BMA health manifesto
With the general election next month the BMA published its manifesto for health yesterday, where we set out our priorities for any incoming government:
NHS and GP pressures
To accompany the manifesto launch we have also published updated analysis of the pressures likely to be faced by the health service this winter, available atwww.bma.org.uk/NHSpressures
As we are all aware, GP surgeries across England are under significant strain with rising demand, practices struggling to recruit, and patients having to wait longer for an appointment. Read more about the pressures practices are under here.
The BMA manifesto and NHS pressures were reported in the Times, Telegraph, Mail, Metro, Sun and Irish Sun, Daily Express, City AM, Independent, Evening Standard, Yorkshire Post, Pulse, GP online.
The Observer ran a story claiming that Downing Street has taken emergency action to head off winter pressures in the NHS, amid fears in Government that a healthcare crisis could derail the general election campaign. In response to this Chaand Nagpaul, BMA chair of council, said: “Under this government’s watch, patients and staff working in the NHS have endured winter after winter of overcrowded emergency departments, long delays and pitifully low staffing levels. It should not take an election to take stock of just how bad the situation has become.” This was also reported by the Mail, Mirror, Metro, Independent, iNews, and some regional publications.
LMC England Conference agenda
The Agenda Committee has published the agenda for the 2019 Conference of England LMCs to be held on 22 November 2019 at the Light at Friends House, London. For those who are registered to attend please note that no paper copies of the agenda will be provided as will be further minimising the carbon footprint for the conference by circulating most of the conference papers electronically, only essential documents will be printed and provided on the day.
Wales LMC Conference 2019
The Welsh LMC Conference 2019 will take place tomorrow, Saturday 9 November in Llandudno, Wales. Read the conference agenda here.
Northern Ireland LMC Conference 2019
The Northern Ireland LMC conference will take place in Belfast on Saturday 16 November. The agenda will be published shortly.
PAC report into NHS Property Services service charges
The Public Accounts Committee have published their report concluding that NHSPS ‘was set up to fail’, and that DHSC are not setting a course of action to address the issue but are leaving others to find a solution. The report finds it is unacceptable that 70% of tenants do not have leases in place and urges DHSC to move towards a more transparent and equitable charging model with adequate funding in place.
In response we issued a press statement saying ““The PAC report into NHS Property Services highlights what the BMA has been saying for some time – the current model is not fit for purpose and never has been. Absurd or extortionate services charges are proving an impossible barrier to many agreeing new leases with the current system actively threatening the future of GP services in some parts of the country. Ultimately, this ridiculous situation means GPs are being forced to spend far too much time and effort trying to resolve these issues instead of caring for patients and is also discouraging many young doctors from becoming GP partners.”
The BMA has already set out in a letter of claim that we believe the NHSPS is acting unlawfully and made clear if no satisfactory response is received, we will take NHSPS to court. BMA guidance is clear that practices should engage with NHSPS, identify areas where there is a dispute and pay undisputed amounts. Practices cannot be forced into any agreement which places the viability of the practice at risk and solutions must be sustainable. Practices should be mindful that the BMA are proceeding with legal action to address historical charges and should ensure that in reaching any agreement independently of this they do not put themselves at risk of any future liability or compromise their future position.
2019/20 Flu vaccine supply (England)
I as interviewed today on ITV News about the shortage of influenza vaccine for children, which is leading to a delay in the primary school-based programme. It is likely that supplies will next be provided to schools towards the end of November. As most practices have already received LAIV Public Health England has advised that GPs should implement the seasonal influenza programme as outlined in the Direct Enhanced Service Specification. As part of this practices should call in those children who are eligible for flu vaccination, and to undertake recall for those children in clinical risk groups for influenza. Because of the phasing of supplies PHE recommends planning the childhood vaccination programme using following priorities:
Please also see attached a letter from NHSE and NHSI regarding the transfer of excess of QIV/LAIV flu vaccine stock between providers. The MHRA has confirmed that with regards to the QIV for those aged under 65 years in clinical risk groups and LAIV flu vaccine for children recommended in the 2019/20 flu season, it would not prevent the transfer of QIV vaccine under the given circumstance of ‘in short supply’ or ‘no supply’ available.
Medicine shortages: PPV and MMR vaccine
Pulse reported on the news that the PPV and MMR vaccine had been added to the list of medicines the DHSC has banned for parallel export because of supply constraints, and PHE has advised have advised that this will mean GPs may not be able to offer both vaccines at the same appointment.
In response to this I said: “We saw a shortage in the PPV vaccine last year and this problem is becoming an increasing frustration for both practices and patients. The measure to restrict export of the vaccine and improve availability for practices in England is sensible. Though supply issues are nothing new, it is something we are now having to deal with more and more which just adds more to the workload burden carried by GPs and their practice teams. The Government must do much more to ensure that problems with the manufacturing and supply of medicines are promptly addressed so that patients have access to timely care.”
Withdrawal of Serious Shortage Protocol for fluoxetine 10mg capsule
The Department of Health and Social Care has advised that the end date for the Serious Shortage Protocol for fluoxetine 40mg capsules (SSP03) is being extended to 20 November 2019.
Wessex model for workforce exchange - webinar
NHS England and NHS Improvement have published guidance on how to run the Wessex Model for workforce exchanges. This is a high impact model for workforce exchanges that is being scaled up after its continued success as an adaptable and enjoyable way of building relationships and trust between professionals working in integrated systems and across interfaces, to generate quality improvement and innovation in patient care. There will be a webinar about the model on 28 November, hosted by Dr Graham Jackson, Chair of NHS Clinical Commissioners and the Interface Working Group – sign up here.
Remote prescribing high level principles
The GMC, and some other healthcare regulators and organisations, published their Remote prescribing high level principles today. The principles outline a set of expectations for UK healthcare professionals when prescribing remotely, whether online, over video-link or by phone. The principles encourage good practice in remote prescribing, and that health care professionals are expected to:
Read the GMC press release here.
Read the latest GPC newsletter here.
Annual QOF report for England published
New figures published by NHS Digital show the recorded prevalence of 21 conditions, including asthma, hypertension, dementia, diabetes, and depression. This publication provides data for the reporting year 1 April 2018 to 31 March 2019 and covers all General Practices in England that participated in the Quality and Outcomes Framework in 2018-19. The data are based on the 6,873 practices (95%) who participated in the QOF this reporting year. Key findings show:
How medical records are accessed by solicitors
We recently highlighted a court case which considered a dispute about how medical records are made available to solicitors requesting them on behalf of patients. Asummary of the case has been prepared by the solicitors acting for the GP practice. We have now considered the details of this case. The judge did not rule on issues related to GDPR and Subject Access Requests (SARs). The court considered the question of disclosure under Civil Procedure Rules. The judge ruled in favour of the practice and did not make an order for disclosure of the records because the practice had made the records available for collection from the practice premises.
It is important for practices to note, however, that this case does not alter any aspect of the law relating to GDPR. When a SAR is received from a solicitor acting for a patient practices should follow the patient’s wishes and make available medical records to the solicitor if this is what the patient has authorised, unless the practice has particular concerns about the patient’s authorisation.
The ICO has recently made a statement about the case which states that: ‘A person should not have to take action to receive the information, such as by collecting it from the controller’s premises, unless they agree to do so’. A group of GPs have since written to the ICO expressing concern about this and we will continue to monitor the situation and provide updates as necessary. Here is the BMA’s guidance on access to health records and SAR FAQs , which also reflects advice from the ICO on this subject.
General practice at breaking point in north Wales
Phil White, Chair of GPC Wales, made a statement about general practice being at breaking point in North Wales. He said: “The BMA has been warning for years that general practice in north Wales is at breaking point, with practices continuing to hand back their keys to the health board. Workload is extremely high, and the gap continues to grow between the demand placed upon general practice and its capacity. Whilst longer term solutions have been put in place to alleviate problems, the issue needs to be addressed with urgency.” It was also reported by North Wales Live.
Patient record system scrapped in Wales
Following the news that NHS Wales has decided to cancel its contract with Microtest Limited, Phil White, Chair of GPC Wales, said: “GPC Wales has been fully involved in the procurement process and consistently highlighted the impact that unacceptable delays were having on practices in planning for their migration to a new system. We remain committed to engaging with the consultation process to ensure that the views of the profession are represented and that clinical IT systems are not only fit for purpose, but will improve and support the working practices of GPs in Wales.” Read the full statement here. It was also reported by BBC News online.
Wales LMC Conference agenda
The Wales LMC conference will take place next week on Saturday 9 November 2019 at St George’s Hotel, Llandudno. Download the conference agenda for 2019
Fighting unfunded transfer of work
Gaurav Gupta, GPC UK member and chair of Kent LMC, has written a blog for Pulse about how practices can fight unfunded transfer of work from hospitals to GP practices. He describes the progress made so far and points to useful resources of information to deal with hospitals that aren’t complying, including the BMA templates letters that practices can use to write to CCGs and hospitals. Read the full article here (log in required).
Outpatients sent back to GPs
An investigation by Pulse has shown that NHS trusts are discharging just under half of patients who do not attend their first appointment back to their GP. In response to this, Farah Jameel, GPC England executive team member, said: “While we recognise that the whole NHS is under intense pressure, it is not appropriate for hospital management to pass their responsibilities to GPs. The BMA’s GP Committee has been clear that this is unacceptable and flies in the face of the hospital contract and, more broadly, a collaborative approach to working.”
Support for PCN clinical directors
During a session I spoke at on the progress of PCNs at the RCGP conference last week, a clinical director warned that PCNs are struggling to resist pressure from CCGs seeking to influence their priorities. In response to this I said, “‘We need to protect our clinical directors, particularly at the moment, so that they are working within their expectations and they are not finding themselves overwhelmed. CCGs and ICSs have been given funding to support leadership development within PCNs. It is up to PCNs to work with their LMCs in order to ensure this funding was put to good use.”
This was reported in GP online
PCSE: what’s your experience?
Please take this final chance to feed in to our short survey about PCSE problems that you have experienced - your responses will be used as evidence to help us push NHS England to resolve the outstanding issues. The deadline for the survey has now been extended until 8 November.
Survey of GP practices
Survey of all GPs including trainees
Supply issue with nasal flu vaccine
Pulse reported on the supply issues of the nasal spray flu vaccine for children, and the advice from Public Health England to practices not to stockpile the vaccine. In response to this, GPC England Executive member, Krishna Kasaraneni, said: “This is very frustrating for GPs and their patients, but we advise teams to continue to follow the flu programme as outline in the DES and for practices staff to order only the vaccines they need, one week at a time.” In discussions this week with PHE we have been informed that practices are following this advice which is helping supply issues.
Medicine shortages put GP funding at risk
GPonline reported that CCG costs are rising due to drug shortages forcing GP practices to prescribe more expensive alternatives. In response to this, GPC England executive member, Farah Jameel, said: “Drug shortages can happen for all sorts of reasons, but they are a daily frustration for GPs and are gradually getting worse. In some cases, this means sourcing an alternative drug, and GPs will issue a generic prescription for a pharmacist to then see what they have in stock, but this can be expensive and lead to mounting costs across the health service, depleting essential funds for other areas of patient care.”
Supply alerts for Seroxat, opicapone and Mitomycin-C injection
Please see attached supply update from the Department of Health and Social Care for Seroxat (paroxetine) 20mg/10ml oral solution which will be out of stock until January 2020 due to manufacturing delays. Paroxetine tablets remain available from various suppliers.
Supply Disruption Alerts have been issued for opicapone 50mg capsules and Mitomycin-C injection, Kyowa Kirin. Also attached are communications for the following:
Withdrawal of Serious Shortage Protocol for fluoxetine 10mg capsule
The Department of Health and Social Care has advised that sufficient stock is now available of fluoxetine 10mg capsules to supply normal demand, so the Serious Shortage Protocol (SSP) for fluoxetine 10mg capsules has been withdrawn, and the 10mg capsules can be prescribed and must be dispensed in the usual way. The SSPs for 30mg and 40mg capsules remain in effect, with extended end dates to 20 November for 30mg capsules and 11 November 2019 for 40mg capsules.
Establishing clinical pharmacy in a PCN - regional events
NHS England and NHS Improvement are holding regional events on Establishing Clinical Pharmacy in a PCN, in partnership with the Primary Care Pharmacy Association, on 11 December in London, Birmingham, Taunton and Leeds. The focus of these events will be highly practical and encourage networking support and engagement with delegates with a view to delivering resources and support to PCN pharmacy teams going forward. The events are aimed at PCN clinical directors and workforce leads, LMC members and pharmacists. For further information go to the NHS England website.
Committee visitors scheme for GPC Meetings
The BMA committee visitors scheme allows those interested in participating as non-voting committee member of GPC, with the opportunity to attend meetings and take part in discussions. If you have not participated in BMA work before the scheme is an excellent opportunity to gain experience of what it is like to serve on a committee and contribute to the future of your profession. For further details, please visit the BMA website
Case studies required to help the national GP recruitment campaign (England)
As you may be aware, HEE is having some success in recruiting more doctors to train as GPs – 3,538 were accepted onto GP training places for 2019-20, the highest ever number. Applicant feedback indicates that accounts from GPs and GP trainees can inspire and influence the decisions of doctors as they choose specialty training. HEE needs more case studies for the GP National Recruitment Office website. If you are willing to describe how you feel about treating your patients, what you’re able to achieve or something around the outcome or benefit(s), please email GP Recruitment gprecruitment@hee.nhs.uk.
This request for support does not negate the many difficulties our existing GP workforce currently faces. We are, however, keen to do everything we can to give the opportunity to and inspire this and future generations of newly qualified doctors to choose GP specialty training. GPC has been working with HEE since 2013 to increase GP recruitment; our ultimate aim is to grow the qualified general practice workforce to levels that ensure workload reaches safe and manageable levels for all practice staff. We continue to work with HEE, NHS England and NHS Improvement to do that and GPC won’t rest until our collective objective is achieved.
Read the latest GPC newsletter here.
General practice under pressure – GMC workforce report published
During June and July, 3,876 doctors completed a GMC survey about satisfaction of their role, the environment they work in and their career intentions. Overall the findings showed that GPs are more likely to feel dissatisfied, to have already reduced or plan to reduce their hours, and to be thinking about leaving the profession. The results showed that over the last year 36% of GPs reduced their clinical hours, compared with 21% of all doctors having taken this action. Only 9% of GPs reported always or usually feeling able to cope while rarely or never working beyond their rostered hours, compared with 29% of all doctors. Conversely, 50% of GPs reported often feeling unable to cope and often working beyond their planned hours, compared with 26% of doctors overall. The report also notes that more GPs work less than full time than other doctors (49% compared to 23% of doctors overall), and touches on the changing make-up of GP training, with international medical graduates now representing 23% of all GP trainees, up from 16% three years ago. The results underline what GPC has been saying publicly for many years: general practice is in crisis.
The report containing the full survey results and a wide range of data on the GMC register is available here.
GMC support for GPs as specialists
Speaking at the RCGP conference in Liverpool, Dame Clare Marx, the chair of the GMC, reiterated the organisation's support for GPs to be recognised as specialists. She welcomed the initiative led by GPC UK and the RCGP and committed to work with us to actively encourage the DHSC to bring all medics together on a single advanced practice register. She said: “There still is within the medical community some very old fashioned snobbery about GP training. [Recognising GPs as specialists] would simplify the structure and make crystal clear the parity of expertise across UK general practice.”
She also called for to the legislation governing how overseas GPs apply to join the UK register to be changed which could 'make a significant difference' to the GP workforce, and said she wanted to see more support for international medical graduates. Her comments were reported by GP Online
NAO investigation into pre-school vaccinations
The National Audit Office published a report today, which found that NHS England has fallen short of Department of Health and Social Care’s (DHSC) performance standard for the uptake of nearly all pre-school vaccinations in England in 2018-19. The National Audit Office said that NHS systems for reminding parents to get their children vaccinated are 'inconsistent' and appointments are difficult to book.
I responded saying that practices are doing their best to reach everyone who could be vaccinated. I did, however, call for improved information systems, so that records of vaccine figures are kept accurate. I also stated that it is positive that the government, NHS England and Public Health England are beginning to prioritise improving vaccine uptake, and crucially we need better research into why certain groups are still not having their children protected and how best to target them effectively. The story was covered by the BBC, the Telegraph, Yahoo News, Pulse, Business Mayor, Sortiwa Portal and Simple News. It was also featured in the print version of the Daily Mail and the BMA was mentioned on BBC Radio 4's Today programme.
Interim findings of the Vaccinations and Immunisations Review
We have been working with NHS England on a Vaccinations and Immunisations Review. This is an interim report which notes that while coverage for most vaccines is high, there has been a decline in the last few years, meaning that we do not have a high enough coverage to prevent the onward transmission of infections, particularly measles. The work of the review will continue and this will then lead in to potential GMS contract negotiations with NHS England in the coming months.
Flu immunisation for practice staff
The state-funded indemnity scheme for England and Wales does not cover GP practices providing flu vaccinations to their own staff. The Seasonal influenza DES Specification makes clear that staff of GP practices/contractors and other primary care staff are the responsibility of their employer as part of occupational health arrangements. However as we previously reported, we have been assured that the schemes provided by all three main Medical Defence Organisations do cover this activity.
In 2018, the BMA’s Occupational Health Committee worked with the Specialist Pharmacy Service and other key stakeholders to identify a way that organisations can offer employee seasonal ‘flu vaccinations within the legislation. The outcome of this work has been to produce a written instruction for seasonal influenza vaccination. The template and advice on how to use it is available here. This advice has also been published on the BMA website
Supply issue with the flu nasal vaccine – England
Public Health England has asked us to cascade the following information regarding a supply issue with the flu nasal vaccine, requiring a phasing of supply of the vaccine. Practices are requested to implement the seasonal influenza programme as outlined in the Direct Enhanced Service Specification. Because of the phasing of supplies PHE recommends planning the childhood vaccination programme using following priorities:
Practice staff are asked to only order vaccine needed for the forthcoming week, even if this is below the maximum quota and to avoid stockpiling. Close adherence to the vaccine storage in the cold chain is essential to avoid vaccine wastage. Further details on eligible groups can be found in ‘The Green Book’ An information leaflet has been developed for parents to explain which children are eligible for vaccination and where this will be delivered.
PCN conference 2020
We have started planning for our second annual PCN Conference. We want this to be as informative and useful as possible, so we’re looking for PCNs and LMCs to share their stories. If you have an example of innovation or good practice that would benefit others, why not showcase it at our PCN conference, which will be held in Birmingham on Saturday 8 February 2020. Whether it’s inventive ways of utilising the funding, success in recruitment, or working well together to deliver PCN services, we want to hear from you.
Please email Dan Hodgson (dhodgson@bma.org.uk) with a short description of your project/work and how it is benefitting your PCNs, teams and/or patients, and we’ll get back to you to discuss further. Please also share with GPs and PCNs in your area – we really want to highlight those experiences that will benefit others.
PCN survey
A final reminder to please fill in our PCN survey to help us understand progress and inform the future development of PCNs, as part of the BMA’s commitment to PCNs as an opportunity to transform primary care by embracing new ways of working. The survey closes on 28 October.
Respond to the NHS pension scheme consultation
Final chance to respond to the Government’s consultation on introducing flexibilities to the NHS pension scheme, before it closes on 1 November. We believe it’s too little too late – we need its commitment to reform pension taxation, in time for the next tax year. This is your chance to raise your concerns – use our template to respond.
You may want to read a helpful blog from Paul Youngs, chair of the BMA Pensions Committee.
PCN Clinical Pharmacists – extension to transfer deadline
NHSE has written to CCGs to extend the deadline for transferring clinical pharmacists from the Clinical Pharmacist in General Practice Scheme to the PCN ARRS scheme, in exceptional circumstances. The deadline was originally 30 September 2019, but has been extended to 30 November 2019. The eligibility criteria for transfer has not changed, it simply provides more time for the transfer to take place.
After 30 November 2019, any clinical pharmacists who have not transferred will no longer be eligible to do so. They will not be counted as an exception to the baseline, meaning that these clinical pharmacists will need to be maintained by PCN member practices in order to claim reimbursement for PCN clinical pharmacists.
Social prescribing academy launched
Health and Social Care Secretary, Matt Hancock, has announced the establishment of the National Academy for Social Prescribing. The independent academy will receive £5 million and will be led by Professor Helen Stokes-Lampard, the outgoing Chair of the RCGP. It has been developed in partnership across government, with Sport England, Arts Council England and a range of voluntary sector partners. It is expected to:
I was interviewed by BBC Radio Oxford (2h 22m) about the potential for social prescribing.
CCG-Practice agreement for the provision and receipt of digital services in General Practice
Last month the NHS England and NHS Improvement published the revised GP IT Operating model. It covers the key policies, standards and operating procedures that CCGs are obliged to work with to fulfil their obligations. The model is intended to ensure that general practices have access to safe, secure, effective and high performing IT systems and services that keep pace with the changing requirements to deliver care. The 2019 edition includes;
A new CCG-Practice Agreement accompanies the release of this operating model. All CCGs and practices will be required to sign this new agreement which will provide clarity and assurance to both parties on the requirements for the provision and use of digital services available to general practices under this operating model. We have been told that NHS England will be publishing this on their website shortly.
Roll-out of electronic prescription service - England
Earlier this week, the Department of Health and Social Care announced the roll-out of electronic prescription service (EPS) in England next month following work done in pilot areas. Phase 4 will be rolled out to all GP practices from Monday 18 November 2019, making EPS the default method for prescribing and dispensing in primary care in England. Find out more about the implications for prescribers here. Please see the Phase 4 national roll out schedule.
Rules on IR35 are changing
Matt Mayer, deputy chair of the Sessionals GPs committee, has put together a helpful blog highlighting that the rules on IR35 are changing and how locum GPs might be affected. Private, as well as public sector bodies will now be responsible for determining the employment status of their workers.
Delays in transforming Welsh primary care
OnMedica has reported about delays in transforming Welsh primary care. In response to this, Phil White, GPC Wales chair, said: “After years of underinvestment in primary care we have been looking towards this new period of investment and policy development with growing impatience. We share the concerns that change is happening at too slow a pace and with too limited scale, something we’ve been highlighting for years. It’s no good to inject a single lump sum of cash into the system and expect effective change, increased funding needs to be supported by the spreading of good practice and sustainable ongoing financial support for successful schemes."
Read the article here.
Medical students in general practice underfunded
The British Journal of General Practice has published an article which showed that teaching medical students in general practice is seriously underfunded, arguing that this would have serious consequences for the NHS workforce if it was to continue. The article clearly demonstrates that the cost of providing undergraduate placements in general practice is considerably more than the funding given. It found that the actual cost of placing a medical student in general practice for a 37-week academic year was £40,700; similar to the cost of teaching undergraduates in secondary care. The average payment rate received by practices, however, was just £22,000 per year. The key messages from the article were reported inPulse (subscription required) and GP online
NHS Practitioner Health - England
NHS England has announced that all NHS doctors and dentists in England now have access to a mental health service 24 hours a day through a dedicated phoneline and a crisis text service available through the night. This builds on the service already available to GPs in England. To sign up, call 0300 0303 300 or email prac.health@nhs.net (Monday to Friday 8am to 8pm and Saturday 8am to 2pm). Text NHSPH to 85258 for the out-of-hours crisis text service.
Read the latest GPC newsletter here.
Read the latest sessional GPs newsletter here.
Publication of report into sexism and sexual harassment at the BMA
Yesterday, the BMA published the report from the independent investigation into sexism and sexual harassment at the BMA. The report makes clear that women have experienced discrimination and poor behaviour in our association and it identifies a number of cultural issues that must be addressed. The BMA has again offered unreserved apologies to all of those who have been affected by these behaviours.
The report makes several recommendations and supports the work we are already doing to implement the recommendations of the GPC UK Gender Task Group, which I established, and which reported back earlier this year. I am determined that we will address the important issues raised by this report and we will be discussing it, and how to take forward the recommendations, at the GPC England meeting next month.
You can read the full statement from BMA Chair of Council, Chaand Nagpaul, on the BMA website alongside the report and the recommendations in full. It was reported in The Guardian, Mail Online, The Independent, The Daily Telegraph, The Times (paywall), Pulse, BMJ and GP Online.
Scottish GPC meeting
The Scottish GP Committee met yesterday (17 October). The committee received updates on contract implementation and negotiations including: premises sustainability loans, income and expenses data collection from practices, and the remote and rural working group including flexibilities to continue delivering services that are transferring in more urban areas. In addition, there were general updates on information management and technology, sessional GP issues, GP training and various reports form external groups. There was more detailed discussion on the work of the Primary Care Prescribing/Dispensing Pathway to reduce paper dependence and a call to consider annual leave entitlement for zero hours workers in out of hours. There was a presentation provided by the Scottish Ambulance Service on a Healthcare Professionals Booking Guide and the progress of this work to improve GPs calls for ambulances.
CQC State of Health report
The Care Quality Commission’s (CQC) annual assessment of the state of health and social care in England showed that quality ratings in general practice remain high, but warns that ‘getting access to services can be a challenge'. The report focuses on the difficulties some patients have in accessing services across the NHS; a sign of the systemic pressures general practice, community and hospital services are under as a result of historic underinvestment. It also highlights that, despite the huge pressures general practice faces, 95% of practices are rated good or outstanding, which is far better than other services the CQC inspects. This is undoubtedly due to the hard work and commitment of practices across the country.
In response to this, Chaand Nagpaul, BMA chair of council said “Patients should be able to expect good standards of care right across the health service but the unacceptable variations of care highlighted in this report shows that many are being let down as a result of historic underinvestment.” This was reported in GPonline (sign-in required) and onmedica.
Queen’s Speech 2019
In the Queen’s Speech on Monday, it was announced that measures will be brought forward to support and strengthen the NHS, its workforce and resources, enabling it to deliver the highest quality care. In addition, new laws will be taken forward to help implement the NHS Long Term Plan in England, and to establish an independent body to investigate serious healthcare incidents. In response to this, Chaand Nagpaul, BMA chair of council said: “With Brexit dominating the political landscape, politicians must not be allowed to lose sight of the immediate pressures facing our NHS as we head into what could be its worst winter yet.” Read the full BMA statement here.
It was reported by OnMedica, and in the letters page of Yorkshire Post.
Safeguarding training update
Following our concerns about the impact on practices of implementing safeguarding training guidelines, NHS England has confirmed that it does not set the training requirements for practice staff, and that under GP contract arrangements it is for contractors to ensure that their staff are adequately trained to a level that keeps them and the public safe. We have updated our practice training resource to reflect CQC and NHS England expectations on safeguarding training. The NHS England letter is attached.
Expansion of multi-disciplinary teams in Northern Ireland
The Department of Health in Northern Ireland has announced that the multi-disciplinary teams (MDTs) initiative is being expanded into two new areas, as part of the latest phase of plans to transform care at GP surgeries across Northern Ireland. In response to this Alan Stout, Chair of NIGPC, said: “This new model will clearly benefit patients, but also importantly the system as a whole, by increasing capacity in primary care, supporting and sustaining practices and improving access for patients with a wide range of conditions.” Read the full statement here. It was reported in Pulse and GPonline (sign-in required for both).
Transfer of clinical pharmacists to the PCN DES
NHS England has extended the deadline for clinical pharmacists employed under the Clinical Pharmacist in General Practice Scheme to transfer to working under PCN DES until the 30th November 2019. This is to allow people more time to finalise the arrangements where a transition has been or was in the process of being agreed. After this date, any clinical pharmacists who have not transitioned to work as part of the PCN workforce delivering the duties outlined in the Network Contract DES will no longer be eligible to do so, and will be counted in the PCN staff baseline.
PCSE surveys
Please click on the links below to complete our PCSE surveys. We will be using the evidence provided to help us push NHS England to resolve outstanding operational issues. We received a high response to our previous survey and we hope that we can achieve the same again, so please encourage your local practices and GPs to give us their views.
Survey of GP practices
Survey of all GPs including trainees
PCN survey
A reminder to encourage local clinical directors to please fill in our first PCN survey to help us understand progress and inform the future development of PCNs. This is part of the BMA’s commitment to support PCNs and address their concerns. The survey closes on 28 October.
Medicine supply issues
The medicine supply update for October from the Department of Health and Social Care is attached. The DHSC has informed us that the MHRA has sent a CAS alert about ranitidine, stating that all oral formulations of ranitidine are anticipated to be out of stock, with no date for resupply until further notice. See more information in the CAS alert
The Pharmacists Defence Association has published the results from a survey of pharmacists about medicine shortages, which showed that on average, they had experienced shortages of 21% of prescription drugs in the last 3 months, with over 90% of respondents feeling that the shortages had increased over the last 12 months. It was reported by the Daily Mail.
Pulse reported that the government had said that 82% of medicine suppliers have a six-week buffer in preparation for Brexit. In response to this I said: “The very fact that manufacturers are being asked to stockpile six weeks’ worth of medicines underlines the graveness of the situation the NHS faces if we leave without a deal. While we hope that pharmaceutical companies are preparing for no-deal — as the Government seems intent on reassuring us — it is difficult for doctors to judge if this is the case as we are not privy to specific arrangements. Read the full article here (sign-in required)
Read the latest GPC newsletter here.
Meeting with Health Minister
Yesterday I met Jo Churchill MP, the new Minister with responsibility of Primary Care in England. It was a positive meeting and provided a good opportunity to discuss many of the issues impacting GPs and practices on a day to day basis. We focused particularly on the need for more GPs and the impact pension tax arrangements was having on retention, the problems many practices are having with premises and the on-going problems caused by Capita/PCSE. We also spoke about the development of PCNs across England, the need to support clinical directors and the opportunity to reconnect with the wider community healthcare team.
Primary Care Networks survey
The BMA has launched an annual survey to understand progress and inform the future development of Primary Care Networks (PCNs). This is part of the BMA’s commitment to PCNs and to ensure we provide them with all the support they need. This annual survey will provide an opportunity for clinical directors to share their perspectives on how PCNs are operating on the ground, to tell us how they see their PCNs developing and will provide us with the necessary information to use in our negotiations with NHS England.
You can access our recently launched PCN package of support. Read Krishna Kasaraneni’s article in Pulse on PCNs being a chance to redefine general practice and feel empowered about the future here (sign-in required).
Primary Care Fellowships
Local integrated care systems and STPs have received funding in 19/20 to support the development of fellowships for April 2020. NHS England and GPC England are working together to provide some joint guidance which will be made available in the next few weeks. LMC and PCNs may want to start thinking about how they see these developing locally to meet local challenges.
Respond to the NHS pension scheme consultation
The Government has reissued its consultation on introducing flexibilities to the NHS pension scheme. We believe it’s too little too late – we need its commitment to reform pension taxation, in time for the next tax year. This is your chance to raise your concerns – use our template to respond.
Locum guidance on pension annualisation
The BMA has sought clarity from NHS Business Services Authority on annualising for sessional GPs who are members of the 2015 career average revalued earnings scheme. Locums who work out-of-hours can now be afforded a different pension status as part of the 2015 scheme. This will change how their pensions are annualised. Read more here.
GDPR and SAR: Update on the provision of medical records to solicitors
A recent court case has considered a dispute about how medical records are made available to solicitors requesting them on behalf of patients. We are seeking full information about the case and once we have this we will review the details to ensure we provide the most up to date guidance to members.
Learning disability registers
NHS England have published new guidance for practices to ensure that learning disabilities registers are comprehensive and up to date and vulnerable patients are given the opportunity to receive flu vaccinations and annual health checks. We encourage practices to use this guidance to regularly review their learning disabilities registers to ensure they are up to date so that the right patients are being invited to attend vaccinations and health checks. However, we have raised concerns with NHSE about the significant amount of GP time that it will take to manually update registers to include all of the conditions listed and are pressing NHS England and NHS Digital to commission an automated system as soon as possible. Meanwhile, where diagnosis of a learning disability is unclear, GPs should refer for a specialist assessment.
Pharmacy contract changes
In July 2019, the Pharmaceutical Services Negotiating Committee (PSNC), NHS England & NHS Improvement and the Department of Health and Social Care agreed a five-year deal for community pharmacies. We contacted the PSNC following some reports about practices being approached by patients about diabetic checks. The PSNC has now produced a web page outlining how these changes are relevant to GPs, including a briefing document which summarises the changes that would be of particular interest to practices. We will also be meeting with the PSNC to discuss how these changes impact on practices. LMCs should discuss with LPCs about how best the pharmacy contract requirements should be done locally.
Medicine shortages
The Department of Health and Social Care has shared the attached communications about supply issues for Adrenaline Auto-Injectors, Detrusitol XL (tolterodine) 4mg capsules and Nardil (phenelzine sulfate) 15mg tablets.
As we reported last week, the Government are introducing new restrictions on the exportation of all variations of HRT products, some of which currently face supply shortages due to manufacturing issues. The Mirror reported of concerns of further shortages in the event of a no-deal Brexit. In response to this, Farah Jameel, GPC England executive team member said: “The menopause can be a very difficult time for women, so it’s essential they have access to the medication they need, particularly as we head into winter. This is when pressure on NHS is most intense and uncertainty grows around the fallout of a potential no-deal Brexit.” Read the article here.
Ibuprofen shortages
Some supermarkets have reported shortages of ibuprofen, claiming it is due to global shortages. In response to this, Farah Jameel, GPC England executive team member said: “While any supply issue impacting the availability of commonly used medicines can worry patients, for those buying painkillers on the high street paracetamol is often a very safe and effective alternative to ibuprofen. If in doubt, patients should speak to a pharmacist for further advice.” The articles refer to our statement on shortages from last week. This was reported by the Sun, Mirror and Daily Record.
STPs and ICSs Guidance
The BMA has published new guidance designed to support members to engage with and influence their local STPs and ICSs, building on our previous work on integration and our wider messaging around the importance of clinical engagement. The guidance, which is available on the STPand ICS webpages, is intended to help frontline doctors to secure and capitalise on local engagement. It provides advice on the changes taking place within ICSs and STPs, suggested questions and tips on engagement, as well as contact information and a template letter to assist members in contacting their system leaders. If you have any questions about the guidance, any feedback you would like to share regarding the changes happening in your area, or would like support in engaging with your local ICS or STP, please contact Tom Bramwell at tbramwell@bma.org.uk
Sunday Mirror campaign
The Sunday Mirror has launched a campaign calling on the Government to end the crisis in doctors’ surgeries, by boosting the number of trainee GPs, creating 30 million extra appointments, and reduce the number of GPs leaving the NHS by improving working conditions. In response to this I said: “Recruitment efforts have been significant over recent years, but despite these efforts, we are still desperately short of GPs across the UK. Despite their best efforts, surgeries are struggling to fill vacancies making it hard to cope with growing patient demand. This leaves teams demoralised, and communities frustrated as they wait longer to get the care they need.” Read the full quote and article here.
Decline in GP pay
The Daily Mail reported on a survey by the University of Manchester over a 10-year period, which showed that, after adjusting for inflation, GPs earn 14% less than they did in 2008. In response to this, I noted the fall in GP income since 2006 and added that “Since 2017, we have seen positive efforts to redress the balance with negotiated contract changes that in the most recent official figures showed a long overdue pay uplift. But the now deepening problem of pension taxation rules is no doubt a looming threat to GP recruitment and retention; add this to increasing workload and demand, and it paints a sorry picture for GPs and others working in general practice”. Read the full article here.
BMA response to no-deal readiness report
The BMA has responded to the Government’s No-Deal Readiness Report, which outlines what will change should no Brexit agreement be reached by October 31, Chaand Nagpaul, BMA council chair, said: “With little more than three weeks to go until Brexit day, there’s no sign of who is going to provide an emergency transport service for critical medicines and medical supplies, or extra freight capacity to guarantee that patients can continue to get the drugs they need in the event of a no-deal. Overall, this document underlines the sheer scale of the task at hand, with almost no area of industry and society unaffected, not least the NHS and the health of the United Kingdom.” Read the full statement here. It was reported by the Times(sign-in required)
NHS app campaign
NHSX are launching an information campaign about the NHS App next week. The App can be used by 96% of people in England, providing a core and consistent digital offer from the NHS, in line with commitments set out in the NHS Long Term Plan. NHSX wanted to make sure the NHS App provides a good service and user experience, and as such, are taking the approach of launching this campaign with staff and partners first, promoting it incrementally, while asking for feedback in order to improve. NHS staff will be able to feed back directly within the NHS App.
They have created a toolkit of materials to help NHS organisations promote the app to staff, which can be used in organisations' internal communications channels. All this work is supported by the promotion taking place in many GP practices across the country, telling patients about the benefits of the app. NHSX will be refreshing GP practice materials to coincide with a public facing phase of our campaign later in the year. If you have any feedback, please send it to appfeedback@nhs.net.
World Mental Health day
It was the World Mental Health day yesterday, which the BMA marked by the publication of a report on mental health and wellbeing in the medical profession, which highlights systemic challenges such as changes to workplace structures and workflows as being fundamentally damaging to doctors’ work life and mental wellbeing.
These factors were interpreted as being imposed on doctors, including through government-led cost-cutting initiatives.
The report also highlighted the problems which are caused by the 10 minute consultation window not being sufficient time. The consultation time was considered at odds with the increasing complexity of patient care in general practice, with an ageing population, and patients presenting with multiple diagnoses and more medicines to monitor. Alongside the report the BMA published a mental wellbeing charter to call on employers to take leadership on staff mental health and provision of support. Read the report and charter here, and the BMA press release here. It was reported by the BMJ, GP online (sign-in required) and Pulse (sign-in required)
The Department of Education and DHSC also published their first 'State of the Nation' report, to coincide with Mental Health Day. The findings show that than 4 in 5 children and young people report being happy with their lives, rating themselves happiest with their family and friends, their health, their school and their appearance as key factors.
CMO report on childhood obesity
The Chief Medical Officer, Professional Dame Sally Davies, has published a special report on Time to solve childhood obesity – read it here.
PCSE surveys
We would be very grateful if LMCs, practices and individual doctors could fill in our short surveys about PCSE to see how things have developed since our previous surveys in December 2017. This will enable us to influence operational issues on your behalf and give us the hard data to substantiate the anecdotal evidence we also receive.
Survey of LMCs - this has three short questions for each statutory LMC to complete.
Survey of GP practices - please could you forward this to all your practices to complete.
Survey of all GPs including trainees - we would appreciate it if you could share this with your members particularly with locum GPs and trainees.
The deadline for responding to the surveys is noon, Friday 25 October. The greater response we have, the stronger our hand when discussing matters with NHS England. We really appreciate your help
Vacancy for new member on GMC
The GMC are recruiting for a new member of our Council. Applications are open to medical candidates with a licence to practice, from diverse communities in the four countries of the UK, until 31 October 2019. You can find out more information about the role on the GMC website
Read the latest GPC newsletter here.
Conservative party conference
Following my visit to the Labour Party Conference last week, I attended a number of events and had some useful conversations at the Conservative Party conference in Manchester this week.
- I spoke to Matt Hancock, Secretary of Health and Social Care, regarding MMR uptake, the NHS App and pensions and GP access
- I went to the annual GMC dinner, hosted by Charlie Massey, alongside Chaand Nagpaul BMA chair of council) and Rob Harwood (Chair, Consultants Committee) – which provided a fruitful opportunity to discuss a range of healthcare and regulatory issues.
- I contributed to the NHS Providers roundtable on building the NHS of the future and spoke with representatives of some of the royal colleges, as well as health select committee member Andrew Selous MP and Sir Geoffrey Clifton-Brown MP, member of the public accounts select committee.
- I met Richard Graham MP to talk about the impact of pension taxation on the NHS and particularly on sessional GPs and partners.
- I attended and contributed to the Centre for Progressive Policy roundtable on health, the Academy of Medical Royal Colleges meeting on Solving the NHS staffing crisis: what do doctors think?and the Policy Exchange event on the topic Is it time for social care to be funded like the NHS? with Baroness Cavendish of Little Venice, former Director of the Number 10 Policy Unit and former Health special advisers
At an event at the Conservative Party conference, Matt Hancock, the health secretary, said that he is "looking very seriously" at making vaccinations compulsory for all children going to school in England, and that he had commissioned legal advice on the matter. Last week NHS Digital data showed a decline in coverage for all routine childhood vaccinations in England. This was widely reported, and many referred to the BMA policy on childhood vaccinations, which has stopped short of calling for compulsory vaccinations. In my brief conversation with the Health Secretary I said that whilst we did not support compulsory vaccination we did want to work with the government to do all we could to improve immunisation uptake and address the measles outbreaks. This was reported by the BBC, Independent, Guardian, Metro
Primary Care Network Package
As you are aware, we launched a PCN package of support last week, which is flexible and wide-ranging and allows different PCNs and Clinical Directors to pick and choose the guidance, support and assistance they need. This includes access to a PCN community App, a forthcoming PCN Conference on 8 February 2020, a package of learning & development services and support for legal, HR and insurance issues. Please promote this resource to clinical directors in your area.
GMS and PMS amendment regulations
The GMS and PMS amendment regulations came into force on 1 October 2019. As usual, this is an amendment and not a new consolidated version of the full regulations, therefore the amendment must be read in conjunction with the 2015 consolidated regulations.
NHS England proposals for the repeal of Section 75 of the Health and Social Care Act
NHS England has approved a series of recommendations to the government for the introduction of an NHS Integrated Care Bill and the scrapping of section 75 of the Health and Social Care Act 2012, which forces the NHS to automatically advertise healthcare contracts for competitive bidding.
The BMA opposed the 2012 Heath and Social Care Act and has repeatedly called for section 75 to be repealed, and we issued a public statement supporting the abolition of current legislation and calling for further details to be provided. We hope new legislation will set out additional measures, reflecting the BMA’s campaigning, and we will be seeking clarity of what arrangements would replace Section 75. We also hope to influence the drafting of the Bill and we will continue to lobby for a publicly funded and publicly provided NHS.
Medicine shortages
A Serious Shortage Protocols for the antidepressant Fluoxetine 10mg, 30mg and 40mg capsules which are currently out of stock was published by the Government yesterday. Fluoxetine 20mg capsules, tablets and oral solutions remain available in sufficient quantities to mitigate this supply issue during the affected period, and therefore SSPs have been issued, allowing pharmacists to switch to another strength of pharmaceutical form of Fluoxetine. Pharmacists would always have to use their professional judgment to decide whether it is appropriate to supply against an SSP and patients can always refuse the alternative and instead go to their GP to discuss alternative treatments. The NHS BSA webpage also includes useful operational guidance on SSPs and Q&As.
In response, Farah Jameel, GPC England Executive team member said “While this protocol is a sensible measure in theory, patients must have the reassurance that changing the strength or form of their much-needed medication – in this case commonly used for mental health related conditions – won’t have any adverse effects. Furthermore, we have to be sure that it won’t add to GP workload or cause unnecessary confusion among practice teams.” Read the full statement here. This was reported by Pulse.
The Government also announced yesterday, that they are introducing new measures to tackle HRT shortages. The Government has confirmed new restrictions on the exportation of all variations of HRT products, some of which currently face supply shortages due to manufacturing issues. The Daily Mail reported on a poll by Chemist and Druggist which showed that pharmacists are experiencing shortages of every major type of medicine, including hormone replacement therapy (HRT) being the most common, antidepressants and anti-epilepsy pills. In response to this, Farah Jameel, said: “There are lots of different reasons why drug shortages happen, but they are gradually getting worse and can have a serious effect on how quickly patients receive appropriate treatment. Practices often won’t know that a drug is in short supply until patients return from the pharmacy, and these extra GP appointments can dramatically add to their already burgeoning workload – as well as distressing patients.” Read the full statement here. This was also reported by the BBC, the Evening Standard, Birmingham Mail, Chronicle Live, ; and Tom Yerburgh, Deputy lead for GPC’s clinical and prescribing policy group, was interviewed by BBC Radio Gloucestershire
Online consultation guidance
NHS England has published guidance and an implementation toolkit for practices and commissioners, in using online consultations in primary care. Read more here.
Babylon GP at Hand planned expansion
GPonline has reported that that the online provider Babylon GP at Hand plans to expand to Manchester from early next year. In response to this I said: “'Practices in Manchester will be concerned about this proposed extension and the potential destabilising impact it could have. Cherry-picking largely healthier and wealthier patients at the expense of the poor and vulnerable is not what the NHS is about nor should be supporting.
Practices want to be able to offer a full range of services to their patients, including where clinically appropriate digital services and video consultations, but they are dependent on CCGs and NHS England enabling this. There is therefore an urgent need to upgrade practice IT and this should be the priority, not focusing on alternative providers.” Read the full article here.
PCSE surveys
GPC England ran a range of surveys in December 2017, which gave us useful detail and evidence of the problems practice staff and LMCs were facing as a result of the service delivery of PCSE. The response was extremely helpful in our efforts to push NHS England to resolve these issues. There are clearly a large number of on-going problems with this service and we are therefore repeating the surveys to gauge how things are now. This will enable us to influence operational issues on your behalf and give us the hard data to substantiate the anecdotal evidence we also receive.
Please would LMCs, practices and individual doctors take a few minutes to complete the following simple surveys:
Survey of LMCs - this has three short questions for each statutory LMC to complete.
Survey of GP practices - please could you forward this to all your practices to complete.
Survey of all GPs including trainees - we would appreciate it if you could share this with your members particularly with locum GPs and trainees.
The deadline for responding to the surveys is noon, Friday 25 October. As you know the greater the response we have to these surveys, the stronger our hand when discussing matters with NHS England. We really appreciate your help on this.
Debt and mental health form (DMHEF)
A new Debt and mental health form and process has been introduced this week following a cross sector agreement with the BMA. New BMA guidance has been published from 1October 2019 and a much shorter form has been introduced that can be completed by a wider range of healthcare professionals, thereby reducing the burden on GPs. As part of the agreement, GPs in England can no longer charge a fee for completing the DMHEF. The only contractual requirement is to answer yes or no when asked whether the indebted person has a mental health condition and if the answer is yes then to give the name of this condition. There is no obligation or expectation to complete the reverse of the form. All forms and accompanying guidance are available on the Money Advice Trust website.
In response, I said: “We want to empower patients by encouraging the use of self-certification and reduce the need for GP practice involvement in these situations, but we hope that, where that’s not possible, this updated form will now make things quicker and easier for those to get the help they need and deserve.” Read my statement here. This was also reported by GP online (log-in required)
Practices and overseas visitor charging
We have been made aware that NHS Trust Overseas Visitor Managers (OVMs – staff member(s) responsible for charging overseas patients for NHS treatment in hospitals) have written to local GP practices requesting their help in identifying whether patients are eligible for free NHS care. Specifically, the OVMs have asked GPs to note on referrals that patients are ‘overseas visitors’ if they have been resident in the UK for less than 6 months. We want to reassure GPs that this is absolutely not their responsibility and that they are not required to do so.
Guidance from the Department of Health and Social Care is explicitly clear that the responsibility for determining a patient’s eligibility for NHS care lies with the Trust and never with a GP or GP practice. This guidance also clarifies that the GMS1 supplementary questions regarding a patient’s eligibility for free care are not required to be completed before a patient can register with a GP practice, and that this should be made clear to prospective patients.
The BMA has also produced specific guidance on access to healthcare for overseas patients, available here. If you have any questions the overseas charging system, or have examples of OVMs approaching your practice please share them with tbramwell@bma.org.uk
The stress of pensions, updating records and TRS statements
The NHS Pension Scheme is complicated but is generally worthwhile, with additional benefits such as ill health retirement and life assurance. As we have previously highlighted, NHS England is working to ensure all pension records are correct. They have assured us that all records will be corrected in the long term and in advance of GPs taking retirement. We would suggest that you keep copies of any correspondence you have with Capita (PCSE) or NHS pensions. In the interim you may want to check your record via the Total Rewards Statement (TRS), which was updated in August and will be updated again in December. The cut-off date for the TRS update is 11 October. Read more in the blog by Krishan Aggarwal, member of GPC UK, Sessional GPs Committee and BMA Pensions committee.
Registration to the MHRA Central Alerting System (CAS)
A reminder that from 1 October 2019, the Medicine and Healthcare products Regulatory Agency will send CAS patient safety and public health alerts directly to GP practices, replacing any local arrangements currently in place. All GP practices in England are contractually required to register to receive CAS alerts directly from the MHRA by accessing this portal. If practices have not already registered, we would suggest you do so as soon as you can.
National Dynamic Purchasing System Events
NHS England and NHS Improvement are launching a new online procurement tool which will include a list of pre-approved GP providers that local commissioners can invite to deliver their local GP service needs, including caretaker services. This approach, known as a Pseudo Dynamic Purchasing System (PDPS), is planned to be live from January 2020. A number of national engagement events are planned for current and prospective GP providers to find out more:
Horizon Leeds - 23 October 2019 (2 – 4 pm)
Edgbaston Stadium - 28 October 2019 (2 – 4 pm)
Ambassadors Bloomsbury Hotel, London - 30 October 2019 (2 – 4 pm)
To book your attendance click on the event booking link here
GP appointment data (GPAD) webinars for LMCs
Since 2004 general practice has experienced major rises in workload relating to direct patient care, with particularly marked increases in face to face and telephone consultation rates. In order to help workforce planning and help measure the effects of new ways of working and supporting patients to self-manage, the Department of Health and Social Care commissioned NHS England to collect information on general practice capacity and utilisation across all practices. This was to inform national policy development but also for use by CCGs and practices to enable them to better manage resources to meet demand from patients. The only potentially useful source of this information is from the appointment books maintained by practices in their clinical systems.
NHSx and NHS Digital would like to invite LMCs to hear about the current progress on work on national categorisation of General Practice appointment data in England, and to provide an update about the pilot work and an opportunity to engage and shape the future outcomes of the project. The webinars will take place on Wednesday 16 October 2019 and Friday 18 October 2019 (12:30pm – 1:30pm). To register, LMCs should email Peter Burke at NHS Digital, on peter.burke3@nhs.net. Note that the webinars will be recorded and made available on Kahootz (NHS collaboration platform), which will allow LMCs to view and cascade them to local GPs.
Primary Care Network Package launch
We have launched a PCN package of support this week, based on what GPC, LMC and PCN colleagues told us they need during a series of roadshows, webinars, masterclasses and the PCN conference earlier this. It is flexible and wide-ranging and allows different PCNs and Clinical Directors to pick and choose the guidance, support and assistance they need. This includes access to a PCN community App, a forthcoming PCN Conference on 8 February 2020, a package of learning & development services and support for legal, HR and insurance issues. Read the blog about it by Krishna Kasaraneni, GPC England Executive team member here
Labour Party conference update
I attended the Labour Party Conference earlier this week, attended some events and had some useful conversations. At a RCGP fringe event, ‘Wearables, Wifi and Workforce’, I joined Jonathan Ashworth (Shadow Secretary of State for Health), Professor Helen Stokes-Lampard (Chair of RCGP Council) Ipsos Mori’s Kate Duxberry and the Health Foundation’s Sarah Deeny on the panel. I had a particularly useful conversation with Jonathan Ashworth about resolutions passed by the conference and his desire to see both investment in General Practice as well as improvements in access for patients. I also met with Julie Cooper MP (shadow health minister), where we discussed a range of issues linked to primary care, including establishing PCNs, pensions, premises, recruitment and retention and multidisciplinary teams.
Other useful meetings included Eleanor Smith MP (co-chair of APPG on social care), who talked about her APPG on social care and the importance of pushing social care in any debate on healthcare. We also discussed potential practice closures due to premise costs, the BMA’s work re NHS Property Services, and GP pensions issues. Representatives from a number of medical royal colleges attend the conferences and I met with Professor Russell Viner, President of the Royal College of Paediatrics and Child Health (RCPCH) to talk about the link between primary care and paediatrics and how this could be strengthened through community developments within primary care networks.
Labour commitment to scrap prescription charges in England
It was announced at the Labour party conference on Saturday that the next Labour government will abolish prescription charges in England as part of the party’s plans to expand universalism in public services. In response to this, Farah Jameel, GPC England executive team member said: “The BMA has repeatedly called for prescription costs to be abolished. Prescription charges can be a huge expense, particularly for patients living with long-term conditions. Getting rid of them will mean more people are able to take the medication they need without having to worry about how they make ends meet; how they choose between paying a bill and buying food or paying for their prescription."
This was reported by Sky News, Nursing Notes, Yorkshire Post, Pulse, BMJ, Pharmacy Magazine, Training Matters, P3Pharmacy and the Yorkshire Evening Post.
GP indemnity update
The Department of Health and Social Care has agreed the arrangements for the existing liabilities scheme (ELS) with Medical and Dental Defence Union of Scotland (MDDUS). This follows a similar agreement with MPS. Read more here
Capita - Incorrectly Archived Records
We recently released a statement regarding the PCSE incident whereby thousands of patient medical records were incorrectly archived instead of being sent to the subsequent GP practices. These records have now been sent back to practices, and NHS England is expecting those practices to undertake an assessment of harm for each patient affected. Practices affected will have received a list of NHS Numbers of the patients whose record was delayed.
GPC England was in discussions with NHS England to highlight the impact this would have on practices and their patients. We were clear that practices should receive the necessary support to cover the additional costs of dealing with a problem for which they are not to blame to ensure that GPs and other practice staff are not taken away from direct patient facing provision. Unfortunately, NHS England was not prepared to provide the amount of funding that we believe is necessary to cover GP and practice staff time required to do this assessment properly, and GPC England was not prepared to agree to a settlement which we believed would not fully compensate practices for the problems created by Capita.
As a result, we are looking for practices to join our potential legal action. Practices will need to complete the attached pro forma and send them to the BMA via info.gpc@bma.org.uk in order to sign up to the case. We will then collate the necessary information to take forward a legal action.
Digital-first primary care consultation outcome
NHS England and NHS Improvement has now published their response to the digital-first primary care consultation, where they sought views on options and proposals to change patient registration, payment and contracting rules. We have drafted a briefing for LMCs about it, which is attached.
Investment in GP Services in Northern Ireland
The Department of Health has announced £26.76 million investment in GP Services in Northern Ireland for 2019/20. In response to this, Alan Stout, Chair of GPC Northern Ireland said: “This funding announcement is good news for GPs, for primary care and for patients across Northern Ireland. The transformation money that has already been spent is beginning to make a difference for GPs, helping to ease their workload and allowing frontline services to patients to be spread across a range of health staff who are best suited to addressing a patient’s needs. This increased investment will mean that more GP practices will be able to begin the process of transforming the way they deliver services.” Read his full statement here. This was also reported by Onmedica and Pulse
Drug shortages
GPonline reports that more than 100 drugs prescribed in primary care are now out of stock. In response to this I said that practices were facing additional workload because patients were frequently being forced to come back following appointments to request an alternative prescription. “It is having a serious impact. There is real uncertainty over whether common medicines are going to be available, and patients may have to return to their practice to get an alternative prescription, or go round lots of pharmacists looking for one that has a particular drug in stock.” Read the full quote and article here.
Supply issues for Provera and Fluoxetine
Please find attached updates on supply issues for Provera and Fluoxetine from the Department of Health and Social Care.
New regulations on notifications of death
For the first time, the Government has introduced regulations that place a duty on registered medical practitioners to notify the coroner of certain deaths, and what information should be provided. They apply to England and Wales, and become law on 1 October 2019. Read the Ministry of Justice’s guidance on complying with the regulations here
Firearms guidance and flowchart
Our joint response to the Home Office consultation on statutory guidance to police on firearms licensing and a flowchart to guide GPs and police through the licensing process are now available on the BMA website.
Statement from regulators on online primary care services
The General Pharmaceutical Council, the GMC and other UK regulators of healthcare services, medicines and health professionals have put out a joint statement on online primary care services and ensuring medicines are prescribed and dispensed safely and appropriately online. This cross regulatory forum are working to address regulatory gaps and to help improve the quality and safety of services, and develop an understanding of the benefits and risks of primary care services delivered online. The aims of the group, and links to existing guidance, is available here.
Equality matters
This week, the BMA launched Equality matters, which is designed to promote equality for all medical students and doctors working in our health service and also within the BMA. On the programme’s web hub you can find training resources, and:
Read a blog by Chaand Nagpaul, BMA Chair of Council, here, where he outlines why this programme is fundamental in the BMA’s call to change the culture within the NHS and the BMA. Please send any feedback on how we can further the aims of this important programme toequalitymatters@bma.org.uk
Benefits for mixed aged pensioner couples
Following a DWP policy change certain pensioners in mixed age couples will have begun claiming working age benefits rather than pension age benefits. New DWP guidance for GPs issuing fit notes for these pensioners has been published.
Updated DWP guidance for GPs
The DWP have also recently updated their Short guide to the benefit system for GPs and their guidance on factual medical reports
New online procurement tool
NHS England and NHS Improvement are launching a new online procurement tool which will include a list of pre-approved GP providers that local commissioners can invite to deliver their local GP service needs, including caretaker services. This approach, known as Pseudo Dynamic Purchasing System (PDPS), is planned to be live from January 2020. A series of national engagement events are being held for local commissioners and GP providers. Find out more here.
Committee visitors scheme for GPC Meetings
The BMA committee visitors scheme allows interested parties to participate as non-voting committee member of GPC, with the opportunity to attend meetings and take part in discussions. If you have not participated in BMA work before the scheme is an excellent opportunity to gain experience of what it is like to serve on a committee and contribute to the future of your profession. For further details, please visit the BMA website
LMC observers at GPC meetings
LMC observers are welcome to attend GPC meetings. If your LMC would be interested in sending an observer, please contact Kathryn Reece (kreece@bma.org.uk). A maximum of three LMC observers may attend any one meeting. The date for the 2019/20 session for GPC meetings are below. Meetings will commence at 10:00am and will usually finish at 5:00pm (never later than 6:00pm).
| GPC England | Thursday 21 November 2019 | BMA House, Tavistock Square, London WC1H 9JP |
| GPC England | Thursday 16 January 2020 | BMA House, Tavistock Square, London WC1H 9JP |
| GPC UK | Thursday 19 March 2020 | Wales – To be Confirmed |
| GPC England | Thursday 16 July 2020 | BMA House, Tavistock Square, London WC1H 9JP |
Please note that all travel and other expenses for LMC observers should be met by the relevant LMC.
GP Retention Scheme
Read the step-by-step guide for the GP retention scheme. The scheme offers support for GPs who are considering leaving the profession if they have no other options to reduce their hours. You can also view the NHS England video and guidance here. If you have any difficulties, please get in touch by emailing sessionalGps@bma.org.uk
BMA Law conference – Supporting General Practice
Join BMA Law’s specialist team for a series of immersive discussions providing advice on the running of your practice at their Conference on Supporting General Practice, on Thursday 31 October 2019, BMA House, London. From PCN governance to practice disputes, this is an excellent opportunity to meet their lawyers and learn about mitigating the legal pressures facing practices today. For further information and to sign up see the BMA Law website
Forensic and secure environments committee elections
The FSEC (forensic and secure environments committee) is holding an online election, which can be accessed via BMA’s elections page. The position for one doctor providing primary healthcare within forensic psychiatric hospitals in the UK remains vacant. If you are interested in this position, please email elections@bma.org.uk for more details.
Read the latest GPC newsletter here.
Read the latest Sessional GPs newsletter here
GPC UK meeting
Yesterday was the first GPC UK meeting of the session. I extended congratulations to Phil White, the newly elected Chair of GPC Wales and to Sandesh Gulhane and Lynn Hryhorskyj on their election as Co-chairs and Marie McVeigh as deputy chair of the GP trainees committee.
The committee focused on a wide range of areas, including updates on contractual negotiations in the four nations, the work of the policy groups and reports from the sessional GP committee and GP trainees committee. We discussed the actions taken in recent months to improve sessional representation and the important work on this area continues, working in partnership with the Sessional GPs Committee. We also received an update on the work of the Cameron Fund which is the only medical benevolent fund that solely supports general practitioners and their dependents.
The committee welcomed the GMC and RCGP statement on GPs as a speciality (see further information below).
We received the results of a GPDF commissioned survey exploring the views of both GPC and LMC office holders. We are working hard to ensure we deliver what LMCs and the GPs we represent want from GPC and receiving feedback is helpful in improving what we do. The results will inform the ongoing work of both GPDF and GPC.
We had a timely update on the issues relating to pensions and the BMA’s plans to respond to the recently published pension consultation. This was an area of work that affects across all 4 nations and GPC UK discussed the implications for frontline GPs including the impact of the current tapering and annual allowances and also the current challenges with annualisation for GPS, particularly for locum GPs.
The next meeting of GPC England will take place on Thursday 21 November in BMA House, London and the next GPC UK meeting will take place on Thursday 19 March 2020 in Cardiff, Wales.
GPC UK Executive and GPC policy leads confidential update
Please see the attached (appendix 1) which is an update that summarises developments since the last meeting of GPC. These updates are produced on behalf of the GPC UK Executive and the GPC Policy Leads.
GP investment report
NHS Digital have today published the report Investment in General Practice, 2014/15 to 2018/19, England, Wales, Northern Ireland and Scotland has now been published. This report details the investment in General Practice and the reimbursement for drugs dispensed in General Practices from 2014/15 to 2018/19. The report draws on information from the financial reporting systems of the health departments of each country and other published data on reimbursement and remuneration for dispensing activity. The report reveal a 1.4% increase on the previous year in investment in general practice, and represents just 8.1% of the NHS budget going to general practice, falling far short of the BMA’s demand of 11%.
I responded to the report saying “For too long investment has not kept up with the demands being placed on general practice, and the marginal increase in the year up to April this year – itself far smaller than in previous years – is completely inadequate. Over the same time period the number of patients registered at practices in England went up by more than 700,000 and we lost more than 500 full-time equivalent GPs – meaning doctors and their teams are being stretched to their limits.” Read the full statement here. Read the press coverage here.
In addition I was interviewed on BBC Radio York, saying that more and more staff were experiencing burnout as understaffed hospitals and GP practices struggle to cope with demand following years of under investment in the NHS. The interview came in the wake of Prime Minister Boris Johnson confrontation with a member of the public during a visit to Whipps Cross Hospital in east London on Wednesday. Is said that "every patient, every clinician who is working within the NHS realises that the NHS is under huge pressure as we've got a growing population, but we haven't seen the similar level of resources increase year on year to be able to match expectations and the needs of our patients….It's down to the hard work and dedication of staff within the NHS hospitals and in general practice as to why we've been able to maintain the high level of services we have."
Listen to the interview in full here (from 17 minutes).
NHS payments to general practice
NHS Digital have also published their annual report on NHS Payments to General Practice in England for 2018/19. This provides information on NHS payments to individual providers of general practice services in England. Figures are given for the main payment categories - which include Global Sum, PMS expenditure, QOF and Local Incentive Schemes. It constitutes the majority of actual monies paid to practices for all activities and costs during the 2018/19 financial year. For further details please use this link
The BMA responded to this report at the same time as the wider in investment in general practice report. I commented that “practices receive just under £155 a year on average per patient to provide virtually unlimited care. Not only is this astonishing value for money for the Government, but it also demonstrates how hard GPs are working to care for patients in their area, many of whom will have a series of complex conditions, with inadequate investment in return.”
Cervical screening Capita incident
We have been informed of yet another incident due to Capita/PCSE not dealing with emails and letters relating to cervical screening and which were delayed or not processed correctly. A full review found the vast majority of these unprocessed items were correctly handled through another route, as part of the NHS Cervical Screening fail safes that are in place, but four women missed an invitation to attend their appointment. In response to this I commented: “Just months after a similar incident came to light, and a year after tens of thousands of women missed vital correspondence on cervical screening, it beggars belief that patients and GPs are dealing with the same issue once again due to Capita’s incompetence. The numbers may be far smaller, but if just one patient comes to harm as a result of this blunder, it’s one patient too many. While Capita has been rightly stripped of the cervical screening programme, this is further evidence that the company is unfit to hold further contracts for GP backroom services and NHS England must take it back in-house immediately.”
Recognition of GPs as specialists by GMC
In January 2017, the General Medical Council (GMC) backed our long-standing call for GPs to be added to the specialist register. Together with the Royal College of GPs (RCGP), we released a joint statement in February 2018 calling for the formal recognition of general practitioners as specialists in the UK. The BMA, RCGP and GMC issued a further statement this week calling for changes to the Medical Act to formally recognise GPs as expert medical generalists and specialists in general practice. Read the September 2019 joint statement here and it was tweeted here.
Read the statement on the RCGP website and on the GMC website. It was also reported in GPonline Practice business.
Primary Care Network addresses
CCGs will be requesting PCNs in their area to confirm an address for the group. This is to allow the allocation of ODS codes for PCNs, which will enable a move to automated payments in future years, as well as providing access to nhs.net email accounts for the PCN. PCNs will need to confirm if they want their nominated payee to be the postal address used and if not, to then confirm what address should be used.
Indemnifying flu vaccines for staff
Following the decision by the Department of Health and Social Care and NHS Resolution that CNSGP will not cover practices who vaccinate their own staff against flu, we have been in discussions with the Medical Defence Organisations on the matter. They have all provided us with reassurance that all current members will be indemnified through them for this activity. If you are in any doubt about any of your indemnity arrangements then we would advise you to contact your MDO who will be able to guide you.
Inability to log on to access the Total Reward Statement
We have been informed that where members have changed their name for work purposes but have retained a former name for pension records access to the Gov.UK Verify portal is restricted as it does not link the two names. Individuals affected by this should contact NHS England (england.pensionescalations@nhs.net) who will support them in resolving their issue, which may include the submission of the marriage certificate to NHS Pensions.
Prescription penalty charge notices
The Mirror reported about the answer given to a written parliamentary question with figures showing thousands of vulnerable patients are being wrongly accused of fraud and being harassed unnecessarily by NHS fraud teams for prescription fines. In response to this I said: “Any fraud that takes place in relation to prescription charges must be addressed especially at a time of intense pressure on NHS resources. However, the current over-complicated system means that genuine mistakes are often at the heart of some of the incorrect claims. We must not create a culture where patients, particularly those in vulnerable circumstances, face barriers to them gaining access to prescriptions they can legitimately claim. Far too many members of the public on the receiving end of distressing, threatening letters or fines which could impact their mental wellbeing. The Government needs to move towards a more streamlined, effective system which places the emphasis on providing clear information to patients about the prescription system.” Read the article in the Mirror. This was also reported by GPonline.
Fire arms consultation response
On 17 September the BMA and the RCGP submitted a joint response to the Home Office consultation on statutory guidance to police on firearms licensing. The BMA and the RCGP have worked collaboratively with the Home Office and other key stakeholders including the National Police Chiefs Council to improve the system for firearms licensing with the core aim of improving safety for the public whilst also recognising the professional and resource implications for doctors.
The response includes a significant number of changes that we believe would be helpful to ensure that the guidance can be effectively implemented at a local level by police authorities. Our priority has been to provide a response in sufficient detail that the perspectives of frontline GPs can be fully recognised, particularly as this consultation is in relation to statutory guidance. The consultation response also includes a flowchart on firearms licensing that is intended as a helpful guide for GPs and police authorities to follow through the various stages of the licensing process. Our joint response document and flowchart are attached, and will also be available on our website shortly. In the meantime, see our firearms support guide here.
Complaints analysis
A number of regional publications have reported on the number of complaints made against GPs. According to the figures from NHS Digital, many complaints related to patients having difficulty communicating their family doctor. Responding to the figures I said: “this survey shows much of the dissatisfaction felt by patients stems from communication problems, rather than clinical errors, and doctors know that they simply don’t have enough time to spend with their patients and cope with rising demand, with the risk that communication issues could arise. All clinicians want to do their jobs safely but need the time, resources and funding to be able to do that.” There are stories in the Peterbrough Telegraph, the Hereford Times, the Swindon Advertisor and the Ilford Recorder. For further details see the link here.
Daily Mail article on opioids
Following the publication of the PHE review on prescribed medicines, in response to which the BMA published a statement, there have been further reports in the media. In response to a Daily Mail article on this, Farah Jameel, GPC England executive team member, said: “We have seen the damage opioids are doing to people’s lives in the US, and while the scale of the problem is on a far lower scale here, doctors in the UK are of course concerned by the increased number of patients being prescribed these drugs. Opioids are an effective treatment for short-term pain, as part of cancer treatment and end of life care, but we know that too often they’re being taken for far longer than is appropriate. The decision to prescribe opioids is never taken lightly. GPs will prescribe them to patients with serious conditions when necessary, but problems can begin when patients need to be taken off them as they may have already become dependent. With other medication often not being able to alleviate their pain and very few alternatives available, GPs are placed in a very difficult situation.”
New medical school
The University of Sunderland’s has opened a new School of Medicine, welcoming its first cohort of 50 medical students this week. Dr George Rae, chair of the BMA’s North East regional council and previous member of the GPC, was interviewed about this on BBC Radio Newcastle, and he explained how the new medical school could help with the current regional workforce pressures in general practice. “The fact that very much it will be concentrating on primary care, which is general practice, is very welcome news but one has got to realise that to train fully a GP starting from scratch when you're going to medical school is going to take eight or nine years there can be no doubt that we still are in a crisis in general practice and the reason for that is workload.” Listen to the interview here (from 1 hour 10 minutes).
Read the latest GPC newsletter here.
Opioid prescriptions
Public Health England has published a review on prescribed medicines this week. The findings show that 5m people in Britain have been prescribed opioids every year, or one in eight of the adult population. Commenting, Andrew Green, BMA Council member and previous GPC prescribing lead, said: “To reduce prescription levels, we need significant investment in support services; this will enable patients and GPs to manage dependencies in the community. GPs will often be the sole clinicians who are often managing a patient’s withdrawal, and there is a real need for better clinical guidance in this respect. We are glad that NICE is in the process of developing these. While there remains a place for prescribing these drugs, we need many more alternatives to medication, such as pain clinics, improved access to mental health services, and physiotherapy – the universal provision of which are all lacking.” Read the full statement here. A link to the review is here, and a blog about it here.
Tom Yerburgh, deputy lead for GPC’s clinical and prescribing policy group, was interviewed on BBC You and Yours radio (about 23 mins in). It was also reported in the Times, the Telegraph, iNews, Mail, Metro, BMJ, Pulse, OnMedica and Nursing Times. I did an interview for Radio Aire on the subject.
No deal Brexit warnings
Last week the BMA published a briefing highlighting the dangers of a no deal Brexit and a member-focused resource, information for doctors if there is a no deal Brexit, which includes information on how to prepare for medicine shortages. The government has now published the ‘Operation yellowhammer’ document, which confirms our warnings on a ‘no deal’ Brexit. In response to this, Chaand Nagpaul, BMA Chair of Council, said “This alarming document reinforces the BMA’s stark warnings about the devastating impact a ‘no deal’ Brexit could have, and vindicates those doctors who have had the courage to speak out on the risks that crashing out of the EU without a deal poses to the NHS, patients and the wider health of the UK.” Read the full statement here.
I was interviewed on a number of regional radio stations about the Yellowhammer report, including BBC Three Counties and Heart Yorkshire, where I said the BMA had 'acute concerns' over medicine supplies in the event of a no deal and called on the Government to offer reassurances that access to essential medicines will not be disrupted. Listen to the interview here (from the 25 minute mark). The BMA's response was covered by BBC News, the Guardian, the Daily Mirror (print), the Evening Standard, and in news bulletins across dozens of regional and national commercial radio stations.
Medicine shortages
The Daily Mail reported about drug shortages, suggesting that Brexit is not to blame. In response to this story, Farah Jameel, GPC England Executive team member commented “I’ve definitely noticed an increase in the number of drugs that we’re short of. Some, but not all, patients can be switched from one drug to another that works in an equivalent way. But this requires time and resources, placing extra demand on doctors and pharmacists.’ Read the full article here.
Flu vaccinations in GP practices – MDU position on indemnity
Following concerns raised about indemnity cover provided for the provision of flu immunisations to practice staff we have been in discussion with NHS England, Public Health England and the MDOs. The Medical Defence Union have provided the following statement about indemnity for flu vaccination of staff in GP practices:
“Our current position on flu vaccinations is that we understand some practices may find it easier to provide flu vaccinations for staff themselves and want to help them to do that. We make no extra charge for indemnity for members whose practices provide flu vaccinations to staff as this is already within the benefits of membership for GP members. We encourage members who want to administer flu vaccinations to staff to contact us and advise the following: We advise members administering flu vaccinations to staff to follow their normal procedures for dealing with unregistered patients and to ensure they make a full assessment of each staff member’s suitability for the vaccine, for example, ruling out contraindications. Consent should be obtained in the usual way as for registered patients. Notes should be kept and, assuming the staff member agrees, their normal registered GP should be advised that they have had the vaccination.” We will update further on this next week.
Public Accounts Committee Investigation into NHSPS
Following publication of the NAO report into NHSPS in June, the PAC- a powerful committee of MPs scrutinising public spending- heard from senior officials at NHSPS, NHSE and the DHSC who answered questions on how the Service is managed and what action can be taken to improve how it manages its tenants. The BMA submitted written evidence to the committee highlighting the significant increases to service charges to GP practices without their agreement and the impact this is having on the profession. We were concerned by comments made by NHSPS during the hearing in relation to the BMA’s position on GP leases. NHSPS stated that a template lease was agreed with the BMA which we shared, but subsequently ‘retracted’ support for. This is not the case. The BMA did and continues to support the principle of lease agreements between NHSPS and practices, and continue to host the lease template letter on our website . We have written to the committee to highlight this inaccuracy. The session is available to view online. Practices should be mindful that the BMA are proceeding with legal action to address historical charges. Practices should ensure that in reaching any agreement independently of this they do not put themselves at risk of any future liability or compromise their future position.
PCN premises requirements for additional workforce
A number of queries have highlighted the issue of practices requiring additional space for Primary Care Network activities. As a Direct Enhanced Service of the GMS contract, Primary Care Networks are an extension of GP practices. The same rules should apply for PCN staff and premises requirements as for GMS. Any space utilised to provide PCN services should be treated as GMS space and treated similarly for rent reimbursements. If you have any further queries on this issue please contact info.lmcqueries@bma.org.uk
EMIS issues
Following reports of problems with EMIS, the EMIS team has advised that there have been several issues in the last 7-10 days within the BT network affecting access to various suppliers’ clinical systems – including, but not limited to, EMIS. There have been no availability issues from the EMIS Web data centre during this period. NHS Digital has been working with BT to address and prevent these issues occurring in the future.
LMC Conference England – submitting motions
A reminder that the deadline for inputting motions for the LMC England Conference is Noon, Friday 20 September 2019 – submit via this link. If you have forgotten your username and / or password, please email info.lmcconference@bma.org.uk for a reminder or for help in setting up a new account.
Read the blog on writing motions here.
The registration form for representatives by 11 October 2019. More information is available on the LMC Conference webpage.
September Medicine Supply Update
Please find attached the monthly supply update for September from the Department of Health and Social Care. There are also supply issues affecting capsaicin cream, mianserin tablets and tiagabine tablets for which additional communications have been prepared and already sent to primary care and community pharmacy teams for cascade to GPs and community pharmacies.
The table below provides a summary (the attachments referred to in the table below, have been emailed out to LMCs in a separate email this morning):
BMA report: vision for the future of the NHS
The BMA published Caring supportive collaborative: Doctors’ vision for change in the NHS yesterday, which outlines the changes needed to ensure safeguarding patient care, making the NHS a great place to work and transform services for the better. It draws on the experience and expertise of our members across all branches of medical practice in the UK.
The report sets out specific recommendations aimed at government and NHS bodies, including:
Some of the changes demand the immediate attention of government and MPs, set out in an accompanying manifesto document.
Access review events
NHS England are holding regional events about the access review:
London and South East regions
Wednesday 18 September 2019 (10.00am – 4.00pm),
etc.venues Fenchurch Street, 8 Fenchurch Place, London, EC3M 4PB
South West region
Thursday 19 September 2019 (10.00am – 4.00pm)
Mercure Bristol Holland House Hotel, Redcliffe Hill, Bristol, BS1 6SQ
For more information, see www.england.nhs.uk/accessreview
Integrated urgent care: Direct booking roadshow
NHS England and NHS improvement, via PCC, are also running a number of free integrated urgent care events focused on supporting practices with direct booking from NHS 111:
London, 10 October 2019, Amba Hotel Marble Arch https://www.pccevents.co.uk/2252
Birmingham 14 October 2019, Birmingham Botanical Gardens https://www.pccevents.co.uk/2253
Leeds, 22 October 2019, Cloth Hall Court, Well Met https://www.pccevents.co.uk/2254
London, 28 October 2019, Mary Ward House https://www.pccevents.co.uk/2255
South West, 29 October 2019, Bristol Marriott https://www.pccevents.co.uk/2256
Manchester area, 20 November 2019, The Midland Hotel https://www.pccevents.co.uk/2257
Read the latest GPC newsletter here.
Read the latest Sessional GPs newsletter here
PCN development
You will be aware that most of the nearly 7000 GP practices in England have taken up the PCN DES. This wouldn’t have been possible without the LMCs supporting practices locally to forge relationships and facilitate some very tricky conversations between practices. So, firstly, thank you to the LMC officers and staff for making it happen.
Acknowledging that this is the first step in this process, and that PCNs will continue to develop over time with Clinical Directors’ leadership, the BMA has been developing a package of support for Clinical Directors and PCNs. Prior to launch later this month, we wanted to provide LMCs with some information about what it will include, to support PCNs in choosing their support for their own development.
The package will consist of:
BMA briefing paper on no-deal Brexit
The BMA published a briefing paper this week, entitled “A health service on the brink: the dangers of a 'no deal' Brexit”, where we outline how a departure from the EU without an agreement could ravage the NHS, leaving no area of healthcare untouched. The report warns that the NHS faces the double whammy of the impact of a 'no deal' Brexit as well as coping with the expected winter crisis. The BMA Chair of Council, Chaand Nagpaul, said: “Cancelled operations, missed cancer treatment targets and patients in corridors waiting for hours on end to be seen; recent winters have seen unprecedented scenes unfold in our hospitals, GP surgeries and across the NHS, with patients suffering and staff under increasing pressure as resources and capacity struggle to keep up with rocketing demand. Add to that chaos a 'no deal' Brexit, and the disintegration of the health service becomes an ever more real prospect.”
Read his full statement here.
This was reported by Mail Online, Daily Mail (print), Times (print), the Daily Telegraph (print), ITV News, Metro, Mirror (print), the BMJ, Pulse, Huffington Post, Al Jazeera, GP Online, Practice Business, Medscape, the Scotsman, and the National. David Bailey, GPC member and BMA Wales council chair, was interviewed by ITV News about medicine supply and shortages – watch it here (7 mins in).
GP pressures
Following on from the BMA’s analysis of the pressures on the NHS in England, we are presenting more detailed figures specifically relating to GP pressures on a monthly basis. The key figures for July are (based on NHS Digital data):
The latest data on appointments in general practice shows the continuing trend of rising demand, with patient numbers and appointment numbers up. This pressure is worsened by the loss of 576 fully qualified GPs as compared to last year, leaving each GP with a greater workload.
The workforce pressures were also reflected in the NHS Digital’s annual GP earnings and expenses report for 2017/18, published last week, to which I commented “These figures suggest that years of repeated, real-terms pay cuts for GPs are starting to be reversed. However, while earnings may have gone up, the number of doctors continues to fall, with the NHS in England losing more than 800 partners alone over the same period. As patient demand rises and the workforce gets smaller, GPs are taking on more work – often in excess of their contracted hours. This places a huge amount of strain on GPs, who are putting their own health and wellbeing at risk to ensure their patients get the best care possible.”
Healthcare insurance needed in EU after Brexit
The Department of Health and Social Care has updated their guidance 'Healthcare after Brexit: visiting the EU, Norway, Iceland, Liechtenstein and Switzerland', which warns anyone travelling to EU countries that they will need travel insurance, and informs patients with pre-existing health conditions to 'speak to your GP and insurer about how to get the right cover and how this affects your travel'. In response to this, Farah Jameel, GPC England Executive team member commented to GPonline that the government advice was another example of poor planning around Brexit, and that “it was not right that the government should expect GPs already working under significant pressure to bear the brunt of poor planning - and warned it was simply not the role of a GP to provide advice on appropriate travel insurance.” Read the full story in GPonline and Pulse (subscription required)
Prescription drug dependency - online pharmacies
The Sunday Times reported on the easy availability of strong prescription-only medications on fraudulent online pharmacies run by overseas criminal gangs. Other drugs were not licensed for use in the UK, and many were counterfeits. Undercover reporters were able to order five types of medicines that should not be dispensed without a prescription, including versions of tramadol and Xanax for about 80p per pill. Responding to this, Farah Jameel, GPC England Executive team lead for prescribing commented: "That people are able to get hold of such potent — and potentially dangerous — medications so easily from unregulated websites is extremely disturbing. In some cases, the drugs are not licensed for sale in the UK, and, even worse, others are completely fake, meaning those taking them have no idea what they are putting into their bodies.”
Read the story in The Sunday Times (subscription required)
LMC Conference England – submitting motions
A reminder that the deadline for inputting motions for the LMC England Conference is Friday 20 September 2019 – submit via this link. Before inputting your motions you will need to ensure that you have the correct email address registered on the database and know your username and/or password. If you have any questions about this, please contact Karen Day (Kday@bma.org.uk).
The chair of the Conference Rachel McMahon, and Nimish Shah of the Sessional GP Committee, have written a blog from a sessional GP perspective on writing motions for the LMC conference. Read the blog here.
The registration form for representatives by 11 October 2019. More information is available on the LMC Conference webpage.
The Primary Care (GP) Digital Services Operating Model 2019-21
NHS England has published Securing Excellence in Primary Care (GP) Digital Services, which outlines the Primary Care (GP) Digital Services Operating Model for 2019-21, setting out the commissioning framework for the provision of high-quality general practice digital services. The model embeds the GP IT Futures Framework, nationally commissioned digital solutions and Primary Care Networks, addresses the challenges for digitally enabled general practice and will be supported by a new CCG Practice Agreement. Read more here
New Medical Director for Primary Care in England
I would like to congratulate Nikki Kanani, who has been appointed the new Medical Director for Primary Care for NHS England and NHS Improvement, after having held the role as Acting Director since last summer.
Survey of CCGs on PCN service specification development
NHSE are planning a short survey of CCGs in the next couple of weeks on the services they may have locally commissioned which are in the same territory as the five PCN service specifications due to go live next year. The aim is to get some further examples of local good practice that can help inform national service specification development over the coming weeks. This should not involve LMCs or PCNs and the data is gathered directly from the CCGs.
Wellbeing campaign conference
The BMA is holding a wellbeing day conference on 8 November 2019. The event is an opportunity to acquire tools to support your personal wellbeing and professional fulfilment, as well as that of your colleagues. It will provide an opportunity to learn, in supportive interactive sessions, the five steps to mental wellbeing as recommended by the NHS – connect; be active; keep learning; give to others; be mindful. Note that this event is for BMA members only. Read more about the event here.
Read the latest GPC newsletter here.
