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LMC Weekly Update 11.10.2019

Meeting with Health Minister

Yesterday I met Jo Churchill MP, the new Minister with responsibility of Primary Care in England.  It was a positive meeting and provided a good opportunity to discuss many of the issues impacting GPs and practices on a day to day basis. We focused particularly on the need for more GPs and the impact pension tax arrangements was having on retention, the problems many practices are having with premises and the on-going problems caused by Capita/PCSE.  We also spoke about the development of PCNs across England, the need to support clinical directors and the opportunity to reconnect with the wider community healthcare team.

Primary Care Networks survey

The BMA has launched an annual survey to understand progress and inform the future development of Primary Care Networks (PCNs). This is part of the BMA’s commitment to PCNs and to ensure we provide them with all the support they need. This annual survey will provide an opportunity for clinical directors to share their perspectives on how PCNs are operating on the ground, to tell us how they see their PCNs developing and will provide us with the necessary information to use in our negotiations with NHS England.

You can access our recently launched PCN package of support. Read Krishna Kasaraneni’s article in Pulse on PCNs being a chance to redefine general practice and feel empowered about the future here (sign-in required).

Primary Care Fellowships
Local integrated care systems and STPs have received funding in 19/20 to support the development of fellowships for April 2020.  NHS England and GPC England are working together to provide some joint guidance which will be made available in the next few weeks.  LMC and PCNs may want to start thinking about how they see these developing locally to meet local challenges. 
 
Respond to the NHS pension scheme consultation
The Government has reissued its consultation on introducing flexibilities to the NHS pension scheme. We believe it’s too little too late – we need its commitment to reform pension taxation, in time for the next tax year. This is your chance to raise your concerns – use our template to respond.
 
Locum guidance on pension annualisation
The BMA has sought clarity from NHS Business Services Authority on annualising for sessional GPs who are members of the 2015 career average revalued earnings scheme. Locums who work out-of-hours can now be afforded a different pension status as part of the 2015 scheme. This will change how their pensions are annualised. Read more here.
 
GDPR and SAR: Update on the provision of medical records to solicitors
A recent court case has considered a dispute about how medical records are made available to solicitors requesting them on behalf of patients. We are seeking full information about the case and once we have this we will review the details to ensure we provide the most up to date guidance to members.
 

Learning disability registers

NHS England have published new guidance for practices to ensure that learning disabilities registers are comprehensive and up to date and vulnerable patients are given the opportunity to receive flu vaccinations and annual health checks. We encourage practices to use this guidance to regularly review their learning disabilities registers to ensure they are up to date so that the right patients are being invited to attend vaccinations and health checks. However, we have raised concerns with NHSE about the significant amount of GP time that it will take to manually update registers to include all of the conditions listed and are pressing NHS England and NHS Digital to commission an automated system as soon as possible. Meanwhile, where diagnosis of a learning disability is unclear, GPs should refer for a specialist assessment.

Pharmacy contract changes

In July 2019, the Pharmaceutical Services Negotiating Committee (PSNC), NHS England & NHS Improvement and the Department of Health and Social Care agreed a five-year deal for community pharmacies. We contacted the PSNC following some reports about practices being approached by patients about diabetic checks. The PSNC has now produced a web page outlining how these changes are relevant to GPs, including a briefing document which summarises the changes that would be of particular interest to practices. We will also be meeting with the PSNC to discuss how these changes impact on practices. LMCs should discuss with LPCs about how best the pharmacy contract requirements should be done locally.

Medicine shortages
The Department of Health and Social Care has shared the attached communications about supply issues for Adrenaline Auto-Injectors, Detrusitol XL (tolterodine) 4mg capsules and Nardil (phenelzine sulfate) 15mg tablets.

As we reported last week, the Government are introducing new restrictions on the exportation of all variations of HRT products, some of which currently face supply shortages due to manufacturing issues. The Mirror reported of concerns of further shortages in the event of a no-deal Brexit. In response to this, Farah Jameel, GPC England executive team member said: “The menopause can be a very difficult time for women, so it’s essential they have access to the medication they need, particularly as we head into winter. This is when pressure on NHS is most intense and ­uncertainty grows around the fallout of a ­potential no-deal Brexit.” Read the article here.

Ibuprofen shortages 
Some supermarkets have reported shortages of ibuprofen, claiming it is due to global shortages. In response to this, Farah Jameel, GPC England executive team member said: “While any supply issue impacting the availability of commonly used medicines can worry patients, for those buying painkillers on the high street paracetamol is often a very safe and effective alternative to ibuprofen. If in doubt, patients should speak to a pharmacist for further advice.”  The articles refer to our statement on shortages from last week. This was reported by the SunMirror and Daily Record.

STPs and ICSs Guidance 
The BMA has published new guidance designed to support members to engage with and influence their local STPs and ICSs, building on our previous work on integration and our wider messaging around the importance of clinical engagement. The guidance, which is available on the STPand ICS webpages, is intended to help frontline doctors to secure and capitalise on local engagement. It provides advice on the changes taking place within ICSs and STPs, suggested questions and tips on engagement, as well as contact information and a template letter to assist members in contacting their system leaders. If you have any questions about the guidance, any feedback you would like to share regarding the changes happening in your area, or would like support in engaging with your local ICS or STP, please contact Tom Bramwell at tbramwell@bma.org.uk

Sunday Mirror campaign
The Sunday Mirror has launched a campaign calling on the Government to end the crisis in doctors’ surgeries, by boosting the number of trainee GPs, creating 30 million extra appointments, and reduce the number of GPs leaving the NHS by improving working conditions. In response to this I said: “Recruitment efforts have been significant over recent years, but despite these efforts, we are still desperately short of GPs across the UK. Despite their best efforts, surgeries are struggling to fill vacancies making it hard to cope with growing patient demand. This leaves teams demoralised, and communities frustrated as they wait longer to get the care they need.” Read the full quote and article here.

Decline in GP pay
The Daily Mail reported on a survey by the University of Manchester over a 10-year period, which showed that, after adjusting for inflation, GPs earn 14% less than they did in 2008. In response to this, I noted the fall in GP income since 2006 and added that “Since 2017, we have seen positive efforts to redress the balance with negotiated contract changes that in the most recent official figures showed a long overdue pay uplift. But the now deepening problem of pension taxation rules is no doubt a looming threat to GP recruitment and retention; add this to increasing workload and demand, and it paints a sorry picture for GPs and others working in general practice”. Read the full article here.

BMA response to no-deal readiness report
The BMA has responded to the Government’s No-Deal Readiness Report, which outlines what will change should no Brexit agreement be reached by October 31, Chaand Nagpaul, BMA council chair, said: “With little more than three weeks to go until Brexit day, there’s no sign of who is going to provide an emergency transport service for critical medicines and medical supplies, or extra freight capacity to guarantee that patients can continue to get the drugs they need in the event of a no-deal. Overall, this document underlines the sheer scale of the task at hand, with almost no area of industry and society unaffected, not least the NHS and the health of the United Kingdom.” Read the full statement here. It was reported by the Times(sign-in required)

NHS app campaign

NHSX are launching an information campaign about the NHS App next week. The App can be used by 96% of people in England, providing a core and consistent digital offer from the NHS, in line with commitments set out in the NHS Long Term Plan. NHSX wanted to make sure the NHS App provides a good service and user experience, and as such, are taking the approach of launching this campaign with staff and partners first, promoting it incrementally, while asking for feedback in order to improve. NHS staff will be able to feed back directly within the NHS App.  

They have created a toolkit of materials to help NHS organisations promote the app to staff, which can be used in organisations' internal communications channels. All this work is supported by the promotion taking place in many GP practices across the country, telling patients about the benefits of the app. NHSX will be refreshing GP practice materials to coincide with a public facing phase of our campaign later in the year. If you have any feedback, please send it to appfeedback@nhs.net.

World Mental Health day

It was the World Mental Health day yesterday, which the BMA marked by the publication of a report on mental health and wellbeing in the medical profession, which highlights systemic challenges such as changes to workplace structures and workflows as being fundamentally damaging to doctors’ work life and mental wellbeing.

These factors were interpreted as being imposed on doctors, including through government-led cost-cutting initiatives.

The report also highlighted the problems which are caused by the 10 minute consultation window not being sufficient time. The consultation time was considered at odds with the increasing complexity of patient care in general practice, with an ageing population, and patients presenting with multiple diagnoses and more medicines to monitor. Alongside the report the BMA published a mental wellbeing charter to call on employers to take leadership on staff mental health and provision of support. Read the report and charter here, and the BMA press release here. It was reported by the BMJGP online (sign-in required) and Pulse (sign-in required)

The Department of Education and DHSC also published their first 'State of the Nation' report, to coincide with Mental Health Day. The findings show that than 4 in 5 children and young people report being happy with their lives, rating themselves happiest with their family and friends, their health, their school and their appearance as key factors.

CMO report on childhood obesity

The Chief Medical Officer, Professional Dame Sally Davies, has published a special report on Time to solve childhood obesity – read it here.

 
PCSE surveys
We would be very grateful if LMCs, practices and individual doctors could fill in our short surveys about PCSE to see how things have developed since our previous surveys in December 2017. This will enable us to influence operational issues on your behalf and give us the hard data to substantiate the anecdotal evidence we also receive. 

Survey of LMCs - this has three short questions for each statutory LMC to complete.
Survey of GP practices - please could you forward this to all your practices to complete.
Survey of all GPs including trainees - we would appreciate it if you could share this with your members particularly with locum GPs and trainees.

The deadline for responding to the surveys is noon, Friday 25 October. The greater response we have, the stronger our hand when discussing matters with NHS England. We really appreciate your help 
 
Vacancy for new member on GMC
The GMC are recruiting for a new member of our Council. Applications are open to medical candidates with a licence to practice, from diverse communities in the four countries of the UK, until 31 October 2019. You can find out more information about the role on the GMC website

Read the latest GPC newsletter here.

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