Additional funding to support rapid care home vaccination (England)
Practice groups around the country have been working extremely hard to protect our most vulnerable patients. The daily reporting of vaccinations given clearly demonstrates this, with over 3 million given. The increased availability of the AstraZeneca vaccine makes it much more possible to vaccinate care home residents and staff and we now need to do this as quickly as possible. We have been discussing this regularly with NHSE/I and welcome their announcement yesterday that additional funding will be provided to support the rapid delivery of vaccinations to care home staff and residents in England. The care homes supplement will now increase as follows:
In addition, NHSE/I has provided new payment to support the administration of the Pinnacle system. Vaccination must be recorded immediately in Pinnacle in order to ensure the clinical record is updated and to be sure that PCNs are paid for the work that they are undertaking. 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 £2,500 per PCN grouping) of funding support.
Finally, there is also a reminder that providers of Community Health Services should do all they can to release staff to support local vaccination services with the vaccination of care home residents and staff during the next fortnight. Lead providers of vaccination centres are able to make staff temporarily available in a flexible manner to support PCN Groupings in this important work and community nursing teams, who provide care daily into care homes, are well placed to support this work. Any financial costs in having to back fill staff can be found in the NHSE/I letter to Regional Directors of Workforce.
There is also to be a significant increase in availability of vaccine from next week, so all sites should expect the opportunity to vaccinate more, as well as covering all care home patients.
Vaccine rollout and mass vaccination centres (England)
This week, the government in England published its vaccination delivery plan which outlined plans for over 1200 local vaccination sites, most led by GP practices, 206 hospital hubs and 50 mass vaccination centres. Seven large scale mass vaccination centres have opened this week, as well as more local practice vaccination sites and hospital hubs, in addition to those that are already operating. NHSE/I has also published a map with all the vaccination sites across England
The clear aim for us all it to ensure that as many people gets vaccinated as quickly as possible, however the BMA is very concerned to ensure all people, not least elderly patients, are given the opportunity to choose to receive their vaccination from their local GP vaccination site. This means all sites need greater provision of vaccinations, which we expect to increase in the coming weeks, and greater certainty on delivery so they can plan their vaccination sessions and book patients in with greater confidence. The letter inviting patients to book in to a mass vaccination centre, which has been sent to thousands of eligible patients, has now been amended following our comments to be clearer that they do have a choice of attending their local practice site, but we are still aware of some confusion and of patients having contacted the national booking service, being redirected to mass vaccination centres at much further distance than local practice sites. NHSE/I has also published a map with all the vaccination sites across England
We have also raised concerns on the COVID Vaccination Programme IT system with NHSE/I and the servers have since been upgraded which should now improve the situation and there is now additional funding for administrative support.
GPs and their teams are generally the best place to deliver community vaccinations and it is therefore imperative that we are provided with sufficient and regular supplies as soon as possible.
COVID Vaccination Programme (Scotland)
While delivery of COVID vaccinations is board led in Scotland, GPs have an important role to play as part of those efforts. An item of service of £12.58 per dose of vaccine administered has been agreed. Vaccinations by practices is now underway, but the pace of delivery is being dictated by available supply, with some practices yet to receive vaccine stocks. SGPC have raised this issue at the highest levels and stressed the importance of delivery to practices being as swift and as predictable as possible.
COVID vaccination programme (Northern Ireland)
The roll-out of the Covid vaccination programme in Northern Ireland has been very successful so far. The latest available figures show a total of 121,711 vaccines had been administered by 13 January. Supplies of the Pfizer vaccine have been distributed solely to Trusts to vaccinate the vaccinators, care home residents and health care workers. This started on 8 December and by 6 January, 91% of the 483 care homes had been visited by mobile vaccination teams, with an uptake level of more than 90% among residents and about 80% among staff.
The AstraZeneca vaccine is being distributed to GP practices with a small amount going to Trusts to deal with people with allergies. Practices started vaccinating the over 80s week commencing 4 January. Vaccination of this group is almost complete and practices will be moving to vaccinate the over 75s w/c 18 January.
The enhanced service was agreed at £12.58 per vaccination with an additional £800 per 1000. A large pool of additional vaccinators is available free to practices if needed. The vaccine management system is scheduled to go live at the start of February.
COVID vaccination programme (Wales)
Welsh Government have directed Health Boards to have ultimate responsibility over all vaccination planning and delivery, to be conducted according to JCVI advice. Pfizer vaccine is only being delivered at Health Board staffed Mass Vaccination Centres. LMCs are engaged with their respective Health Boards to discuss implementation locally.
BMA Cymru Wales will be writing to all HB chief execs asking for their covid-19 vaccination delivery plans. The Welsh government’s published a high level vaccination strategy on 11 January.
Vaccination of healthcare workers
The BMA continues to call for all health and social care workers to be given urgent priority to protect an already depleted workforce and to help prevent the NHS becoming overwhelmed.
Practices should ensure that locum GPs they are in regular contact with are invited for vaccination either via hospital hubs or by the practice itself. Additionally, any healthcare staff who self-identify with their own registered GP practice should be vaccinated as per the JCVI guidance.
Please do not decline or turn away any health and social care workers. Consider maintaining waiting lists or signpost to other providers if vaccine availability is the rate limiting factor.
Healthcare professionals have now also been added to the priority list of eligible patients
Change in legislation to allow any GMC registered doctor to administer the COVID-vaccine in primary care settings
The Government has announced that doctors who offer their support in delivering the Enhanced Service Specification COVID vaccination programme in primary care settings will be exempt from the requirement to be included on the England Medical Performers List. The Regulations, which came into force on 14 January, remove previous barriers and mean that any GMC registered doctor will be able to administer the vaccine and any ancillary vaccine services under the enhanced service specifications in a primary care setting. We welcome this change in legislation which will support the rapid roll out of the vaccine, allowing more doctors to administer more COVID vaccines.
Practices are reminded of their existing obligations to ensure staff have the qualifications, skill, competence, training and experience to deliver safe care under the Health and Social Care Act 2008.
COVID-19 vaccinations programme guidance
The national protocol for the Pfizer/BioNtech vaccine has been updated to define minimum dose interval and vaccination in accordance with national recommendations “For operational purposes the second dose may be given between 3 to 12 weeks following the first dose or in accordance with official guidance at the time.”
The AstraZeneca (Oxford) vaccine national protocol has also now been published.
NHSE/I has published a letter with an Instruction on timing of second dose of COVID-19 vaccinations, which sets out that all vaccination sites ensure that all second dose appointments for both patients and health and care staff that have not already been rescheduled, must be rearranged to take place in the 12th week. The Academy of Medical Royal Colleges has also published a statement supporting the decision of the four UK CMOs to prioritise the delivery of the first COVID-19 vaccine dose, and to delay the second dose to up to 12 weeks.
Public Health England has this week published a UK COVID-19 vaccine delivery plan as well as a vaccine surveillance strategy. PHE will monitor vaccine effectiveness at preventing both symptomatic and severe disease and at reducing infection and transmissibility. This will be accounted for across multiple different sub-groups including age (and other clinical risk factors), viral variants, number of doses administered, timing of doses, and the comparative effectiveness of different vaccines in the real world. The BMA has produced a summary about the vaccine surveillance strategy.
The CQC has confirmed in a letter about the administration of the Pfizer-BioNTech Covid-19 vaccination that adhering to ‘appropriate, authoritative guidance’ such as JCVI/CMO national guidance on vaccinations ‘is considered to be entirely appropriate’. Similarly, in the attached letter the GMC advised: ‘were a complaint to be received in the future where the sole concern was about a doctor having administered a vaccine in line with the recommendations of JCVI and the four CMOs it seems highly unlikely that this would raise any fitness to practise concerns about the individual’.
The BMA’s guidance on the COVID-19 vaccination programme has been updated to include the national protocols for both vaccines, the updated joint document on workload prioritisation, funding to support rapid care home vaccination, in addition to the other recent information about how access to vaccines for all frontline health and social care workers, and further support to enable practices to prioritise vaccine delivery.
Supporting doctors throughout the second COVID-19 wave (UK)
The four Chief Medical Officers, NHSE/I, The General Medical Council and The Academy of Medical Royal Colleges have written a letter to doctors on working through the second wave.
Workload prioritisation: Level 4 or 5
We have updated our joint guidance with RCGP on workload prioritisation for primary care, which sets out what practices should consider doing are in a national lockdown, to help practices during the immense workload pressures are currently under. This is in addition to the set of further measures that we agreed with NHSE/I to help and support practices.
Update on CQC’s regulatory approach
Following our call on CQC to suspend routine reviews they have now published an update on their regulatory approach during the pandemic, which states:
‘For primary medical services we will only inspect in response to significant risk of harm – including concerns raised by people working in services and people using them – and when we cannot seek assurances through other routes. If an inspection is necessary, we will carry out as much activity off-site as possible’
Guidance for clinically extremely vulnerable (CEV) patients
Following the introduction of another national lockdown, the Government will be sending a letter with updated guidance to all clinically extremely vulnerable people, which again advises to take extra shielding measures to protect themselves, until at least 21 February 2021. The Government has also extended the offer of a free 4-month supply of vitamin D supplements for all adults who are clinically extremely vulnerable to support general. Access their updated guidance for clinically extremely vulnerable people
GP practices continue remain open and whilst remote consultations should be the main way in which patient care is delivered, when it is clinically necessary to see vulnerable patients face-to-face they would normally be expected to attend the surgery. Read our updated guidance.
COVID PPE scheme extended until June 2021
The Government has announced that it is extending the provision of free COVID-19 PPE for all health, social care and public sector workers, until at least the end of June. This will ensure frontline and wider public service workers can continue to access rigorously tested and high-quality PPE.
Practices should continue to access COVID-19 PPE via the PPE portal.
The BMA has also called for enhanced and more appropriate PPE to be made available to staff in all healthcare settings, in a letter to the Government’s health minister for prevention, public health and primary care Jo Churchill, and a letter to Public Health England. Read more here
Vote on future negotiations on the PCN DES and PCN survey results (England)
We would like to remind you that the vote of the profession as to whether GPC England should continue negotiations on the PCN DES is open until 23:59 on Tuesday 19 January (the vote is open to all GPs in England, regardless of contractual status (partner/sessional/trainee) or BMA membership status.
The ballot has been designed with the agreement and in careful collaboration with GPC England and the LMC England conference chair and agenda committee, as well as in consultation with the BMA’s internal experts on survey design. Read more about the vote here
Pulse oximetry guidance update
The guidance for pulse oximetry to detect early deterioration of patients with COVID-19 in primary and community care settings has been updated. Pulse oximeters can be used as a tool for patients most at risk of poor outcomes from COVID-19. It is used to identify oxygen levels and warn the patient to the risk of ‘silent hypoxia’ and rapid deterioration at home.
Pre-registration for offenders leaving prison
The contractual requirement of the General Medical Services (GMS) Contract 2017/18 (page 64) to accept patients from the secure estate prior to their release has increased importance during the COVID-19 pandemic. Among other benefits, pre-registration may help the smooth rollout of the COVID-19 vaccine. For individuals leaving the secure estate between the first and second doses of their vaccination who have been registered with a community GP, their GP record will be updated with their vaccination status. GP practices are asked to ensure that processes are in place to meet this contractual requirement, with information on how to do this here.
NHSE/I legislative proposals on Integrated Care Systems (England)
The BMA has responded to new legislative proposals put forward by NHSE/I, which would see ICSs (Integrated Care Systems) made statutory bodies and could dramatically alter the role of CCGs.
In the response, we are critical of the manner in which the consultation has been carried out but also examine the potential implications of the proposals which, we believe, are currently incapable of delivering the integrated and collaborative NHS that staff and patients need. We have also set out where we believe further changes have to be made - both to the proposals and to the present system itself - including highlighting the need for strong clinical voices within ICSs and for the NHS to be made the preferred provider of NHS services, for example. We have been clear about the fundamental importance of the independent contract system for general practice and of the role of LMCs as the representative of all GPs in an area.
The response is now available on the BMA website here and should you have any questions regarding it or the proposals themselves please contact info.policy@bma.org.uk
Lateral flow test ordering (England)
To ensure that the correct quantities of lateral flow test boxes are delivered to primary care contractors, and that there are enough tests to distribute among staff, any contractors who have placed an order of over 100 test boxes on the PCSE portal have been contacted to confirm, as soon as possible, the number of patient-facing staff and therefore the correct number of boxes of tests they wish to receive, to avoid any delays to deliveries.
Practices who have not yet placed their order, should log onto the portal and complete their order by COP Sunday 17 January to start to receive deliveries from the following week.
Fit notes (med 3)
GPs are reminded that they are still required to issue fit notes (med 3) as normal. There are specific scenarios relating to COVID-19 where patients can use the isolation note service, instead of seeing a GP, as outlined below. Please do not signpost patients to NHS 111 in order to get a fit note as they are not provided by the service. During the pandemic DWP is encouraging employers to use their discretion as to what medical evidence is required to support periods of sickness absence.
Previously advice was issued on issuing fit notes (med 3s) remotely during the pandemic, which remains in place until further notice. A properly signed and scanned fit note sent via email to the patient will be regarded as 'other evidence' and will be accepted by DWP for benefit purposes. Not signing fit notes can mean that they are rejected by employers and DWP, so we have been asked to remind GPs that fit notes must be signed. The original hard copy does not need to be retained if there is an electronic copy of the fit note in the medical record.
If the patient is unable to receive their fit note electronically, they will be required to collect a hard copy from the practice or it will posted to them, at the practice’s discretion. Isolation note service:
The isolation service does not provide fit notes (med 3s). It is an automated service that can be used to provide evidence of the need to self-isolate by those who:
- Have symptoms of coronavirus
- live with someone who has symptoms of coronavirus
- are in a support bubble with someone who has symptoms of coronavirus
- have been told to self-isolate by a test and trace service
It can be used to cover continuing periods of isolation if patients still have symptoms or develop new symptoms following their initial isolation period.
GP Trainee by-election
The GP Trainee Committee are seeking nominations for the position of Lancashire representative.To be eligible to stand in this election you must be training in the Lancashire region. To submit your nomination, please login to the BMA’s election system. The deadline for nominations is 12pm Tuesday 19 January 2021.
To find out more about the committee please visit their webpage or contact gptrainees@bma.org.uk with any specific queries. If you have any queries regarding the election process, please contact elections@bma.org.uk
COVID-19 media
The Guardian reported Sir John Bell, a leading immunologist, said that the NHS could vaccinate the entire population in five days but is being hampered by NHS bureaucracy. In response, I commented: “Doctors and their colleagues across the NHS want to get these vaccines into the arms of as many people as possible as quickly as they can. However, this crucially relies on supplies, which are nowhere near the levels they need to be yet. Meanwhile, the NHS has for too long been plagued by bureaucracy, and we need a drastic slashing of red tape to ensure that everyone who can safely administer vaccines, and is willing to help with the effort, is allowed to do so.”
I discussed the progress of the vaccine rollout via large scale vaccination centres on Channel 4 News, ITV Calendar News (Yorkshire), and BBC Radio York about the BMA’s concerns around access for elderly people, who want and need local vaccination sites to be available. I argued in the Yorkshire Post that GPs are generally better-placed to deliver community vaccinations than pharmacies, provided that sufficient supplies can be delivered safely and on time. I was also quoted in the Yorkshire post, where I said that current GP-led sites are well placed to administer the vaccines but the number of available doses is the main issue now holding them back.
I was interviewed on BBC Radio Leeds (at 17.14) about NHS pressures and its impact on healthcare workers, and the need for support for them. I also commented on the issues with the Pinnacle IT system in the Daily Telegraph (print version only, 11 January), where I said that the Pinnacle software was all too often running slowly or crashing, and failing to link properly to the existing EMIS and SystmOne, so adding unnecessary delays and work in to the system.
BMA Welsh Council chair David Bailey spoke to LBC radio (from 07:15) to discuss the problems with vaccine delivery in Wales. “We want to see deliveries coming out, we’ve had deliveries cancelled this week to practices which has caused concern, but in terms of the ambition to deliver first doses to all the outlined priority groups - we’re fine with that.”
Welsh GPC chair Phil White was featured on BBC Wales Today (from 05:00), also discussing vaccine rollout. He said: “We had an agreement with welsh government of how this would progress and then of course, many practices have been promised some vaccines and then either received much less than expected or none at all.”
NIGPC chair Alan Stout was interviewed on Good Morning Ulster (from 1:09) about the publication of the DH’s phased plan for the COVID vaccination programme. He said: "We made some very sensible early on based around the vaccines themselves. We took the really difficult decision to focus on the care homes. The trust teams have done unbelievably well and now we're 90% vaccinated." NI GPC deputy chair Frances O’Hagan was interviewed on Good Morning Ulster programme (1:47:16) about the commencement of the AZ/Oxford vaccination programme
Read the latest GP bulletin here
National lockdown, workload prioritisation and vaccination of healthcare professionals (England)
The BMA believes the right decision was made to introduce the third national lockdown in England, announced by the Prime Minister earlier this week, which comes at a time of immense workload for doctors. Practices must continue to be supported, in particular with shielding having been reintroduced, and all healthcare professionals must receive the COVID-19 vaccine as soon as possible to be protected so that they can continue to provide a service to patients.
As the workload pressures caused by the pandemic grow, and as practices engage in the COVID vaccination programme practices will need to prioritise their work. We have now agreed with NHSE/I further measures that help with this, and which are outlined in a letter published yesterday, and which I referred to in an interview this morning on the BBC Radio 4 Today Programme (starting 1 hour 21 mins in). This includes income protection for QOF QI and prescribing indicators, meaning the vast majority of QOF is now income protected, income protection for minor surgery for this quarter, a direction to CCGs to suspend LESs and to take a supportive pragmatic approach to contract management, and crucially, providing additional funding to support the work of PCN clinical directors and those who have worked so hard in the initial delivery of the COVID-19 vaccination programme, with an increase in payments from 0.25 WTE to 1 WTE for those PCNs where at least one practice is taking part in the vaccination programme. This follows the additional £150m secured in November to support practice workforce expansion.
In addition, the BMA and RCGP published guidance on workload prioritisation for primary care, published earlier in the pandemic, continues to be a useful resource and sets out what practices should consider doing now that we are in a national lockdown. This guidance followed the joint guidance with the RCGP published at the start of the pandemic, on workload prioritisation for clinicians in general practice during COVID-19.
The JCVI and NHSE/I have advised in their recent communications, that vaccinating all healthcare professionals is a priority and whilst hospital hubs have been tasked with doing this practice sites can also do this when asked alongside those in their 80s (or those 75 and above once that older cohort has been covered). NHSE/I also published an update yesterday which provides additional operational guidance on the immediate requirement to vaccinate frontline health and social care workers. Practices should ensure locum GPs they are in regular contact with are invited for vaccination either via hospital hubs or by the practice itself. Additionally, any healthcare staff who self-identify with their own registered GP practice should be vaccinated as per the JCVI guidance above. LMCs should work with other contractor bodies, such as their respective LPC, LDC and LOC, as well as their CCG, to ensure all community based healthcare workers are given the opportunity to be vaccinated as soon as possible. It is essential that this is now operationalised and for the vaccine to be readily available to all healthcare staff in primary care.
Lockdown in Scotland
Lewis Morrison, Chair of BMA Scotland, has written a blog about the new lockdown restrictions in Scotland that were introduced from 5 January. Mainland Scotland will move from Level 4 to a temporary Lockdown, with new guidance to stay at home except for essential purposes.
COVID-19 vaccinations programme
This week I have met with the CMO in England, Prof Chris Whitty, Sir Simon Stevens and Prof Steve Powis, NHSEI medical director, to discuss the crucial role general practice is already playing in the COVID vaccination programme. It was good to see, following the MHRA authorisation of the AstraZeneca (Oxford) COVID-19 vaccine for use in the UK, the vaccine rolled out to practice sites this week, following the initial use in hospital hubs. We are also pleased to see NHSE/I confirm that this vaccine can, with appropriate cold-chain requirements, be transported from designated sites to other practices. We believe this will both improve access to vaccinations for our patients and significantly speed up the delivery of the programme, particularly as more vaccine becomes available. It is imperative though that once vaccine is available it is given to patients as quickly as possible.
NHSE/I stated in a letter on the 30 December on the next steps for COVID-19 vaccination that the second dose of the Pfizer BioNtech vaccine should be given 12 weeks after the first dose. This followed a letter to the profession by the four CMOs in the UK. The JCVI has also published a statement about prioritising the first dose.
This decision has had a significant impact for many practice sites, with staff working hard to re-book the appointments of thousands of elderly patients and at-risk healthcare workers. This was in addition to the need to reschedule many vaccination sessions due to changes in vaccination delivery for some sites. In a statement released last week, and in conversations with NHSE/I, I made it clear how difficult this would be at such short notice not least over the New Year Bank Holiday weekend. NHSE/I have subsequently put in place a national call centre that can be used to support practices with rebooking appointments and provided £1000 for sites in recognition of this additional workload. Read my recent message about the COVID-19 vaccination developments here
The COVID-19 local vaccination services deployment in community settings Standard Operating Procedure has been updated to reflect the addition of the AstraZeneca vaccine and the change to the second dose.
NHSE/I has also amended the Enhanced Service specification to permit the vaccination of unregistered frontline health and social care workers as well as those who are registered with a practice outside of the PCN grouping and to reflect the JCVI guidance on administration of the second dose, with the item of service payment now to be paid per dose.
The Patient Group Direction for the Pfizer vaccine has been amended to permit the drawing of 5 or 6 doses from the vial, and the administration of a potential sixth dose is now covered within the PGD. All the NHSE/I guidance about the COVID-19 Vaccination programme can be accessed here.
NHSE/I has started publishing weekly data report showing the number of COVID-19 vaccinations provided by the NHS in England. The latest figures (7 January) show that a total of 1,112,866 people have received an NHS vaccination since 7 December when vaccinations began.
The PGD for the AstraZeneca (Oxford) vaccine and guidance about the movement of the AZ/Oxford vaccine have now been published. The Green Book chapter about COVID-19 has also been updated to include advice about the AstraZeneca (Oxford) vaccine. Unlike with the Pfizer/BioNTech vaccine, there is no requirement for 15 minutes observation after administering the AZ/Oxford vaccine unless this is indicated after clinical assessment.
The BMA’s guidance on the COVID-19 vaccination programme has been updated to include information about the changes to the dosing schedule, transitional arrangement for second dose appointments, approval of the Oxford AstraZeneca vaccine and the ability for practices to transport and administer it from sites other than the designated site, access to vaccines for all frontline health and social care workers, and further support to enable practices to prioritise vaccine delivery.
Vote on future negotiations on the PCN DES (England)
Following a resolution of LMC England conference in November, we have emailed the profession to vote as to whether GPC England should continue negotiations on the PCN DES. The ballot has been designed with the agreement and in careful collaboration with GPC England and the LMC England conference chair and agenda committee, as well as in consultation with the BMA’s internal experts on survey design.
We know that this is currently an extremely busy period for all in general practice, however we would encourage as many GPs as possible to participate as this will have a direct influence upon negotiations and funding available for the 2020/21 contract and beyond. The vote will run until 23:59 on Tuesday 19th January and is open to all GPs in England, regardless of contractual status (partner/sessional/trainee) or BMA membership status. Read more about the vote here
To help inform your decision we’ve published this attached short briefing on the vote and the PCN DES.
PCN Clinical Director Survey Results
At the end of last year we conducted our second annual survey of PCN clinical directors. We have now published the results of the survey of PCN Clinical Directors.
A significant number of clinical directors responding were confident that by 2023/24 PCNs will have contributed to providing better support for patients in care homes (66%), increasing the wider GP workforce (59%), improving the quality of prescribing (57%), delivering new services (49%), and better collaborative working between general practice and community care (49%). 44% of clinical directors think that provision of adequate funding is the most important condition for the success of PCNs with the second most highly ranked option being the availability of the GP workforce (20%), followed by the need for adequate premises (17%).
The results of the survey also revealed that not surprisingly both PCN clinical directors and member practices are still facing a high level of workload which they are managing with increased difficulty, and which is also having an impact on workforce morale across their network. 59% of clinical directors class their workload as manageable with difficulty while 27% have indicated that their workload was not at all manageable. The announcement this week of additional funding for clinical directors involved in the COVID-19 vaccination programme is therefore a welcome step in recognising this.
Domestic abuse letters
The BMA believes that there is no need for medical involvement in the process for gaining access to legal aid for domestic abuse victims. We feel that such requests can compromise the relationship between doctor and patient, and that legal aid agencies should take the word of victims without needing to consult a GP – who themselves may not be best placed to confirm whether domestic abuse has occurred. This is a position we continue to make clear through our input into the Government’s ongoing review into bureaucracy in General Practice.
While these letters are not funded by the NHS contract and practices are able to charge patients a fee for their completion, the BMA recommends that they do not. Ultimately, however, this is at the practice’s discretion.
Home delivery of medicines and appliances (England)
Following the announcement of the national lockdown, NHSE/I will be commissioning the Home Delivery Service of medicines and appliances again for those identified as clinically extremely vulnerable (CEV) on the shielded patient list until 21 February. If friends and family are not able to collect medicines for CEV people, and it is not possible to arrange a volunteer, then CEV patients will be eligible for free medicines delivery.
Read more in the letter announcing the service published this week.
BMA Law partnership webinar
BMA Law’s specialist solicitors hosted a webinar in December covering every aspect of partnership agreements and why they are vital to protecting your partnership. From the perils of partnership at will to last man standing and green socks clauses, this webinar outlines why you need a partnership agreement, how often you should update it, and the common pitfalls to avoid when drafting one. Access a recording of the webinar here
GPDF response to ICS Consultation
Please see the response to the Integrated Care Systems Consultation together with the initial letter sent to NHSE/I and the reply received on 31 December. The BMA response will be available shortly.
GP Trainee by-election
The GP Trainee Committee are seeking nominations for the position of Lancashire representative.To be eligible to stand in this election you must be training in the Lancashire region. Please email elections@bma.org.uk if you are training in a different region to where you are listed on the member register.
To submit your nomination, please login to the BMA’s election system. The deadline for nominations is 12pm Tuesday 19 January 2021.
To find out more about the committee please visit their webpage or contact gptrainees@bma.org.uk with any specific queries. If you have any queries regarding the election process, please contact elections@bma.org.uk
The GP International Induction and Return to Practice Programmes
The GP Induction & Refresher Scheme has been rebranded as two separate programmes. All the features of the previous scheme have been retained but are now divided into distinct programmes:
Condolences
On behalf of the profession I would like to offer our condolences and pay tribute to two dedicated and courageous GPs who have died in the last month. Dr Augustine Obaro, was a GP in Walthamstow, and died on New Year’s Day, and Dr Abdul-Razaq Abdullah, 68, was a GP in Rainham, and died on 8 December. They will be missed not only by their family, friends and colleagues, but also by their patients to whom they dedicated many years of service and care.
COVID-19 media
In response to the news about the Oxford AstraZeneca vaccine and that doctors would be expected to cancel appointments for patients to have their second dose of the Pfizer vaccine, the BMA re-issued our call for radical action to speed up vaccine delivery. Chaand Nagpaul, BMA Chair of Council, was interviewed on Sky News (see a clip on Twitter), The Independent and The Telegraph. I have spoken to Times Radio, the Daily Telegraph, BBC Online, MailOnline, The i paper, the Metro, The Standard, Management in Practice, and Medscape. I also appeared on LBC where I said: “The chief concern we had was that on New Year's Eve we were given this indication that there would be a change in the arrangements just a few days before our patients were expecting their second dose and there was simply not enough time nor the important information available to us to understand the change and then to inform our patients appropriately.”
I responded to news that the NHS will have to deliver at least two million vaccines a week from next week if the Government's pledge to vaccinate all four high-priority groups (13.8m people) by mid-February is to be achieved. My comments were picked up by BBC News and the Guardian, where I said: “As long as we have the vaccines we can give it to them in a matter of days so [delivery] is primarily down to the supply. Within weeks we should have supplies to get the first dose into all care home residents.” This was also reported by the Guardian, twice, Sky News, Telegraph (behind a paywall), Daily Mail, Guardian, and Telegraph.
I spoke about the vaccine rollout on BBC Leeds (around 7.10am), talkRADIO (starting around 7.10am), BBC 4 Today (starting around 1h20 mins in), and BBC Look North. In a statement, I said: "To focus on the huge task at hand of vaccinating millions of people over the next few weeks and months, and at time of rising Covid-19 prevalence, GPs need to be given the flexibility to prioritise their workloads, and we are glad that NHS England has listened to and worked with the BMA by releasing guidance clarifying what services can be paused, and making further commitments for income protection to ensure practices can focus on the most important priorities." The story was also covered by GP Online and Pulse.
Dr Nagpaul was also quoted by the Daily Mail and GPonline about the need to vaccinate healthcare professionals.
David Bailey, GP and Chair BMA Welsh Council, appeared on BBC Radio Wales to discuss the latest developments in the Covid-19 pandemic. He said: “It’s important that people do listen to the rules, when we can see some light at the end of the tunnel and a vaccine in the coming months it's just selfishness to continue to break the rules. We’ll start to come out of this crisis over the next few months, but there is a new mutant virus out there and we know it is more transmissible so we need to continue to protect the NHS and make sure we don’t overwhelm our intensive care units.”
Sara Bodey, member of GPC Wales, took part in a panel discussion on BBC Radio Wales Sunday Supplement (from 33 mins) to talk about a year of online consultations and the upcoming vaccine rollout. She said: “In Wales it’s been left to health boards to organise the vaccine programme, GPs undoubtedly will be involved but the exact way that will work isn’t fully clear on the ground yet. We’re juggling our normal workload, combined with staff health concerns, so there are definitely capacity issues and concerns over the rollout in the next couple of weeks.”
In response to the gap between the first and second dose of the Pfizer vaccine, BMA Scotland council chair, Lewis Morrison, said there was "clearly disagreement" among experts on the decision to delay the second dose, with his comments picked up by the Mirror and BBC News. The importance of delivering the vaccine in Scotland was also covered by the Telegraph, as GPs urge the public to help the rollout by limiting non-urgent appointments.
Read the latest GP bulletin here
As we approach Christmas and the end of this dreadful year, I again want to thank you, and the team you work with, for all that you have done for your patients and your colleagues. Through the hard work and dedication of thousands of GPs, nurses, healthcare assistants, reception staff, practice managers, administrative and support staff, LMC officers and now increasingly joined by pharmacists, physios, paramedics, social prescribers and other healthcare workers, General Practice has been open throughout the pandemic, supporting and caring for so many of our patients at this time of significant need. We can be proud of the role that we have played responding to the challenges that COVID-19 brought.
It's been a tough and tiring year, one that has left so many of us physically and mentally drained, and sadly also a year when we lost some of our valued colleagues to this terrible infection. Caring for one another has never been more important and if you need help at any time, your LMC and the BMA are here for you.
We can though start to hope that the New Year will be better, with general practices across the country working together and taking a leading role in protecting our patients through the COVID vaccination programme. Within just a week we will have provided the first vaccination for hundreds of thousands of our most vulnerable patients, a world class achievement from a world class GP service.
Whilst many will be working throughout the Christmas and New Year period, I hope that you do have some time to rest and relax.
On behalf of the GPC UK team, thank you again for all that you have done, and for all that you will do in the coming year.
Roll out of COVID-19 vaccination programme (England)
As even more areas of England move in to the strictest (Tier 3) restrictions, amidst an alarming rise of COVID-19 cases in these areas, we are pleased that the first wave of practice group sites have started to vaccinate eligible people (those aged 80 and over, care home workers and residents and some healthcare workers) this week. This is an incredible achievement, especially given the speed of the roll out and many practical hurdles that practices have had to overcome and we would once again like to thank all those involved.
With such a major and complex logistical operation it was always going to be challenging getting so many sites up and running and supplied with vaccinations. We know that many people have spent many frustrating hours and had long days to prepare for this programme. We have been in regular contact with NHSEI throughout to help resolve issues as quickly as possible. We have also seen a lot of feedback that the staff involved have been really encouraged by the many appreciative patients, many of whom who have been self isolating for most of the year, who are so pleased to be able to receive their first dose of vaccine and make the first important step towards some degree of normality.
Following BMA advice, NHSE/I has updated the collaborative agreement to strengthen the indemnity and information sharing sections. NHSE/I and Public Health England have also issued a Patient Group Direction which practice groups are now using, and therefore will not need to use the Patient Specific Direction that hospitals had to use in the initial phase. More information about using PGDs and PSDs is available on our website. Today the government has issued the National Protocol for COVID-19 mRNA vaccine and this will allow vaccination sites greater flexibility. All the NHSE/I guidance about the CVP can be accessed here.
Read our guidance about the COVID-19 vaccination programme.
Patient videos in different languages for COVID-19 vaccination programme
Colleagues in West Yorkshire have produced some short videos in alternative languages to help people understand more about the coronavirus vaccine and what it means for them. These are recorded by GPs and are based on the patient leaflets produced by Public Health England to make sure patients get consistent information. The videos, available on YouTube, are aimed at helping people over the age of 80, for whom English may not be their first language, have the right information about the vaccine in a way that is meaningful and easy to understand.
It is hoped that these videos will help to reassure and encourage our BAME communities to take up the offer of the vaccine when invited. At the moment these videos are available in English, Pashto and Urdu, but they are hoping to release other languages soon. Please share them with relevant patients, and local communities, who are being invited for the vaccine.
Media
There was extensive coverage of GP practice teams rolling out the Covid-19 vaccination, centred on GPs' readiness to administer it swiftly and safely but also voiced concerns (Daily Mail) about prioritisation and logistics. I was quoted in the BBC On-line feature on vaccines, and interviewed by Sky News and BBC Radio Humberside saying that doctors stood ready to start the unprecedented roll-out but were concerned about the huge range of logistical difficulties involved.
Dr Helena McKeown, chair of the BMA representative committee, was interviewed on BBC South West outlining how the roll-out was being planned in her local area.
Inews featured a story about concerns about issues over the IT system that alerts GPs to whether their patients have had the first dose of the Pfizer/BioNTech vaccine in a hospital, with quotes from Drs Zoe Norris, Peter Holden and Jackie Applebee. Inews ran a further story about IT system problems, and I said “When practices have pulled out all the stops to ensure they’re ready to begin vaccinating their patients in such a short timeframe, it is frustrating to hear reports of IT problems and delayed deliveries of equipment.”
The Times (subscription required) reported that some GP practices have had to delay vaccinating patients after vaccine and other stocks failed to arrive at sites. In response to this I said: “When practices have worked so hard to get prepared in such a short period of time, it is frustrating to hear reports of some vaccine deliveries being delayed, and of sites being stood down from the next wave of the programme. It will be particularly concerning for some patients who will have had appointments rescheduled and those same patients will be understandably disappointed. We always knew that delivering such a large programme would not be without its challenges in the early days.”
Support for University Practices (England)
Due to the impact of the pandemic on universities, some practices with a significant proportion of patients being university students have been impacted by a reduction in registrations. This has meant the global sum and other income is much lower than normal and yet the running cost for these practices remains the same.
Following GPCE intervention, NHSE/I has released guidance that CCGs must review such practices and where there is a significant reduction in their global sum (suggested to be greater than a 2% reduction), then the CCG should protect that income. CCG allocations are based on a whole year assumption of patient registrations per practice, so they already have the additional funding within their allocations for this.
The attached guidance has been sent to Heads of Primary Care and CCGs to provide a framework for supporting such practices and we are sending on to such practices for information. All practices with a significant university student population should contact their CCG to seek the support they need, including back-payments to cover the period from when registrations dipped.
Supporting General Practice – additional £150 million of funding
Last month, NHSE/I wrote to practices and CCGs regarding £150 million of additional, non-recurrent funding which practices should now be receiving. Since then, we have been contacted by GPs asking us to clarify elements of the scheme and how it fits with other schemes:
Lateral flow antigen testing in primary care (England)
Practices will this week receive notification of the availability of lateral flow antigen testing kits which will be rolled out to regularly test asymptomatic patient-facing staff delivering NHS primary care services in England. Patient-facing staff will be asked to test twice a week using self-administered nasal swabbing and report their results through an online platform, and any positive lateral flow antigen tests will need to be followed up by a confirmatory PCR test. It is voluntary for practices and individuals to take part in this, and is not a contractual requirement, however, if you do start testing, it is a statutory requirement to report all of your results.
Primary care contractors will receive an invitation to order lateral flow testing devices directly from Primary Care Services England (PCSE), who will be managing the ordering and delivery process.
Following receipt of an invitation, practices should log on and complete their order by Wednesday 30 December.
This letter from NHSE/I has further information on how to order and receive deliveries of lateral flow antigen testing kits for staff. Standard Operating Procedures and guidance for staff self-testing have also been published.
We are producing guidance on this, which will be published shortly. In the meantime, find out more in this blog by Mark Coley, member of the Sessional GPs committee.
Guidance for claiming reimbursement for PPE
The guidance for claiming reimbursement for PPE for non-hospital providers, including general practice, has now been published. Claims may be made for COVID-19 PPE purchased from 27February to 31 December 2020 for use in delivery of NHS clinical services. There will be no further entitlement to reimbursement for PPE purchased after 31 December 2020 as this can be obtained free of charge from the DHSC portal.
Upcoming vote on future negotiations on the PCN DES (England)
Following a resolution of LMC England conference in November we will shortly be seeking a mandate from the GP profession on whether GPC England should continue negotiations on the PCN DES. This will be open to all GPs in England and will take place in January. We know that this is currently an extremely busy period for all in general practice, however we would encourage as many GPs as possible to participate as this will have a direct influence upon negotiations and funding available for the 2020/21 contract and beyond. Further information on the vote will be sent out early in the new year.
AISMA and ICAEW joint statement about account issues for PCNs (England)
In order to assist PCNs to have a better understanding of the obligations to prepare statements of account to ensure tax and pension liabilities are dealt with correctly in their member practices, AISMA and the ICAEW have jointly prepared the attached information.
New portal for PCN Additional Roles Reimbursement Scheme claims (England)
NHSEI have launched an online portal to allow PCNs submit to submit claims for reimbursement for roles claimed under the Additional Roles Reimbursement Scheme. This will go live later today. It has been created to allow PCNs to submit their monthly claims through the portal; and CCGs to approve/reject claims forms through the portal
The portal has been designed with PCNs and CCGs and will support a more streamlined approach for submission and approval of additional roles claims. This page on FuturesNHS provides further information on the process and the new portal, as well as guides to help users start to use the new process, FAQs to support with the most common questions and also a video to help guide both PCNs and CCGs through the new process. They are also in the process of adding a link to the portal claim form on the NHS website, so it sits alongside the existing excel claim form. PCNs will be able to use either the portal or manual excel claim form.
Falsified Medicines Directive update Now the UK has left the EU and the Transition Period ends on 31 December 2020, the ‘safety features’ elements of the EU Falsified Medicines Directive cease to have effect in Great Britain. However, certain EU legislation will continue to have effect in Northern Ireland under the Northern Ireland Protocol. See an update on this issue which is also available on our website.
EU Exit: Medicines Supply in Primary Care - Joint statement by the BMA and PSNC
The UK will leave the EU Single Market on 31 December and as we reported last week, the Chief Pharmaceutical Officer has reminded primary care providers of the need to avoid local stockpiling of medicines. This message extends to patients.
National plans are in place seeking to ensure continuity of supply, and GPs and pharmacists are encouraged to reassure patients that they do not need to order extra medication as this could contribute to or cause supply problems. Additionally, NHSE/I have said that prescription durations will be monitored and investigated where necessary - the aim is to keep prescribing and dispensing as close to business as usual as possible.
The DHSC’s work in this area is supported by the Medicines Shortages Response Group which advises, for example, on whether the development of a Serious Shortage Protocol (SSP) would be beneficial to help mitigate a shortage. See more information about medicine shortages procedures here
We are in regular contact with DHSC on medicines supply and will continue to monitor the situation and resolve any issues as they arise. However, should there be any disruption to medicines supply next year, GP practice staff and community pharmacy teams will need to work together to make sure that all patients continue to have access to the medicines they need, when they need them.
Community pharmacies will do all that they can to ensure that patients do have access to the medicines they need. These efforts may include phoning around suppliers, ‘staged’ dispensing, or considering potential alternative treatments. GPs will continue to liaise with pharmacies on this as necessary. Medicine shortages can bring additional workload to both GPs and pharmacists, but collaborative working at a local level is essential to maintain patient care.
BMA and RCGP statement on ‘Cancard’
Some concerns have been raised by practices about the Cancard UK website and its proposed ‘GP endorsed’ ID card. The website offers the ability to apply for: ‘A holographic photo ID card. Designed in collaboration with GPs and verified at the patients surgery. The card is for people who qualify for a legal prescription but are unable to afford one.”
Applications are said to have opened on 1 November 2020. The Medicinal Cannabis holographic photo ID card is being offered by Cancard UK to patients who meet the following criteria:-
- Have a diagnosis (confirmed by their GP) that is currently being prescribed for privately.
- Have tried two types of prescription medication or have discussed and discounted these options based on side effect profile or dependence concerns.
- Are unable to afford a private prescription.
- Are required to be in possession of a small amount of Cannabis in order to manage their symptoms.
- Are at risk of criminalisation.
The BMA and RCGP supports the use of ‘cannabis-based products for medicinal use in humans’ under the supervision of specialist clinicians or prescription of MHRA authorised licenced products by doctors who have the necessary clinical experience and competences.
These products must have been produced in accordance with the necessary standards for the production of medicinal products in the UK in order to ensure their safety and authenticity. We also support the call for further research into the safety and potential indications for use of these medical products.
The BMA and RCGP cannot however support the use of the Cancard, nor the suggestion that UK registered GPs sign a declaration confirming a diagnosis in order for the card to be issued.
The Cancard UK website states that the Cancard has been designed in collaboration with GPs, but neither the RCGP nor BMA have been formally consulted or given endorsement.
Whilst we sympathise with patients who struggle to pay a private prescription charge, we do not believe that this is a justifiable reason to encourage the purchase of unregulated unlicensed cannabis products from unregulated or illegal dealers.
If a patient is deemed to meet the criteria for an NHS prescription for an MHRA authorised prescriptible product then this may be issued where appropriate. Those patients on low incomes or with medical conditions qualifying for prescription charge exemption will be exempt from prescription charge in line with current regulations.
Read the BMA guidance on Cannabis-based medicinal products here
Read the RCGP clinical guidance Cannabis-based medication: an interim desktop guide
Parental leave webinar and workshop
The videos from the recent parental leave webinars sessions are now available – watch Session 1 and Session 2. Access the BMA guide for GPs on maternity and other types of parental leave here
Gender Pay Gap in Medicine Review
The Gender Pay Gap in Medicine Review has been published this week. It is the largest review of gender pay gap in the public sector and involved interviews, online surveys and the examination of doctors' pay via ESR (electronic staff records) and HMRC returns. A steering group oversaw the review, chaired by Prof Jane Dacre, with representation from the BMA as a key stakeholder. The government has now also committed to the formation of an Implementation Panel moving forwards.
The GPC’s Education, Training and Workforce group has been considering how to address gender pay gap in general practice, and there will be a series of webinars and work streams to help support this.
Launch of the Institute of General Practice Management (UK)
The Institute of Institute of General Practice Management (IGM) was launched this week, with the aim of being recognised as the professional body that represents all managers working within general practice in the UK. The BMA has had initial discussions with members of IGPM and will be building on this in the future about supporting General Practice. Read more in this communication about the formation of IGPM.
COVID-19 media
Dr Phil White, GPC Wales chair, took part in Dros Ginio on BBC Radio Cymru (from 1m10s) to talk about post-Christmas restrictions in Wales to try to reduce transmission amid worries about the severe pressures on the NHS.
BMA NI council chair, Dr Tom Black, was interviewed on RTÉ Radio One’s Drivetime (1:40:32) about the end of the two week circuit breaker in Northern Ireland coinciding with a rise in COVID-19 cases. He was also interviewed in the Belfast Telegraph and quoted in Suzanne Breen’s Sunday Life column about the high likelihood of a surge in COVID cases over the Christmas period, and interviewed in the Belfast Telegraph about fears for Northern Ireland medical shortages in the event of a ‘No deal’ Brexit.
Northern Ireland Executive has announced a six-week full lockdown from Boxing Day, to which BMA Northern Ireland released a short statement. NIGPC chair Alan Stout was interviewed on the Nolan Show (21:55) about the need for personal responsibility in stopping the spread of covid-19. He also took part in a Belfast Live Facebook Live interview on what the families can do over Christmas to keep themselves safe from the virus.
See this week’s GP bulletin here
Read the latest Sessional GPs newsletter here
COVID-19 vaccination programme (CVP) implementation
After such a terrible year, it is really good news to see the COVID-19 vaccination programme up and running. This is a massive achievement and I wish to thank all those involved in getting to this stage, not least the many hundreds of practices working through over 200 designated wave 1 practice group sites that start vaccinating their patients next week. They will be rapidly followed by wave 2 and 3 in the coming days enabling thousands of our most vulnerable patients to begin to be protected from this dreadful infection.
NHSE/I has written to the initial sites to set out the requirements, and have said they will be given full support to mobilise within the timescale. They have also outlined all the equipment that will be provided free to designated sites, in addition to the £20m provided to cover other additional costs. This followed the publication of an updated version of the Enhanced Service Specification for the delivery of the CVP, to include modifications following discussion with MHRA and to ensure patients from non-participating practices can be provided vaccinations. There will be further updates to reflect the new requirement by MHRA for a 15 minute observation period following giving the vaccine. We would expect CCGs to work with and support practice groups should there be a need to review the premises arrangements to accommodate this new requirement.
NHSE/I has published a collaborative agreement for the use by practice groups, which our legal team has reviewed further. We are liaising with NHSE/I to make amendments to the data sharing and indemnity sections of this agreement so that they provide more security for practices, and it will therefore be re-published very shortly. It remains a template that practices could adapt further if they wanted to, but we hope that following our legal review this will not be necessary. In addition, they have also produced a document outlining the legal mechanism for the administration of COVID-19 vaccines as it was necessary for the hospital sites to use a Patient Specific Direction rather than a Patient Group Direction to support the initial vaccination process. However, NHSE/PHE have now issued a PGD which practice groups can use, and therefore will not need to use the PSD. There are also accompanying letters that responds to many of the issues that have been raised, giving details of the wave 1 mobilisation of vaccinations. A SOP for the management of COVID-19 vaccination clinical incidents has also been published. Access all details here.
In order for vaccinations to be delivered promptly and as matter of priority, practices will need to re-prioritise other work and NHSE/I have now been clear that they can offer an urgent-only service whilst vaccinating practice teams are involved in the programme.
The CVP is a voluntary scheme. Whilst it’s very positive that so many practices have stepped up to take part in such a short period of time, when so much of the programme was in development and subject to change, no practice should be pressured in to doing this, nor should any commissioner be placing unreasonable pressure on them to do so. In addition, should practices feel that new requirement for 15 minute post-vaccination observation makes their model of working no longer possible, they should firstly discuss this with their CCG to see what alternative arrangements could be made, but ultimately they could withdraw from the programme if they wished, providing vaccine has not already been dispatched to their site. NHSE/I will only send vaccine to sites that are ready and able to use it.
Public Health England has published a range of resources (leaflets and posters) about the CVP
Read the my full message about the vaccination programme sent last weekend.
Read our guidance about the COVID-19 vaccination programme, and the newly published guidance on how practices can utilise extra workforce to deliver the programme.
COVID-19 vaccination programme precautionary advice
As noted above, the MHRA has produced urgent precautionary advice for healthcare professionals following two case reports of anaphylactoid reactions associated with administration of Pfizer BioNtech COVID-19 vaccine:
The new requirement to monitor patients for 15 minutes will have an impact on primary care plans for the clinics and if this raises issues relating to premises capacity and patient flow practice groups should discuss this with their CCG and seek their support to resolve this.
Media
I spoke to BBC London about the safety of the COVID-19 vaccine, and answered questions from listeners. I also spoke to BBC Leeds (around 7.12am) and BBC Humberside (around 5.40pm) where I said the first wave of the rollout will include more than 200 sites across England and that practices will be working closely together to do it.
Brian McGregor, GPC England member and chair of the BMA's Yorkshire regional council, spoke to BBC York and BBC Look North about the COVID-19 vaccine, saying that prioritisation in the area focuses on areas with care home residents, their carers and patients over 80.
Helena McKeown, GP and chair of the BMA’s representative body, spoke to talkRADIO (around 8.05am) about the prioritising of the COVID-19 vaccine as well as news that the Oxford vaccine has now be deemed safe and effective.
NI Council chair Tom Black and NIGPC chair Alan Stout were interviewed about the commencement of the first stage of the Covid vaccination programme in Northern Ireland – listen and read here: BBC Radio Foyle Breakfast (1:23:27), Good Morning Ulster (45:19), Talk Back (05:28), Belfast Telegraph
Rob Barnett, GPC England member, spoke to BBC North West about the vaccine rollout, where he said that there are 11 GP sites in Liverpool that will administer the vaccine over the next few weeks, with two ready to go from Monday. They expect to see about 300 patients a day and that people will be invited for the vaccine before completing a health questionnaire with a clinician on the day.
Read the statement by Chaand Nagpaul, Chair of BMA Council, about the roll out of the programme.
University of Oxford / AstraZeneca Covid-19 vaccine trial data
The data from Phase III of the University of Oxford / AstraZenecaCovid-19 vaccine trial has been published which provides further good news in that it suggests that this vaccine could prevent asymptomatic disease, and we look forward to the trial to be completed. The data is promising, particularly as we know that this vaccine can be stored at fridge temperature and can be more easily be delivered in primary care. Read the Wellcome Trust statement here.
2019/20 annual allowance charge compensation scheme (England and Wales)
As we reported last week, following significant pressure by the BMA, NHS England and NHS Wales introduced the annual allowance repayment scheme last year, which guarantees that any annual allowance tax charge in 2019/20 for eligible clinicians will be compensated for at the time of retirement.
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 via scheme pays. The formal scheme pays deadline is 31 July 2021, however, members are encouraged to complete the forms as soon as possible, preferably by 31 December 2020 (to minimise any interest applicable).
As the deadline is fast approaching, and to help members, the BMA has produced a template letter, to be submitted alongside the scheme pays election form. You will then need to complete the 2019/20 Annual Allowance Charge Compensation Policy Form. Find more information on how to apply, as well as resources for employers, FAQs and infographics, on the NHSE/I website.
Read more in this update from the BMA’s Pensions Committee and the guidance on annual allowance repayment scheme on the BMA website.
Ethnicity data (England)
The GMS regulation (England) amendments for recording of ethnicity information have been laid and will come into force from 1 January 2021. This follows the significant impact COVID-19 has had on BAME people and the need to have better quality data to support the most effective healthcare planning.
This amendment places a requirement on practices to record ethnicity data provided by a patient when a practice ask for this. Read the Statutory Instrument and the Explanatory Memorandum here.
Christmas parties and gifts – accountancy advice
Accountancy advice from James Gransby, Partner at RSM Accountants, Vice Chair AIMSA
With the traditional style Christmas party unlikely to be going ahead this year, what can practices do as an alternative? RSM accountants advises the following for practices:
Tax efficient options can be gifts or a remote get-together; normally there would be a £150 allowance per employee per year which would cover the cost of a Christmas party, but this isn’t transferable into other options such as gift vouchers where the limit is £50 per person.
Gift vouchers - When giving vouchers up to £50 you are keeping within the HMRC ‘Trivial Benefits’ exemption limits. One of the conditions of this is that the gift must not be a reward for work or performance, therefore if the gift card comes with a message of “thank you for all your work over this challenging time” then HMRC could look to tax it, but a simple “season’s greetings” will avoid this issue (the same advice applies for other times of celebration such as Diwali, or in Easter). Read more in the HMRC tax guidance on trivial benefits
Reward for service - If you want to give over and above a £50 voucher or if you do want to reward for service or performance then this should go through the payroll in the normal way as overtime or a bonus would do, and then be subject to PAYE in the hands of the staff member.
Remote parties - If you are planning a remote Christmas party then there is some good news, as HMRC has confirmed that the £150 per head exemption still applies. (There had been some concern that a virtual event would not meet the definition of an annual event and that food and drink sent to employees to consume during the party might be considered a separate gift which would therefore not be covered by the exemption). Note that this would be subject to the usual conditions:
- the event is available to all employees (there may be separate parties for different departments or branch surgeries)
- a record is taken of attendees, to ensure that those receiving food presents are at the party
- if costs exceed £150 per head the full cost of the party, not the excess cost, is taxable on the employee.
For further advice please contact your practice accountant.
Medical Aid Films community language COVID-19 resources
Medical Aid Films, supported by BMA Giving, have produced community language versions of their informative COVID-19 animation ‘Getting the help you need’, which offers important patient information on medical rights, where and how to access services, as well as self-care strategies. The animations are available in English, Punjabi, Urdu and Arabic.
This resource is intended to aid doctors and health care professionals to better support their patient communities who may be lacking access to COVID-19 information and messaging in their own language. Additional languages versions will be available from next month.
In addition, the charity is inviting healthcare workers fluent in Punjabi, Urdu and Arabic to take part in an online screening and Q&A session that will review the animation and highlight information needs and preferences around COVID-19 for non-English speaking communities. If you are interested in this opportunity, Medical Aid Films are able to cover small project expenses. Contact meghan@medicalaidfilms.org for more information or fill out the online feedback survey.
Scottish Conference of LMCs
I was pleased to join the annual SLMC conference which took place last Friday. The virtual conference brought together LMC representatives from across Scotland to debate and discuss issues affecting general practice and to help set the direction for the BMA’s Scottish GP Committee in the coming year.
The conference heard keynote speeches from the Scottish Government’s Health Secretary Jeane Freeman MSP and from Andrew Buist, chair of the Scottish GP Committee, both of which provided updates on what is to be done in response to the confirmation that delivery of MDT services set out in the 2018 GMS contract are behind schedule and which was a running theme of discussion throughout the conference.
Motions passed by the conference also included calls for:
Denise McFarlane was elected as chair of conference for next year, replacing Teresa Cannavina who steered the event through the challenges of delivering an online conference.
Following the conference, Chair of the Scottish GPC, Andrew Buist blogged on his reflections of the conference and the views LMCs provided on the next steps for the Scottish GMS contract.
EU Exit update – medicines supply continuity letter (England)
The NHSE/I has published a letter from Dr Keith Ridge, Chief Pharmaceutical Officer for England, with an update on EU Exit on 31 December 2020, specifically on medicines supply continuity. The letter sets out that:
The DHSC guidance is that it is not necessary for local providers, whether in hospitals or primary care, to stockpile medicines or for clinicians to write longer prescriptions for patients. Unnecessary stockpiling puts more pressure on the supply chain and can risk additional pressure on the availability of medicines in other parts of the country. Prescribers and pharmacists should explain to patients that they should continue to order their prescriptions as normal.
Workforce data reminder (England)
A reminder that NHS Digital will extract the latest general practice workforce data from the National Workforce Reporting System (NWRS) on Thursday 31 December. Practices and PCNs should review their records and make any updates, including recording GP locums (practices) or commissioned services (PCNs), before then. This is a contractual requirement and a prerequisite for access to the Covid Capacity Expansion Fund, and important for planning for workforce supply, data which the BMA also uses in our lobbying. Information on how to register and the latest workforce statistics are available on the NHS Digital website.
Investment and Impact Fund 2020/21 – reminder to sign up to PCN CQRS service (England)
The Investment and Impact Fund represents a significant source of income for PCNs and to calculate this, NHSE/I measures PCN performance against indicators defined in the 2020/21 Network Contract DES, by using data extracted from practice systems via the Calculating Quality Reporting Service.
In order for practices to record their performance against these indicators, commissioners must have offered them the PCN service on CQRS. If they do not, PCNs containing these practices risk not receiving IIF funding this year, so if your practice is not signed up to this service, please contact your CCG as soon as possible to ensure that it is offered.
More information can be found on NHS Digital’s website and for any questions about the service, please contact england.gpcontracts@nhs.net.
Partnership Agreement webinar – BMA Law
BMA Law are holding a free webinar on Partnership Agreements on Tuesday 15 December at 1pm. The webinar will cover all aspects of Partnership Agreements - why you need a partnership agreement, how often you should update it, and the common pitfalls to avoid. Register here
COVID-19 media
The Chair of Northern Ireland Council, Tom Black, was interviewed on RTÉ Radio One Morning Ireland programme (1:53:02) about COVID-19 in Northern Ireland and the roll-out of the COVID vaccination programme. He was also featured various media outlets about the Northern Ireland Executive’s decision to reopen non-essential retail and some sections of the hospitality sector from today, 11 December, such as Belfast Telegraph, Derry Journal, Belfast Telegraph, Head Topics Ireland
Writing in Armagh i, NIGPC deputy chair Frances O’Hagan rebuts public misconceptions around access to general practice during the pandemic, and explains why it has been necessary to carry out more online consultations, but that all patients whose clinical needs demand that they are seen by a doctor in person are catered for. "There seems to be a perception that GPs are hiding in their surgeries, avoiding patients and twiddling their thumbs during this pandemic...nothing could be further from the truth. As a GP of 25 years, this winter has been one of the busiest in my career".
The nine health unions in Wales have issued a plea to the public to “take the risk seriously and minimise contact as much as possible”, warning that “Covid-19 has not gone away.” To read the full BMA Wales press release, click here. The story was covered by ITV Wales, Wales Online and Deeside.
See this week’s GP bulletin here
COVID-19 vaccination programme specifications and guidance (England)
Following the agreement between GPC England and NHSE/I for general practice to play a leading role in the delivery of the COVID-19 vaccination programme, we have been negotiating the detail of the Enhanced Service Specifications, which have now been re-published to include modifications following discussion with MHRA and to ensure patients from non-participating practices can be provided vaccinations, alongside a letter that responds to many of the issues raised by practices and highlighted at the recent LMC England conference. This does though continue to be a very fluid and fast changing situation as more information becomes available about vaccine availability and the logistics of delivery. NHSE/I have provided further information this evening, including details on the first wave of vaccinations and a collaborative agreement. All details can be seen here.
Practices are asked to sign up to this Enhanced Service by Monday 7 December, and will be provided at least 10 days’ notice of the first vaccines becoming available. Whilst the timeline is very short, this is because practices need to be ready to deliver vaccinations in the very near future, particularly with the approval this week of the first COVID-19 vaccination by the MHRA.
NHSE/I have this evening published more information about the first practices to deliver covid vaccinations. Yesterday they asked CCGs for approximately 280 practice group sites to be the ‘Wave 1’ providers and selection of these sites will largely be based on the areas where there are the highest number of people aged 80 or more, and where the sites are ready to start within those timescales. Those practices should now know that they have been put forward as potential sites and this will then be confirmed next week. We expect these sites to be fully supported by their local systems to enable the successful delivery of this first wave of vaccinations. We will also offer them all the support necessary.
These initial sites should receive a box of 975 Pfizer BioNTech vaccines on or close to 14th December, to enable them to start vaccinating from the following day. Following the regulatory requirements set by MHRA they will need to use the vaccine within 3.5 days, not the previously suggested 5 days, and so need to ensure patients are invited to attend within that timescale. All patients will need to be offered a second appointment 21 days afterwards for their second vaccination. Vaccines are being held back nationally to ensure they are available to provide this second dose.
NHSEI will be writing to sites identified as part of Wave 1 on Monday, setting out full details of vaccine supply dates, delivery of other consumables and equipment to the site, and the process for assuring readiness before delivery of vaccines. This will include a delivery of IT equipment necessary to deliver the programme and a fridge for each site. Access to necessary training will be provided and sites will be given full support to mobilise within the timescale.
The short timescale for delivery of this vaccine means that practices will need to re-prioritise and postpone other activities, such as non-essential health checks and reviews, in order to focus on the Covid-19 vaccination programme, particularly with the short period in which the vaccine will need to be used. Practice vaccination teams will need to work in core hours and therefore cannot be available for other more routine activity at the same time. We believe that patients will appreciate this prioritisation and that CCGs and NHSE/I must support practices in doing this.
Sir Simon Stevens said earlier this week that around 1000 GP group sites had indicated their willingness to take part in the programme. Once the vaccine becomes more widely available these other community sites will be able to start vaccinating. They will also be given at least 10 days notice of this. It is therefore important for practices not involved in the first wave to continue to review the enhanced service specification and indicate to their CCG as soon as possible their decision about involvement in this programme.
The COVID-19 Vaccination Collaboration Agreement has been published today and can be found here. This is designed to support the delivery of the CVP by setting out the responsibilities and relationships between collaborating practices. GPC England has had legal support to scrutinise the document and is satisfied that it is fit for purpose, being in line with other similar collaboration agreements already in place.
Wessex LMC have shared an excellent presentation about the vaccinations from Professor Saul Faust, the lead investigator for the Southampton arm of the Oxford AstraZeneca trial. To watch it - click here
PHE Guidance for healthcare professionals delivering the COVID-19 vaccine
Public Health England has published guidance for healthcare professionals who will deliver the COVID-19 vaccine which includes information about the vaccines (as they become available), vaccine recommendations and eligibility, contraindications and precautions, and vaccine administration issues.
PHE has also published a new COVID-19 chapter in the Green Book which has guidance on the vaccine, provisional priority groups, advice on high risk groups and on potential adverse effects, which current evidence suggests are mild and short-term.
GPC guidance on the COVID-19 vaccine programme (England)
Our guidance page about the COVID-19 vaccination programme has been updated to and has FAQs throughout to answer questions from practices. We continue to update this regularly, as and when new information becomes available, so please refer back to this guidance page.
We have also published guidance on how practices can utilise extra workforce to deliver the COVID-19 vaccine programme. Members of staff already qualified to provide vaccinations are likely to be the main part of the workforce administering vaccine in general practice, and most of the programme should be delivered by staff other than GPs, who will be more useful in other areas.
The BMA are also calling for the prioritisation of those at the greater risk, including those with underlying health conditions and those of a BAME background, when vaccinations are rolled out. Read the full statement here
COVID-19 vaccine media
Following the news that the Health Secretary, Matt Hancock, had confirmed an initial order of 800,000 doses of the Pfizer vaccine was on its way from Belgium – with around five million to arrive by the end of the year, I said: "Today is a significant step towards overcoming Covid-19 and GPs share in the optimism of the rest of the nation as a future beyond the pandemic comes more clearly into sight. Practices have responded rapidly in recent weeks to put in place arrangements so that they are ready to deliver vaccinations once they are made available.” Read the full BMA press statement here. The comments have been covered in The Times, The i and the The Mirror. I was also interviewed by GP online and BBC Look North. I did interviews for a number of local radio stations including BBC Radio Somerset, Radio London, Radio Newcastle, Radio Hereford and Worcester, Radio Merseyside, Radio Shropshire and 3 Counties Radio. There have also been a number of interviews and quotes by BMA spokespeople on regional and national media, including Times Radio (2hrs 4mins), BBC Sussex (2hrs 15mins), BBC York (2hrs 09mins), BBC Somerset (1hr 05mins), BBC Spotlight, Guardian, Independent and Mirror.
BMA NI Council chair, Tom Black, was interviewed on BBC Foyle’s Breakfast Show (from 1hr38min), about the Pfizer vaccine approval where he said the vaccine 'was very good news' adding: "The sooner we get this in and start vaccinating the better." NI GPC chair, Alan Stout, was interviewed on Good Morning Ulster (from 2hrs) on the Pfizer covid vaccine and what part general practice may play in the roll-out of a local vaccine programme. The interview was also carried by BBC News NI online. Tom Black and GPC chair Alan Stout were also interviewed – can listen to the interviews at TalkBack (14:32), Newsline (05:23), UTV Live (1:50), Radio Foyle lunchtime news (11:30) and Q Radio News.
The Telegraph (paywall) has published an article highlighting concerns over GP funding for the Covid vaccine after concerns have been raised that some surgeries may refuse to sign up. In response to this I said that I was hopeful that all practices would sign up, but acknowledged that significant uncertainties over the specifics of the roll-out plan remain. I also called on the Government to suspend safety inspections by the CQC, as well as various bureaucratic duties, while the roll-out takes place.
Christmas and New Year period (England)
As highlighted in the NHSE/I primary care bulletin this week, general practices are not expected to open for delivery of core services over the weekend and bank holidays for this coming Christmas and New Year period. Local commissioners and primary care providers can therefore continue to plan on the basis of their planned cover arrangements.
This followed the concerns that we had raised of the importance of all those working in general practice needing time off during the Christmas bank holiday to rest after the difficult year we've had.
Guidance for clinically extremely vulnerable people (England)
As of 2 December, lockdown has ended in England and returned to a regionally differentiated three-tiered system. Due to this, the government has sent a letter this week with updated guidance to all clinically extremely vulnerable (CEV) people on the Shielded Patient List.
In each tier, there is a set of rules that everyone in that area must follow. The letter, which sets out the new guidance, no longer advises CEV people to stay away from work or school, but does suggest limiting the number of social interactions. Read the government’s guidance for clinically extremely vulnerable people at each local tier.
The DHSC has also announced that people on the CEV list and those in residential and nursing care homes will receive free winter supply of Vitamin D to help support general health, in particular bone and muscle health, during the winter months, which is even more important for those that have been shielding and may not have been able to obtain enough vitamin D from sunlight.
NHS Digital has published letter templates for high-risk patients for use by GPs when notifying patients newly identified as clinically extremely vulnerable from COVID-19.
We have also updated our guidance aboutclinically extremely vulnerable people.
Joint letter on next steps for the GP contract in Scotland
Ahead of the Scottish LMC Conference, held today, Andrew Buist, Chair of GPC Scotland, and Jeane Freeman MSP, the Cabinet Secretary for Health and Sport, have written a letter setting out the next steps for the GMS Contract in Scotland for 2021/22 and beyond. The Cabinet Secretary spoke at the conference today and praised the significant contribution that GPs and their practice teams had made over the last year. This is the third health minister to speak at the national LMC conferences in recent weeks.
Joint message on COVID-19, the easing of lockdown and winter pressures (Scotland)
BMA Scotland and the Academy of Royal Medical Colleges and Faculties in Scotland have published a joint statement on COVID-19, the easing of lockdown and winter pressures. The statement raises significant concerns about the how the five-day period over Christmas may impact upon Covid-19 infection rates. Read the statement here
Accessing your GP animation
To support general practice, the NHSE/I has created an animation to help explain to the public how they can continue to access GP services, including how to get in contact, the different ways care may be delivered, and how face-to-face appointments have changed.
CQC review of the use of do not resuscitate decisions during COVID-19
The CQC has produced a briefing clarifying how it will be undertaking a DHSC requested review of the use of ‘do not resuscitate’ decisions during COVID-19 (made after 17 March 2020).
Some practices have already raised concerns regarding CQC ‘spot checks’ or communications from CCGs. Please note that these reviews are not CQC practice inspections and reports of review visits will not be published. If CQC do find examples in records which raise concerns about the way DNACPR decisions were made it will feed this back to the practice and to the CCG. CQC will also provide information to its local CQC inspection team as part of their routine monitoring.
As you may recall, we recently wrote to Matt Hancock calling for an immediate suspension of all CQC inspections and reviews of general practice (other than those required for serious safety issues) for the duration of the pandemic to enable practices to focus on other priorities, not least the COVID-19 vaccination programme. This was also reported by BBC news online.
Conference of England LMCs 2020
The virtual England LMC Conference took place last Friday, 27 November 2020. This document details the conference resolutions, election results and motions lost.
You can watch my speech to the conference here and the webcast of the conference is available here. All of these, including the agenda, are also available on the BMA website.
Watch some edited highlights from the conference on the BMA GP twitter page
The BMJ reported on the motion which calledfor partners to receive same pay rise as salaried colleagues.
Cameron Fund Christmas Appeal
This year and subsequent years will be difficult for the Cameron Fund, which is the only medical benevolent fund that solely supports GPs and their dependents, as the Fund faces increased pressure from those affected by the COVID crisis and a reduced income from investments. As such, they have launched a Christmas appeal to try and raise more money for the Fund to be able to help more GPs in need. Read more in the letter from Dr Ian Winterton, Cameron Fund Treasurer and on the Cameron Fund website
GP trainees mileage payment
NHS Employers and the BMA have published joint guidance for the reimbursement of home to principle place of work mileage for trainees in a GP practice. The guidance will provide the necessary information for employing organisations on operationalising the current provisions in the absence of an updated version of the terms and conditions. This is applicable to both back dated and future claims.
Institute of General Practice Management
A new organisation representing Practice Managers has now been formed and is called Institute of General Practice Management. A website is currently being designed by Wessex LMCs and there is currently a Facebook page (Institute of General Practice Management) and twitter @TheIGPM. The next webinar for all PMs is on Wednesday 16th December at 5.00 p.m. – all this information is on the Facebook page and twitter.
Integrated Care Systems consultation (England)
Following the publication of the NHSE/I consultation last week about the next steps for ICSs, which raises some fundamental issues about how the NHS will be structured and work in the future, I was quoted in an article by the BMJ: I said that the changes offered an opportunity to “undo some of the damage” caused by the 2012 NHS reforms, but warned, “This must not be done in a way that is counter productive, and we have serious concerns about the risk of vertical integration, which would lead to an end to the independent contractor model for general practice.” I also stressed the crucial role that LMCs should play in enabling the voice of all GPs to be heard at all levels within a regional structure.
Parental leave webinar and workshop
We will be hosting a workshop for GPs on parental leave next week, 9 December from 12.30pm – 2.30pm – Workshop - ‘GP maternity’. Register here
If you would like to submit questions in advance to be covered at either session, please contact Christopher Scott via cscott@bma.org.uk
COVID-19 media
Pulse reported how this year GPs have had to be more dedicated and adaptable than ever, taking on new ways of remote working and run outdoor or socially distanced clinics, often with smaller teams due to staff self-isolating. The article refers to my speech at last week’s LMC England Conference where I said that GPs have shown ‘great bravery and determination’ this past year, putting patient safety first while also witnessing colleagues tragically unable to survive the virus, and far from closing, practices remained open, and are now delivering more appointments than a year ago, all while contending with the devastating impact of the pandemic.’
Alan Stout ,chair of Northern Ireland GPC, was interviewed on BBC Newsline about primary care’s involvement in the roll out of the Covid vaccination programme, which was subsequently picked up by BBC News NI online and the Good Morning Ulster programme. NIGPC deputy chair Frances O’Hagan was also interviewed on Saturday’s BBC Newsline.
See this week’s GP bulletin here.
2020 Conference of England LMCs
As many of you will be aware, the 2020 Conference of England LMC was held today, 27 November, as a virtual event. Rachel McMahon chaired the conference, support by deputy chair Shaba Nabi, who was also elected as chair of Conference of England LMCs for 2021.
In my opening speech I thanked and commended GPs for having stepped up at this time of national crisis and for responding to the COVID-19 pandemic with such speed and effectiveness. I praised the hard work and diligence of our colleagues across primary care over the last nine months, while criticising the Government for being “behind the curve” with delayed guidance, limited initiatives and inadequate funding.
I noted that with the daunting covid vaccination programme facing us there can be no better people to succeed in this task which the whole nation is depending on. Once a safe and effective vaccine is available, our practice teams will work to the best of their considerable ability to protect our patients as quickly as practically possible. And whilst we may have super-powers we cannot be in two places at once and so we will need the help of everyone, we’ll need to be able to prioritise the rest of our workload and crucially we’ll need the understanding of our patients in doing so. We will need all hands to the pump.
The event was webcast via this link and a recording of the event and the resolutions will be published on the website as soon as possible after the event. They are also available here. Read the agenda here . GPonline has reported on my speech
Welsh LMC conference update
I attended the annual conference of Welsh LMCs last weekend, which was chaired by Nimish Shah. Phil White, chair of GPC Wales, gave a report to conference and thanked GPs for their continued dedication to their local communities and how rapidly the profession reacted early on, whilst maintaining a high-quality service throughout a global pandemic.
The health minister had addressed and been welcomed by the NI LMC conference two weeks ago, and similarly Vaughan Gething MS, the Minister for Health and Social Care, was welcomed to the Welsh LMC conference and thanked GPs and staff for “dedication and commitment” shown when caring for people in Wales during the pandemic, and acknowledged the “unprecedented challenges” faced by the health and social care system.
Motions debated included: access and remote consultations, clusters, pandemic response, digital and enhanced services, immunisation, workforce, workload and sustainability, primary and secondary care interface. A full report from the conference and the resolutions are available here.
COVID-19 vaccination programme guidance (England)
NHSE/I has published a letter about the outcome of general practice site designation processto provide commissioners and practices with more information to help with planning. This follows on from a letter that NHSE/I sent to NHS Trusts last week, outlining the wider COVID-19 vaccination deployment strategy and operational readiness for mass immunisation sites.
The letter sets out that NHSE/I aims to give all designated sites at least 10 days’ notice of the first vaccines becoming available to ensure sites can be prepared and clinics arranged. It also suggests practices may wish to use this opportunity to invite the extended flu vaccination programme cohort of 50-64 year olds to their single designated site, to test arrangements.
In addition, NHSE/I has published FAQs on their FutureNHS platform (sign in required) based on the information known at present about eligible cohorts, appointment booking, administration of the vaccine, workforce and funding, to help answer any question that practices may have. We also expect that the COVID-19 vaccination programme specifications will be published imminently.
Practices have stepped up to the challenge of putting in place arrangements at an unprecedented speed and should be commended for doing so. It's been vital to be prepared for all possible options and once the regulatory process is complete we will have greater clarity and be able to finalise plans. The difficulties with storing and moving the Pfizer vaccine make the delivery of this particularly challenging. As a result it may be that initial vaccination plans of priority groups including care homes residents and healthcare staff will depend on the specific vaccinations available.
Please see our recent guidance about the COVID-19 vaccination programme which has FAQs throughout to answer some of the questions that we know practices must have, and we will regularly update it when new information is available.
Public Health England have produced two videos in which Wei Shen, chair of the Joint Committee on Vaccination and Immunisation, explaining the vaccine prioritisation and the rationale for the age-based approach. The videos can be found on the Public Health England twitter page.
COVID-19 winter plan and exiting lockdown (England)
Last week, the BMA launched a ‘blueprint’ for leaving lockdown, to help save lives and prevent the collapse of health services this winter, outlining major reforms for England to sustainably control the spread of COVID-19.
Earlier this week, the Prime Minister set out the COVID-19 winter plan and announced the return to a three-tiered system when England ends lockdown next week on 2 December. He also confirmed that that mass testing will be introduced in all England's tier three areas, the highest alert level. In response to this, Chaand Nagpaul, BMA council chair, said:
“The Government has had nearly a month to devise a realistic plan to halt the spread of Covid-19, in order to protect people’s health and prevent the NHS facing collapse. Worryingly, the Prime Minister has revealed a plan that is full of risks and threatens to undo the progress and undermine the difficult sacrifices the public have made in that time.
The Prime Minister says the new measures are tougher than October when in reality many are far more relaxed, at a time when infection rates and covid-related hospitalisations and deaths remain high. For doctors and NHS staff who are already working under incredible pressure, the potential impact on NHS services is deeply worrying.” Read the full BMA statement here
The full COVID-19 winter plan is available here and information about the local restriction tiers
Guidance for clinically extremely vulnerable people
From Wednesday 2 December, once the current national restrictions in England are replaced with a regionally differentiated approach of the country, the government is planning to communicate updated guidance with all c.2.3m people on the Shielded Patient List (SPL) via letter The government has provided specific guidance for clinically extremely vulnerable people at each local tier. This letter should be published on Saturday 28 November on the GOV.UK website. Letters may start arriving with patients from Saturday 28 November, and throughout all of next week (w/c 30 November).
Media
Responding to initial reports over the weekend, I appeared on BBC News, saying that the suggestion of tightening Tier restrictions is a good thing, but that we must have a proper plan in place before we consider relaxing any rules over Christmas. I also spoke to BBC 5Live (around 7.10am) BBC West Midlands (around 8am) and was interviewed by BBC Radio Humberside where I voiced scepticism about the efficacy of the previous Tier system, making it clear that we must avoid returning to arrangements that "don't work and put everybody at risk" and reiterated that the BMA advocates replacing the 'rule of six' with a 'rule of two (households)'.
There was also general reporting of the BMA’s Exit Strategy including in the Guardian, Huff Post, ITV News, the Herald, Asian Image, the National, Daily Telegraph
New two-week circuit breaker for Northern Ireland
Northern Ireland Executive has agreed to introduce a two-week circuit breaker to slow the spread of Coronavirus in the community and protect the health service. The new restrictions will cover two weeks from November 27 until December 11.
Tom Black, Chair of the BMA's council in Northern Ireland, took part in interviews about the new two-week circuit breaker announced by the Northern Ireland Executive late last week. On Friday, he spoke to BBC Radio Four World at One programme (30:45), the Nolan Show (1:19:35), Irish News, Irish Times, RTE online news, Daily mail online, i News, BBC Newsline
COVID-19 select committee: digitalisation of physical health services and impact on wellbeing
Farah Jameel, GPC England executive team member, gave oral evidence to the Lords’ COVID-19 select committee this week, regarding the digitalisation of physical health services and the impact on our future wellbeing. Alongside other panellists from the King’s Fund, HealthWatch and Staffordshire’s STP, Dr Jameel talked about the increasing role digital technology has had in healthcare delivery – catalysed by the COVID-19 pandemic – and some of the risks and opportunities that should be considered in order to ensure patients receive the right care, at the right time, via the right medium. Watch Dr Jameel giving evidence to the committee here
Integrated Care Systems consultation (England)
The NHSE/I has published a consultation inviting comments on the next steps for ICSs (Integrated Care Systems). The consultation raises some fundamental issues about how the NHS will be structured and work in the future and invites a discussion about how ICSs could be embedded in legislation or guidance. It signals an intent to make significant changes to CCGs and move the focus from competition to provider collaboration. The BMA will be carefully considering this and its implications. Read more about the proposals here
GP trainees mileage payment
NHS Employers and the BMA have published joint guidance for the reimbursement of home to principle place of work mileage for trainees in a GP practice. The guidance will provide the necessary information for employing organisations on operationalising the current provisions in the absence of an updated version of the terms and conditions. This is applicable to both back dated and future claims.
QOF system suppliers update (England)
As practices will be aware QOF 2020/21 has been revised to reflect the impact of COVID-19 on general practice. We recognise that practices need to reprioritise aspects of care not related to COVID-19 and the QOF requirements have been modified for 2020/21 to support this and to help release capacity in general practice. Practices and commissioners have been asked to work together to confirm that any population stratification is clinically appropriate for their local population.
Clinical system suppliers have recently updated QOF indicators and prompts. In some instances, this may have impacted on practices’ records of progress to date. Practices should be reassured that the indicators affected by this update are those that are subject to income protection as outlined in 2020/21 QOF guidance. Practices are not expected to re-code or re-review patients for indicators affected by this system update, unless there is a clinical need to do so.
Local funding protection – template letter for LMCs (England)
We know some local authorities have advised they will be expecting practices to maintain pre-pandemic levels of service in order to receive agreed payments through Q3 and Q4 of this financial year – GPC England does not believe this is appropriate. The government, through NHS England, recognises the need for practices to prioritise their workload, and has protected their core income to allow them to do this. Local Authorities must follow suit. We also know some local authorities are using unnecessarily bureaucratic process for practices to claim supplier relief – again this is not appropriate. The funding must be protected and paid from the outset.
In response to this emerging issue we have produced a letter which can be sent to relevant local authorities, urging them to reconsider this position and guarantee income protection for these services for the remainder of the financial year.
We hope that this will be useful to LMCs and can contribute to ensuring that there is one less issue for practices to be concerned about over the difficult coming months.
GP appointment data (England)
The latest appointment data for October was published yesterday. There were nearly 1.6 million more appointments in October than September, and October also had the highest number of appointments of any month in 2020 (28,236,193), and the highest since October 2019. There were 1.8million more face-to-face appointments in October than September and the highest number since February.
This data continues to show that general practice remains open and is delivering a high number of appointments during the second wave of the pandemic.
Government spending review
This week, the Chancellor announced funding plans for the NHS during his spending review speech. The announcements fall short of what is needed to improve GP practices/ estates and expand the GP workforce. Read our briefing on the announcements.
GMC State of medical education and practice in the UK
The GMC has released it’s annual survey findings in it’s State of medical education and practice in the UK report. Last year they looked at general practice in detail. This year, not surprisingly, they have found that 80% of GPs said they were working remotely more often, with fewer face-to-face consultations. Of concern, 34% reported seeing situations where patient safety or care was compromised. However, 59% felt the pandemic has had a positive impact on the speed of implementing change. 38% of GPs responding said they were satisfied or very satisfied in their day-to-day work, up from just 20% in 2019.
RCGP call for suspension of GP appraisal during the Covid-19 pandemic
The Royal College of GPs’ Council has passed a motion to call for suspension of GP appraisal for the duration of the Covid-19 pandemic. Although the College was pleased to see the introduction of a ‘lighter touch’ approach to appraisal, they remain concerned that many GPs simply do not have the capacity to engage even with a simpler process. Read the full statement here
Parental leave webinar and workshop
We will be hosting a webinar and a workshop for GPs on parental leave on:
2 December from 12.30pm – 2.00pm – Webinar - 'GP Maternity and Parental leave Guide: launch and introduction to the guide’. Register here
9 December from 12.30pm – 2.30pm – Workshop - ‘GP maternity’. Register here
If you would like to submit questions in advance to be covered at either session, please contact Christopher Scott via cscott@bma.org.uk
COVID-19 media
Gaurav Gupta, GPC policy lead for premises and finance and Kent representative, spoke to BBC Kent on Monday about the COVID vaccine and NHS spending. Listen to the interview here (starts at 7am).
GP online reported that GP practices in England can use their share of a £150m Covid capacity fund to hire locums, helping ease staffing pressures. In response to this I said: "The whole intent of the £150 million is to provide support direct to practices with minimum bureaucracy to help them through the tough winter ahead. There should not be bureaucratic hurdles. I think we should trust practices to use it as best they can to expand their workforce - it can be GPs or practice staff, and they can use it for locums."
In a look back at key news events from 2016, the Yorkshire Post (print only) quoted my response to a survey of GPs which found that 80 per cent felt their workload was 'unmanageable or excessive', and that this was negatively impacting on patient care. I said: "The Government has to fund an expansion of services. Failure to do so will result in the failure of the NHS as a whole."
See this week’s GP bulletin here.
Read the latest Sessional GPs newsletter here
COVID-19 vaccination programme guidance (England)
We expect the specification for the COVID-19 vaccination programme to be published early next week, with more information for the many practices that have identified designated sites to use for the shared delivery of the programme. We have updated our newly published guidance about the CVP to explain the specific characteristics for two of the potential vaccines that are likely to be supplied in the UK and how practices can prepare for this. There is also a clarification that the latest information on the vaccines suggests that patients do not need to be observed following administration of the vaccine, but patients must not drive for 15 minutes after.
We have added a new section about how practices can utilise the resources and contractual flexibilities provided, including the use of PCN staff, extended access services and using QOF and local enhanced services income protection to enable workload prioritisation, and considering what is needed to practically deliver the vaccine and workforce issues.
I’ve also written a blog about GPs taking lead role in defeating the virus which you can read here
Flu vaccination programme
The Department of Health in England have announced that all those over-50 can be included in the influenza programme from 1 December. Practices can order additional vaccines from the national store.
Following the impressive work of practices in recent weeks, flu vaccine uptake is higher in all vulnerable groups except pregnant women compared to this time last year. Provisional data published by PHE suggests 72.9% of those aged 65 and over, 45.0% of 2 year olds and 46.8% of 3 year olds have had their vaccine.
Media
I was interviewed on BBC 5 Live (1hr 11minutes) on Sunday morning speaking about the COVID vaccine. I was also interviewed by Sky News on Tuesday and LBC yesterday. Nigel Watson, chief executive of the Wessex Local Medical Committees, spoke on BBC Radio 4’s Today Programme (1hr 31 minutes) this morning regarding plans for delivering the COVID vaccine.
The Mirror reported about the pressures that the COVID vaccine will bring, to which I commented: “We want to be able to provide immunisations – but we’ll need to prioritise or it’ll end in burnout. We need a reduction of bureaucracy and more support. GP practices have had a really tough time and can’t be in two places at once.” The Daily Mail reported on the challenges in delivering the COVID-19 vaccine and that ‘We will need patients to understand that they should keep their appointments to ensure we can vaccinate as many people as possible and don’t waste any of the vaccine’.
Chaand Nagpaul, chair of BMA Council has an opinion piece in today’s i-Newspaper on the BMA’s lock down exit strategy, which was also covered extensively on the BBC and other media this week.
Secretary of State praises GPs’ pandemic response
Matt Hancock, Secretary of State for Health and Social Care in England, led the No 10 briefing on Monday, and in response to a question from the media he said:
“What I’d say to every GP is how grateful I am for the work that you’re doing, and your whole practice, everybody in primary care, both on the flu vaccine right now, which is being rolled out in record numbers – we’ve had a record uptake, we’ve had a 10 percentage point increase in the normal uptake of flu vaccines and that’s really good news – and of course on the normal pressures of primary care. I’m really glad that a much bigger proportion of appointments in primary care are now done either over the phone or by video because that makes life easier for GPs and patients and there’s been a really positive response to that. But that doesn’t of course lift the whole burden, even though it makes access easier. I want to thank in advance GPs for all the work that I know that they’re doing now and that there’ll be even more of this winter to keep people safe.”
GPC England meeting
GPC England held its first meeting of the session yesterday. I was pleased to congratulate Bruce Hughes on his re-election as the GPC UK Policy Lead for representation and Rachel Ali on her appointment as the committee’s first ever gender diversity champion, which was one of the main proposals of GPC’s Gender Task and Finish Group. I also thanked Rachel McMahon for her work as England LMC Conference Chair and for her contributions as a member of GPC England in that capacity. As chair of England conference she has set the bar very high for the incoming chair as Rachel’s term of office will end after the England LMC conference which is due to be held virtually on Friday 27th November.
GPC England spent significant time considering the important work being undertaken in general practice in response to COVID 19. There was also an important discussion on the preparations for the delivery of the COVID vaccination in primary care. We also received 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, well-being, and education and training issues.
Other items on the agenda included, an update on issues relating to Digital First, considering the BMA council decision about submitting evidence to the DDRB, and an update on the DHSC/NHSEI bureaucracy review of general practice.
Letter to Secretary of State for Health on the need for CQC support for general practice
We have received a response from the CQC (Care Quality Commissioning) to our letter which urged the CQC to halt all non-essential inspections and practice monitoring to allow GPs and their teams, currently under immense pressure, to focus on the job at hand during the pandemic. Disappointingly, the CQC are not prepared to change their transitional regulatory approach, although it has confirmed that it will only inspect based on risk – i.e. where there are serious concerns around safety and quality of care.
We have now written a letter to Matt Hancock to raise our concerns about this calling again for an immediate suspension of all CQC inspections and reviews of general practice, other than those required for serious safety issues. This should be for the duration of the pandemic and to enable practices to focus on other priorities, not least the COVID-19 vaccination programme.
Highest ever GP trainee acceptances figures (England)
Health Education England (HEE) has published figures this week which show the highest ever number of GPs entering training in England with 3,793 posts accepted, exceeding their target of 3,250. GP trainee acceptances have increased year on year for the last 7 years and these figures represent a 40% increase on the figure of 2,700 recruits when HEE started its recruitment drive back in 2014. This is welcome news, and a sign that the changes that we have made is leading to more and more young doctors are being attracted to a career in general practice. Read more here
BMA report on exiting the lockdown in England
BMA has launched a new report warning that lifting lockdown in England without new measures in place risks deepening the crisis in our health service, and will leave hospitals and GP practices overwhelmed, unable to provide even the most critical of patient care.
The report outlines major reforms for England, once lockdown is lifted, to keep infection rates low and pull back the NHS from collapse this winter. The BMA is calling for the new measures to be brought in, to bridge the time between the planned end of lockdown in England, on December 2nd, and an effective vaccine programme getting underway. Read more here
Level 4 lockdown restrictions in Scotland
First Minister of Scotland, Nicola Sturgeon, has announced that 11 areas of Scotland (City of Glasgow, Renfrewshire, East Renfrewshire, East Dunbartonshire, West Dunbartonshire, North Lanarkshire, South Lanarkshire, East Ayrshire, South Ayrshire, Stirling and West Lothian) will move to level 4 COVID restrictions (highest) from today, Friday 20 November and will remain in place until 11 December.
Update from NI conference 14 Nov
I attended the virtual Northern Ireland LMC Conference themed ‘The radical reshaping of general practice by the pandemic – where do we see our future service?’ last weekend. Alan Stout, NIGPC chair, gave a report and thanked both GPs and LMCs for their work during the pandemic. He also reported that over the course of the pandemic NIGPC had worked tirelessly and negotiated a contract freeze for GPs, an immediate extension of the sickness scheme, indemnity for all Covid-19 related work, and extension to the death in service scheme, flu vaccination programme and better and enough PPE for practices. NIGPC is currently in discussions with the Department of Health and the Public Health Agency regarding the covid vaccine. Achieving a solution to the indemnity situation is the committee’s priority as despite investment into practices to cover costs and increases over the past three years, the financial risk in particular to individual practitioners still remains. This was also reported by GPonline.
England LMC conference
We have today emailed participants of the conference and LMCs with some important information ahead of the conference, including how to connect to the virtual LMC conference platform, and importance to test broadband access and to log in as soon as possible. Please read the information now as there are things that you need to do in advance of conference.
The deadline for proposer to submit a pre-record a video of their speech has been extended to 5pm Monday 23 November. These should be emailed to info.lmcconference@bma.org.uk and using a MP4 format if that is possible.
The deadlines for submissions for chosen motions etc are:
| Item | Deadline for submission |
| Chosen motions (see note below) | 9am on Wednesday 25 November |
| Notification of rider | 9am on Thursday 26 November |
| Notification of amendment | 9am on Thursday 26 November |
| Emergency motions | 9am on Thursday 26 November |
Please submit these to the LMC conference inbox which is info.lmcconference@bma.org.uk
Elections will take place using the BMA’s online election system – representatives will be sent a link from the BMA online election team and please loom out for that.
The deadline to submit questions for the executive team and policy leads has been extended to Monday 23 November, and should be emailed to Karen Day (kday@bma.org.uk).
Bone health card to help patients stay on osteoporosis medication
Each year a large number of people suffer from fragility fractures, and over three quarters of people who are prescribed osteoporosis medication are not on treatment a year on from their fracture. People who have sustained one fragility fracture are twice as likely to sustain another, which can be life altering and it has been shown that osteoporosis medication needs to be taken continuously for several years to be effective at preventing further fractures.
The Royal College of Physicians’ Fragility Fractures Audit Programme (FFFAP) has, in collaboration with the BMA’s GP committee and the Royal College of GPs, developed the bone health card to help patients with fragility fractures to discuss their medication and any issues with their primary healthcare team to ensure key information is discussed when reviewing medication and where to get further information and support.
PCN Clinical Director survey
A reminder that the BMA’s second edition of its annual survey of PCN Clinical Directors is open until 23 November. This aim of the survey is to fully understand the situation on the frontline, by asking clinical directors for their unique insights into the recruitment of the new workforce, the delivery of services throughout the pandemic and the future of PCNs.
The responses will contribute to our ability to respond to the issues and challenges PCNs are experiencing, and will help to support the long-term development of PCNs and help inform the BMA for its annual negotiations with NHSE/I.
Please encourage your PCN clinical director to complete the survey here
Parental leave webinar and workshop
We will be hosting a webinar and a workshop for GPs on parental leave on:
2 December from 12.30pm – 2.00pm – Webinar - 'GP Maternity and Parental leave Guide: launch and introduction to the guide’. Register here
9 December from 12.30pm – 2.30pm – Workshop - ‘GP maternity’. Register here
If you would like to submit questions in advance to be covered at either session, please contact Christopher Scott via cscott@bma.org.uk
Read our COVID-19 toolkit for GPs and practices, to help answer questions on a large range of topics relating to COVID-19. There is also guidance on the following topics:
COVID-19 media
GPonline reported on a motion due to be debated at the Welsh LMC conference tomorrow, that practices do not have ‘the time or financial resources’ to deliver large-scale vaccination campaigns over and above those they already carry out.
See this week’s GP bulletin here.
Covid-19 vaccination programme (England)
It was encouraging to hear the news of the successful Pfizer Covid-19 vaccine trial which brings widespread protection of the population against Covid-19 a step closer. This is the first of a number of potential vaccines that could become available in the coming months. There is though much that needs to be done to ensure any vaccine is safe and effective.
This only serves to increase the importance of successfully administering the vaccine when it potentially could be available for some patients from December onwards. Once we have a safe and effective vaccine, we need to ensure it is given as soon as practically possible to our most vulnerable patients. We have therefore negotiated arrangements for general practice to be given the opportunity to lead delivery of the vaccination programme.
Practices are now in discussion with colleagues in their area and considering whether their practice can take part and if so how this will be implemented, as well as considering the impact on non-Covid patient demand as we prioritise services. Our newly published guidance aims to answer as many questions as we can and directs you to further resources and links. It will be regularly updated. The guidance covers:
COVID-19 vaccination programme contractual arrangements
Following the announcement of the Covid vaccination programme, I would like to confirm that this will now take the form of an Enhanced Service Directed by NHSE/I under Section 7a of the 2006 NHS Act. Whilst discussion with NHSE/I had initially been on the basis of a Directed Enhanced Service to ensure binding national agreement, and the full details that we had at the time were provided to GPC England for agreement and then announced to LMCs and practices, NHSE/I has since advised that S7a arrangements would provide the most appropriate contractual vehicle for the programme.
S7a delegates powers from the Secretary of State to NHSE/I and allows it to exercise all the powers that the Secretary of State would have in terms of a DES, but it cannot be called a DES as that refers to a Direction from the Secretary of State. Similarly, this is not a NES, as many people understand it from 2004.
Commissioning under S7a provides flexibility for necessary amendments to the Specification to be made swiftly, by national agreement between NHSE/I and GPCE only. This is crucial in such a fast moving environment where we will need to add in new information without delay as more vaccines are supplied with different requirements.
To be clear:
In these respect there is no difference to a DES and is in line with other public health vaccination programmes already delivered by general practice as Enhanced Services Directed by NHSE/I, such as shingles catch-up, pertussis for pregnant women, freshers meningococcal and childhood flu. .
The process has not been ideal, it has clearly caused confusion, and I apologise for this. This was in large part due to the necessary speed with which we have had to develop these proposals and begin implementation as details about potential vaccinations became clearer.
We have been advised by our legal team that this change in contractual mechanism makes no difference to the details we have agreed. They should not alter national or local plans to implement the substance of what has been agreed, and must not prevent practices that wish to engage in this vitally important programme from discussing this with their colleagues and making the immediate preparations that are required to ensure our patients can access the vaccine as soon as it becomes available.
Media
I wrote an op-ed article in inews outlining why GPs are the right people to deliver the Covid-19 vaccine.Farah Jameel, GPC England executive member, and I also gave multiple interviews for BBC News 24, BBC Look North, Greatest Hits Radio, Sky News, Radio 5 Live, ITV news, Channel 5 news and BBC Radio York. The CVP was also reported in Pulse, GP online, Yorkshire's Telegraph and Argus, BBC regional outlet, Times Radio, ITV news, Sky News and Mail online.
The BMA responded to the news that Pfizer and BioNTech have developed what could be the first effective coronavirus vaccine which was reported by BBC national and regional outlets as well as LBC and Times Radio and local print outlets including the Shropshire Star. In response to this I said: “GPs and their teams know how vital a safe, effective vaccine will be in defeating Covid-19, and we are all encouraged by this breakthrough – which brings widespread protection a step closer."
Letter to CQC on supporting general practice during a period of unprecedented pressure
We have written a letter to the CQC again urging them to immediately halt all non-essential inspections and practice monitoring to allow GPs and their teams, currently under immense pressure, to focus on the job at hand during the pandemic.
We made clear to the CQC that, in addition to delivering flu vaccinations to 30 million patients in England this year (and also leading the upcoming Covid-19 vaccination campaign), GPs and their teams must be supported and enabled to provide care that best serves the needs of their patients, in a way that adds most clinical value and keeps patients, clinicians and staff safe - it is imperative that they are not distracted from their primary focus of ensuring the ongoing care of their patients.
Guidance for doctors who are isolating and those in vulnerable groups
With new national restrictions in place, the Government is advising people who are clinically extremely vulnerable to work from home. The BMA has now published some FAQs explain what this means for doctors in that group, or who live with someone who is. See our guidance >
As we reported last week, patients who are on the shielding list will receive a letter directly from government about what they should do, and a copy of the letter is sufficient to give to an employer as evidence for Statutory Sick Pay purposes – and patients should therefore not need a fit note issuing by the practice. Read more in our guidance for practices on protecting clinically extremely vulnerable patients
GP workforce figures
The latest GP workforce figures were published last week showed an overall increase in number of GPs including trainees which is good news. Recruiting new GPs is a crucial factor in turning around our workload pressures. However there is still a continued and worrying decline in the number of FTE GPs and GP partners specifically over the last year.
Recent schemes aimed at improving recruitment and retention, such as the partnership premium, the GP fellowship scheme, and the expansion of GP training places may help in the longer term, but the Government must do much more to turn these figures around, to show that GPs are valued and make general practice a genuinely attractive place to work again.
Updated Directed Enhanced Service Specification for flu
Following the announcement and the recent publication of guidance, an updated DES Specification for the seasonal flu and pneumococcal vaccination programme 2020/21 has been published to reflect practices now being able to access central flu vaccines supplies.
Influenza immunisation call and recall error
We are aware of some practices being approached by concerned patients after mistakenly having been sent letters from NHSE/I telling them they should book a flu vaccination. We raised this with NHSE/I, and we have now been informed that this was in response to an error made by NHS Digital.
In developing a cohort of people at greater risk from influenza for NHSE/I, NHSD mistakenly included those who had a diagnosis of glandular fever at some point in the past. Although current glandular fever causes people to be immunosuppressed, past glandular fever does not. As a result, a number of people we had incorrectly added to that cohort received letters from NHSE/I encouraging them to have a flu vaccination. When the mistake was discovered, the process of sending letters was stopped, and the misidentified people removed from the cohort. NHSD has written a letter to GPs to inform them of this mistake and provide information that can be used within practices to advise patients in this situation if necessary. They are also, as of today, writing to the misidentified patients, in three cohorts depending on their age and hence what further action, if any, they should take. An example of the letter to patients is also available here for information.
The early implementation of PCNs - evaluation study
The University of Birmingham has published a new research report: Early evidence of the development of primary care networks in England: a qualitative rapid evaluation study.
Their findings show that PCNs were swift in successfully establishing organisational structures, recruiting to new roles, and providing services as required by the national specification. Effective management and leadership were critical to enabling early progress of PCNs, particularly with respect to having a committed clinical director, and constructive relationships between primary care networks and clinical commissioning groups. However, in rural areas, there was some perceived lack of fit of the PCN policy with aspects of the national network service specification. Read more here
PCN Clinical Director survey
A reminder that the BMA’s second edition of its annual survey of PCN Clinical Directors is open until 20 November. This aim of the survey is to fully understand the situation on the frontline, by asking clinical directors for their unique insights into the recruitment of the new workforce, the delivery of services throughout the pandemic and the future of PCNs.
We have already received a good number of responses to the survey but please encourage your local CD to complete it as it will contribute to our ability to respond to the issues and challenges PCNs are experiencing, and will help to support the long-term development of PCNs and help inform the BMA for its annual negotiations with NHS England and NHS Improvement.
Please encourage your PCN clinical director to complete the survey here
Avoidable harm in Primary Care in England
BMJ Quality has published a national study on avoidable significant harm in primary care in England, which showed that the frequency of incidents of significant avoidable harm in primary care, and also important new details. According to the research the main causes are diagnostic error (more than 60%), medication incidents (more than 25%) and delayed referrals (nearly 11%).
Parental leave webinar and workshop
We have published guidance for GPs on parental leave and will be hosting a webinar and workshop for more in depth guidance on these issues:
2 December from 12.30pm – 2.00pm – Webinar - 'GP Maternity and Parental leave Guide: launch and introduction to the guide’. Register here
9 December from 12.30pm – 2.30pm – Workshop - ‘GP maternity’. Register here
If you would like to submit questions in advance to be covered at either session, please contact Christopher Scott via cscott@bma.org.uk
GMC virtual conference
The General Medical Council is holding a virtual conference, Delivering change together, from Monday 30 November to Wednesday 2 December. Lord Victor Adebowale, Chair of the NHS Confederation, will be joining day one of the event and will discuss the role of healthcare system leaders in tackling inequalities, and what closing the gap means for health outcomes. If you are interested in attending or finding out more about the programme, you can register your interest here. There is no cost to attend, but places are limited.
If you have any questions, please contact the GMC at events@gmc-uk.org
Read our COVID-19 toolkit for GPs and practices, to help answer questions on a large range of topics relating to COVID-19. There is also guidance on the following topics:
COVID-19 media
GPC Wales chair Phil White spoke to BBC Radio Cymru (9 mins 43 seconds in) in a Welsh language interview about the importance of maintaining hygiene measures, along with social distancing and masks when the Covid-19 vaccine is introduced. He also spoke to BBC Radio Cymru (17min in, also in Welsh) about long Covid, where he stated, as per a recent BMJ article, that long Covid may not be a single disease and can occur in people who have not been in hospital.
See this week’s GP bulletin here.
COVID-19 vaccination (England)
Yesterday, GPC England and NHSE/I agreed a Directed Enhanced Service for general practice to lead the delivery of the COVID-19 vaccination programme which will be ready for the beginning of December – with the rollout of the campaign dependent on when vaccines are approved and delivered to surgeries.
The nature of the first vaccinations that are likely to be available will require significantly different arrangements to the flu campaign but we believe that GPs and their teams are uniquely placed to deliver this vitally important programme to ensure that their communities are properly protected from this deadly virus. With their proven track record in delivering large scale vaccination campaigns, such as this year’s flu programme, they are the right people to be leading this COVID vaccination drive.
Practices will be able to choose to take part in the programme, and if they do will need to work together in their local area, initially with vaccinations taking place at one site – most likely a nominated practice.
We are under no illusion about the scale of this task. Not only is this a complex vaccine – for example it needs special storage conditions - a campaign of this magnitude will be a huge undertaking for practices already struggling to cope with the impact of the pandemic as well as supporting the large number of patients with other healthcare concerns. We will therefore need significant support from many others, including community nursing teams, CCGs and NHSEI. LMCs will also play a crucial role in local discussions and planning to enable practices to deliver this programme successfully.
We will do all we can to support practices in this vitally important task, for our patients and the whole nation.
Read more in our press statement. We had hoped that full details would have been published by NHSE/I today but this has been delayed. We will update you as soon as we can.
Media
This was reported by GPonline and Pulse today.
Messages of thanks to general practice
Following a tumultuous time and lack of appreciation of general practice, both by Government and the media, general practices have now received some welcome messages of thanks.
In yesterday’s press briefing by the Prime Minister, Sir Simon Stevens, Chief Executive of NHS England, said “we are doing very well thanks to the brilliant work of GPs in expanding the flu vaccination uptake this winter which is so important given that if you have flu and coronavirus at the same time you’re twice as likely to die from coronavirus than you otherwise would, that’s why it’s so great that 2.5 million more people have had their flu jab this time this year compared to the same time last year”.
In addition, Jo Churchill, health minister in England with responsibility for primary care, has written a letter of thanks to GPs and practice staff for their work throughout the pandemic.
She expressed appreciation about the unprecedented pace at which general practice has adapted in response to COVID-19 and how primary care services have been transformed by introducing total triage, delivering remote consultations alongside face-to-face appointments in order to serve as many patients as possible, while protecting staff and the public from risk of infection.
She also highlighted the high workload in the health service and how grateful she is for the efforts GPs and all practice staff continue to make to support patients. Read the full letter here
Second lockdown in England
As of yesterday, 5 November, the government has introduced new national restrictions in England, until 2 December, to help control the spread of COVID-19. The following measures will be put in place:
A number of public services will remain open, including GP surgeries and hospitals, and people are allowed to leave home to visit them if they need any kind of medical care.
The BMA has welcomed the decision to put England into a second lockdown amidst the threat that that the NHS would be overwhelmed if nothing was done, but it is regrettable that warnings form SAGE were not actioned on sooner.
What is vital now is a clear exit strategy to avoid a repeat of the first lockdown – which was followed by a rebound surge in infection and impacts on the nation’s mental health – where the economy is made even more fragile and where the NHS and its workers teeter on the verge of collapse because of delays, confusing rules and guidance that doesn’t work.
Read the BMA statement here
BMA council chair, Chaand Nagpaul appeared on several BBC news bulletins on Monday welcoming the news of the new England lockdown. He said: "The Government's decision to put England into a second lockdown, is the right one and the only option left, dictated by the exponential rise in the infection levels and a very real threat that the NHS will be overwhelmed if nothing was done." The BMA statement on the national lockdown was included ITN on-line andMail on-line.
Fire breaker lockdown ends in Wales
The fire breaker lockdown that was introduced in Wales on 23 October to help regain control of coronavirus, is due to end on Monday 9 November 2020.
David Bailey, Chair Welsh Council, appeared on BBC 2’s The Jeremy Vine Show (1hr 18 mins in) to discuss the fire breaker lockdown in Wales, including increasing numbers of admissions to intensive care, and said: “We’re still seeing a small rise in numbers but we always knew there would be a delay. We need to try to manage the numbers of patients with Covid-19 coming into intensive care units, as we’re trying desperately to resume services.”
Sara Bodey, member of GPC Wales, was interviewed on the Jason Mohamed show on BBC Radio Wales, and said: “It’s early days at the moment in terms of seeing the results, people who were exposed to the virus before the fire break are still not showing symptoms. It’s a difficult juggling act in terms of education, we know that in terms of safeguarding and long term education its best for children to be in school and for younger children the infection risk appears to be much lower.”
New coronavirus restrictions in Scotland
A new five-level system of coronavirus restrictions has come into effect in Scotland this week, which replaces the measures which had been in place since 9 October, under which people living in the central belt experienced tighter restrictions than the rest of the country. Lews Morrison, Chair of Scottish BMA Council has published an update on priorities for Scotland.
NI council chair calls for national lockdown in Northern Ireland
Northern Ireland Council chair Dr Tom Black was interviewed on Nolan Show (45:14) about concerns over re-opening the hospitality sector next week during the current second surge and has called for a full lockdown similar to the Republic of Ireland, while keeping the schools open. This was also covered by News Letter, Belfast Telegraph, Belfast Telegraph editorial, Belfast Live, Irish Times, Irish Independent, Irish News, BBC Newsline, and UTV Live
Protecting clinically extremely vulnerable patients (formerly shielding)
Following the announcement of a second lockdown in England, the Government has updated their guidance for people who are clinically extremely vulnerable alongside the new national restrictions.
NHSEI has written to practices to inform them of the new arrangements and although shielding is not being reintroduced as before, two additional groups have been added (adults with stage 5 chronic kidney disease and adults with Down’s syndrome).
Patients who are on the shielding list will receive notification directly from government about what they should do. The letter to the patients also states that a copy of the letter is sufficient to give to an employer as evidence for Statutory Sick Pay purposes should that be required. Patients in this situation should therefore not need a fit note issuing by the practice.
Practices are also asked to review any children and young people remaining on the Shielded Patient List (SPL) and, where appropriate, remove them from the Shielded Patient List. Read more in our updated guidance Protecting clinically extremely vulnerable patients
Medicines home delivery service (England)
The Community Pharmacy Home Delivery Service and the Dispensing Doctor Home Delivery Service have been commissioned for those identified as clinically extremely vulnerable on the shielded patient list for the national lockdown period in England, which means that all pharmacies and dispensing doctors in England will again be required to ensure patients on the Shielded Patient List receive their medicines at home.
Read more in this letter to pharmacies and dispensing doctors and in the service specifications
Temporary approval to suspend the need for signatures on prescriptions (England)
The Secretary of State for Health and Social Care has approved a temporary measure in England to help limit the transmission of coronavirus by suspending the need for patients to sign prescriptions until 31 March 2021, to avoid cross contamination and help minimise the handling of paperwork when collecting medicines.
Patients are still required to either pay the relevant charge or prove their eligibility for an exemption from charges. Where patients are exempt from charges, the dispensing contractor will mark the form on the patient’s behalf to confirm the patient’s entitlement to exemption and, where applicable, to confirm that the patient’s evidence of eligibility has not been seen. Read more here
Workload prioritisation during COVID-19 pandemic
In response to the COVID-19 pandemic, and rising workload pressures we have prepared joint guidance with the Royal College of GPs to help practices prioritise the clinical and non-clinical workload in general practice.
As we enter the second national lockdown the prevalence of COVID-19 the pressures on health and social care services are growing. GPs and their teams must be supported and enabled to provide care that best serves the needs of their patient population, in a way that adds most clinical value and keeps patients, clinicians and staff safe from the risk of contracting COVID-19.
Whatever steps are taken to manage workload, we must not undermine the message that general practice remains open and that patients will be seen face to face where it is clinically appropriate.
PCR COVID testing
NHSE/I announced in their latest primary care bulletin that NHS Test and Trace is making PCR COVID testing available on a voluntary basis for self-administration, following a number of pilots in practices over recent weeks. This will be a supplementary option for practices and does not replace any of the existing routes to access testing. Members of the public will continue to be directed to regional testing centres or home testing kits in the first instance.
The tests will be part of the Pillar 2 process and can be offered to patients who attends a practice when the GP feels that a test would be appropriate and there would be difficulties for them to access the standard routes for testing. The tests can also be used for GP staff and symptomatic household members. More information about the service and how to opt in, will be emailed out to practices shortly.
We have raised concerns with NHSE/I that this could lead to patients contacting practices for tests inappropriately rather than using the current drive in or postal routes and as a result there will be no media launch of this initiative. Further information is available here
PCN Clinical Director survey (England)
The BMA has launched the second edition of its annual survey of PCN Clinical Directors. In order to understand the situation on the frontline, the BMA is asking PCN Clinical Directors for their unique insights into the recruitment of the new workforce, the delivery of services throughout the pandemic and the future of PCNs.
The responses to the survey will contribute to supporting the long-term development of PCNs and help inform the BMA for its annual negotiations with NHS England.
Please make sure to send the survey to your PCN Clinical Director. Access the survey here
Performance Tracker 2020: How public services have coped with coronavirus
This week, the Institute for Government and Chartered Institute of Public Finance and Accountancy have published Performance Tracker 2020:How public services have coped with coronavirus.
The report highlighted that the disruption in general practice caused by coronavirus led to years of change in a matter of weeks and that the best of these reforms – improved collaboration – must be kept and expanded. It is suggested that the government should promote increased data sharing, combined with greater transparency about how patient data is shared and used. The government should also assess the impact of increased use of technology, particularly remote consultations, on care quality, service efficiency, patient satisfaction and staff wellbeing.
It concluded that the government should invest more in IT equipment and training for staff to maximise the potential benefits.
DWP Work Capability Assessments
The Department of Work and Pensions has issued a plea for GP practices to return requests for further evidence for Capability for Work Assessments as quickly as they can. People who have made these applications are often suffering financial hardship, hence their concern. The following is the DWP statement:
"DWP are currently prioritising Work Capability Assessments for new claims to Universal Credit / Employment and Support Allowance and continuing to process all Personal Independence Payment claims. Ensuring individuals can access financial support in a timely manner is essential and we would therefore ask GPs to treat requests for further evidence as a priority.”
NHS Community Pharmacist Consultation Service (CPCS)
From 1 November 2020, the NHS Community Pharmacist Consultation Service (CPCS) is being extended across England to include referrals from general practices as well as from NHS 111. GPs will be able to refer patients to community pharmacies to receive a CPCS consultation for minor illness (unlike NHS 111, GPs cannot refer patients for an urgent supply of a medicine or appliance).
General practices can choose whether they want to refer patients to the CPCS and before GPs can make referrals, there must be local discussions to agree how this will work. These discussions will involve pharmacy contractors, the Primary Care Network (PCN) and the member general practices, the NHS and your Local Pharmaceutical Committee (LPC).
DS1500 research
DWP is researching how services supporting the journey of accessing and completing a DS1500 for special rules claims affects practitioners, patients and other individuals involved in this process.
They are currently looking to conduct research with GPs/Consultants/Specialist nurses/MacMillan nurses/others involved with the process to understand more about your role, and your experience with the DS1500 so that they can improve the whole journey for all those involved.
They are looking to talk to GPs on an individual basis to understand your experiences, these sessions will last approximately 1 hour. If you would like to take part in this research or have questions around the project please contact Hannah Knowles (User researcher) Hannah.knowles@engineering.digital.dwp.gov.uk
RCGP campaign - General practice is open
The Royal College of GPs has launched a campaign to make it clear to patients that general practice is open and that general practice services are available, albeit being delivered differently than usual in many cases. The RCGP is urging patients, if sick, to continue accessing general practice - and other NHS - care throughout the second national lockdown.
They have produced downloadable resources for GP practices across the UK to support GPs to get the message out to patients about general practice being open, and how they can expect care to be delivered. These can be shared on practice websites, social media or any other channels.
LMC England Conference 2020 agenda
The Agenda Committee has published the agenda for the 2020 Conference of England LMCs to be held on 27 November 2020 which has also been sent to all registered representatives today. This year, we will be holding the conference completely virtually to ensure the safety of representatives and staff supporting the conference as we experience the second wave of the COVID-19 pandemic. A virtual conference platform is being built and links will be sent separately to those who have registered to participate on the day. Please note that the registration date for representatives to conference has now closed.
Note that no paper copies of the agenda will be provided as will be further minimising the carbon footprint for the conference by circulating all of the conference papers electronically. The virtual conference will also be webcast for those that wish to watch conference but please be aware that this will be a view only facility. See more information here
Read our COVID-19 toolkit for GPs and practices, to help answer questions on a large range of topics relating to COVID-19. There is also guidance on the following topics:
COVID-19 media
GPonline reported on the results from the BMA’s latest tracker survey which showed high level on staff on sick leave or self-isolating, impacting on patient care. In response to this I argued that further government support would be needed to help GPs cope with absences this winter, and that: “Inevitably, any staff absences put general practices - which are already struggling to cope with rapidly-increasing numbers of COVID patients and people with winter respiratory tract infections - under additional and unwelcome strain.”
Practice Business reported that the BMA has called for the COVID support fund to be expanded, for an extension until March 2021, and for other measures to support general practice, including provision of free PPE. Krishna Kasaraneni, GPC England executive team member, commented: “As COVID infections rise, practices in the north of England and across the country are once again coming under intense pressure. Nobody should doubt the commitment of GPs to serve their communities, but to do this effectively in a time of crisis they need more support from government and the NHS leadership—and for this support to be delivered without further delay.”
See this week’s GP bulletin here.
See also the message from Chaand Nagpaul, Chair of BMA Council, here
GP appointments data (England)
The latest GP appointments data for England was published yesterday, which shows that there were 6.5 million more appointments in September than in August and almost a million more appointments than in September 2019. The data also shows that there were:
This data clearly shows that despite the pandemic and what has been portrayed in the media, general practice remains open and is delivering more appointments that we did at this time last year. Our tracker survey (see Q30) also shows that remote consultations actually take longer than face-to- face ones, leaving GPs more tired and with longer working days as a result - so simple appointment numbers only tells half the story of the change taking place. Read the BMA statement in response here
We sent a letter to NHS England/Improvement yesterday to highlight our serious concerns over the increasing pressures in general practice as evidenced both in the GP appointment data and our latest tracker survey, and the immediate need for NHSE/I support.
I was quoted in the Daily Mirror (printed version) today about the increase in remote consultations in primary care, where I said: “Physical appointments will always be a vital part of general practice”.
Secretary of State for Health and Social Care, Matt Hancock, has recorded a video message, thanking all NHS staff for their work during COVID-19 and going into the winter. Nikki Kanani, Medical Director of Primary Care for NHSE/I has also sent a message of thanks to Primary Care.
Tracker survey results
The BMA’s latest tracker survey was published this week which shows that more than 74% of GPs responding are quite or extremely anxious about work in the coming months and 47% say their levels of stress, anxiety and emotional distress had got worse since the pandemic began.
64% of GPs reported higher than normal level of fatigue or exhaustion from working during the pandemic and 62% reported that they or a clinical colleague in their practice had been forced to self-isolate within the past two weeks - with 39% of all respondents reporting a 'moderate' or significant' impact on patient care. View the GP specific results
The survey also demonstrated that worries about workload pressures are more from non-covid related issues - underlining why we need more support from NHSE/I to support practices maintain some degree of services at a time when hospitals can and are stopping doing routine elective work.
These figures clearly highlight the increasing pressure on general practice during the second wave of the pandemic. Staff are working harder, they are very tired and concerned that they are going to have difficulty satisfying demand in the next few months and the overwhelming reason for moving to remote consultations is to keep staff and patients safe. Read the BMA statement here
The survey was reported on by Mail online, Sunday Mirror, PA, Independent, iNews, Metro, Huff Post UK, Sunday Express, Evening Standard, Manchester Evening News and a number of other regional publications including the Yorkshire Post and Nottingham Post. GPonline reported on the GP specific results.
COVID-19 vaccination
Recent media reports have highlighted the possibility of a COVID-19 vaccination being available by December. Government have been planning for this but it depends on a number of fundamental issues such as the effectiveness of the early vaccines once trials have completed, the quantity that can be produced, supply logistics and the licencing arrangements.
As we have previously informed you, JCVI have published their interim recommendations outlining the priority for vaccination.
We are now in negotiations with NHSEI to agree the role that general practice will play in the vaccination programme. We have successfully made the case to government that practices are experts in mass vaccination, as is clearly demonstrated by the current massive flu campaign, and patients, particularly those who normally receive a flu vaccination, would expect to receive their COVID-19 vaccination from their local practice team.
The nature of the first vaccinations that are likely to be available will require different arrangements to the flu campaign but we believe that practices, probably working together within their area, will be best placed to deliver this vitally important programme. We hope to be able to share more details in the next few days.
General practice workforce initiatives
We have published a guide to inform GPs, PCNs and LMCs about the range of workforce initiatives and schemes in England. The guide includes helpful information about what is on offer in each of the scheme and how to apply for them.
We have also published a new guide to applying for the GP partnership scheme, which will help you navigate what can be a complicated application process. The scheme was launched on 1 July and supports clinicians who are interested in becoming a practice partner. You can read more in this blog by Krishna Kasaraneni, member of GPC England’s Executive team and workforce lead.
Specialty training applications
Applications for Round 1 of 2021 GP specialty training will be open from 2 November to 1 December 2020. Please ‘like’ and follow the #Choose GPFacebook page to keep up to date with news and views, and forward this information to any doctors who may be thinking about career options.
The GP National Recruitment Office (GPNRO) website is the place to go for more information or there are a number of GPs and trainees who are able to help with local or general enquiries. Email Daryl at gprecruitment@hee.nhs.uk to be put in touch.
Parental leave guidance
We have published A guide for GPs – maternity leave and other types of parental leave which contains key information and useful links on the full range of parental leave topics. It will serve as a checklist for each stage of your leave. You can read more in this blog by Sarah Westerbeek.
We will also be hosting a webinar and workshop for more in depth guidance to explain these issues:
2 December (12.30 – 2.00pm) – Webinar - 'GP Maternity and Parental leave Guide: launch and introduction to the guide’. The session will also touch on local maternity workshops and there will be a Q&A session. Register here
9 December (12.30 – 2.30pm) – Workshop - ‘GP maternity’. An in depth run through everything you need to consider before, during and after maternity leave, including advice on leave and pay entitlements, notifying your practice, appraisals, CPD and returning to work. Register here
No change to CQC fees
The CQC fees scheme will not change in 2021/22. This means that, for most providers, their fees will remain the same as in 2019/20 and 2020/21, providing their registration or size does not change. The fees for General Practice remain fully reimbursable. Since the fees scheme will remain the same in 2021/22 as in the last two years, you can find the fees scheme, guidance and calculator at www.cqc.org.uk/fees
LMC UK conference 2021
The dates for the LMC UK Conference 2021 have now been set for 12-13 May. It is hoped that this will be a full conference at the Barbican in York. However, the situation is still very uncertain at this time and will be kept under constant review by the Chairman and Conference Team. If the Covid situation does not improve, then this will be changed to a virtual event. The final decision on this will be made within the next few months.
Mental health and wellbeing
The BMA continues to offer wellbeing services and confidential 24/7 counselling and peer support for all doctors and medical students, as well as their partners and dependents, on 0330 123 1245. Access the BMA’s COVID-19 wellbeing pages here.
The BMA has welcomed the NHSE/I announcement of further funding for the expanded and rapid access provision of mental health services for NHS staff in England over the winter. This is urgently required and something the BMA has been calling for to support the major challenges NHS staff are facing. At the ARM, a motion was passed expressing concern at the potential long-term impact of the pandemic and called for resources to support the profession. As we head into a second wave of the virus it is vital that staff are protected. Find out more here
Read our COVID-19 toolkit for GPs and practices, to help answer questions on a large range of topics relating to COVID-19. There is also guidance on the following topics:
COVID-19 media
Brian McGregor, GPC member and chair of the BMA Yorkshire regional council, appeared on Good Morning Britain (around 6.25am) to discuss the latest restrictions facing the north. He told the programme that introducing tougher restrictions must be met with a national prevention plan to ensure we can really start to curb the virus, including an effective test and trace system. He was also interviewed on BBC Look North.
Dr McGregor also wrote a piece in the Yorkshire Post on Wednesday, highlighting the 'grim prognosis' for the NHS if doctors continued to be underappreciated. He also wrote that while the NHS has been overwhelmed by public thanks, "the rainbows and rounds of applause are not enough to make many of our most senior doctors feel that they are truly appreciated by the people who hold the power and the purse strings in our country".
Rob Barnett, GPC member and deputy chair of the BMA north west regional council, spoke to BBC Merseyside (around 7am) about how the NHS will cope this winter given Covid-19 and the natural increase in pressures over the colder months. He talked about the pressures in general practice, saying that the difficulties are not helped by issues like workforce shortages.
See this week’s GP bulletin here.
