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LMC weekly update 13.9.19

Opioid prescriptions
Public Health England has published a review on prescribed medicines this week. The findings show that 5m people in Britain have been prescribed opioids every year, or one in eight of the adult population.  Commenting, Andrew Green, BMA Council member and previous GPC prescribing lead, said: “To reduce prescription levels, we need significant investment in support services; this will enable patients and GPs to manage dependencies in the community. GPs will often be the sole clinicians who are often managing a patient’s withdrawal, and there is a real need for better clinical guidance in this respect. We are glad that NICE is in the process of developing these. While there remains a place for prescribing these drugs, we need many more alternatives to medication, such as pain clinics, improved access to mental health services, and physiotherapy – the universal provision of which are all lacking.” Read the full statement here.  A link to the review is here, and a blog about it here.

Tom Yerburgh, deputy lead for GPC’s clinical and prescribing policy group, was interviewed on BBC You and Yours radio (about 23 mins in). It was also reported in the Times, the TelegraphiNewsMailMetroBMJPulseOnMedica and Nursing Times. I did an interview for Radio Aire on the subject.

No deal Brexit warnings
Last week the BMA published a briefing highlighting the dangers of a no deal Brexit and a member-focused resource, information for doctors if there is a no deal Brexit, which includes information on how to prepare for medicine shortages. The government has now published the ‘Operation yellowhammer’ document, which confirms our warnings on a ‘no deal’ Brexit. In response to this, Chaand Nagpaul, BMA Chair of Council, said “This alarming document reinforces the BMA’s stark warnings about the devastating impact a ‘no deal’ Brexit could have, and vindicates those doctors who have had the courage to speak out on the risks that crashing out of the EU without a deal poses to the NHS, patients and the wider health of the UK.” Read the full statement here.

I was interviewed on a number of regional radio stations about the Yellowhammer report, including BBC Three Counties and Heart Yorkshire, where I said the BMA had 'acute concerns' over medicine supplies in the event of a no deal and called on the Government to offer reassurances that access to essential medicines will not be disrupted.  Listen to the interview here (from the 25 minute mark). The BMA's response was covered by BBC News, the Guardian, the Daily Mirror (print), the Evening Standard, and in news bulletins across dozens of regional and national commercial radio stations.
Medicine shortages
The Daily Mail reported about drug shortages, suggesting that Brexit is not to blame. In response to this story, Farah Jameel, GPC England Executive team member commented “I’ve definitely noticed an increase in the number of drugs that we’re short of. Some, but not all, patients can be switched from one drug to another that works in an equivalent way. But this requires time and resources, placing extra demand on doctors and pharmacists.’ Read the full article here.

Flu vaccinations in GP practices – MDU position on indemnity
Following concerns raised about indemnity cover provided for the provision of flu immunisations to practice staff we have been in discussion with NHS England, Public Health England and the MDOs. The Medical Defence Union have provided the following statement about indemnity for flu vaccination of staff in GP practices:

“Our current position on flu vaccinations is that we understand some practices may find it easier to provide flu vaccinations for staff themselves and want to help them to do that.  We make no extra charge for indemnity for members whose practices provide flu vaccinations to staff as this is already within the benefits of membership for GP members. We encourage members who want to administer flu vaccinations to staff to contact us and advise the following: We advise members administering flu vaccinations to staff to follow their normal procedures for dealing with unregistered patients and to ensure they make a full assessment of each staff member’s suitability for the vaccine, for example, ruling out contraindications.  Consent should be obtained in the usual way as for registered patients.  Notes should be kept and, assuming the staff member agrees, their normal registered GP should be advised that they have had the vaccination.” We will update further on this next week.
Public Accounts Committee Investigation into NHSPS
Following publication of the NAO report into NHSPS in June, the PAC- a powerful committee of MPs scrutinising public spending- heard from senior officials at NHSPS, NHSE and the DHSC who answered questions on how the Service is managed and what action can be taken to improve how it manages its tenants. The BMA submitted written evidence to the committee highlighting the significant increases to service charges to GP practices without their agreement and the impact this is having on the profession. We were concerned by comments made by NHSPS during the hearing in relation to the BMA’s position on GP leases. NHSPS stated that a template lease was agreed with the BMA which we shared, but subsequently ‘retracted’ support for. This is not the case. The BMA did and continues to support the principle of lease agreements between NHSPS and practices, and continue to host the lease template letter on our website . We have written to the committee to highlight this inaccuracy. The session is available to view online. Practices should be mindful that the BMA are proceeding with legal action to address historical charges. Practices should ensure that in reaching any agreement independently of this they do not put themselves at risk of any future liability or compromise their future position. 

PCN premises requirements for additional workforce

A number of queries have highlighted the issue of practices requiring additional space for Primary Care Network activities. As a Direct Enhanced Service of the GMS contract, Primary Care Networks are an extension of GP practices. The same rules should apply for PCN staff and premises requirements as for GMS. Any space utilised to provide PCN services should be treated as GMS space and treated similarly for rent reimbursements. If you have any further queries on this issue please contact

EMIS issues
Following reports of problems with EMIS, the EMIS team has advised that there have been several issues in the last 7-10 days within the BT network affecting access to various suppliers’ clinical systems – including, but not limited to, EMIS. There have been no availability issues from the EMIS Web data centre during this period. NHS Digital has been working with BT to address and prevent these issues occurring in the future.

LMC Conference England – submitting motions
A reminder that the deadline for inputting motions for the LMC England Conference is NoonFriday 20 September 2019 – submit via this link. If you have forgotten your username and / or password, please email for a reminder or for help in setting up a new account.
Read the blog on writing motions here.

The registration form for representatives by 11 October 2019. More information is available on the LMC Conference webpage.

September Medicine Supply Update 
Please find attached the monthly supply update for September from the Department of Health and Social Care. There are also supply issues affecting capsaicin cream, mianserin tablets and tiagabine tablets for which additional communications have been prepared and already sent to primary care and community pharmacy teams for cascade to GPs and community pharmacies.

The table below provides a summary (the attachments referred to in the table below, have been emailed out to LMCs in a separate email this morning):

BMA report: vision for the future of the NHS 
The BMA published Caring supportive collaborative: Doctors’ vision for change in the NHS yesterday, which outlines the changes needed to ensure safeguarding patient care, making the NHS a great place to work and transform services for the better. It draws on the experience and expertise of our members across all branches of medical practice in the UK. 

The report sets out specific recommendations aimed at government and NHS bodies, including:

  • radically changing the way patient safety incidents are investigated so that they are seen as an opportunity to improve future care rather than assigning blame
  • new legislation in England to create much clearer lines of accountability for safe staffing in line with recent developments in Scotland
  • investing in IT systems that work across different parts of the NHS, so that patient information can be securely shared between clinicians and with patients
  • underpinning these changes with sufficient resources by reversing the underfunding that has left the NHS in crisis over the last decade.

Some of the changes demand the immediate attention of government and MPs, set out in an accompanying manifesto document.

Access review events
NHS England are holding regional events about the access review:

London and South East regions
Wednesday 18 September 2019 (10.00am – 4.00pm),
etc.venues Fenchurch Street, 8 Fenchurch Place, London, EC3M 4PB

South West region
Thursday 19 September 2019 (10.00am – 4.00pm)
Mercure Bristol Holland House Hotel, Redcliffe Hill, Bristol, BS1 6SQ 

For more information, see

Integrated urgent care: Direct booking roadshow
NHS England and NHS improvement, via PCC, are also running a number of free integrated urgent care events focused on supporting practices with direct booking from NHS 111:

London, 10 October 2019, Amba Hotel Marble Arch 
Birmingham 14 October 2019, Birmingham Botanical Gardens 
Leeds, 22 October 2019, Cloth Hall Court, Well Met 
London, 28 October 2019, Mary Ward House 
South West, 29 October 2019, Bristol Marriott 
Manchester area, 20 November 2019, The Midland Hotel

Read the latest GPC newsletter here.

Read the latest Sessional GPs newsletter here

Last updated on: 
September 27, 2019
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