GPC England New Year’s message
I want to send you all best wishes for the New Year. Many of you will have been working in Out of Hours, Urgent Treatment Centres, Prisons, and other settings this Christmas and my thanks goes to you. Many will have continued working at home to clear backlogs built up due to the increased patient demand and the recent respiratory influx. Despite this I hope that you and your teams had some time to rest and recuperate after this unprecedented period of pressure.
General practices have never been so busy, with over 31 million appointments carried out in November, fifteen percent more than in November 2019, and this with fewer and fewer GPs as shown in the November GP workforce figures, with a fall of 77 full-time equivalent fully-qualified GPs in England between October and November, and 471 in the 12 months to November.
The Government has now overseen the loss of the equivalent of more than 1,900 full-time fully-qualified GPs in England since 2015, and that almost a quarter of this loss happened in the last 12 months alone – the biggest annual fall in almost three-and-a-half years – speaks volumes to the intense pressures that practices and staff are under. With workload demands soaring, and financial stresses on practices bearing down, alongside the impact of punitive pension rules, many GPs are having to take the difficult to decision to reduce their hours or leave altogether to protect their wellbeing.
Fewer GPs means patients are suffering. GPs and our colleagues in general practice are doing unsafe levels of consultations. We risk making mistakes if we try to work beyond our mental and physical capacity. We will burn out and harm our own health if we continue to work in this way.
To save ourselves and protect our patients we have to move to delivering safe working models. We have produced guidance to help practices, LMCs, and ICBs to develop models which deliver for patients and keep doctors safe.
The NHS in general is at breaking point, and this is putting untold pressure on general practices. We need investment in traditional general practice. This is what patients want. This is what GPs want.
The Health and Social Care Select Committee report into the Future of General Practice provides some hope as we move into a new year. I move towards the new year with more determination to get general practice the support it needs so that GPs and practices thrive and enable them to deliver the services which patients require.
Wishing you all a safe and prosperous New Year.
Read the press statement about the GP workforce and appointments data.
Read more about the pressures in general practice here
Junior doctors’ ballot in England for strike action
Next week the junior doctors’ ballot in England for strike action will open. Today, the BMA’s Junior Doctor Committee (JDC) has confirmed that following a successful ballot, the first form of strike action will be a full walkout of junior doctors for 72 hours. JDC have been brought to this point by the year-on-year pay erosion that has left our junior doctor members with a real term pay cut of 26.1% since 2008/2009.
As the co-chairs of JDC set out in a blog published today, this strategy builds on the lessons learnt from 2016 when junior doctors last took industrial action. Then, full walkout maximised participation in the strike by junior doctors and had greatest impact on the government.
GPC England is unequivocal in its support of all our GP trainees in this dispute for full pay restoration to protect our profession and the services our patients rely on. This support was demonstrated by English GP representatives at the recent LMC England conference. You can find out more information about the ballot at www.bma.org.uk/juniorspay.
Junior doctors' guide to strike action - guidance for GP trainees
Guidance for GP trainees has been added to the junior doctors' guide to strike action.
If a GP trainee wishes to picket, legally, it must be picket at or near their place of work. They are not able to picket at a place that is not considered their place of work. However, a GP trainee is not barred from taking part in a protest that takes place near to a hospital or other NHS building. If they are not part of a picket line, they are fine to join any organised protest.
We are in the process of preparing more GP specific advice for trainees and practices which we will share in due course.
GP Retention survey and focus groups
NHS England have launched a GP retention survey alongside a form for registering to participate in focus groups on GP retention. They want to understand the impact existing approaches to recruitment and retention have had to feed into future proposals for support for GPs and others working in general practice. This includes improving their understanding of the experience of GPs and other general practice workforce with protected characteristics and underrepresented groups, so they can identify any disparities in experience and any adjustments required to meet their needs.
Links to the survey and focus groups form can be found here. As the survey was launched over the Christmas period, there is less than a week to complete it, with 11 January being the last day for submissions. The focus groups will take place between 16 and 27 January.
Long covid survey
We know that a proportion of the medical profession has suffered from the chronic health complications which continue after acute infection by COVID-19. This includes people who may have Long COVID and/or other complications. What is less well described is the impact such chronic health complications have continued to have on doctors’ work, home, financial security, and overall quality of life. In partnership with Long COVID Doctors for Action, which campaigns and advocates for doctors suffering the continuing effects of COVID, the BMA is undertaking a survey of doctors in the UK to:
If you have experienced any type of post-acute COVID ill health, we value you taking the time to complete the survey. The survey will close at midnight, 15 January 2023
Wellbeing
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter,
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.GPC@bma.org.uk
Read the last GP bulletin: GP pressures | advice on NHS strike action | Streptococcus A update
Colleagues
I want to send you all best wishes for the festive season. Many of you will be working in Out of Hours, Urgent Treatment Centres, Prisons, and other settings this Christmas and my thanks goes to you. Many will continue working at home to clear backlogs built up due to the increased patient demand and the recent respiratory influx. Despite this I hope that you and your teams get time to rest and recuperate after this unprecedented period of pressure.
General practices have never been so busy, with over 31 million appointments carried out in November, fifteen percent more than in November 2019, and this with fewer and fewer GPs.
ARRS colleagues are welcome in our practices, but we all know that they have not reduced our workload, which was confirmed by the National Institute for Health and Care Research in November. Fewer GPs means patients are suffering. GPs and our colleagues in general practice are doing unsafe levels of consultations. We risk making mistakes if we try to work beyond our mental and physical capacity. We will burn out and harm our own health if we continue to work in this way.
This state of affairs was brought into harsh clarity by the suicide earlier this year of Dr Gail Milligan. Dr Milligan’s death by suicide is not the first in general practice, but we must work to make it the last. To save ourselves and protect our patients we have to move to delivering safe working models. The BMA has produced guidance to help practices and we are creating more so that practices, LMCs, and ICBs can develop models which deliver for patients and keep doctors safe.
The NHS in general is at breaking point, and this is putting untold pressure on general practices. We need investment in traditional general practice. This is what patients want. This is what GPs want.
With this in mind we are soon to enter a period of negotiation for the 23/24 contract. The GPCE officer team met with senior representatives of NHS England and DHSC this week. We have agreed terms of reference for negotiations in advance of any proposed changes to the GP contract for 2023/24, and will be entering into negotiations in early January. There will likely be an accelerated process given the time available in advance of April 2023.
GPCE officers also discussed the extreme pressures being experienced by practices currently. Workforce and workload issues are such that it is increasingly difficult to maintain patient safety, and many practices have told us they are genuinely scared as to how they can continue. Some ICBs have been supportive and created local plans to support practices, but this is not universal. ICBs have been advised that to suspend QOF and IIF locally or nationally would require a level 4 national incident as these schemes are part of the statement of financial entitlement (SFE). All ICBs have now been encouraged to use local flexibilities; for example, those already within the ARRS specification to support additional workforce to provide direct patient care, suspending locally negotiated schemes whilst guaranteeing payments, and using transformation monies. There should be minimal reporting and bureaucracy involved, and the greatest imagination used as to how current schemes can support practices as quickly as possible.
That ICBs want to help their systems at this time has been welcome, but I am worried that the rigidity shown during last year’s negotiations, which led to contract imposition, will transpire again this year.
The continued negative rhetoric aimed at general practice and the rest of the NHS by politicians and some sections of the press is a dark cloud which foreshadows as we enter negotiation.
The light which gives me hope though has been the Health and Social Care Select Committee report into the Future of General Practice. This report held many helpful and useful recommendations: cessation of QOF and IIF, investment into GP premises, dealing with punitive pension taxation, supporting the partnership model, and most importantly the need to “make the job not just manageable but once again fulfilling and enjoyable”. I hope that the author of this report, Jeremy Hunt, will continue to support general practice in his new role as Chancellor of the Exchequer.
We move towards a new year with some hope. I move towards the new year with more determination to get general practice the support it needs so that GPs and practices thrive and enable them to deliver the services which patients require.
Wishing you all a safe a prosperous festive season and New Year.
Kieran
Dr Kieran Sharrock
Acting Chair, GPC England
GP pressures
General practice continues to face monumental pressures and demand, which are beyond our capacity and compromises our ability to offer safe and high-quality care for our patients. The workload for practices has escalated further with the highest level of GP appointments on record combined with an ever decreasing GP workforce. There’s a limit to what general practice can safely deliver.
At a time like this it also is demoralising to hear about the Labour Party’s assertion that five million patients were ‘denied’ an appointment in October 2022, when in fact, GPs and their teams are working under exceptional circumstances, with limited resource and support. Read our statement in response. We are urgently seeking a meaningful dialogue with the Labour Party.
We have just written to Steve Barclay MP, Secretary of State for Health and Social Care, highlighting the current pressures in general practice, requesting a meeting to discuss how the Government can provide urgent support to general practice and to prioritise contract negotiations.
We have also drafted a template letter to ICBs (Integrated Care Boards) asking for QOF and IIF be protected for the remainder of 22/23 within the local ICB area, so that practices can focus on delivering care for those patients who are contacting practices desperate for our care. NHS England have indicated that at this time they will not be issuing a national pause on these areas of work, although ICBs are able to institute additional support for practices to help bolster them during such an unprecedentedly busy time.
We would encourage practices to continue to review their working practices in reference to our Safe working in general practice guidance. Practices must prioritise what care they provide for patients in order to manage the finite workforce and resources available to them.
We have also written to the CQC requesting that all routine and non-urgent CQC inspections of general practices in England be paused with immediate effect, and we await their response.
We are considering what further actions may be necessary in order to protect our patients and GPs this winter and beyond. We also ask that LMCs, practices, and individuals consider what action they would be willing to take in future if support for general practice is not forthcoming in negotiations.
Read more about the pressures in general practice here
Advice to colleagues and practices on strike action being undertaken across the NHS
Many professional groups are undertaking industrial action this winter as part of contractual negotiations and disputes with government and their employers. Whilst practice staff are not in dispute with their employing practices, some of these actions will impact on GPs and practices. The background to these disputes is very similar to pressures that GPs will recognise as currently impacting on them and their practices. Erosion in real terms pay, lack of effective workforce planning, deteriorated terms and conditions, failure to provide sufficient training places, and a disregard for the wellbeing of an exhausted and demoralised workforce apply to all NHS profession groups.
Government and NHS England have recognised that strikes will inevitably disrupt patient care, whilst unions have committed to preserve emergency care so as not to put patients at risk.
Practices may receive requests to help support secondary care or community services at times of industrial action. Examples of requests made may include:
We would strongly advise practices to carefully consider the implications and impact on the care of their own patients if becoming involved in these plans. By depleting our practice workforce to support these services it will risk harm to our patients in general practice, potentially increase their waiting times, put practices at contractual risk by reducing the service that they are able to offer, and have GPs and practice staff working beyond their competence in roles they would not ordinarily fulfil. This is in addition to potentially undermining the cause of our clinical colleagues in their trade disputes, and the likelihood of their support of any potential future action by members of the BMA
GPs and practice staff are faced with unmanageable demand for our services and skills, and practices are finding it increasingly difficult to provide safe care. The care of the patient is our primary concern, and it is vital that we devote ourselves to doing this within our practices, and not artificially shoring up other parts of the NHS, which are impacted by industrial action.
More information can be found here
Junior doctors' guide to strike action - guidance for GP trainees
New guidance for GP trainees has been added to the junior doctors' guide to strike action. Legally, a GP trainee must picket at or near their place of work. They are not able to picket at a place that is not considered their place of work. However, a GP trainee is not barred from taking part in a protest that takes place near to a hospital or other NHS building. If they are not part of a picket line, they are fine to join any organised protest.
We are in the process of preparing more GP specific advice for trainees and practices which we will share in due course.
Streptococcus A
With parents and colleagues across the country understandably worried about the Strep A situation, the reported shortages of the supply of antibiotics will likely be even further cause for concern. As well as the anxiety caused, medicine shortages, particularly at a time when demand for them is higher, can cause increased workload and disruption for GPs and their teams as they have to find alternative treatment options.
While the Government have insisted there are sufficient supplies of antibiotics nationally, this will be little comfort to pharmacists, GPs and patients who are experiencing shortages locally, and therefore those responsible for supply chains must double down on efforts to ensure there are enough medicines to meet demand. We have raised the issue of supply with the Department of Health and Social Care, who has assured us that there is sufficient supplies but that the increased demand means some pharmacies have difficulties in obtaining certain antibiotics.
The Chief Medical Officer for England has written to the profession and in his letter he emphasised the importance of prescribers and local pharmacy teams working together to understand availability of antibiotics locally and ordering antibiotic stocks sensibly, in line with patient demand, ensuring that excessive quantities are not ordered and avoiding more pressure on the supply chain. The DHSC Medicine Supply Notification (MSN) also provides advice on the management of the current supply issues, including direction to use alternatives.
We have been calling for clear and effective public health messaging on Strep A to ensure that it is clear where to go for help and to reassure the vast majority of people that they will not go on to become seriously unwell, and NHS England, the UK Health Security Agency, and others have now published joint interim guidance for clinicians.
Mandatory Training on Learning Disability and Autism - update
In our last update to LMCs we reported that a recent NHS England Bulletin referenced ‘The Oliver McGowan Mandatory Training on Learning Disability and Autism’, as being the preferred training for NHS England and Health Education England, and that the CQC had suggested that this training was mandatory.
The Health and Care Act 2022 states that ‘Service providers ensure that each person working for the purpose of the regulated activities carried out by them receives training on learning disability and autism, which is appropriate to the person’s role’. The Code of Practice mentioned in the Act, which sets out the details of the training, has not yet been published and is not expected until April 2023.
We have contacted the Secretary of State to ask to input into this to ensure the requirements are appropriate and proportionate to our roles. We also raised our concerns with NHS England who has agreed that the McGowan training is NOT mandatory and that practices should use their judgement as to what training is appropriate to their role.
The CQC has now amended its guidance, which now clarifies that there is no specific training that is mandatory. CQC states that training ‘provided to staff is appropriate and provides staff with knowledge about how to interact and support people with a learning disability’.
There may be GPs who have already had Autism and Learning Disability training or who may decide that it is appropriate that one person from a practice or PCN is best placed to do the Oliver McGowan or other similar training. This could then be disseminated to the wider team.
LMC England Conference 2022
The resolutions and election results from the Annual Conference of England LMCs 2022, which was held 24-25 November, have now been published
Watch a recording of the event: https://bma.streameventlive.com/archive/286
Read more about the event here: Local medical committees (bma.org.uk)
Cameron Fund Christmas Appeal 2022
The Cameron Fund is the GPs' own charity and it is the only medical benevolent fund that
solely supports general practitioners and their dependents. The fund relies on donations from members and Local Medical Committees. Please read more about how to donate in the Cameron Fund Christmas Appeal letter
Long covid survey
Many doctors have suffered from chronic health complications after COVID, including long COVID. To improve support, we need to understand the impact on doctors’ work, financial security and quality of life. If you’ve experienced any type of post-acute COVID ill health, please take our survey, in partnership with Long COVID Doctors for Action. Take the survey (closing at 5pm, 6 January)
Autumn statement 2022
The BMA has created a briefing analysing the impact of the Government’s autumn fiscal statement on doctors. The statement details the UK government’s plans for tax and public spending over the next five years. Read more about budget and fiscal events here (updated link from last week).
Pooled code practices warned to check for significant reimbursement shortfalls
Practices in England and Wales with a pooled list are being advised to check for significant shortfalls in reimbursement since the transition from Open Exeter to PCSE. An explanatory letter is available to download here (updated link from last week).
Wellbeing
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing. A range of wellbeing and support services are available to doctors, from the BMA’s confidential counselling and peer support services to networking, as well as the NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.gpc@bma.org.uk
| Read the latest GP bulletin (England) here |
GPC England Officer team update
We are pleased to announce that Clare Bannon has been elected to the GPC England Officer Team as deputy chair covering the maternity leave of Farah Jameel. She has been a GP Partner in Barnsley for since 2010, she is the current Chair of the Association of South Yorkshire LMCs (Local Medical Committees) and has been Medical Secretary of Barnsley LMC for four years.
In response to this, she said: “I do not underestimate the challenge ahead, General Practice is at breaking point, with intense pressure on GPs across the country to meet the ever-growing demands of the job. I will join the rest of the Officer Team in rebuilding general practice to ensure we meet the needs of our patients and protect the Wellbeing of GPs and their teams”.
Read more about GPC England here
Accelerated citizen access to GP records - mass roll-out halted
You well have seen from our message earlier this week, that the mass roll-out that would have turned on prospective access to the medical record from 30 November 2022 is not now occurring for those who wish to delay the process.
GPC England has been in ongoing dialogue with NHS England (NHSE), the Department of Health and Social Care (DHSC) and others on your behalf about the GP access to records programme and the planned rollout schedule.
The BMA has committed to work with NHSE, system suppliers and others to review the current approach to accelerating access and to see if we can jointly find an alternative path to improve the uptake of access in a way that allays the concerns of practices whilst ensuring practices remain in control of the process. The protections within the current contract need to be recognised with regard to ensuring you can provide essential services. General practice will be informed ahead of any system changes being implemented.
Read our statement and FAQs here
Read our full guidance here
Read our press statement here
We will be issuing more guidance and updates in the coming weeks.
GP appointment and workforce data
The latest GP appointment and workforce data for England was published last week. The data makes for alarming reading. There are nearly 1,900 fewer full time fully qualified GPs since September 2015, yet the number of face-to-face appointments is going up and show the highest level of GP appointments on record. This demonstrates how busy practices are, but there’s a limit to what general practice can safely deliver with such a depleted workforce.
We need the Government to find solutions to address the staffing crisis, and to make general practice a safe place to work so that doctors can continue to deliver the care our patients need and deserve.
For the first time, the appointment data also include data at practice level. As we reported last week, we have already expressed concerns over the data being published this way. There are bound be many differences in the way practices operate and how staff provide care for their local communities - none of these nuances have been taken into account. Rather than this being a useful tool to aid patient choice, it is naming and shaming practices when the morale of dedicated staff is at rock bottom. Ultimately, such data should be used to support, not punish practices.
Read the full statement by Kieran Sharrock, GPCE Deputy Chair, here
Read more about the pressures in general practice here
Read our guidance on Safe working in general practice which is designed to enable practices to make decisions as to how to prioritise care, and deprioritise certain aspects of their day to day activity, within the confines of the GMS contract.
Autumn statement 2022
The BMA has created a briefing analysing the impact of the Government’s autumn fiscal statement on doctors. The statement details the UK government’s plans for tax and public spending over the next five years. The main things that will impact doctors are:
Read more about budget and fiscal events here
Mandatory Training on Learning Disability and Autism
LMCs have raised that a recent NHS England Primary Care Bulletin references ‘The Oliver McGowan Mandatory Training on Learning Disability and Autism’.
This is one form of training available, but to clarify, undertaking this specific training is NOT mandatory. There is a requirement under the Health and Care Act 2022, that all practices ensure their staff have training on a Disability and Autism appropriate to their role.
The Secretary of State for Health is required to set out a Code of Practice detailing the requirements. This has not yet been published and is expected 2023, until then practices should not be pressured to undertake specific training, and should decide what training is appropriate for their staff.
GP Trainee visas
The BMA continues to call for a permanent solution to barriers to staying and working in the UK currently faced by trainee GPs as they approach completion of their training. In October 2022, we wrote to Home Secretary Suella Braverman, to urge her to act and work with colleagues in the Department of Health and Social Care to deliver a permanent solution.
Conservative MP Matt Warman led a Westminster Hall Debate on international doctors’ visas on 2 November, during which he called on the Home Office and Department of Health to work together on a lasting solution to the issue in the best interests of the NHS workforce and patient care. Ahead of the debate, GPC England Deputy Chair Kieran Sharrock and members of the Public Affairs team briefed Mr Warman, and he drew on the work of the BMA on a number of occasions. During the debate, Immigration Minister Robert Jenrick gave the clearest indication yet that the Government was willing to look at umbrella sponsorship as a potential solution.
We have since written to the Minister directly on the issue and have made clear the BMA’s willingness to be included in conversations with the Home Office on this.
Pooled code practices warned to check for significant reimbursement shortfalls
Practices in England and Wales with a pooled list are being advised to check for significant shortfalls in reimbursement since the transition from Open Exeter to PCSE. An explanatory letter is available to download here
CQC work in general practice
Mani Hussein, the Director of Primary Care at CQC, has offered to come and talk to LMCs about the work the CQC is doing in general practice. This is an opportunity for questions to be asked and for him to put a face to the CQC policies. If you are interested, please contact: Jane.Deacon@cqc.org.uk
Wellbeing
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing.
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information.
GPC England committee pages and guidance for practices
Read more about the work of the Committee
Read practical guidance for GP practices
See the latest update on Twitter: @BMA_GP / Twitter @TheBMA / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
Contact us: info.gpc@bma.org.uk
Read the latest GP bulletin (England) here Read the latest Sessional GPs newsletter here
GP workforce shortages
There have been reports that the Prime Minister has omitted the Government's manifesto pledge to increase the number of GPs in England by 6,000 by 2024 from the Health Secretary’s to-do list. If this is the case, the Health Secretary has been dispensed of the ultimate humiliation of admitting that the Government has failed in its manifesto commitment and should have the good grace to openly admit this.
Since the Government first pledged to grow the GP workforce, practices been decimated by workforce shortages, with GPs and their patients suffering the consequences. The latest workforce figures for England show that we have lost the equivalent of more than 1,800 full-time, fully qualified GPs since 2015. This long-term trend of decrease in GPs coincides with a rocketing demand with each practice having on average 2,131 more patients than in 2015.
In September 2022, there was a record-high of nearly 62 million patients registered with practices in England, with a record high average of 9,596 patients registered per practice. As a result, the average number of patients each full-time equivalent GP is responsible for has now reached 2,248. This is an increase of 310 or 16% since 2015, demonstrating the mounting workload in general practice. Read more about the pressures in general practice here
Ultimately, GPs and patients deserve more than broken promises. Instead of pulling the wool over our eyes, the Government should be open that it is failing in its manifesto pledge and talk to GPs about the solutions – to do nothing threatens to make this situation far, far worse.
Read the full BMA statement on workforce targets
Read our guidance on Safe working in general practice which is designed to enable practices to make decisions as to how to prioritise care, and deprioritise certain aspects of their day to day activity, within the confines of the GMS contract.
Appointment data at practice level
GPC England has met with NHS Digital to discuss their plans to publish GP appointments data (GPAD), which will be published at practice level on 24 November 2022, in the form of an annex to the current publication. NHS Digital also informed the BMA that this publication will be further updated for April 2023, integrating practice level data into the report, and a dashboard of appointment data at a practice level which will be available for Integrated Care Boards (ICBs) to access. We raised concerns about the accuracy of the data, and its potential use, and NHS Digital greed that further work is required.
Wellbeing
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing.
It's Self Care Week this week 14-20 November, which is a good opportunity to promote wellbeing in your practice. Dedicated resources have been created to support this.
Read my blog on how to Care for yourself during the hard times ahead:
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information.
GMS and PMS requirement to pass on DDRB recommended uplifts
Practices with a GMS contract, or with a post-2015 PMS contract, have a contractual requirement to “ only offer employment to a general medical practitioner on terms which are no less favourable than those contained in the document entitled “Model terms and conditions of service for a salaried general practitioner employed by a GMS practice” published by the British Medical Association “.
The Model Terms states under clause 6 “Your salary will be increased by annual increments on [incremental date] each year and in accordance with the Government’s decision on the pay of general practitioners following the recommendation of the Doctors’ and Dentists’ Review Body”
Practices who have salaried GP employed under the terms of the model contract should offer the DDRB recommended 4.5% pay uplift as a minimum.
GPCE has lobbied for global sum to be uplifted to accommodate this increase for salaried GPs and other practice staff and will continue to do so. Read the BMA’s statement about the DDRB
Updated webpages regarding travel with medications
Following recent correspondence with airlines regarding their requests for medical information to be provided by GPs, we have updated our guidance on our webpages here
Health Education England training contract
It has been brought to our attention that training practices are being asked to sign a Health Education England training contract. As GPC England did not have input into the development of this contract, we are currently in the process of reviewing the contents. Practices who have not already signed and are unsure about doing so should either seek their own advice or hold off until you hear more from us.
Proposed Dispensing Feescales for GMS Contractors, England and Wales - 2021, October release
NHS Digital has published new dispensing feescales for General Medical Service (GMS) contractors in England and Wales from 1 October 2021. They are available here
CQC clinical searches – new survey
The CQC developed a suite of clinical searches, initially in response to the pandemic, which are now routinely used when carrying out inspections of GP practices. They were designed to focus on areas of clinical importance. The majority of the searches focus on safe prescribing, monitoring of higher risk drugs, management of long-term conditions and identification of potential missed diagnoses. CQC is undertaking a survey to identify how useful / easy to use these searches have been. Practices are encouraged to complete the anonymous survey here.
Support in challenging times – share your views
The BMA is working on an enhanced offering for GP practices to better support them during such challenging times. To ensure the new proposition will meet their needs, the Insight team is conducting interviews with GP partners and practice managers to get their feedback on the new proposition and see whether we could provide anything else to help them in their daily work.
If you are a GP partner and are happy to share your views or put us in contact with other members or practice managers, please email Ashlyn Manikandan (AManikandan@bma.org.uk). The interviews will last about one hour, and as a token of our appreciation, participants will enter a prize draw.
LMC England conference 2022
The LMC England Conference will take place in London next week on 24 November, and the Special conference on 25 November. For more information see here: Local medical committees.
Please send any queries to info.lmcconference@bma.org.uk
| Read the latest GP bulletin (England) here |
Accelerated citizen access to records
There has been a lot of work undertaken over our concerns about this roll out and we previously advised colleagues they had options before them including asking your system supplier to delay the roll out by using a template letter we had provided. You can find this template letter in our guidance to practices which urges for a delay to the rollout of the programme, as many practices are not currently in a position to activate it safely. We also offer guidance on codes you can add to the records.
The Rt. Hon Steve Barclay MP, Secretary of State for Health and Social Care, announced earlier this week that the Citizens' Access to Records programme would be going live. NHS Digital are now suggesting the switch on will occur for all by November 30th and we are challenging this as our major concerns have not yet been addressed. As a reminder you can inform your supplier to pause the roll out by using our template letter in this guidance and email it to your supplier.
In response to the announcement, the BMA issued a statement calling for clarity over the deployment of the programme and assurances that practices who do not yet feel ready, have ample time as they deem necessary to make preparations in order to ensure patients are protected.
We continue to have significant concerns over your role as a data controller being ignored, the redaction software not being fit for purpose, the risk to patients (especially ones in coercive relationships) and not to forget of course the workload involved at a time when we are already seeing intolerable demands on us day to day.
We are very keen to ensure you are aware of this current guidance from NHS Digital:
You may still wish to send in the template letter even if you missed the deadline above. We believe additional support is needed for practices to implement this change and we recommend that practices follow the guidance and steps as set out. If you have any questions, please get in touch with info.lmcqueries@bma.org.uk
We will be in touch again next week with more information as this issue develops.
GPC England meeting update
GPC England met yesterday, 3 November, where we discussed accelerated citizens access to data, and how we have been in regular contact with NHS Digital, continuing to raise our concerns. The Committee received an update on the forthcoming negations for the 2023-24 contract, the final year of the five-year contract deal, and discussed strategy going forward.
Snapshot Survey
What are your views on the Health and Social Care Select Committee report on the future of general practice?
Answer our brief survey here
Wellbeing
As we continue to face overwhelming pressures in general practice, we encourage practices to focus on their own team’s wellbeing.
Dr Vongai Shuro, a GP at Spilsby surgery, Lincolnshire, has written a blog considering the value of taking time out to reflect on wellbeing. Read the blog here
A range of wellbeing and support services are available to doctors, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Visit the BMA’s dedicated wellbeing support services page for further information and resources.
We encourage you to access any, or all, of the forms of support mentioned above, and encourage colleagues to do so too if you are ever struggling.
It is due to this crisis, that we are recommending that practices take action to preserve patient care and their own wellbeing, and our guidance on Safe working in general practice is designed to enable practices to make decisions as to how to prioritise care, and deprioritise certain aspects of their day to day activity, within the confines of the GMS contract.
Network Contract DES guidance – pay codes updated for 1st November
When NHS England published the October variation to the Network Contract DES (directed enhanced service), and associated guidance, there were a number of placeholders in the payments section of the guidance while they waited for new pay codes to be produced.
This reflected the transition from Calculating Quality Reporting Service (CQRS) and manual payments to automated payments via Primary Care Support England (PCSE) Online, as well as the short notice introduction of the new primary care network Capacity and Access Payment. The new automated pay codes are now in place and ready for use, in the updated guidance.
NHS Property Services settlement letters
We know that many NHS Property Services (NHSPS) practices across England have recently received ‘invitation to settle’ letters, ostensibly from credit controllers, seeking to encourage NHSPS practices to settle disputed historical debt with respect to non-reimbursable service charges. Understandably, some partners may read these letters with alarm, especially as they involve a common pressure tactic of requiring a response within a tight timeframe.
Practices that engage with NHSPS on this issue should do their own due diligence. We wanted to take this opportunity to reiterate our guidance for NHSPS practices in dispute with NHSPS; in short, practices should:
Punitive pensions tax rules
You should have all received the recent newsletter from the BMA Pensions Committee providing an update on their continued lobbying of Government to fix punitive pension tax rules. If you haven’t already done so, we encourage you to take a look at the newsletter which is available to view here.
Trust Registration Requirements
The GPDF has published a guidance note on primary care related trust registration requirements, which have come about as a result of the Fifth Anti-Money Laundering Directive. The guidance outlines a process by which practitioners can determine whether their trust may benefit from one of the exemptions, or whether they are required to register as a trust. The deadline for registering non-exempt trusts created before 3 June 2022 passed on 1 September 2022; trusts created after 3 June 2022 must be registered within 90 days. Read the guidance note
LMC England conference 2022
The Agenda for the 2022 LMC England Conference in London which takes place on 24 November, and the Agenda for a special conference on 25 November, have now been published.
For more information see here: Local medical committees.
Please send any queries to info.lmcconference@bma.org.uk
| Read the latest GP bulletin (England) here
Read the sessional GPs newsletter here |
Crisis in general practice
The Health and Social Care Committee report: The future of general practice was published today. The report, which the BMA fed into by providing both written and oral evidence, highlights the crisis in general practice. We know that patients benefit from continuity of care, with the quality, strength and consistency of their relationship with their family doctor having a significant impact on their health outcomes.
Against a backdrop of a global healthcare workforce shortage, recruiting and retaining more GPs, funding more GP training places, targeting under-doctored areas, and empowering practices to recruit the right skill mix of professionals to care for the needs of their community by disabling current barriers are recommendations that must be acted on as a priority.
We have lost the equivalent of 1,850 fully-qualified, full-time GPs since 2015, leading to more pressure and the greater likelihood that even more healthcare professionals will either reduce their hours or leave the NHS altogether. This comes with serious patient safety risks.
The report also reiterated that the punitive pensions taxation must urgently be addressed to tackle the chronic staff shortages in the NHS, asking the Government and NHS England to adopt the recommendations laid out in its workforce report, something that the BMA has long been calling for.
Read the full statement in response to the report, by Farah Jameel, chair of GPC England.
The issue of GP pressures was also mentioned during a discussion on the Government’s health statement last week in the House of Lords, referencing BMA surveys to highlight the increases in GP workload, including the excessive burden of administration, and the impact of government pushing for more appointments, without an increase in the GP workforce to support this. We will continue to brief MPs and peers over the coming weeks to highlight our concerns and recommendations for better supporting GPs, with the aim of pushing government to support our asks.
It is due to this crisis, that we are recommending that practices take action to preserve patient care and their own wellbeing, and our guidance on Safe working in general practice is designed to enable practices to make decisions as to how to prioritise care, and deprioritise certain aspects of their day to day activity, within the confines of the GMS contract.
We continue to look at other ways of supporting practices - please let us know if you have any feedback on how we can develop further tools to help practices: info.gpc@bma.org.uk
Citizen access to records programme
Ahead ofNHS England’s scheduled rollout of accelerated citizen access to recordson Nov 1st, GPC has been involved indiscussions with stakeholders and will issue guidance to practices in an all-member newsletter in due course.
Survey on how inflation and energy costs are impacting your practice
We know GP practices across England are feeling the impact of inflation and high energy costs. Please complete our survey so that we can collect the evidence we need to advocate on your behalf.
The survey asks for a range of information relating to practice costs including energy, staffing and other expenses. It may be that your practice manager is best placed to complete the survey, and while we would encourage you (or your practice manager) to complete the whole survey, if you do not yet have the information, please still do complete the parts you can.
We need to hear from as many practices as possible to enable us to make a strong case to NHSE/I, DHSC and the government to seek solutions. Answer our short survey (closing 9am, 28 October).
Seasonal flu payments
As practices may be aware NHS England recently sent out a communication regarding issues identified with the September seasonal flu extracts, asking practices not to submit their vaccination data until further notice.
This relates to two separate issues with the Seasonal Flu and Childhood Flu extractions. Firstly, seasonal flu injectable vaccines pharmacy reference sets had not been updated to reflect changes to the list of seasonal flu vaccines for 2022/23 (as per the annual flu letter), so practices using only prescription codes to record flu vaccination (rather than an administration code or both together) will have lower than expected figures from the GPES extraction for September flu activity. This has been compounded by a second specific issue with TPP systems which meant the practice data extracted could be lower than the level of activity completed in September.
Consequently, NHS England is now advising that practices undertake the following steps:
If practices need further details on these issues, or have concerns regarding cash due to delayed payments, they should contact their local commissioner, who will be able to assist.
Letter from GP for travel with medication
It has been brought to our attention that some airlines are advising travellers bringing medication in their hand luggage, should bring a letter from their medical practitioner confirming the type of medication and what it is for.
We have raised this issue with the airline, who advised that if a passenger packs their medication in their hold luggage, they do not require any of their medical information. However, if a passenger seeks to carry their essential medication in their cabin luggage, and the form of the medication contravenes aviation regulations e.g., the use of sharps, liquids more than 100ml or oxygen cylinders, they require the passenger to produce confirmation from their healthcare practitioner that the medication is necessary to be carried as it may be required on board.
However, as the advice on their website is not clear on this point as it advises passengers to take their medication in their hand luggage, and it does not specify which sort of medication requires a letter, we have written to the airline again asking for their webpage to be updated on this point.
Practices may choose to do this private work but are not obliged to do so. Practices should advise patients that they can print off their medical record from the NHS app, or alternatively, practices are able to charge for travel-related requests for information.
PCN DES opt out window
As mentioned in the last newsletter, at the end of September NHS England published a letter outlining support for practices and PCNs. This includes changes to the ARRS (including changes to reimbursement rates to reflect the Agenda for Change pay award and the introduction of ‘GP Assistants’ and PCN Digital Leads’), removal/postponement of some IIF indicators, and a new PCN ‘capacity and access support payment’, funded from the reduced IIF indicators.
As these changes have been introduced by NHSE in-year, an opt-out window for the PCN DES has been triggered open until 31 October. Within this opt-out window, practices can choose to opt-out of the DES without risking a breach of contract. We have developed this guidance as a primer to support practices that are considering opting out of the DES.
We would advise practices to read the guidance and consult with their staff and fellow PCN members as to whether to utilise the window to leave their PCN. If practices choose to stay in their PCN, the next op-out window is expected to be April 2023.
Concerns about the delivery of anti-viral drug treatment for Covid
The BMA has written to the UK Health Security Agency (UKHSA) to highlight our concerns about the delivery of anti-viral drug treatment for Covid, and in particular the consistency of the Covid Medicines Decision Units (CMDUs) and their ability to deliver appropriate and timely anti-viral drug treatments to patients.
We also asked that public communication about the service be improved so that eligible persons understand the pathway and are aware of the benefits of early treatment.
Best practice conference
The BMA had a dedicated theatre at the Best Practice Show at the NEC Birmingham from 12-13 October, a conference event for event for the primary care and general practice community. The programme in the theatre focused on the most pressing issues facing general practice, including the future of general practice, working within ICSs, workload and workforce management, and primary care estates. Presentations were led by GPC England Committee Officers, Policy Leads, and BMA staff members, and were well attended by clinical and non-clinical staff across primary care.
All four GPC England Committee Officers led a listening session each day on the future for General Practice, including the future of the GMS contract, which drew hundreds of attendees and sparked productive and insightful discussion.
GP Committee elections
Nominations for the below seats to the General Practitioners Committee (GPC) in the following regions are open until 12pm Tuesday 25 October 2022.
You must be a BMA member to stand in this election. Please note that in previous years there was a requirement that only GPs who paid the voluntary levy could nominate themselves for election. That requirement has now been removed.
To submit your nomination for any of the above seats please visit https://elections.bma.org.uk/
Voting will open at 12pm 25 October 2022 and will close at 12pm Tuesday 1 November 2022.
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk. If you have any queries regarding the election process, please contact elections@bma.org.uk.
Wellbeing
We encourage anybody who is feeling under strain to seek support, and also check in on your colleagues’ wellbeing. A range of wellbeing and support services are available, such as our 24/7 confidential counselling and peer support services, as well as the NHS practitioner health service and non-medical support services such as Samaritans. Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information.
For all other support, speak to a BMA adviser on 0300 123 1233 or email support@bma.org.uk. We encourage you to access any, or all, of the forms of support mentioned above, and encourage colleagues to do so too if you are ever struggling.
| Read the latest GP bulletin (England) here |
General practice in crisis
General practice continues to face overwhelming pressures, with unmanageable workloads, coupled with a rapidly shrinking and exhausted workforce. The COVID-19 pandemic has generated a vast backlog of care, which is so far largely unmeasured and unrecognised in general practice, exerting greater pressure on a system already at breaking point.
The pressures practices are under are evident from the most recent GP appointment data which shows that in August, practices in England delivered a staggering 3 million more appointments than in the same month in 2019, meaning we are now managing the levels of demand used to see in a pre-pandemic winter in the middle of summer, fighting an uphill battle to meet patients’ needs, with fewer GPs.
It is therefore disappointing to see the announcement by the shadow health secretary last week demanding that GPs provide face-to-face appointments for every patient who wants them, making divisive headline-grabbing promises that are not grounded in reality suggesting the existing workforce are somehow not trying hard enough.
The present crisis is so acute that we now recommend practices take urgent action to preserve patient care and their own wellbeing, and have updated our guidance on Safe working in general practice, which is designed to enable practices to make decisions as to how to prioritise care, and deprioritise certain aspects of their day to day activity, within the confines of the GMS contract.
As part of this guidance, we strongly recommend practices take immediate measures to move to 15 minute appointments, move towards capping consultation numbers to a safe number per day - safe for clinicians and safe for patients. Excess demand beyond these levels should be directed to NHS 111, extended access hubs, or other providers.
Changing the way we work would allow practices to devote their resources to those patients and problems that general practice is uniquely positioned to help, and those with the greatest need, and not simply as a provider of last resort for other parts of the NHS and social care.
Practice might also want to read our guidance on How to improve the safety of your service and wellbeing of your workforce, setting out safe limits of the numbers of patient contacts per day, and what is considered ‘essential services’ under the GMS contract.
We will be looking at other ways of supporting practices - please let us know if you have any feedback on how we can develop further tools to help practices: info.gpc@bma.org.uk
| This week’s snapshot question In each LMC update we will include a question on a current issue, which will be used to help inform thoughts at GPCE and in negotiations. What would you be willing to give up in order to reduce your workload? Being part of a Primary Care Network (PCN) Seasonal vaccinations (Flu & Covid enhanced services) Quality and Outcomes Framework (QoF) Investment and Income Fund (IFF) Routine vaccinations Please answer here |
Mental health and wellbeing
We are all affected in different ways by the increasing workload and pressures faced each day in practices, with many of us feeling exhausted and drained at the end of a day in surgery. If our wellbeing is suffering, we cannot care for our patients as well as we would like, if we are in need of care ourselves. We, as doctors, have to start prioritising our wellbeing so that we can continue to provide the care to patients that they need.
It is World Mental Health Awareness Day on Monday 10 October. The day is dedicated to raising awareness of mental health and the theme of the day this year is to 'make mental health and wellbeing for all a global priority’. We encourage anybody who is feeling under strain to seek support, and also check in on your colleagues’ wellbeing. We also encourage practices who could not participate on 9 September to reflect and focus on their wellbeing, to consider identifying another time when they could meet as a practice to focus on wellbeing and how to reduce workload.
A range of wellbeing and support services are available to doctors, from the BMA’s 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans. The organisation Doctors in Distress also provides mental health support for health workers in the UK.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Visit the BMA’s dedicated wellbeing support services page for further information and resources.
For all other support, speak to a BMA adviser on 0300 123 1233 or email support@bma.org.uk. We encourage you to access any, or all, of the forms of support mentioned above, and encourage colleagues to do so too if you are ever struggling.
PCN DES opt out window
As practices may be aware, at the end of September NHS England published a letter outlining support for practices and PCNs. This includes changes to the ARRS (including changes to reimbursement rates to reflect the Agenda for Change pay award and the introduction of ‘GP Assistants’ and ‘PCN Digital Leads’), removal/postponement of some IIF indicators, and a new PCN ‘capacity and access support payment’, funded from the reduced IIF indicators.
As these changes have been introduced by NHSE in-year, an opt-out window for the PCN DES has been triggered. Within this opt-out window, practices can choose to opt-out of the DES without risking a breach of contract. We have developed this guidance as a primer to support practices that are considering opting out of the DES.
We would advise practices to read the guidance and consult with their staff and fellow PCN members as to whether to utilise the window to leave their PCN. If practices choose to stay in their PCN, the next op-out window is expected to be April 2023.
Survey on how inflation and energy costs are impacting your practice
We know GP practices across England are feeling the impact of inflation and high energy costs. Please complete our survey so that we can collect the evidence we need to advocate on your behalf. The survey asks for a range of information relating to practice costs including energy, staffing and other expenses.
It may be that your practice manager is best placed to complete the survey, and while we would encourage you to complete the whole survey, if you do not yet have the information, please still complete the parts you can. We need to hear from as many practices as possible to enable us to make a strong case to NHSE/I, DHSC and the government to seek solutions. Take the short survey here (closing Thursday 20 October).
Citizen access to records programme
Following representations made to NHS England, GPC England has not received satisfactory assurance that the citizen access to records programme scheduled to rollout on 1 November can go ahead. Against a backdrop of sky-high pressures on general practice, the necessary planning and resourcing required to launch the programme at this time cannot be put in place to enable a safe and successful rollout. We are supportive of the initiative to enable patients to view their medical records but this cannot be rushed. We remain open to discussions with NHS England about how best to facilitate a delay to the programme.
Updated flu specification
NHSE/I has published an updated flu specification, alongside updated guidance, which now covers vaccination of practice staff. Whilst this will ensure that flu vaccinations provided to staff will be covered under the CNSGP, please be aware, however, that practice staff vaccination will still not be eligible for an IoS (Item of Service) payment or vaccine reimbursement for this year. We recognise this is a frustrating decision and will continue to press NHS England about this issue and try to reach a better solution for many practices out there who are already facing enormous pressure as we head into the winter months.
NHSE vaccination strategy consultation
As you may be aware NHS England (NHSE) is seeking engagement from providers to inform the future shape of vaccination services and share views on ways in which NHSE can maximise uptake of vaccinations and reduce inequalities.
The original ‘market engagement exercise’ closes at midnight, 7 October, however, as part of the same process NHSE have also published an alternative consultation page on the proposed ‘strategy’, which remains open to the 13 October. If practices or LMCs still wish to contribute, you can do so via either method using the links below:
For more information on this exercise, the Future NHS page here provides a copy of the draft vision, the feedback questions, a portal user guide and FAQs.
It remains our view that general practice remains the best route to engaging with patients and encouraging vaccine uptake across all GP based V&I programmes, and that any expansion of providers runs the risk of simply redistributing existing patients and undermining practice funding patients, rather than increasing uptake. We have subsequently made clear to NHSE that the key to meeting the aims of its strategy is to build upon and support existing practice based programmes.
We will continue to engage with NHSE on their proposals and update as things progress.
Proposed repeal of the IR35 tax reforms
As part of the recent ‘mini-budget’ the government announced that it intends to repeal the 2017 and 2021 IR35 reforms of the IR35 off-payroll working rule. The changes are expected to come into force from April 2023 and, once confirmed, the BMA will produce further guidance in due course.
Best Practice Show, 12-13 October 2022, NEC Birmingham
The BMA and GPC England will have a dedicated theatre at the at Best Practice Show at the NEC Birmingham on 12-13 October 2022. The programme focusses on the most pressing issues facing general practice, including the future of general practice, working within ICSs, workload management, workforce management and primary care estates.
Free for healthcare professionals, the conference programme will provide up to 12 hours of CPD certified training, expertly tailored to meet the training requirements of healthcare professionals.
If you are interested in attending, you can register here.
GP Committee elections
Nominations will open at 12pm on Tuesday 11 October for a by-election for the below seats to the GPs (GPC) in the following regions:
Please note that in previous years there was a requirement that only GPs who paid the voluntary levy could nominate themselves for election. That requirement has now been removed.
To submit your nomination for any of the above seats please visit https://elections.bma.org.uk/ (the deadline is 12pm Tuesday 25 October 2022). You must be a BMA member to stand in this election.
For any questions relating to the role or GPC please contact info.gpc@bma.org.uk
If you have any queries regarding the election process, please contact elections@bma.org.uk.
Music video - A tribute to the NHS
We have been contacted by Dr Alex Watson, a GP in Ashtead and Leatherhead in Surrey, who wanted to share a song that he wrote earlier this year called ‘Change’ about the impact of the COVID pandemic. It is intended to be a tribute to the NHS and all those health and care workers who lost their lives. The final production can be seen via this link: https://youtu.be/lVwDKAK8OVo
We began this week commemorating the life of There has been substantial social and political change around the world during her stewardship of the nation, and her role in this will never be forgotten.
As King Charles III begins his reign, we also see the start of a new Parliament. While this could have been an opportunity to signal a change in step within Government - injecting some much needed hope and positivity into the profession - we have instead seen a further demonstration of the failure to understand the crisis in general practice.
Three health secretaries in six months has been the lead-up to the latest ill-informed missive from the current Health Secretary. I hasten to add, that none of today’s announcement is underpinned by any contractual agreements and so for all intentions and purposes it’s nothing more than a lot of hot air. But of course, the reality is that these divisive political statements set us up to fail in our communities and with our patients. I do wish to believe that the Health Secretary has her heart in the right place, and hope that in the coming days and weeks, my team and I can help her find a way to deliver the care we all so desperately wish to enable. Read my full statement in response
The Government’s Plan for Patients also looks to change the NHS pension scheme to help retain doctors and other NHS staff to increase capacity, but is not the long term fix the NHS needs. Read also the statement about the plan by BMA Chair of Council, Professor Phil Banfield
Change being the only constant, I want to share some personal news – I am expecting my second child. This will mean that I will in due course be on maternity leave for a period of time.
In preparation for my leave, I am developing a plan to ensure my responsibilities are taken care of and that the work of GPC England continues moving forward during my planned absence. To this effect, Deputy Chair Dr Kieran Sharrock will serve as Acting Chair and take over the day-to-day management of GPC England during my planned absence, with support from Deputy Chairs Dr Richard Van Mellaerts and Dr David Wrigley.
I expect to return to work in 2023. I will write again before I go on leave.
With warmest wishes,
Farah
Dr Farah Jameel
Chair, GPC England
GPC England meeting
GPs Committee England met today, Thursday 22 September, in an emergency meeting to discuss our concerns about ongoing pressures in general practice and any potential actions that GPs can take as a profession in response to the underinvestment by the government and the crippling workloads faced by GPs. The Committee also debated the GP contract, discussing what needs to be done to support practices struggling with inadequate premises, maintaining the declining workforce, bureaucracy, and our negotiating strategy for the forthcoming year. The GPC England representatives will be providing reports from the meeting to their constituencies.
We also held a one minute silence in memory of Her Majesty the Queen, Elizabeth II. The BMA has offered its deepest and most sincere condolences to the Royal Family.
Read updates from the meeting on the BMA GP twitter account @BMA_GP / Twitter
Read more about the work of the Committee
Read practical guidance for GP practices
Read about BMA in the media: BMA media centre | British Medical Association
Contact us on: info.lmcqueries@bma.org.uk
GP practices continue work under immense pressure with rising demand and a huge shortage of GPs, and colleagues are now also bracing themselves for a torrid winter in the NHS as the combined pressures of COVID and flu, as well as the enormous NHS backlog, threaten to shatter our fragile health service.
As shown by the latest GP practice workforce data, published today, as of August 2022 we now have the equivalent of 1,850 fewer fully qualified full-time GPs compared to September 2015. This long-term decline coincides with a rise in patients: in August 2022, there was a record-high total of almost 61.9 million patients registered, with a record high average of 9,576 patients per practice, an increase of 16% patients each full-time equivalent GP is responsible for since 2015, demonstrating the mounting workload in general practice.
I recently wrote to the new Secretary of State for Health and Social Care Dr Thérèse Coffey to highlight the pressures general practice is facing as we approach the winter months, including vaccine delivery, increased patient demand and rising utility and premises costs and called for her to work with us in addressing these issues. However, today’s announcement from the Secretary of State, which promises to improve access to general practice by freeing up over 3 million appointments, so all patients who need an appointment can get one within two weeks, while well intentioned, falls well short of what’s needed and there simply aren’t enough GPs and staff to deliver the care our patients need and deserve.
We have also met with Shadow Secretary of State Wes Streeting MPs advisors, to discuss the current state of general practice workload and workforce and the impact this is having on the wellbeing of practice staff. Read more about the pressures in general practice here
Workload and wellbeing
In our last newsletter we wrote about the overwhelming pressures that we face each day in general practice, encouraging practices to spend some time on 9 September focusing on their own team’s wellbeing and identifying the best ways of supporting each other’s mental health, ahead of World Suicide Prevention Day on 10th September 2022.
We encouraged practices to think about how you manage your workload as set out in our Workload Control in General Practice and Safe working in general practice documents. We also published guidance on How to improve the safety of your service and wellbeing of your workforce, setting out safe limits of the numbers of patient contacts per day, and what is considered ‘essential services’ under the GMS contract.
A recent BMJ article has shown that a substantial proportion of healthcare professionals report symptoms of burnout, and that there is the need for urgent action to protect patients, physicians, and health systems.
We will be producing further guidance on safe working, and please let us know if you have any feedback on how we can develop further tools to help practices: info.lmcqueries@bma.org.uk
Wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support. Please take a moment to check in on your colleagues’ wellbeing and look out for each other.
Support comes in various forms, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s wellbeing support services page for further information and resources.
For all other support, speak to a BMA adviser on 0300 123 1233 or email support@bma.org.uk. We encourage you to access any of the support resources and encourage colleagues to do so too.
Suicide prevention - priorities in the next decade – lunchtime webinar
The BMA’s Board of Science is hosting a live lunchtime (12.30-13.30) webinar on 19 October, where Dr JS Bamrah will speak to Prof Louis Appleby, from the University of Manchester.
Prof Appleby leads the National Suicide Prevention Strategy for England and directs the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Prof Appleby will present on current suicide prevention priorities, tying in with recently announced suicide prevention strategy from the UK government, before answering questions from the chair and the audience.
This event is free, and open to both BMA members and non-members. You can sign up for it here
If you have any questions, you can get in touch with the board via info.bos@bma.org.uk
In each newsletter we plan to include a question on current issue, which will be used to help form thoughts at GPCE and in negotiations. This will take only a couple of minutes of your time.
If given the opportunity today, with the knowledge you now have about the Network DES and how PCNs are working in reality, would you sign up for the Network DES? Answer here by 29 September
Vaccines and Immunisations
NHSE/I has produced draft specifications for both COVID-19 and flu vaccinations. We expect that these will be published in the next few days. We have fed back to NHSE/I that further clarification is required regarding the ability and/or requirement for practices to vaccinate frontline patient-facing staff, and reiterated our concerns about the extremely tight timeframes associated with the vaccination of care home residents. NHSE/I has intimated practices will be indemnified for vaccinating their own staff, and we will share official confirmation as soon as possible.
We have also been firm in our objections to NHSE/I’s plans to implement a national call/recall flu programme for 2-3 year olds. We fully recognise that ensuring good flu vaccine uptake is a key public health priority heading into winter. However, the timing proposed by NHSE/I – with emails and texts to parents and guardians to go out on 21 September – is extremely unfortunate, coming directly on the heels of an unscheduled bank holiday with the significant administrative burden this entails. We have made strong representations to NHSE/I that this will create additional demand at a time where there is no capacity to spare.
Email your MP to solve the NHS pension crisis
It is vital MPs understand the impact the current punitive pension taxation rules are having on retention across the already understaffed general practice workforce and the steps which must be taken to solve the issue, both in the short and long term, to allow doctors to stay in the NHS for longer. Please ask your MP to take action using our online tool here
Advice for managing long COVID with GP staff
While the symptoms may vary, and the diagnosis may be slow to be confirmed, long COVID is most likely to be categorised as a disability in employment terms. This means that, as an employer, you must take extra care in managing the employment relationship – not just managing the absences themselves but also in the day-to-day management of staff affected, to ensure employees are not suffering a detriment as a result of their condition. Investing time and skill early in the process can reduce the long-term liabilities of the practice and encourage a supportive working environment. If decisions must be made about the termination of employment of any staff member, with a disability or not, as the employer you must be able to show that you have acted fairly and reasonably. Talk to the BMA’s Employment Advisory Service to get help and support with your staff employment issues.
Three ways the BMA can support GPs managing HR issues
As a GP partner or practice manager, your BMA membership includes HR and employment law advice and practical support. Read our blog to find out how we can help with:
Best Practice Show, 12-13 October 2022, NEC Birmingham
The BMA and GPC England will have a dedicated theatre at the at Best Practice Show at the NEC Birmingham on 12-13 October 2022. The programme focusses on the most pressing issues facing general practice, including the future of general practice, working within ICSs, workload management, workforce management and primary care estates.
Free for healthcare professionals, the conference programme will provide up to 12 hours of CPD certified training, expertly tailored to meet the training requirements of healthcare professionals.
If you are interested in attending, you can register here.
| Read the latest GP bulletin (England) here |
We wrote to you last week about the overwhelming pressures that we face each day in general practice, and how we wish to prevent the loss of more colleagues dying by suicide.
Tomorrow (9th September), the BMA is encouraging all GP practices in England to spend some time focusing on their own team’s wellbeing and identifying the best ways of supporting each other’s mental health, ahead of World Suicide Prevention Day on 10th September 2022. As part of this time to reflect we also suggest that you think about how you manage your workload as set out Workload Control in General Practice and Safe working in general practice documents.
We have produced guidance on How to improve the safety of your service and wellbeing of your workforce, which sets out safe limits of the numbers of patient contacts per day, and what is considered ‘essential services’ under the GMS contract, so that you can plan how you run your practice. This includes a template letter to Patient Participation Groups (PPGs) to explain their rationale for moving to a safer model of delivery. We have also encouraged practices to write to their PPG ahead of tomorrow.
The BMA has also written to the new Prime Minister, Liz Truss, highlighting the need to tackle NHS pressures and that practices are bearing the brunt of excessive waiting times while many are themselves overwhelmed with demand. In response to the appointment of Thérèse Coffey as the new Secretary of State for Health and Social Care, the BMA highlighted the huge decline in GP numbers and debilitating workloads and has also urged her to lay out her emergency plan for the NHS, underlining that a promise of extra appointments cannot be realised without additional doctors.
Please do try to use 9th September as a time to reflect and an opportunity to improve the safety and wellbeing of your practice for yourselves, your colleagues, and your patients.
Kieran Sharrock, GPC England Deputy Chair, explains why this is important and suggests discussion points for the practice during this protected time. Read the blog
Read our slide on suggested GP wellbeing session structure on 9 September
Access our Suggested telephone message script
We will be producing further guidance on safe working, and please let us know what changes you would like to make in your practice following these discussions, so that GPC England team can develop the tools to enable this: info.lmcqueries@bma.org.uk
Wellbeing resources
A range of wellbeing and support services are available to doctors, and we encourage anybody who is feeling under strain to seek support. Please take a moment to check in on your colleagues’ wellbeing and look out for each other.
Support comes in various forms, from our 24/7 confidential counselling and peer support services to networking groups and wellbeing hubs with peers, as well as the NHS practitioner health service and non-medical support services such as Samaritans.
The Louise Tebboth Foundation is a charity that campaigns for the prevention of suicide and the mental wellbeing of doctors in England and Wales
The organisation Doctors in Distress also provides mental health support for health workers in the UK, providing confidential peer support group sessions.
See our poster with 10 tips to help maintain and support the wellbeing of you and your colleagues.
Please visit the BMA’s dedicated wellbeing support services page for further information and resources.
NHSE/I Autumn Care Home COVID-19 Vaccination Programme
NHSE/I has announced its proposal for additional support for practices vaccinating care home residents in Autumn.
NHSE/I brought an initial proposal and after concerted discussions, we were unable to secure concessions sufficient for us to endorse this programme. Whilst additional support to deliver services is always welcome, we know that general practice does not have the capacity to absorb additional workload pressures in the lead up to winter. As it stands, we found the proposal unduly prescriptive, overly bureaucratic, and underfunded. We made a number of our own suggestions to try to remove these barriers, which NHSE/I declined to adopt, nor was there an appetite to increase the funds available from c£3.5m (assuming 100% uptake and success).
We fully appreciate the importance of vaccinating the most vulnerable as soon as possible, in line with JCVI guidance. However, practices and PCN groupings need to be appropriately resourced to do this workforce-intensive work. They also need sufficient time to plan, make workforce arrangements, and order vaccines.
Some practices/PCNs may feel that they can take up NHSE/I’s offer, either because they have the capacity to spare or because this is broadly in line with how they have planned to administer care home vaccines anyway. We fully support these practices/PCNs and their efforts. Other practices will decide not to take part, and we would like to reassure you that it would be entirely reasonable to forgo this offer. We recommend that practices and PCNs carefully consider the workload required to undertake this activity, and if the resources on offer are sufficient for that purpose.
Digital firearms marker
Members will be aware of issues with the implementation of the new digital firearms marker for practices using the EMIS system. GPC raised these issues with the Home Office and NHS Digital has agreed to a temporary suspension of the EMIS system marker to ensure that the system is addressing the issues raised and enable testing to ensure the accuracy and completeness of the flags that are currently popping up.
We are continuing to work with the Home Office, Police Chiefs and NHS Digital to implement a firearms marker that will improve the current system for GPs and provide a safer and more efficient system to benefit the public. However, we are still looking for clarification/guidance on what doctors should do immediately when the flag comes up. GPC is conscious that any revised system remains easy to use for GPs and importantly, does not distract or amount to an administrative burden and workload for practices.
GP premises update
Two key policy developments – the Premises Cost Directions and the NHS England Ownership Review – have been due ‘any week now’ for some months. Either could have seismic implications for how the primary care estate is managed and funded, immediately and in the future. We will of course monitor developments closely and communicate them widely.
While we await the arrival of these strategic-level publications, we have been busy resolving operational issues as they emerge. We receive multiple queries every week from practices struggling with NHS Property Services (NHSPS) or – less frequently – Community Health Partnerships (CHP) and have been providing advice about how to resolve these issues and move forward. We continue to meet with the chief executives from both organisations, using this as an opportunity to escalate problems that have become intractable on the ground, with consistent success.
We have also continued to engage with NHSE officials, most recently on the Housing Building Note 11-01 Facilities for primary and community care services, to be published shortly, giving best practice guidance on the design and planning of new healthcare buildings and on the adaptation/extension of existing facilities. We have also conveyed our concerns (evidenced by issues raised by our membership) about the 3 Facet Survey, emphasising the need to ensure a ‘light touch’ approach to gathering information about the primary care estate, and that practices should not have to submit information that has already been collected (e.g., at a CCG/ICS level).
As many of you will have seen from our prior update, the NHS PS case (Valley View v NHS Property Services Ltd [2022] EWHC 1393) is ongoing. We have produced FAQs outlining the key issues, and their relevance to practices, which will also be available on the BMA website shortly.
Inflation and your practice
GPs across England are grappling with increasing levels of inflation, sky high fuel costs and the impact it is having on practice costs. We are interested in learning more about how individual practices are experiencing inflationary cost pressures (i.e. gas and other utilities, staffing costs), and would value an opportunity to speak to you about this. Your contributions will better enable us, on behalf of the profession, to advocate to and pressure NHSE/I, DHSC and the government to seek solutions.
To share your experiences and help bolster the BMA’s evidence-based lobbying and influencing case for urgent General Practice support, please get in touch with Rachel McGuire, BMA Senior Research Advisor in the Independent Contractor Doctors Team (icdqueries@bma.org.uk).
Accelerating citizen access to records
NHS England will be enabling clinical record access to patients via the NHS App on 1st November. We are expecting a toolkit to be circulated to practices ahead of this and have remained in discussions to ensure rollout is neither burdensome nor disruptive to practices. NHSE will be in touch with practices directly to explain the changes taking place and how GPs can support rollout.
Health and Social Care Select Committee’s Workforce report briefing
The BMA has published a member briefing summarising and analysing the Health and Social Care Select Committee’s Workforce report. One of the recommendations in the report is that International Medical Graduates (IMG) GP trainees should be offered Leave to Remain on successful completion of speciality training, which the BMA supports. We are calling on the UK Government to go further by introducing a permanent solution to allow newly qualified GPs to transition into full time employment without the anxiety of having to find a GP practice with a sponsorship licence. Read the full briefing here
Understanding more about the experience of International Medical Graduate GPs
NHSE/I is working with Ipsos UK to explore the experience of GP IMGs who are in training or have completed training in England, to provide insight into the support needed for IMGs through their training and employment journey. The BMA supports this research by reaching out to our networks.
If you know an IMG who did GP training in England but is not working in general practice please encourage them to talk to Ipsos UK, who are keen to understand their experiences. They want to speak to doctors who trained, but are not working as GPs, for example, working in a hospital or elsewhere in England, or those working outside of England.
Please help if you can. Participants will be offered a £120 incentive to thank them for their time and should email UK-NHS-IMG-research@ipsos.com
DHSC Medicine Supply Tool
DHSC and NHSE/I have launched an online Medicines Supply Tool, which provides up to date information about medicine supply issues. The Tool also details any changes to resupply dates and updates to the entries.
Best Practice Show, 12-13 October 2022, NEC Birmingham
The BMA and GPC England will have a dedicated theatre at the at Best Practice Show at the NEC Birmingham on 12-13 October 2022. The programme focusses on the future of general practice, working within ICSs, workload and workforce management and primary care estates. Free for healthcare professionals and provides up to 12 hours of CPD certified training. Register here.
GPC England committee pages and guidance for practices
Read more about the work of the GP Committee
Read practical guidance for GP practices
See the latest update on Twitter: @TheBMA / Twitter, @BMA_GP / Twitter @DrFJameel / Twitter
Read about BMA in the media: BMA media centre | British Medical Association
| Read the latest GP bulletin (England) here |
