General practice appointment updated guidance (England)
We have published joint guidance with NHSE/I on creating more accurate general practice appointment data (GPAD), so that we can more accurately reflect the workload delivered in general practice. The guidance introduces an agreed definition of an appointment and asks general practice to start applying this now and systematically, as an important first step to improve data quality. This is to ensure all appointments are being recorded in general practice appointment systems, and to fully capture the scale of work and workload in general practice,
Further technical system specific advice and guidance will be issued to support practices with configuring appointment books and applying a set of new, standardised national categories for appointment types. Read more here
Supporting Mentors Scheme and GP Fellowship programme (England)
Following our 2020/21 GP contract agreement, NHSE/I has now launched the Supporting Mentors Scheme and GP Fellowship programme, as part of a group of GP recruitment and retention initiatives.
The supporting mentors scheme aims to support the training of at least 450 GPs as mentors, who will then form a cohort of locally based and highly experienced doctors who can each support between 4-6 mentees. GPs on the scheme will be provided with funded training, leading to a recognised mentoring qualification. Once trained, GP mentors will be reimbursed to conduct one session of mentoring every week.
GP mentors will be able to connect with newly qualified doctors on the GP Fellowship programme and to support them into become part of the local primary care team.
NHSE/I has also published a letter this week about Expanding the primary care workforce in 2020/21, which highlights the New to Partnership Payment Scheme, to support practices to recruit GP partners, and highlights the inclusion of nursing associates to the Additional Roles Reimbursement Scheme.
Updated Standard Operating Procedures for general practice (England)
NHSE/I has updated its Standard Operating Procedures for general practice, which now includes sections on cases definition of COVID-19, patients at increased risk of severe illness from COVID-19, patients advised to shield, safeguarding, symptom management and end-of-life care.
Risk assessments
Practices are reminded of the importance of undertaking workforce risk assessments on their staff. The BMA has guidance which looks at the implications of risk assessments for practices – specifically what impact the adjustments required for high risk staff could have on practices, staff and patients. It also suggestions what mitigation practices could do, such as working from home or removal from areas that are considered hazardous. The guidance also lists risk assessment tools that are available to practices to use. Read the guidance here
Impact of long-term Covid-19 symptoms on patients and doctors
The latest BMA tracker survey, published yesterday, shows the impact of long-term COVID-19 symptoms on patients and doctors, highlighting concerns that the NHS will continue to experience pressure in the upcoming months.
In response to this I said: “It's increasingly clear that the long-term impact of Covid-19 on individuals and on health services will be profound. These statistics suggest that patients are, even once they have recovered from the worst of this virus, still suffering the after-effects for some time. With more patients presenting with conditions as the result of infection, it’s essential that sufficient capacity is in place to support and treat them. With the growing backlog of non-Covid treatment, the likelihood of a season flu outbreak, and the possibility of a second wave of infections we need to see a more comprehensive long-term plan to enable doctors to care for their patients this winter and beyond.” Read the full quote here. I was interviewed by ITV news (feature begins at 15:07) on Wednesday, commenting on the range of impacts the virus can have on patients and for Radio Aire. This was also reported by the Daily Mail, Wales online, and in regional media including the Lancashire Telegraph and Oxford Mail.
The BMJ has now published an article about the Management of post-acute covid-19 in primary care – you can read it here.
Indemnity for flu vaccinations
All three Medical Defence Organisations (MDOs) have confirmed that they will provide indemnity cover, at no extra charge, for practices who vaccinate their own staff against flu this year. We are in discussions with NHSR about the indemnity arrangements for staff vaccinations for any coronavirus vaccine that may become available.
Vaccine supply for the 2020 to 2021 children’s flu programme
The Fluenz Tetra vaccine will be made available to order by all NHS providers of the 2020/21 children’s flu programme on Friday 28 August. First deliveries will be made on your normal scheduled delivery day, beginning on Wednesday 2 September.
The inactivated vaccine (QIVe) for children in clinical risk groups for whom LAIV is unsuitable will be available to order from ImmForm by early September.
These timings remain subject to change and plans for vaccination sessions should be made with this in mind. Any changes to this schedule will be communicated on the ImmForm website and PHE Vaccine Update.
NHS People Plan 2020/21 – BMA summary & commentary (England)
The BMA has published a summary and commentary of the NHS People Plan that was published on 30 July and which we have previously highlighted. The document summarises the commitments made in the Plan with a focus on those most relevant to doctors, and it also provides a commentary and analysis on each section. It can be read here
New GP practice profiles on the NHS website
NHS Digital has updated the GP practice profiles on the NHS website which feature improved support for mobile and tablet devices. Your practice’s existing profile information will be automatically copied over to the new platform and the way you update your profile has not changed. Profiles editors should have received further information from the NHS website service desk. Use the NHS website GP practice finder to find and view your new profile.
Final pay controls
RSM (a provider of audit, tax and consulting services) have produced a video on final pay controls for the NHS pension scheme, which explains the charge, how it is calculated and what to do to avoid it. This would be useful for both GPs and practice managers to watch.
Serious Shortage Protocol for fluoxetine
Due to ongoing supply issues, the Serious Shortage Protocol (SSP) currently in effect for fluoxetine 40mg capsules has been extended. The SSP was issued on 20 May 2020 and will now end on Friday 4 September 2020.
StopCOVIDNI Contact tracing app (Northern Ireland)
Northern Ireland launched its StopCOVIDNI contact tracing app last week, which has been designed using the same technology as the app in the Republic of Ireland to ensure all-Island functionality and with other countries in Europe.
Cervical Screening Administration Service – new telephone number
The transfer of the Cervical Screening Administration Service (CSAS) from PCSE back to the NHS includes the allocation of a new telephone number, which as of 19 August 2020 will be 0300 124 0248. As part of this second phase, CSAS will also be deleting all old email addresses on 31 August 2020 which link to Capita / PCSE. Practices should now use this online form to contact CSAS.
PPE Portal
Practices are reminded that you can register and place orders for PPE via the PPE portal, which can be delivered within 48 hours, to ensure regular supplies of PPE in advance of the winter and flu campaign. More information is available on the DHSC PPE portal guidance page and the portal customer service team can be reached on 0800 876 6802 for enquiries or registration support.
Less Than Full Time (LTFT) conference
The BMA will be hosting a virtual conference for Less Than Full Time (LTFT) doctors from all branches of practice on Friday, 13 November. The conference will be a good opportunity for LTFT doctors from across the UK to network and learn through some tailored workshops. Please mark the date in your calendar, and further information and registration details will be announced nearer the time.
Specialist and professional committee elections - reopened nominations and voting open
Voting is now open for the following BMA committees:
– Committee of medical managers (CMM) is looking for qualified managers in primary care to join its committee for two sessions (September 2020-2021).
– 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/ by 12pm, 25 August
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/
ARM Agenda
The Agenda for the BMA’s Annual Representative Meeting, to be held virtually on Tuesday 15 September, has now been published. Read more in a blog by Helena McKeown, Chair of the BMA’s representative body.
ARM Elections
Elections for a number of BMA committees, including GPC UK, are open for nominations until 15 September at 10am. The full list of committees and more information are available here, and to submit a nomination click here. More information, including instructions on how to nominate yourself, is available here. If you have any queries regarding, please contact elections@bma.org.uk
LMC England Conference – Friday 27 November 2020
This year’s annual LMC England conference on Friday 27 November and will be held virtually. LMCs have been sent an email with information on how to submit motions (deadline for submitting motions is midday Friday 18 September 2020) and how to register (applications must be submitted by 16 October 2020). More information will be provided nearer the time on how to access the virtual conference, and will be added to the LMC page on the BMA website. For further information please contact Karen Day on kday@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 mental wellbeing pages here
BMA COVID-19 guidance
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.
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 and priorities for easing lockdown.
Other COVID-19 media (Northern Ireland)
Northern Ireland GPC chair, Alan Stout, was interviewed by BBC Radio Foyle and quoted in a piece in the News Letter on rise in COVID infection rates. He also appeared on BBC Radio Ulster TalkBack programme to discuss an interview of the Health Minister Robin Swann about the current state of play with the coronavirus pandemic (the Minister’s interview starts at 04:40 and Alan’s at 23:39).
See this week’s GP bulletin here.
The national flu immunisation programme 2020 to 2021: update
Details of the 2020-21 flu immunisation programme were announced this week in a joint letter from the CMO for England, the Public Health England Medical Director and Director for Public Health, and the NHSE/I medical director. The letter outlines that this year as part of the wider planning for winter, and subject to contractual negotiations, flu vaccination will be additionally offered to:
· household contacts of those on the Shielded Patient List - specifically individuals who expect to share living accommodation with a shielded person on most days over the winter and therefore for whom continuing close contact is unavoidable.
· children of school Year 7 age in secondary schools (those aged 11 on 31 August 2020).
· health and social care workers employed through Direct Payment (personal budgets) and/or Personal Health Budgets, such as Personal Assistants, to deliver domiciliary care to patients and service users.
It is intended to further extend the vaccine programme in November and December to include the 50 to 64-year-old age group but this will be subject to vaccine supply and notification about this is likely in September. It is planned that this extension is phased to practices to prioritise those in at risk groups first.
While we welcome that the detail has finally been made available to those delivering the programme and now allows practices to do some further detailed planning, we are urgently seeking confirmation that all PPE will be provided for practices, guidance on delivery models (although this will be up to individual practices (working with their localities) to decide), and we acknowledge that this is going to be the most challenging flu programme there needs to be support, resources and leniency so that practices can prioritise the flu programme over this uncertain period. Practices should be signed up to the PPE portal, which can be delivered within 48 hours, to ensure regular supplies of PPE in advance of the winter and flu campaign. More information is available on the DHSC PPE portal guidance page and the portal customer service team can be reached on 0800 876 6802 for enquiries or registration support.
It is clear that delivering this challenging programme at this time will require a monumental effort from general practice at a time when workload is already increasing. The government has an obligation to facilitate this by supporting general practice with the additional resources required, along with a clearly and easily understood patient facing public health campaign.
COVID funding guidance for general practice published
After months of significant pressure and lobbying of both government and NHSE/I by the BMA, it is good to see that the long delayed COVID fund has finally been released. This long overdue funding was and is needed to support practices that have been going above and beyond to continue caring for their patients in the face of the pandemic.
Hundreds of practices recently told us they were still waiting for reimbursement for additional expenses incurred during the COVID response for things like taking on additional staff, including those needed to cover absences of team members who were shielding or self-isolating. So, these details around this financial support is welcome and commissioners now need to act swiftly to provide practices with this funding.
However, this package only covers until the end of July, and as we all know, the fight against COVID-19 is far from over. It does however set an important precedent. Both commissioners and NHSEI must guarantee that practices will continue to get all of the support and resources they need as we move into the latest phase of the pandemic. Furthermore, DHSC must urgently give practices more details on how they will be reimbursed for extra PPE they have had to acquire when national supplies fell far short of what was needed.
We are now urging those CCGs that have not already done so to act swiftly and provide practices with the funding for all the additional costs they’ve incurred. Funding will be provided to cover additional costs of:
· bank holiday opening (for Easter and May 8) including staff and non-staff costs
· services to care home residents (from 1 May to 30 September)
· additional capacity (from 23 March to 31 July) where supported by the Commissioner
· additional consumable expenses (including PPE)
· absence cover from day 1 (from 23 March to 31 July): practices which have provided full pay for employees who were unable to work will be able to claim the costs of cover
Practices should now:
· review additional costs already incurred and submit claims to the commissioner
· discuss with commissioners any anticipated further costs that might require approval
· keep records and evidence of additional costs
Read more about COVID funding in our toolkit for GPs and practices
In response to this I said: “This package only covers until the end of July, and as we all know, the fight against Covid-19 is far from over. Both commissioners and NHS England must guarantee that practices will continue to get all of the support and resources they need as we move into the latest phase of the pandemic. Furthermore, DHSC must urgently give practices more details on how they will be reimbursed for extra PPE they have had to acquire when national supplies fell far short of what was needed.” The story was covered by Pulse and Management in Practice.
Face coverings
Following the Government’s announcement that face coverings will be mandatory for people visiting shops in England from 24 July, we reiterate our longstanding position that people using any healthcare facilities, including GP surgeries, should be wearing face coverings and that now that the government have finally issued guidance on this we need them to do more to support practices in getting across the message to all patients that they should wear a face covering to protect others, including practice staff, who are there to care for them.
Practices should, as always, use their clinical judgement when dealing with patients or carers who have difficulties with face covering.
Public Health England has now published New recommendations for infection control in primary and community health care providers, which states that:
· Practices should ensure that measures are in place so that all settings are, where practicable, COVID-secure, using social distancing, optimal hand hygiene, frequent surface decontamination, ventilation and other measures where appropriate
· where a setting cannot be delivered as COVID-19 secure, a local assessment may conclude that primary care staff, when not otherwise required to use personal protective equipment, should wear a face mask, to prevent the spread of infection from the wearer
· where a COVID-19 secure environment cannot be maintained, patients and members of the public entering primary care premises should be advised to use facecoverings in line with government advice
The most recent tracker survey also showed that 86% of doctors said it should be mandatory to wear face masks in settings where the public either cannot or will not social distance.
The BMA believes that the government must do more to protect healthcare workers in community settings, including GP surgeries, and require those entering a healthcare facility to wear a face covering, as is the case for shops and other indoor settings.
It is for practices to decide how to deliver services to their patients. It is also a practice’s responsibility for them to protect their staff and patients, many of whom may be vulnerable to the most severe effects of Covid-19, from unnecessary risk. Therefore, if a patent refuses to wear a face covering inside a practice, without good reason, the practice can choose to provide services to that patient by means other than face-to-face consultation within the practice.
Practices should inform patients, in advance of their attendance, that a face covering will be required to protect other patients, clinicians and other staff who they will inevitably come into proximity with inside the building. If a patient has a legitimate reason for not wearing a face covering the practice will need to consider this on an individual basis. I was interviewed about this on LBC on Wednesday. Read more here
I was interviewed on BBC Radio Leeds (from around 1hr11) last Saturday about the introduction of local lockdown measures in the region.
GP appraisal restart (England)
We have been in discussions with NHSE/I in recent weeks regarding a planned restart of appraisals in general practice. While full details are yet to be officially published, we have been encouraged by the positive approach to a redesigned appraisal process focussing on a formative doctor-centred approach. We welcome the significant simplification of appraisal requirements and the reduction in the volume of evidence and paperwork expected. This will be a step forward in empowering doctors to use their appraisal to reflect on their professional development and is part of the wider BMA strategy of bureaucracy reduction and our re-professionalisation agenda set out in our policy document ’Trust GPs to Lead’. Full details of the new system and its requirements will be released officially by NHSE/I in the very near future, and we will issue updates as these become available. Mark Sanford-Wood, GPC England executive team member, was quoted on this in Pulse.
2020/21 Healthcare Education & Training Tariff Guidance for England
The DHSC has published their healthcare education and training tariff guidance and prices for the 2020-21 financial year. The guidance confirms the introduction of a minimum tariff for UG medical placements in general practice of £28,000 per FTE “from the point at which placement activity resumes”. It also provides confirmation of the tariff payments for the 2020-21 financial year, and includes:
• An overview of the introduction of the tariff payment mechanism for secondary care placements.
• Powers and requirements with regards to the application of the secondary care placement tariffs.
• Confirmation of the changes to the secondary care placement tariffs from 1 April 2020
• Further information relating to the scope of the secondary care placement tariffs.
• An explanation of the calculations underpinning the secondary care placement tariffs.
• Health Education England's position on tariffs for primary care medical undergraduate placements and response to Covid-19 impact on education and training activities
• Further information on the local implementation of the secondary care placement tariffs, including where to direct any queries.
• Early planning for 2021-22.
Menopause report
The BMA has published a report on Challenging the culture on menopause for working doctors, following a survey of our members to understand specific challenges they face.
The survey showed the physical and mental impact that women doctors experience during the menopause, and that for some it has meant a change to their working lives. The report also highlights a lack of support for many and a reluctance to discuss the problem with managers and colleagues. Symptoms such as insomnia, fatigue, loss of confidence and debilitating hot flushes were cited by 90 per cent of doctors as affecting their ability to work – with 38 per cent saying the impact was ‘significant’. Read more in the message from Helena McKeown, GP and Chair of the BMA’s Representative Body.
Locum GP webinar 13 August (England)
The BMA’s Sessional GPs committee will be hosting Locum GPs and COVID-19 webinar on 13 August, 6.30–7.30pm. The impact of the pandemic on locum GPs has been unique: while other doctors have been called to take on longer hours, you may have seen your sessions cancelled.
The sessional GPs committee understands the problems locums are facing, and the need for guidance in these uncertain times. This webinar will offer advice to secure your income and future-proof your career. It will:
The webinar is free and open for all England-based locum GPs – sign up here
Report on how COVID might affect the number of GPs available to see patients (England)
The Health Foundation has published analysis looking at how COVID risk might affect the number of GPs available to consult face-to-face in England. The report shows that one in three GPs who singlehandedly manage a GP practice are at ‘high risk’ of death or serious illness from COVID-19, and estimates that this could potentially leave over 700,000 without face-to-face appointments with their GPs if those at high risk take the difficult decision to limit direct patient contact. In response to this I said: “As this data shows, some GPs working alone are at a higher risk of becoming ill from Covid-19 and therefore, potentially not able to see patients face-to-face. If needed, locum GPs can be recruited to help these practices, but surgeries need financial support to do so, as well as adequate space in their practices to accommodate another practitioner. This research therefore not only highlights the need for more GPs in the system, especially in deprived areas, as well as the continued provision of effective PPE, but also free access to comprehensive occupational health services to support clinicians with risk assessments.”
RPS calls for pharmacists to be able to alter prescriptions
The Royal Pharmaceutical Society is calling for all community pharmacists to be allowed to make changes to prescriptions that would reduce unnecessary delays in providing medicines to patients in the event of a supply shortage. The proposals would also allow pharmacists to dispense another generic version of a medicine on prescription without having to contact the prescriber every time.
Read more here
ARM Elections
Elections for a number of BMA committees, including GPC UK, are open for nominations, until Tuesday 15 September at 10am. The full list of committees and more information are available here, and to submit a nomination please click here. More information, including instructions on how to nominate yourself, is available here.
If you have any queries regarding the election process, please contact 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
The recent BMA report The impact of COVID-19 on mental health in England; Supporting services to go beyond parity of esteem, warns of a mental health crisis as we emerge from the COVID-19 pandemic and outlines key recommendations for the Government to take.
Access the BMA’s mental wellbeing pages here
BMA COVID-19 guidance
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.
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 and priorities for easing lockdown.
See this week’s GP bulletin here.
Read the latest Sessional GPs newsletter here
NHS England/Improvement “Third phase of NHS response to COVID-19”
NHSE/I have released their Third phase of NHS response to COVID-19 letter today. It highlights the priorities for the NHS as a whole, including accelerating the return of non-Covid services, in particular cancer services, and Trusts are asked that they should ensure, working with GP practices, that every patient whose planned care has been disrupted by Covid receives clear communication about how they will be looked after, and who to contact in the event that their clinical circumstances change. A modified national contract will be in place giving access to most independent hospital capacity until March 2021 and Trusts should ensure their e-Referral Service is fully open to referrals from primary care.
The restoration of primary and community services is also seen as a priority and they state that “we recognise that capacity is constrained, but will support practices to deliver as comprehensive a service as possible”. They encourage a focus on childhood and flu immunisations, cervical screening, building on the enhanced support practices are providing to care homes and reaching out to clinically vulnerable patients and those whose care may have been delayed.
CCGs are told to work with GP practices to expand the range of services to which patients can self-refer, freeing-up clinical time. All GP practices are now expected to offer face to face appointments at their surgeries as well as continuing to use remote triage and video, online and telephone consultation wherever appropriate – whilst also considering those who are unable to access or engage with digital services.
The letter restates the commitment to increase the GP workforce by 6,000 and the extended primary care workforce by 26,000.
Health and care workers to self-isolate on return to UK from high-risk countries
The Department of Health and Social Care has announced that registered health and care professionals travelling to the UK from high-risk countries will be required to self-isolate for 14 days. We have published guidance and advice for doctors planning to travel to or from countries that are considered a COVID-19 risk.
The current list of countries exempt from self-isolation measures is available on GOV.UK. The data for all countries and territories is kept under constant review, and the exemptions list is updated with any changes on a regular basis as and when required to reflect the shifting international health picture. Health and care professionals returning from a country which has a travel corridor to the UK will not be required to self-isolate on return.
Joint statement on performance management processes
We have published a joint statement on performance management processes which sets out a range of NHSEI commitments secured through discussions with GPC England. NHSEI have agreed to implement improvements to the performance management process for NHS GPs and support fair decision making among everyone involved in the handling of performance concerns.
The commitments include further work to increase early resolution and consistency of approach, improved performance management data capture and analysis, and a commitment to ensuring equal treatment of GPs with protected characteristics. Read the full statement >
Flu programme
The Department of Health and Social Care has announced their plans for this year’s flu programme, which has been expanded to potentially include a new cohort of people aged 50 to 64, who will be eligible for free vaccination. The programme will also include households of those on the shielded patient list and for the school programme to be expanded to the first year of secondary schools.
We have been in discussions with NHSE/I about the delivery of the programme, including the operational issues, implications for PPE, vaccine provision and for additional funding to support the programme. Any decision on the delivery of the vaccination to 50- to 64-year-olds will be made later in the year and will depend on vaccine availability following the initial focus on those most at risk. The CMO’s next flu letter outlining more details of the programme will be issued next week.
PPE portal
Practices are reminded that you can register and place orders for PPE via the PPE portal, which can be delivered within 48 hours, to ensure regular free supplies of PPE in advance of the winter and flu campaign. More information is available on the DHSC PPE portal guidance page and the portal customer service team can be reached on 0800 876 6802 for enquiries or registration support.
Shielding guidance for staff on returning to work (UK)
Shielding is coming to an end in England, Northern Ireland and Scotland today, 31 July, and will come to an end on 16 August in Wales, after which those who have been shielding will be able to return to work provided their place of work is ‘COVID-19 safe.’ Read the BMA guidance on Making the NHS ‘Covid-19 safe’ and supporting return to work, which sets out recommendations on ensuring staff can safely return to work.
Dispensing Services Quality Scheme
NHSE/I have now confirmed that the DSQS will be reinstated from 1 August 2020; dispensing practices wishing to participate in the Scheme this year will need to inform their commissioner. Following further discussions with GPC England, NHSE/I plan to revise the scheme’s requirement in relation to patient medication reviews this year.
The scheme currently requires dispensing practices to deliver medication reviews for at least 10% of their dispensing patients. This requirement will be reduced to 7.5% this year in light of the current circumstances. Practices are asked to prioritise patients who they consider to be higher-risk or would benefit most from a review. Practices will also be able to undertake these reviews remotely if they so wish and it is clinically appropriate. The Statement of Financial Entitlements (SFE) will be amended to reflect this. All other requirements of DSQS remain the same. A letter will be sent to dispensing practices soon confirming the position.
June appointments in general practice statistics published
Yesterday’s NHS Digital statistics show that the number of appointments delivered by practices are continuing to rise, reaching the numbers we saw before the pandemic reached the UK. Practices are therefore working incredibly hard not only to deal with the continued impact of COVID-19, but also to provide other routine services as well as they are able to. This means continued use of triage arrangements to keep both patients and staff as safe as possible and using remote consultations where appropriate – both of which have been instrumental in general practice’s response to the pandemic.
Matt Hancock, secretary of state for health and social care, talked about the use of remote triage in his speech yesterday about the future of healthcare, and as we have long said, if doctors are given access to the right technology, they will embrace it. However, his suggestion that all appointments going forward will be remote by default must be approached with caution. I have been clear in the media that physical appointments will always be a vital part of general practice, and they continue to be necessary for many patients and the management of specific conditions, and we must not lose sight of that. While GPs will always embrace new ways of working, being able to see patients face-to-face will remain a key aspect of primary care.
My comments were covered by the i, Telegraph, Guardian, Pulse and GP Online, and the print version of the Daily Mail. The BMA’s response to Matt Hancock’s speech can be found here.
Support for doctors affected by discriminatory pension scheme changes
The Government has opened a consultation on changes to the transitional arrangements to the 2015 schemes after conceding that the protection offered to older members resulted in unlawful age discrimination. Following legal cases brought against the Government, they have conceded that the protection offered to older members when introducing new public sector pension schemes resulted in unlawful age discrimination.
The BMA brought legal cases on behalf of its members which are currently on hold. However, similar protection to older members was offered when the NHS 2015 career average revalued earnings scheme was introduced and as such this is also likely to amount to unlawful age discrimination. It is important to note however that it was the offering of protection to older members rather than the introduction of the new scheme that is unlawful.
To remedy this age discrimination, the Government has released a consultation proposing two options for the period in which the discrimination occurred (1 April 2015 to 31 March 2022). The consultation outlines that the likely solution to rectify this discrimination is to offer affected members the choice of whether they are transitioned to the 2015 scheme or remain in their legacy scheme (1995/2008) for the remedy period. After the remedy period, all scheme members are likely to move to the 2015 scheme, probably in April 2022.
The BMA will be making a considered response to the consultation in due course. The deadline for the consultation is 11 October 2020. In addition, the BMA will continue with its own legal case to ensure members are fully supported. Read the BMA statement
Read the consultation
DDRB pay award
As we made clear to the Government when it was announced, it is unacceptable that the 2.8% pay uplift award for senior hospital doctors, has not been applied to GP partners or junior doctors who have long term pay deals in place which were agreed before anyone could have predicted the impact of the COVID-19 pandemic, nor the financial pressure it would put practices under, and this must be rectified.
It’s unacceptable, therefore, that the Government continues to fail to fund the gap to support practices in funding the increases for staff and salaried GPs. GPs and their dedicated staff have spent the last few months working incredibly hard in overhauling services to guarantee that patients can continue receiving the care they need from their local surgery safely. For this not to be recognised by the Government is a real blow to morale.
I, along with Dr Sarah Hallett, chair of the BMA junior doctors committee, have written a letter this week to Matt Hancock on this important issue, expressing the hurt and disappointment which GP partners and junior doctors are feeling when they have contributed so much to the nation’s health and wellbeing during this time of national crisis. BMA council chair, Chaand Nagpaul, is meeting shortly with health secretary Matt Hancock to also strongly make that case and to firmly outline the reality of the significant and vital contribution of GP partners and junior doctors during the COVID crisis. Read the BMA’s full response to the DDRB report here.
We have updated our salaried GP pay ranges webpages following the DDRB uplift announcement, along with our guidance on how practices should apply that uplift.
Extension of self-isolation period to 10 days
The Department of Health and Social Care has announced that the self-isolation period has been extended to 10 days for those in the community who have COVID-19 symptoms or a positive test result, stating that: 'In symptomatic people COVID-19 is most infectious just before, and for the first few days after symptoms begin. It is very important people with symptoms self-isolate and get a test, which will allow contact tracing. Evidence, although still limited, has strengthened and shows that people with COVID-19 who are mildly ill and are recovering have a low but real possibility of infectiousness between 7 and 9 days after illness onset. We have considered how best to target interventions to reduce risk to the general population and consider that at this point in the epidemic, with widespread and rapid testing available and considering the relaxation of other measures, it is now the correct balance of risk to extend the self-isolation period from 7 to 10 days for those in the community who have symptoms or a positive test result. This will help provide additional protection to others in the community. This is particularly important to protect those who have been shielding and in advance of the autumn and winter when we may see increased community transmission.' Read the full announcement here.
Government obesity strategy
This week the Government published its strategy to tackle obesity. The BMA has long campaigned for government to hold industry to account as its main policy on obesity, rather than asking the public to shoulder the bulk of the responsibility. We’ve done this both as an individual organisation, and as part of the Obesity Health Alliance.
The main policies outlined in the strategy include:
· A 9pm watershed on HFSS (food high in fat, sugar or salt) adverts on TV and online (with a short consultation on a total ban online) – to be brought in by end of 2022. Ahead of this, the Government will also hold a new short consultation on whether the ban on online adverts for HFSS, should apply at all times of day.
· Restrictions on multi-buy and location promotions of HFSS in retailers and online. There will also be a ban on these items being placed in prominent locations in stores, such as at checkouts and entrances, and online. In the UK we spend more buying food products on promotion than any other European country and a survey from 2018 shows that around 43% of all food and drink products located in prominent areas were for sugary foods and drinks, compared to just 1% for healthy items.
· Calorie labelling in large out-of-home outlets. New laws will require large restaurants, cafes and takeaways with more than 250 employees to add calorie labels to the food they sell.
· Consultation on front of pack food labelling and calorie labelling of alcohol. The government will launch a consultation to gather views and evidence on our current ‘traffic light’ labelling system to learn more about how this is being used by consumers and industry, compared to international examples.
· Expansion of weight management services. Weight management services will be expanded so more people get the support they need to lose weight. This will include more self-care apps and online tools for people with obesity-related conditions and accelerating the NHS Diabetes Prevention Programme.
We will be discussing with NHSE/I the potential of QOF indicators for 2021/22 relating to obesity which NICE recently consulted on. Primary care network staff will also have the opportunity to become ‘healthy weight coaches’ though training delivered by PHE. Separately, GPs will also be encouraged to prescribe exercise and more social activities to help people keep fit, but the details on this are not yet clear.
In our submission to that consultation we emphasised that the indicators would need to accurately reflect the role of GPs in the wider healthcare ecosystem when it comes to obesity, and that weight management services must be significantly ramped up to ensure accessibility. These will form part of negotiations later in the year.
Alongside the obesity strategy, DHSC launched a ‘Better Health’ campaign, which announced prescriptions for cycling. We understand this initiative will commence in 2021/22 as limited pilots in a small number of areas with further information to be provided soon. We will continue to keep you updated. I spoke to LBC and BBC Radio 4’s Today programme about this on Monday and you can hear the interview here at around 1hr33.
NHS People Plan published
The NHS People Plan was published yesterday. In response BMA council chair Chaand Nagpaul said: 'The NHS People Plan comes at a time when the NHS is possibly in the most precarious state it has ever been - in the midst of a pandemic - which has served as a stark reminder of just how much we depend on the workforce for our NHS to survive and succeed. The People Plan highlights several areas for improvement that the BMA has been calling for – a focus on wellbeing, research and education, equality and diversity and flexible working – and this is encouraging to see. Initiatives such as the appointment of wellbeing guardians, boosting the mental health workforce, tackling violence against staff, and improving occupational health standards will make an important difference to the lives of staff and the development of a more open and inclusive culture. What is important now is delivering these plans in a timely manner so that these long-overdue aspirations become a reality. The BMA will continue to work with Government to bring about real change for the better in these areas.
We are significantly short of doctors compared with our EU neighbours, and also without equivalent levels of hospital beds and community facilities. This has resulted in doctors being exhausted and pressured to work in an environment lacking adequate infrastructure with almost a third of doctors telling us they are experiencing emotional distress or mental health issues that have become worse during the pandemic. We, therefore, need greater clarity on the scale of plans to expand the workforce to ensure that this goes far enough to address the historic levels of understaffing in the health service. We also need to see more detail on how the Government intends to retain staff.
It is also crucial that the plan factors in the wider demand now being placed on the NHS, and therefore the workforce, with a growing backlog of millions of non-COVID patients who have not received care during the pandemic. Delivering this will require new resources; it is vital that the Government matches these ambitions with a transparent long-term costed funding plan that delivers these long-overdue changes.'
We are concerned that the rhetoric in the NHS Peoples Plan does not match the reality of recent experience for GPs, with respect to the DDRB award, lack of access to occupational health services to support risk assessments and significant delays in releasing the Covid-fund to help practices in their pandemic response. The Government and NHSE/I must do much more to demonstrate their support for the general practice workforce.
ARM Elections
Elections for a number of BMA committees, including GPC UK, are open for nominations, until Tuesday 15 September at 10am. The full list of committees and more information are available here, and to submit a nomination please click here. More information, including instructions on how to nominate yourself, is available here.
If you have any queries regarding the election process, please contact 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
The recent BMA report The impact of COVID-19 on mental health in England; Supporting services to go beyond parity of esteem, warns of a mental health crisis as we emerge from the COVID-19 pandemic and outlines key recommendations for the Government to take.
Access the BMA’s mental wellbeing pages here
BMA COVID-19 guidance
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.
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 and priorities for easing lockdown.
See this week’s GP bulletin here.
DDRB report (England)
The Government in England has announced that they have agreed with the DDRB's recommendation of a 2.8% pay uplift. This applies to salaried GPs, GP trainers and GP appraisers, with payments to be backdated to April 2020, but does not include junior doctors or GP contractors in England.
The long-term pay deals for both GPs and junior doctors were agreed before anyone could have predicted the serious impact COVID-19 would have on the NHS, nor the financial pressure it would put practices under, and this must be rectified.
This is the second year of our 5 year contract agreement, which not only provides 100% funding for a large workforce expansion to help manage practice workload pressures but also provided for the removal of the significant cost of indemnity last year. For 2020/21, it secures additional funding to cover annual pay increases of 1.8%. This is at a time when RPI is currently at 1.1% and CPI at 0.8%. However this is far from a normal situation and the government made clear in their announcement that this higher pay award was "in recognition for doctors efforts on the frontline during the battle against COVID-19”.
It’s unacceptable therefore that the government failed to fund the gap to support GP contractors in funding the increases for staff and salaried GPs. I have raised this in an urgent meeting with the Health Minister, Jo Churchill, and made clear that this comes at a time when practices are also feeling the impact of not being reimbursed for additional costs to manage the COVID-19 pandemic. GP practices and their dedicated staff have spent the last few months working incredibly hard in completely overhauling services to guarantee that patients can continue receiving the care they need from their local surgery safely during the pandemic, and for this not to be recognised by the Government will be felt as a serious blow. The applause of politicians for hardworking doctors now rings hollow. The BMA is therefore pushing for this to be addressed and the will be raising this directly with the Secretary of State for Health and Social Care.
Applying the uplift
While we continue to put pressure on DHSC and NHSE/I for more funding, practices are encouraged to provide the full 2.8% uplift for all Salaried GPs, although how any pay uplift is provided to Salaried GPs, as with all practice staff, will be determined by the terms of their employment contract.
The GMS contract regulations, and standard PMS agreement (since 2015), state that practices must employ Salaried GPs on terms no less favourable than the model contract. Therefore, all GMS practices, and those PMS practices that have agreed to that wording, must employ Salaried GPs on terms no less favourable than the Salaried GP model contract.
The Salaried GP model contract states ‘annual increments on [incremental date] each year and in accordance with the Government’s decision on the pay of general practitioners following the recommendation of the Doctors’ and Dentists’ Review Body’. Therefore, if this wording is included in the employment contract, the full 2.8% uplift must be provided. The model contract however may be amended by agreement, so it will depend on the individual agreement between the practice and the Salaried GP. If it includes the clause above then the 2.8% must be provided. If a different annual increment/calculation is included in the contract, or if the contract is silent on this point, then the practice is still encouraged to pass on the full 2.8%. We must not let this pay award be a source of division between GP contractors and salaried GPs but respect one another as professional colleagues.
GPs and their teams have played a vital and essential role on the pandemic frontline and its therefore disingenuous in the extreme for the government not to provide the necessary funding to recognise this. We will do all we can to address this unacceptable situation.
You can read my response to the announcement in Pulse and GP Online including the impact this will have for general practice, and the BMA’s response more broadly.
Face coverings in general practice (England)
Following the Government’s announcement that face coverings will be mandatory for people visiting shops in England as from today, 24 July, we have been calling for the policy to be extended for all places where social distancing cannot be maintained, including GP practices.
Public Health England has now published New recommendations for infection control in primary and community health care providers, which states that:
This guidance is in addition to existing national COVID-19 IPC guidance, which advises on appropriate PPE usage in patient facing clinical settings and other measures to reduce transmission risk.
The most recent tracker survey showed that 86% of doctors said it should be mandatory to wear face masks in settings where the public either cannot or will not social distance. This issue was also highlighted in the article The scramble for facemasks, in the BMA’s The Doctor magazine. In response to this I said: “The BMA is clear that face coverings should be mandatory in all situations where physical distancing of more than 2 metres is not possible. It makes no sense that the government has introduced one measure for shops and public transport, while other indoor spaces, including GP practices, are exempt. This virus is just as infectious in a practice as it is in a shop or on a bus”. This was reported by the Guardian
Letter for exemptions
Our guidance on Reducing COVID-19 transmission and PPE now includes updated advice on face coverings, which confirms that practices do not have to provide letters of support for those who fall under the list of exemptions, or to those who do not. Individuals should self-declare if they believe they should be exempt from wearing a face covering. They should not be directed to their GP to ask for evidence to support this. I was interviewed by BBC Radio Leeds about this.
Flu programme announcement
The Department of Health and Social Care has announced their plans for this year’s flu programme, which has been expanded to include a new cohort of people aged 50 to 64, who will be eligible for free vaccinations. The programme will also include households of those on the shielded patient list and for the school programme to be expanded to the first year of secondary schools.
We have been in discussions with NHSE/I about the delivery of the programme, including the operational issues, implications for PPE, vaccine provision and for additional funding to support the programme. A final decision on when it will be possible to deliver the vaccination to 50-64 year olds will be made later in the year and will depend on vaccine availability following the initial focus on those most at risk. We expect further guidance by the CMO to be published next week. I was interviewed by Sky and Channel 5 News today about the forthcoming flu campaign.
Action to improve vaccine coverage rates across the UK
The BMA has published a report on what actions need to be taken to improve vaccine coverage rates across the UK. The report says that many immunisation programmes have been disrupted because of the pandemic as the NHS focused on responding to immediate health concerns and that it is now imperative that they are re-started and that people are encouraged to be immunised. It also notes that childhood vaccination in particular has plummeted during this time – dropping by around a fifth in total – despite advice that childhood immunisation should continue during COVID-19. Read the BMA press release here.
RCGP guidance on delivering mass vaccinations
The Royal College of GPs has published guidance on delivering mass vaccinations during COVID-19, including guidance on using non-traditional vaccination settings. The guidance is written with the understanding that a number of mass vaccination programmes may need to be delivered during mid-2020 to 2021, while COVID-19 continues to be in general circulation, and addresses approaches to delivering large-scale vaccination programmes in this context. Read more on the RCGP COVID-19 Guidance page
GP trainee recruitment
Health Education England has released figures which show that GP trainee numbers in England have risen for the third year in a row, with recruitment up by 15% compared to the same time last year.
3,441 doctors have so far been accepted to GP specialty training in 2020, with one more recruitment round to go, HEE is hoping to reach its overall target for recruiting 3,500 doctors in training to general practice this year.
It’s good to see that more and more young doctors are being attracted to a rewarding and varied career in general practice. There remains an urgent need, however, to capitalise on the rising number of GP trainees by fully supporting and retaining our existing qualified GP workforce so that they do not burn out. According to the latest statistics, there are 1418 fewer full time equivalent qualified GPs now than there were in late 2015, the year we embarked on our collaborative approach with HEE, RCGP and NHSE/I. This means the NHS is still losing more qualified GP hours than it is gaining even with the increase in doctors entering GP training each year.
It is also vitally important that we increase the support for the GPs that will be supervising and training these new GP trainees, and those that come in the future. GPC will continue its tireless lobbying to improve resourcing and conditions for GP trainees.
In response to this, Krishna Kasaraneni, GPC England executive team member said: “Increases to the numbers of those in GP specialty training clearly shows how important general practice is to the NHS, and how stimulating a career it can be. Whilst this is encouraging, it is vitally important that we increase the support for the GPs that will be supervising and training these future GPs, and those that come in the future.” This was reported by GP online, Pulse, Management in Practice
Shielding guidance for staff on returning to work (UK)
Shielding will be coming to an end in England, Northern Ireland and Scotland on 31 July, and 16 August in Wales, after which those who have been shielding will be able to return to work provided their place of work is ‘COVID-19 safe.’ The BMA published guidance on Making the NHS ‘Covid-19 safe’ and supporting return to work last week, setting out recommendations for safe return of staff. Read also the BMA guidance on Risk assessments. The latest tracker survey also showed that most GPs who are currently shielding do not feel safe returning to work.
Mental health support in practices
The King's Fund and Centre for Mental Health have published a report on Mental health and Primary Care Networks, which suggests that more and better mental health support is needed in GP surgeries following the pandemic. The report found that current provision of mental health support in general practice is variable and often inadequate, and calls for PCNs to seize the opportunity to strengthen mental health provision in primary care, to help to fill the gap at a time of increased need for mental health care in the aftermath of the pandemic. This is an important issue and we are in discussion with NHSE/I about the potential to include mental health workers within the scope of the PCN workforce.
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
The recent BMA report The impact of COVID-19 on mental health in England; Supporting services to go beyond parity of esteem, warns of a mental health crisis as we emerge from the COVID-19 pandemic and outlines key recommendations for the Government to take.
Access the BMA’s mental wellbeing pages here
IGPR scheme to be paused and reviewed
It has been confirmed that NHS England have terminated all contracts with the International GP Recruitment Schemerecruitment companies as of 30 November 2020. This means that the programme will be paused ahead of a full review next year. Health Education England will retain funding to see any doctors through the scheme who are already in the system, while the Induction & Refresher scheme will continue to take international doctors on an individual basis.
Given the current challenges presented by COVID-19 and Britain’s future relationship with the EU, it is a difficult period for international recruitment and it is logical that the scheme should be paused. While the scheme supported some GPs from abroad to work in the NHS, it is now clear that it will fall far short of meeting both its initial target of recruiting 500 GPs and the vastly increased number of 2,000 set more recently. It is now important that we evaluate how much value it delivered for the investment made.
ARM Elections
Elections for a number of BMA committees, including GPC UK, are open for nominations, closing on Tuesday 15 September at 10am.
The full list of committees and more information are available here, and to submit a nomination please click here. Voting is for ARM delegates only and will open on 15 September.
If you have any queries regarding the election process, please contact elections@bma.org.uk
BMA COVID-19 guidance
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.
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 and priorities for easing lockdown.
See this week’s GP bulletin here.
GPC England meeting
GPC England met yesterday and discussed our proactive strategy for responding to the next stages of COVID-19, following the recent publication of our Trust GPs to lead report, which sets out our vision for addressing the need for change in general practice following the pandemic. The committee heard from many members reflecting the significant concerns they had about rising workload pressures, in part related to changes to hospital out-patient and referral management, as well as plans to use NHS 111 to reduce attendance in Emergency Departments. This was also evident in our last tracker survey, which clearly showed the significant increase in requests for practices to do additional activity without the necessary funding or workforce being made available to make this change sustainable. I have therefore co-signed a joint letter with Rob Harwood, chair of the BMA consultants committee, to Professor Stephen Powis, NHS England Medical Director, on behalf of all primary and secondary care doctors, proposing and seeking solutions to the issues in workload and workflow across NHS sectors. It’s imperative that NHS England and CCGs commission sustainable primary and community services to support patients and clinicians, particularly as more patients are being directed away from attending hospital settings. It's vital that we solve these issues as quickly as possible, not least as winter and any potential second wave of the pandemic approaches.
GPCE noted the updated toolkit for GPs, partners and practice managers to manage employment and contractual issues and service provision during the pandemic. The committee discussed on-going issues relating to PCSE and the transformation projects they are taking forwards. We also had an update on our support for a legal case being brought against NHS Property Services.
This would normally have been the first meeting of the 2020/21 session, but because of our rescheduled ARM it was GPCE’s last meeting of the extended 2019/20 session. We therefore said thank you to the members of the committee who were ending their term of office, including Mary McCarthy, John Rawlinson, Jonathan Ireland, and Pamela Martin.
Please see the Executive and Policy groups update for July 2020.
Government commitment for additional NHS funding
Following the Government’s announcement that the NHS in England would receive £3bn in funding to help it prepare for winter and a possible second spike in Covid-19 infections the BMA put out a media statement last night reacting to parts of the announcement that had been trailed. Dr Chaand Nagpaul, BMA council chair, said that it was vital that we’re given an understanding of how exactly this announced money will be used – and whether it is enough – to boost capacity both for a potential second wave, but also to meet the needs of millions of patients who have had care delayed during the pandemic. The BMA’s comments were carried across national and regional BBC News bulletins through the night and this morning, as well as on the BBC News website. Chaand was interviewed by Good Morning Britain (you can watch the segment [itv.com/hub/good-morning-britain/2a3211a2832]here from 6:03am) and he later appeared on LBC News. Just ahead of the Prime Minister’s speech he appeared as the opening guest on BBC One’s News Special, and was then interviewed by Sky News’s Adam Boulton immediately after the announcement to give a rapid response (you can watch the full interview here). Deputy council chair, Dr David Wrigley, was also interviewed on Times Radio about the announcement – you can listen back here at around 2hrs15 – and GPC England executive team member Dr Krishna Kasaraneni appeared on Hallam FM to discuss the announcement from a regional angle.
COVID-19 Fund (England)
Following the Prime Minister’s announcement I have written a letter to Sir Simon Stevens, Chief Executive of NHS England, calling for the promised COVID Fund to be released immediately. At the outset of the pandemic the Government committed to establishing a national COVID-fund, to reimburse NHS additional expenses related to the treatment of COVID-19. However, there has been a prolonged and unacceptable delay to releasing this funding, and whilst many CCGs have done the right thing and reimbursed these costs for practices, many have not. The impact of this is highlighted in our most recent member survey which showed that significant numbers of practices were not being reimbursed by their CCGs for out of pocket expenses directly linked to tackling COVID-19. Practices swiftly responded, in good faith and for the benefit of their patients, at the outset of this pandemic, but they have been badly let down by the failure of the Government to honour their commitments. This must now be addressed, not least as practices start to plan for the difficult winter ahead.
GPC England guidance on arrangements for GP services for remainder of 2020/21 (England)
Last week NHSE/I released its most recent letter regarding arrangements for practices for the rest of 2020/21. We have since updated our comprehensive COVID-19: toolkit for GPs and GP practices to reflect these new arrangements, including service provision, funding, and QOF. As they have done throughout the pandemic, practices can only work within their capacity and capability, and with the on-going constraints relating to social distancing, the use of PPE, risk assessments, workforce pressures and many other challenges, practices must be supported by CCGs and NHSE/I and not burdened with unrealistic expectations.
Face coverings
Following the Government’s announcement that face coverings will be mandatory for people visiting shops in England from 24 July, the BMA called for measures to be introduced immediately rather than waiting for 11 days and that the policy must be extended for all places where social distancing cannot be maintained.
The seventh BMA tracker survey, published this week, showed that 86% of doctors surveyed in England and Wales said it should be mandatory to wear face masks in settings, where the public either cannot or will not social distance. Read the BMA statement here
We have updated the Reducing COVID-19 transmission and PPE section of the GP practice toolkit, to include the new advice on face coverings. The Government guidance suggests there is no requirement for evidence for exemption, therefore practices do not have to provide letters of support for those who fall under the list of exemptions, or to those who do not.
The BMA has called for masks to be worn 'as a matter of course'. This was reported by BBC News, Good Morning Britain, Politico's London Playbook morning bulletin, The Huffington Post, and The Times (subscription required), Telegraph, Yahoo News, and Daily Mail. The BMA has also called for the wearing of face masks by members of the public attending GP surgeries to be made compulsory. Read more in the article The scramble for facemasks, in the BMA’s The Doctor magazine. I spoke to GP Online about face coverings in general practice
Face covering to become mandatory on public transport in Wales
The Welsh Government has announced that face covering to become mandatory on public transport in Wales from, 27 July. Phil White, Chair of GPC Wales, took part in a BBC Radio Cymru phone in on COVID face coverings (from 6m40s), appeared on BBC Wales News (8mins 39 secs) and ITV Wales News (4mins 55 secs) advising that evidence shows face coverings reduce transmission. David Bailey, Chair of BMA Welsh Council, was featured on BBC Wales News and Wrexham.com for his BMA Cymru Wales statement. This was also reported by BBC Wales
NHS pressures and back log of services
The latest tracker survey and the newly released BMA report The hidden impact of COVID-19 on patient care in the NHS in England, also show the struggle many face to tackle the backlog built up as social distancing remains in place.
Our latest commentary on the most recent data release from NHS England revealed the continued indirect impact of COVID-19 on patient behaviour and NHS activity in May and June. The monthly number of GP-made referrals made in May has started to climb since dropping in April, however the size of the waiting list remained low due to GPs being unable to refer. Despite this, more and more patients are waiting longer than ever for treatment. This reflects a large backlog of care needs that have accumulated beyond the focus on COVID-19, and we have analysed the potential magnitude of these changes in our Hidden impact of COVID-19 report. Read the BMA statement here
View the GP specific results of the tracker survey here
Joint guidance for remote intimate clinical assessments
GPC England, NHSE/I, RCGP and a number of other relevant organisations have developed joint guidance setting out the key principles for intimate clinical assessments undertaken remotely in response to COVID-19.
The pandemic has accelerated the use of online and video consultations in general practice and the guidance is aimed at clinicians who are consulting remotely and focuses on how to safely manage the receipt, storage and use of intimate images taken by patients for clinical purpose, which must be guided by the principle of the interests of the patient. The approach to video consulting, image sharing, and storage should be the same as it would be for face-to-face interactions.
The principles described in the guidance aim to support patients to access care in a way that meets their needs and to support clinicians to provide care in a way that is in the best interests of their patients, whilst protecting both from the risks associated with remote intimate assessments.
Shielding guidance for staff on returning to work (UK)
Shielding will be coming to an end in England, Northern Ireland and Scotland on 31 July, and 16 August in Wales, after which those who have been shielding will be able to return to work provided their place of work is ‘COVID-19 safe.’ The BMA has published guidance on Making the NHS ‘Covid-19 safe’ and supporting return to work, setting out recommendations for safe return of staff:
Read the BMA guidance on Risk assessments. The latest tracker survey also showed that most GPs who are currently shielding do not feel safe returning to work. This was reported by Pulse
Welsh Government testing strategy
The Welsh Government have published their high level COVID-19 testing strategy, which will be underpinned by local delivery plans for management of local outbreaks. Testing of asymptomatic individuals will be encouraged, initially focused on ‘closed’ settings e.g. care homes and prisons.
BMJ Learning clinical guidance: COVID-19 in primary care
BMJ Learning has updated their clinical e-learning module on managing COVID-19 in primary care. The module provides practical support to GPs on the following issues:
· When and how to consult remotely and face-to-face during the pandemic
· Key clinical features and complications of COVID-19 in primary care, and how to manage them
· How to prioritise ongoing clinical care in general practice during the pandemic
· The role of GPs in identifying and advising shielded patients
· The importance of working safely in primary care during the pandemic, including appropriate use of PPE, and consideration of the wellbeing of GPs and other practice staff.
Tax on COVID-19 testing by employers
The HMRC published guidance on 6 July which advised that employees would face a taxable benefit in kind when their employer pays for COVID-19 testing. We raised concerns over this with the Department of Health and Social Care, and they have now advised that HMRC has removed the guidance. It is in the process of being updated to provide some clarity regarding NHS staff, with the expectation that they will not be subject to tax for COVID-19 testing.
ARM Elections
Elections for a number of BMA committees, including GPC UK, are now open for nominations, closing on Tuesday 15 September at 10am.
The full list of committees and more information are available here, and to submit a nomination please click here. Voting is for ARM delegates only and will open on 15 September.
Representatives to ARM
Nominations for representatives from LMCs and members of BMA committees to attend the virtual ARM meeting on 15 September 2020 are now open. The deadline for nominations is 12pm on Friday 24July 2020. Voting, if required, will follow the nomination period.
To stand for election you must be an LMC member or member of one of the BMA committees within a specified region [i.e. GPC UK, Sessional GPs Committee, GP Trainees Committee, LMC Conference Agenda Committees] and a BMA member. To submit your nomination or vote for either of these elections, please login to the BMA’s election system. More information, including instructions on how to nominate yourself, is available here. If you have any queries regarding the election process, please contact elections@bma.org.uk
LMC UK Conference
As the 2019/20 UK LMC Conference has been cancelled, and in line with our standing orders, members elected from the 2018/19 UK LMCs conference to GPC UK will remain in post until the 2020/21 UK LMCs conference is held in May 2021.
NHS Confederation report on PCNs (England)
NHS Confederation has published a report about Primary Care Networks – one year on, to mark the one-year anniversary of PCNs being established across England and assess their progress so far. The report sets out a national picture of variability but does describe how some networks are now delivering tangible benefits for the health of their populations and offering mutual support to their member practices.
Mental health and wellbeing
The BMA published a new report last week which warns of a mental health crisis as we emerge from the COVID-19 pandemic and outlines key recommendations for the Government to take, including the recruitment of more mental health staff.
Read the BMA’s report on the mental health and wellbeing of the medical workforce which sets out ten recommendations to be addressed to protect staff during the pandemic and in the future.
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
BMA COVID-19 guidance
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:
Model terms of engagement for a GP providing temporary COVID-19 services
· Guidance on risk assessments which includes specific information for practices.
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 and priorities for easing lockdown.
See this week’s GP bulletin here.
Update on GP services for 2020/21 (England)
NHSE/I has released its next letter regarding arrangements for practices for the rest of 2020/21. In summary the letter outlines:
Further guidance will be provided in the coming weeks, specifically regarding appraisal, QOF and funding arrangements, following further discussions with NHSE/I.
Easing lockdown measures and the need for local infection data (England)
After Leicester became the first place in England to be placed in local lockdown due to a surge in infections, the BMA has issued a statement calling on the government to share timely, comprehensive and reliable information on local infection rates, confirmed cases and known instances of contact to all those involved with local government officials and public health leaders. Although weekly rates of infections per 100,000 people are published by Public Health England, this is not very easy for the public to find or interpret.
The BMA has urged Ministers to set clearly defined metrics of “trigger points” around infection rates so that a consistent, clear and objective approach to introducing local lockdowns can be applied and preventing a second spike. Read more about the case for decisive action to protect lives as lockdown is eased in the recent Focus blog by the BMA Chair of Council, Chaand Nagpaul.
This was reported by Pulse,
Easing lockdown (Devolved Nations)
The Scottish government has announced that the two-metre social distancing rule will be maintained and the wearing of face masks will become mandatory in shops in Scotland from 10 July. This is in line with the BMA’s position that face masks must be worn in any space where social distancing is not possible.
This followed a recommendation made by the Welsh Government last month that three-layer face coverings should be worn in all areas where social distancing isn’t possible, which was welcomed by BMA Cymru Wales.
BMA Northern Ireland had previously responded to the Northern Ireland Executive’s decision to reduce their social distancing requirement to one metre by stating that this change could would only be acceptable if people are recommended to wear appropriate face coverings in all indoor spaces outside of their own homes and in all public places where they might come into contact with others at less than two meters’ distance. The BMA Northern Ireland team followed this up with a statement last urging people to use common sense as pubs re-opened.
GP patient survey results
The latest GP patients survey results have now been published by Ipsos MORI. The report shows that the public continue to have a positive view of general practice, with the majority (82%) of patients reporting that they had a good overall experience of general practice, and 95% have have confidence and trust in the healthcare professional they saw. It is worth noting that the survey was undertaken in January to March this year, and although it relates to the experience of patients prior to the current pandemic, GPs and practice teams have been working harder than ever to provide services to patients in one of the most challenging times the NHS has ever seen in its history, and we should celebrate their remarkable achievements.
It is only with an increase in investment in general practice, including expanding the workforce, that GPs will be empowered to continue to develop and deliver innovative patient-focus services for both the short and long-term future of the health service.
A summary of the results is available in this infographic
This was reported by GPonline
Social Prescribing Link Worker report
The National Association of Link Workers has published a report on Social Prescribing Link Workers, which raises issues about quality, safety and sustainability. In response to this, I said: “It’s disheartening to hear that 29% of social prescribing link workers plan to leave in the next year due to a lack of clinical supervision and support, especially when we know how many patients and practices are already benefiting from their work. Social prescribing is a key and growing part of primary care though, which is why it’s vital that they are provided with the training and support they need, but also that PCNs and practices are provided with the resources needed to provide appropriate clinical supervision”. Read more on the NALW website. This was reported by GPonline.
RCGP report - General Practice in a Post-COVID World
The Royal College of GPs has published their report General Practice in a Post-COVID World,which outlines how GPs will be on the frontline of dealing with the physical and psychological health consequences of the COVID-19 pandemic, and the need for urgent government planning and funding to prepare general practice services for facilitating the recovery of local communities.
It echoes our recent report Trust GPs to lead: learning from the response to COVID-19 within general practice in England, and supports our call for a reduction in bureaucracy and regulation, and an increase in investment for digital technology to support the new ways of working and by doing so both improve access and work towards a greener way of delivering general practice.
Both GPC England and the RCGP are using our reports and the evidence of the experience of recent months in submissions to the Ministerial Working Group established as part of our 20/21 contract agreement to reduce the bureaucratic burden on general practice.
This was reported by the Times
NHSE/I bureaucracy review
NHS England and NHS Improvement and the government are reviewing how to reduce bureaucracy to free up frontline NHS staff and to improve your experience at work. They would like to hear directly from practice staff and managers specifically to better understand the things you spend time on which could be streamlined or removed, allowing you to spend more time with patients.
They are looking for expressions of interest to participate in a series of virtual focus groups in weeks commencing 20th and 27th July 2020.
If you would like to participate and find out more about the discussion topics, please contact the review team directly bu noon Monday 13 July at: england.gpbureaucracyreview@nhs.net.
The NHSE/I team leading this work also plan to also engage with LMCs to seek their expertise and will be liaising with us to make contact with individual LMC representatives on GPC England’s LMC reference group.
NHS Health Check: Restart Preparation (England)
Public Health England has published a document about restarting NHS Health Checks, which advises that the previous advice by NHSE/I to stop NHS health Checks during the pandemic, expires on 31 July 2020. The decision on when to restart NHS Health Checks is one for local authorities to take and we would encourage LMCs to discuss this with them. This is not something that GPC England was consulted on, and we have raised our concerns directly with Public Health England.
Faulty PPE
As we reported last week, a product recall notice has been sent to practices and care homes with safety warnings, notices for destruction and distribution stoppages for Cardinal Surgical masks. Read the full BMA statement here
Practices are reminded that they can obtain PPE supplies via their supplier of the original stock or the Local Resilience Forum (LRF). Practices can also place register and orders via the Portal, which can be delivered within 48 hours.
More information is available on the DHSC PPE Portal guidance page and the Portal customer service team can be reached on 0800 876 6802 for enquiries or registration support.
Clinical guidance on maintaining immunisation programmes during COVID-19
Public Health England has published Clinical guidance for healthcare professionals on maintaining immunisation programmes during COVID-19
The advice for general practices, which we support, is that the routine immunisation programme should be maintained. This is in order to protect the individual patient, as well as to avoid outbreaks of vaccine-preventable diseases that could further increase the numbers of patients requiring health services. Non-scheduled vaccinations should still be given, e.g. for control of outbreak of vaccine preventable conditions as well as opportunistically, e.g. missing doses of MMR.
We are in discussion with NHSEI about the forthcoming influenza immunisation campaign, including the significant logistical and PPE requirements that will need to be considered.
Patients being redirected to NHS111
There have been reports that some patients with COVID-19 symptoms are being redirected to NHS 111 by their GP practice when calling for advice in hours. Practices are reminded that this is not appropriate and if a patient who calls/attends the practice is symptomatic they should be assessed rather than redirected to NHS111. This is to prevent unwell patients deteriorating due to delays in accessing medical help.
If a patient needs an antigen test, they can be directed to the dedicated number of 119. More information about coronavirus testing is available here.
The latest version of the SOP includes a flowchart on the interface between NHS111, CCAS and GPs.
Judicial Review against the Northamptonshire safeguarding partners
The BMA recently applied for Judicial Review against the Northamptonshire safeguarding partners (Northamptonshire County Council, the Chief Constable of Northamptonshire, Nene and Corby CCGs). We argued that the safeguarding partners had failed to discharge various statutory obligations in publishing their Local Safeguarding Arrangements Plan. The Plan was deficient because it did not specify what sum the Defendants had budgeted to meet the cost of GPs’ work on safeguarding cases, including the production of safeguarding reports and attendance at safeguarding conferences.
Unfortunately, the Judge found against the BMA and dismissed the application. However, he did make a number of very helpful comments which clarify GPs’ rights in this area and the BMA will continue to demand appropriate arrangements at the national level to ensure safeguarding partners around the country comply with NHS England’s requirements for GPs to be paid for their safeguarding work. The BMA will be appealing to the Court of Appeal. This was reported by the BMJ
GP appointment data (England)
The GP appointment data published last week, showed a large increase in remote consultations during lockdown - 48% of GP appointments in May were carried out over the telephone, compared with 14% in February. In response to this I said: “There has been a massive change from the vast majority of consultations in general practice taking place face to face, to now the vast majority taking place by telephone or increasingly by video consultation”. This was reported by the Guardian
NICE indicators consultation
The National Institute for Health and Care Excellence (NICE) has published a consultation on proposed new QOF indicators, on vaccinations and immunisations, obesity and cancer, which we will be submitting a response to (deadline is 15 July) and LMCs may wish to do this too. This was reported by Pulse, Pulse and the Mirror
COVID-19 care home support service (England)
NHSE/I have published a transition note clarifying that under the COVID-19 care home support service training will be provided for personalised care staff.
Transition between COVID-19 care home support and the Care Homes service in the PCN DES
From 31 July 2020, the interim COVID-19 care home service will transition into the Enhanced Health in Care Homes service as described in the Network Contract Directed Enhanced Service (DES). We have agreed with NHSEI that to provide some continuity and stability the Network Contract DES will be amended so that when appropriate the clinical lead role for the service may, as now, be held by a clinician, other than a GP, with appropriate experience of working with care homes provided this is agreed by the practices in the primary care network, the CCG and the relevant community provider.
Mental health and wellbeing
The BMA has published a new report which warns of a mental health crisis as we emerge from the COVID-19 pandemic and outlines key recommendations for the Government to take, including the recruitment of more mental health staff. This follows the latest tracker survey which revealed high levels of exhaustion and stress amongst doctors. David Wrigley, BMA deputy chair of council and former member of GPC, spoke to BBC Radio Lancashire (about 7.10am)
Read the BMA’s report on the mental health and wellbeing of the medical workforce which sets out ten recommendations to be addressed to protect staff during the pandemic and in the future.
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
BMA COVID-19 guidance
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.
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 and priorities for easing lockdown.
See this week’s GP bulletin here.
Faulty PPE
MHRA have advised a product recall notice to practices and care homes with safety warnings, notices for destruction and distribution stoppages for more than 85 million Cardinal Surgical masks and 3m and Cardinal respirators in the PIPP stockpile since it was deployed in March. This comes despite repeated assurances by Public Health England, NHS England and the Department of Health and Social Care, that all PPE products had been rigorously tested and are safe for use.
This is an unacceptable situation that has put healthcare workers at risk and now could leave some practices without any face masks to use, therefore potentially having a major impact on patient care. We have raised our serious concerns about this with NHSE/I. They have responded to say that they have not supplied any Cardinal masks since May and are working through a replacement plan with the wholesalers who supplied primary care. Practices can obtain PPE supplies via their LRFs (who have good supplies) and the Portal that can be delivered within 48 hours. Find out how to register and contact the Portal Customer services team here
If doctors and health and care workers have been supplied with, and worn, faulty, re-dated masks, this is clearly a dereliction of duty to ensure the safety of NHS staff and patients. Wearing substandard PPE places doctors at risk of becoming infected and also spreading the illness to patients and nothing short of 100% fit for purpose PPE should have been supplied from the outset. Read the full BMA statement here
This was reported by Sky News, Channel 4 News, Pulse, Telegraph, and Nursing Notes,
New to Partnership Payment Scheme (England)
The New to Partnership Payment Scheme was launched on 1 July and will apply to all new clinical partners from 1 April 2020. The partnership model, which gives GPs based in communities the autonomy to lead and advocate for their patients, is the foundation of general practice, and vital for its survival and sustainability. However, in recent years the number of partners in England has been steadily falling and it was clear to us that action needed to be taken to attract and equip GPs to take on partnership. This scheme, secured through our recent contract negotiations, follows the Partnership Review and shows faith in GPs and the partnership model – backed with additional investment – so that new partners can have the confidence in taking on this important role.
There are still wider issues facing partners – and those considering becoming partners - that need urgent attention, which includes cutting back on bureaucracy and regulation, and empowering GPs as leaders enabled to shape sustainable services with the necessary resources in their area. Recent months have shown practices overhauling systems to ensure patients receive high quality care during the pandemic, and GPs must be trusted to continue this leadership and deliver the best for their patients and communities for the long term. This was reported by GPonline and Pulse
Lapse of the emergency GMS regulations (England)
The emergency regulations relating to general practice, which were part of the NHS response to the COVID-19 pandemic, lapsed on 1 July. We have been in discussion with NHSE/I about what the arrangements will be for the rest of the year as we are clearly a long way from the end of the pandemic and need to be prepared for a second wave or impact of local outbreaks as we are already seeing. We are seeking urgent clarification of this so that practices can plan for the months ahead and will provide an update as soon as we can.
Social distancing guidelines
Following the PM’s announcement last week about the change in the guidance on social distancing, we are working through the implications of this with NHSE/I and the impact it will have on services.
From 4 July, the guidance will change from ‘Stay 2 metres apart’ to ‘Where it is possible to keep 2 metres apart people should’, it also advises people to keep a social distance of ‘one metre plus’, meaning in areas where it is not possible to keep 2 metres apart such as in public transport and some working environments, they should remain at a minimum one metre apart, while also taking physical steps to reduce the risk of transmission. The government guidance continues to state that businesses should maintain 2 metre distancing wherever possible. This would apply to practices who should continue to apply social distancing. I have done an interview for Sky News today on these changes.
The BMA has written to the Secretary of State for Health and Social Care to express concerns over the lack of clarity in the Westminster government’s plans to ease lockdown and calling on government ministers to produce clear and consistent guidance on social distancing.
The BMA has also called for the Government to be more open and transparent with local COVID-19 data and about how regional spikes will be managed in the future, following the announcement of a reintroduction of lockdown measures in and around Leicester due to increasing levels of infection in the city. This was reported by the BBC, BBC Online, The Guardian, The Independent, Metro, Mirror, Huffington Post, Telegraph, Evening Standard and MSN
Read more in the BMA statement calling for consistent guidance on social distancing
COVID-19 risk assessments
Last week we were disturbed by the results of the latest BMA tracker survey which found that more than a third of BAME doctors in the UK are still not being given access to potentially life-saving COVID-19 risk assessments – nearly two months after NHS England issued recommendations that risk assessments should be carried out for all staff as a precautionary measure.
In response to my letter to Simon Stevens earlier this month and our lobbying on these issues, NHSE/I have issued a letter which sets out that CCGs should commission an occupational health service to support practices with this risk assessment process. We do not believe practices should be expected to pay for this, and it should be made freely available as soon as possible through local OH capacity, or by commissioning more to complement existing OH services via this Dynamic Purchasing Solution, if additional capacity or access outside normal working hours is needed. CCGs are asked to assure that this is happening comprehensively and speedily in their areas.
Read the BMA’s guidance on risk assessments which includes specific information for practices.
Shielding update
We have updated our guidance on shielding following the announcement that the guidance for clinically extremely vulnerable people who are currently shielding from coronavirus, will be eased in two stages – on 6th July and 1st August.
These patients will be sent a letter advising them to continue with the care/treatment arrangements currently in place. More detailed advice will be provided by the Government as the changes in advice come into effect, and unless there is a significant rise in COVID-19 cases the shielding programme is expected to be paused on 31 July.
The shielded patients list will continue to be maintained after August so that it can be used again in the future if necessary. Work is also being done to develop a new predictive risk tool which could lead to an updated list in the future.
We have heard of situations where individuals, employers, businesses or insurance companies have been suggesting that shielding patients obtain a letter from their GP to engage in certain activities, including having their hair cut. There is no requirement or necessity for such letters and patients and others should follow the government guidance relating to social distancing and other necessary precautions.
Read the Government’s guidance on shielding for patients and the letter to the NHS on shielding
Trust GPs to lead: learning from the response to COVID-19 within general practice in England
Our report Trust GPs to lead: learning from the response to COVID-19 within general practice in England, which was published last week, explores and highlights the scale of extra work being taken on by GPs during the pandemic, which was also highlighted in the BMA’s latest tracker survey.
I have joined a ministerial working group on renewal and recovery in general practice, set up by Jo Churchill MP, Parliamentary Under-Secretary of State for Health and Social Care. This is also linked to the contract agreement for a government review to reduce unnecessary bureaucracy impacting general practice. The BMA will be submitting evidence to the review and participating in the ongoing discussions. The final recommendations will be agreed by the ministerial working group to take forward. Read more here
Scottish GPC newsletter
Please see attached the latest newsletter from Scottish GPC, which includes updates on an update from the latest SGPC meeting, COVID-19, negotiation issues and contracts, IT, and LMC update.
COVID-19 has rewritten the rulebook for how the NHS operates
I have written a feature in the HSJ (log in required) highlighting how the pandemic saw general practice rapidly responding to enable the needs of patients to be met safely. The NHS has had to adapt significantly since the start of COVID-19, with general practice leading the way, and now most patients will have recognised the changes made over the last few months – all of which have been done more easily due to the reduced bureaucracy and increased autonomy for practices.
Pandemic Medicines Delivery Service extension
NHS England/NHS Improvement have now announced that the Pandemic Medicines Delivery Service will be extended until 31 July 2020. This new commission will be under the same terms of the current scheme with the same claims processes in place. Their letter announces that pharmacies and dispensing doctors across England will be required to ensure shielded patients can receive a home delivery of their medicines until 31 July 2020. Read the service specification and guidance here
GP appointment data (England)
NHS Digital has published the appointment data in England for May 2020, which show that there has been a significant reduction in appointments to non-COVID period in April and May. However we know that the reality on the ground is quite different with many seeing an initial drop in appointments at the start of the pandemic, but now experiencing a significant increase back to historic levels or in some cases over pre-COVID levels as practices manage delayed presentations.
Survey on digital primary care and COVID
The inSIGHT study is an international project that aims to understand the impact of COVID-19 on the use of digital-first technologies in primary care, and they would like to hear from GPs. The inSIGHT project is led by the Institute of Global Health Innovation at Imperial College London, involving collaborators from 17 organisations worldwide. Take the survey here
Annual GP recruitment drive (England)
Applications for GP specialty training open on the 28 July–13 August 2020. Please ‘like’ and follow the #Choose GP Facebook page to keep up to date, and forward this informationto anyone who may be thinking about career options. Visit the GP National Recruitment Office for more information. Health Education England has a number of GP and trainee volunteers who can help with local or general enquiries. Email Daryl at gprecruitment@hee.nhs.uk to be put in touch with them.
HEE thanks all GPs and trainees who responded to the call for volunteers willing to be contacted by doctors considering GP training - your support is very much appreciated.
Performers List processes associated with GP Registrars and professional standards (England)
Please find attached PLAN 07 that provides formal notification from NHSE/I confirming the joint agreement with Health Education England that GPRs due to start training in August 2020 are exempt from the requirement to be included in the England Medical Performers List.
Self Care Forum Coronavirus Innovations Award
Every year the Self Care Forum invites submission of examples of good practice and innovation, to be celebrated during Self Care Week, and be given a £500. This year they are asking for examples of good practice and innovations in self care that have been implemented during the pandemic and which have made a difference to individuals and the community. Closing date for admissions is 31st July 2020. More information about the award and an application form can be found here
Mental health and wellbeing
The BMA’s latest tracker survey revealed high levels of exhaustion and stress amongst doctors. 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
Read the BMA’s report on the mental health and wellbeing of the medical workforce which sets out ten recommendations to be addressed to protect staff during the pandemic and in the future.
BMA COVID-19 guidance
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:
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 and priorities for easing lockdown.
Thanking your colleagues on 5 July
The NHS as we know it would be nothing without the hard work and dedication of its staff, so the BMA is encouraging you to use the NHS’s 72nd anniversary on 5 July to recognise the colleagues who have been supporting you during the pandemic– by tagging them in a photo or a message of thanks on social media. If you also tag the BMA (@theBMA on Twitter, Instagram and Facebook) we can make sure it’s seen by as many people as possible.
See this week’s GP bulletin here.
Read the Sessional GPs newsletter here
Trust GPs to lead: learning from the response to COVID-19 within general practice in England
The results of our fifth and sixth tracker survey highlighted the scale of extra work being taken on by GPs during the pandemic, something that is continuing to increase. Our new report, Trust GPs to lead: learning from the response to COVID-19 within general practice in England, which was published this week, explores how these demands can be managed both in the short and long term.
We set out five principles that must be addressed as part of learning the lessons of COVID-19 as follows:
The report also sets out a range of solutions that will enable GPs and practices to manage the ongoing demands of responding to COVID-19, and looks at GPs being supported to continue delivering innovative patient-focused local services for both the short and long term. I have already had the opportunity to talk to the Health Minister, Jo Churchill MP, about our report and its recommendations.
Read our full BMA statement about the survey and the Trust GPs to lead report here
This was reported by Pulse and GP Online
BAME doctors not being given access to COVID-19 risk assessments
The BMA’s sixth tracker survey also showed that more than a third of BAME doctors in the UK are still not being given access to potentially life-saving COVID-19 risk assessments. The survey also showed revealed that BAME doctors are still less likely to feel fully protected from coronavirus compared to their white colleagues (29% compared to 46%), and far more likely to often feel pressured into treating patients without the proper protective equipment4 (7% compared to 2.5%). Read the BMA statement here. This was reported by The Daily Telegraph and GP online
We updated our guidance on risk assessments last week to include two new sections for GP practices looking at the implications of risk assessments for practices and the risk assessment tools that are available to practices to use.
As Dr Farah Jameel, GPC England Executive Team member, has stated: “This week, many doctors, including myself, were rightly disturbed by the results of the latest BMA survey. It found that more than a third of BAME doctors in the UK are still not being given access to potentially life-saving Covid-19 risk assessments – nearly two months after NHS England issued recommendations that risk assessments should be carried out for all staff as a precautionary measure. For white doctors, 42% said they haven’t had risk assessments yet. Every other healthcare worker in community and hospital trusts have access to an occupational health service that provides expert help, advice and support, but this most fundamental of services to support the workforce is something that has been denied to those working in general practice for decades. This pandemic has exposed how short-sighted this lack of provision is, and if the Westminster Government is going to learn anything from the last few months, then it must take swift steps to address this.”
In response to my letter to Simon Stevens earlier this month and our lobbying on these issues, NHSEI have issued a letter which sets out that CCGs should commission an occupational health service to support practices with this risk assessment process. This should be made freely available to practices as soon as possible through local OH capacity, or by commissioning more to complement existing OH services via this Dynamic Purchasing Solution, if additional capacity or access outside normal working hours is needed. CCGs are asked to assure that this is happening comprehensively and speedily in their areas.
Need for robust digital systems and sustainable plans to manage GP workload
The latest tracker survey has shown a lack of robust IT systems and digital solutions to help secondary care colleagues complete necessary tasks, leading to work being transferred to general practice without sustainable services in place. At the same time, we are still facing intense resource shortages, with 80% of GPs surveyed saying they need an increased supply of face masks for staff.
Half of those responding to the survey said that they are having to provide care that would normally be delivered by secondary care colleagues and 81% said they have been asked to carry out new investigations and manage ongoing care, which would also usually be done in hospitals, further adding to GPs’ growing workload.
Due to reduced numbers of patients attending hospital, practices are being expected to perform blood tests for hospital outpatients, prescribe medication that would normally be given in secondary care, and at times complete tests before making a possible cancer referral, which could lead to delays in treatment. This needs rapid action to deliver long-term solutions to improve the interface between secondary and primary care, and make sure we have the digital infrastructure in place to stop unnecessary prescribing, duplication of workload and extending patient pathways. The NHS must be properly joined up and resourced at all times – not only in preparation for something as serious as COVID-19, but also for when the crisis has subsided
The importance of this was illustrated by a misjudged question at the final No 10 daily press briefing earlier this week. It is clear that clinicians in general practice, hospital and other services have all been under immense pressure throughout the last few months as we all played our part in responding to the COVID-19 pandemic and it's now vital that we work together to develop improved care pathways that are sustainable and do not place unrealistic expectations on anyone. We will be working with our secondary care colleagues in the BMA on this and have also raised these issues with government ministers and NHS England and Improvement.
The extra work and lack of support, on top of the challenge of the pandemic, is also likely to explain why 31% of doctors surveyed feel as though they are currently suffering from a form of depression, anxiety, stress, burnout, emotional distress, or other mental health condition, and that it’s been worse while working during COVID-19.
Read the full BMA statement about the survey and the Trust GPs to lead report here.
Shielding update
The Government has announced that from Monday 6 July, the advisory guidance for clinically extremely vulnerable people who are currently shielding from coronavirus, will be eased, and that they will be able to gather in groups of up to 6 people outdoors and form a ‘support bubble’ with another household. The guidance will be relaxed further in August, should the reduction in viral prevalence continue. In relation to this the Government in England has informed practices that it will write to those on the shielded list to make them aware of the updated guidance. Read the Government’s guidance on shielding for patients.
The NHS will continue to maintain the Shielded Patient List in order to enable targeted advice and support to those who are most vulnerable should that be required in the future. Practices should therefore continue to add or remove patients from this list as is clinically appropriate. In addition, we are talking to NHSEI about research being done that could refine the identification of those who are most at risk and would benefit from shielding should that necessary.
Indemnity arrangements for NHS Primary Care staff undertaking COVID-19 antibody tests
NHSE/I has now confirmed that where primary care staff undertaking COVID-19 antibody tests are not covered for this activity under their existing indemnity/insurance arrangements, they will be indemnified under the Clinical Negligence Scheme for Coronavirus (CNSC) which was established in accordance with new powers from the Coronavirus Act 2020. NHS Resolution has added an FAQ which states:
Where you are appropriately trained and competent to undertake this activity, and you are not covered for this activity under your existing indemnity/insurance arrangements, you will be indemnified under the Clinical Negligence Scheme for Coronavirus (CNSC). The CNSC has been established by NHS Resolution to meet liabilities arising from the special healthcare arrangements being put in place in response to the coronavirus outbreak.
Antibody testing undertaken in NHS trusts will be covered under the Clinical Negligence Scheme for Trusts. Further information on the rollout of the antibody testing programme is set out in NHSE/I letter on 25 May 2020.
Read all the FAQs on the Clinical Negligence Scheme for Coronavirus here
Temporary resident registration for antibody testing (England)
GPC England continues to be clear that it is wholly inappropriate to use the temporary residents mechanism to offer antibody testing for staff and that to do this may be in breach of the GMS regulations. NHSE/I agree with us that this is outwith the regulations and not practical for practices or their staff. Antibody testing for those working in general practice is not mandatory. If those working in general practice wish to have an antibody test, we believe the results should, as is happening in some areas of the country, be provided directly to the individual having the test and should not require the involvement of the employer.
GP Standard Operating Procedure updated
NHSE/I have added two new sections to the GP Standard Operating Procedure and updated it with some additional information and links for ease of access. The updated sections are on:
The Healer in times of COVID: supporting each other through adversity
The BMA and NHS Practitioner Health are holding a virtual conference on Thursday 23 July 2020, 12.30 - 3.30pm to address the health and wellbeing of the health care workforce in the context of COVID-19. Chaired by leading experts, the conference will explore the impact of pandemics on the mental health and wellbeing of health care staff. By discussing the global impacts of the pandemic, and bringing together a vibrant community of professionals, we will share lessons learned and collaborate to build a vision moving forward post-COVID-19.
Join expert speakers and panellists including Professor Neil Greenberg, Dr Michael Myers and Anna Soubry. Register your place at this free event here.
BMA issues holiday guidance ahead of domestic tourism return
Following the guidance issued by GPC England about the support practices can continue to offer their patients when travelling on holiday this year in order to support colleagues in tourist areas, the BMA has today issued further advice and public health information for the public. This comes just days after pictures of a crowded Bournemouth beach raised concerns over social distancing.
The BMA’s public messaging campaign1 urges people to:
To read more about the principles see PDF here
BMA COVID-19 guidance
We continue to regularly update our toolkit for GPs and practices, which should help to answer many of the questions we have been getting 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 and priorities for easing lockdown published last week.
Mental health and wellbeing
The BMA’s latest tracker survey revealed high levels of exhaustion and stress amongst doctors. 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
Read the BMA’s report on the mental health and wellbeing of the medical workforce which sets out ten recommendations to be addressed to protect staff during the pandemic and in the future.
Other COVID 19 resources
See this week’s GP bulletin here.
PPE – face masks and coverings
As of this week, face masks and coverings should be worn by all hospital staff and visitors and we have been calling for this to be extended to all healthcare settings, including primary care.
It is imperative that we do all we can to prevent the spread of infection, so that patients and visitors can attend practices without fear of contamination - the wearing of masks by staff and face coverings by the public will play a role in enabling this. With the UK chief medical officers reducing the COVID-19 alert level from four to three today it is all the more important to do this to avoid a return to greater levels of virus circulation. It will also reduce the risk of a whole team within a practice being required to self-isolate should one member contract COVID-19. Read the BMA statement here
Practices should be aware of current guidance, which includes:
The PHE guidance recommends that those working in reception and communal areas who are unable to social distance, should wear a fluid repellent mask. We believe patients should be encouraged to wear face coverings whenever they attend the practice (with practices continuing to triage arrangements to keep face-to-face contact to a minimum) and that staff should continue to be enabled to work remotely whenever possible, to create more space for social distancing. We believe that CCGs and NHSE/I should also fund perspex screens wherever needed to protect staff and reception areas, reducing the potential for spread of infection.
This was reported by GP online
Following the release of government guidance regarding the wearing of face masks in various public settings (including the circumstances where an individual might be exempt), practices are reporting increases in requests from patients for letters of exemption. The government guidance on exemptions suggests there is no requirement for evidence for exemption, therefore it should be sufficient for an individual to self-declare this. Practices are not required to provide letters of support for those who fall under the list of exemptions. The responsibility for issuing exemptions is with the transport provider, not GPs – see for example, this information from First Bus and Arriva. Similarly, practices are under no obligation to provide letters of support for anyone who does not fall under the list of exemptions but considers them to have another reason to be exempted.
BMA risk assessment guidance for practices
The BMA has updated its guidance on risk assessments to include two new sections for GP practices. The first section looks at the implications of risk assessments for practices – specifically what impact the adjustments required for high risk staff could have on practices, staff and patients. The mitigation that practices would need to do could include working from home or removal from areas that are considered hazardous, which could lead to a reduction in workforce and in activities that could affect patient safety, or an increased use of locum support and procurement of PPE, at a significant cost. This section also covers a number of suggestions of what commissioners can do to support negatively impacted practices. The second section sets out the risk assessment tools that are available to practices to use. Read the guidance here
This was reported by the Daily Mail,
GP pressures (England)
We recently published analysis of the latest data release from NHS England, which revealed the far-reaching impact of COVID-19 on patient behaviour and NHS activity in April and May. The monthly number of GP-made referrals has dropped, waiting times for treatment are now increasing (on average) by a week every week, and A&E demand is at its lowest on record. These changes reflect a large backlog of care needs that have accumulated beyond the focus on COVID-19 and inability of practices to make routine referrals since March. Even though the waiting list has dropped due to the lack of referrals, it will likely balloon in future months. Read more on the website.
Antibody testing of practice staff (England)
We are concerned at the significant variation in approaches across the country to the provision of antibody testing for practice staff. This is as a result of the failure of government and NHSE/I to make available an occupational health service to general practice staff, something we have written to Sir Simon Stevens about. We are aware that some CCGs are suggesting GP practices undertake antibody tests for their staff, using the temporary resident functionality of the clinical system to process the test. They have argued this will not be considered to be registering the individuals as temporary residents under contractual arrangements for primary medical care services but will be considered to be an ‘NHS commissioned activity’ and therefore falls within the CNSGP arrangements for practice indemnity. We are seeking clarification from NHS Resolution on whether CNSGP will cover this activity if a practice decided to undertake these tests.
GPC England believes that it is wholly inappropriate to use the temporary residents mechanism to test staff and may be in breach of the GMS regulations. We have contacted NHSE/I and have been advised they have told CCGs that this is outwith the regulations and not practical for practices or their staff. Antibody testing for those working in general practice is not mandatory. If those working in general practice wish to have an antibody test, we believe the results should be provided directly to the individual having the test and should not require the involvement of the employer.
The Independent reported on the BMA statement about reports that some healthcare workers have had applications for insurance deferred on the basis of a positive COVID-19 antibody test. The BMA has written to the Association of British Insurers to seek urgent clarification on this issue and have produced guidance on this.
Shielding
The Health Service Journal reported that ‘shielding’ programme for those at highest risk from coronavirus would be dropped at the end of July. We expect an announcement about the government’s actual intentions shortly. GP Online also reported on this story, to which I commented: 'GP practices have undertaken a huge amount of work over the last few months to support their patients who are shielding and this continues to mean many additional consultations on a daily basis as practices try to respond to the concerns these patients and their families have. That's why it’s imperative that clear information is given to both patients and practices to both reduce the need for patients to contact their GP in the first place and also to provide practices with the necessary information to be able to advise patients when they do contact the practice. Any changes to shielding guidance should only be made in line with falls in COVID-19 infection rates and with clear information provided by Government to patients and timely information to GP practices.'
Pensions guidance and update (England and Wales)
The BMA has updated its guidance for GPs about the annual allowance, following extensive lobbying, resulting in two important changes that affect the 19/20 and subsequent tax years.
As an emergency measure for 19/20, NHS England and the Welsh Government made a commitment to pay the annual allowance tax charges in full for eligible clinicians in the England and Wales NHS pension schemes. Doctors who were subject to an annual allowance tax charge should use the option of the ‘scheme pays’ regulations to pay the tax due for 2019/20. From 2020/21 onwards the reduced Tapered Annual Allowance will only affect those with adjusted income of £240,000 and over. Read the full guidance here.
The BMA has also won a court appeal against the Government’s controversial changes to pensions rules introduced in April 2019, granting the Secretary of State for Health and Social Care the power to suspend pension payments to a doctors or NHS professionals charged with certain criminal offences, but not yet convicted. Read the BMA statement here
PCN DES (England)
NHS England has announced that 98 per cent of practices have chosen to participate in the Primary Care Networks (PCN) for 2020/21. With 1,250 PCNs aross England this is the same number as last year. The focus for PCNs and practices remain in dealing with COVID-19, but will also now be in expanding the workforce to relieve the workforce pressures for GPs, as the latest workforce data clearly showed. The DES remains modified including the investment and impact fund (IIF) having been replaced by the PCN support fund until at least October, with funding protected. It is for the PCN to decide how this funding is used. Read more about the PCN DES in our GP practice toolkit.
This was reported by Pulse
Appraisal update
As we reported last week, the GMC has moved forward revalidation dates for those due to revalidate between 1 October 2020 and 16 March 2021, for one year. NHSE/I have also confirmed in the a letter that whilst appraisals remain on hold, the future of appraisals is still being discussed whilst they await the national decision confirming the date for recommencement of appraisals. We continue to engage with the Responsible Officer network to agree a revised format for appraisal that we hope will be regarded as more formative and supportive.
CQC inspections
GPC and BMA council member, Clare Gerada, has written to the CQC urging them not to resume inspections of practices as planned this autumn, but to defer for at least another 12 months. She urged the CQC to allow GPs healing time following the pandemic, including time to mourn lost colleagues and relatives, and warned that the alternative could lead to widespread burnout and early retirement among GPs. In response to this I said that the reduction in bureaucracy since the start of lockdown had given practices the space to innovate and dedicate more time to patients. ”GPC has long called for an overhaul of inspection processes, and now is the precise time for that as we all reflect on learning from this crisis”'. This was reported by GP online and Pulse. We have also raised our concern about the planned resumption of CQC inspections directly with CQC as well as with government ministers and NHSE/I and will continue to lobby for changes to the current regulatory arrangements.
Regulation of physician associates
The GMC has published an update about the regulation of physician associates (PA) and anaesthesia associates (AAs), as new legislation is expected to be introduced in the second half of 2021. Over the next year the GMC will be designing the processes and policies needed to regulate PAs and AAs. Read the full statement on the GMC website
They have also published a short survey asking for views on this process, in particular the questions focus on experience of working with PAs/AAs, their education and training, and views the GMC’s professional guidance and how it could relate to PAs and AAs. You can feed in to the survey here (closing date is 29June).
ARM 2020
This year’s BMA Annual Representative Meeting will be held virtually with committee elections and motion debates on Tuesday, 15 September. Find out more here
Conference of England LMCs 2020
The annual England LMC conference will be held on 27 November 2020. LMCs will be inviting motions from LMCs as normal, and close of motions date will be noon 18 September. Further details will be provided as soon as possible regarding the options for the conference, which most likely be delivered via virtual technology. If you have any questions, please contact the Conference chair, Rachel McMahon or (rachelmcmahon@nhs.net) or Stuart Abrahams (sabrahams@bma.org.uk).
A thank you from HEE (Health Education England) to the GP community (England)
In our update at the start of June, we asked you to consider assisting with HEE’s national ‘Choose GP’ recruitment campaign. This involved taking part in peer to peer conversations with doctors considering general practice as a career. HEE have since confirmed a very helpful increase in enquires from GPs willing to offer their time and assistance, and have asked us to send a big “thank you” to you all for supporting the ongoing drive to expand the GP workforce.
BMA President elect to chair COVID-19 CMO advisory group in Scotland
The BMA President elect, Sir Harry Burns, has been announced by the interim CMO in Scotland as the chair of a new group to analyse and advise on managing risks around Covid-19 and other threats over the Autumn/Winter in Scotland.
BMA COVID-19 guidance
We continue to regularly update our toolkit for GPs and practices, which should help to answer many of the questions we have been getting on a large range of topics relating to COVID-19. Last week we added a section on high-risk patients and shielding arrangements. 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 and priorities for easing lockdown published last week.
Mental health and wellbeing
Read the BMA’s report on the mental health and wellbeing of the medical workforce, which sets out ten recommendations to be addressed to protect staff during the pandemic and in the future.
The BMA 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
Other COVID 19 resources
See this week’s GP bulletin here
Risk assessment for BAME doctors and other staff
I attended a BMA coordinated meeting last Friday with representatives from thirteen BAME, International Medical Graduate and faith-based medical organisations, to discuss the disproportionate impact of COVID-19 on BAME doctors and other healthcare workers. We all expressed deep disappointment at the recent Public Health England report and its complete failure to look at the reasons behind the large number of deaths of BAME healthcare workers or offer any recommendation. As a result of the meeting the group has written a joint letter to the Government not only to express its disappointment in the recent PHE review, but to demand robust risk assessments, sufficient provision of PPE, and comprehensive data to be collected about occupational factors that may put healthcare workers at risk. This must be accompanied by work – immediately and in the longer-term – to end systemic discrimination and structural inequalities in the NHS and develop inclusive cultures where all doctors feel safe to raise concerns.
Read the BMA statement about the meeting here.
The letter was covered by The Times (log-in required), ITV News, ITV news, Huffington Post, and the Daily Mail and Telegraph's print editions.
Following the news that a section of the PHE report was left unpublished last week, the BMA has called on the Government to urgently publish the full report on COVID-19 impact on BAME communities. Read the BMA statement here
The BMA has also published a statement in support of the Black Lives Matter movement, reflecting on the inequality, racism and discrimination which Black and ethnic minority people continue to suffer in the US, the UK and around the world.
The updated BMA resource on conducting COVID-19 risk assessments specifies that all doctors should be able to have a COVID-19 risk assessment and sign posts practical actions that should be taken to avoid or mitigate the risks.
BMA statement on wearing face masks (England & Wales)
Following our earlier lobbying, the BMA welcomed the announcements last week that face coverings will be mandatory on public transport in England from June 15 and that face masks and coverings should be worn by all hospital staff and visitors, after we made a statement suggesting that this should include settings where social distancing is not possible.
However, we believe this must be extended to all healthcare settings, including primary and social care. Whilst all practices have taken major steps to reduce face-to-face consultations, as the number of people attending surgeries increases again we should continue to encourage patients to wear a face-covering when attending a practice, which will help further protect staff and patients.
Having a consistent rule across all healthcare settings will also avoid confusion for the public and make life easier for the staff and healthcare workers who will be trying to implement these safety measures. The continued concerns many have about the availability of medical masks in general practice and community settings must be addressed as a matter of urgency and I have raised this directly with NHSE/I and government. We have also called for clear guidance for the public about what type of covering they need and how to wear it. The latter is particularly important as WHO updated its guidance on the use of face coverings in public, advising that those in vulnerable groups are now recommended a medical grade mask. Read the BMA statement here.
In response to this, I said to Pulse: "The BMA is clear that the latest rules around face coverings and hospitals must be extended to cover all health and social care settings, including general practice. So this recommendation for all staff to wear masks is a step in the right direction and we await the guidance from Public Health England. However, it’s crucial that patients also wear face coverings when attending practices, as they are being told to in hospitals, in order to help prevent the spread of Covid-19." This was also reported by GPonline, Management in Practice, BBC East Midlands, GP Online and Pulse. I also spoke to LBC earlier this week and to BBC Leeds about this today (around 7.37am).
BMA Cymru Wales has also welcomed the announcement by the Welsh Government that the public will be recommended to wear three-layer face coverings in areas where social distancing is not possible. Read the statement by David Bailey, BMA Wales chair of council, here.
This was reported by ITV Wales, Wrexham.com, Wales Online, Wales News Online, Mail Online and AOL. David Bailey was interviewed by BBC Radio Wales (from 13 mins 48 seconds in).
Shielding (England)
Following the government’s updated guidance which advises that shielded patients can now leave their home, and the letter from NHSE/I about the NHS support to people who have been shielding, we have now updated our guidance on shielding on the recent changes. This also includes guidance on removing patients from the list of patients at high risk of COVID-19.
The Royal College of Paediatrics and Child Health have updated their guidance for clinicians identifying children who are ‘clinically extremely vulnerable’ to severe COVID-19 infection.
Sustainable and environmentally friendly general practice report (England)
GPC England has published a report, developed with support from Greener Practice and Sheffield GPs Dr Aarti Bansal and Dr Mike Tomson, which looks at ways in which GP practices can develop, and can be helped to develop, environmentally responsible practices. One of the more positive consequences of the COVID-19 pandemic has been the dramatic reduction in carbon emissions and this demonstrates what can be achieved with specific actions. The NHS, including general practice, has a significant opportunity to make a difference for the long-term and this report highlights the current carbon footprint of general practice and includes a 10 point plan calling on Government and NHS policy makers to help ensure that the impact of health services on climate change is reversed.We would encourage all practices to use this to review what actions they could do, working with others in their area. You can read my comment piece in GP Online about the report here
A new normal - Doctors’ lives post COVID-19
The BMA’s the Doctor magazine has published an article where doctors talk about their experiences at work and sets out the actions the BMA is taking to keep doctors safe and learn from the pandemic. A specific section looks at safeguarding doctors’ rights and health, where I highlight that as the patient numbers in primary care start to return to previous levels, we are calling for secondary care referral pathways to be re-established. While continuing to use the digital technology so prevalent in lockdown, we want the pendulum to ‘swing back a little’, as general practice is built on long-term relationships and face-to-face contact. Read the article here
Minimising nosocomial infections in the NHS
NHSE/I has sent out a letter on tackling infections acquired in the NHS, whether it involves staff, visitors or patients. The letter calls on all primary care contractors to take the following actions:
Note that the flowchart in the appendix on page 8 sets out the actions that providers need to take if there is an incident in general practice. If an incident should happen in general practice, it is important that the necessary funding is available, and we will raise this issue with NHSE/I.
Welsh Government guidance on safe return to routine arrangements for healthcare environment
The Welsh Government’s Nosocomial Transmissions Group and Shared Services Partnership have prepared an operational guide for the safe return of healthcare environments to routine arrangements. The document offers guidance on the adaptation and reconfiguration of healthcare buildings and reshaping of environments using principles of communication, social distancing, signage and rigorous infection prevention and control measures, but recognises that local solutions will be required to reflect particular circumstances.
Northern Ireland plans for rebuilding health and social care services post-COVID
Northern Ireland’s Health Minister has published his initial plans for rebuilding health and social care services post-Covid this week. Read more here.
Implications for life insurance following antigen and antibody tests
The BMA has published guidance for doctors on life insurance and income protection during the pandemic, following a number of doctors having raised concerns about the impact of COVID-19 on their application and how insurers are taking into account the results of antibody and antigen tests for the virus, and after some reports about doctors having their applications for insurance policies deferred as a result of COVID. Read the guidance here
Antibody testing
The Daily Mail and Pulse reported that NHS England has said that any patient can ask their GP for antibody test when having a blood test for another reason. In response to this I said there was no obligation to offer antibody testing and that this could increase inappropriate attendance at surgeries. GPs would use their clinical judgement to decide whether to offer patients COVID -19 antibody tests.
Covid19 Pillar 2 lab results flow into GP records
NHS Digital have now implemented a process to facilitate the flow of Pillar 2 test results from COVID-19 tests undertaken through national testing to GP systems. These will appear in a patient’s record as a laboratory test result. The tests will have the requesting GP as G9999981 and GP Surname of COVIDpillar2; this will ensure they are clearly distinguishable from other test results.
We have been working closely with NHS Digital and system suppliers to minimise the action required from practices or any subsequent test results manually, enabling bulk filing and automated uploads where possible for test results requested through channels outside of primary care.
See guidance from your supplier in efficiently managing these test results within your system.
Referral to treatment (RTT) and re-referral
Some patients are declining a hospital procedure for COVID reasons and this is leading to concerns that they would they be discharged to primary care. In response, NHSE/I has referred to their document Referral to treatment measurement and COVID-19, which states:
“If a patient cancels, rearranges or postpones their appointment, this has no effect on the RTT clock, which should continue to tick. Patients should not be discharged back to their GP simply because they have cancelled or rearranged appointments; this should always be a clinical decision, based on the individual patient’s best clinical interest.”
I spoke to BBC's Look North to discuss how COVID-19 has impacted referrals and delivery of other services. I said: “The NHS has geared itself up to respond to the real and unprecedented challenges of coronavirus and it’s done remarkably well at trying to do that, but that’s taken key staff away from other services, making it difficult to provide these in a safe way and avoid the risk of infecting people going to hospital or other venues in order to get necessary investigations. So it’s understandable why we’ve had to do this but we now really need to redouble our efforts to ensure that those patients who need investigations and who need treatments get them as quickly as possible."
Revalidation
Due to the pandemic, the GMC initially moved revalidation dates by one year for those who were due to revalidate between 17 March and 30 September 2020. This week, it has written to doctors due to revalidate between 1 October 2020 and 16 March 2021 to let them know that their dates will move by one year as well. In addition, the GMC has given Responsible Officers more flexibility to make revalidation recommendations at any time up to a doctor’s new submission date.
NHS Digital national GP data extraction to support COVID-19 planning and research
Registration among practices for the tactical GPES extraction for planning and research related to COVID-19 has now reached 90%. The DPN, which contains all relevant information on the extraction, is available here. The next extract will take place on 18th June and any practices wishing to be included should register by 17th June.
Capturing beneficial innovation: call for examples (England)
NHSE/I are looking at the beneficial changes across general practice, PCNs and community pharmacy as we move into the next phase of COVID-19. In particular they are looking for examples of innovation – clinical, operational and system based – to understand which should be kept and protected. If you want to contribute, the following weblink contains a short series of questions and there is more information in the attached letter. The deadline for comments is Thursday 25 June.
If you have any queries, please email: england.capturinginnovation@nhs.net
BMA COVID-19 guidance
We continue to regularly update our toolkit for GPs and practices, which should help to answer many of the questions we have been getting on a large range of topics relating to COVID-19. This week we have added a section on high-risk patients and shielding arrangements. 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 and priorities for easing lockdown published last week.
Mental health and wellbeing
The latest tracker survey also showed the personal impact of the pandemic on doctors' mental health and wellbeing, with increased stress, anxiety and emotional exhaustion in recent months. The survey was reported on by the BMJ.
You can read the BMA’s report on the mental health and wellbeing of the medical workforce, which sets out ten recommendations to be addressed to protect staff during the pandemic and in the future.
The BMA 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
Individual coaching support for primary care staff
As we reported previously, at the end of April, NHSE/I and RCGP launched a remote coaching support service for clinical and non-clinical primary care staff, to provide staff the opportunity to process experiences, develop coping skills, deal with difficult conversations and develop strategies for self-management in difficult circumstances.
This service has now been evaluated by the Institute for Employment Studies (IES), which found that the majority of those responding had a positive outcome from using the service; that they felt listened to and supported by the coach, and that they were able to move forward after the call. Primary care staff can register and book individual coaching here.
Other COVID 19 resources
COVID-19 media
Pete Horvath-Howard, member of GPC Wales, took part in a coronavirus phone in on BBC Radio Wales (from 7min30sec in) this week. He said: “There’s a lot of uncertainty right now, but there’s often a lot of uncertainty in clinical medicine. What I’m hoping to do is make things simpler so that people come away with less worries about the spaghetti of guidance going around.”
See this week’s GP bulletin here
