COVID alert levels and advice for practices and patients at risk
Following the announcement of a three-tier lockdown approach for England last week, Greater Manchester and South Yorkshire have now joined Liverpool City and Lancashire in the Tier 3 (very high) alert level. Warrington will be added next week. Read the full list of COVID alert levels in England by area here. A 17-day national "firebreak" will begin in Wales at 6pm today and a 5 tier system will be introduced in Scotland from 2 November.
We recognise that few will welcome these restrictions, but unless rising rates of transmission are curbed urgently, we will soon see an increase in patients needing care, and sadly a rise in deaths. Some hospitals have already announced that they will have to once again reduce some elective procedures, with all the implications that then brings both for patients and practices. More stringent lockdown measures are therefore necessary, and we urge everyone to take the new rules seriously. People need to have confidence that the sacrifices they are now required to make are understood by those in power and these new restrictions must be backed with more support for GP practices in those areas who will be impacted significantly.
As we reported previously, NHSE/I has confirmed that local flexibilities should be made available, to support practices to clinically prioritise capacity in these challenging times. We are in discussion with NHSEI about how they can provide clearer support to practices struggling with workload pressures as the prevalence of patients with COVID-19 increases. We are also making it clear in our public messaging that despite some media reports, whatever the current local COVID alert levels are, GP practices continue to remain open as they have done throughout the pandemic. Whilst remote consultations should be the main way in which patient care is delivered, when it is clinically necessary to see high risk patients face to face, they should be able to attend the.
Ordering additional adult flu vaccine stock (England)
As we reported last week, DHSC has written to practices to confirm the process by which they will be able to access the additional adult flu vaccine stock secured to support the expanded vaccination programme this season.
GP practices are now invited to begin ordering or pre-ordering the following vaccines:
If a GP practice has a provisional order with Sanofi for QIVe, please contact them to confirm this, before placing another order for QIVe for this cohort.
On placing an order, practices will be asked by manufacturers to verify that stock is being ordered for NHS eligible patients or frontline social care workers, where there is a genuine shortage for this cohort. Orders should only be placed where you have a shortfall in supply for existing eligible patients at this stage.
Further instruction on timing of extension of eligibility to all 50 to 64 year olds will follow and stock should not be ordered for this cohort at this stage.
Influenza immunisation FAQs (England)
NHSE/I have now produced a set of FAQs relating to the influenza immunisation programme and can be found here. They have also issued guidance on how practices and CCGs can make use of the additional £15.4m made available to local systems and primary care providers to cover reasonable additional costs (over and above the usual fee structures) associated with this year’s extended flu programme.
Pensions newsletter
The BMA’s pension committee has been at the forefront of fighting to maximise your pension benefits. Please see the first quarterly newsletter here. The newsletter provides an update you on what actions the committee is taking on a range of issues, and also provides access to educational resources, blogs and information on how to access BMA support regarding your pension.
DDRB pay award and template letter
The Sessional GPs Committee has received reports that some salaried GPs are struggling to get their 2.8% paylift, as recommended by DDRB and approved by the government, despite being entitled to it. We believe it is only fair that this uplift is awarded to all doctors, and this includes all practice-based salaried GPs. Practices are encouraged to apply this uplift across all of their employed GPs, regardless of individual contractual requirements. However, it is worth noting that there is a contractual requirement to implement this pay increase for salaried GPs employed on the model contract.
If you are a salaried GP struggling to obtain the pay increase, even after having a conversation about the matter with your practice manager, you may wish to send a formal letter. The BMA DDRB template letter can be adapted to reflect your individual circumstances. Please get in touch with the BMA if you need further assistance in this area. Read more in the Sessional GPs newsletter.
GPC Wales meeting
GPC Wales met for the first meeting of the 20/21 session yesterday, 22 October 2020 and I was pleased to be able to join them in the morning. A major focus of the meeting was a discussion about the second wave of COVID-19 and what it meant for GP practices already facing the challenges of winter pressures and flu campaign delivery. The committee unanimously supported GPC Wales’ proposals for contractual relaxation and support measures, while also unanimously voting that Welsh Government’s efforts to date were insufficient. Other items discussed included the NHS Wales flu campaign for 20/21, COVID vaccination plans, the committee’s workplan and taking forward future contractual agreements.
Circuit breaker lockdown in Wales
BMA Wales issued a press release welcoming plans for a circuit breaker lockdown in Wales, which means that a series of restrictive measures will be in place from 6pm Friday 23 October until the start of Monday 9 November 2020. Dr David Bailey, Chair BMA Cymru Wales, said: "Cases are climbing fast across Wales… It's clear that the current restrictions are not strong enough to suppress the spread of the virus. Doctors in Wales support, and are calling for as a matter of urgency, a circuit-breaker lockdown for a number of weeks. It is imperative that robust action is taken now without delay, to protect the citizens of Wales, and the Welsh NHS." Read more in the Welsh Government’s’ coronavirus firebreak FAQs here
This was reported by the BBC, BBC Radio Five and BBC Radio Wales breakfast show (at 08:37).
Dr Phil White, Chair GPC Wales, was a guest on Y Post Cyntaf on BBC Radio Wales (from 19m30s) to discuss the new ‘fire break’ lockdown for Wales.
GPC Scotland meeting
SGPC held its first meeting of session yesterday, 22 October 2020 and I was pleased to be able to join in the afternoon. Progress on delivery of the 2018 GMS contract was discussed along with work to negotiate transitionary arrangements following the end of the implementation period. The committee discussed recovery and remobilisation with a focus on general practice priorities, urgent care and enhanced COVID-19 pathway proposals, and GP IT issues, and received reports from various GPC meetings, external groups, and the GP Sessional Committee.
SGPC also heard updates on letters produced by Scottish Government including the Primary Care Improvement Fund letter, and an update on NHS Scotland Primary Care National Premises meeting, GP Wellbeing, and the SLMC Conference on 4 December. A pensions update was provided by Alan Robertson, a member of the BMA Pensions Committee who was leading on a lot of the work.
Congratulations to Andrew Cowie and Patricia Moultrie who were elected uncontested as joint deputy chairs of SGPC and to Chris Black, Iain Kennedy, John Ip, Denise Mcfarlane and Tyra Smyth were elected to the SGPC Executive for the 2020-21 session.
CQRS system supplier change (England)
NHSE/I is overseeing a programme to ensure the CQRS system supports efficient GP incentive-based payments. As part of this work NHSE/I is working with NHS CSUs to bring the running and development of the CQRS system in-house from 1 November 2020 and to introduce a new centrally funded system (CQRS Local) to support locally commissioned schemes by April 2021. These changes aim to streamline processes and reduce the administrative errors in GP payments as called for in GPCE’s Saving General Practice.
A structured transition from the existing supplier is in place to ensure the continued provision of the CQRS system from November with minimal interruption for end users. How users access and use the CQRS system is not changing and no action is required from practices or commissioners.
From 1 November the new number for the CQRS service desk will be 0330 124 4039, although the email address remains support@cqrs.co.uk
While the system itself will look and feel the same a new CQRS welcome page is now live providing direct links to the CQRS system and online training modules, guidance and news updates.
Tackling health inequality webinar
The BMA committee for medical managers is hosting a free, online panel event on Tackling health inequality, with speakers Tracie Jolliff (head of inclusive system development at NHSEI) and Roger Kline (author of The Snowy White Peaks of the NHS) on Wednesday 4 November 5.30-7pm. The event will explore why diverse leadership is essential to create an NHS that truly serves the whole country and, crucially, what steps medical managers can take to achieve this. Find out more and to book your place here
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
On Monday I did an interview for BBC Radio York following the news that Test and Trace information could be shared with the police. GPC member Gaurav Gupta spoke to BBC Radio Kent (8.45am) on Wednesday discussing the issue of face covering exemptions.
There was extensive media coverage on NIGPC’s concerns over the flu vaccination programme shortages. NIGPC chair Alan Stout was interviewed by BBC News NI, The Nolan Show, UTV Live, BBC Newsline, News Letter. NIGPC deputy chair Frances O’Hagan appeared on BBC Talk Back (48:47).
Pulse reported on future Covid-19 vaccination campaign, and I was quoted: “While we don’t have a specific date when the vaccines will be ready, the BMA fully expects general practice to play a significant part in administering them, and practices will require significant support for what is set to be a huge immunisation campaign."’
See this week’s GP bulletin here.
Read the latest Sessional GPs newsletter here
New three tier lockdown approach and BMA recommendations to help reduce spread of COVID-19
The rapid rise across the country in the number of people with COVID-19 is already putting a significant strain on general practice services. GPs and their teams have responded incredibly well throughout the pandemic, remaining open, maintaining services and going the extra mile to care for our patients. Recent media reports and briefings suggesting otherwise have not only been wrong but also deeply damaging to the morale of a dedicated and committed workforce. I made this situation clear in my one-to-one meetings with Sir Simon Stevens and Jo Churchill, the health minister with responsibility for primary care in England, earlier this month, and they both acknowledged the central and important role general practice has played and will play in dealing with the pandemic.
However as practices, out-of-hours providers, PCNs and other GP services do their best to prepare for the difficulties this winter will bring, we expect NHSE/I and government to do far more to support us, and with parts of the country now back where they were in March that support must come urgently.
On Monday, the Government announced the introduction of a new three-tier (medium, high, very high) lockdown approach for England. Prior to this, the BMA called for new, stronger measures to reduce the spread of the COVID-19 infection and published a series of recommendations which could help reduce the level of infection as well as supporting businesses and those who are in vulnerable groups. The BMA still believes the government needs to do more to properly respond to the growing infection rates. Our recommendations include:
It’s notable that the Scottish Government has moved in line with the BMA’s position and has now introduced a requirement for face coverings to be worn in indoor communal settings, such as staff canteens and corridors in workplaces. Read the full set of recommendations here
Read the BMA statement about the new measures
The recommendations and BMA statement were reported by BBC Breakfast, BBC News, ITV News, Times Radio (around 8.05am) and LBC (from 12pm), BBC Radio 4's PM programme (around 5.05pm), the Times, Mail Online, Sky News, Evening Standard, Guardian, Metro, Mirror, Telegraph, and the i, The Daily Record and MailOnline. MailOnline also reported on the rule of 6 recommendations.
I was interviewed by LBC and BBC 5Live (from 8.30pm) about the face mask recommendations, by LBC and BBC Look North about the BMA’s response to the new Government guidelines, where I discussed the need for a national plan to combat the covid pandemic.
New advice for patients at high risk of COVID-19 infection
Following the announcement of a new three-tier lockdown approach in England, the Department of Health and Social Care published updated guidance for those considered most clinically vulnerable, depending on the level of risk in their local area, in line with the new Local COVID Alert Levels framework.
This new guidance provides advice for the clinically vulnerable to follow in addition to the new rules and guidance for everyone based on the level of risk in their local area. The government are not yet suggesting the reintroduction of shielding arrangements that were paused in the summer. More restrictive ‘shielding’ measures could be considered in the future in areas facing the highest risk and if that happens the Government will write to relevant people separately to inform them directly should they be advised to shield.
Whatever the current local COVID alert levels are, as we have made clear, GP practices 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 we would normally expect them to attend the surgery with good infection control arrangements in place.
Read more in our updated guidance for patient at high risk
General practice “Green Fund”
We have written a letter to Parliamentary Under-Secretary of State for Prevention, Public Health and Primary Care, Jo Churchill MP, this week to request support for primary care to meet net zero carbon emissions.
At a time when our primary focus is on responding to the massive challenges brought by the COVID-19 pandemic, we cannot forget and must do more as a country to reduce the serious impact of climate change. The NHS, including general practice, can play a role in this. We have therefore called on the Minister to back our recommendation for a general practice ‘Green Fund’ to enable GPs to put in place more sustainable and environmentally friendly practices. We have also called for an extension of arrangements in place during the pandemic such as promoting use of technology, labelling medicines to allow for carbon footprint tracking and continuing the ability to make use of previously prescribed but unused medicines to reduce waste.
Complaints (KO41b form) data collection for 2019/20
Following our lobbying for a reduction in bureaucracy impacting practices, and particularly in light of the current pressures that general practice face in responding to COVID-19, NHS Digital have confirmed that the annual complaints (KO41b form) datacollection relating to 2019/20 will not be collected as usual. Practices are instead encouraged to continue to use the information collected locally for local service improvement purposes. Read more here
CQC state of care annual report
The Care Quality Commission (CQC) state of care report for 2019/20 has been published today. The report showed that before COVID-19, care was generally good. In primary care, the overall ratings picture remained almost unchanged, with excellent ratings of 89% of GP practices rated good and 5% outstanding. They did though suggest that this masked a more varied picture, with some practices deteriorating and a similar number improving.
In response to this I said: “GP practices across the country continue to provide safe, high quality care to their patients, as shown by the CQC’s own figures with the vast majority delivering good or outstanding care, but of course there will always be variations, and there must be a supportive, not punitive, approach from regulators to help struggling practices improve, particularly in the midst of this unprecedented pandemic. Practices overcame huge challenges in recent months. As this report notes overhauling services ‘almost overnight’ to ensure patients could continue accessing their GP safely, whether that was via telephone, online or face-to-face where that was safe and appropriate.
The increase in remote access and triage during the first wave of the pandemic was there to keep patients and staff safe – and it is what the Government instructed practices to do. Of course, remote consultations are not suitable for everyone and will never be a complete replacement for in-person care. Practices have been working incredibly hard, remaining open for patients throughout this time, to ensure everyone has access to the right professional, and the latest data has shown a significant rise in face-to-face appointments in recent weeks.” Read the full response here.
We continue to call for CQC inspections to be suspended for the duration of the pandemic and do not believe their transitional regulatory approach is appropriate or necessary at this time.
Primary Care representation on ICS boards (England)
Chandra Kanneganti, GPC policy lead for commissioning and service development, and I have today written to Ian Dodge, National Director at NHS England and NHS Improvement, with responsibility for Primary Care, to urge him to issue guidance to all ICSs (integrated care systems) stressing the importance of primary care provider representation on their boards and other decision-making bodies.
We are aware that in some local systems, only GPs employed from CCGs are representing primary care at ICS level and LMCs are not as involved as they ought to be. While those GPs are an important voice in terms of representing commissioners, they cannot be seen as the representative of primary care as providers. The BMA believes that LMCs, which are the local representative voice of general practice and PCNs, should also form part of the leadership team of ICSs and ‘have a seat at the table’.
General practice is open, get checked for cancer – social media campaign
Londonwide LMCs has launched a new social media video campaign, highlighting that GP practices are open and seeing patients. To mark the start of Breast Cancer Awareness Month, they are launching the campaign with this video. Throughout the rest of October, they will be releasing further videos, as part of a month-long campaign. All the videos can be viewed here
BMA Library resources
The BMA library is providing trial access to Clinical Key for BMA members throughout October.
Clinical Key provides access to the full text of the latest editions of hundreds of medical e-books published by Elsevier. It also provides full text access to a large number of e-journals and other key online medical resources produced by Elsevier. Read more in a blog post by the BMA library team.
BMA members can also access the collection of Oxford Medical Handbooks, including the brand new, 5th edition of the Oxford Handbook of General Practice. Access the collection here
Covid Virtual ward
Wessex LMC recently held a webinar on Virtual Wards – with Karen Krikham (GP and NHSE/I primary care advisor) and Matt Inada-Kim (Consultant and national lead for sepsis) as speakers, both part of a group developing national proposals. View the webinar here. It is also available as audio podcast.
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.
There are two NHS Practitioner Health webinars next week focused on wellbeing: Beating burnout on Monday 19 October and Taking a break from COVID-19: how to escape, unwind and reboot on Tuesday 20 October. Read more about these and future events 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
Phil White, chair of BMA Wales GPC, appeared last Friday’s BBC Radio Wales show with Dot Davies (interview starts about 7 mins in). He expressed concerns that winter will see an increase in people congregating indoors, which will cause further spread of the virus. He also said it will be a difficult winter and advised listeners to seek out their flu vaccination. He also expressed concern over intensive care units being full, leading to waiting lists deteriorating in other areas of the hospital.
There was extensive coverage of the BMA Northern Ireland Council chair Dr Tom Black's response to the range of significant interventions announced this week by the NI Executive to curb the spread of Covid-19. His overall message was that while these restrictions were welcome, NI doctors felt they were too little, too late and do not go far enough in view of the rising numbers of cases. Interviews included BBC Newsline (9:06),BBC News NI, Belfast Telegraph, Irish News The NI statement was the lead story on the BBC News NI news website throughout most of the day and carried on all BBC Radio Ulster and Radio Foyle hourly news bulletins. Dr Black was also interviewed on The Nolan Show, RTE News at One and by RTE online news.
See this week’s GP bulletin here.
Accessing additional flu vaccine supplies
The Department of Health and Social Care have today outlined how GP practices will be able to access additional supplies of influenza vaccinations. It has secured an additional supply of influenza vaccines, which arrive later in the season to top up local supplies once they run low. Expected first delivery dates are included within the attached letter.
Practices will be provided the DHSC vaccines free of charge but will only be able to claim an Item of service fee for each DHSC supplied vaccine that is administered. The majority of the additional DHSC stock will arrive from November onwards, and GP practices will be able to access this only once their own local stocks are depleted. The MHRA has granted a dispensation to allow movement of vaccines locally between practices and other NHS provider organisations and we would encourage you to work with your regional NHSEI Public Health Commissioning team to understand what stock is available locally before accessing the national DHSC supply. The DHSC supply should only be used when there are no other alternative options to accessing more vaccines locally.
DHSC stock is available for GP practices to order from 4 different suppliers, across different products. This ensures that there are sufficient vaccine supplies to cover the extension to the flu programme and mitigate the risks to overall supply if there are serious problems with the delivery or manufacture of one of the products. Practices should follow JCVI guidance and use the recommended vaccines for each cohort as set out in the Second Annual Flu Letter.
NHSPS charging for COVID-19 related requests (England)
In a communication this week, NHS Property Services (NHSPS) announced its intention to increase service charges and facilities service charges for practices across England to meet costs associated with COVID-19. This is a deeply disappointing decision made unilaterally by NHSPS, and will be extremely unwelcome news to NHSPS practices.
Yesterday, GPC premises policy lead Dr Gaurav Gupta wrote to acting Chief Executive of NHSPS Mark Steele NHS PS seeking an immediate reversal of this increase to charges. In his letter, he set out the extraordinary challenges facing General Practice and the severely misjudged nature and timing of this decision taken to increase financial pressure on an already beleaguered profession as it prepares for a second wave of the pandemic.
Practices have received increasingly unreasonable and inflated service charge demands from NHSPS for several years. These demands are often made without reference to contractual arrangements (or lack thereof), and practices are rarely even given an itemised list of charges.
We continue to advise that practices should only make payments if they agree with the legal basis on which they are due. You can find more guidance on this issue here.
NHS Pension Scheme consultation (UK)
A reminder that the deadline for the consultation about Public Service Pension Schemes: changes to the transitional arrangements to the 2015 schemes is 11 October. The BMA will be responding to the consultation, but is also urging members to make their own submission to the consultation. To help do this, the BMA has created a template consultation tool, where you can outline your own experiences. Read more in the message from Vish Sharma, Chair of the BMA’s Pensions Committee
GPC Executive and policy leads update
The GPC England Executive and GPC UK policy leads update is available here along with an update on CQC inspections and appraisals.
Roche supply issues impact lab tests
Reports of supply chain problems at the diagnostics company Roche, the major provider of swabs and reagents to the Lighthouse labs, has led to serious concerns for further delays in the processing of COVID-19 tests and to patient care, as capacity to complete lab analysis of blood samples and storage capacity will be impacted.
Practices in parts of the country already affected will not have timely access to vital tests, and we have asked NHS England for details about how widespread the issue is and what clinicians should be telling their patients.
While we understand the need during the pandemic to maintain the COVID testing system to identify new cases, there are still many patients who will need tests for a range of conditions that could be equally as life-threatening if delayed or not done. We have therefore called for assurances that patient care will be prioritised over COVID antibody tests, which are of limited immediate clinical value.
GPs and all doctors will need urgent support from NHS England in managing these delays and ensuring those who need urgent testing, regardless of condition, can access it before their health worsens considerably. This will also have a major impact on the ability of many hospital labs to process blood tests and on waiting times for urgent and cancer referrals, with concerns for patient care and safety.
BMA and GPDF confirm agreement on GPC grant arrangements for three years
The BMA and GP Defence Fund (GPDF) have agreed a new long-term deal that will provide additional funding for GPC UK for a further three years up to June 2023. The agreed deal will provide support on top of BMA funding for the work of GPC and the negotiating teams in England, Scotland and Wales, as well as enabling the ongoing support provided to LMCs in the form of guidance and advice by the BMA.
The work of GPC is essential to ensuring that national negotiated terms and conditions are protected, and that GPs are represented at the highest levels amongst governments and policy makers. Both the BMA and GPDF are pleased that a long-term funding settlement has been agreed and look forward to working together in the coming years.
Dr Douglas A Moederle-Lumb, Chair, GPDF
Dr David Wrigley, deputy chair, BMA Council
Dr Trevor Pickersgill, BMA Treasurer
New to Partnership scheme
We are pleased that practices are now making applications so that their new partners can benefit from the new to partnership payment. We would encourage all practices with partners who have joined the practice since 1 April to do so. However, we recently became aware of a potential issue with the ‘New to Partnership Payment Scheme’ which apply to new clinical partners from 1 April 2020, causing a 'catch 22' situation.
We know that new partners often commence with fixed share ‘probationary’ period, before moving to a full equity share. We have discussed this issue with NHSE/I and we have agreed that in these situations, an individual will be accepted on to the scheme once they become a shareholding partner on an equity basis, as long as the probationary period commenced after 1 April 2020.
NHSE/I has also considered the barriers to individuals obtaining the evidence required to support their application to the New to partnership Payment Scheme, and have identified alternative evidence that can be submitted:
These changes are effective immediately and the guidance documents have been updated. Those who have already applied to the scheme will be contacted by NHSE/I and do not need to reapply.
Changes to the Supporting Mentors Scheme (England)
NHSE/I has amended its guidance in relation to the recognised accredited mentorship qualification that mentors should receive via the supporting mentors scheme. In the original national guidance, the ILM Level 5 in Coaching and Mentoring was cited as a benchmark example, however it is now recognised that there are a number of other mentorship qualifications that are equally high quality and will equip mentors with the right mentoring skills and knowledge. The guidance has therefore been updated so that systems have the flexibility to deliver other appropriate mentorship qualifications that are equivalent to ILM Level 5, with the agreement of NHSE/I regions.
GP Fellowship scheme podcast
The GP Fellowship Scheme was launched recently to address the recruitment and retention challenges in general practice. The scheme incentivises newly qualified GPs to become a salaried GP or Partner, and include support for the individual and provide additional experience of different practices, the ability to develop a portfolio career with the opportunity of to develop clinical expertise and providing protective time for personal development and a GP Mentor.
This podcast produced by Wessex LMC explains how the scheme will benefit newly qualified GPs and general practice more widely, and will be of interest to GPs in training, practices who are looking to recruit salaried GPs or Partners and those responsible for delivering the scheme locally. The panel included: Nigel Watson, GP and Chief Executive of Wessex LMCs and Independent Chair of the GP Partnership Review , Nikki Kanani, GP and Primary Care Medical Director, NHS England, Samira Anane, GP in Manchester and Education & Workforce Lead, GPC and Faye Sims, Head of Primary Care Workforce NHS England and Lead for GP Fellowships.
NHS.net email address
There is currently a process of upgrading the Outlook system for NHS.net users. Some of you might have noticed that for nhs.net emails, the icon with your initials now appear back to front. We have raised this with NHS Digital who informed us that this is due to the email naming convention on NHSmail, the initials in O365 are driven by the users email display name.
Due to the scale of the service they have had to implement a standard naming convention for all users, and to aid searching the directory the discussion was taken several years ago to have this formatted as SURNAME, First Name (Organisation). NHSDs own legacy O365 environment uses the hscic.gov.uk directory which only has ~4000 entries, so was able to use First name, Surname. However, with over 2 million entries in the new directory, NHSD is not able to change this at source, but are investigating whether there is a way of making a change in O365 to reverse the order.
Clinical validation of surgical waiting lists framework and supporting tools
NHSE/I has published the clinical validation of surgical waiting lists framework and supporting tools, designed to support systems to clinically validate their waiting lists and establish patient’s wishes regarding treatment. This project is centred around making the best mutually agreed decisions with patients regarding their treatment and is not an exercise to reduce numbers on waiting lists.
The hospital will contact all patients on an admitted pathway by 23 October 2020 to establish their wishes about their preferred next steps. The patient’s GP practice will then be notified of the outcomes of discussions regarding their procedure.
BMA survey on physician-assisted dying - results
The BMA has published the results of a survey into BMA members’ views on physician-assisted dying. Nearly 29,000 members responded, making it one of the largest surveys of medical opinion carried out on this issue. Read an update from medical ethics committee chair John Chisholm
Survey of Salaried GPs (England)
A reminder about our survey of Salaried GPs in England, about the terms and conditions under the BMA’s salaried GP model contract, which closes on 12 October. If you have any questions about the survey, please email us at info.pcs@bma.org.uk
Survey to assess the impact of COVID-19 on child protection conferences (England & Wales)
The Nuffield Family Justice Observatory is launching a new research project with Kings College London to examine how practice around child protection conferences throughout England and Wales has been affected by COVID-19. The research team is calling for parents and professionals with experience of child protection conferences during the pandemic to take part. To take part in the survey visit the Nuffield FJO website
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.
BMA COVID-19 guidance
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:
For further information, see the BMA’s COVID-19 Webpages
COVID-19 Media
I wrote a letter in response to an editorial in The Telegraph paper - People need their GPs which was published on Monday. I challenged the view that implied that General Practitioners are letting patients down by relying excessively on telephone or online consultations. I wrote that "Doctors have worked tirelessly to serve their communities throughout the pandemic, often at personal cost, and would challenge this in the strongest possible terms. Practices have remained open for their patients throughout this crisis, but to protect both patients and our workforce, and following government guidance, we have used telephone and video consultations to reduce the need to attend the surgery. We understand and share the frustrations that many people feel about the constraints imposed by this pandemic. The BMA has received numerous reports of GPs and nurses being forced to work from home due to the lack of availability of Covid-19 tests for themselves or their families. Resolving this should be of the highest priority for the Government and NHS leadership."
Katie Bramall-Stainer, deputy chair of UK Conference of LMCs, also had a letter published in The Telegraph on the same issue, stating that “Many lives have been lost, directly and indirectly, due to Covid and that general practice was following the standard operating protocol enforced by NHS England, of a total triage system” and that practices needed to protect their staff.
I appeared on Radio 4's consumer programme You and Yours, responding to callers who were concerned about access to face-to-face appointments. I stressed that GPs were struggling to cope with unprecedented workload, the need to protect both patients and the workforce and dealing with substantial backlogs for treatment caused by the pandemic - but were working tirelessly to serve their communities safely and comprehensively. I was supported by GPs who also rang in to point out that they were open for business, seeing many extra patients after surgeries and doing home visits. I highlighted that more support from Government will be essential to enable GPs to cope with the expected additional demands that winter would bring.
I have also been interviewed on BBC Look North about the use of the NHS Covid App and BBC Radio Humberside about the potential for more stringent local restrictions due to rising rates of covid-19 infection.
In articles by the Shields Gazette and Derbyshire Times (both print only) about the slow increase in the number of face-to-face appointments being offered by GPs, BMA council chair Chaand Nagpaul also defended the profession's record in serving patients: "GPs, like hospital doctors, have worked flat out providing millions of appointments, including face-to-face, throughout the pandemic."
The Daily Mirror, Daily Mail, The National and the Daily Telegraph reported on the BMA's response to the findings of a Freedom of Information on request, conducted by Pulse, showing that 99 GP surgeries closed across the UK last year. In response to this I said: “England lost almost 1,000 full-time GP partners between 2018 and 2019, so whilst worrying, it’s sadly not surprising that practices closed or merged over the same period. We have a workforce crisis, making an impact long before the pandemic; unsustainable workload, mounting bureaucracy and historical under-resourcing are behind these changes and the impact of these pressures on patients is grave.”
See this week’s GP bulletin here.
GPC UK meeting
GPC UK met yesterday, 1 October, for its first meeting of the new session 2020/21. We had had to cancel our last meeting in March at the beginning of the pandemic and so this virtual meeting provided a good opportunity to reflect on the profound changes that have taken place over the last 6 months. Together with the other national GPC chairs we described the significant COVID related activity being undertaken in each part of the UK. We also received update reports from the sessional GPs committee, GP trainees committee and GPC policy leads. The BMA Treasurer, Trevor Pickersgill and the Deputy Chair of Council, David Wrigley also attended and provided an update on the GPDF/BMA Deed of Grant negotiations which have now concluded with a three year agreement.
COVID-19: general practice during the second wave
Following the experience of the last six months, we have developedproposals outlining the urgent measures needed to ensure general practice is protected and supported, as we move into the second wave of the pandemic. Implementing these proposals will be critical in enabling general practice to respond to the needs of our patients, not least whilst delivering the biggest flu programme ever and on top of previous and on-going workload and workforce pressures.
Our proposals are based on the government’s ‘protecting the NHS to save lives’ campaign and learning the lessons from the first wave, as well as what we’ve learnt from colleagues elsewhere. Our main concerns include the increase in patient demand and workload shift from elsewhere in the NHS where services remain limited, and the insufficient financial support from NHSE/I and government. These were issues that I was able to discuss directly this week with Sir Simon Stevens and Jo Churchill, the health minister with responsibility for primary care in England.
Read our call for action to support general practice during the second wave of COVID-19 here
This was reported by the BMJ, where I was quoted saying: “GPs, like all doctors, are extremely concerned that without decisive action now services will be overwhelmed if we see another spike in the coming weeks and months.” It was also reported by GPonline
GMS contract amendments (England)
NHSE/I has written to practices to outline amendments to the contract, as agreed in our last round of negotiations in February this year, as well as extending/amending some of the amendments that have been made in order to assist with managing the pandemic. The Friends & Family Test remains suspended, as does the requirement for individual patient consent for electronic repeat dispensing.
NHSE/I has listened to our concerns and relaxed the requirement for practices to make appointments available for NHS111 to directly book. The maximum that should be made available remains 1 per 500 patients, but practices can now only make available what is necessary to meet demand. This may therefore be covered by the previous arrangement of 1 per 3000 patients. We are aware that most practices do not see many of the slots available being booked into, so practices can now reduce this and only make available what they believe is required. Practices should though monitor this to ensure they are offering sufficient opportunity for direct booking.
Some of the contractual agreements made earlier this year for 2020/21 implementation have been delayed due to the pandemic, but the ones that commence from 1 October include a contractual requirement for practices to participate in the Appointments in General Practice data collection, participating in the NHS Digital Workforce Collection, new measures around list cleansing and patient removal and assignment, as well as a relaxation of subcontracting arrangements for the PCN DES.
Supporting effective collaboration between primary, secondary and community care in England
As we know prior to COVID-19 the NHS was already struggling to cope with increased activity, capacity constraints and financial pressures. It now faces a huge uphill struggle to deal with the inevitable backlog of care that has developed since March. Tackling these challenges over the coming months will require effective collaboration between systems and clinicians across primary, secondary and community care. However, there are a number of barriers to making this happen, including high workload, the need to adapt physical spaces to prevent the spread of infection, lack of joined up IT, historic workforce shortages and a lack of consistent communication and trust between different parts of the health system.
Building on the work of the BMA’s Caring, Supportive, Collaborative project, we have published a paper which sets out what needs to happen to empower doctors to work together to tackle the backlog. The key recommendations include:
Read the report and full list of recommendations here
NHS Community Diagnostics Hubs (England)
Yesterday, Professor Mike Richards presented the recommendations from his report Diagnostics: Recovery and Renewal. The report was commissioned as part of NHS Long Term Plan implementation. However in the context of the response to the COVID-19 pandemic and the re-start of NHS core services, the centrality of diagnostics to the NHS’s ability to deliver patient care has come to the fore like never before. The report confirms that the last six months have underlined the need to change the structure of and increase diagnostics capacity. Professor Richards suggests improved clinical models – such as the separation of acute and elective diagnostics – which, along with additional investment, will enhance health outcomes for all patients.
The main recommendation of the report is the creation of Community Diagnostics Hubswhich will both relieve the burden on primary care and acute hospital sites and provide patients with easier access to one stop diagnostic services. It will also lead to major efficiency gains in terms of procurement of diagnostic equipment, workforce and skills mix requirements, and savings for the NHS. This follows lobbying we have been doing on the need for increased commissioning of diagnostics capacity in the community, as highlighted in our paper Supporting effective collaboration between primary, secondary and community care in England in the wake of Covid-19 and we will continue to engage with NHS Diagnostics Board to ensure appropriate capital and revenue funding is provided for these changes that the report suggests.
NHS Pension Schemes consultation (UK)
The Government is holding a consultation about Public Service Pension Schemes: changes to the transitional arrangements to the 2015 schemes, with a deadline of 11 October. The BMA will be responding to the consultation, but is also urging doctors to make their own submission to the consultation. To help do this, the BMA has created a template consultation tool, which is editable so you can outline your own experiences, while also emphasising the key points which we will believe will affect the majority of our members. Read more in the message from Vish Sharma, Chair of the BMA’s Pensions Committee
Practice rental payments
As we reported last week, the issue of some tenants of GP practices either decreasing, or threatening to decrease their rents, was recently raised with GPC. Tenants cannot unilaterally change the existing arrangements without due process and discussions, and to do so is not acceptable. The legal principle is that subject to the lease arrangements that are in place, no one party can unilaterally change the terms of the agreement and adjust the rent without agreement and without being transparent. Both parties must work together and the entire process must centre around collaboration, with both parties acting reasonably and responsibly in reaching any agreement. We have now written to Chief Executive of Well Pharmacy, one of the larger tenants, to further highlight our concerns.
Influenza vaccination: Principles for collaboration
The RCGP and the Royal Pharmaceutical Society have published a joint statement on Influenza vaccination: Principles for collaboration across Great Britain, setting out the need to ensure a high uptake of flu vaccination to keep people well and negate excessive pressures on NHS services. This is particularly important this winter, with COVID-19 still in circulation. The following principles have also been developed to ensure a high uptake of the flu vaccine:
Read the statement here
JCVI advice on priority groups for COVID-19 vaccine
The Joint Committee on Vaccination and Immunisation (JCVI) has published updated advice on the priority groups to receive COVID-19 vaccine. The committee has advised that vaccine should first be given to care home residents and staff, followed by people over 80 and health and social workers, then to the rest of the population in order of age and risk. The advice will continue to be updated as more information is available on vaccine effectiveness, safety and clinical characteristics.
GP appointment data
The link to the GP appointment data for August that we included last week was incorrect – it should be this. The data showed that the number of appointments delivered by practices that month remained relatively stable, with the percentage of appointments delivered face to face having risen compared to previous months.
One career endless opportunities #Choose GP
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 informationto 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.
Survey of Salaried GPs (England)
We are conducting a survey of Salaried GPs in England about the terms and conditions under the BMA’s salaried GP model contract, which focuses on pay and the provision of parental leave rights under the model contract and your answers will inform our work on reviewing salaried GPs remuneration package and may be used in negotiating discussions. It should only take 5 minutes, and your responses will be anonymous. The survey closes on 12 October. If you have any questions about the survey, please email us at info.pcs@bma.org.uk
Responding to the death by suicide of a colleague in primary care: a postvention framework
The Louise Tebboth Foundation and the Society of Occupational Medicine have launched a report which provides a framework to support primary care organisations following the death by suicide of a colleague. The report draws on interviews with people working in practices who have personal experiences of a death by suicide within their team, and includes useful practical advice suicide postvention guidelines proposals to put appropriate support in place to help people and organisations recover.
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. For hard copies of our Wellbeing poster, please email wellbeingsupport@bma.org.uk
BMA COVID-19 guidance
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:
Re-election as Chair of GPC UK and GPC England
It was announced yesterday that I have been elected unopposed as chair of GPC UK and GPC England for a second three-year term starting immediately. I am deeply honoured by the trust shown in me by the BMA’s GP committee, and humbled by the privilege and responsibility of leading our great profession, particularly during this time of national health crisis. Thank you for all the messages of best wishes that I have received. GPC, in partnership with LMCs, will continue to fight hard to resolve the workload and workforce crisis which threatens to undermine our profession, and the health service which it is the bedrock of. We will work hard, and I will do all I can, to secure a future for our profession that ensures that generations of future doctors will continue to look upon general practice as providing the most rewarding of medical career.
New rules for controlling the spread of COVID-19
You will have seen the announcement from the Prime Minister on Tuesday evening regarding the latest measures which are being introduced in England to help combat a second peak of COVID-19 infections. You will have also seen that the UK's coronavirus alert level has been being upgraded from 3 to 4, meaning transmission is "high or rising exponentially". Those of us on the front line of general practice know very well that general practice never stopped working or seeing patients during the height of the COVID-19 crisis despite reports to the contrary in the press. We know that the reality is that general practice is now experiencing significant workload demand and that this is rising rapidly.
As we move toward a second peak of the COVID-19 pandemic, whilst delivering the biggest flu programme ever and on top of the usual winter pressures, GPC is calling on NHSE/I and the Government to ensure general practice is properly protected and supported.
With regard to the new restrictions for controlling the spread of COVID-19 in England the BMA have said that further action is needed. BMA Council Chair Dr Chaand Nagpaul said that it is encouraging that the Government has, at last, recognised the need for more stringent measures to control the virus’s spread, but there are a number of further actions which the Government could take to prevent a second peak. The BMA has consistently argued that it was illogical for staff not to be required to wear facemasks in shops, pubs and restaurants as customers are, so we are pleased to see this belatedly coming into force. However, given that the infection is equally like to spread in all indoor settings, these rules should also apply to offices and other workplaces. You can read the full BMA press response here.
New restrictions have also been announced for controlling the spread of COVID-19 is Scotland, Wales and Northern Ireland with an upsurge in cases across all the countries.
I gave an interview to BBC Look North (East Yorkshire and Lincolnshire) and answered viewers' questions relating to COVID-19. You can watch the interview here, (3:47 minutes in on Tuesday). I was interviewed by BBC Radio York on Monday, BBC Radio Humberside on Tuesday and again on Thursday morning about access to GP surgeries during Covid-19 and the importance of triage to keep both patients and the workforce safe, but stressed that patients would be seen face to face when it was clinically necessary to do so. You can listen to the interview here (at 10.08am on Thursday).
GPC executive team member Dr Krishna Kasaraneni appeared on BBC Politics North on Sunday morning to condemn the recent letter from NHSEI warning GPs that they must provide face-to-face appointments. He stressed that GPs have been working tirelessly throughout the pandemic to provide face-to-face appointments whenever there is a clinical need for this, and that suggestions to the contrary are damaging and unwarranted. You can watch this from the 16 minute mark.
Dr Alan Stout, NI GPC chair, spoke to BBC Ulster about care homes and hospitals potentially being subject to further restrictions to help contain Covid-19. You can listen to the interview here, (at 9.35am on Wednesday).
NHS contact tracing app
The NHS Covid-19 app was launched yesterday in England and Wales. In our response we highlighted that tracing and isolating people who have been in contact with infected individuals is important in helping prevent spread of the virus. The more people who download the app, the more people who may have COVID-19 but otherwise wouldn’t be traced should be identified and instructed to self-isolate. We said that the use of the app does not diminish the pressing need to have sufficient testing capacity, and must complement a properly functioning national test and trace system which can also quickly identify local outbreaks. Please see the full BMA press release here.
The app has a feature that allows any premises to generate and print a QR code to allow visitors to ‘check-in’ by scanning it. The QR code functionality is intended to consolidate all existing digital check-in services that have largely been in use in pubs and restaurants. Although all commercial premises are still obliged to offer a paper check in service, if they offer a QR one then it must be via the app. While GP surgeries are not obliged to offer either (appointment IT systems keep an accurate log of visitors) as part of wider efforts to encourage the public to download the app, practices may generate and display QR codes generated through the app on the understanding that these are not mandatory and patients are not obliged to scan them in order to attend. QR codes can be generated here.
The app features the ability to turn contact tracing on and off – this feature was built in for users working in high-risk environments but with adequate PPE to ensure that they do not receive notifications to isolate where it is not necessary.
GP appointment data
The GP appointment data for August was released yesterday, which show that the number of appointments delivered by practices that month remained relatively stable, with the percentage of appointments delivered face to face having risen compared to previous months. However new weekly appointment figures have also been published for the first time, showing a jump in appointment figures in early September, with concerns related to COVID-19 adding to the expected rise in activity as we move into autumn and with schools returning. Read my response here.
Delivering the flu vaccination programme
We are well in to the biggest influenza immunisation campaign that many of us will have engaged in, with large numbers of patients now having received their flu jab. We have heard reports of some practices already concerned that they have or will run out of vaccine. We are taking this up with NHSE/I and DHSC as a matter of urgency.
As I have stated two weeks ago, practices working in their PCNs where appropriate are encouraged to work together with pharmacies to support a successful 2020/21 flu campaign. This is even more important in light of COVID-19, and the challenges that we face in delivering this year’s flu programme. As in previous years, this is a national service with both practices and community pharmacies providing NHS flu vaccinations, and we all have a role to play in identifying and engaging patients and vaccinating to protect as many as possible at a very vulnerable time.
Practices and pharmacies should talk to each other about the vaccination service they are planning to offer to understand each other’s plans. Where possible discussions should include how to reduce health inequalities and how to target harder to reach or under vaccinated populations which can help achieve an effective campaign.
Locum doctors and flu vaccine
We have received several reports of locum doctors finding it difficult to secure flu vaccinations from their registered practice. Locum GPs are fully entitled to receive the flu vaccination from their registered GP, and practices are contractually responsible for providing the flu vaccination to locum GPs who are their registered patients. It is vital that we work together during this unprecedented winter season to protect our already over stretched workforce.
Survey of Salaried GPs
We are conducting a survey to hear from salaried GPs in England, about their terms and conditions under the BMA’s salaried GP model contract. In this survey we are particularly focusing on pay and the provision of parental leave rights under the model contract. Your answers will inform our work on reviewing salaried GPs remuneration package and analysis may be used in negotiating discussions with NHS England. The survey should only take five minutes, and your responses will be anonymous. The survey will close on 12 October. If you have any questions about the survey, please email us at info.pcs@bma.org.uk Thank you for taking the time to complete this survey – we appreciate your input.
Revised Network Contract DES material published
NHSE/I has now published the revised Network Contract DES materials on their website. This includes a cover note, amended 2020/21 Network Contract DES Specification and guidance, IIF guidance and SMR guidance. We have summarised the changes here.
GP Pay and Pensions system
The new GP pay and pensions system was planned to launch imminently. However following final performance testing the launch has now been postponed. GPs and practices should continue to use Open Exeter until notified otherwise. PCSE are communicating to all practices and LMCs to confirm this. As a key stakeholder, GPCE has been central to testing and questioning the new system and, while we are disappointed by the delay, we are glad that that a system which is not 100% ready for use is being held back until such a time as it is.
NHSE/I wrote to practices last week, setting out the reasons for introducing the new system. The letter also explained that an end goal is to ensure that no practice should have their payments negatively affected by the system switch. Testing has shown that this is largely the case but that around 200 practices might experience that affect without further reconciliation work. PCSE have contacted those practices to offer patient list reconciliation exercises to correct these anomalies and the majority have responded. However, we understand that around 50 practices have not and we would urge those practices to do so at the earliest opportunity. Undertaking this work will result in practices receiving the correct payment.
For the majority of practices, we anticipate no difference, but are taking a precautionary approach and will be closely scrutinising the early performance of the system. We have absolute assurance that robust business continuity arrangements are in place to enable payment if there is major problem.
Practice rental payments
The issue of some tenants of GP practices either decreasing, or threatening to decrease their rents was recently raised with GPC. Tenants cannot unilaterally change the existing arrangements without due process and discussions and to do so is not acceptable. The legal principle is that subject to the lease arrangements that are in place, no one party can unilaterally change the terms of the agreement and adjust the rent without agreement and without being transparent. Both parties must work together and the entire process must centre around collaboration, with both parties acting reasonably and responsibly in reaching any agreement.
We have met with the legal team of Well Pharmacy, one of the larger tenants and discussed their advice to their members. While we understand the impact the pandemic has had on their businesses, we made clear it was not helpful for them to issue letters to their landlords advising they will be paying only 75% of the usual rent for the foreseeable future citing the current situation and a subsequent reduction in footfall. The code of practice published by the government in June has been cited by some tenants, but the fact is that it remains voluntary and does not give pharmacies the authority to adjust their rent unilaterally, without agreement and without being transparent. Both parties must work together for the benefit of aiding swifter economic recovery, and the entire process must centre around that collaboration with both parties acting reasonably and responsibly in reaching any agreement. If practices need legal support to pursue this, they are encouraged to contact BMA Law or other legal firms with expertise in this area.
First Contact Physiotherapist evaluation and webinar
The final phase of a national evaluation into the First Contact Physiotherapist (FCP) role will be published at the end of September. The evaluation, conducted by teams at Keele and Nottingham universities, includes quantitative data on patient outcomes along with qualitative research based on interviews with patients, GPs, practice staff and FCPs.
To coincide with the publication, NHSE/I, Health Education England and the Chartered Society of Physiotherapy are holding a webinar to discuss the findings and explore the recommendations made by researchers. Samira Anane (GPC policy lead for Education Training and Workforce) will appear on the panel. The event is designed to promote successful implementation of the role, which is fully funded under the additional roles reimbursement scheme. You can register for the event here.
Template letter to private providers about screening
Last week, we included the incorrect link for the joint template letter that we published with the Royal College of GPs, that practices can use to write to private providers offering non-approved screening tests. Numerous private companies are offering screening that is not recommended by the UK National Screening Committee and there is a lack of evidence of how results of private screenings are presented in NHS services and is of benefit to patients, which is a cause of serious concern. The letter can also be accessed here
Caring for transgender people
The BMA has been mentioned in the media after the Government announced that transgender people cannot legally change their gender without a medical diagnosis. Speaking in the Times, Dr Helena McKeown, chair of the representative body and diversity lead, said: “This is a missed opportunity for the Government to publicly commit to caring for and valuing trans people by ensuring the way by which they legally declare their gender is free from stress and stigma, and removes bureaucratic and financial obstacles. The BMA supports transgender people’s rights to live their lives with dignity.” The story was also covered by Sky News.
BMA COVID-19 guidance
Paula Wright, a member of the GP sessional committee, has written an article on how the COVID-19 pandemic has seen a shift of sessional GP work opportunities from practices to providers of 111 advice. Please see the article 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:
For further information, see the BMA’s COVID-19 Webpage with all the latest guidance including links to the BMA’s COVID-19 ethical guidance
Mental health and wellbeing
We continue 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. For hard copies of our Wellbeing poster, please email wellbeingsupport@bma.org.uk
Access the BMA’s COVID-19 wellbeing pages here
See this week’s GP bulletin here.
See the most recent sessional GPs bulletin here.
Face-to-face appointments
It was appalling that earlier this week NHSE/I briefed the media to suggest that practices were not offering face-to-face appointments to patients, implying that we are not available for the patients that need us.
As we all know, the reality is that GPs and their teams have been working incredibly hard to keep their services as accessible as possible during the COVID-19 pandemic, with most offering telephone and digital triage as the first point of contact in order to help keep their workforce and communities safe. This is exactly what the Government has been encouraging us to do.
Throughout the pandemic practices have continued to enable face-to-face appointments when it was clinically necessary. Any inference that in-person consultations were not provided when needed is an affront to the thousands of committed GPs who have continued to deliver the best possible care to their patients, despite the many challenges we have faced. This is also an insult to the memory of the GPs who tragically died from COVID-19 which they contracted during face-to-face consultations.
Whilst we look forward to the time when it’s possible for more face to face consultations to take place without the need for PPE, thanks to the dedication of practice teams across the country and the use of new arrangements, patients’ concerns can now often be dealt with more efficiently, including redirecting patients to the appropriate professional service, such as to digital physiotherapy consultations, social prescribers or pharmacy. Surgeries should be commended, not criticised, for adapting so quickly and seamlessly to what is a massive shift in their usual working pattern and the Government needs to do much more to recognise and support practices doing this.
The anger and hurt within then profession is understandable, but that should not lead to abusive messages being directed towards individuals. We have raised our concerns with NHSE/I and with the Department of Health and Social Care about this unacceptable situation and highlighted how damaging to morale this has been for GPs and their staff. I have also sent the attached letter to Simon Stevens calling for an apology and action to address our concerns with this letter.
Read our full statement here
This was reported by the Independent, where I said: "Any inference that in-person consultations were put on hold is an affront to the committed GPs who have continued to go to work throughout the pandemic". I was also interviewed on LBC about this.
Pharmacy changes to reduce GP workload
This week, we sent a joint letter to the Secretary of State for Health and Social Care, Matt Hancock, calling for Government to amend medicines legislation to allow pharmacists to make changes to prescriptions and provide a different quantity, strength, formulation or generic version of the same medicine, if it is in short supply.
At a time of significant increase to GP workload and the problems with supply of medications, allowing pharmacists to make these changes so that patients can obtain their medicines in a timely manner would be helpful for both doctors and patients. We are working to try to reduce the bureaucracy that contributes to GP workload pressures and changes like this will go some way in addressing that, especially as we head into winter and at a time when we are seeing the number of patients with COVID-19 increase again. Read more here
Annual Representatives Meeting 2020
The BMA’s ARM was held this week. You can watch my presentation here
The meeting held a commemoration followed by a minute’s silence to pay our respects to the at least 34 doctors and many other colleagues, many of whom came from overseas to work in the NHS, who have died from COVID-19. Read more and watch the video here
Read more about the debate and what happened here
Revised Network Contract DES guidance (England)
NHSE/I has now published the revised Network Contract DES materials, which include:
· A cover note
· Amended 2020/21 Network Contract DES Specification
· Amended 2020/21 Network Contract DES Guidance
· IIF Guidance
· SMR Guidance
We will produce a brief summary in the next few days to outline the key areas.
Template letter to private providers about screening
We have co-badged a template letter with the Royal College of GPs, that practices can use to write to private providers offering non-approved screening tests. Numerous private companies are offering screening that is not recommended by the UK National Screening Committee (UKNSC), and there is a lack of evidence of how results of private screenings are presented in NHS services and is of benefit to patients, which is a cause of serious concern. This follows our joint Position Statement on Screening by organisations which have not been approved by the UKNSC, which was published last year.
You can also access the letter here
NHS Test and Trace App
The new NHS Test and Trace App will launch next week on 24 September. The QR codes are not intended for healthcare settings but for business and other public buildings that will be mandated to keep a record of those entering. If practices want to apply for and display a QR code they can do so voluntarily but there is no expectation or contractual requirement to do so.
COVID-19 media
Dr Krishna Kasareneni featured on the main BBC News bulletins on Tuesday 16 September, and again on BBC Look North yesterday, talking about the failures in the Test and Trace system. I have also done two interviews on BBC Look North this week about the widespread problems with testing and the rising number of cases, as well as interviews for BBC Radio Leeds and Greatest Hits Radio national stations.
CQRS update
This document from CQRS contain a reminder of the payment declaration and details around the signing onto CQRS from the 23rd September.
NHS Clinical Entrepreneur Programme
Applications for the NHS Clinical Entrepreneur Programme opened on 15 September 2020. This is an educational workforce development programme designed for healthcare professionals who want to develop and scale their most innovative ideas for patient benefit.
The programme was launched in 2016 and has already recruited over 500 individuals including doctors, dentists, pharmacists and nurses from a range of diverse backgrounds. Places on this programme will be offered through a competitive process, to applicants who have developed clinical innovations to improve patient care and support service redesign through commercial and non-commercial enterprises. You can find more about this programme, and the application portal, here
See this week’s GP bulletin here.
ARM 2020
The BMA’s Annual Representatives Meeting will be held virtually next week, on Tuesday 15 September. Debates will focus on some of the key issues currently impacting the profession but the meeting will also provide an opportunity to pay our respects to the at least 34 doctors and many other colleagues, many of whom came from overseas to work in the NHS, who have died from COVID-19. Royal colleges and other organisations are urging their members to join us in a minute’s silence and commemoration. The ceremony will begin at 10.45am with the minute silence observed at 11.00am. The memorial will be broadcast online and details will be circulated in the coming days so that people not attending ARM can join in this important act. I hope you and your colleagues will join us.
In my presentation on behalf of GPC to the ARM I highlight that this has been a year like no other. GPs, practices, PCNs, out-of-hours providers, LMCs and GPC have been tested as never before and despite the many challenges we have all responded and delivered. Working together, at national and local level, GPC and LMCs, we have advocated and lobbied on behalf of the profession, and helped and supported GPs and their teams to rapidly respond to the many changes and challenges they’ve faced and as a result they have not let their patients down. I am proud of what GPs and those working with them in general practice have done this year and this is an opportunity to thank them once again. You can watch my presentation to the ARM here
Read more about how to follow the debate on the day and how to download the ARM app here
QOF at a glance
As I reported last week, NHS England have now published revised QOF guidance which details the requirements for 2020/21. This guidance is effective immediately and the Statement of Financial Entitlement will be amended shortly to reflect this.
We have drafted a QOF at a glance document, which summarises the changes for QOF for the remainder of 2021/22. In light of COVID-19, QOF has been refocussed to:
• support practices to reprioritise aspects of care not related to COVID-19
• serve those patients most in need of long-term condition management support
• guarantee significant income protection and the relaxing of some requirements for practices.
We have drafted the attached ‘QOF at a glance’ guidance, which summarises the changes.
Flu guidance 2020/21
Last week, NHSE/I published the updated flu specification for 2020/21 and the updated DES directions. Practices will need to respond to commissioners’ invitation to participate in the 2020/21 Flu DES by no later than 14 September. Additional BMA guidance and NHS England FAQs will be published shortly.
Delivering the flu vaccination programme
Practices working in their PCNs where appropriate are encouraged to work together with pharmacies to support a successful 2020/21 flu campaign. This is even more important in light of COVID-19, and the challenges that we face in delivering this year’s flu programme. As in previous years, this is a national service with both practices and community pharmacies providing NHS flu vaccinations, and we all have a role to play in identifying and engaging patients and vaccinating to protect as many as possible at a very vulnerable time.
Practices and pharmacies should talk to each other about the vaccination service they are planning to offer to understand each other’s plans. Where possible discussions should include how to reduce health inequalities and how to target harder to reach or under vaccinated populations which can help achieve an effective campaign.
This year the new Investment and Impact Fund includes a shared goal across the PCN to provide immunisations to patients 65 years and over and this includes those given both by practices and pharmacies in the area. Read more in the GP contract agreement document
GP earnings and expenses 2018/19 (England)
NHS Digital has published the GP earnings and expenses for 2018/19, which show an average increase in income before tax of 3.4% for GP contractors and 3.8% for salaried GPs in England. For non-dispensing GP contractors in England the increase was 4.1%. Increases were higher in Scotland, in part related to the introduction of new contract arrangements, and in Wales, but lower in Northern Ireland. After many years of sustained real-terms pay cuts for GPs, these figures show that this trend is slowly beginning to be reversed, although not yet for GPs in Northern Ireland. This is despite in 2018 the Government in England yet again failing to recognise the huge contribution of family doctors by going against its own pay review body and imposing an award that was half of what was recommended, which would have left GPs with another sub-inflation pay uplift.
That practices were able to offer uplifts to both employed doctors and partners shows how much they value their highly-skilled staff, which is vital to both recruitment and retention – and ultimately guaranteeing high quality patient care.
Pressures in general practice still remain as demand rises amid large workforce shortages - before we consider the huge challenges over the last few months - which practices were quick to meet with both innovation and compassion. The pandemic has shone a light on the huge contribution GPs make to the NHS, and it is crucial that doctors are rewarded appropriately for their hard work and dedication. This was reported by GP online
Automation of PCN payments (England)
From 1 September, payments for PCN (Primary Care Network) core payments, CD (Clinical Director) payments, Extended Hours Access, and Network Participation Payments, became automated (previously manually processed by CCGs). As part of this change, each practice is now required to verify the Network Participation Payment in CQRS before it is released.
RCA and Less Than Full Time (LTFT) trainees
The BMA GP trainees committee (GPT) have heard concerns from Less Than Full Time (LTFT) doctors about their ability to prepare for the RCA (the temporary replacement for the CSA exam). As trainees are provided with a set number of weeks to collect evidence for their assessment, those on LTFT schedules feel at a disadvantage to their full-time colleagues.
The committee continues to work with the RCGP about this issue, and raise these concerns. GPT notes that the college will soon evaluate the first sittings of the RCA exam, and this will provide them with scope to ensure the assessment is fair to all trainees.
COVID-19 antibody test results flowing to GP records
From 10 September, when a person undertakes an antibody test that is taken through the public antibody portal (an ELISA test), the result will be loaded directly into their patient records. This will be in addition to flowing of test results for pillar 2 viral testing and will follow the same process, according to each practice’s IT system provider.
Results will be presented on patients’ records as ‘positive’, ‘negative’ or ‘unknown’. As for viral testing, there will be no action required from the GP practice on receipt of the test results. Bulk upload of test results into GP records will take place without any manual patient by patient process. Practices will receive further guidance by their own system supplier about how this will work.
Remote fit notes - please remember to sign them
DWP has asked us to remind GPs that as per previously agreed guidance they will accept fit notes that are printed, signed, scanned and e-mailed to patients. This advice has also been given to employers, who should also be accepting signed, scanned and emailed fit notes.
However, DWP is receiving a significant number of unsigned fit notes which they cannot accept and this results in inconvenience for both patients and GPs. We would therefore remind GPs thatfit notes must be signed.Read more about remote fit notes in our COVID-19 toolkit for practices
LMC England Conference – motion deadline
The deadline for submitting motions for the LMC England Conference is midday, Friday 18 September 2020. LMCs have been sent an email with information on how to submit motions and how to register (by 16 October). The conference itself will be held virtually on Friday 27 November. More information will be provided nearer the time and will be added to the LMC page on the BMA website. For further information contact Karen Day on kday@bma.org.uk
We regularly update our toolkit for GPs and practices, which includes a large range of topics relating to COVID-19. There is also guidance on the following topics:
· Guidance on risk assessments which includes specific information for practices.
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. For hard copies of our Wellbeing poster, please email wellbeingsupport@bma.org.uk. Access the BMA’s COVID-19 wellbeing pages here
COVID-19 media
I was interviewed by LBC following the Prime Minister’s announcement about restricting gatherings of people to no more than 6.
Alan Stout, Chair of GPCNI, was mentioned in an article by the Daily Mirror Northern Ireland on Tuesday, which addressed people's perceptions about GP opening times during the pandemic, with many thinking surgeries were closed when they weren't. The article read: "GP practices are still open and have been operating throughout the pandemic despite public perceptions they closed, medics have said. Dr Margaret O’Brien, from the Health and Social Care Board, Dr Laurence Dorman from the Royal College of GPs, and Dr Alan Stout, from the British Medical Association, are working together to reassure patients they can still access GP treatment, advice and prescriptions.”
Future Scotland reported that that the Scottish health secretary Jeanne Freeman has rejected a suggestion by Matt Hancock to make ‘all’ GP appointments online – ‘unless there’s a compelling clinical reason not to’. In response to this, Andrew Cowie, deputy chair of GPC Scotland: “It’s fair to say that we will need to embed the kind of digital innovations that have supported more remote consultations throughout the past few months. These are necessary to cut down footfall in GP practices, and reduce the risk of transmitting COVID-19 in waiting rooms.” Read his full quote here.
See this week’s GP bulletin here.
GMS and PMS regulations changes from October 2020 (England)
The amendments to GMS and PMS regulations in England to commence from October have now been laid before Parliament and published. These mainly bring into force elements of the GP contract agreement from earlier this year. The amendments include:
· Requirement for monthly data submissions to the NHS Digital Workforce Collection
· Requirement to participate in the existing GP appointments data collection
· Requirement for practices to ensure patient registration data is regularly updated
· Removal of patients who move outside of the practice catchment area: the practice is responsible for the patient’s care for up to 30 days (unless and until the patient registers at another practice) but is not responsible for home visits or out of hours services during that period.
· A modification to make sure that patients who have previously been removed from a practice list and been put onto a violent patient scheme cannot be permanently refused readmission to a practice list if they have been correctly discharged from that scheme.
· Patient assignment to any practice within the patient’s local CCG, rather than within the practice area.
· Patient assignment as part of a list dispersal
· An exemption to the ban on subcontracting a subcontract in order to allow PCNs greater flexibility to deliver the DES
· Final cancellation of CQC registration is a ground for termination of a GMS contract
· Other minor amendments to wording without significant change to the meaning
Impact of delays for cancer patients
I wrote a letter to the Sunday Times (log-in required) highlighting the impact of the pandemic on cancer referrals and treatment, following a Times article (15 August) which reported that cancer survival rates were expected to fall due to delays in getting urgent referrals or treatment during the pandemic. The letter reads:
“The Institute for Public Policy Research is right to highlight the impact of the Covid-19 pandemic on cancer referrals and treatment. Its warnings echo the concerns doctors have been raising for months. In the latest survey for the British Medical Association (BMA), more than half of GPs said they had seen more patients presenting later with conditions than they would normally expect, with cancer symptoms causing them most concern. Yes, the government and NHS must urgently address the huge backlog in nonCovid care. Equally, patients should not be put off seeking help when they need it.”
Registering patients prior to their release from the secure residential estate (England)
As we reported last week, practices have a contractual obligation to support patients prior to their release from the secure residential estate, as set out in the NHS England Standard General Medical Services (GMS) Contract 2017/18. Practices are therefore asked to ensure that processes are in place to support this and information on how to do this here.
Our guidance page on patient registration has now been updated to reflect this clarification.
Redacting GP records
In June, GPC wrote to NHSE/I to raise concerns over the redaction of records and unintended consequences of any processes put in place to facilitate patient access to records. The letter sought reassurances that a) patients would not be able to view incoming correspondence before a GP has had the opportunity to review it and b) that the workload of GPs should not increase as a result of needing to review individual records and mark consultation notes for redaction. We have now received a response outlining what measures have been put in place to mitigate these concerns. We also received reassurances that where practices feel granting access to patients’ records during the pandemic would have an adverse impact on provision of essential services, they are not required to do so. NHSE/I is now reviewing their patient-facing guidance on access to records to reflect these points.
GP workforce data (England)
The latest GP workforce data has been published. In response to this I said: “The prolonged and continued decline in the number of FTE GPs in England is a matter of serious concern, but this data is hardly surprising when we consider the immense pressures family doctors are under across the country – both now and long before the pandemic hit. Before Covid-19, GPs were contending with chronic underfunding, rising patient demand, and toppling workloads, all of which has been exacerbated by the virus, with many surgeries going above the call of duty to keep patients safe.
This further drop of 1.4% FTE GPs since March speaks for itself, and yet despite the clear need to do more to attract and retain more GPs, the government have just undermined morale further by failing to use the DDRB recommendations to recognise the incredible work GPs and their teams have done during the pandemic.
Whilst the schemes that we have recently succeeded in introducing, such as the partnership premium, the GP fellowship scheme and the expansion of GP training places may help in the longer term, much more needs to be done to turn these figures around. That's why, as we prepare for a potential second wave, it’s therefore never been more important that the Government does far more to value GPs and to ensure general practice has the resources it needs for GPs to keep their patients safe and well”. This was reported by Pulse
GP appointment data
The GP appointment data for July was released yesterday, which show that the number of appointments delivered by practices are continuing to rise towards pre-pandemic levels. Although total figures still remain around 6% down on those for March, the number of same or next day appointments has risen to the highest in the 18 months covered by the dataset, supported by the continued pragmatism and flexibility of practices utilising triage arrangements and remote consultation methods.
NIGPC media (Northern Ireland)
NIGPC chair Alan Stout was interviewed on the BBC Good Morning Ulster programme (starting at 35:43) about the latest quarterly waiting list statistics and what needs to happen to address the waiting list crisis in terms of HSC transformation. Dr Stout was also on the Nolan Show (from 31:24) talking about the winter flu jab programme during the ongoing pandemic.
Influenza and Pneumococcal Vaccination (Coronavirus Outbreak) Directions 2020 (Scotland)
The directions will have the effect of directing Health Boards to deliver those parts of the Influenza and Pneumococcal Immunisation Scheme which GP contractors cannot reasonably deliver under the Influenza and Pneumococcal DES in Scotland.
Annual Representative Meeting 2020
The BMA’s Annual Representative Meeting will be held virtually on Tuesday, 15 September. Find out more about the ARM and why it matters for BMA members in this short video and read more about how to take part and make a difference, in this blog by Helena McKeown, Chair of the BMA’s representative body.
BMA photography competition
Do you have a photograph that captures COVID and what the pandemic has meant to you? There's still time to enter the BMA photography competition – the deadline is 31 August. The winner will be announced at the ARM meeting. Enter the competition here
Social Prescribing Link Worker Day Conference
The National Association of Link Workers will be hosting a virtual Social Prescribing Link Worker Day Conference on 9 October 2020, with the theme of ‘The Social Innovators Powering up wellbeing’. This event is open to GPs, social prescribing link workers, community health and social care industry leaders, Primary Care Networks and clinical directors across the UK. It will provide updates and examples of local arrangements benefitting practices and patients through social prescribing – find out more here. There are 50 free tickets available for BMA members via this link
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We continue to regularly update our toolkit for GPs and practices, which includes a large range of topics relating to COVID-19. There is also guidance on the following topics:
· Guidance on risk assessments which includes specific information for practices.
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. For hard copies of our Wellbeing poster, please email wellbeingsupport@bma.org.uk
Access the BMA’s COVID-19 wellbeing pages here
See this week’s GP bulletin here.
See the latest sessional GPs newsletter here
NHS Property Services legal action
As many of you will know, the BMA is supporting five GP practices who have started court proceedings against NHS Property Services (NHSPS) to clarify the basis on which NHSPS calculates service charges. Since 2016, many practices have received increasingly costly service charge demands from NHSPS. In defence of these expensive non-reimbursable charges, NHSPS had argued that it was moving to a “full cost” approach to the recovery of charges via a “consolidated charging policy”. The BMA position was – and continues to be – that the consolidated charging policy cannot be unilaterally incorporated into the terms of individual practices’ tenancy agreements.
NHSPS has filed Defences and Counterclaims in each of those claims. Within the five Defences, NHSPS has finally conceded that the consolidated charging policy has not varied the existing leases and that the service charges are not due pursuant to the policy.
Supported by the BMA, the test claimants are now applying to the High Court to ask that it upholds their claims against NHSPS and issues declaration that the ‘consolidated charging policy’ does not form part of their tenancy.
Although such judgments would not automatically bind any GP practices beyond the five test claimants, they will be highly persuasive evidence that other GP practices in similar circumstances can rely upon when facing disputed demands from their landlord.
You can read more about the case and the BMA’s position in the attached letter to practices.
Infection prevention and control guidance (UK)
Public Health England and the equivalent organisations in the devolved nations have now published Guidance for the remobilisation of services within health and care settings which sets out infection prevention and control recommendations. It re-emphasises that where possible services should continue to utilise virtual consultations and classifies general practice physical consultations as medium risk. PPE should therefore continue to be worn for all face-to-face contacts.
The guidance advises that for vaccination clinics, where contact with individuals is minimal, the need for single use PPE items for each encounter is not necessary and staff administering vaccinations must apply hand hygiene between patients and wear a sessional facemask. More guidance relating specifically to the flu campaign will be issued shortly.
In response to the publication of the guidance I said: “At the beginning of the Covid crisis, many practices were forced to buy their own PPE or rely on donations from local schools and businesses, such was the woeful system of accessing supplies. We absolutely cannot afford a repeat of this as we seek to see more patients face-to-face, and especially as we deliver the biggest flu vaccination programme in recent history. GPs and their teams are resourceful, but this should not be relied upon as an excuse for not providing practices with the equipment they need to protect staff, and at a time when their priority, as always, should be on providing care for their patients.”
The BMA has now updated its guidance on PPE for doctors.
GMC fees and maternity leave
The aim of the GMC’s income discount scheme is to assist doctors whose overall financial circumstances makes it more difficult for them to afford the full annual fee. However some doctors may miss out on the discount if their period of maternity spans two registration years, with the result that their income does not fall below the threshold in either year. We challenged the GMC about this and following our intervention they will be undertaking a review of their discount scheme, as it recognises the need to allow all women on maternity leave (irrespective of the time of year their baby is born) to access a discount if their income falls below the threshold while they are on maternity leave.
In the meantime, the GMC will offer doctors a discount if they expect their income to be below the £32,000 threshold during a 12-month period that overlaps with their period of maternity leave. This discount is available for one registration year, so doctors will need to indicate on the income discount application form which year they would like the discount to be applied to.
The GMC will be updating its information to reflect this interim change – for further information please contact the GMC directly (contact details are on the income discount application form).
BMA analysis of NHS England - phase three of the response to COVID-19
Following NHS England’s letter announcing the start of Phase Three of its response to COVID-19, the BMA has produced an analysis, which can be read here, outlining what this means for doctors and for the health service.
In our recent Trust GPs to Lead report, we set out a range of principles and solutions that will enable GPs and practices to manage the ongoing demands of responding to COVID-19. Elements of the phase three announcement reflect this and show the successful lobbying carried out by GPC England, such as the requirement for CCGs to increase the range of services available for self-referral in order to free up clinical time, and the recognition of the importance of in-person appointments within general practice, alongside the use of remote consultations. We have also secured significant reform to annual appraisals that should benefit all GPs. However, it is important that NHS England acknowledges the ongoing pressure on primary care services and that the need to deliver services in as safe an environment as possible.
Tracker survey shows doctors have little confidence that wider NHS services can manage demand Whilst practices are reporting that workload levels have returned to previous levels, if not greater, the latest COVID-19 BMA tracker survey has shown that the majority of doctors in primary and secondary care have little to no confidence the wider health service will be in a position to resume a normal level of service before the end of this year, which reflects on the enormity of the backlog of care following the first peak of COVID-19. The survey also found that:
• 60% of all doctors and 73% of GPs said they were not confident in their local health economy managing demand as normal NHS services resume
• Half of all doctors and 63% of GPs responding said they were not confident in being able to manage a second wave of COVID-19.
After years of underfunding and understaffing, and in the midst of a once-in-a-century public health crisis, it is clear that the Government and NHS England need to step up and deliver a strategy for how these services can be brought back online and up to speed. This needs the NHS to be properly
funded to give it the capacity required to meet the needs of patients in the immediate and longterm.
Read more about the survey and outcomes here
This was reported by the Sunday Telegraph and the Guardian
Mask exemption letters for air travel
We are aware of some airlines that are still asking for letters from GPs for mask exemption. To restate our previous guidance, this is not required as per the government advice on exemption cards, which states: “Those who have an age, health or disability reason for not wearing a face covering should not be routinely asked to give any written evidence of this, this includes exemption cards. No person needs to seek advice or request a letter from a medical professional about their reason for not wearing a face covering. Some people may feel more comfortable showing something that says they do not have to wear a face covering. This could be in the form of an exemption card, badge or even a home-made sign. This is a personal choice and is not necessary in law.”
New National Institute for Health Protection (England)
The Government has announced the creation of a new National Institute for Health Protection (NIHP) with immediate effect, whose primary focus is public health protection and infectious disease capability, and with a single command structure to advance the response to the COVID-19 pandemic. It will bring together Public Health England and NHS Test and Trace, as well as the analytical capability of the Joint Biosecurity Centre under a single leadership team.
In response to this, Chaand Nagpaul, BMA Chair of Council, said: “We already have public health expertise in this country which is of the highest quality but despite the hard work of our colleagues in the last six months, substantial budget cuts and fragmentation of these services over years have hampered the response to the Covid-19 pandemic. We must absolutely not allow PHE and its staff to shoulder the blame for wider failings and Government decisions.” Read the full BMA statement here
The story was reported by ITV, Guardian, Daily Mail, Evening Standard, Daily Express, BBC, LBC, Pulse, Nursing Times, Medscape, GP Online, Newsweek and the i. Chaand Nagpaul was also interviewed by Times Radio (around 5.45pm).
Impact on practices of the government lifting the cap on medical school places
The government confirmed yesterday that it would be lifting the cap on the number of places to study medicine, in light of the issues around A-level grading, after the BMA called for universities to honour all earlier offers. The BMA had urged medical schools to review the applications of those who were earlier denied places due to the unfair grading process.
Due to the shortage of doctors in primary care, it is essential that an increase in intake to medical school is followed up with support and funding both for medical schools and GP practices, particularly to provide greater opportunities for practice-based training for medical students, which then often leads to more students choosing general practice as a career. While the BMA is pleased that the undergraduate tariff has recently been increased for placements in general practice, we know more can be done to distribute this funding and offer support for GP practices to enhance the undergraduate general practice experience for medical students. Read the BMA’s response to earlier reports on lifting the cap here. The story was covered by the Daily Mail, twice, and then a third time, Telegraph, London Economic
Briefing on the ‘McCloud’ public consultation on the NHS Pension Scheme
The Government Actuary’s Department and the NHS Pension Scheme (Scotland) Scheme Advisory Board have published the attached briefing which is a helpful summary on the progress of the ‘McCloud’ Public Consultation on the NHS Pension Scheme in Scotland, which closes on 11 October 2020. The aim of the consultation is to seek feedback on UK government’s proposals for removing the discrimination identified in the 2015 reforms, and covers all public service pension schemes in the UK, with the exception of schemes covered by Northern Ireland Executive and judicial and local government pension schemes, which will have separate consultations.
Registering patients prior to their release from secure residential estate (England)
Practices have a contractual obligation as set out in the NHS England Standard General Medical Services (GMS) Contract 2017/18 (page 64) to support with registering patients prior to their release from the secure residential estate. GP practices are asked to ensure that processes are in place to support this, with information on how to do this here. Plans are also progressing to enable patients to register with a GP in their place of detention in the same way as they register with a community GP. This change will enable a patient’s general practice record to transfer to their place of detention, allowing clinicians working in these settings full access to the individual’s medical record and history. This will be rolled out next year in a phased approach across England. BMA guidance will be updated to reflect this clarification and will be circulated as soon as possible to LMCs.
New restrictions on stimulant laxatives to counter risks from overuse
The Medicines and Healthcare products Regulatory Agency (MHRA) will be adding extra label warnings to new packs of stimulant laxatives to reduce abuse and overuse, and to make it clear that they do not help with weight loss and can lead to damage to the digestive system. Instead, patients should be encouraged to use alternatives, such as diet and lifestyle changes, or potentially switch to other products such as bulk laxatives.
Specialist and professional committee elections
Voting is for the following BMA committees is open until noon, 25 August.
– Committee of medical managers (CMM) - is looking for qualified managers in primary care
– Armed forces committee (AFC)
– Private practice committee (PPC)
– Forensic and secure environments committee (FSEC)
– Civil and public services committee (CPSC)
To submit your vote please visit https://elections.bma.org.uk/
Nominations to a number of seats have also been reopened. To submit your nomination or to find out more details about which seats are still available please visit https://elections.bma.org.uk/
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. For hard copies of our Wellbeing poster, please email wellbeingsupport@bma.org.uk
Access the BMA’s COVID-19 wellbeing pages here
We continue to regularly update our toolkit for GPs and practices, which includes a large range of topics relating to COVID-19. There is also guidance on the following topics:
· Guidance on risk assessments which includes specific information for practices.
Read the BMJ article about the Management of post-acute covid-19 in primary care here
See this week’s GP bulletin here.
