Autumn Budget statement
This week’s budget announcement has left GP partners hugely concerned about the significant rise in employment costs from April 2025 and the impact this will have on their practice. For many the cost of these changes to national insurance contributions and the lowering of the threshold will be a hammer blow to practice finances. Previously, these cost increases have been fully compensated, but Treasury officials have said there will be no reimbursement this time.
This is completely unacceptable and as a GP partner myself, I know how stressful and difficult announcements like this can be. We are NHS GPs and have been in partnerships since the inception of the NHS and all we are asking is to be treated like all other parts of the NHS who will see these costs reimbursed. We are not like traditional businesses who have shareholders or who can increase their costs when increased expenses arise, and we are making this quite clear to Government and their officials.
We need the Government to rapidly change its mind, and you can help us put pressure on it by writing to your local MP using our online tool.
The chancellor has publicly committed to ‘no reduction in spending powers across the NHS’, which, we have been told, includes NHS general practice. However, at the same time the Treasury has been saying that GP practices may not be compensated in full. We need clarity and certainty, not promises and conjecture.
We are on your side, and we are doing all we can to sort this problem out and make the Government see sense.
GPC England is due to meet on 14 November and the conference of England LMCs is taking place on 22 November, where discussions will be taking place on the flexibilities and asks within the £22bn headline budget figure, as well as the insufficient capital around estate and premises commitments. The team is aware of the concerns of practices and want to assure you that we have this at the top of our agenda.
Collective action
Thank you to every practice now taking part in our collective action to protect our patients and practices. These actionshave already, and will continue to, make a difference: they are safe, sustainable, and do not breach your contract. Most importantly, these actions are turning up the pressure on the Government to do the right thing for patients and general practice. We are the bedrock of the NHS, but our services have been driven to near collapse.
We need you to take action to protect our patients and protect our practices.
Focus on: patient appointments
We are producing more guidance around individual collective actions to support practices in undertaking specific actions. This week we are focusing on patient appointments.
Watch our collective action video on patient appointments
This two-minute video shows GPC England colleagues’ views on this specific collective action. We are asking you to consider extending patient appointments to give patients more time to address their health concerns and create a sustainable working day for GPs and stop supporting the system at the expense of your patients, practice and staff.
BMA GP opinion survey 2024
The latest BMA GP opinion survey is open. This annual survey gathers GPs’ views on current issues and opportunities facing general practice, helping to influence and inform this year’s contract negotiations in addition to our longer-term strategy of promoting and protecting the future of general practice.
The survey is open to all GPs in England, including partners, salarieds, locums, and GP registrars at ST3 and above. It is open to GPs working in all settings and practices, wider primary care roles, trusts, urgent care, and secure or out-of-hours settings.
Participants do not need to be a member of the BMA to participate but we will need a GMC number to ensure that responses are coming from eligible GPs based in England. All responses will be anonymised.
The survey will close on Monday, 11 November, at 9am. We urge you to complete the survey as soon as possible, to ensure GPC England’s negotiating position is made as strong as possible.
Bringing back the family doctor: a roundtable discussion
GPC England will be holding a roundtable discussion ‘Bringing back the Family Doctor’ at 2–4pm on 28 November at BMA House.
In advance of the event, you can read our recently published paper, Patients First: why general practice is broken and how we can fix it. This paper outlines the critical steps required to prevent the closure of local practices, retain experienced NHS GPs, and provide the necessary funding for practices to recruit additional GPs and practice nurses to increase appointment availability and better continuity of care.
Flu vaccinations
Flu vaccinations for practice staff
As in previous years, under the terms of the flu enhanced service, practices are able to provide flu vaccination to their patient-facing staff. Unfortunately, while these will not be eligible for an item of service payment due to an NHSE decision, such vaccinations will be covered under CNSGP.
Flu vaccinations for locum GPs
Locum GPs are also eligible to receive free flu vaccination under the flu enhanced service. While this may be received from their registered practice, under the terms of the ES they do not need to be a registered patient in order to receive the vaccination, and so may receive it from their substantive workplace, if applicable, and vaccinations provided to locum GPs are eligible for an item of service payment, as with other patient cohorts. Further guidance on this, including how such vaccinations should be recorded, is available on the NHS England website.
NHS England 10-year health plan
DHSC and NHS England have launched a consultation – Change NHS – to help inform the development of a new 10-year health plan. The consultation is looking for ideas on how the NHS can improve, as well as views on these three proposed ‘shifts’; moving more care from hospitals into the community; going from analogue to digital; and moving toward prevention and away from sickness. The BMA is developing its response to the consultation, but individual NHS workers can also respond to a separate survey on the Change NHS website.
UEMO statement on MAPs and letter on prison doctors
At the UEMO (European Union of General Practitioners) autumn general assembly in Brussels over the weekend of 19 Oct, UEMO published a statement expressing its concern with the deployment of MAPs (medical associate professionals). The statement calls on governments across Europe to legislate prohibiting the unsupervised initial assessment, unverified diagnosis, treatment, and discharge of the undifferentiated patient by MAPs. The statement was proposed by our own committee member, UEMO vice president and head of the UK delegation, Peter Holden and was agreed to unanimously.
The statement goes on to unequivocally support the ethos that holistic cost-effective family medicine requires continuity of care primarily delivered by substantively appointed generalist professionals in (small and locally based) organisations acting as the first point of contact for patients, and which holds the patient’s lifetime record of care and draws in specialist skills as judged clinically necessary.
Do you look after asylum seekers or refugees?
It is well-evidenced that this group of patients continue to face significant barriers accessing appropriate and timely healthcare. We’re now looking to conduct a survey to capture your experiences, so the BMA can better support you in enhancing healthcare services for asylum seekers and refugees. Look out for our survey which will launch next week.
Supporting GP registrars in practice placements – supernumerary status
The GP registrars committee is aware that some GP registrars are facing challenges in securing leave and would like to clarify their status as supernumerary to the practice workforce.
GP registrars play a vital role in practice teams, bringing valuable clinical skills to patient care as part of their training. However, they are additional to the core workforce and should not be relied upon to meet staffing requirements or staffing gaps. Embedding this principle into workforce planning is essential for creating a supportive training environment that allows registrars to develop effectively.
Thank you for helping ensure registrars feel valued and well-supported in their roles.
Read more about the work of GPC England and practical guidance for GP practices.
See the latest update on X @BMA_GP and read about BMA in the media.
Contact us: info.GPC@bma.org.uk
Read the latest GPCE bulletin: Autumn Budget statement | collective action | GP opinion survey
The Single Electronic Referral Form (SERF)
LMC members continued to express concerns that the SERF was not fit for purpose and generated administration for clinicians which reduced their time for clinical tasks. Discussions continue with the CCG, RCHT and CFT.
Committee Roles
After a request for expressions of interest the three Executive posts were elected by Committee unopposed in line with the current Executive’s proposals for the new three-year term. Commencing September 2021, the Executive will be re-structured as follows:
Chair’s Report
Dr Will Hynds reported on the following:
KCCG Report
Andrew Abbott and Kirsty Lewis report on:
KHCIC Training Hub update
Laura Wheeler from KHCIC gave an update on the various training courses available. Please refer to their website for further information https://www.kernowhealthcic.org.uk/cornwall-training-hub/
Institute of General Practice Management (IGPM)
Nicola Davies from Roseland Surgeries gave a presentation on the newly formed Institute of General Practice Management (IGPM) which Kernow LMC is supporting. Further information can be found on our website here - About the IGPR - Kernow LMC
Observer seat for KHCIC at our Committee
It was agreed by members for Kernow Health CIC to have an Observer seat at our Committee meetings as a reciprocal arrangement for our seat on their Board
Post Covid Service
Dr Robert Gardner gave an update on the Post Covid Service and reported that referral forms are now available to share with colleagues.
VTE pre-assessment tool
A reminder was given that valid referrals to secondary care cannot be refused. The LMC are following up a recent refusal from fracture clinic to accept a referral without a VTE pre-referral assessment. The LMC continue to campaign for a reduction in administrative burden on practices – this is one practical example.
LMC Remuneration Survey
LMC salaries and Committee remuneration rates were found to represent good value to Cornwall when benchmarked with other areas.
ICS and system-wide influence
Various LMC members already sit on the ICA Boards in Cornwall but anyone with ideas/views/comments on how GPs/the LMC can influence the ICS (Integrated Care System) further please email emma@kernowlmc.co.uk
COVID alert levels and advice for practices and patients at risk
Following the announcement of a three-tier lockdown approach for England last week, Greater Manchester and South Yorkshire have now joined Liverpool City and Lancashire in the Tier 3 (very high) alert level. Warrington will be added next week. Read the full list of COVID alert levels in England by area here. A 17-day national "firebreak" will begin in Wales at 6pm today and a 5 tier system will be introduced in Scotland from 2 November.
We recognise that few will welcome these restrictions, but unless rising rates of transmission are curbed urgently, we will soon see an increase in patients needing care, and sadly a rise in deaths. Some hospitals have already announced that they will have to once again reduce some elective procedures, with all the implications that then brings both for patients and practices. More stringent lockdown measures are therefore necessary, and we urge everyone to take the new rules seriously. People need to have confidence that the sacrifices they are now required to make are understood by those in power and these new restrictions must be backed with more support for GP practices in those areas who will be impacted significantly.
As we reported previously, NHSE/I has confirmed that local flexibilities should be made available, to support practices to clinically prioritise capacity in these challenging times. We are in discussion with NHSEI about how they can provide clearer support to practices struggling with workload pressures as the prevalence of patients with COVID-19 increases. We are also making it clear in our public messaging that despite some media reports, whatever the current local COVID alert levels are, GP practices continue to remain open as they have done throughout the pandemic. Whilst remote consultations should be the main way in which patient care is delivered, when it is clinically necessary to see high risk patients face to face, they should be able to attend the.
Ordering additional adult flu vaccine stock (England)
As we reported last week, DHSC has written to practices to confirm the process by which they will be able to access the additional adult flu vaccine stock secured to support the expanded vaccination programme this season.
GP practices are now invited to begin ordering or pre-ordering the following vaccines:
If a GP practice has a provisional order with Sanofi for QIVe, please contact them to confirm this, before placing another order for QIVe for this cohort.
On placing an order, practices will be asked by manufacturers to verify that stock is being ordered for NHS eligible patients or frontline social care workers, where there is a genuine shortage for this cohort. Orders should only be placed where you have a shortfall in supply for existing eligible patients at this stage.
Further instruction on timing of extension of eligibility to all 50 to 64 year olds will follow and stock should not be ordered for this cohort at this stage.
Influenza immunisation FAQs (England)
NHSE/I have now produced a set of FAQs relating to the influenza immunisation programme and can be found here. They have also issued guidance on how practices and CCGs can make use of the additional £15.4m made available to local systems and primary care providers to cover reasonable additional costs (over and above the usual fee structures) associated with this year’s extended flu programme.
Pensions newsletter
The BMA’s pension committee has been at the forefront of fighting to maximise your pension benefits. Please see the first quarterly newsletter here. The newsletter provides an update you on what actions the committee is taking on a range of issues, and also provides access to educational resources, blogs and information on how to access BMA support regarding your pension.
DDRB pay award and template letter
The Sessional GPs Committee has received reports that some salaried GPs are struggling to get their 2.8% paylift, as recommended by DDRB and approved by the government, despite being entitled to it. We believe it is only fair that this uplift is awarded to all doctors, and this includes all practice-based salaried GPs. Practices are encouraged to apply this uplift across all of their employed GPs, regardless of individual contractual requirements. However, it is worth noting that there is a contractual requirement to implement this pay increase for salaried GPs employed on the model contract.
If you are a salaried GP struggling to obtain the pay increase, even after having a conversation about the matter with your practice manager, you may wish to send a formal letter. The BMA DDRB template letter can be adapted to reflect your individual circumstances. Please get in touch with the BMA if you need further assistance in this area. Read more in the Sessional GPs newsletter.
GPC Wales meeting
GPC Wales met for the first meeting of the 20/21 session yesterday, 22 October 2020 and I was pleased to be able to join them in the morning. A major focus of the meeting was a discussion about the second wave of COVID-19 and what it meant for GP practices already facing the challenges of winter pressures and flu campaign delivery. The committee unanimously supported GPC Wales’ proposals for contractual relaxation and support measures, while also unanimously voting that Welsh Government’s efforts to date were insufficient. Other items discussed included the NHS Wales flu campaign for 20/21, COVID vaccination plans, the committee’s workplan and taking forward future contractual agreements.
Circuit breaker lockdown in Wales
BMA Wales issued a press release welcoming plans for a circuit breaker lockdown in Wales, which means that a series of restrictive measures will be in place from 6pm Friday 23 October until the start of Monday 9 November 2020. Dr David Bailey, Chair BMA Cymru Wales, said: "Cases are climbing fast across Wales… It's clear that the current restrictions are not strong enough to suppress the spread of the virus. Doctors in Wales support, and are calling for as a matter of urgency, a circuit-breaker lockdown for a number of weeks. It is imperative that robust action is taken now without delay, to protect the citizens of Wales, and the Welsh NHS." Read more in the Welsh Government’s’ coronavirus firebreak FAQs here
This was reported by the BBC, BBC Radio Five and BBC Radio Wales breakfast show (at 08:37).
Dr Phil White, Chair GPC Wales, was a guest on Y Post Cyntaf on BBC Radio Wales (from 19m30s) to discuss the new ‘fire break’ lockdown for Wales.
GPC Scotland meeting
SGPC held its first meeting of session yesterday, 22 October 2020 and I was pleased to be able to join in the afternoon. Progress on delivery of the 2018 GMS contract was discussed along with work to negotiate transitionary arrangements following the end of the implementation period. The committee discussed recovery and remobilisation with a focus on general practice priorities, urgent care and enhanced COVID-19 pathway proposals, and GP IT issues, and received reports from various GPC meetings, external groups, and the GP Sessional Committee.
SGPC also heard updates on letters produced by Scottish Government including the Primary Care Improvement Fund letter, and an update on NHS Scotland Primary Care National Premises meeting, GP Wellbeing, and the SLMC Conference on 4 December. A pensions update was provided by Alan Robertson, a member of the BMA Pensions Committee who was leading on a lot of the work.
Congratulations to Andrew Cowie and Patricia Moultrie who were elected uncontested as joint deputy chairs of SGPC and to Chris Black, Iain Kennedy, John Ip, Denise Mcfarlane and Tyra Smyth were elected to the SGPC Executive for the 2020-21 session.
CQRS system supplier change (England)
NHSE/I is overseeing a programme to ensure the CQRS system supports efficient GP incentive-based payments. As part of this work NHSE/I is working with NHS CSUs to bring the running and development of the CQRS system in-house from 1 November 2020 and to introduce a new centrally funded system (CQRS Local) to support locally commissioned schemes by April 2021. These changes aim to streamline processes and reduce the administrative errors in GP payments as called for in GPCE’s Saving General Practice.
A structured transition from the existing supplier is in place to ensure the continued provision of the CQRS system from November with minimal interruption for end users. How users access and use the CQRS system is not changing and no action is required from practices or commissioners.
From 1 November the new number for the CQRS service desk will be 0330 124 4039, although the email address remains support@cqrs.co.uk
While the system itself will look and feel the same a new CQRS welcome page is now live providing direct links to the CQRS system and online training modules, guidance and news updates.
Tackling health inequality webinar
The BMA committee for medical managers is hosting a free, online panel event on Tackling health inequality, with speakers Tracie Jolliff (head of inclusive system development at NHSEI) and Roger Kline (author of The Snowy White Peaks of the NHS) on Wednesday 4 November 5.30-7pm. The event will explore why diverse leadership is essential to create an NHS that truly serves the whole country and, crucially, what steps medical managers can take to achieve this. Find out more and to book your place here
Mental health and wellbeing
The BMA continues to offer wellbeing services and confidential 24/7 counselling and peer support for all doctors and medical students, as well as their partners and dependents, on 0330 123 1245. Access the BMA’s COVID-19 wellbeing pages here.
The BMA has welcomed the NHSE/I announcement of further funding for the expanded and rapid access provision of mental health services for NHS staff in England over the winter. This is urgently required and something the BMA has been calling for to support the major challenges NHS staff are facing. At the ARM, a motion was passed expressing concern at the potential long-term impact of the pandemic and called for resources to support the profession. As we head into a second wave of the virus it is vital that staff are protected. Find out more here
Read our COVID-19 toolkit for GPs and practices, to help answer questions on a large range of topics relating to COVID-19. There is also guidance on the following topics:
COVID-19 media
On Monday I did an interview for BBC Radio York following the news that Test and Trace information could be shared with the police. GPC member Gaurav Gupta spoke to BBC Radio Kent (8.45am) on Wednesday discussing the issue of face covering exemptions.
There was extensive media coverage on NIGPC’s concerns over the flu vaccination programme shortages. NIGPC chair Alan Stout was interviewed by BBC News NI, The Nolan Show, UTV Live, BBC Newsline, News Letter. NIGPC deputy chair Frances O’Hagan appeared on BBC Talk Back (48:47).
Pulse reported on future Covid-19 vaccination campaign, and I was quoted: “While we don’t have a specific date when the vaccines will be ready, the BMA fully expects general practice to play a significant part in administering them, and practices will require significant support for what is set to be a huge immunisation campaign."’
See this week’s GP bulletin here.
Read the latest Sessional GPs newsletter here
The LMC's monthly newsletter for the Duchy’s GPs and practice managers includes:
