Bramall-Stainer (Retained GP)
Jonathan Rial (Retained GP)
Paula Wright (Sessional GPs Committee)
Tim Morton (GPC)
The session will be of interest to GPs who are considering applying to join the scheme or who would like to know more about it, GP employers and practice managers who would be interested in employing a retained GP and existing Retained GPs who have questions about the scheme or would like to hear some perspectives from other retained GPs and employers.
The webinar will be recorded and will be made available to view on the BMA website during the following week. There will a Q&A session at the end and you can submit any questions in advance to cscott@bma.org.uk. Click here to sign up
GPC UK regional elections
Nominations for regional seats as well as for a prison representative for GPC UK closed today (12 February) at 12pm. Voting will open at 12pm on Friday 19 February for all seats, until 12 March for the by-election and prison GP seat and 19 March for all other regional seats. To submit your vote after they have opened, please visit https://elections.bma.org.uk/.
To participate in this election you must have a BMA web account, if you do not have one please click here to create one.
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk. If you have any queries regarding the election process, please contact elections@bma.org.uk.
Read more, including link to the BMA committee profile, on the BMA website
COVID-19 media
Vaccine passports
The Daily Mail reported on the suggestion that the vaccine minister Nadhim Zahawi said that GPs should provide COVID-19 vaccine certificates to travellers, to which I commented: “Practices are working flat out successfully delivering the Covid vaccination programme while continuing to provide non-Covid care to many other patients. To prioritise this vital work, we need a reduction in bureaucracy and admin tasks – including writing letters, which practices can charge for as this work is not funded by the NHS. It would far better if all patients had easy access to their vaccination history electronically, so that they are able to provide evidence of this without needing to request a letter from their surgery.”
I told the Telegraph that the UK should set up an internationally-recognised system enabling people to have access to their own vaccination records, and told BBC Radio 4’s World at One that it was untenable for GPs to administer vaccine passports. “We need to enable people who have been vaccinated to have access to the information about that. What we don’t want is millions of people contacting their GPs for a letter outlining that. It’s so much easier if we can empower patients to do this themselves. It’s possible through apps – the NHS app can be configured to enable patients to see elements of their record including their vaccination status and that should be sufficient. What we need is a national or an international recognised system. But we need to avoid the need for large numbers of requests from letters from GPs because that simply isn’t tenable.”
Vaccine rollout (England)
I spoke to BBC News about the government’s vaccine rollout targets, to get all adults over the age of 50 vaccinated against coronavirus by May, where I said: ''We are on track to hit the government's previous target by the middle of February, and if the supply keeps coming, GP practice teams, mass vaccination centres pharmacists and others will continue to vaccinate patients so we should hit the target again if we get the supply.'''
I also appeared on BBC News and BBC Breakfast on Sunday and spoke about the evolving logistics for the vaccine rollout. I welcomed the funding to cover the costs for GPs vaccinating housebound patients and said: ''It recognises the additional cost in enabling people to do this type of work.'' Explaining how the evolving logistics of vaccine delivery are having a positive impact on the rollout, I commended the ''GPs, practice nurses, pharmacists, paramedics, and a whole range of people supporting the work, delivering vaccines to people in households.”.''
I spoke to BBC Radio 5 Live (from 2.07) to discuss the progress of the vaccination roll out following over-70s being told to contact their GPs for vaccination if they haven't yet been contacted. I said: ''GP practice teams, mass vaccination centres, pharmacists, hospital centres, have all done remarkably well, delivering over 30 million vaccinations in a very short time. We want to get to as many patients as we possibly can and to as many healthcare workers as we possibly can. If anybody feels they have not had the opportunity because they've not received the invitation, despite people trying to contact them, now is the time to contact us, because we want to ensure everybody gets vaccinated and protected from this deadly infection.''
Vaccine rollout (Wales)
BMA Wales chair, Dr David Bailey, appeared on BBC Radio Wales (from 1.13.00) to discuss the vaccine roll out in Wales because the Welsh Government announced that Wales is expecting to be the first country in the UK to have vaccinated the four most vulnerable groups, hitting the target they set out and vaccinating approximately 21% of the population. Dr Bailey said: “We have vaccinated the most vulnerable groups, the over 70s and the clinically vulnerable are the people who are most likely to get very sick with Covid or die and we’ve covered almost all of them and this will make a huge difference in terms of admissions to hospitals and to deaths.”
Read the latest GP bulletin here
COVID-19 vaccination programme (England)
Vaccination of JCVI cohorts 1-4
NHSE/I wrote a letter to LVS sites yesterday, to remind them that everyone in JCVI cohorts 1-4 should be offered the opportunity to be vaccinated by Monday 15 February, and to try to minimise any inequalities in vaccine uptake between different patient groups in those cohort wherever possible. NHSE/I are asking each PCN site to confirm that they have made an offer to all patients in cohorts 1-4 by the 15th by filling in the form in this link by close on Monday 8 February.
If a vaccination site does not believe they have sufficient vaccine to complete this, they should contact NHSE/I through their local system as soon as possible so that additional supplies can be provided.
The letter also included details about a welcome additional supplement of £10 per visit to a housebound patient to administer the COVID-19 vaccinations. This supplement is on top of the £12.58 Item of Service fee. The supplement applies retrospectively to any first dose vaccinations since 14 December 2020, and second doses within the arrangement.
National call/recall letters to Clinically Extremely Vulnerable people
As of 3 February, people aged 18 and over in the clinically extremely vulnerable (CEV) cohort (as identified through the Shielded Patient List) will receive letters from the national call/recall service informing them that they are now eligible to receive their COVID-19 vaccine. The letters make it clear that people have a choice of where to get vaccinated and can choose to wait for their GP services to contact them directly, if they haven’t already, or book into a vaccination centre or community pharmacy. A copy of the letter and a PCN letter template are available in the letter pack on the FutureNHS platform (sign in required).
It is concerning that these letters are not directly linked to a patient’s local GP vaccination service, nor the stage at which the local area has reached in terms of vaccination coverage, and we are continuing to discuss how to improve this with NHSE/I.
Movement of AstraZeneca vaccines
Moving the AstraZeneca/Oxford vaccine between locations across a single PCN grouping is both encouraged and legal if it will help minimise inequalities, maximise access and ensure timely vaccine usage. We believe the delivery of vaccination from local practices will enable more patients to access and receive the vaccine and would expect local systems to support this. The Standard Operating Procedures, outlines the cold chain arrangements which need to be adhered to do this. See more information in the NHSE/I letter of 7 January 2021.
NHSE/I has also published a position statement for the vaccination of care home residents using COVID-19 Vaccine AstraZeneca (AZ), recommending that when planning a vaccination session for local care homes, a risk assessment should be undertaken to identify the risk factors associated with the transfer of the vaccine for administration to remaining care home patients.
Annex B of the recent NHSE/I document Mutual aid and the transfer of COVID-19 vaccines between Hospital Hubs, Vaccination Centres and Local Vaccination Services sets out that as long as the relevant guidance is followed, local commissioners should be offering a supportive role in facilitating the movement of the AZ vaccine within a PCN grouping and do not need to seek formal approval for moving the vaccine in line with the arrangements set out in the letter. It also advises that once moved, the vaccine should either be administered or immediately put in a refrigerator at a practice site within the PCN grouping, and ideally administered within 24 hours or over the following days.
Second doses
Chapter 14a (on COVID-19) of the ‘The Green Book’ has been updated for patients due to start immunosuppressive treatment, so that for example, if prior to cancer the patient has had therapy or a solid organ transplant they could be offered a vaccine prior to starting treatment, if clinically recommended. This includes potentially having the second dose at 3 or 4 weeks after the first.
Last week, we raised with NHSE/I the need for practice sites to be able to start planning giving second doses by booking appointments. On Friday, LVS (Local Vaccination Service) sites were sent a message about the scheduling about preparing for the second dose vaccination clinics for cohorts 1-2 which should go live as of week commencing 1 March 2021.The allocated quantity of vaccines will be based on quantity of first dose delivered by site (full pack unless a pack-down option was provided). The second dose clinics will take place 11 weeks post first dose clinics so the 12 week lead time between doses is achieved. Practice sites should be provided with scheduled delivery day of second dose volumes by the end of this week, and are asked to schedule clinics up to the end of March once delivery schedule by day has been communicated.
We also believe it would be reasonable for GP sites to now give all those patients who have received the AstraZeneca vaccine an appointment for a second dose, and to do this for these patients when the first dose is given to reduce the workload involved in contacting patients at a separate time.
New vaccination information helpline and alternative point of care systems
A new COVID-19 vaccination information web resource and helpdesk has been set up for practice managers to help you find out answers to questions about records of vaccinations.
New assured point of care systems for recording COVID-19 vaccinations will also be available soon for practices which can be used as an alternative to Pinnacle. This provides greater choice and reduces reliance on any one supplier. As currently happens, all the data will flow into the GP record within 48 hours. These developments are in direct response to requests from GPC England on behalf of general practice.
Find out more information about your COVID-19 vaccination queries, how the vaccinations are recorded, common errors or difficulties and how to get help in these FAQs by NHS Digital.
Read our guidance on the COVID-19 vaccination programme which includes information about what is expected of practices and the support available to enable practices to prioritise vaccine delivery.
Vaccine doses data
This week, we are celebrating the milestone of over 10 million COVID-19 vaccination doses having been given in the UK, which has risen to almost 11 million today, and the latest data report , show that as of 3 February a total of 9,126,930 doses have been given in England. This is an enormous achievement, in particular when practices have also provided millions of flu and childhood immunisations this year. Thank you to all those who have made this possible so quickly.
The most recent BMA vaccine survey, which aims to track the roll out of first and second vaccine doses among members UK wide, shows that as of 29 January:
The survey also showed that with regards to ethnicity and being at higher clinical risk,there is no difference in one or both vaccine dose rate by ethnicity (BAME doctors 94%, white doctors 93%) or by being at a higher clinical risk (higher risk 94%, not at higher risk 94%).
Contract agreement webinar for 2021/22 (England)
Following the recent contract agreement for 2021/22, we will be holding two contract virtual roadshows/webinars on the following dates:
24th February – 19.30-20.30
25th February – 12.30-13.30
Look out for the registration details next week.
Government backs BMA proposal to fix unlawful age discrimination of the NHS Pension scheme
The Government has backed the main proposal from the BMA to fix the unlawful age discrimination that resulted when transitional protection was offered to older but not younger members when the 2015 NHS pension scheme was introduced. However, BMA pensions committee chair Vish Sharma warns the overall changes do not go far enough. Read more here
The BMA’s pensions committee will be holding webinars at 7pm on 17 and 23 February discussing in detail the changes and what they mean to members. More details will be sent next week.
Flu vaccine reimbursement 2021/22
NHSE/I has issued guidelines on vaccines for use during the 2021/22 flu programme, following the publication of JCVI advice. The vaccines recommended for use are:
Those aged 65 years and over: aQIV or QIVc (where aQIV is not available)
At-risk adults, including pregnant women, aged 18 to less than 65 years: QIVc or QIVe (where QIVc is not available).
Practices should read the guidelines and submit vaccine orders as soon as practical.
Staff with long COVID (England)
CCGs should now have fully allocated their share of the £150m funding to practices maintain capacity in general practice. This funding can be used when staff are off sick with Long COVID, both for paying extended sick leave for staff that are off with Long COVID and to fill any shortfall to maintain a service when staff are off sick.
Freedom of Information requests for practices’ Gift and Hospitality register
Practices were this week sent an email by St Andrew’s University, asking for copies of their Gifts and Hospitality register and Declaration of Interests Register for 2019/20, following a recommendation by NHS Employers to request and annually publish declarations of interests in the NHS.
This caused significant concern when practices are so busy focusing on the pandemic and the COVID vaccination programme, and after we raised this issue urgently with the University they apologised for the concern caused and we were pleased that they immediately agreed to withdraw their request.
SSP for levothyroxine 12.5 mcg tablets (England, Scotland and Wales)
The Department of Health and Social Care have informed us that a Serious Shortage Protocol (SSP) for levothyroxine 12.5 microgram (mcg) tablets has been issued, commencing 3 February 2021 with an expiry date of 5 March 2021.
The SSP will enable community pharmacists in England, Scotland and Wales to supply patients with 1 x levothyroxine 25 microgram tablet to be taken on alternate days. The SSP form has now been placed, along with endorsement guidance and supporting QA on the NHS Business Services Authority’s dedicated SSP website.
If you have any questions regarding the SSPs please contact the NHS Prescription Service (Email: nhsbsa.prescriptionservices@nhsbsa.nhs.uk; Tel: 0300 330 1349; Textphone: 18001 0300 330 1349”)
GPC UK regional elections
Nominations for seats for GPC UK in the following regions are open and successful nominees will take their seat for a three-session term from 2021-24, commencing after the ARM 2021:
The below seat is a by-election for a two-session term from 2020-22, commencing once this election concludes. Please hold the next date of GPC UK, 18 March 2020, in your diary if you are standing for this seat.
Nominations are also open for a Prison GP representative on GPC UK – this seat is for a three-year term from 2021-24.
Please note that in previous years there was a requirement that only GPs who paid the voluntary level could nominate themselves for election. That requirement has now been removed.
To submit your nomination please visit https://elections.bma.org.uk/. The deadline for all nominations is 12pm Friday 12 February: Voting will take place from 12pm 19 February to 12 March for the by-election and 19 March for all other seats.
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk. If you have any queries regarding the election process, please contact elections@bma.org.uk.
Read more, including link to the BMA committee profile, on the BMA website
Recruitment of GPC England Executive Team members
As you are aware, the GPC England Executive team is made up of an elected chair and three appointed members. A maximum of one non-GPC member (who could also be a non-doctor) could be included within that membership. Responsibility for the appointment of these three members lies with the GPC England chair working with senior BMA staff and with external expert advice.
Terms of office for the executive team are aligned with the GPC England chair’s term of office and end in summer 2023; there is no limit to the number of terms of office for executive team members. These are senior roles in which post holders will be accountable for leading, developing and representing the views of GPC (England) on all policy matters affecting GPs working in England, and will work with the rest of the team taking forward negotiations on all aspects of GP contracts in England.
Under normal circumstances the process to appoint the GPC England Executive team would have commenced with the election of the chair of GPC England in July 2020 and ended with appointments by the end of the year. However, due to the postponement of the BMA ARM (which marks the end of one BMA session and beginning of the next session) as a result of the COVID pandemic, I was not re-elected until October 2020. In consultation with senior BMA staff a decision was taken to undertake the appointment process when interviews and assessments could take place in person. However it is now increasingly clear that meetings in person will not be a possibility for some time to come. We have therefore decided not to delay this further and to open the process now.
The roles require an experienced professional, with extensive experience of influencing policy or negotiating contracts/terms and conditions, either for independent GP contractors or on behalf of employees or employers. Candidates should be confident communicators, able to demonstrate evidence of leading and motivating teams, as well as possessing personal resilience and significant influencing skills. A detailed role profile is attached.
A remuneration and support package will be available commensurate with these requirements. Applications are now invited for three members of the GPC England Executive team. This notification is being sent to current members of GPC and circulated to LMCs.
In order to apply, candidates should submit their CV and covering letter, together with their answers to the following three questions (the answer to each question should not exceed 400 words):
1. How do your skills and experience meet the GPC England executive team role profile?
2. What do you think are the main challenges facing the GPC England executive team over the next 12 months, and how would you deal with these?
3. Explain what you think the role of the GPC England Executive is in improving equality, diversity and inclusion for GPs and improve the working culture in primary care?
Applications should be sent to Richard Pursand (rpursand@bma.org.uk) by 26 February 2021.
BAME Forum launch
The BMA launched its first national BAME (black, Asian and minority ethnic) member forum last week. The forum aims to unify and empower the voices of our BAME members and influence positive change in the pursuit of race equality, in our association and across the NHS. The event was chaired by BMA council chair Chaand Nagpaul, with talks from Baroness Doreen Lawrence, Doyin Atewologun and Roger Kline. A recording of the launch event can be found here.
A recent BMA survey also showed that, a year on, Black, Asian and other minority ethnicity doctors still don’t feel protected from Coronavirus in the workplace.
Scottish GPC LMC update
Please find attached SGPC-LMC Update -February 2021 for your information. We would also like to use this opportunity to ask for some feedback on the update and whether you find it useful and if there are any improvements you would like for us to consider. Please email Andrea Ma (ama@bma.org.uk) with any feedback.
LMC UK Conference 2021 – submitting motions and registering
Please be reminded that the deadline for submitting motions to the LMC UK conference (to be held virtually on 12 and 13 May) is midday Friday 19 February 2021). The deadline to register for the conference is Friday 26 March 2021. More information will be provided nearer the time on how to access the virtual conference, and will be added to the LMC page on the BMA website. For further information please email info.lmcconference@bma.org.uk
GP Retention Scheme Webinar
A webinar on the GP Retention Scheme will be taking place on Thursday 25 February from 7pm – 8.15pm. We will be looking at how the GP Retention Scheme works for both employees and employers, tackling some of the common misconceptions about the scheme and hearing from GPs who are currently on the scheme. There will a Q&A session at the end and you can submit any questions in advance to cscott@bma.org.uk. A full list of speakers will be confirmed shortly. Click here to sign up
COVID-19 media
A BMA survey of doctors has revealed that, one year on, Black, Asian and other minority ethnic doctors still don't feel protected from Coronavirus in the workplace. The survey findings, alongside comments from Dr Chaand Nagpaul, were covered in The i, Mail Online, ITV news, The Independent and The Sunday Express. GPC member Gaurav Gupta was interviewed on Times Radio and on LBC on the same issue.
In a piece by the Telegraph, comparing the AstraZeneca and Pfizer vaccines, I commented: “We have concerns over the logistical challenges the Pfizer vaccine has left us with. It's been hugely difficult to manage - the deep freeze conditions, the rapid timeframe it needs to be used in. It's been a mammoth task for practices... We hope the AstraZeneca vaccine will remove many of these problems because it can be stored in a standard fridge and there are going to be more doses available.”
Brian McGregor (GPC member and BMA Yorkshire Regional Council Chair) told BBC Radio York that the current lockdown should only be lifted when it is safe to do so. He said: “We have seen a significant drop off in numbers, but it's more of a plateau. We're not getting the very low figures that we were getting previously, but we're hopeful that by the time the lockdown finishes we will be back down to less than three figures per one hundred thousand.”
NIGPC chair Alan Stout was interviewed in the Sunday Times about concerns over residents in the south of Ireland booking covid vaccination appointments in the north. NIGPC deputy chair Frances O’Hagan was interviewed on RTÉ Radio One Good Morning Ireland programme about vaccine roll-out in Northern Ireland as well as falling numbers of Covid-19 cases.
Read the latest GP bulletin here
Contract agreement for 2021/22 (England)
As you will be aware, we secured a contract agreement for 2021/22 with NHSE/I last week. This contract package delivers significant additional funding, enabling above inflation rises to pay and covering expenses. We have made improvements to the vaccination and immunisation scheme that we hope will lead to increased levels of uptake. We have also secured additional funding for important areas in QOF and been able to make a significant expansion of the PCN workforce, all with 100% reimbursement and guaranteed funding, and greater flexibility for employment in London.
Importantly with no new service specifications to be introduced in April practices can continue to focus on their pandemic response, and we will keep this under review as the outcome of the pandemic becomes clearer. Above all there will be a continued focus on supporting practices particularly as we deliver the vital COVID vaccination programme, something general practice is doing so successfully.
See my presentation about the contract here. The video and full details of the contract agreement are also available on our website. We are also planning to hold some webinars and will provide more details shortly.
COVID-19 vaccination programme (England)
The roll out of the COVID-19 vaccination programme continues at pace, with the inclusion of two new cohorts (people over 70 and those clinically extremely vulnerable to COVID-19) last week. Vaccinating the first two groups (care home residents and staff, and those aged 80 and over and frontline health and care staff) will remain the priority, but vaccination sites with enough supply and capacity for vaccinating further people are allowed to offer vaccinations to the next 2 cohorts.
Following earlier issues with vaccine supply, we are being reassured that they are becoming more stable each week although some batches can still vary.
Vaccination of healthcare workers
The BMA has been campaigning to ensure all healthcare workers are given the opportunity to be vaccinated as soon as possible. We are therefore pleased that NHSE/I has reiterated that vaccinating all healthcare staff against COVID-19 is an absolute and immediate priority. NHS staff do not require an NHS number or GP registration to receive a vaccination and should never be denied one on this basis, either in person when presenting for a vaccine, or through design of booking systems. If a member of staff does not have an NHS number, then employers should vaccinate now, record locally via a paper system and ensure that that the vaccination event is more formally documented later. NHSE/I is working towards a longer-term solution, but employers should not wait for this before vaccinating. NHSE/I has also written a letter encouraging frontline health and social care workers to get the COVID-19 vaccine as soon as possible.
Vaccine wastage
We continue to have reports of some CCGs demanding that vaccines are thrown away rather than giving second doses or vaccinating other cohorts. We would like to reiterate that NHSE/I has made it clear that the top priority is that all vaccines be used and therefore must not be deliberately wasted. All sites should have reserve lists that they can use to make every effort to invite patients or healthcare professionals to ensure that they can make full use of any unused vaccines rather than have any go to waste. Read more about vaccine supply in the BMA’s advice webpage on healthcare worker vaccination and report any concerns about this via the feedback portal.
Second doses
We have raised with NHSE/I the need for practice sites to be able to start planning for giving second doses by booking appointments. This requires confirmation of delivery schedules in March and April, particularly of the Pfizer vaccine. We hope NHSE/I will be able to confirm arrangements for this shortly. Practices should plan for 6 doses per vial for second dose, but where there is not enough for a 6th dose, NHSE/I will look to make an emergency delivery of smaller amounts of more vaccine to make up the difference.
IT issues
As a result of IT problems some vaccination sites have had to record patient information on paper rather than inputting it directly in to the Pinnacle system. We would therefore encourage practice sites to upload this information as soon as possible, which also needs to do be done for payment purposes. This will also help NHSE/I to plan properly for the timing of the second dose delivery. Extra funding has been made available to PCN groupings to bring in additional workforce until the end of January to ensure that all records for vaccination of priority cohorts are up to date and recorded properly in Pinnacle. PCN groupings will be eligible to claim up to £950 per week of funding support.
Transfer of vaccines
This week, NHSE/I has published guidance on Mutual aid and the transfer of COVID-19 vaccines between Hospital Hubs, Vaccination Centres and Local Vaccination Services. Annex B of the document sets out that as long as the relevant guidance is followed, local commissioner should be offering a supportive role in facilitating the movement of the AstraZeneca vaccine within a PCN grouping and do not need to seek formal approval for moving the vaccine in line with the arrangements set out in the letter. It also advises that once moved, the vaccine should either be administered or immediately put in a refrigerator at a practice site within the PCN grouping, and ideally administered within 24 hours or as soon as practical over the following days.
Care homes
NHSE/I have written a letter thanking colleagues in adult care homes for the progress in delivering vaccinations and information about the next steps by 31 January. In order to be included in the February payment to the lead practice within your PCN Grouping, all activity relating to vaccinations administered between 14 December 2020 and 31 January 2021 should be recorded within the Outcomes for Health (Pinnacle) system no later than 23:59 on 31 January 2021.
NHSE/I/has also published guidance on Access to National Workforce Supply Routes for Primary Care Network (PCN) Groupings. All NHSE/I guidance for primary care about the COVID-19 vaccination programme is available here
The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Medicine have published a statement responding to misinformation around COVID-19 vaccine and fertility. RCOG has also published information and advice for pregnant women about the COVID-19 vaccine, including an updated Q&A section.
Read our guidance on the COVID-19 vaccination programme which includes information about avoiding vaccine wastage, and other information about what is expected of practices support available to enable practices to prioritise vaccine delivery.
We were pleased to see the joint letter from Secretary of State Matt Hancock and Nadhim Zahawi, the minister with responsibility for the covid vaccination programme, recognising and praising the significant role GP practices have played in the successful roll-out of the vaccination programme. They wrote: “We are enormously impressed with how readily primary care teams have come forward to play such a vital role in the vaccination programme, under truly unique circumstances.”
Coronavirus vaccination figures (UK and England)
Coronavirus vaccination figures are now produced on a daily basis. As of 27 January, approximately 7.45 million people in the UK had received their first dose of the Covid-19 vaccine, while 476,298 people had received their second dose.
NHS England data shows thata total of 79.7% of over 80s have had their first dose of the Covid-19 vaccine, an increase of 20% on the figures published last week. There remains quite a large regional variation in the proportion of over 80s vaccinated; only 65% of Londoners aged over 80 have received their first dose, compared to other regions where the proportions vary between 78.3% (South East) - 83.7% (North East). This data is reflective of last week’s figures - the North East continues to have the highest proportion of over 80s vaccinated, although other regions appear to have caught up, for instance East of England which previously had the lowest proportion of over 80s vaccinated (along with London) across the regions but now the data shows that 79.9% of the over 80s have been vaccinated compared to 53% last week. Thank you to all practices that have made this possible.
Until now, weekly figures published by NHS England have contained information based on region and age group. Going forward, these figures will be supplemented by ethnicity and occupational data to understand vaccination uptake in high-risk groups (BAME, people living in deprived areas) in order to tackle health inequalities. Data according to site of administration, i.e. mass vaccination centre, hospitals hubs, GP practices are not yet published but we understand that in England over 70% of vaccinations are given by GP sites.
Covid-19 mass vaccination programme in Wales
On 11 January 2020, Welsh Government published their national COVID-19 vaccination strategy which sets out the aim to vaccinate the first four priority cohorts with first dose by 14 February. Health Boards have ultimate responsibility over all vaccination planning and delivery - according to JCVI advice. This delegation to individual HBs has led to significant variation in approach across Wales. Wales has a mixed delivery model using Mass Vaccination Centres (MVCs), GP practices and some community pharmacies, as well as a ‘bespoke and robust digital infrastructure’ across all settingsknown as the Welsh Immunisation System (WIS) for booking appointments and recording activity. GPC Wales has raised issues with the WIS system with Welsh Government and NWIS regarding the lack of ‘write back’ to GP patient records; discussions are ongoing.
A Primary Care Covid-19 Immunisation Service (PCCIS)underpins the delivery of the AZ/Oxford vaccine across primary care contractors with an item of service payment of £12.58 per jab as per other UK nations. Welsh Government had a desire to involve all primary care contractor services in providing vaccination, despite the historic track record of GP practices in delivering vaccination campaigns and GPC Wales’ suggestion of a National Enhanced Service. As a result, Local Medical Committees are engaged with their respective HBs to discuss implementation and negotiate local arrangements under the PCCIS.
Rollout of the AZ/Oxford vaccine to primary care from mid-January has been hampered by supply issues, but the input of general practice within the last week has seen Wales’ vaccination statistics significantly improve after an initial slow start. More recently, Health Boards have been discussing LES agreements with their health board to enable the delivery of Pfizer vaccine in general practice, after some initial small scale cluster pilots.
GPC Wales
GPC Wales met for the second meeting of the 20/21 session on 28 January 2021 and I was pleased to be able to join the meeting. As expected, members discussed the ongoing pressures due to the second wave of COVID-19 and the challenges of delivering the vaccine programme. Other items discussed included the outcomes from Welsh conference of LMCs, ongoing issues with Indemnity and GP Locum Hub Wales.
Members were advised of the decision made at UK Council to postpone ARM until September 2021 which meant an additional meeting for the 20/21 session will be held in July.
NIGPC meeting update
NIGPC also held a meeting this week, which I was pleased to attend. We heard that the Covid-19 vaccination programme in Northern Ireland is changing rapidly and becoming increasingly challenging. On 21 January, the Department of Health decided to remove a cohort from general practice, the 65-69 group and vaccinate them in Trust centres via an online booking system which went live on 27 January which would run in parallel with GPs vaccinating the over 70s group. This change has caused confusion with the public and resulted with large numbers of queries to practices. There are also ongoing problems with the supply of the AstraZeneca vaccine to practices making it extremely difficult to plan clinics and move ahead with vaccinating the next priority group. The Vaccine management system is due to go live in early February.
GMS contract negotiations
The contract freeze introduced at the start of the pandemic has been extended to the end of the year. The Chair and deputy chairs are meeting with the Department of Health and Health and Social Care Board to discuss re-starting the GMS contract and agree priorities going forward. The roll-out of multi-disciplinary teams remains a priority for NIGPC. The Health and Social Care Board has advised of dire financial constraints in next year’s budget.
Troubles Permanent Disablement Payment Scheme
NIGPC has been in discussion with the Department of Justice about the introduction of The Troubles Permanent Disablement Payment Scheme. NIGPC has informed the DoJ of serious concerns that medical evidence required to inform eligibility could potentially lead to a significant increase in GP workload. 40,000 people were injured which equates to 122 victims per GP. NIGPC is working with the DoJ to try to minimise the impact on general practice and to devise a template proforma.
New Planning Model
The NI health minister endorsed the commencement of a programme of work to develop a new planning model for Northern Ireland. The proposed closure of the HSC Board in March 2022 will have a direct impact on existing processes and structures in terms of service planning and delivery. The DoH Director of Organisational Change gave a presentation on proposals post-closure to replace these structures and processes. NIGPC has representation on the Project Board which has been established to oversee the progression of the associated programme of work.
New to Partnership Scheme (England)
The New to Partnership Scheme was launched in England in July 2020 (backdated to April 2020). So far about 400 applications have been approved and many more are being processed. NHSE/I has now finalised the S96 contract for GMS practices, which forms the agreement between the practice, the new partner and NHSE/I. This contract has been agreed with the BMA.
Contracts are now being sent out to applicants from GMS practices to sign and seek their partners’ signatures, within 4 weeks. The funding will then be released to the practice to pass onto the new partner. Contracts for PMS practices are expected to follow shortly.
Thank you for bearing with us while we get this right – we hope this development will now speed up the process and encourage even more new partners to apply for the scheme.
Read our guide to applying for the GP partnership scheme, which will help you navigate what can be a complicated application process.
NHS Pension Scheme Access for ARRS staff (England)
There were potential issues with access to NHS pension scheme access for ARRS staff employed by GP Federations who might lose their APMS contract as a result of the Extended Access changes (and which cease, therefore, to be an Employing Authority under the NHS pension scheme).
The delay to the formal handover of the Extended Access arrangements to Primary Care Networks (PCNs) until April 2022 means this issue is probably less pressing for many GP Federations than it was a few weeks ago. Nevertheless, the provisions for GP Federations without a GMS/PMS/APMS contract to apply for temporary access to the NHS pensions scheme for its staff has now been extended until March 2023. That position has now been confirmed in the updated NHS BSA guidance on access to the NHS pension scheme for PCNs – see scenario 3 in this document
We will continue our work on a more permanent provisions for this group of staff and will keep you updated.
GP appointment data (England)
The GP Appointment data for December has now been published. The data shows that there was a drop of just over 1.25 million appointments from November to December (from 25 million to 23,7 million) but that is a significantly smaller drop than for November – December 2019 (26.8 million to 23.5 million), and there was an increase of around 170,000 appointments in December 2020 compared to the previous year.
Waiting times also appear to have dropped compared to the same period in the previous year, with the number of appointments within 7 days up by 1.9 million in December 2020 compared to December 2019, and appointments over 8 days down by 1.76m.
This shows the incredible achievement of general practice with 100% of appointments in December 2020 as December 2019 in addition to launching and running the vaccination programme.
Updated PCN vaccine planning and progress tracking tool (England)
A new version of the PCN vaccine planning and progress tracking tool has been launched on the LVS workspace in Foundry. The updated version helps PCNs to plan their COVID-19 vaccination programmes for the AZ and Pfizer vaccines and users to calculate weekly vaccination capacity for each vaccine based on site and workforce scenarios. The tool also enables users to track progress with vaccination, including filters for different cohorts, delivery at each site against plan and progress with cohort coverage for PCNs, grouping population across different delivery methods (LVS, Hospital Hubs, Vaccination Centres). A user guide is also available (log in required)
CQC activity in Primary Care
Following our update on CQC’s regulatory approach provided on 15 January, and the lobbying on this issue that we have been doing, CQC has written to all CCG primary care leads and NHSE/I regional directors confirming that it will only inspect GP practices in response to significant risk of harm and when it cannot seek assurances through other routes. If an inspection is necessary, it will carry out as much activity off-site as possible. Full details are available here.
GP referrals into CPCS
The PSNC (Pharmaceutical Services Negotiating Committee) has published an animation to explain how GP practices can refer patients with minor illnesses to local pharmacies, by using the referral pathway of the Community Pharmacist Consultation Service (CPCS), which is in the process of being rolled out to include GP referrals.
The CPCS enables the safe referral of patients from other parts of the NHS to community pharmacies and frees up other healthcare providers to provide more appointments for patients with more complex or higher acuity needs whilst improving access for those with lower acuity conditions.
Before the service can be rolled out in an area, there must be local discussions between the PCN, general practices and community pharmacies to agree how the referral process will operate – and practices are encouraged to begin those local conversations now. Read more on the PSNC website
GP Retention Scheme Webinar
A webinar on the GP Retention Scheme will be taking place on Thursday 25 February from 7pm – 8.15pm. We will be looking at how the GP Retention Scheme works for both employees and employers, tackling some of the common misconceptions about the scheme and hearing from GPs who are currently on the scheme. There will a Q&A session at the end and you can submit any questions in advance to cscott@bma.org.uk. A full list of speakers will be confirmed shortly. Click here to sign up
LMC UK Conference 2021 – submitting motions and registering
Please reminded that the deadline for submitting motions to the LMC UK conference (to be held virtually on 12 and 13 May) is midday Friday 19 February 2021). The deadline to register for the conference is Friday 26 March 2021. More information will be provided nearer the time on how to access the virtual conference, and will be added to the LMC page on the BMA website. For further information please email info.lmcconference@bma.org.uk
LMC Secretaries Conference
The LMC secretaries conference will be on Thursday 4 March 2021, and will be held virtually. If you require any further information, please contact info.lmcconference@bma.org.uk
LMC England Conference
The annual conference for England LMCs will be held on Friday 26 November 2021. Save the date and look out for further information on the BMA website.
GPC regional elections
Nominations for seats for GPC UK in the following regions are open and successful nominees will take their seat for a three-session term from 2021-24, commencing after the ARM 2021:
The below seat is a by-election for a two-session term from 2020-22, commencing once this election concludes. Please hold the next date of GPC UK, 18 March 2020, in your diary if you are standing for this seat.
Nominations are also open for a Prison GP representative on GPC UK – this seat is for a three-year term from 2021-24.
Please note that in previous years there was a requirement that only GPs who paid the voluntary level could nominate themselves for election. That requirement has now been removed.
To submit your nomination please visit https://elections.bma.org.uk/. The deadline for all nominations is 12pm Friday 12 February: Voting will take place from 12pm 19 February to 12 March for the by-election and 19 March for all other seats.
We can confirm that mass emails regarding the elections have been sent to almost 13,000 GPs in the regions that are open for election. We are aware that some colleagues have not received the mass email, and we will check with the comms team to ensure that all emails are correctly targeted. If anyone is aware of colleagues who have not received communications, can you let the election team know (elections@bma.org.uk) and we will update the comms team to ensure they are included.
The elections have also been advertised in the all member GP newsletter last week and again yesterday and we ask that colleagues in the relevant regions circulate through their networks as well.
We will also be pushing election comms through our social media accounts and ask that you share as widely as possible when you see them.
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk. If you have any queries regarding the election process, please contact elections@bma.org.uk.
Read more, including link to the BMA committee profile, on the BMA website
COVID-19 media
The BMA wrote a letter (link to twitter) on Friday calling on the Chief Medical Officers to review the current guidance which delays the second dose of Pfizer to 12 weeks, despite Pfizer suggesting the second dose should come within 3 weeks. In the letter it was argued that the gap could reduce the effectiveness of the vaccine, and that while we understood the rationale behind the decision to delay the second dose, the UK should follow “best practice” and reduce the wait time to six weeks.
I was interviewed about the letter on Sky News and it was referred to in BBC news on Friday, and the BMA council chair, Chaand Nagpaul, was interviewed on BBC Radio 4 Today programme (8.40am), BBC Breakfast (7.30am), ITV News and Sky. It was also covered by Channel 4 News, Guardian, Telegraph, Sunday Times, Mirror, Metro, Mail, BBC online, ITV online, and the Independent. It was also widely covered by international media including TIME, Los Angeles Times, ABC news, Washington Post, and CNN.
David Bailey, Chair BMA Welsh Council, was featured on BBC Radio Five Live (from 2h43min) to talk about the proposed delay between first and second vaccinations of the Pfizer vaccine, and said: “We’re concerned that there is no published scientific basis for the 12 week wait for the second dose with the Pfizer vaccine, we’re completely out on a limb and the WHO, the EMA and the FDA in America are all saying we should be sticking to 21-28 days gap, as are Pfizer themselves.” He was also quoted, along with Phil White, Chair of GPC Wales, calling for the delay to be halved by the BBC: “There's been considerable disquiet among BMA members across the country regarding this decision to extend the gap to 12 weeks. We're looking for a half-way house, say 42 days, which is six weeks, which is halfway to what the government propose.” Dr White also appeared on BBC Radio Cymru’s Post Prynhawn (from 12 min) to discuss vaccine rollout and the importance of frontline health care workers receiving their second Pfizer dose as promised.
I was interviewed on BBC Radio 4 Today Programme (from 02.45) where I addressed the efforts of GPs to prevent vaccine dose wastage, and explained that GPs have a list of people they can call to offer the vaccine at short notice, which is a particular problem with the Pfizer vaccine which has to be used withing three and a half days of arriving at the practice. I said “The number one, top priority is not to waste the vaccine. This is a precious resource and we must use that resource as effectively as we can.” I also told BBC News online that the overriding principle will be to avoid wastage, and that all vaccination sites should have a reserve list so they can call people at short notice. This morning I spoke to BBC Radio Leeds, a year after the first case of COVID-19 was reported in York.
GP online reported that limited supplies of COVID-19 vaccine have forced local GP vaccination sites to operate below maximum capacity, whilst several new mass vaccination sites have opened, to which I argued that more supplies should be directed to local GP-led sites, which are better suited to deliver vaccines to those in the first eligible cohorts. I also said: ‘It is frustrating for practices who are ready and able to deliver vaccines, to see these centres opening and in receipt of consistent supplies of vaccine, when their own deliveries are so unreliable.”
Northern Ireland GPC chair Alan Stout was interviewed across several BBC Northern Ireland news outlets (BBC News NI online, BBC Newsline (15:50), Good Morning Ulster (1:09:38)) about the roll-out of the covid vaccination programme to the 65-69 cohort in local vaccine centres. During his Good Morning Ulster interview, Alan was also asked about the news that the SEHSCT has emailed staff to offer early covid vaccination slots to friends and family falling under the 65-69 cohort. His comments were included in a BBC News NI online piece. Dr Stout was also interviewed on The Nolan Show (47:07) and on The View (27:33) where he was asked about vaccinating teachers.
NIGPC deputy chair Frances O’Hagan was interviewed on Good Morning Ulster (piece starts at 42:19 and Frances’ interview starts at 43:53). Dr O'Hagan spoke about the delay in vaccine supplies to some GP surgeries for the over-75 cohort as the covid vaccination programme continues.
Read the latest GP bulletin here
Contract agreement for 2021/22 (England)
At our meeting yesterday GPC England supported the agreement we have secured with NHSE/I for minimal contract changes for 2021/22 whilst retaining the significant increases in funding already planned. Some of the previous agreements due to start in April will be delayed. This is to give practices support and stability through the continued pandemic and whilst practices are playing such a significant role in the COVID-19 vaccination programme. Some of these changes will be implemented throughout 2021/22 depending on the pandemic, and will be agreed later in the year. Practices will then be provided with adequate time to prepare.
The full details are available on our website, but in summary, from April:
Full details are available on the website and further guidance will be provided in due course, but we hope that this will provide practices with some stability during this challenging time. Read our press statement here
PCN DES ballot results (England)
In November, the LMC England conference passed the following resolution: Conference notes that the BMA GPC (GP committee) England has never secured a robust democratic mandate for the PCN DES and so again asks the GPC England to secure a firm mandate from the entire profession by means of ballot before negotiating any extension or changes to the PCN DES for the year 2021 / 2022.
As a result GPCE have completed a ballot, with the question based on the motion: “Prior to any further negotiations, extension or changes for 2021/22, do you give GPC England a mandate for the PCN directed enhanced service?
The result of the ballot was:
Yes: 80% (3,619)
No: 20% (915)
Total number responding: 4,534
This outcome provides a clear mandate from the profession for the PCN DES, and GPC England will therefore continue to negotiate on this, seeking improvements and further developing it, as part of the whole GP contract, for the benefit of practices and our patients. Read more here
This was reported by GPonline and Pulse, where I commented: “We are glad that the profession has spoken so clearly, giving GPC England a clear mandate for the PCN directed enhanced service and telling us that we should continue negotiating this important contract on behalf of grassroots GPs throughout the country.”
GPC England meeting
GPC England met yesterday to discuss the 2021/22 contract agreement, the PCN DES ballot results, and the COVID vaccination programme.
I was pleased that Rachel Ali gave her first regular update following her appointment as the Committee’s first gender diversity champion. This was one of the key proposals of GPC’s Gender Task and Finish Group. There were update reports from the sessional GPs committee, GP trainees committee and GPC policy leads. These focused on a number of recent developments including pay and contracts, premises, well-being, and education and training issues. The GPC Executive and Policy Lead update from the meeting is available here for your information.
Other items on the agenda included an update on the planned BMA submission to the DDRB, and a discussion on the BMA response to the integrated care systems proposals being made by NHSE/I. The response highlighted the critical role of LMCs must play in representing all GPs in any new structures and the committee raised concerns about how they may be implemented.
Scottish GPC meeting
SGPC met yesterday and discussed a number of issues, including the agreement reached with the Scottish Government on the next steps for the GMS contract in Scotland. The committee heard in more detail about the timescale by which responsibility for services outlined in the contract will be written out of GMS regulation and will transfer to the HSCPs. Transitionary Services will be introduced to compensate practices who are still required to temporarily deliver such services until the HSCP is in a position to provide them. SGPC also discussed the progress of the Covid vaccination programme and concerns about the pace of supplies reaching practices, along with appraisal and ongoing changes to urgent care in Scotland.
COVID-19 vaccination programme
From this week, people aged 70 and over and those clinically extremely vulnerable to COVID-19 can be invited to get their vaccinations as the roll out of the vaccination for the next 2 priority groups begins. Vaccinating the first two groups (care home residents and staff, and those aged 80 and over and frontline health and care staff) will remain the priority, but vaccination sites which have enough supply and capacity for vaccinating further people are allowed to offer vaccinations to the next 2 cohorts. We have however raised with NHSE/I our concerns about the way invitation letters are being sent to patients, and that these are not coordinated with local practice group sites, causing potential confusion for some patients and unnecessary travelling to more remote vaccination centres.
NHS England has made it clear that vaccines should not be wasted, and sites should have reserve lists that they can use to make every effort to invite patients or healthcare professionals to ensure that they can make full use of any unused vaccines rather than have any go to waste. We have also added a section on vaccine supply to the BMA’s advice webpage on healthcare worker vaccination and are encouraging members to anonymously report any concerns about this via our feedback portal.
Following last week’s announcement about additional funding to support the rapid delivery of vaccinations to care home staff and residents, NHSE/I has now published Process for the payment of Item of Service fees and Care Home Supplement payments to PCN groupings (log in required, so document is also attached). We have raised concerns about the complexity of this process but PCNs bringing in additional workforce between now and the end of January to ensure that all records for vaccination of priority cohorts are up to date and recorded properly in Pinnacle will be eligible to claim up to £950 per week (a maximum of £2500 per PCN grouping) of funding support.
There have been some concerns about the availability of the COVID vaccine for private patients. The easiest way for private patients to access the vaccination programme is to temporarily register with an NHS practice involved in the vaccination programme. If they have not got an NHS number they will be provided with one as part of the registration process. We would encourage practices to do this for private patients and for local vaccination sites to make the bookings. However if a patient does not want to do this if they have ever had any contact with an NHS service they should still receive a vaccination letter via the national database.
Read our guidance on the COVID-19 vaccination programme which includes information about the added funding to support rapid care home vaccination, and other recent information about how to administer the vaccine, and further support to enable practices to prioritise vaccine delivery.
NHSE/I’s guidance for primary care about the COVID-19 vaccination programme is available here
The latest data report of the number of COVID-19 vaccinations provided by the NHS in England, show that as of 20 January, a total of 4,419,704 have received an NHS vaccination since 7 December when vaccinations began.
The BMA is tracking the rollout of both first and second dose vaccination against COVID-19, as we campaign for rapid vaccine distribution to doctors. Thank you to all who have participated so far – we found that while most UK doctors have now received a vaccination, there is variation by country and grade, and one in 10 are yet to receive a first dose. See the results here
PM praises GPs
We were pleased to hear the Prime Minister and Chief Medical Officer praising GPs and their teams in the COVID-19 press conference last week. The Prime Minister said, “A massive thank you...they’ve now stood up the vaccination on top of everything else...we should all be enormously grateful for what they have done.” Read more on the BMA’s GP twitter account
Securing enhanced and suitable PPE
In light of the continued spread of the new more transmissible variant of COVID-19, as well as growing evidence of aerosol transmission of the virus in non-AGP settings, the BMA is determined to ensure that every doctor is properly protected with adequate and suitable PPE. That’s why the BMA has written to Public Health England asking for an urgent review of their PPE guidance.
As we reported last week, the Government has extended the provision of free COVID-19 PPE for all health, social care and public sector workers, until at least the end of June. Read the BMA’s updated PPE guidance and the guidance for practices on reducing COVID-19 transmission and PPE.
BMA joins calls for emergency legislation to protect medics from 'unlawful killing' cases
The BMA has co-signed a letter calling for emergency legislation to protect healthcare workers from 'inappropriate' legal action over Covid-19 treatment decisions. The story was covered by Sky News and BBC News. The letter, organised by the MPS and signed by other health organisations and addressed to Matt Hancock, reads: "With the chief medical officers now determining that there is a material risk of the NHS being overwhelmed within weeks, our members are worried that not only do they face being put in this position but also that they could subsequently be vulnerable to a criminal investigation by the police."
Judicial Review against Northamptonshire safeguarding partners (safeguarding fees)
The BMA made an application for Judicial Review against the Northamptonshire safeguarding partners, which was heard in May 2020. We argued that they had failed to discharge various statutory obligations in publishing their Local Safeguarding Arrangements Plan 2019-2021, because it did not specify what sum the Defendants had budgeted to meet the cost of GPs work on safeguarding cases, including the production of safeguarding reports and attendance at safeguarding conferences.
Judgement in the Judicial Review brought by the BMA was handed down in July 2020. Unfortunately the Judge found against us and dismissed the application for Judicial review. The Judge reached a different conclusion to us about the correct interpretation of the Children Act 2004 and in particular, sections 16E and 16F. He interpreted those sections narrowly, as only requiring safeguarding partners to ‘make arrangements to enable themselves, when they exercise their individual safeguarding functions, to work together’. He held therefore, that they did not have a bearing on how safeguarding partners discharge related safeguarding obligations arising under different legal provisions.
We were advised that there were sufficient, if limited grounds for appeal and an application was made. We have now heard that we were unfortunately unsuccessful in the appeal. The judicial review cannot now be taken any further.
However, in reaching his original decision, the judge said that safeguarding partners can reasonably be expected to agree suitable arrangements to pay GPs, and if they don’t, GPs may well take legal action to force them to. Although this is much the same position we were in before we started the JR, it helps us that it is confirmed in a High Court judgment which at the same time dismisses the main legal arguments that local authorities would rely on to say GPs have to provide the work for free.
LMCs are therefore asked to consider the possibility of finding some suitable test cases to challenge non-payment for these services. Please contact Greg Lewis, Senior Policy Advisor, on glewis@bma.org.uk
Payments during suspension - SoS Determination (England)
GPC is aware of a case where a GP has been asked to refund to the NHS a significant sum of money, that had allegedly been wrongly paid during a period of suspension. The payment was made under the Secretary of State’s Determination: Payments to Medical Practitioners suspended from the Performers List and there is nothing to suggest the interpretation of the Determination by NHSE/I was anything other than correct. However, the original payment was mistakenly made on the GP’s profits and not their drawings. The Determination sets out that entitlement is based on an individual’s normal monthly payments where they practise as an individual and in the case of partnerships, 90% of the normal monthly drawings from the partnership account. NHSE/I were correct in the re-interpretation of the Determination, payment Is based on drawings not profit, often a much lower sum, but not the one on which tax is payable.
It has been suggested this amounts to discrimination against contractors when compared to other GPs and hospital doctors. The purpose of this update is to ensure members are aware of the consequences of this interpretation and the impact it might have on them if they receive payments when suspended.
LMC UK Conference 2021
This year’s annual LMC UK Conference will be held on virtually on 12 and 13 May. LMCs have been sent an email with information on how to submit motions (deadline for submitting motions is midday Friday 19 February 2021) and how to register (applications must be submitted by Friday 26 March 2021). More information will be provided nearer the time on how to access the virtual conference, and will be added to the LMC page on the BMA website. For further information please email info.lmcconference@bma.org.uk
LMC England Conference resolutions
The virtual England LMC Conference took place on 27 November 2020. This document which details the conference resolutions, election results and motions lost, has now been updated to include the voting statistics for each motion. All of the votes were quorate.
GPC regional elections
Nominations are opening at 12pm on Friday 22 January for seats to the General Practitioners Committee (GPC) in the following regions:
*This is a by-election and is for a two-year term only from 2021-23. The next meeting of GPC UK is Thursday 18 March – if you are standing in this election please hold this date in your diary.
These seats are for a three-year term, 2021-24 sessions, subject to governance structure review.
Nominations are also opening on 12pm on Friday 22 January to the below seat on GPC UK – this seat is for a three-year term from 2021-24:
Please note that in previous years there was a requirement that only GPs who paid the voluntary level could nominate themselves for election. That requirement has now been removed.
To submit your nomination please visit https://elections.bma.org.uk/. The deadline for nominations is 12pm Friday 12 February. Voting will take place from 12pm 19 February to 12 March for the by-election and 19 March for all other seats.
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Meeting on public health restructuring for public health doctors working outside of PHE (England)
Following discussions at the last joint Public Health Medicine Consultative Committee (PHMC) and with the ADPH, the Faculty of Public Health (FPH) has agreed to host a joint meeting with the BMA on Thursday 28 January 2021, 14:00 - 15:30 on the restructuring of public health in England.
This meeting is primarily for public health doctors working in the English system outside of Public Health England, and also relevant to GPs with a special interest in Public Health. You can register your free place here. When registering, you will be asked to enter your Faculty membership ID if you have one. If you have any difficulties registering or are unable to attend but would like to ask a question, please contact the PHMC on info.phmc@bma.org.uk
Read our COVID-19 toolkit for GPs and practices, which includes updates in the COVID-19 vaccination programme section and protecting clinically extremely vulnerable (CEV) patients section. There is also guidance on the following topics:
COVID-19 media
I have been quoted extensively in a range of national and regional media this week, speaking about the vaccine rollout. My comments were covered in the Mail Online, BBC Online, Evening Standard, Yorkshire Post, among others, which were in response to reports that areas such as the North East and Yorkshire were having vaccine supplies reduced to allow for more supplies to be distributed to other areas where vaccine coverage had not been as great. I have been absolutely clear that the Government needed to be far more honest and transparent about vaccine supplies and to provide clear justification about where they were being sent. I was also interviewed on BBC Look North (from 4m42s) and ITV Calendar. I’ve also been interviewed for BBC Look North again today.
I spoke to BBC 5Live (around 10.20pm) and appeared on Good Morning Britain on Tuesday speaking about the challenges of the vaccine rollout. I said that the urgency of the vaccine rollout was very clear and emphasised the efforts of GPs so far and “It’s a bit frustrating where vaccine deliveries change. It means practices are having to reorganise clinics and rebook those clinics, often about a 1,000 people at a time and that's a real burden on practices. Practices want to provide vaccinations to their patients as quickly as possible.”
On Sunday, I was interviewed live by BBC News about the possibility of all adults in the UK being offered the first dose by September. While this is welcome news, it is vital to stay focused on the task at hand and make sure the vulnerable and healthcare workers are protected first. I also spoke to BBC Radio London (around 7.10am) and BBC 5Live (around 9am) on the same topic.
The Guardian and Metro reported on a record number of vaccinations done in one day (343,000) and that ministers refuse to reveal how much stock is in the system, despite concerns about supply issues, to which I commented: “Unfortunately, we are hearing of supply issues which are impacting the speed of the rollout of the vaccine. Despite having the staff and resources available, some GP-led sites are not able to vaccinate patients at the rate at which they could if they had continued access to the vaccine. As well as accelerating the delivery of supplies to ready and willing sites across the country, the Government needs to be honest both with the public and practices about what supplies are available.
The Financial Times (paywall) reported that hundreds of thousands of patients without access to a car will struggle to reach their nearest vaccination centre as the 'postcode lottery' risks exacerbating income, ethnic and geographic divides. I commented that the ability to set up vaccination sites had in some cases been “limited by geography”, with rural areas in particular finding it harder to find suitable locations. Speaking on the vaccine supply issue I said: “We want to be able to plan ahead so we know in nine weeks’ time we’ll have vaccine so we can book people in. We’re not there yet because the NHS isn’t providing us with long-term projections around vaccine availability. We’re working from hand to mouth at the moment.”
Chaand Nagpaul, BMA’s Chair of Council, has spoken live to BBC News and Radio 4 News about reports of vaccine wastage and said that the issue is not widespread and that the BMA is only aware of a very small amount of problems, most of which have now been resolved. He also gave a written statement on this to the Telegraph and Pulse, saying: "Reports of vaccination sites feeling pressured to discard unused doses of the Pfizer vaccine are extremely concerning. This is absolutely unacceptable and morally wrong. Any wasted dose would deny a real person the chance to be protected from serious illness or even death." This was also covered by the Mirror.
Brian McGregor, GPC member, also highlighted the issue in the Telegraph and the Mirror where he said that NHS England had told his local CCG to dispose of unused vaccine doses, and claimed they had been warned the would be "performance managed" on the issue. He said: "They control our contracts, payments, vaccine supply, regulation, and can make life unbearable." Robert Morley, GPC member, was also quoted saying: "This is ridiculous, bordering on the criminal, to actually be wasting vaccines when you have the worst global healthcare crisis for a century."
GPC member Gaurav Gupta was interviewed on BBC Radio Kent (from 2hrs 18mins) speaking about NHS pressures in the region. He said: “We are used to having extra pressure in the winter time but this year has been compounded by the number of patients who are Covid positive – this is completely unheard of." He was also interviewed on BBC South East (from 3mins) on the vaccine rollout in Kent.
BMA Northern Ireland has released a statement in advance of an expected surge of admissions for COVID-19 in Northern Ireland saying that medical staff will face pressures unlike any they have faced before, and the BMA is deeply concerned about the long term impact on doctors mental health and the impact on the health service. The statement was picked up across the majority of news outlets in Northern Ireland, including Belfast telegraph, Irish News, News Letter, BBC News NI, UTV News online, and Belfast Live. NI Chair of Council, Tom Black, was also interviewed on Good Morning Ulster show (2:23:16) and BBC Radio Foyle Breakfast (1:24:25). He was also interviewed in the Sunday Life about the effects of long covid on doctors, and by News Letter about the new strain of covid-19 found in Brazil and what could happen if it established itself in NI.
NIGPC chair Alan Stout was interviewed in the Belfast Telegraph about concerns over St Patrick’s Day parties being organised during the ongoing pandemic. The interview was then highlighted in the paper’s editorial.
NI GPC chair and deputy chair Alan Stout and Frances O’Hagan were interviewed across several BBC news outlets about concerns over the delays in supplies of the Oxford-AstraZeneca vaccine. Dr O'Hagan was interviewed on BBC Newsline (from 5.38) and in a BBC News NI online article, telling patients: "As soon as we get the vaccine, we will get it to you." Dr Stout was interviewed on Talk Back (from 12:49).
David Bailey, Chair BMA Welsh Council, spoke on BBC Wales (from 3m45s) about supply issues where he said: “Any vaccines that we’ve got in Wales need to be got out as quickly as possible, if that means people in mass vaccination centres will be underemployed for a couple of weeks when we exhaust our supply then so be it. It still means all of those vaccines are starting to protect Welsh patients.” Phil White, Chair of GPC Wales, appeared on BBC Radio Cymru (from 10m54s) to talk about the disappointing comments from the First Minister on slowing vaccination rollout.
Read the latest GP bulletin here
Read the latest Sessional GPs bulletin here
