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LMC weekly update - 15 January, 2021

Additional funding to support rapid care home vaccination (England) 

Practice groups around the country have been working extremely hard to protect our most vulnerable patients.  The daily reporting of vaccinations given clearly demonstrates this, with over 3 million given. The increased availability of the AstraZeneca vaccine makes it much more possible to vaccinate care home residents and staff and we now need to do this as quickly as possible. We have been discussing this regularly with NHSE/I and welcome their announcement yesterday that additional funding will be provided to support the rapid delivery of vaccinations to care home staff and residents in England. The care homes supplement will now increase as follows:  

  • £30 for first doses administered Monday 14 December - Sunday 17 January 
  • £20 for first doses administered Monday 18 - Sunday 24 January 
  • £10 for first doses administered Monday 25 - Sunday 31 January 
  • £10 for all second doses administered 

In addition, NHSE/I has provided new payment to support the administration of the Pinnacle system. Vaccination must be recorded immediately in Pinnacle in order to ensure the clinical record is updated and to be sure that PCNs are paid for the work that they are undertaking. PCNs bringing in additional workforce between now and the end of January to ensure that all records for vaccination of priority cohorts are up to date and recorded properly in Pinnacle will be eligible to claim up to £950 per week (a maximum of £2,500 per PCN grouping) of funding support. 

Finally, there is also a reminder that providers of Community Health Services should do all they can to release staff to support local vaccination services with the vaccination of care home residents and staff during the next fortnight. Lead providers of vaccination centres are able to make staff temporarily available in a flexible manner to support PCN Groupings in this important work and community nursing teams, who provide care daily into care homes, are well placed to support this work. Any financial costs in having to back fill staff can be found in the NHSE/I letter to Regional Directors of Workforce

There is also to be a significant increase in availability of vaccine from next week, so all sites should expect the opportunity to vaccinate more, as well as covering all care home patients. 

Vaccine rollout and mass vaccination centres (England) 

This week, the government in England published its vaccination delivery plan which outlined plans for over 1200 local vaccination sites, most led by GP practices, 206 hospital hubs and 50 mass vaccination centres. Seven large scale mass vaccination centres have opened this week, as well as more local practice vaccination sites and hospital hubs, in addition to those that are already operating. NHSE/I has also published a map with all the vaccination sites across England 

The clear aim for us all it to ensure that as many people gets vaccinated as quickly as possible, however the BMA is very concerned to ensure all people, not least elderly patients, are given the opportunity to choose to receive their vaccination from their local GP vaccination site. This means all sites need greater provision of vaccinations, which we expect to increase in the coming weeks, and greater certainty on delivery so they can plan their vaccination sessions and book patients in with greater confidence.  The letter inviting patients to book in to a mass vaccination centre, which has been sent to thousands of eligible patients, has now been amended following our comments to be clearer that they do have a choice of attending their local practice site, but we are still aware of some confusion and of patients having contacted the national booking service, being redirected to mass vaccination centres at much further distance than local practice sites. NHSE/I has also published a map with all the vaccination sites across England 

We have also raised concerns on the COVID Vaccination Programme IT system with NHSE/I and the servers have since been upgraded which should now improve the situation and there is now additional funding for administrative support. 

GPs and their teams are generally the best place to deliver community vaccinations and it is therefore imperative that we are provided with sufficient and regular supplies as soon as possible. 

COVID Vaccination Programme (Scotland) 

While delivery of COVID vaccinations is board led in Scotland, GPs have an important role to play as part of those efforts. An item of service of £12.58 per dose of vaccine administered has been agreed. Vaccinations by practices is now underway, but the pace of delivery is being dictated by available supply, with some practices yet to receive vaccine stocks. SGPC have raised this issue at the highest levels and stressed the importance of delivery to practices being as swift and as predictable as possible.  

COVID vaccination programme (Northern Ireland) 

The roll-out of the Covid vaccination programme in Northern Ireland has been very successful so far.  The latest available figures show a total of 121,711 vaccines had been administered by 13 January.  Supplies of the Pfizer vaccine have been distributed solely to Trusts to vaccinate the vaccinators, care home residents and health care workers.  This started on 8 December and by 6 January, 91% of the 483 care homes had been visited by mobile vaccination teams, with an uptake level of more than 90% among residents and about 80% among staff. 

The AstraZeneca vaccine is being distributed to GP practices with a small amount going to Trusts to deal with people with allergies.  Practices started vaccinating the over 80s week commencing 4 January.  Vaccination of this group is almost complete and practices will be moving to vaccinate the over 75s w/c 18 January.   

The enhanced service was agreed at £12.58 per vaccination with an additional £800 per 1000.  A large pool of additional vaccinators is available free to practices if needed.  The vaccine management system is scheduled to go live at the start of February.   

COVID vaccination programme (Wales) 

Welsh Government have directed Health Boards to have ultimate responsibility over all vaccination planning and delivery, to be conducted according to JCVI advice.  Pfizer vaccine is only being delivered at Health Board staffed Mass Vaccination Centres.  LMCs are engaged with their respective Health Boards to discuss implementation locally.  

BMA Cymru Wales will be writing to all HB chief execs asking for their covid-19 vaccination delivery plans. The Welsh government’s published a high level vaccination strategy on 11 January.  

Vaccination of healthcare workers 

The BMA continues to call for all health and social care workers to be given urgent priority to protect an already depleted workforce and to help prevent the NHS becoming overwhelmed.    

Practices should ensure that locum GPs they are in regular contact with are invited for vaccination either via hospital hubs or by the practice itself. Additionally, any healthcare staff who self-identify with their own registered GP practice should be vaccinated as per the JCVI guidance.  

Please do not decline or turn away any health and social care workers. Consider maintaining waiting lists or signpost to other providers if vaccine availability is the rate limiting factor.  

Healthcare professionals have now also been added to the priority list of eligible patients  

Change in legislation to allow any GMC registered doctor to administer the COVID-vaccine in primary care settings 

The Government has announced that doctors who offer their support in delivering the Enhanced Service Specification COVID vaccination programme in primary care settings will be exempt from the requirement to be included on the England Medical Performers List. The Regulations, which came into force on 14 January, remove previous barriers and mean that any GMC registered doctor will be able to administer the vaccine and any ancillary vaccine services under the enhanced service specifications in a primary care setting. We welcome this change in legislation which will support the rapid roll out of the vaccine, allowing more doctors to administer more COVID vaccines.  

Practices are reminded of their existing obligations to ensure staff have the qualifications, skill, competence, training and experience to deliver safe care under the Health and Social Care Act 2008. 

COVID-19 vaccinations programme guidance 

The national protocol for the Pfizer/BioNtech vaccine has been updated to define minimum dose interval and vaccination in accordance with national recommendations “For operational purposes the second dose may be given between 3 to 12 weeks following the first dose or in accordance with official guidance at the time.” 

The AstraZeneca (Oxford) vaccine national protocol has also now been published.  

NHSE/I has published a letter with an Instruction on timing of second dose of COVID-19 vaccinations, which sets out that all vaccination sites ensure that all second dose appointments for both patients and health and care staff that have not already been rescheduled, must be rearranged to take place in the 12th week. The Academy of Medical Royal Colleges has also published a statement supporting the decision of the four UK CMOs to prioritise the delivery of the first COVID-19 vaccine dose, and to delay the second dose to up to 12 weeks. 

Public Health England has this week published a UK COVID-19 vaccine delivery plan as well as a vaccine surveillance strategy. PHE will monitor vaccine effectiveness at preventing both symptomatic and severe disease and at reducing infection and transmissibility. This will be accounted for across multiple different sub-groups including age (and other clinical risk factors), viral variants, number of doses administered, timing of doses, and the comparative effectiveness of different vaccines in the real world.  The BMA has produced a summary about the vaccine surveillance strategy. 

The CQC has confirmed in a letter about the administration of the Pfizer-BioNTech Covid-19 vaccination that adhering to ‘appropriate, authoritative guidance’ such as JCVI/CMO national guidance on vaccinations ‘is considered to be entirely appropriate’. Similarly, in the attached letter the GMC advised: ‘were a complaint to be received in the future where the sole concern was about a doctor having administered a vaccine in line with the recommendations of JCVI and the four CMOs it seems highly unlikely that this would raise any fitness to practise concerns about the individual’. 

The BMA’s guidance on the COVID-19 vaccination programme has been updated to include the national protocols for both vaccines, the updated joint document on workload prioritisation, funding to support rapid care home vaccination, in addition to the other recent information about how access to vaccines for all frontline health and social care workers, and further support to enable practices to prioritise vaccine delivery. 

Supporting doctors throughout the second COVID-19 wave (UK) 

The four Chief Medical Officers, NHSE/I, The General Medical Council and The Academy of Medical Royal Colleges have written a letter to doctors on working through the second wave. 

Workload prioritisation: Level 4 or 5 

We have updated our joint guidance with RCGP on workload prioritisation for primary care, which sets out what practices should consider doing are in a national lockdown, to help practices during the immense workload pressures are currently under. This is in addition to the set of further measures that we agreed with NHSE/I to help and support practices. 

Update on CQC’s regulatory approach 

Following our call on CQC to suspend routine reviews they have now published an update on their regulatory approach during the pandemic, which states:  

‘For primary medical services we will only inspect in response to significant risk of harm – including concerns raised by people working in services and people using them – and when we cannot seek assurances through other routes. If an inspection is necessary, we will carry out as much activity off-site as possible’ 

Guidance for clinically extremely vulnerable (CEV) patients 

Following the introduction of another national lockdown, the Government will be sending a letter with updated guidance to all clinically extremely vulnerable people, which again advises to take extra shielding measures to protect themselves, until at least 21 February 2021. The Government has also extended the offer of a free 4-month supply of vitamin D supplements for all adults who are clinically extremely vulnerable to support general. Access their updated guidance for clinically extremely vulnerable people 

GP practices continue remain open and whilst remote consultations should be the main way in which patient care is delivered, when it is clinically necessary to see vulnerable patients face-to-face they would normally be expected to attend the surgery. Read our updated guidance

COVID PPE scheme extended until June 2021 

The Government has announced that it is extending the provision of free COVID-19 PPE for all health, social care and public sector workers, until at least the end of June. This will ensure frontline and wider public service workers can continue to access rigorously tested and high-quality PPE.  

Practices should continue to access COVID-19 PPE via the PPE portal.  

The BMA has also called for enhanced and more appropriate PPE to be made available to staff in all healthcare settings, in a letter to the Government’s health minister for prevention, public health and primary care Jo Churchill, and a letter to Public Health England. Read more here 

Vote on future negotiations on the PCN DES and PCN survey results (England) 

We would like to remind you that the vote of the profession as to whether GPC England should continue negotiations on the PCN DES is open until 23:59 on Tuesday 19 January (the vote is open to all GPs in England, regardless of contractual status (partner/sessional/trainee) or BMA membership status. 

The ballot has been designed with the agreement and in careful collaboration with GPC England and the LMC England conference chair and agenda committee, as well as in consultation with the BMA’s internal experts on survey design. Read more about the vote here 

Pulse oximetry guidance update 

The guidance for pulse oximetry to detect early deterioration of patients with COVID-19 in primary and community care settings has been updated. Pulse oximeters can be used as a tool for patients most at risk of poor outcomes from COVID-19. It is used to identify oxygen levels and warn the patient to the risk of ‘silent hypoxia’ and rapid deterioration at home.  

Pre-registration for offenders leaving prison 

The contractual requirement of the General Medical Services (GMS) Contract 2017/18 (page 64) to accept patients from the secure estate prior to their release has increased importance during the COVID-19 pandemic. Among other benefits, pre-registration may help the smooth rollout of the COVID-19 vaccine. For individuals leaving the secure estate between the first and second doses of their vaccination who have been registered with a community GP, their GP record will be updated with their vaccination status. GP practices are asked to ensure that processes are in place to meet this contractual requirement, with information on how to do this here

NHSE/I legislative proposals on Integrated Care Systems (England) 

The BMA has responded to new legislative proposals put forward by NHSE/I, which would see ICSs (Integrated Care Systems) made statutory bodies and could dramatically alter the role of CCGs.  

In the response, we are critical of the manner in which the consultation has been carried out but also examine the potential implications of the proposals which, we believe, are currently incapable of delivering the integrated and collaborative NHS that staff and patients need. We have also set out where we believe further changes have to be made - both to the proposals and to the present system itself - including highlighting the need for strong clinical voices within ICSs and for the NHS to be made the preferred provider of NHS services, for example. We have been clear about the fundamental importance of the independent contract system for general practice and of the role of LMCs as the representative of all GPs in an area. 

The response is now available on the BMA website here and should you have any questions regarding it or the proposals themselves please contact info.policy@bma.org.uk 

Lateral flow test ordering (England) 

To ensure that the correct quantities of lateral flow test boxes are delivered to primary care contractors, and that there are enough tests to distribute among staff, any contractors who have placed an order of over 100 test boxes on the PCSE portal have been contacted to confirm, as soon as possible, the number of patient-facing staff and therefore the correct number of boxes of tests they wish to receive, to avoid any delays to deliveries. 

Practices who have not yet placed their order, should log onto the portal and complete their order by COP Sunday 17 January to start to receive deliveries from the following week. 

Fit notes (med 3) 

GPs are reminded that they are still required to issue fit notes (med 3) as normal. There are specific scenarios relating to COVID-19 where patients can use the isolation note service, instead of seeing a GP, as outlined below. Please do not signpost patients to NHS 111 in order to get a fit note as they are not provided by the service. During the pandemic DWP is encouraging employers to use their discretion as to what medical evidence is required to support periods of sickness absence. 

Previously advice was issued on issuing fit notes (med 3s) remotely during the pandemic, which remains in place until further notice. A properly signed and scanned fit note sent via email to the patient will be regarded as 'other evidence' and will be accepted by DWP for benefit purposes. Not signing fit notes can mean that they are rejected by employers and DWP, so we have been asked to remind GPs that fit notes must be signed. The original hard copy does not need to be retained if there is an electronic copy of the fit note in the medical record. 

If the patient is unable to receive their fit note electronically, they will be required to collect a hard copy from the practice or it will posted to them, at the practice’s discretion. Isolation note service: 

The isolation service does not provide fit notes (med 3s). It is an automated service that can be used to provide evidence of the need to self-isolate by those who: 

-       Have symptoms of coronavirus 

-       live with someone who has symptoms of coronavirus 

-       are in a support bubble with someone who has symptoms of coronavirus 

-       have been told to self-isolate by a test and trace service 

It can be used to cover continuing periods of isolation if patients still have symptoms or develop new symptoms following their initial isolation period. 

GP Trainee by-election 

The GP Trainee Committee are seeking nominations for the position of Lancashire representative.To be eligible to stand in this election you must be training in the Lancashire region. To submit your nomination, please login to the BMA’s election system. The deadline for nominations is 12pm Tuesday 19 January 2021

To find out more about the committee please visit their webpage or contact gptrainees@bma.org.uk with any specific queries. If you have any queries regarding the election process, please contact elections@bma.org.uk 

COVID-19 media  

The Guardian reported Sir John Bell, a leading immunologist, said that the NHS could vaccinate the entire population in five days but is being hampered by NHS bureaucracy. In response, I commented: “Doctors and their colleagues across the NHS want to get these vaccines into the arms of as many people as possible as quickly as they can. However, this crucially relies on supplies, which are nowhere near the levels they need to be yet. Meanwhile, the NHS has for too long been plagued by bureaucracy, and we need a drastic slashing of red tape to ensure that everyone who can safely administer vaccines, and is willing to help with the effort, is allowed to do so.” 

I discussed the progress of the vaccine rollout via large scale vaccination centres on Channel 4 News, ITV Calendar News (Yorkshire), and BBC Radio York about the BMA’s concerns around access for elderly people, who want and need local vaccination sites to be available. I argued in the Yorkshire Post that GPs are generally better-placed to deliver community vaccinations than pharmacies, provided that sufficient supplies can be delivered safely and on time. I was also quoted in the Yorkshire post, where I said that current GP-led sites are well placed to administer the vaccines but the number of available doses is the main issue now holding them back. 

I was interviewed on BBC Radio Leeds (at 17.14) about NHS pressures and its impact on healthcare workers, and the need for support for them. I also commented on the issues with the Pinnacle IT system in the Daily Telegraph (print version only, 11 January), where I said that the Pinnacle software was all too often running slowly or crashing, and failing to link properly to the existing EMIS and SystmOne, so adding unnecessary delays and work in to the system. 

BMA Welsh Council chair David Bailey spoke to LBC radio (from 07:15) to discuss the problems with vaccine delivery in Wales. “We want to see deliveries coming out, we’ve had deliveries cancelled this week to practices which has caused concern, but in terms of the ambition to deliver first doses to all the outlined priority groups - we’re fine with that.” 

Welsh GPC chair Phil White was featured on BBC Wales Today (from 05:00), also discussing vaccine rollout. He said: “We had an agreement with welsh government of how this would progress and then of course, many practices have been promised some vaccines and then either received much less than expected or none at all.” 

NIGPC chair Alan Stout was interviewed on Good Morning Ulster (from 1:09) about the publication of the DH’s phased plan for the COVID vaccination programme. He said: "We made some very sensible early on based around the vaccines themselves. We took the really difficult decision to focus on the care homes. The trust teams have done unbelievably well and now we're 90% vaccinated." NI GPC deputy chair Frances O’Hagan was interviewed on Good Morning Ulster programme (1:47:16) about the commencement of the AZ/Oxford vaccination programme 

Read the latest GP bulletin here 

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