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LMC weekly update - 11 December, 2020

COVID-19 vaccination programme (CVP) implementation  

After such a terrible year, it is really good news to see the COVID-19 vaccination programme up and running.  This is a massive achievement and I wish to thank all those involved in getting to this stage, not least the many hundreds of practices working through over 200 designated wave 1 practice group sites that start vaccinating their patients next week. They will be rapidly followed by wave 2 and 3 in the coming days enabling thousands of our most vulnerable patients to begin to be protected from this dreadful infection. 

NHSE/I has written to the initial sites to set out the requirements, and have said they will be given full support to mobilise within the timescale.  They have also outlined all the equipment that will be provided free to designated sites, in addition to the £20m provided to cover other additional costs. This followed the publication of an updated version of the Enhanced Service Specification for the delivery of the CVP, to include modifications following discussion with MHRA and to ensure patients from non-participating practices can be provided vaccinations. There will be further updates to reflect the new requirement by MHRA for a 15 minute observation period following giving the vaccine. We would expect CCGs to work with and support practice groups should there be a need to review the premises arrangements to accommodate this new requirement. 

NHSE/I has published a collaborative agreement for the use by practice groups, which our legal team has reviewed further. We are liaising with NHSE/I to make amendments to the data sharing and indemnity sections of this agreement so that they provide more security for practices, and it will therefore be re-published very shortly. It remains a template that practices could adapt further if they wanted to, but we hope that following our legal review this will not be necessary. In addition, they have also produced a document outlining the legal mechanism for the administration of COVID-19 vaccines as it was necessary for the hospital sites to use a Patient Specific Direction rather than a Patient Group Direction to support the initial vaccination process. However, NHSE/PHE have now issued a PGD which practice groups can use, and therefore will not need to use the PSD. There are also accompanying letters that responds to many of the issues that have been raised, giving details of the wave 1 mobilisation of vaccinations. A SOP for the management of COVID-19 vaccination clinical incidents has also been published. Access all details here. 

In order for vaccinations to be delivered promptly and as matter of priority, practices will need to re-prioritise other work and NHSE/I have now been clear that they can offer an urgent-only service whilst vaccinating practice teams are involved in the programme.  

The CVP is a voluntary scheme. Whilst it’s very positive that so many practices have stepped up to take part in such a short period of time, when so much of the programme was in development and subject to change, no practice should be pressured in to doing this, nor should any commissioner be placing unreasonable pressure on them to do so. In addition, should practices feel that new requirement for 15 minute post-vaccination observation makes their model of working no longer possible, they should firstly discuss this with their CCG to see what alternative arrangements could be made, but ultimately they could withdraw from the programme if they wished, providing vaccine has not already been dispatched to their site.  NHSE/I will only send vaccine to sites that are ready and able to use it.  

Public Health England has published a range of resources (leaflets and posters) about the CVP  

Read the my full message about the vaccination programme sent last weekend. 

Read our guidance about the COVID-19 vaccination programme, and the newly published guidance on how practices can utilise extra workforce to deliver the programme.  

COVID-19 vaccination programme precautionary advice 

As noted above, the MHRA has produced urgent precautionary advice for healthcare professionals following two case reports of anaphylactoid reactions associated with administration of Pfizer BioNtech COVID-19 vaccine:  

  • Any person with a history of a significant allergic reaction to a vaccine, medicine or food (such as previous history of anaphylactoid reaction or those who have been advised to carry an adrenaline autoinjector) should not receive the Pfizer BioNtech vaccine. 
  • Vaccine recipients should be monitored for 15 minutes after vaccination, with a longer observation period when indicated after clinical assessment. 

The new requirement to monitor patients for 15 minutes will have an impact on primary care plans for the clinics and if this raises issues relating to premises capacity and patient flow practice groups should discuss this with their CCG and seek their support to resolve this. 

Media 

I spoke to BBC London about the safety of the COVID-19 vaccine, and answered questions from listeners. I also spoke to BBC Leeds (around 7.12am) and BBC Humberside (around 5.40pm) where I said the first wave of the rollout will include more than 200 sites across England and that practices will be working closely together to do it. 

Brian McGregor, GPC England member and chair of the BMA's Yorkshire regional council, spoke to BBC York and BBC Look North about the COVID-19 vaccine, saying that prioritisation in the area focuses on areas with care home residents, their carers and patients over 80.  

Helena McKeown, GP and chair of the BMA’s representative body, spoke to talkRADIO (around 8.05am) about the prioritising of the COVID-19 vaccine as well as news that the Oxford vaccine has now be deemed safe and effective. 

NI Council chair Tom Black and NIGPC chair Alan Stout were interviewed about the commencement of the first stage of the Covid vaccination programme in Northern Ireland – listen and read here: BBC Radio Foyle Breakfast (1:23:27), Good Morning Ulster (45:19), Talk Back (05:28), Belfast Telegraph 

Rob Barnett, GPC England member, spoke to BBC North West about the vaccine rollout, where he said that there are 11 GP sites in Liverpool that will administer the vaccine over the next few weeks, with two ready to go from Monday. They expect to see about 300 patients a day and that people will be invited for the vaccine before completing a health questionnaire with a clinician on the day. 

Read the statement by Chaand Nagpaul, Chair of BMA Council, about the roll out of the programme. 

University of Oxford / AstraZeneca Covid-19 vaccine trial data 

The data from Phase III of the University of Oxford / AstraZenecaCovid-19 vaccine trial has been published which provides further good news in that it suggests that this vaccine could prevent asymptomatic disease, and we look forward to the trial to be completed. The data is promising, particularly as we know that this vaccine can be stored at fridge temperature and can be more easily be delivered in primary care. Read the Wellcome Trust statement here

2019/20 annual allowance charge compensation scheme (England and Wales) 

As we reported last week, following significant pressure by the BMA, NHS England and NHS Wales introduced the annual allowance repayment scheme last year, which guarantees that any annual allowance tax charge in 2019/20 for eligible clinicians will be compensated for at the time of retirement.  

If an eligible clinician who is a member of the NHS England and Wales pension scheme incurs an annual allowance tax charge, they must elect to pay this via scheme pays. The formal scheme pays deadline is 31 July 2021, however, members are encouraged to complete the forms as soon as possible, preferably by 31 December 2020 (to minimise any interest applicable).  

As the deadline is fast approaching, and to help members, the BMA has produced a template letter, to be submitted alongside the scheme pays election form. You will then need to complete the  2019/20 Annual Allowance Charge Compensation Policy Form. Find more information on how to apply, as well as resources for employers, FAQs and infographics, on the NHSE/I website.  

Read more in this update from the BMA’s Pensions Committee and the guidance on annual allowance repayment scheme on the BMA website.  

Ethnicity data (England) 

The GMS regulation (England) amendments for recording of ethnicity information have been laid and will come into force from 1 January 2021. This follows the significant impact COVID-19 has had on BAME people and the need to have better quality data to support the most effective healthcare planning. 

This amendment places a requirement on practices to record ethnicity data provided by a patient when a practice ask for this. Read the Statutory Instrument and the Explanatory Memorandum here

Christmas parties and gifts – accountancy advice 

Accountancy advice from James Gransby, Partner at RSM Accountants, Vice Chair AIMSA 

With the traditional style Christmas party unlikely to be going ahead this year, what can practices do as an alternative? RSM accountants advises the following for practices: 

Tax efficient options can be gifts or a remote get-together; normally there would be a £150 allowance per employee per year which would cover the cost of a Christmas party, but this isn’t transferable into other options such as gift vouchers where the limit is £50 per person. 

Gift vouchers - When giving vouchers up to £50 you are keeping within the HMRC ‘Trivial Benefits’ exemption limits. One of the conditions of this is that the gift must not be a reward for work or performance, therefore if the gift card comes with a message of “thank you for all your work over this challenging time” then HMRC could look to tax it, but a simple “season’s greetings” will avoid this issue (the same advice applies for other times of celebration such as Diwali, or in Easter).  Read more in the HMRC tax guidance on trivial benefits 

Reward for service - If you want to give over and above a £50 voucher or if you do want to reward for service or performance then this should go through the payroll in the normal way as overtime or a bonus would do, and then be subject to PAYE in the hands of the staff member. 

Remote parties - If you are planning a remote Christmas party then there is some good news, as HMRC has confirmed that the £150 per head exemption still applies. (There had been some concern that a virtual event would not meet the definition of an annual event and that food and drink sent to employees to consume during the party might be considered a separate gift which would therefore not be covered by the exemption). Note that this would be subject to the usual conditions:  

- the event is available to all employees (there may be separate parties for different departments or branch surgeries)  

- a record is taken of attendees, to ensure that those receiving food presents are at the party  

- if costs exceed £150 per head the full cost of the party, not the excess cost, is taxable on the employee.  

For further advice please contact your practice accountant. 

Medical Aid Films community language COVID-19 resources 

Medical Aid Films, supported by BMA Giving, have produced community language versions of their informative COVID-19 animation ‘Getting the help you need’, which offers important patient information on medical rights, where and how to access services, as well as self-care strategies. The animations are available in English, Punjabi, Urdu and Arabic.  

This resource is intended to aid doctors and health care professionals to better support their patient communities who may be lacking access to COVID-19 information and messaging in their own language. Additional languages versions will be available from next month.  

In addition, the charity is inviting healthcare workers fluent in Punjabi, Urdu and Arabic to take part in an online screening and Q&A session that will review the animation and highlight information needs and preferences around COVID-19 for non-English speaking communities. If you are interested in this opportunity, Medical Aid Films are able to cover small project expenses. Contact meghan@medicalaidfilms.org for more information or fill out the online feedback survey

Scottish Conference of LMCs 

I was pleased to join the annual SLMC conference which took place last Friday. The virtual conference brought together LMC representatives from across Scotland to debate and discuss issues affecting general practice and to help set the direction for the BMA’s Scottish GP Committee in the coming year.  

The conference heard keynote speeches from the Scottish Government’s Health Secretary Jeane Freeman MSP and from Andrew Buist, chair of the Scottish GP Committee, both of which provided updates on what is to be done in response to the confirmation that delivery of MDT services set out in the 2018 GMS contract are behind schedule and which was a running theme of discussion throughout the conference.  

Motions passed by the conference also included calls for: 

  • Clearer public messaging around what is reasonable to expect of general practice currently 
  • Improved data on general practice workload 
  • The prioritisation of investment in GP and community health infrastructure 
  • Improved access to mental health support workers in practices 
  • Making ‘wet signatures’ for prescribing a thing of the past 

Denise McFarlane was elected as chair of conference for next year, replacing Teresa Cannavina who steered the event through the challenges of delivering an online conference.   

Following the conference, Chair of the Scottish GPC, Andrew Buist blogged on his reflections of the conference and the views LMCs provided on the next steps for the Scottish GMS contract. 

EU Exit update – medicines supply continuity letter (England) 

The NHSE/I has published a letter from Dr Keith Ridge, Chief Pharmaceutical Officer for England, with an update on EU Exit on 31 December 2020, specifically on medicines supply continuityThe letter sets out that: 

The DHSC guidance is that it is not necessary for local providers, whether in hospitals or primary care, to stockpile medicines or for clinicians to write longer prescriptions for patients. Unnecessary stockpiling puts more pressure on the supply chain and can risk additional pressure on the availability of medicines in other parts of the country. Prescribers and pharmacists should explain to patients that they should continue to order their prescriptions as normal.

Workforce data reminder (England) 

A reminder that NHS Digital will extract the latest general practice workforce data from the National Workforce Reporting System (NWRS) on Thursday 31 December. Practices and PCNs should review their records and make any updates, including recording GP locums (practices) or commissioned services (PCNs), before then. This is a contractual requirement and a prerequisite for access to the Covid Capacity Expansion Fund, and important for planning for workforce supply, data which the BMA also uses in our lobbying. Information on how to register and the latest workforce statistics are available on the NHS Digital website

Investment and Impact Fund 2020/21 – reminder to sign up to PCN CQRS service (England) 

The Investment and Impact Fund represents a significant source of income for PCNs and to calculate this, NHSE/I measures PCN performance against indicators defined in the 2020/21 Network Contract DES, by using data extracted from practice systems via the Calculating Quality Reporting Service

In order for practices to record their performance against these indicators, commissioners must have offered them the PCN service on CQRS. If they do not, PCNs containing these practices risk not receiving IIF funding this year, so if your practice is not signed up to this service, please contact your CCG as soon as possible to ensure that it is offered.  

More information can be found on NHS Digital’s website and for any questions about the service, please contact england.gpcontracts@nhs.net

Partnership Agreement webinar – BMA Law 

BMA Law are holding a free webinar on Partnership Agreements on Tuesday 15 December at 1pm. The webinar will cover all aspects of Partnership Agreements - why you need a partnership agreement, how often you should update it, and the common pitfalls to avoid. Register here 

COVID-19 media 

The Chair of Northern Ireland Council, Tom Black, was interviewed on RTÉ Radio One Morning Ireland programme (1:53:02) about COVID-19 in Northern Ireland and the roll-out of the COVID vaccination programme. He was also featured various media outlets about the Northern Ireland Executive’s decision to reopen non-essential retail and some sections of the hospitality sector from today, 11 December, such as Belfast TelegraphDerry JournalBelfast TelegraphHead Topics Ireland 

Writing in Armagh i, NIGPC deputy chair Frances O’Hagan rebuts public misconceptions around access to general practice during the pandemic, and explains why it has been necessary to carry out more online consultations, but that all patients whose clinical needs demand that they are seen by a doctor in person are catered for. "There seems to be a perception that GPs are hiding in their surgeries, avoiding patients and twiddling their thumbs during this pandemic...nothing could be further from the truth. As a GP of 25 years, this winter has been one of the busiest in my career". 

The nine health unions in Wales have issued a plea to the public to “take the risk seriously and minimise contact as much as possible”, warning that “Covid-19 has not gone away.” To read the full BMA Wales press release, click here. The story was covered by ITV WalesWales Online and Deeside. 

See this week’s GP bulletin here 

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