GP earnings and expenses report
NHS Digital has released the latest annual GP earnings and expenses report for 2017/18, which shows that the average taxable income for GPs in the UK increased by 2.5% (to £94,800) against a 1% awarded pay uplift, and expenses for contractor GPs increased by 7% that year. The report does not take into account hours worked or the reduced number of GPs.
The report provides a breakdown of earnings and expenses for contractor GPs and salaried GPs for each of the nations and for different contract types (GMS, PMS, dispensing, non-dispensing).
In response to this, Krishna Kasaraneni, GPC England Executive team lead said “'Today’s 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.” Read the full quote in GP Online and Pulse.
Joint statement on the danger of a no-deal Brexit
The BMA has signed a joint statement with 10 other health organisations and unions, warning of the danger that no-deal Brexit poses to the NHS, and urging the Government to take it off the table.
The statement warns that a no-deal could lead to vital medicine shortages and intensify the NHS staffing crisis, while the economic shock would hit the health service particularly hard. BMA council chair, Chaand Nagpaul told the Independent “From our invaluable EU workforce to the supply of vital medicines, and collaboration on medical research to Irish cross-border health arrangements, there is practically no area of health that will be unaffected if we crash out without a deal.”
You can read about this in the ‘BMA Council Chair Focus’. The statement was also covered by Mail Online, Evening Standard, Nursing Times, Daily Mirror (print) and on Sky News’ All Out Politics (9:45am, 29 Sept).
Fivefold increase in deaths from opioids
The Times reported that the number of Britons killed by the opioids drugs oxycodone and fentanyl has increased fivefold. In response to this, I commented “We have seen the damage these drugs are doing to people’s lives in the US, and this data shows the devastating effect they are now having here in the UK”. Read the full article in the Times(subscription required)
GP workforce figures
The latest GP workforce figures have been published, which show :
- The number of fully qualified full-time equivalent GPs down 576 over the past year (-2%)
- In the last quarter, the number of FTE GPs had also fallen. In March, there were 28,697 GPs in England - a fall of 1.5% in three months.
- The number of FTE GP partners also decreased to 18,511 – down 5.3% from last year.
In response to this, Krishna Kasaraneni (GPC England Executive team member and workforce lead) said ‘These statistics are a stark illustration of the workforce crisis that continues to blight general practice. In the face of high workloads, punitive pension regulations and the overly burdensome admin that comes with running a practice, it is no surprise that the number of GPs, and in particular partners, is continuing to fall. This is despite repeated pledges from the Government to boost numbers by thousands. Read the full statement here.
This was reported in the Daily Mail, Pulse, Times, GPonline, Daily Express (print only)
Digital first providers
Nearly two thirds of GPs who responded to a GPonline survey said that digital first providers should be forced to open premises in any CCG where more than 1000-2000 of their patients live. In response to this, Richard Vautrey, GPC Chair, said “We believe that the out-of-area regulations are no longer needed and should be removed. All practices should be supported with a better level of IT so that they can build on what they already do in terms of telephone and other forms of remote consultations. Doing this would mean there was no need to create new practices. Creating new APMS practices will just add more complexity and cost to the system without really resolving the problems.” Read the article here(sign-in required)
NICE hypertension guidelines
NICE has published updated guidance on hypertension, despite concerns we raised about workload pressures. In response to this, I commented “It's important that patients with hypertension are diagnosed as early as possible, and that the latest clinical guidelines for managing high blood pressure are evidence-based – so in many ways these refreshed guidelines are helpful. GPs treat patients as individuals, rather than as a whole population, and there is a fine balance between aiming for targets across population groups and allowing doctors to take into account the personal situation of the patient in front of them. It is therefore positive that the new guidelines take this into consideration, where for those less at risk, a discussion about pros and cons rather than an offer of treatment is encouraged.
As we have said before, GPs are already working flat-out treating patients with increased cardiovascular risk, and as NICE itself recognises, these changes have significant workload implications – with potentially hundreds of thousands more patients now in scope for treatment who weren’t before. Any additional workload created as a result must be fully resourced. 'Of course, we should always avoid overmedicalisation and discuss management plans – including a range of non-pharmacological options – with the patient, based on their individual circumstances.”
Read the full article in Pulse (sign-in required), and our response to the NICE consultation here.
GMS uplift 2019/20 - Scotland
The attached letter from Scottish Government outlines the details of the GMS uplift in Scotland for the current year. This includes:
- Uplift of GP pay net of expenses by 2.5%
- Uplift of 1.9% for inflation of non-staff expenses
- Increase of 3% for practice staff pay
- £4.2 million added to the Global Sum for population growth
- Total value added to the contract is £23.2 million
The uplift for practices applies to the Global Sum and Income and Expenses Guarantee, meaning it will be received by all practices – as per the agreement for the new contract. Practices should receive the uplift from the October payment. Read more in this blog by Patricia Moultrie, Deputy chair of the SGPC.
PCSE Locum payments
We are aware there are issues with the PCSE login webpage for locum payments and some members have also reported they have been unable to upload their documents to the PCSE website. The Sessional GPs Committee has raised this with Capita which informed us this was a sporadic issue not affecting everyone, but they are working with their IT team to solve the issues.
MHRA alert about HRT link to breast cancer
In addition, the MHRA has issued a CAS alert to healthcare professionals and women about the risk of breast cancer associated with use of HRT, following a large meta-analysis by the Lancet, confirming the known increased risk of breast cancer with use of all types of HRT, except vaginal estrogens, compared to women who do not use HRT.
The MHRA asked that prescribers of HRT discuss the new information with women on HRT or who are contemplating starting HRT at their next routine appointment.
HRT supply issue
The Department of Health and Social Care issued the attached communications about HRT supply issue last week.
Regional council elections
The BMA’s regional council elections are now open for voting and are open to BMA members in all branches of practice in England. The voting closes 23 September. Read morehere.
LMC Conference England – submitting motions
All LMCs in England should now have received an email with information on attending the LMC conference England on 22 November, including instructions on how to submit motions. Before submitting motion, we need to obtain the correct name and email address of each person who will be submitting the motions, but before you do so, each LMC will need to:
• ensure the correct email address is registered on our database
• know your password.
Earlier this week, the database sent an automated email with confirmation of password and login details to the person who was registered for March's UK conference. If you have not received this information and / or it needs correcting then please contact Karen Day (Kday@bma.org.uk) asap.
The deadline for inputting this year's motions is noon Friday 20 September 2019.
Each LMC will have the same number of representatives as for the UK LMC Conference 2019. The makeup of your delegation is for LMCs to decide, but the agenda committee have requested that you take account of the groups that are often under represented at conference. Please complete the registration form by 11 October 2019.
More information is also available on the LMC Conference webpage.
Read the latest GPC newsletter here.
Read the latest Sessional GPs newsletter here.
And finally, warm hearty congratulations to all colleagues who have been featured in this year's Pulse Power 50, GP of the year and Rising stars list.
GMS and PMS amendment regulations
Following the contract agreement in England earlier this year, the GMS and PMS amendment regulations have been laid before Parliament and have now been published on the gov.uk website. These amendment regulations will come into force from 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.
Half day closures
You will have seen the recent outrageous claims from NHS England that ending half-day closures could save more than 280,000 GP appointments a year. We responded promptly and publicly stating that as we know GP practices are working hard to deliver the best possible service with the resources available as they strive to meet the growing needs of their patients. In many cases they not only work long hours during the day but also deliver services out-of-hours and with many doctors also working evenings and weekends. I described the claims as a 'fantasy' arguing that forcing GPs to remain open throughout the day could drive down capacity to offer appointments at evenings or weekends.
GP practices want to deliver the best for their communities but with significant workforce shortages, and a failure of NHS England to invest in much needed premises and IT infrastructure, it’s left GPs under greater pressure than ever before. NHS leaders must therefore work to address the ongoing recruitment and retention crisis rather than devoting time and effort to threatening GPs with a reduction in funding that will only undermine morale further. We need long term commitment and support to bring about lasting improvement to patient care and avoid putting overworked doctors under further strain.
You can also hear GPC Exec member, Farah Jameel’s, response to the issue on BBC Radio here. The story was picked up by the Daily Mail, the inewspaper, GP Online and Pulse.
Our guidance on how GP practices can meet the reasonable needs of their patients remains unchanged and can he found here
Pensions
Previous updates to LMCs have contained details of the work being undertaken by the BMA on pensions issues. This week Paul Youngs, chair of the BMA pensions committee, had an article published in BMJ that made it clear that pension tax reform needs to be swift to tackle doctors’ sense of injustice. There has also been an editorial item in BMJ calling for Government to act decisively to avert potentially catastrophic workforce losses. The article states that this problem comes at the worst possible time for the NHS, with hospital consultants, staff and associate specialists, and general practitioners all facing critical workforce shortages.
This week the GPC England email to BMA members focused on the impact of annualisation on many sessional GPs, and a link to this can be found below.
PCSE medical records incident
We have previously highlighted the PCSE incident whereby 148,000 patient medical records were erroneously archived instead of being sent to the subsequent GP practices. These records will have been sent to the practices that currently have the patients registered, and NHS England expects those practices to undertake an assessment of harm for each patient affected.
Over the past few weeks, GPC England has been in discussions with NHS England to highlight the impact this will have on practices and their patients. We have been 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. Further BMA guidance on the service failures can be accessed using the link
Unfortunately, NHS England is 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. GPC England was not prepared to agree to a settlement which we believed would not fully compensate practices for the problems created by Capita. If you would like to some forward and ask NHS England what compensation they are able to offer to your practice, please contact england.reports@nhs.net. Practices should carefully consider whether any offer made reflects the work that will need to be undertaken and whether it will adequately compensate them. If a practice believes the offer is sufficient and accepts it, they will not be able to claim additional monies via any legal route. If, however, a practice considers the offer does not reflect the work that will be required and decides to reject it with the hope of claiming compensation via a legal route for the additional work, we would recommend that the practice contacts the BMA support@bma.org.uk with the attached pro forma so that we can start to collate the necessary information to take forward legal action.
Additional roles reimbursement guidance
NHS England has now published the joint guidance on the Additional Roles Reimbursement Scheme (ARRS) that will commence in April 2020. We hope that by releasing it now, PCNs will be able to better prepare for the additional workforce from 2020. This guidance includes the process by which Primary Care Networks (PCNs) can claim reimbursement for additional staff.
Data sharing agreement
NHS England and the GPC England have agreed on a non-mandatory, high-level data sharing template for use by PCNs. To make things simpler for practices, the BMA has also produced a version of the agreed template which expands on a number of areas with greater detail, along with guidance on the document. This provides practices with a better idea of how they may wish to populate the template agreement, including proposed best practice when sharing and transferring data between partners within the network. Further information and a link to the BMA resources are available on the BMA web page here.
NHS England FAQs on Integrated Care Providers Contract
NHS England have released some explanatory FAQs on how the Integrated Care Providers (ICP) contract will operate and what will be the impact of the contract. We have repeatedly highlighted our serious concerns about the ICP contract and that we believe it to be unnecessary with the development of PCNs.
The FAQs cover many of the same issues covered in the BMA’s own guidance and briefings on ICPs. However, there are some questions within the document of particular relevance to GPs in England. The most relevant questions are; 13, 14, 15 and 17. These particular questions cover; how GPs participation in ICPs is voluntary, the different options available to GPs who do decide to partner with ICPs and, how ICPs will engage with PCNs.
For more information around the impact of the ICP contract please read the BMA guidance, as well as the NHS England FAQs. If you have any further questions around the impact of the ICP contract, please contact our policy team.
Registration onto the Medicine and Healthcare products Regulatory Agency (MHRA) Central Alerting System (CAS)
The Medicine and Healthcare products Regulatory Agency (MHRA) Central Alerting System (CAS) is the national system for issuing patient safety alerts, important public health messages and other safety critical information to all providers, including GP practices. From 1 October 2019, MHRA will send CAS 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 link to the portal. Registration is recommended to be completed by 13 September 2019 to allow sufficient time for registration checks and testing.
Clinical Practice Research Datalink
Practices are invited to share their patient databases with Clinical Practice Research Datalink (CPRD). Practices can expect CPRD to be contacting them in the future and we would encourage them to participate. The GPC IT policy team have been working with CPRD and are satisfied with their systems. No free text is extracted, nor documents nor associated files, just the coded components. Opt outs, as recorded in the practices database are respected. Practices will need to carry out a Data Protection Impact Assessment (DPIA) and add an entry in their Article 30 processing register (CPRD will provide pre-prepared sample documents for practices to use, which the BMA have seen and reviewed). You will need to ensure your privacy notices are up to date and cover the use of patient data for research.
Government action to improve immunisation coverage
Public Health England has estimated that 1 in 7 five-year-olds have yet to be fully immunised against MMR. In response the BMA board of science chair Professor Dame Parveen Kumar said: “Doctors are very concerned that the number of young children who are up to date with vaccinations seems to be falling. Measles can be a very serious illness and whilst diphtheria and whooping cough are thankfully relatively rare, they remain a risk to children who are not vaccinated. The BMA has always maintained that the Government and NHS England must take practical steps to make people far more aware of their local immunisation services and ensure they have proper access to them. However, health leaders have been slow to act – proven by the figures from Public Health England. The Prime Minister’s announcement on measures to improve vaccination rates is long overdue and though welcome, more must be done”.
I was interviewed on BBC Radio Leeds about the fall in children being receiving the MMR vaccine. I said: "There is a range of reasons why some parents choose not to have it. Whilst we should stress that the vast majority of parents are still choosing to have the vaccine for their children and get their children protected, there's a small number who maybe are complacent about vaccination because they've not seen these illnesses in their own lifetime and they don't necessarily think it is going to impact their child”. Listen to the full interview here (from 9 minutes in).
Age UK calls for a more considered approach to prescribing medicines for our older population
Age UK launched a new report that says too many older people are on too many prescribed medicines, putting them at risk of side effects that in a worrying number of cases can lead to falls and a range of other serious harms. The report, ‘More Harm than Good’, provides evidence showing that prescribing more drugs is not always the best option, particularly when it comes to older people. Age UK estimates that almost two million people over 65 are likely to be taking at least seven prescribed medicines. This number doubles to approaching four million for those taking at least five medicines. I was interviewed on BBC Radio Kent where I stressed the importance of patients being aware of the need to review their medication at least once a year or more often if they had complex problems that required regular monitoring. I highlighted the need for patients to inform practices and pharmacies if they had stopped medication or were receiving items they were not using to avoid unnecessary waste. Listen to the full interview here (from 7 minutes in).
Babylon GP at Hand
GP online reported that the numbers of patients in Birmingham registered with Babylon GP at Hand could rise from next month after commissioners agreed to remove a temporary cap, subject to the provider meeting conditions around access to screening and local referral pathways. The BMA have consistently raised concerns regarding the joint agreement between NHS England, Hammersmith and Fulham CCG, and Birmingham and Solihull CCG, to allow Babylon’s GP at Hand service to expand its service to Birmingham. We continue to state that this initiative flies in the face of place-based care delivered by practices embedded in local communities, which the recent changes in the GP contract are committed to deliver.
Cervical screening test result delays
Pulse reported that GP practices in the East of England have been informed of patients facing delays in receiving their cervical cancer screening results. In a document seen by Pulse, GPs have been informed that letters containing the results of cervical cancer screening samples are being sent later than the usual 14 days due to 'ongoing changes' within the programme. GPs have been told these delays are ‘expected’ to continue until the HPV primary screening programme is fully implemented by December. In March, Capita was stripped of the cervical screening contract and NHS England began a phased transition back in-house in June. I responded that 'Our first and foremost concern is the safety of our patients, for this to be ensured we require safe and efficient systems to be in place. As with any delay in processing test results and issuing letters, there will always be anxiety for patients and frustration for GPs. We are seeking urgent clarification from NHS England about this issue and how widespread it is.”
Progress on Clinical Review of Standards
NHS England and NHS Improvement have provided us with an update on the progress of the Clinical Review of Standards. You may remember that last summer the previous Prime Minister asked the NHS to undertake a clinical review of current access targets. The aim of the review is to determine whether updating and improving the targets currently in use could better support frontline staff to deliver the highest quality care for patients and save more lives – taking into account advances in clinical practice, and what patients say matters most to them. The following hospital trusts have worked with the NHS nationally to agree how they will safely test the proposed new standard for cancer diagnosis, and will begin the first phase of the trial from late August 2019.
• Mid Essex Hospital Services
• Epsom and St Helier University Hospitals
• Kingston Hospital
• Chesterfield Royal Hospital
• Northampton General Hospital
• Gateshead Health
• Sheffield Teaching Hospitals
• Doncaster and Bassetlaw Teaching Hospitals
• East Lancashire Hospitals
• Warrington and Halton Hospitals
• Hampshire Hospitals
• The Royal Bournemouth and Christchurch Hospitals
• Torbay and South Devon
The field sites were selected against an agreed set of criteria that reflect a diversity of provider sites including geography, performance and data quality and these were published today. Further information can be found on the NHS England web site using this link
The trusts will be testing the use of the existing faster diagnosis standard whilst suspending the performance management of the 2 week wait standard for people with suspected cancer. This means that people can expect to be told whether or not they have cancer within 28 days of an urgent referral from their GP or a cancer screening programme - instead of the current standard of seeing a specialist within 14 days. NHS England and NHS Improvement will work with these trusts to ensure that they keep their local primary care colleagues informed about any changes to their practice. We understand that letters will be sent directly to primary care stakeholders including GPs and LMCs within each of the areas listed above.
SGPC Executive election results
Yesterday I attend SGPC in Edinburgh. The meeting heard that the following members were successful in being elected to the SGPC Executive: Chris Black, John Ip, Iain Kennedy, Denise Mcfarlane and Iain Morrison. Congratulations to all of them.
BMA Regional Council Elections
The BMA regional council elections are opening their voting next Tuesday. These elections are open to BMA members in all branches of practice in England. The voting dates are:
• Voting opens –27 August at 9am
• Voting closes –23 September at 12pm
Read the latest GPC newsletter
I have met with Prostate Cancer UK to discuss the role of primary care in diagnosis and management of patients with prostate cancer. I stressed that testing an asymptomatic person for latent disease is screening and should not be dressed up as case-finding. Screening should be approved by the UK National Screening Committee and, if worthwhile, set up properly and funded. The transfer of patients from secondary care to primary care for follow up, either because they are part of active surveillance, or because of a single unconfirmed raised PSA, or because they have cancer but have completed active treatment, is reasonable but only in the context of a local enhanced service and computer-aided recall systems and decision aids.
Richard Vautrey and I met with the National Cancer Czar Professor Sir Michael Richards to provide an input into his forthcoming review of cancer screening. He seemed well versed in the barriers patients find in accessing screening services, and in particular we raised the problems trans patients have in accessing screening services.
NICE have completed their consultation exercise on new quality metrics for primary care, and of particular interest are those that will impact QOF through the Heart failure, Asthma, and COPD domains. I attended the annual meeting to review the responses, though only as a ‘GP with expertise’ rather than representing the GPC, which would be against their terms of reference. There are some technical problems with the proposed indicators but I am quietly confident a set will emerge which will be helpful.
The BMA’s PCN Clinical Directors Conferenceincluded a module on the QOF changes.
The last meeting of PHE’s Expert Reference Group - prescribed medicines that may cause dependence or withdrawal has taken place, and the report is awaiting publication. This is a subject where the default option will be to blame GPs for over-prescribing, but I was heartened by the support given to us by the addiction and pain specialists on the group, who were clear that without extra resources no amount of ‘better training’ would reduce prescribing.
We were concerned about the advice from the General Pharmaceutical Council suggesting GPs should authorise prescriptions from on-line companies for high-risk medications. I met with them, and they do appreciate our concerns, and with encouragement may tighten their guidance to do more to dissuade these prescriptions from being issued in the first place.
