BMA 20 - Kernow LMC

NHSE/I primary care bulletins

NICE resources

COVID-19 media

Pete Horvath Howard, member of GPC Wales, took part in Jason Mohammad’s 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

Read the latest sessional GPs update here

Read the latest update from the BMA Chair of Council here.

LMC weekly update 5 June, 2020 - download as a pdf

NHS Test and Trace services across the UK

The DHSC announced its NHS Test and Trace local outbreak control plans for England designed to help control the COVID-19 virus. The plans involve rapid testing at scale, integrated tracing to identify, alert and support, and using data to target approaches to flare ups, at a local and national level.

Anyone who tests positive for coronavirus will be contacted by NHS Test and Trace and will need to share information about their recent interactions. This could include household members, people with whom they have been in direct contact, or within 2 metres for more than 15 minutes. If those in isolation develop symptoms, they can book a test at nhs.uk/coronavirus or by calling 119. If they test positive, they must continue to stay at home for 7 days or until their symptoms have passed. If they test negative, they must complete the 14-day isolation period. Members of their household will not have to stay at home unless the person identified becomes symptomatic, at which point they must also self-isolate for 14 days to avoid unknowingly spreading the virus.

The GPC England Exec team have raised with NHSE/I the need for much greater clarity on the any implications for health care professionals of the Test and Trace system. They have now said that if someone who works in, or has recently visited, a health or social care setting such as a practice tests positive for coronavirus, their case will be escalated to local public health experts, who will liaise with the relevant setting to agree on the most appropriate action. If they were wearing PPE at the time of the contact, this will not count as a contact. An FAQ document is available here.

The NHS Test and Trace service, including 25,000 dedicated contact tracing staff working with Public Health England, will have the capacity to trace the contacts of 10,000 people who test positive for coronavirus per day and can be scaled up if needed. The system is expected to have the capacity to carry out 200,000 tests a day. This includes 50 drive-through sites, more than 100 mobile testing units and 3 mega laboratories.

In the BMA press statement responding to the announcement that the system will launch in England from today, BMA public health medicine committee member and past chair Dr Penelope Toff said: ‘Having a robust test, track and trace system in place is vital to being able to effectively prevent a second wave of infection and to ensure that we can safely ease out of lockdown. What will be absolutely crucial is that the Government can implement this effectively with all the components in place, so it can run at capacity. Success will not just hinge on the availability of testing and delivering test results quickly but on rapid identification of contacts and support to enable them to self-isolate.’

In the BMJ it was reported that Venki Ramakrishnan, president of the Royal Society and DELVE (data evaluation and learning for viral epidemics) committee chair, said, “Countries that have managed to, at least temporarily, control their covid-19 epidemics have almost all enacted and maintained substantial testing and contact tracing efforts from early in their epidemics. Our report suggests that a test, trace, and isolate programme, if effectively delivered, can play an important part in bringing this pandemic under control but that it should not be considered a silver bullet.”

Scotland

On Thursday the Scottish Government announced it was moving to a trace and isolate model for Covid-19, where patients diagnosed positive for the virus have to inform a team of “tracers” who they have been in contact with. Those identified will then have to isolate at home for a minimum of a fortnight.The Government has published guidance for employers on Test and Protect see link here and will be publishing further information and guidance as soon as possible.

In response Dr Patricia Moultrie, deputy chair of the BMA Scotland GP committee, said: “We have raised with the Scottish Government the pressing need to be clear about what will be considered a ‘contact’ when it comes to GPs and practice staff”. She added that “In particular, we need to know how the wearing of PPE is factored into the definition of a contact requiring isolation. While the system does need to work effectively to protect the public, there are also clearly risks to patients if GP surgeries face staff shortages or are forced to close because doctors and staff have had to self-isolate.”

Wales

From 1 June, Welsh Government will implement population contact tracing on receipt of a positive test result. From this date Welsh Government will implement population contact tracing on receipt of a positive test result. Testing capacity in laboratories in Wales - which process tests from drive-in centres, hospitals, and care homes - has risen to more than 9,000 a day. Additionally Welsh residents can access home tests via the UK government site.

When Welsh Government issued details of their Test Trace Protect strategy BMA Wales issued the following statement. The chair of BMA Welsh Council Dr David Bailey, also commented on the BBC Radio Wales drive time show and listen to the interview here (2hr 9 mins in).

Northern Ireland

On 27 April, the Department of Health in Northern Ireland began an "enhanced contact tracing pilot", running on a five-day-a-week basis. From mid-May it was rolled out more widely to include all confirmed positive Covid-19 cases and operates seven days a week. The system is being carried out exclusively by telephone at the moment. The Public Health Agency talks to people with a positive test about their infection and ask them if there are people they have been close to who may be at risk of becoming ill (their contacts). They will phone their contacts and talk to them about their risk of infection. Everyone who has the infection and who is a close contact will have to self-isolate. People need to provide their phone number when they get a test. The Public Health Agency said staff are contacting all cases and contacts within 24 hours, with a team of five to seven tracers, depending on the number of positive results it receives daily.

Antibody testing programme rollout for NHS staff and patients

NHSE/I has written to all health systems advising them to commence antibody testing as soon as their laboratory capacity permits. The antibody testing programme will provide information on the prevalence of COVID-19 in different regions of the country and help better understand how the disease spreads.

Each NHS region is coordinating its own arrangements to roll out antibody testing. This requires a venous blood test and will be processed through NHS pathology networks. The test will progressively be offered to NHS staff who want it, including those working on NHS premises but not directly employed by the NHS, working for the NHS but not on NHS premises, and those in primary, community and mental healthcare including community pharmacists. The likely staff groups to test first are in acute trusts in which prevalence has been highest.

NHSE/I has now confirmed that the antibody test will be available for practices to use from today as practices deem appropriate to help manage their patients. The NHS lab result will be available to the practice in the normal way and it is their responsibility to inform the patient of the result and that a positive test does not indicate immunity to COVID-19. Where there is not a specific clinical indication for the test it may be offered to patients having their blood taken for other reasons if they wish to know whether they have been infected with COVID-19. However, there is no obligation for practices to do this.

NHS Employers risk assessment guidance for BAME and other staff

NHS Employers has now published guidance on risk assessment for NHS organisations on how to enhance their existing risk assessments particularly for at risk and vulnerable groups within their workforce due to COVID-19. This includes staff returning to work for the NHS, and existing team members who are potentially more at risk due to their race and ethnicity, age, weight, underlying health conditions, disability, or pregnancy. NHS Employers have advised that employers take an inclusive approach and have described that the guidance is applicable, with appropriate local adaptations, in all healthcare settings. The guidance includes further resources to provide advice on supporting health and wellbeing, mitigating strategies and risk assessment discussions.

Guidance has also been produced by the Health and Safety Executive (HSE) that is intended to help organisations identify who is at risk of harm. It includes templates and examples that organisations can adopt, along with specific guidance. This guidance emphasises the legal obligation of employers to do a workplace assessment.

TheBMA has been lobbying government to take urgent steps to address the need to protect Black, Asian and minority ethnic (BAME) communities from COVID-19,. The BMA had previously written to Sir Simon Stevens on the need for more practical advice, to practices, on risk assessment. Also read the BMA guidance on risk assessments.

This follows on from the publication of FOM Risk Reduction Framework for NHS staff at risk of COVID-19 that is now included in the further reference section of the NHS Employers guidance.

Protection of the public’s health and the most vulnerable must be an ‘absolute priority’ as lockdown eases

Responding to the announcement that the Government in England will move forward with the next stage of easing the lockdown, BMA council chair Dr Chaand Nagpaul said “the protection of the public’s health must be the absolute priority in easing lockdown with a health-driven strategy that does not result in the spread of infection or risk a spike in cases...given what we now know about who is the most susceptible to Covid-19, it is crucial that this strategy adequately protects the most vulnerable and at-risk in society and that the public adheres to the new social distancing measure”. He also commented that “the new test and trace system is central to the easing of lockdown and as such, the Government must ensure that it has the capacity to meet demand. Additionally, local authorities and PHE units, many of whom are already overwhelmed, must have the resources and ability to respond to Covid-19 outbreaks at a local level in an agile and effective way”.

PPE Portal

Earlier this week the Government announced that GPs and small care homes can register on the PPE Portal, a new online portal for ordering emergency personal protective equipment (PPE) from a central inventory, to supplement the wholesale supply route that already operates. The Department of Health and Social Care developed the portal in partnership with eBay UK, NHS Supply Chain, the Army, Clipper and Royal Mail.

Temporary residents and travelling patients

We have issued new guidance on the use of remote consultations by practices as a way of supporting other practices in tourist areas who would normally have to deal with temporary patients visiting area this summer. Patients are now much more likely to contact their own practice by phone or video rather than having to temporarily register with another practice. Read the guidance here

GP workforce data shows further fall in FTE GPs in England

The number of fully qualified full-time equivalent GPs dropped by 2.5% from March 2019 to March 2020, the latest official figures show. The report released by NHS Digital this week shows there were 27,985 FTE GPs on 31 March 2020 - 712 fewer than 31 March 2019. The total number of GPs also decreased by 0.6%. The number of FTE GP partners fell by 5.4% in the year, with the number of salaried GPs increasing by 4.5%.

Dr Krishna Kasaraneni, BMA GP committee executive team workforce lead, said: ’These figures continue to show a worrying decline in the number of full-time equivalent GPs and GP partners specifically over the last year. In recent months, general practice has rallied around in the face of the Covid-19 pandemic, working innovatively to continue providing care to patients, and proving the true value of holistic, person-centred care delivered within communities. In a post-Covid world it is imperative that this work is not forgotten and that this value is truly recognised, to ensure this foundation of the NHS is given the freedom and resources it needs to provide high quality care to patients.’ His comments were reported in Pulse and GP Online.

Appointments in General Practice in England

NHS Digital are now releasing data on a weekly basis showing weekly counts of appointments and the first report can be found here. It is broken down by appointment status, health care professional, mode and time between booking date and appointment date at national level and a weekly sum of the total scheduled duration of appointments (in minutes) at national level.

The data has a number of significant caveats, specifically that the information does not give a complete view of GP activity so should not be used to infer a view of workload. The data presented only contains information which was captured on the GP practice systems which limits the activity reported on and does not represent all work happening within a primary care setting or assess the complexity of activity. It should also be noted that the duration data presented in this data release is scheduled duration, which is the planned length of time an appointment should take not the actual length of time it does take. i.e. the scheduled duration could be 8 minutes for an appointment but it the actual duration may be 6 minutes. Or the scheduled duration could be 10 minutes but the actual duration is 12 minutes. This means that the data presented is not the actual amount of time practices spent on appointments but the amount of time practices planned to be spent on appointments. GPC England is meeting NHS Digital to discuss these significant flaws in recording. However practices should be aware that this information is being recorded and published and therefore should try to ensure that all patient contacts are appropriately recorded in clinical systems.

Principles of safe video consulting in general practice

NHSEI have published updated guidance on the principles of safe video consulting in general practice during COVID-19.

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 84% (the figures reported today). The DPN, which contains all relevant information on the extraction, is available here. NHSD has asked that all practices register their participation by 27 May before the first fortnightly extract takes place. A supplementary transparency notice aimed at patients has now been uploaded here which GPs can utilise should they wish.

General practice research

You may wish to see the QResearch News Update for Spring 2020. This covers a wide range of activities and research projects using data uploaded from GP practices.

GP and practice COVID-19 toolkit

A chance to press the reset button in general practice

COVID-19 has changed the way GPs work and presents an opportunity to pull general practice out of the administrative nightmare many struggled with before the crisis unfolded – read the article by Leicestershire GP Mayur Lakhani here and an article by East London GP Farzana Hussein here.

District valuer services

We met with NHSE/I last week for an update on the Premises Review, and to clarify expectations regarding engagement and consultation as more of the review workstreams get underway. NHSE/I advised that it has suspended physical inspections of Primary Care Premises by District Valuer Services (DVS) in light of COVID-19, and that valuations will now take place via desktop review. DVS will be in touch with instructing CCG or local NHS England teams to confirm arrangements on a case by case basis.

Supply of additional Direct Oral Anticoagulants (DOACs)

NHSE/I has published guidance on the supply of additional DOACs (direct oral anticoagulants) during COVID-19 to support patients currently prescribed warfarin being prescribed a DOAC instead, where this is clinically appropriate.

Other COVID 19 resources

LMC weekly update 29 May, 2020 - download as a PDF

COVID-19 and other media

Dr Andrew Buist, chair of the BMA’s Scottish GP Committee (SGPC) commented in the Daily Herald that it "will be up to us as a country to reflect" on how we provide social care to the elderly in future, as he said the Covid crisis has shone a light on the "difficult situation" faced by care homes.

In an interview with BBC Radio Merseyside, Dr Rob Barnett, deputy chair of the BMA North West regional council, highlighted the mental health impact of Covid-19 on NHS staff. Calling for better support to protect the mental health of the workforce both during and after the pandemic, he said: “You can understand how people feel, they are carrying quite enormous burden on them and actually there's no easy way of offloading” Listen to the interview in full here from 2 hours and 5 minutes.

Dr George Rae, chair of the North East regional council spoke to BBC Radio Tees to discuss the Covid-19 death rate in the region. Dr Rae said the pandemic had ‘shone a light’ on areas like the north-east of England and certain other areas where socio-economic problems were causing health problems.

“We need to be sure that this epidemic is can be controlled and therefore that is the testing the tracing the isolating and we really need to be having the local public health expertise here being used here being used to plan and implement this for the future.” Listen to the interview in full here from 2 hours 11 minutes.

Northern Ireland GPC chair, Dr Alan Stout, was interviewed on yesterday’s BBC Radio Ulster’s Talk Back programme on the latest waiting list statistics.

See this week’s GP bulletin here

GPC England meeting update

GPC England held its first ever virtual meeting yesterday. The meeting began with heartfelt tributes to the many GPs and other healthcare workers who have lost their lives during the COVID-19 crisis.

There was a detailed discussion regarding the many issues which have arisen and been addressed by GPCE over the last few months during the COVID-19 crisis. We also considered our strategy for the next stages of the pandemic, and in particular what changes made during the last few months should be retained, what should be stopped, and what elements could be brought back when capacity and the new environment we will be working in the for the foreseeable future allows.

We considered other important matters, including agreeing to establish a gender diversity champion for GPC England. The establishment of that role was one of the recommendations of the GPC Gender Task and Finish Group, which I established to make recommendations to improve the gender balance of the committee. The GPC England gender diversity champion will work in collaboration with their counterparts on the nation GPCs to promote and champion the central importance of gender equality, diversity and inclusion issues to the committee and its work. They would also have an important ambassadorial role in promoting good practice in those areas to LMCs. Committee members also raised the importance of extending this role to focus on wider diversity and inclusivity issues.

The committee also spent time debating a paper regarding how GP practices can develop, and can be helped to develop, environmentally responsible policies. That work aligns with a wider BMA workstream in line with 2019 ARM policy to campaign and cooperate to deliver carbon neutrality by 2030. It is vital that GPCE, and general practice more widely, continues to lead in this important area.

Primary Care Network Contract DES 2020/21 (England)

Over the last three months, and following the Special LMC Conference, GPC England has been raising issues relating to the PCN DES with NHSE/I, particularly in the light of the COVID-19 pandemic and as many practices are in the process of making decisions about whether to sign up. NHSE/I has responded in a letter outlining gratitude to the many thousands of GPs and practice staff who have worked tirelessly to transform their services in response to the pandemic and noting that the DES was modified to provide greater support to practices working together in their areas. They will continue to keep the DES under close review in response to the pandemic and they believe PCNs have enormous potential to support the sustainability and resilience of general practice, and to improve delivery of care to patients.

Importantly it confirms the DES is clear that contract management will be supportive and collaborative and, in the rare circumstances that remedial actions are needed, NHSE/I expects CCGs to focus on the DES itself rather than other elements of the practice’s core contract. However they also made clear that should a practice opt out of the DES they will lose their Network Participation Payment of £1.76 per patient from their core practice contract, as well as their entitlements to funding and the workforce employed through the DES. CCGs will not be permitted to offer the service to those practices – or their associated Federation – on better terms through a local scheme as they will be expected to commission an alternative provider.

Their latest figures suggest 96% of practices have either signed up to the DES or expressed their intention to do so, with 74 practices (1%) having informed their CCG that they have decided not to participate.

BMA survey of the profession

The BMA has now published the results of the latest, and fourth, tracker survey, which show that the majority of doctors have no confidence in being able to manage patient demand in the coming weeks and that caring for those with COVID-19 has severely impacted the treatment and care available for other patients.

Last month the Government insisted that before lockdown was eased, the NHS must be able to cope. These results clearly show that doctors on the frontline feel this is not the case.

The lowest level of confidence is for managing demand in the community, in particular for care homes, with 69% saying they are not very or not at all confident of being able to do this. In terms of patients being able to have tests, scans and other diagnostic type treatment, around 60% of doctors said they had little or no confidence that demand could be properly managed.

This was reported by FT (log in required) and the Independent

Immigration health surcharge for overseas healthcare workers

The BMA has welcomed the announcement that the Government is going to scrap the immigration health surcharge for overseas healthcare workers. Chaand Nagpaul, BMA council chair, said: “This announcement is long overdue but is testament to the BMA’s persistent lobbying for this surcharge, unfair to so many NHS workers from overseas, to be abolished. This is without a doubt a moral victory and brings huge relief to those facing bills of up to thousands of pounds – as well as the insult of having to pay for the very services they are working so hard to provide.” Read the statement here

Care homes

As we reported last week, following our lobbying of government, care homes are now being supported to do virtual consultations. Practices should continue provide proactive support for care home residents with suspected or confirmed COVID-19 through remote monitoring, or face-to-face assessment where clinically appropriate.

The Government have published an updated COVID-19: care home support package, as well as a new operational model to help pharmacy and medicines teams implement the NHSEI guidance Primary Care and Community Health Support for Care Homes.

Remote consultations for learning disability health checks

Providing support to people with learning disabilities is an important part of general practice activity, which includes offering the opportunity for an annual health check. NHSEI have confirmed that, with regards to health checks for people with a learning disability, where this cannot be delivered safely face to face or where the patient has other medical conditions which require them to shield or socially isolate, the review could be conducted remotely. Decisions about the best way to conduct a health check should be made on an individual basis, taking in to account the challenges some patients might have with this. Our toolkit for practices now also includes an FAQ for locum doctors working remotely.

Home working and distribution of high-risk work

Many practices now have some access to remote working and it is appropriate for clinical staff to make use of this where possible to reduce risk to staff and patients. For those situations where a face to face appointment is required then this should be arranged equitably between all clinical staff and based upon risk assessment where indicated. Read more in the our toolkit

BMA Risk assessment guidance

The BMA has been lobbying government to take urgent steps to address the need to protect Black, Asian and minority ethnic (BAME) communities from COVID-19, as was highlighted in the ONS data published last week, which showed that those with BAME background are more likely to die from the virus. The BMA has written to Sir Simon Stevens this week to address these concerns and the need for more practical advice, to practices, on risk assessment. The letter also highlights that the great local variation in the use of and approach to risk assessments, and that occupational health services are not available to most staff in primary care. Read the BMA guidance on risk assessments. This follows on from the publication of FOM Risk Reduction Framework for NHS staff at risk of COVID-19 and NHS Employers guidance on risk assessment for staff

New coronavirus life assurance scheme

On 27 April a new life assurance scheme was introduced covering health and social care workers during the COVID-19 pandemic. Details of the scheme have now been published by NHS Business Service Authority - scheme rules including guidance for claimants and employers can be found here. This payment is in addition to Death in Service (DiS) benefits linked to the pension schemes. We are aware of outstanding issues around DiS benefits, particularly for locum GPs, and continue to lobby on those.

Testing (UK)

Anyone over 5 who has symptoms of COVID-19 (a high temperature, a new, continuous cough, or a loss or change to their sense of smell or taste) can now access antigen testing.Practices in England, Scotland and Northern Ireland should direct symptomatic patients to the NHS website, for further information on how to access the test online. People in Wales can ask for a home test kit here.

If there are any questions about a test that has been booked, you can call the customer contact centre from 7am to 11pm. In England and Wales – call 119 free, and in Scotland and Northern Ireland call 0300 303 2714. Read more here

I commented on testing in The Guardian, highlighting the problem of false negative tests.

GP and practice COVID-19 toolkit

We continue to 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 for locum doctors working remotely, and also flagged the section on reducing COVID-19 transmission, in relation to social distancing within GP practices. The guidance also suggests clarity must be given to healthcare workers about the future contractual position and plans to restore training and career development. Read more here

Bank holiday Monday 25 May (England)

NHSE/I have confirmed that GP practices in England are not expected to open outside the normal bank holiday cover arrangements for the upcoming Whitsun Bank Holiday, 25 May. Pharmacies are also not expected to open, as they did at Easter and on 8 May 2020.

Temporary residents and travelling patients (England)

GPC England has issued new guidance on the use of remote consultations as a way for practices across the country to support colleagues working in practices in tourist areas who may face a large increase in visitors this summer. Patients are now much more likely to contact their own practice by phone or video rather than having to temporarily register with another practice. Read the guidance here

Domestic abuse during COVID-19: advice for NHS staff (England)

There has been a concerning increase in domestic abuse cases during the pandemic, and the Home Office have launched a national campaign to raise awareness of the support available. NHSEI has sent a letter with advice for NHS staff on dealing with domestic abuse during pandemic, which lists a number of resources that may be useful for NHS staff in signposting to specific support teams.

The DHSC has also launched a resource that looks at how health professionals can support patients who are experiencing domestic abuse. The document helps health staff to identify potential victims, initiate sensitive routine enquiry, respond effectively to disclosures of abuse.

BMA paper on principles for restarting non-COVID care

The BMA has published a paper on the Ten principles for how the NHS should approach restarting ‘non-Covid care’. The paper warns that healthcare leaders should be ‘realistic and cautious’ about restarting shelved, non-treatment NHS work and re-balancing COVID-19 and non-COVID-19 capacity. The principles suggest that managers should take a realistic and cautious approach, that there must be adequate PPE for HCWs, and that decisions about staffing levels and redeployment must be safe and measures must be taken to safeguard staff wellbeing.

Welsh Government’s lockdown exit plan (Wales)

The Welsh Government has published Unlocking our society and economy – continuing the conversation’, which sets out a traffic light system for lifting lockdown in Wales, with phased reductions in the lockdown across different parts of daily life. Most areas are now in ‘Red’ with others still in lockdown. This includes a series of ‘circuit breakers’ that will trigger the re-imposition of measures if the growth of COVID-19 becomes unacceptable and could not be controlled by ‘test, trace and protect’. Read the BMA statement by David Bailey, Chair of BMA Wales Council, here

Scottish route map to easing lockdown (Scotland)

The Scottish Government published the Scottish ‘Route map’ to easing lockdown yesterday, in which a “careful relaxation” of lockdown measures will begin on May 28. More outdoor activity will be allowed, letting people sit in parks with people from one other household while observing social distancing. Non-contact outdoor activities will resume, along with allowing people to travel a short distance to take part in recreation, and schools will reopen from 11 August. BMA Scotland welcomes the cautious approach to restarting NHS services in Scotland – read the statement here

COVID-19 media

NIGPC chair Alan Stout was interviewed on the BBC Radio 5 Nolan Show discussing care home COVID infection and death rates for the Belfast Trust. The interview is at the 03:30 part of the recording.

Dr Phil White, GPC Wales Chair, was appeared on BBC Radio Wales’ Jason Mohammad COVID phone in (listen from 8mins).

Referrals (England)

GP online reported that GP practices are under increasing pressure, with patient demand rising, while some hospitals continue to refuse referrals, despite being told to begin restoring non-COVID-19 services, including routine procedures, as part of the second-phase response to the pandemic. In response to this I said that blocked referrals 'continues to be a concern' for GPs and that some areas could only make urgent referrals, as I called for trusts to create a safe referral system to reduce patient anxiety and ease workload for GPs.

Restoration of cervical smear services

NHSE/I and Public Health England have published guidance on the restoration of cervical smear services, following the advice to step up urgent services which includes screening. The document provides guidance to NHSEI regional public health commissioning teams to support conversations with providers of NHS Cervical Screening Programme services to ensure that they are restored in a consistent, safe way. Read the guidance here

Premises update – NHSPS and NHSE/I engagement (England)

Last week, GPC premises policy lead, Gaurav Gupta, and deputy, Ian Hume, met for the first time with the recently appointed CEO and COO of NHS Property Services (NHSPS). Initial dialogue was constructive, and the group have resolved to meet regularly to escalate and troubleshoot operational concerns relating to COVID-19, as well as ongoing issues raised by members. The leads also met with NSHE/I for an update on the Premises Review, and to set expectations regarding engagement and consultation as more of the review workstreams get underway.

Serious shortage protocol for Fluoxetine 40mg capsules

The DHSC have issued a Serious Shortage Protocol (SSP) for fluoxetine 40mg capsules, which came into effect on 20 May, and will expire on 20 July 2020. The SSP will enable community pharmacists in England, Wales and Northern Ireland to supply patients with 2 x fluoxetine 20mg capsules.

NHS Confederation webinar (England)

NHS Confederation will be holding a webinar ‘The PCN DES: a discussion for the undecided’ on Wednesday 27th May 12.30-1.30pm. This will focus on issues relating to the DES and offer an opportunity for questions to be raised. They have also published a briefing regarding the PCN DES. Register for the webinar here

NHS Digital national GP data extraction to support COVID-19 planning and research

The DPN for the GPES Data extraction for pandemic planning and research (COVID-19) was uploaded last week, which will allow data to be collected using GPES to be made available for approved uses through NHS Digital’s Data Access Request Service in accordance with robust information governance standards and consultation with the BMA and RCGP.

As of 19 May, 54% of practices have participated in the extract, which represents 3815 practices (from a total of 7013). If you haven’t already registered, the DPN can be found here. NHSD have asked all practices to try to register by 27 May with extractions taking place on a fortnightly basis.

An opportunity to join a virtual ‘Doctors' Mess’

Former GPC member and London GP, Dr Rebecca Viney, has developed a twice-weekly confidential meeting place to talk, share, offload and give space to plan and prioritise in small virtual break out rooms. It began in April 2020 and now meets every Tuesday at 15.30-16.30 and Thursday 18:30 – 19:30. See more information in the attached flyer – or email direct to contactdoctorsmess@gmail.com

BMA COVID-19 webpage and guidance

The BMA COVID-19 webpage is updated regularly with guidance and links to official information:

· General practice toolkit

· Model terms of engagement for a GP providing temporary COVID-19 services

· Terms and conditions for sessional GPs

· BMA’s COVID-19 ethical guidance

If BMA members have any specific concerns or issues related to COVID-19 please contact the BMA’s advisers on 0300 123 1233 and support@bma.org.uk.

Wellbeing

As part of Mental Health Awareness Week this week, the BMA has published a report on the mental health and wellbeing of the medical workforce - now and beyond COVID-19, which sets out ten recommendations to be addressed to protect staff now and in the future. Read more here

The BMA continue to offer wellbeing services and confidential 24/7 counselling and peer support for all doctors and medical students, regardless of BMA membership, as well as their partners and dependents, on 0330 123 1245.

If practices or LMCs would like hard copies of our Wellbeing poster, with tips for doctors supporting each other during the crisis, please email wellbeingsupport@bma.org.uk.

Other COVID 19 resources

· Model terms of engagement for a GP providing temporary COVID-19 services

Diploma of Legal Medicine

The Faculty of Forensic & Legal Medicine of the Royal College of Physicians offer a Diploma of Legal Medicine (DLM), which would be appropriate for LMC secretaries and officials as well as Practice Managers and Medical Advisers, interested in medicolegal issue. For more information, please see the attached letter and flyer, which can be distributed as you wish.

See this week’s GP bulletin here

Roadmap out of lockdown (England)

In response to the Government’s announcement to ease some lockdown measures in England from this week, the BMA has said that the plan is too fast, too confusing and too risky. Since then further guidance has been released and we will continue to scrutinise this carefully and challenge government when necessary. Read the Government’s recovery strategy here. Read the full BMA statement here

In light of this announcement, GP practices could be faced with new workload as many people will be anxious about returning to a workplace where adequate social distancing measures have not been put in place, leading to more requests for fit notes and letters to employers, with people who cannot work from home being urged to return to work. Patients making these requests should be directed to discuss this with their employers, and employers should be making reasonable adjustments and performing appropriate risk assessments for their staff, with occupational health support when necessary. In this situation a fit note should not be required.

If this phase is not managed extremely carefully there is a risk of the virus spreading and putting renewed strain on the NHS, including GP services. One of the Westminster Government’s key tests for easing lockdown is ensuring the NHS can cope – and this of course must include general practice.

I was quoted in Pulse, and the BMA response was reported by BBC breakfast (from 01:16:35), The Sun, BBC, Daily Mail and The Independent

As we move in to the next phase of responding to the COVID-19 pandemic, with the need to both deliver services to our patients whilst also continuing with the challenge of on-going viral circulation, we know that many areas are considering how this can be done safely. It’s also leading many to consider what has changed in the last couple of months that we want to retain and what the 'new normal' General Practice should look like. Wessex LMC has produced two discussion documents to help with this thinking and has agreed for them to be shared. A briefing document includes a summary, key recommendations and a conclusion and a full document provides links and examples and further explores the questions practices are facing currently.

GP and practice COVID-19 toolkit

Following the announcement about easing the lockdown in England, the Government has published guidance for employers to help getting more people back to work and operating safely. However, as this does not specifically include healthcare settings, we would advise practices to refer to our toolkit for GPs and practices, and in particular the section on reducing COVID-19 transmission, which refers to social distancing within GP practices.

The toolkit, which is updated regularly, should also help to answer many of the questions we have been getting on a large range of topics relating to COVID-19.

Care home arrangements

Following our lobbying of government on this issue, care homes are now being supported to rapidly upgrade their ability to do virtual consultations. These changes include the rollout of NHSmail to care homes and domiciliary care providers, supporting remote consultations, and reducing social isolation and loneliness for care home residentsby providing tablet devices capable of secure video calling, and increased access to up-to-date and accurate information for care professionals through the new Care workforce app. In addition CCG directors of nursing should now be assisting local authorities with training in infection prevention and control in care homes.

Practices and LMCs can use the NHSEI guidance on how practices can support care homes during the pandemic, working with others in their area to do what they can to support their local care homes at this critical time. Most areas now have arrangements in place.

The NHSEI primary care bulletin today (15 May) clarified that the clinical lead for the service is not also medically responsible and accountable for the care of individual care home residents. Medical responsibility and accountability for the care of individual care home residents remains with their registered GP – and there may be residents with different registered GPs within a care home. NHSEI does not expect residents to be re-registered.

NHSEI have stated that a reimbursement mechanism for general practice will be established to help practices meet the additional costs of COVID-19 related activity which cannot be met from existing practice resources. Reimbursement will be managed through clinical commissioning groups (CCGs), on the basis of national guidance.

Remote consultations

The way consultations are conducted in general practice has been adapted to cope with COVID-19 and has forced GPs to revolutionise how they work in just a few short weeks. Practices have rapidly moved both to protect patients and staff, and support social distancing, by introducing total triage arrangements with the vast majority of consultations now taking place by telephone or video, with face-to-face consultations either in the practice or at home only taking place when clinically necessary. Read more in our feature wholesale transformation of general practice

The level of change in general practice is also evident from the figures reported in an NHSEI primary care bulletin this week, which show that video consultations are now available in 97% of practices. However, we still need to see faster rollout of the necessary IT upgrades tosupport this way of working in a sustainable and resilient way.

Our toolkit for practices has been updated to include a FAQ for locum doctors working remotely.

PPE

Concerns over lack of adequate and sufficient PPE remain, as shown by the results the BMA’s most recent, and third tracker survey. The BMA has called for ministers to take whatever action is necessary to scale up production in the UK, and further explore overseas suppliers. The results of the latest survey will be released over the weekend. Read more about the BMA’s campaigning for PPE here.

If you are in need of urgent advice about inadequate PPE in your place of work, you can call us 24/7 on the PPE hotline on 0300 123 1233 or use the webchat >

This was reported by the Mirror, where I commented: “The UK is now seven weeks into lockdown and it is unacceptable that we should still be worrying about availability of these essential items that protect both healthcare workers and patients. It’s vital that any changes to official guidance can be bolstered by government supplies and that PPE availability becomes an issue of the past, not one healthcare professionals across the country find themselves living with every day.”

CPR guidance for primary and community care

The Resuscitation Council, together with the Royal College of GPs, have published guidance for healthcare workers (HCWs) who are performing cardiopulmonary resuscitation (CPR) in primary and community care setting. The guidance clarifies that as CPR is an aerosol generating procedure (AGP) in the context of COVID-19, AGP PPE is the safest option for HCWs when undertaking chest compressions and other resuscitation procedures on patients with suspected or confirmed COVID.

However, it is recognised that this may not always be achievable in a primary or community care setting depending on the availability of PPE. In the absence of AGP PPE, non AGP PPE if available for clinical care, must be worn as a minimum for resuscitation events. Read the guidance here.

COVID-19 model salaried GP contract (Scotland)

GPC Scotland has agreed a model salaried GP contract with Scottish Government, for health boards to offer during the pandemic. This will see boards offer, and those taking up these contracts commit to, at least one shift per week in order for sessional GPs to secure these benefits. Where existing local arrangements fall short of the terms in this contract, they should look to adopt the terms in this model contract. The circular instructs boards, and includes a link to the wording of the model contract. Read more in this blog by Patricia Moultrie, deputy chair of SGPC.

Death in Service benefits (Scotland)

The Scottish Government has announced that full death-in-service benefits will be extended to all healthcare workers in Scotland, including those who have left the NHS pension scheme. Read the statement from BMA Scotland here and a BMA News feature here.

BMA threatens legal action over coroner’s direction on death verification (England)

The BMA has written to the Essex Chief Coroner asking them to withdraw incorrect guidance to local GPs around the verification of deaths in the region, ahead of possible legal action. This is following the Essex Chief Coroner wrote to local GPs at the end of April, instructing them that it was only acceptable for healthcare workers to verify expected deaths, and that this must take place in person.

The letter from the BMA outlines that this direction is contrary to English law, which states that any competent adult can verify a death, and that it is not supported by joint guidance from the BMA and the RCGP, as well as separate guidance from NHSE/I. The letter also makes it clear that demanding that healthcare workers attend deceased patients to verify deaths not only takes staff away from direct patient care unnecessarily at a time when they are most needed, but it also puts both staff and other people at risk by potentially exposing them to COVID-19.

The BMA is taking this action in support of Essex LMCs. Read the full press release here

This was reported by BMJ and Pulse

Risk assessment guidance

The Office of National Statistics published data on Covid-19 related deaths by ethnic group last week, which showed that those with Black, Asian and minority ethnic (BAME) background are more likely to die from the virus. The BMA is deeply worried and has been lobbying government to take urgent steps to address this as this data highlights the need to protect BAME communities from COVID-19 and that they are effectively risk assessed. Read the BMA statement here. Various national organisations have developed resources that are included below for your information.

The Faculty of Occupational Health Medicine: Risk Reduction Framework for NHS staff at risk of COVID-19
NHS Employers has published: guidance on risk assessment for staff
Public Health England is carrying out a review into factors impacting health outcomes from COVID-19

We have highlighted to NHSEI that primary care needs a nationally agreed tool for risk assessment that practices can use to take an appropriate and consistent approach in protecting staff.

Chaand Nagpaul, BMA chair of council, was interviewed by BJGP about BAME colleagues and their contribution to the NHS.

Preparing for flu immunisation 2020/21

NHSEI has published the annual flu letter for the 2020/21 programme. It is recognised that delivering the flu immunisation programme is likely to be more challenging this year because of the impact of COVID-19. NHSEI will publish further guidance nearer the planned start of the programme in September 2020, but in the meantime, practices should continue to plan for the programme as usual. The letter sets out which groups are eligible for flu vaccination (same as last year but different vaccinations for different groups) and how to prepare for this autumn’s vaccination campaign.

NHS Digital national GP data extraction to support COVID-19 planning and research (England)

NHS Digital has issued a DPN outlining a framework for a tactical GPES extraction for planning and research related to COVID-19. This extraction was requested by the BMA and RCGP as means of relieving the burden being placed on GPs at this time to provide data for research purposes. Under this interim arrangement, NHSD will become the data controller for a predetermined set of data extracted from GP records in England with all requests to practices redirected to them.

BMA and RCGP will have sight of the process for requesting this data and will regularly meet with NHSD to review applicants who wish to use it. The DPN contains all relevant information on the extraction and in this NHS Digital circular. NHSD have asked that all practices register by 27 May.

NHS 111 referring into general practice and COVID-19 tests (England)

In a recent NHSEI primary care bulletin,practices are reminded that if theyreceive a referral from NHS 111, whether from the national CCAS (COVID-19 Clinical Assessment Service) or from a local service, then the practice should assume clinical responsibility for the patient. It is up to the local practice to decide on the best course of action for their patients, including the option to re-triage. However, the patient should not be re-directed back to NHS 111 as this could result in delay of urgent clinical care, nor should they be directed to NHS 111 to co-ordinate testing for COVID-19.

Misuse of COPI regulations for GP data requests (England)

Following our letter to NHSX asking for assurances on the misuse of COPI regulations to request GP data, we have now received the attached response. NHSX, NHS Digital and Public Health England have, in response to our concerns, established a single front door to triage requests for data, including research, for COVID-19 purposes. Practice can now to direct any requests they receive for data to the single front door via covid-19datasharing@nhsx.nhs.uk

Letter to the Local Government Association (England)

I wrote to Mark Lloyd, Chief Executive of the LGA, to ask him to confirm local authorities will continue to pay for enhanced services they commission from local practices. We have received examples where local authorities have advised they will not be paying for services commissioned by the local authority (eg NHS health checks) and were asking practices to complete a form to claim supplier relief from the council. To claim this relief they would be required to proactively apply and justify their claim by way of management costs etc. they have incurred while services have not been delivered due to the current pandemic. Only after this would their claim be considered. The Local Government Association has replied saying they do not believe such requests are widespread and have asked us to share examples. They continue to encourage a collaborative approach between local authorities, councils and the health sector. If LMCs have any examples, please email glewis@bma.org.uk

BMA COVID-19 webpage and guidance

The BMA COVID-19 webpage is updated regularly with guidance and links to official information:

· General practice toolkit

· Terms and conditions for sessional GPs

· BMA’s COVID-19 ethical guidance

If BMA members have any specific concerns or issues related to COVID-19 please contact the BMA’s advisers on 0300 123 1233 and support@bma.org.uk.

Wellbeing

The BMA continue to offer wellbeing services for your emotional health during the crisis. Confidential 24/7 counselling and peer support for are open to all doctors and medical students, regardless of BMA membership, as well as their partners and dependents, on 0330 123 1245.

If practices or LMCs would like hard copies of our Wellbeing poster, with tips for doctors supporting each other during the crisis, please email wellbeingsupport@bma.org.uk.

Other COVID 19 resources

LMC weekly update 15 May, 2020 - download as a PDF

COVID-19 media

Phil White, Chair GPC Wales, answered listener questions on BBC Radio Wales (listen from 09:10)

See this week’s GP bulletin here

Care homes arrangements (England)
In their Primary Care Bulletin 1 May, NHSEI advised CCGs to work with primary care and community providers to ensure timely access to clinical advice for care home staff and residents, proactive support for people living in care homes, and that care home residents with suspected or confirmed COVID-19 are supported through primarily remote monitoring, or face to face assessment where clinically appropriate and necessary. This is therefore not just about the role that practices can fulfil, but should be delivered by a multidisciplinary team working together.

CCGs should be working with LMCs, practices, community care teams, specialist services, local pharmacies, local authorities and others, using this guidance, to do what they can to support their local care homes at this critical time.

Identifying high risk patients and shielding (England)

NHSEI has provided an update in their primary care bulletin on shielded patients this week, and as stated previously a small number of patients have been identified who will be advised to shield via a centrally generated letter and text message. The addition of flags on GP records and distribution of central letters is expected to have been completed by 7 May. Any patients that practices have identified as clinically extremely vulnerable prior to 28 April should now be recognised by the Government support website.

If they have not already done so, practices should contact these patients as soon as possible, using the updated version of the template letter. This contains the same information as in previous versions but confirms that the Government is currently advising people who are clinically extremely vulnerable to shield until 30 June, subject to ongoing review. A link to this has also been added to our guidance for practices about steps to take about the list of shielded patients.

In an interview on the main BBC News bulletins on Sunday I described the challenges practices have had dealing with shielding lists and discussing this with patients involved. I also spoke to Talk Radio yesterday morning about the risks of moving out of the current lockdown.

PPE

The BMA continues to put pressure on Government to provide adequate and sufficient PPE for all healthcare workers, as was yet again evident by the results of our third tracker survey published a few days ago which showed that overall, nearly half the doctors say they have sourced their own PPE for personal or departmental use, or they have relied upon donations.

The BMA 24/7 emergency support helpline is available for doctors who find their PPE is inadequate and need urgent advice. Call the PPE hotline on 0300 123 1233 or use the webchat >

We continue to work hard to ensure that practices get the necessary PPE that they need to work safely. Read our latest FAQs: Refusing to treat where PPE is inadequate >

PPE media

The BMA survey results were covered by The Telegraph, which suggested that the figures call into question how the Government could be "anywhere near" meeting two of five tests that the Prime Minister said would have to be met before any easing of the lockdown measures. It was also covered by The Guardian and the BBC. Chair of BMA NI, Tom Black was interviewed on BBC Radio Ulster (1:39:25), and on the Radio Foyle Breakfast Show (01:18:33). David Bailey, Chair of BMA Wales, was quoted by ITV. Ben Molyneux, Chair of Sessional GPs Committee, was quoted in Pulse saying that PPE supply remains 'a postcode lottery'.

GP and practice COVID-19 toolkit

Our toolkit for GPs and practices has been updated to include a section on minimising risk of transmission in general practice. The toolkit helps to answer many of the questions we have been getting on a large range of topics relating to COVID-19. Any updated guidance or FAQs from us will be added to this toolkit so please check it regularly for any new additions.

Testing of healthcare workers

Testing of COVID-19 for primary care staff and household members as well as for all asymptomatic NHS and social care staff and care home residents is now available in testing sites across the country.

Staff isolating who need a home test kit should use the Employee (Self-Referral) portal. For further information see this guidance about staff accessing tests. For technical issues related to booking tests and results enquiries contact the Coronavirus Testing Helpdesk - 0300 303 2713

Testing in the media

BMA Chair of Council, Chaand Nagpaul, was quoted in The Financial Times saying that successful contact tracing would require “far greater capacity” and that “It is vital that levels continue to be ramped up to allow for widespread community testing and contact tracing. This will require far greater capacity than 100,000 tests daily if we are to be able to properly identify, contain and prevent spread of the virus”.

GP speciality training

Following discussions between the BMA, RCGP, GCE, HEE and devolved nations education leads, it has been agreed that a remote CSA assessment will be available for GP trainees who were due to CCT in August. GP trainees will therefore be able to CCT and gain their full MRCGP this summer, despite the COVID-19 situation. For more information on how CCT will work, please see the recently issued joint letter and the full statement by the co-chairs of the GP trainees committee.

Read more about how to achieve CCT amid COVID-19, in this blog by Sandesh Gulhane, co-chair of the GP trainees committee.

Bank Holiday arrangements (England)

NHSEI’s arrangements for opening on bank holiday, Friday 8 May, mean that CCGs have flexibility to plan the most suitable arrangements for their local area and it is for CCGs working with LMCs and practices to determine what the most suitable bank holiday cover should be. NHSEI have also stated that unless the situation changes significantly it will not be necessary for practices to open on the next bank holiday at the end of May.

We have produced a template that practices in England to claim for the expense of opening as normal on Bank Holidays. This includes staff expenses, salaried GPs, locum (up to maximum rate), partners, and an amount to cover daily non-staff expenses.

Improving vaccine uptake

The JCVI recently published a statement on the importance of maintaining immunisation services to reduce the risk of vaccine-preventable disease during the COVID-19 outbreak. Following this, NHSEI has advised that it may be necessary for CCGs and PCNs to facilitate the transfer of locally held vaccine stock from one provider to another to ensure the continued delivery of immunisation programmes. In addition, MHRA has confirmed that it will not prevent the transfer of locally held vaccine stock from the NHS routine immunisation services during the pandemic.

We support the NHSEI campaign to encourage uptake of immunisations that was launched last weekend. Practices should do what they can to encourage all those eligible for vaccinations, particularly children and vulnerable adults, to get protected as no one wants an outbreak of another infection against which we have effective vaccinations.

Death verification and certification

The DHSC have now published guidance on verification of death which aims to clarify existing practice for the verification of death outside of hospitals and to provide a framework for safe verification of death in this coronavirus (COVID-19) emergency period. The guidance is linked on our website and sits alongside our own guidance on this.

The CQC has published a joint statement with the General Medical Council and Healthcare Improvement Scotland about death certification during the COVID-19 pandemic. The statement is a reminder that prompt and accurate death certification is crucial, particularly during this emergency period. Ait also emphasises that all doctors must complete a medical certificate care of death (MCCD) as accurately as possible, citing what they believe to be the most likely cause of death.

NHSPS services charge dispute update (England)

The BMA is supporting 5 test claimant GP practices who have received demands from NHS Property Services (NHSPS) to pay inflated service charges based on their Consolidated Charging Policy. The case is ongoing and on 4 May we learned that due to COVID-19 NHSPS have sought an extension until 21 May to file defences and counterclaims.

In the meantime, we have been informed that some practices have continued to receive demands from NHSPS for the payment of disputed service charges. These demands are highly inappropriate, not only because these charges are the focus of the ongoing legal case, but because they serve to unnecessarily exacerbate the already immense pressure on practices as they work to combat COVID-19. Last week, Gaurav Gupta, Premises and Practice Finance Policy Lead, wrote to Martin Steele, the new CEO of NHSPS, to express these concerns and asking NHSPS to desist from sending practices further demands for disputed service charges until legal proceedings have been concluded and the current health crisis has abated. They have now agreed to restart regular engagement to address various issues faced by practices.

If your practice has experienced any issues regarding NHSPS, please raise this at the earliest opportunity with your LMC.

Community Health Partnerships (England)

Dr Gaurav Gupta, chair of the Premises and Practice Finance policy group, together with deputy chair Dr Ian Hume, met with the CEO and COO of CHP in March to discuss recurring issues raised by members. CHP committed to work with GPC in resolving these problems faced by their GP tenants. If your practice has experienced any issues regarding CHP, please raise this at the earliest opportunity with your LMC.

PCSE provision of Performers List data to LMCs (England)

Following years of lobbying, PCSE has confirmed that LMCs will once again be provided with lists of registered GPs for their area. This had stopped when NHSE reorganised primary care support services and we are pleased that at long last this action has finally been taken. We are still working on the implementation timeline and will keep LMCs up to date when we know more.

GPC UK Gender Task and Finish Group

The Gender Task and Finish Group implementation plan is attached. It outlines GPC’s progress on implementing both the Gender Task and Finish Group’s original set of recommendations designed to improve the gender balance of GPC, as well as the committee specific recommendations of the Daphne Romney QC report, all of which have been brought within the Task and Finish Group’s workplan. Many of the recommendations of the Romney report were already actions in the plan, such as the development of plans for multi-member constituencies, and the group were happy to bring those other recommendations into the implementation plan to action.

This is a living document, with many actions completed and others underway. It is the intention of the group to regularly share the plan with LMCs as and when it is updated. The COVID-19 crisis has unfortunately but inevitably meant that some of these actions have been delayed.

I would like to thank Dr Rachel Ali, chair of the group, all the other members of the Task and Finish Group and members of the GPC secretariat for their hard work in taking these actions forward. The group are happy to take receive any comments and suggestions via the GPC secretariat at lmclaren@bma.org.uk

NHS pension scheme death in service guidance

Dr Krishan Aggarwal, BMA pensions committee deputy chair, has written a blog to provide guidance about the NHS pension scheme death in service arrangements and can be found here.

Guidance on support strategy and easing lockdown in Scotland

The Scottish Government has published Coronavirus (COVID-19): test, trace, isolate, support strategy, which sets out their plans to help disrupt community transmission of the virus. They have also published a further document to progress the discussion with the public on the decision making framework for easing lockdown, and re-starting NHS services – read the document here

BMA COVID-19 webpage and guidance

The BMA COVID-19 webpage is updated regularly with guidance and links to official information:

Guidance for GP practices
General practice toolkit
Model terms of engagement for a GP providing temporary COVID-19 services
Terms and conditions for sessional GPs
BMA’s COVID-19 ethical guidance

If BMA members have any specific concerns or issues related to COVID-19 please contact the BMA’s advisers on 0300 123 1233 and support@bma.org.uk.

Wellbeing

The BMA continue to offer wellbeing services for your emotional health during the crisis. Confidential 24/7 counselling and peer support for are open to all doctors and medical students, regardless of BMA membership, as well as their partners and dependents, on 0330 123 1245.

If practices or LMCs would like hard copies of our Wellbeing poster, with tips for doctors supporting each other during the crisis, please email wellbeingsupport@bma.org.uk.

Other COVID 19 resources

BMJ – news and resources

RCGP COVID-19 information

NHSE/I daily primary care bulletins on COVID-19

NHSE/I COVID-19 webinars

COVID-19 Google Drive resource

Primary Care Pathways COVID-19 resource centre

NICE resources on COVID-19

See this week’s GP bulletin here

LMC update May 8, 2020 - download as a PDF

NHSEI letter to the profession on second phase of NHS response to COVID-19

NHSEI has sent a letter to NHS organisations setting out the second phase of NHS response to COVID-19. The letter outlined what practices have already been doing in proactively contacting their high-risk patients with ongoing care needs, including those in the ‘shielding’ cohort, to ensure they are accessing needed care and are receiving their medications. It highlighted that practices should continue to triage all patients, complete work on implementing digital and video consultations, and deliver as much routine and preventative work as can be provided safely including vaccinations immunisations, and screening.

With the nationally recognised increase in the number of deaths of patients in care homes there is now a greater and long over due focus on the need to provide greater support for care homes. The letter suggested that one part of this response would be to bring forward key components of the Enhanced Care in Care Homes service, planned to begin in October. It was disappointing to see this expressed intention and we were clear with government ministers and NHSEI that this approach was unacceptable. As a result, and following discussion with NHSEI and government, changes have been made which now stress the importance of supporting practices and other community providers to do what most are already doing, working hard to care for their patients in care homes. This new guidance can be found here. It is now important that practices use this guidance, working with others in their area, including LMCs, to do what they can to support their local care homes at this critical time. Read our initial statement here

With regards to referrals to secondary care, NHS local systems and organisations are advised to step up non-COVID 19 urgent services as soon as possible over the next six weeks. Urgent action should be taken by hospitals to receive new two-week wait referrals and provide urgent outpatient and diagnostic appointments (including direct access diagnostics available to GPs) at pre-COVID 19 levels. We have been raising concerns about the variation in approaches being taken on this across the country and so NHS Digital has now produced guidance that details the various features of the NHS e-referral service that can help referrals to be managed safely, triaged and processed according to clinical priority.

The letter also responds to the serious concerns raised by the BMA in a letter sent to Sir Simon Stevens this week about the need to take action in response to the emerging UK and international data suggest that people from Black, Asian and Minority Ethnic (BAME) backgrounds are also being disproportionately affected by Covid19. Public Health England have been asked by DHSC to investigate this. In advance of their report and guidance, on a precautionary basis they recommend employers should risk-assess staff at potentially greater risk and make appropriate arrangements accordingly. Practices should consider how they can do this and take action to protect members of their team.

It should also be noted that potential new treatments for COVID-19 are being researched and many practices are being approached to take part in this. The letter was also referred to in the NHSEI primary care bulletin (29 April).

Contractual responsibilities of providing care during COVID-19 pandemic

We have received several queries and concerns in the last few days from LMCs and others about the contractual responsibilities of providing care for patients with COVID-19. We have as a result taken legal advice on this.

It is clear that the care of patients within the community with, or suspected of having, COVID-19 is part of the provision of essential primary medical services and a requirement of the GMS contract. Practices not doing this, or if they have inadvertently taken steps whereby they have stopped providing care for these patients, including not seeing patients face to face in their practice (or another premises such as a hub if they have a contractual arrangement for this) or at home when it is clinically necessary to do so, would be breaching their contract.

In addition, it would also be very damaging for the profession as a whole at a time when the public is applauding the work done by general practice and others in the NHS and care services, if reports emerge of practices failing to provide necessary care to patients with COVID-19. This is particularly the case when we are highlighting to government ministers and others the good work practices across the country are doing to support their vulnerable care home patients. We are sure LMCs will provide the necessary advice to practices should that be required.

Guidance on this matter is provided in the attached document, and we have updated our GP and practice toolkit.

GP and practice toolkit

Updates to the toolkit this week include a new section on I&R and IGPR scheme doctors returning to work and contractual responsibilities of providing care during COVID-19 pandemic (in the service provision section) as mentioned above.

PPE

The BMA continues to put pressure on Government to provide adequate and sufficient PPE for all healthcare workers, as was evident by the results of our latest snapshot survey which showed that basic PPE continue to fail to reach frontline doctors. The results of our tracker survey completed this week will be released over the next few days.

The BMA has launched a 24/7 emergency support helpline for doctors who find their PPE is inadequate and need urgent advice. Call the PPE hotline on 0300 123 1233 or use the webchat >

We will continue to work hard to ensure that practices get the necessary PPE that they need to work safely. Read our latest FAQs: Refusing to treat where PPE is inadequate >

CPR should be reinstated to the list of aerosol generating procedures

The BMA has reviewed the guidance on Aerosol Generating Procedures (AGP) and agreed with the Resuscitation Council UK position that CPR is an AGP. This follows concerns that members are being asked to resuscitate patients without adequate protection due to a lack of national consensus on this issue, in that CPR is not classified as an AGP in Public Health England guidance.

The guidance from Resuscitation Council UK provides a clear process for protecting patients and healthcare workers – treating CPR as an AGP. Read our guidance and statement here

Identifying high risk patients and shielding

Last week, NHSEI advised that additional people have been flagged to be at highest clinical risk, and letters and text messages are now being sent to this group. This has again be emphasised in the letter from Sir Simon Stevens. If they have not already done so, practices are being asked to contact all the people on their patient list who are shielding as a follow-up to the letter. It’s likely that most practices will have already done this.

The latest update on shielding in the NHSEI primary care bulletin (27 April) advised that renal dialysis patients should also be shielding. Where they have not already done so, renal units will get in touch with patients, send them a letter and add them to the Shielded Patient List via the regular trust submissions to NHS. It has also been confirmed that splenectomy patients should be included in the Shielded Patient List.

NHS Digital has published a template letter that GPs can use, if they wish, for patients who self-registered as ‘highest risk’ but do not in fact fall into the highest risk groups so do not need to be advised to shield. A link to this has also been added to our guidance for practices about steps to take about the list of shielded patients.

Media

GP practices in England have spent an average of 26 hours a week reviewing whether patients should be shielding during the pandemic, according to a survey of the profession by Pulse. In response to this I said: “Ensuring the list of shielding individuals is accurate is extremely important to ensure the most vulnerable in society are protected. It is a complex and timely process that does requires the input of GPs, patients and NHS England and Improvement, including clinical and non-clinical systems to ensure it is accurate and maintained. It is vital that NHSEI factors in the time needed for GPs to make adequate patient assessments so as to not add to the additional workload burden being placed on GPs at this time.” This was also reported by Management in Practice.

Pandemic delivery service

Patients meeting the COVID-19 shielding criteria need to stay at home and away from community pharmacy and dispensing doctor premises and must be offered a home delivery option for their prescription items unless a family member, friend, relative or volunteer can collect the medicine for them. The National Health Service (Amendments Relating to the Provision of Primacy Care Services During a pandemic etc.) Regulations 2020 came into effect on 27 March 2020 and provide for such an option.

PSNC has published helpful information on their website that includes a flowchart providing an overview of the Pandemic Delivery Service for pharmacies.

Self-referrals to the NHS Volunteer Responders scheme

People who feel they are vulnerable at home during the COVID-19 pandemic, and who would benefit from support from NHS Volunteer Responders, can now self-refer to the scheme rather than depending on their GP practices or other professionals to refer them.

The number for people to call to make a self-referral is 08081963646 – and you can share this with your patients.

The range of professionals who can now also refer people in for support with tasks like shopping, prescription deliveries, biological sample collections and transport to medical appointments has been expanded to include some charities, all emergency services staff, local councillors and MPs.

Testing of healthcare workers

Extended testing of COVID-19 for primary care staff and household members should now be available in testing sites across the country and access to this is primarily via the GOV.UK website although some CCGs are continuing to coordinate access if required. The DHSC announced this week of further expansion of the testing regime to include testing of all asymptomatic NHS and social care staff and care home residents.

GPs seeking testing don’t have to be based at a practice, either: locum GPs can also access CCG-led testing services, or directly order home testing kits. Any staff isolating who need a home test kit should use to the Employee (Self-Referral) portal

For technical issues related to booking tests and results enquiries contact the Coronavirus Testing Helpdesk - 0300 303 2713

The BMA Chair of Council, Chaand Nagpaul, appeared on BBC Newsnight (from 28 min) urging for a faster turnaround on COVID tests to help protect health workers. He said: “The wait can be up to 5 days – I’m concerned because if we are to ease the lockdown…it is really important to have the results very quickly.”

GP retention scheme

The lifting of the cap on retained GP sessions has been extended until further notice. Additionally, if you are due for your scheme annual review before the end of September 2020 you may now seek (through your HEE lead) to defer the review until a later date. If you are approaching the end of the scheme (e.g. doctors in their final three months of the scheme) then you can ask for an extension until the end of September 2020. Further COVID-19 GP retention scheme info can be accessed here

GPC England member, Dr Pamela Martin has written a blog about her experience of returning to practice as a GP help with the COVID-19 effort – read the blog here

Bank Holiday arrangements (England)

NHSEI (primary care bulletin 24 April) has outlined the planned arrangements for opening on the next bank holiday, Friday 8 May. CCGs have flexibility to plan the most suitable arrangements for their local area and it is for CCGs, working with LMCs, practices and local out of hours providers, to determine what cover is required based on local workload expectations.

Last week we also published a template that practices in England can use to claim for the expense of opening as normal on Bank Holidays. This includes staff expenses, salaried GPs, locum (up to maximum rate), partners, and an amount to cover daily non-staff expenses.

Additional Funding for GP practices (Scotland)

On 7 April 2020, the Scottish Government announced additional funding of £15 million to be shared across all GP practices for the period from 3rd March 2020 to recognise the pressure on General Practice caused by COVID-19. Scottish Government and SGPC agreed that no practice should receive less than £4000 and the remainder of the £15 million sum (excluding April Public Holiday) would be distributed to practices by the Scottish Workload Formula (plus Income & Expenses Guarantee). Please see attached a circular on Additional Funding for GP practices and related claims forms.

Death in Service benefits

On Monday, the Government announced the introduction of a life assurance scheme for health and social care workers, including GPs, who die from COVID-19 in the course of essential frontline work, meaning their families would receive a £60,000 payment in compensation. The BMA said that although this may provide some immediate financial relief, it could leave families bereft of longer-term financial security, particularly if their loved one was not a current member of the NHS pension scheme or had only recently joined the scheme. Read the statement here. This view was also echoed by BMA Wales – see their statement here.

Locum GPs are advised to make use of the BMA’s practice/provider agreement – model terms of engagement for a GP providing temporary COVID-19 services. This contract is intended to create mutual obligations to offer and accept work between the employer and locum, which is one of the key indicators of whether an individual can access the continuous death in service benefits

This follows the BMA continued demand for urgent answers from Westminster to its calls for full death in service benefits available under the NHS pension scheme, and our letter to the Chancellor last week to match the arrangements in Scotland.

DiS media

Chair of the BMA’s pensions committee, Vishal Sharma, spoke to LBC Radio (from 28min) discussing his concerns about the death in service payments. David Bailey, Chair of BMA Wales, spoke to BBC Wales (from 08.30) and said: “£60,000 certainly sounds like a lot of money until you put it against 15 to 20 years of life, it's right the government should recognise that sacrifice.” He was also quoted in a BBC News article on the same subject. Tom Black, Chair of BMA Northern Ireland, spoke to the Belfast Telegraph and described the scheme a "terrible insult" to workers.

Coronavirus (COVID-19) is a notifiable disease

As COVID-19 remain on the list of notifiable diseases, practices are reminded that all registered medical practitioners, including GPs, have a statutory duty to notify any clinically suspected cases of COVID-19. They should not wait for laboratory confirmation to notify the cases. Read more here.

Reusing of medicines in a care home or hospice

Following pressure from the GPC and BMA, and working with the DHSC and Chief Pharmaceutical Officer’s team, DHSC has now published the new standard operating procedure for EOLC medicine reuse in care homes and hospices. The guidance sets out criteria for when and how to run a safe and effective medicines reuse scheme in a care home or hospice during the coronavirus outbreak.

Mitigating the COVID 19 impact on GP training and supply

Read a statement and blog by the GP trainees committee co-chairs, Sandesh Gulhane and Lynn Hryhorskyj, about the specific challenges that GP trainees due to CCT in August are facing during the COVID 19 pandemic.

GP Connect to provide access to patient data via the Summary Care Record (England)

As we reported last week, during the pandemic additional patient data from primary care records will be made available to doctors, nurses and authorised professionals outside of primary care and the functionality of GP Connect will be temporarily expanded.

As part of the changes, GP Connect will now allow support GPs to treat patients outside of their registered practice by making patient records available to authorised individuals involved in the care of that patient. The changes will also enable remote organisations such as 111 to book appointments on behalf of patients as part of the COVID Clinical Assessment Service (CCAS).

Changes to the Summary Care Record (SCR) mean that where additional information is held on patients by GPs (medications, immunisations, care plan information and details of the management of long term conditions, significant medical history) and they have not opted out of having a SCR, this information will be made available via the SCR. This interim measure forgoes the requirement to get the explicit consent of a patient to share this information. Patients can still opt-out of either GP Connect or the SCR, or additional information being uploaded to the SCR, should they wish.

GP practices should have been contacted already with instructions on how to facilitate the measures above. More information can be found in the attached document and here

Performers List update (England)

We have been informed by PCSE that the Performers List public facing website is currently being tested and is due to go live on Monday 4 May. The new website will be more interactive than the current site, and an individual can do a search and download the search into an excel file.

At the moment there is the capability to do a search by local office however, in two weeks there will also be the search field of CCG and an individual practice, therefore a practice or LMC could do a search and have a list of all the performers within their practice or CCGs that they cover. As this is the public site it will not provide any contact details or their GP type. We encourage any GP who has not already done so, to log onto PCSE online and check their details.

CQC statement on its regulatory approach during COVID-19

CQC has developed an Emergency Support Framework to help it identify and respond to the increased risks to people, both to those with COVID-19 and those without it, whose treatment and care is being directly or indirectly affected by Covid-19. CQC will introduce this updated regulatory approach from 4^th May, sector by sector. Further information is contained in the full CQC statement.

BMA COVID-19 webpage and guidance

The BMA COVID-19 webpage is updated daily with guidance and links to official information:

NHS England guidance for primary care

Health Protection Scotland guidance for primary and secondary care
Public Health Wales updates
Public Health Agency Northern Ireland latest information

Update of BMA’s COVID-19 ethical guidance

The BMA’s COVID-19 ethical guidance has been updated to reflect the that we are now some weeks into the pandemic, and it has been made even clearer that the BMA does not support discrimination solely on the basis of age or disability (or any protected characteristic). The duty to make reasonable adjustments in the context of disability has also been highlighted.

If BMA members have any specific concerns or issues related to COVID-19 please contact the BMA’s advisers on 0300 123 1233 and support@bma.org.uk.

Wellbeing

At times of crisis it is vital that we all look after our emotional as well as physical health, which is clear from the recent BMA survey which showed that almost half of UK doctors suffering from burnout, depression or anxiety. The BMA offers wellbeing services, including 24/7 counselling, for your emotional health.

If practices or LMCs would like hard copies of our Wellbeing poster, with tips for doctors supporting each other during the crisis, please email wellbeingsupport@bma.org.uk.

Other COVID 19 resources

LMC update 1 May, 2020 - download as a PDF

Condolences

We would like to offer our condolences and pay tribute to all the GPs and others working in primary care who have died as a result of COVID-19.

This week we have been informed of the death of Dr Yusuf Patel, who was a GP in Newham, London. He will be sadly missed and we wish to offer our sincere condolences to his family and friends.

At 11am on Tuesday we remembered our colleagues who have died from COVID-19, in support of the minutes silence that was held as part of International Workers’ Memorial Day. Chaand Nagpaul, BMA Chair of Council, paid tribute and offered condolences to all health care staff that have lost their lives – read the statement here

See this week’s GP bulletin here

GP and practice COVID-19 toolkit (England)

GPC England has published a toolkit for GPs and practices which should hopefully answer many of the questions we have been getting on a large range of topics relating to COVID-19.

The toolkit covers: service provision, home visits and care homes, redeploying staff, working in hubs and furlough, indemnity, annual leave, dispensing and medications, locum doctors, primary care networks and has links to our updated guidance on returning doctors, IT, homeworking and remote consultations.

Any updated guidance or FAQs from us will be added to, or linked from, this toolkit so please do check it regularly for any new additions.

PPE

The BMA continues to put pressure on Government to provide adequate and sufficient PPE for all healthcare workers, which as shown by the results of our latest snapshot survey which shows that basic PPE continue to fail to reach large numbers of frontline doctors despite scores of factories ready and willing to make them, and that almost two-thirds of GPs (64 per cent) reported shortages or no eye protection at all.

We will continue to work hard to ensure that practices get the necessary PPE that they need to work safely.

Following the PHE announcement on Friday recommending to re-use PPE, we issued a statement condemning these new guidelines. Read our statement here. This was reported by the BMJ, Sky news, Newsnight (from 14mins30 in), The Times, The Guardian, ITV News and the Financial Times

Testing of healthcare workers

We continue to push for testing of GPs and their staff to be rolled out across the country as a matter of priority and the BMA is calling for government to drastically improve access to, and availability of, Covid-19 testing facilities for healthcare workers – read the BMA statement here

This follows NHSEI advising last week about plans to extend testing of COVID-19 for primary care staff and household members, which should now be available in testing sites across the country. Access to this is being coordinated by CCGs and practices are advised to contact their local lead if testing is required or directly access appointment is via GOV.UK. Read the government announcement here

Identifying high risk patients and shielding

We have published guidance for practices about steps to take about the list of shielded patients. Practices will have also received the names of patients that have self identified through the Cabinet Office site. Read the guidance here

Yesterday’s NHSEI primary care bulletin explained that additional people have now been flagged to be at highest clinical risk, and that letters and text messages will be sent to this group starting today. It’s likely that practices will now have already contacted all the people on their patient list who are shielding, but if not they should still do so. NHSEI also confirmed that splenectomy patients should be included in the Shielded Patient List.

QOF year-end process

Some practices have raised concerns after seeing lower than normal QOF year-end actual achievement data. However this is before NHSEI have carried out the planned analysis in order to make a one-off adjustment for practices who earned less in 2019/20 than 2018/19 as a result of COVID-19 activities. More details will follow about final payments to be made.

BMA COVID-19 contract for temporary engagements

In particular, it is aimed at locum GPs in order to provide access to employment benefits such as maintaining continuous coverage of death in service benefits while supporting COVID-19 services, and access to the employer’s occupational sick pay and annual leave entitlements.

Read more about supporting sessional GPs in the COVID-19 crisis in this blog by Ben Molyneux, Chair of the Sessional GPs committee

Verification of death and cremation forms

BMA guidance for GPs has now been published on the BMA’s death certification and cremation webpage which outlines the key issues, protocols and principles that should be considered during this time for verification of death, completing MCCDs and cremations forms. Read the guidance on Verification of Death, Completion of Medical Certificates of Cause of Death and Cremation Forms

We have worked jointly with the RCGP to produce guidance that can be accessed remotely by various people to assist clinicians in verifying death remotely. Access the Guidance for Remote Verification of Expected Death Out of Hospital

The Cremation Medical Certificate (form 4) has been updated to provide for a medical practitioner completing the form on their computer or other device to embed an electronic signature. This will enable the form to be sent via another person’s email account, such as a medical administrator, without the form having to be first printed and signed.

Practice expenses for bank holidays (England)

With the support of the Association of Independent Specialist and Medical Accountants (AISMA) we have produced a template that practices in England can use to claim for the expense of opening as normal on Bank Holidays. This includes staff expenses, salaried GPs, locum (up to maximum rate), partners, and an amount to cover daily non-staff expenses. Access the template here

NHS111 CCAS appointments update (England)

The NHSEI preparedness letter highlighted that all practices in England must now make a minimum of 1 appointment per 500 patients available for direct booking from NHS 111 through the CCAS clinical triage service. This replaces the previous requirement to make 1 in 3000 appointments available for NHS111. CCAS has been established to help reduce the pressure on practices by providing direct support for patients with suspected COVID-19. Patients directly booked by NHS 111 will not be given a specific appointment time but added to a practice list as these are not ‘traditional’ appointments. Practices should then deal with these patients based on their priority and need.

Returners guidance

The RCGP has published guidance for colleagues returning to the general practice workforce in response to COVID-19. The guidance aims to help returners identify the types of roles which are right for their own personal skills, abilities and preferences, and to provide a high-level guide on how to return to the workforce, including by directing returners to relevant guidance from government and other organisations.

This follows our joint letter with RCGP regarding returning GPs published last week and our own guidance for returners.

The BMA is waiving membership fees for any retired doctors joining the BMA or any current retired members who are returning to work to support the fight against COVID-19, until 1 October 2020. You do not need to do anything to update your membership. If you have any questions please email membership@bma.org.uk

Recruitment of returning educators, academics and others to support HEE’s educational functions

Health Education England (HEE) recognises that doctors in training have been asked to work in difficult and complex circumstances with great clinical pressure. HEE is seeking to help trainees by recruiting experienced medical educators, academics and others who are unable to take up or wish to supplement clinical work to provide personal and organisational professional support. HEE anticipate that up to 2000 experienced doctors will return, ensuring their skills and experience further strengthen the NHS clinical effort to protect lives during this pandemic.

HEE has identified a need for additional educational support for learners and local office education functions throughout all phases of the COVID-19 pandemic. Medical educators, academics and others with appropriate skills, who have been retired for up to 10 years, can support educational functions during the emergency by joining the scheme. This could be in addition to returning to clinical practice. This group will provide a new and essential national professional mentoring service to medical clinical and academic trainees and other clinicians and support for local medical education. The group will work remotely from home within current HEE local office structures and management but be linked nationally to share ideas and be mutually supportive. Find more information here.

Death in Service benefits

The Scottish Government has announced a commitment to providing a comprehensive death in service package for all NHS workers, and the BMA is demanding that full protections are put in place in the other UK nations in a second letter to the Chancellor.

The Scottish Government’s statement reads “The Health Secretary recognises how important the death in service benefit is to NHS staff, including bank nurses. That is why we have agreed with the principal health service unions, including the BMA, RCN and Unison, that all staff affected by COVID-19 as a result of providing frontline treatment for COVID-19 patients will receive the full lump sum and survivor’s pension benefits available under the terms of the NHS pension scheme, this includes permanent and fixed-term staff who are not members of the pension scheme, NHS Bank and NHS Locum staff.”. Read the BMA statement here. This was reported by GP online, FT adviser and Pulse

BMA Wales is also calling for full death in service benefits for NHS workers, urging the Welsh Government to follow Scotland’s lead. Read the press statement here

Regulation 61 – temporary arrangements for dispensing doctors

Under regulation 61 (1) of The National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, NHS England “may require a dispensing doctor to provide pharmaceutical services (“temporary services”) to patients to whom the dispensing doctor is not otherwise entitled to provide pharmaceutical services”. This can only happen during an emergency and for the first time since their enactment, this has now been declared. As noted above these are temporary only and for a specified period, currently up until 1 July 2020.

However, NHS England is not required to automatically require a dispensing doctor to provide temporary services, even if the nearest pharmacy is closed. GPC has raised concerns with NHS England’s national position that regulation 61 does not need to be implemented at present. We are receiving reports of problems caused by this stance locally and do not see why implementation should not happen. This is a view shared by the Dispensing Doctors Association and PSNC.

Community Drug Charts

There is no need for a practice to complete a community drug chart/medicine administration record (MAR Chart) as a prescription is all that is legally required for a nurse, care home worker or community worker to administer medication. It is sometimes misunderstood that a MAR chart is an instruction for the medication to be administered, whereas it ought to be regarded as a record that a medication has been given, with the instruction being provided by the information provided by the prescriber on the prescription and recorded by the dispenser on the original packet. We are concerned that some organisations that use MAR charts still use them inappropriately as an authority to administer, rather than as a record of that administration.

If the employer of the community or care home nurse or worker requires any additional documentation then the responsibility for completing that resides with the organisation whose staff are using it, compiled from the information provided by the prescriber, and completed by staff trained in the process. The drugs themselves should be given according to the prescription as recorded on the original packet, with only the fact that it was given (or not) entered on the MAR chart. Access the GPC prescribing guidance here

GP Connect to provide access to patient data via the Summary Care Record (England)

To better enable the ability of the service to respond to COVID-19, additional patient data from primary care records will be made available to doctors, nurses and authorised professionals outside of primary care. The Joint GP IT Committee has indicated their support for this as an interim measure to help manage increased and complex demand during the current period. The letter of support is included in the guidance that has been issued here

Letter to NHSX raising concerns over COPI regulations (England)

GPC England has written a letter to NHSX to seek assurances on the misuse of COPI regulations to request GP data. We have had several queries from GPs concerned that they are being asked to provide data to projects that do not have approval from the Secretary of State or requests that fall outside of those areas covered by the regulations. While we appreciate the importance of sharing relevant clinical data at this time, requests to extract data which put the trust in the patient-doctor relationship in jeopardy or risk exposing GPs to liability must not be made.

Temporary removal of the routine D4 medical

The government has announced the temporary removal of the routine DV medical for bus and lorry drivers. Under the new scheme, drivers will be able to receive a temporary 1-year licence, providing they do not have any medical conditions that affect their driving and their current licence expires in 2020, and they do not have to provide further medical evidence. Read full details here.

BMA COVID-19 webpage and guidance

The BMA COVID-19 webpage is updated daily with guidance and links to official information:

NHS England guidance for primary care
Health Protection Scotland guidance for primary and secondary care
Public Health Wales updates
Public Health Agency Northern Ireland latest information

The BMA has published ethical guidance on COVID-19.

If BMA members have any specific concerns or issues related to COVID-19 please contact the BMA’s advisers on 0300 123 1233 and support@bma.org.uk.

Individual coaching support for primary care staff

NHSEI and RCGP have developed individual coaching support service for clinical and non-clinical primary care staff which is available by video link or telephone with highly trained, experienced coaches. The aim is that this will provide staff with opportunities to process experiences, develop coping skills, deal with difficult conversations and develop strategies for self-management in difficult circumstances. Primary care staff can register and book individual coaching here. This service complements the wider range of health and wellbeing resources launched at www.people.nhs.uk.

Wellbeing

If practices or LMCs would like hard copies of our Wellbeing poster, with tips for doctors supporting each other during the crisis, please email wellbeingsupport@bma.org.uk.

NHSEI health and wellbeing offer for NHS staff

NHSEI have launched a package of support for NHS staff this includes:

· A suite of free guides and apps offering support via guided meditation, tools to reduce anxiety and help with sleep problems.

· A wellbeing support helpline (including coaching, bereavement care, mental health and financial help) on 0300 131 7000, or alternatively, you can text FRONTLINE to 85258 for support 24/7.

· Wellbeing webinars, including further details on the national NHSE/I offer. The sessions will be held every Wednesday between 4pm and 5pm. Previous sessions are recorded.

Other COVID 19 resources

BMJ – news and resources

RCGP COVID-19 information

NHSE/I daily primary care bulletins on COVID-19

NHSE/I COVID-19 webinars

COVID-19 Google Drive resource

Primary Care Pathways COVID-19 resource centre

NICE resources on COVID-19

Condolences
We would like to offer our condolences and pay tribute to all the GPs and others working in primary care who have died as a result of COVID-19. This week we have been informed of the deaths of Dr Craig Wakeham, a GP and longstanding member of Dorset LMC, and Dr Krishan Arora, who was a GP in Croydon. In addition, Dr Eddie Josse, who was a former member of the BMA's GP committee in the 1990s and previously a GP in Bounds Green, North London has also died. They will all be sadly missed and we wish to offer our sincere condolences to their family and friends.

See this week’s GP bulletin here

See the latest Sessional GPs newsletter here

LMC update 24 April, 2020 - download here

PPE update

The BMA continues to put pressure on Government to provide adequate and sufficient PPE for all healthcare workers, which as shown by the results of our survey, are still lacking and most doctors do not feel safely protected from COVID-19 where they work. These results will be updated by our second tracker survey published tomorrow.

This situation comes despite repeated assurances by the government that additional stock is being delivered to practices, but many areas across the country are still lacking the necessary equipment. We have raised this again with NHS England and Government ministers and have been told there now should be enough supplies available within the wholesale system. However this does not yet match the experience of practices across the country.

NHSEI has now set up a PPE supply page which includes options available for primary care, via wholesalers that routinely supply to GPs or through Local Resilience Forums. Other systems are being rapidly tested.

Public Health England’s PPE guidance advises that in primary care PPE should include eye protection and should be worn for all contacts. All patients must be assumed to have COVID-19 infection, and it is recommended that they should wear a mask during any face-to-face consultation. We will continue to work hard to ensure that everyone gets the necessary PPE that they need to work safely. Read the latest BMA guidance on PPE here and the BMA calling for urgent supply of PPE

PPE media

I appeared on LBC on Saturday evening to talk about PPE and on Tuesday our survey and my comments led BBC Look North. This morning I was interviewed about testing and PPE availability on TalkRadio. Phil White, Chair of GPC Wales, was interviewed on BBC Radio Cymru, about PPE (from 25 mins in). Alan Stout, Chair of NIGPC, said to Irish News that there is enough PPE available for GPs in Northern Ireland, following concerns from both health workers and patients about lack of PPE.

Identifying high risk patients and shielding

As you will be aware, last week NHSE/I and NHS Digital informed practices how to complete the process of identifying patients at highest clinical risk, as set out in the CMO letter and subsequent NSHEI guidance, and where practically possible, to do this by the end of 14 April or soon thereafter.

Many practices will have already completed most of this work using previous data provided and may only have needed to check the most recent lists provided to them via system suppliers to ensure they are as accurate as possible. However, some of the work of keeping clinical records up to date will be an on-going task should further information about individual patients be provided by hospital specialists or if patients develop new conditions that require them to shield. Find more information in this letter from NHSEI and NHS Digital. If you have any questions, contact the NHS Digital Shielded Patients List Hub: splquery@nhs.net

We have published guidance for practices about steps to take about the list of shielded patients and those that have self identified through the Cabinet office site.

The Government’s COVID-19: guidance on shielding and protecting people defined on medical grounds as extremely vulnerable has been updated today.

Social distancing

I spoke on Talk Radio to discuss the Governments latest guidance on social distancing (start listening between 8:30am and 9:00am).

Testing of healthcare workers

We continue to push for testing of GPs and their staff to be rolled out across the country as a matter of priority, following the NHSEI advice that staff in initial priority groups such as critical care and emergency departments would be tested first. The NHSEI bulletin advises that plans have been outlined on widening testing of COVID-19 for primary care staff and household members including primary care staff, this should now be available in testing sites across the country. Access to this is being coordinated by CCGs and practices are advised to contact their local lead if testing is required.

Widening access to testing sites

I raised the importance of widening access to testing with Health Minister, Jo Churchill MP, today. A number of sites are now operating and there are plans to rapidly increase the number of sites to 50 by the end of April. These are open to both primary care and care home staff. CCGs should be contacted to book appointments and CQC are also supporting access for care home staff.

The current live test sites are Birmingham (Edgbaston), Chessington, Gateshead, Gatwick, Haydock, (Liverpool/Warrington), Leeds, Manchester, Midland Metropolitan, Nottingham, Plymouth, Stansted, Wembley (IKEA), Worcester, Aberdeen, Belfast, Edinburgh, Greenwich, Preston

Sheffield, Twickenham.

Impact on GP services

The Mirror reported on the pressures that GPs are under, and I commented: “We will need to stop doing much of the routine work that we do week-by-week to enable us to focus on the sickest patients and prioritise those who most need us. Practices that are routinely doing routine health checks, assessing blood pressure, diabetic control, and long-term problems with heart and lung disease - those routine checks will need to stop."

BMA COVID-19 contract for temporary engagements

The Sessional GP Committee, working with GPC and BMA Law, has produced a model contract with terms for the engagement of a GP providing temporary COVID-19 services. The model terms are intended to provide practices with the ability to flexibly employ additional GPs to deal with the demands of responding to COVID-19. In particular, it is aimed at locum GPs in order to provide access to employment benefits such as maintaining continuous coverage of death in service benefits while supporting COVID-19 services, and access to the employer’s occupational sick pay and annual leave entitlements.

NHS111 CCAS appointments

The latest NHSEI preparedness letter (14 April) highlights that the recent amendments to the GMS regulations, will increase the minimum number of appointments that practices must make available for 111 direct booking and all practices in England must now make a minimum of 1 appointment per 500 patients available for direct booking from NHS 111 through the CCAS clinical triage service.

We have raised concerns with NHSEI and NHS Digital about these figures and the proposed process, and they have clarified that there is a difference between the current local NHS111 appointments, which were used to book in to practice appointment systems for patients that don't have COVID-19 related symptoms, and the new national CCAS which is staffed by clinicians, including returning GPs, and which is intended to take the pressure off practices by dealing directly with many of their patients with COVID-19 related symptoms. The CCAS service is additional capacity to support your practice, and should reduce the number of patients the practice has to deal with directly.

Patients should not be told by CCAS that they will be phoned back at a particular time, as per the nominal appointment slot they may have been put in to. The appointment slots are just a technical way of transferring patients from CCAS to the practice. It is for the practice to determine how they respond to the patients who have been transferred to them. Practices may therefore set up a separate triage list that they monitor during the day alongside whatever their normal arrangements are for managing patients who have contacted the practice directly. In most areas the numbers transferred will be far fewer than were originally modelled, and which led to the 1 in 500 figure.

Returning GPs

The GMC have now granted temporary registration to retired doctors so that they can return to practice and help with the coronavirus pandemic. However, we are aware that due to overwhelming number who have applied to get involved, there have been delays to returners being added to the system after relicensing and we are working with NHSE/I and government to encourage them to speed this process up as much as possible.

The significant numbers expressing the intention to get involved has overwhelmed current systems and processes, and we know that many are currently waiting for the next steps. Both the BMA and the RCGP are working to try and speed up the process as much as possible, and on additional guidance which is currently being finalised.

The BMA has published a joint letter with RCGP regarding returning GPs as well as guidance for returners. Please share these with colleagues who are intending to return. For any retired doctors joining the BMA or any current retired members who are returning to work to support the fight against COVID-19, we are waiving their membership fees until 1 October 2020. You do not need to do anything to update your membership. You will make no further payments until 1 October 2020 and we will email you to confirm. If you have any questions please email membership@bma.org.uk

GP Induction and Refresher scheme and International GP Recruitment Scheme

As we reported last week, new regulations have been published which enable medical practitioners who are not on the performers list to provide GP services during the pandemic. In addition to GPs on a devolved nation performers list being able to apply to be included on the Performers List in England, those on the GP Induction and Refresher (I&R) or International GP Recruitment (IGPR) schemes, can also use the Fast Track COVID-19 application process to seek approval to be added to the Performers List for the duration of the COVID-19 crisis.

Some doctors who had been pursuing the I&R and IGPR routes into general practice had been left unable to work due to the cancellation of the MCQ and Simulated Surgery Assessments.

The online application form can be accessed here while questions about the application process should be directed to the NHS England national team using england.ftc19@nhs.net. NHS England will be contacting all scheme applicants and inviting them to make a Fast Track application.

If a doctor decides to pursue this route they must continue with their standard application alongside the Fast Track process. The evidence obtained during the COVID-19 period may be used to support full inclusion on the Performers List. While this may negate the need for any additional assessment or supervised placement, some doctors may be asked to complete the standard programme when the COVID-19 crisis period is over.

The Fast Track route will only be available to doctors who are considered by Health Education England / NHS England leads to be safe to start a clinical placement without completing the MCQ and simulated surgery assessments. The Fast Track process is also open to applications from MoD GPs, performers on the respective lists in Wales, NI, Scotland, Isle of Man and the Channel Islands, private GPs and NHS GPs who wish to return to work as a general practitioner having been off the performers list for more than 5 years.

GP retention scheme (England)

NHSEI has extended the relaxation of the maximum number of in-hour sessions retained GPs can conduct until further notice so they can contribute to the COVID-19 response. For the retained GPs due for their scheme annual review, CCGs will now be able to:

· agree with retained GPs, who are due for a scheme annual review before the end of September 2020, to defer their annual review until a later date

· consider granting retained GPs, who are approaching the end of the scheme (e.g. those in their final three months of the scheme), with a scheme extension until the end of September 2020.

Retained GPs are encouraged to contact their HEE local scheme leads if they require any support.

Death certification and verification of death

This complex area continues to be the subject of intense work between BMA, RCGP, NHSE and CQC. We will be publishing updated guidelines on all death related matters in the coming days. In the meantime there are specific updates in relation to:

Verification of death

London Coroners wrote an open letter on Tuesday 14^th April. The text can be found here. We have challenged this position and our response can be read here.

Certificate of death

Following the relaxation of certain aspects of the rules around the completion of death certificates the BMA has written to the government to ask for further changes to fit more closely with the working patterns in general practice and to streamline the system.

Ethical considerations advance care planning

The BMA issued a joint statement last week about the importance of continuing with advance care planning during the COVID-19 emergency. I was also interviewed by BBC Radio 4 about the ethical considerations around COVID-19 end of life care – listen here (from 2:39:30 onwards)

JCVI statement on immunisation prioritisation

The Joint Committee on Vaccination and Immunisation (JCVI) has published a statement on the importance of maintaining immunisation services to reduce the risk of vaccine-preventable disease during the COVID-19 outbreak. This will provide important protection to children and other vulnerable groups and will also avoid increasing further the numbers of patients requiring health services because of vaccine-preventable diseases. Read the full statement here

Dispensing delivery services (England)

The letter on Home delivery of medicines and appliances service during the COVID-19 outbreak from the Chief Pharmaceutical Officer and NHSEI, outlines changes of essential services for dispensing doctors in England. Due to the emergency changes to GMS contract regulations, from 9 April, community pharmacies and dispensing doctors provide a home delivery option service for shielding patients.

Community pharmacies and dispensing doctors have to ensure that medicines are delivered to people at high risk of complications from COVID-19 who are advised to isolate at home for 12 weeks and meet the 'shielding' criteria if these medicines cannot be collected and delivered by a family member, friend, carer or volunteer. The funding of these services will be in addition to the current contractual agreement for both pharmacies and dispensing doctors.

Referrals to secondary care

Following concerns GPCE has been raising about the risks to patients of practices not being able to make referrals when necessary, yesterday’s NHSEI Primary Care bulletin advises that GPs should continue to refer patients to secondary care using the usual pathways and to base judgments around urgency of need on usual clinical thresholds. GPs should also continue to use specialist advice and guidance where available to inform management of patients whose care remains within primary care including those who are awaiting review in secondary care when appropriate. Further NHS guidance will be published shortly advising secondary care to accept and hold clinical responsibility for GP referrals.

Laptops for use in general practice (England)

Following GPCE highlighting the difficulty many practices have had enabling staff self-isolating at home to continue to work, NHSEI has now confirmed that 9,500 laptops have been sent to CCGs this week for use in general practice, and 13,000 more laptops to be sent over the next few weeks. Practices should contact their CCG to request a laptop when this is needed.

NHS staff absence tracker

NHSEI has launched a new staff absence tracker service, which is a tool for staff and managers to report COVID-19 related absence from work and subsequent return to work. It will provide a source of national data on the absence rate in general practice that will allow them to better target support. Staff can register using their NHS email address and if they provide the details of their practice manager or rota manager, they will be automatically informed of the absence. Although there is no obligation for practices to use this service, this would be a way to demonstrate the pressures on general practice.

NHS Volunteer Responders: open to referrals from health professionals

NHSEI has published guidance for health professionals about the NHS Volunteer Responders programme and how to refer patients for support who are considered to be vulnerable and at risk.

Any member of practice staff, not just GPs, can make the referral, by using their nhs.net address. You can refer people who are at very high risk from coronavirus where no local support is available, for example if they have been asked to self-isolate and ‘shield’, if they are over 70 and have underlying health conditions, or if they are self-isolating and you consider them to be especially vulnerable. You can continue to use your local schemes where they exist and please speak to your patients if in doubt about whether they require support.

Requests can be made via the NHS Volunteer Responders referrers’ portal or by calling 0808 196 3382. Read more about how the referrals work here

BMA COVID-19 webpage and guidance

The BMA COVID-19 webpage is updated daily with guidance and links to official information:

Health Protection Scotland guidance for primary and secondary care
Public Health Wales updates
Public Health Agency Northern Ireland latest information

The BMA has published ethical guidance on COVID-19.

If BMA members have any specific concerns or issues related to COVID-19 please contact the BMA’s advisers on 0300 123 1233 and support@bma.org.uk.

Wellbeing

At times of crisis it is also vital that we all look after our emotional as well as physical health and the BMA has a range of wellbeing services including 24/7 counselling, available to ALL doctors and medical students (not just BMA members).

If practices or LMCs would like hard copies of our Wellbeing poster, with tips for doctors supporting each other during the crisis, please email wellbeingsupport@bma.org.uk.

PHE have launched a new campaign to support people to manage their mental wellbeing during the pandemic, using Every Mind Matters self-care resources.

Other COVID 19 resources