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LMC weekly update - 16 October, 2020

New three tier lockdown approach and BMA recommendations to help reduce spread of COVID-19  

The rapid rise across the country in the number of people with COVID-19 is already putting a significant strain on general practice services. GPs and their teams have responded incredibly well throughout the pandemic, remaining open, maintaining services and going the extra mile to care for our patients. Recent media reports and briefings suggesting otherwise have not only been wrong but also deeply damaging to the morale of a dedicated and committed workforce.  I made this situation clear in my one-to-one meetings with Sir Simon Stevens and Jo Churchill, the health minister with responsibility for primary care in England, earlier this month, and they both acknowledged the central and important role general practice has played and will play in dealing with the pandemic. 

However as practices, out-of-hours providers, PCNs and other GP services do their best to prepare for the difficulties this winter will bring, we expect NHSE/I and government to do far more to support us, and with parts of the country now back where they were in March that support must come urgently. 

On Monday, the Government announced the introduction of a new three-tier (medium, high, very high) lockdown approach for England. Prior to this, the BMA called for new, stronger measures to reduce the spread of the COVID-19 infection and published a series of recommendations which could help reduce the level of infection as well as supporting businesses and those who are in vulnerable groups. The BMA still believes the government needs to do more to properly respond to the growing infection rates. Our recommendations include: 

  • Modify the current ‘Rule of 6’ with the rule that only two (exclusive) households can meet (and not exceed 6 people) – ideally outdoors, rather than indoors. 
  • Making the wearing of face masks mandatory in all offices and working environments, unless you are working alone. 
  • Wear masks in all outdoor settings where two metre distancing isn’t possible. 

It’s notable that the Scottish Government has moved in line with the BMA’s position and has now introduced a requirement for face coverings to be worn in indoor communal settings, such as staff canteens and corridors in workplaces.  Read the full set of recommendations here 

Read the BMA statement about the new measures 

The recommendations and BMA statement were reported by BBC BreakfastBBC News, ITV News, Times Radio (around 8.05am) and LBC (from 12pm), BBC Radio 4's PM programme (around 5.05pm), the TimesMail OnlineSky NewsEvening StandardGuardianMetroMirrorTelegraph, and the iThe Daily Record and MailOnlineMailOnline also reported on the rule of 6 recommendations. 

I was interviewed by LBC and BBC 5Live (from 8.30pm) about the face mask recommendations, by LBC and BBC Look North about the BMA’s response to the new Government guidelines, where I discussed the need for a national plan to combat the covid pandemic. 

New advice for patients at high risk of COVID-19 infection 

Following the announcement of a new three-tier lockdown approach in England, the Department of Health and Social Care published updated guidance for those considered most clinically vulnerable, depending on the level of risk in their local area, in line with the new Local COVID Alert Levels framework. 

This new guidance provides advice for the clinically vulnerable to follow in addition to the new rules and guidance for everyone based on the level of risk in their local area. The government are not yet suggesting the reintroduction of shielding arrangements that were paused in the summer. More restrictive ‘shielding’ measures could be considered in the future in areas facing the highest risk and if that happens the Government will write to relevant people separately to inform them directly should they be advised to shield. 

Whatever the current local COVID alert levels are, as we have made clear, GP practices 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 we would normally expect them to attend the surgery with good infection control arrangements in place. 

Read more in our updated guidance for patient at high risk 

General practice “Green Fund” 

We have written a letter to Parliamentary Under-Secretary of State for Prevention, Public Health and Primary Care, Jo Churchill MP, this week to request support for primary care to meet net zero carbon emissions.  

At a time when our primary focus is on responding to the massive challenges brought by the COVID-19 pandemic, we cannot forget and must do more as a country to reduce the serious impact of climate change. The NHS, including general practice, can play a role in this. We have therefore called on the Minister to back our recommendation for a general practice ‘Green Fund’ to enable GPs to put in place more sustainable and environmentally friendly practices. We have also called for an extension of arrangements in place during the pandemic such as promoting use of technology, labelling medicines to allow for carbon footprint tracking and continuing the ability to make use of previously prescribed but unused medicines to reduce waste. 

Complaints (KO41b form) data collection for 2019/20  

Following our lobbying for a reduction in bureaucracy impacting practices, and particularly in light of the current pressures that general practice face in responding to COVID-19, NHS Digital have confirmed that the annual complaints (KO41b form) datacollection relating to 2019/20 will not be collected as usual. Practices are instead encouraged to continue to use the information collected locally for local service improvement purposes. Read more here 

CQC state of care annual report 

The Care Quality Commission (CQC) state of care report for 2019/20 has been published today. The report showed that before COVID-19, care was generally good. In primary care, the overall ratings picture remained almost unchanged, with excellent ratings of 89% of GP practices rated good and 5% outstanding. They did though suggest that this masked a more varied picture, with some practices deteriorating and a similar number improving. 

In response to this I said: “GP practices across the country continue to provide safe, high quality care to their patients, as shown by the CQC’s own figures with the vast majority delivering good or outstanding care, but of course there will always be variations, and there must be a supportive, not punitive, approach from regulators to help struggling practices improve, particularly in the midst of this unprecedented pandemic. Practices overcame huge challenges in recent months. As this report notes overhauling services ‘almost overnight’ to ensure patients could continue accessing their GP safely, whether that was via telephone, online or face-to-face where that was safe and appropriate. 

The increase in remote access and triage during the first wave of the pandemic was there to keep patients and staff safe – and it is what the Government instructed practices to do. Of course, remote consultations are not suitable for everyone and will never be a complete replacement for in-person care. Practices have been working incredibly hard, remaining open for patients throughout this time, to ensure everyone has access to the right professional, and the latest data has shown a significant rise in face-to-face appointments in recent weeks.” Read the full response here.

We continue to call for CQC inspections to be suspended for the duration of the pandemic and do not believe their transitional regulatory approach is appropriate or necessary at this time. 

Primary Care representation on ICS boards (England) 

Chandra Kanneganti, GPC policy lead for commissioning and service development, and I have today written to Ian Dodge, National Director at NHS England and NHS Improvement, with responsibility for Primary Care, to urge him to issue guidance to all ICSs (integrated care systems) stressing the importance of primary care provider representation on their boards and other decision-making bodies. 

We are aware that in some local systems, only GPs employed from CCGs are representing primary care at ICS level and LMCs are not as involved as they ought to be. While those GPs are an important voice in terms of representing commissioners, they cannot be seen as the representative of primary care as providers. The BMA believes that LMCs, which are the local representative voice of general practice and PCNs, should also form part of the leadership team of ICSs and ‘have a seat at the table’.

General practice is open, get checked for cancer – social media campaign 

Londonwide LMCs has launched a new social media video campaign, highlighting that GP practices are open and seeing patients. To mark the start of Breast Cancer Awareness Month, they are launching the campaign with this video. Throughout the rest of October, they will be releasing further videos, as part of a month-long campaign. All the videos can be viewed here 

BMA Library resources 

The BMA library is providing trial access to Clinical Key for BMA members throughout October. 

Clinical Key provides access to the full text of the latest editions of hundreds of medical e-books published by Elsevier. It also provides full text access to a large number of e-journals and other key online medical resources produced by Elsevier. Read more in a blog post by the BMA library team. 

BMA members can also access the collection of Oxford Medical Handbooks, including the brand new, 5th edition of the Oxford Handbook of General Practice. Access the collection here 

Covid Virtual ward 

Wessex LMC recently held a webinar on Virtual Wards – with Karen Krikham (GP and NHSE/I primary care advisor) and Matt Inada-Kim (Consultant and national lead for sepsis) as speakers, both part of a group developing national proposals. View the webinar here. It is also available as audio podcast

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.  

There are two NHS Practitioner Health webinars next week focused on wellbeing: Beating burnout on Monday 19 October and Taking a break from COVID-19: how to escape, unwind and reboot on Tuesday 20 October. Read more about these and future events here 

BMA COVID-19 guidance 

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 

Phil White, chair of BMA Wales GPC, appeared last Friday’s BBC Radio Wales show with Dot Davies (interview starts about 7 mins in).  He expressed concerns that winter will see an increase in people congregating indoors, which will cause further spread of the virus. He also said it will be a difficult winter and advised listeners to seek out their flu vaccination. He also expressed concern over intensive care units being full, leading to waiting lists deteriorating in other areas of the hospital. 

There was extensive coverage of the BMA Northern Ireland Council chair Dr Tom Black's response to the range of significant interventions announced this week by the NI Executive to curb the spread of Covid-19. His overall message was that while these restrictions were welcome, NI doctors felt they were too little, too late and do not go far enough in view of the rising numbers of cases. Interviews included BBC Newsline (9:06),BBC News NI, Belfast Telegraph, Irish News The NI statement was the lead story on the BBC News NI news website throughout most of the day and carried on all BBC Radio Ulster and Radio Foyle hourly news bulletins. Dr Black was also interviewed on The Nolan ShowRTE News at One and by RTE online news

See this week’s GP bulletin here.

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