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LMC weekly update - 17 July, 2020

GPC England meeting

GPC England met yesterday and discussed our proactive strategy for responding to the next stages of COVID-19, following the recent publication of our Trust GPs to lead report, which sets out our vision for addressing the need for change in general practice following the pandemic. The committee heard from many members reflecting the significant concerns they had about rising workload pressures, in part related to changes to hospital out-patient and referral management, as well as plans to use NHS 111 to reduce attendance in Emergency Departments.  This was also evident in our last tracker survey, which clearly showed the significant increase in requests for practices to do additional activity without the necessary funding or workforce being made available to make this change sustainable. I have therefore co-signed a joint letter with Rob Harwood, chair of the BMA consultants committee, to Professor Stephen Powis, NHS England Medical Director, on behalf of all primary and secondary care doctors, proposing and seeking solutions to the issues in workload and workflow across NHS sectors. It’s imperative that NHS England and CCGs commission sustainable primary and community services to support patients and clinicians, particularly as more patients are being directed away from attending hospital settings. It's vital that we solve these issues as quickly as possible, not least as winter and any potential second wave of the pandemic approaches. 

GPCE noted the updated toolkit for GPs, partners and practice managers to manage employment and contractual issues and service provision during the pandemic. The committee discussed on-going issues relating to PCSE and the transformation projects they are taking forwards. We also had an update on our support for a legal case being brought against NHS Property Services.

This would normally have been the first meeting of the 2020/21 session, but because of our rescheduled ARM it was GPCE’s last meeting of the extended 2019/20 session. We therefore said thank you to the members of the committee who were ending their term of office, including Mary McCarthy, John Rawlinson, Jonathan Ireland, and Pamela Martin.

Please see the Executive and Policy groups update for July 2020.

Government commitment for additional NHS funding

Following the Government’s announcement that the NHS in England would receive £3bn in funding to help it prepare for winter and a possible second spike in Covid-19 infections the BMA put out a media statement last night reacting to parts of the announcement that had been trailed. Dr Chaand Nagpaul, BMA council chair, said that it was vital that we’re given an understanding of how exactly this announced money will be used – and whether it is enough – to boost capacity both for a potential second wave, but also to meet the needs of millions of patients who have had care delayed during the pandemic.  The BMA’s comments were carried across national and regional BBC News bulletins through the night and this morning, as well as on the BBC News website. Chaand was interviewed by Good Morning Britain (you can watch the segment [itv.com/hub/good-morning-britain/2a3211a2832]here from 6:03am) and he later appeared on LBC News. Just ahead of the Prime Minister’s speech he appeared as the opening guest on BBC One’s News Special, and was then interviewed by Sky News’s Adam Boulton immediately after the announcement to give a rapid response (you can watch the full interview here). Deputy council chair, Dr David Wrigley, was also interviewed on Times Radio about the announcement – you can listen back here at around 2hrs15 – and GPC England executive team member Dr Krishna Kasaraneni appeared on Hallam FM to discuss the announcement from a regional angle.

COVID-19 Fund (England)

Following the Prime Minister’s announcement I have written a letter to Sir Simon Stevens, Chief Executive of NHS England, calling for the promised COVID Fund to be released immediately. At the outset of the pandemic the Government committed to establishing a national COVID-fund, to reimburse NHS additional expenses related to the treatment of COVID-19. However, there has been a prolonged and unacceptable delay to releasing this funding, and whilst many CCGs have done the right thing and reimbursed these costs for practices, many have not. The impact of this is highlighted in our most recent member survey which showed that significant numbers of practices were not being reimbursed by their CCGs for out of pocket expenses directly linked to tackling COVID-19. Practices swiftly responded, in good faith and for the benefit of their patients, at the outset of this pandemic, but they have been badly let down by the failure of the Government to honour their commitments. This must now be addressed, not least as practices start to plan for the difficult winter ahead.

GPC England guidance on arrangements for GP services for remainder of 2020/21 (England)

Last week NHSE/I released its most recent letter regarding arrangements for practices for the rest of 2020/21. We have since updated our comprehensive COVID-19: toolkit for GPs and GP practices to reflect these new arrangements, including service provision, funding, and QOF. As they have done throughout the pandemic, practices can only work within their capacity and capability, and with the on-going constraints relating to social distancing, the use of PPE, risk assessments, workforce pressures and many other challenges, practices must be supported by CCGs and NHSE/I and not burdened with unrealistic expectations.

Face coverings

Following the Government’s announcement that face coverings will be mandatory for people visiting shops in England from 24 July, the BMA called for measures to be introduced immediately rather than waiting for 11 days and that the policy must be extended for all places where social distancing cannot be maintained.

The seventh BMA tracker survey, published this week, showed that 86% of doctors surveyed in England and Wales said it should be mandatory to wear face masks in settings, where the public either cannot or will not social distance. Read the BMA statement here

We have updated the Reducing COVID-19 transmission and PPE section of the GP practice toolkit, to include the new advice on face coverings. The Government guidance suggests there is no requirement for evidence for exemption, therefore practices do not have to provide letters of support for those who fall under the list of exemptions, or to those who do not.

The BMA has called for masks to be worn 'as a matter of course'. This was reported by BBC News, Good Morning Britain, Politico's London Playbook morning bulletin, The Huffington Post, and The Times (subscription required),  TelegraphYahoo News, and Daily Mail. The BMA has also called for the wearing of face masks by members of the public attending GP surgeries to be made compulsory. Read more in the article The scramble for facemasks, in the BMA’s The Doctor magazine. I spoke to GP Online about face coverings in general practice

Face covering to become mandatory on public transport in Wales

The Welsh Government has announced that face covering to become mandatory on public transport in Wales from, 27 July. Phil White, Chair of GPC Wales, took part in a BBC Radio Cymru phone in on COVID face coverings (from 6m40s), appeared on BBC Wales News (8mins 39 secs) and ITV Wales News (4mins 55 secs) advising that evidence shows face coverings reduce transmission. David Bailey, Chair of BMA Welsh Council, was featured on BBC Wales News and  Wrexham.com for his BMA Cymru Wales statement. This was also reported by BBC Wales

NHS pressures and back log of services

The latest tracker survey and the newly released BMA report The hidden impact of COVID-19 on patient care in the NHS in England, also show the struggle many face to tackle the backlog built up as social distancing remains in place.

Our latest commentary on the most recent data release from NHS England revealed the continued indirect impact of COVID-19 on patient behaviour and NHS activity in May and June. The monthly number of GP-made referrals made in May has started to climb since dropping in April, however the size of the waiting list remained low due to GPs being unable to refer. Despite this, more and more patients are waiting longer than ever for treatment. This reflects a large backlog of care needs that have accumulated beyond the focus on COVID-19, and we have analysed the potential magnitude of these changes in our Hidden impact of COVID-19 report. Read the BMA statement here

View the GP specific results of the tracker survey here

Joint guidance for remote intimate clinical assessments

GPC England, NHSE/I, RCGP and a number of other relevant organisations have developed joint guidance setting out the key principles for intimate clinical assessments undertaken remotely in response to COVID-19.

The pandemic has accelerated the use of online and video consultations in general practice and the guidance is aimed at clinicians who are consulting remotely and focuses on how to safely manage the receipt, storage and use of intimate images taken by patients for clinical purpose, which must be guided by the principle of the interests of the patient. The approach to video consulting, image sharing, and storage should be the same as it would be for face-to-face interactions.

The principles described in the guidance aim to support patients to access care in a way that meets their needs and to support clinicians to provide care in a way that is in the best interests of their patients, whilst protecting both from the risks associated with remote intimate assessments.

Shielding guidance for staff on returning to work (UK)

Shielding will be coming to an end in England, Northern Ireland and Scotland on 31 July, and 16 August in Wales, after which those who have been shielding will be able to return to work provided their place of work is ‘COVID-19 safe.’  The BMA has published guidance on Making the NHS ‘Covid-19 safe’ and supporting return to work, setting out recommendations for safe return of staff:

  • There needs to be clear guidance and protocols on how healthcare settings can be made safe for staff who have been shielding.
  • Funding needed to ensure that practices are able to make the necessary adjustments
  • Practices should be funded to cover the full pay of the staff that can’t return to work as well as cover for their replacement.
  • Every employer should undertake individual COVID-19 risk assessments which cover the basis of shielding properly and make a decision on return to work on a case-by-case basis.
  • Employers should engage with staff on a plan for returning to work and make appropriate workplace adjustments, including access to adequate PPE.
  • Employers should support staff to make informed personal decisions about returning to work, by providing honest and open information about risks and act on any concerns.

Read the BMA guidance on Risk assessments. The latest tracker survey also showed that most GPs who are currently shielding do not feel safe returning to work. This was reported by Pulse

Welsh Government testing strategy

The Welsh Government have published their high level COVID-19 testing strategy, which will be underpinned by local delivery plans for management of local outbreaks. Testing of asymptomatic individuals will be encouraged, initially focused on ‘closed’ settings e.g. care homes and prisons.

BMJ Learning clinical guidance: COVID-19 in primary care

BMJ Learning has updated their clinical e-learning module on managing COVID-19 in primary care. The module provides practical support to GPs on the following issues:

·         When and how to consult remotely and face-to-face during the pandemic

·         Key clinical features and complications of COVID-19 in primary care, and how to manage them

·         How to prioritise ongoing clinical care in general practice during the pandemic

·         The role of GPs in identifying and advising shielded patients

·         The importance of working safely in primary care during the pandemic, including appropriate use of PPE, and consideration of the wellbeing of GPs and other practice staff.

Tax on COVID-19 testing by employers
The HMRC published guidance on 6 July which advised that employees would face a taxable benefit in kind when their employer pays for COVID-19 testing. We raised concerns over this with the Department of Health and Social Care, and they have now advised that HMRC has removed the guidance. It is in the process of being updated to provide some clarity regarding NHS staff, with the expectation that they will not be subject to tax for COVID-19 testing.

ARM Elections
Elections for a number of BMA committees, including GPC UK, are now open for nominations, closing on Tuesday 15 September at 10am.

The full list of committees and more information are available here, and to submit a nomination please click here. Voting is for ARM delegates only and will open on 15 September.

Representatives to ARM
Nominations for representatives from LMCs and members of BMA committees to attend the virtual ARM meeting on 15 September 2020 are now open. The deadline for nominations is 12pm on Friday 24July 2020. Voting, if required, will follow the nomination period.

To stand for election you must be an LMC member or member of one of the BMA committees within a specified region [i.e. GPC UK, Sessional GPs Committee, GP Trainees Committee, LMC Conference Agenda Committees] and a BMA member. To submit your nomination or vote for either of these elections, please login to the BMA’s election system. More information, including instructions on how to nominate yourself, is available here. If you have any queries regarding the election process, please contact elections@bma.org.uk

LMC UK Conference

As the 2019/20 UK LMC Conference has been cancelled, and in line with our standing orders, members elected from the 2018/19 UK LMCs conference to GPC UK will remain in post until the 2020/21 UK LMCs conference is held in May 2021.

NHS Confederation report on PCNs (England)
NHS Confederation has published a report about Primary Care Networks – one year on, to mark the one-year anniversary of PCNs being established across England and assess their progress so far. The report sets out a national picture of variability but does describe how some networks are now delivering tangible benefits for the health of their populations and offering mutual support to their member practices.

Mental health and wellbeing
The BMA  published a new report last week which warns of a mental health crisis as we emerge from the COVID-19 pandemic and outlines key recommendations for the Government to take, including the recruitment of more mental health staff.

Read the BMA’s report on the mental health and wellbeing of the medical workforce which sets out ten recommendations to be addressed to protect staff during the pandemic and in the future.

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. For hard copies of our Wellbeing poster, please email wellbeingsupport@bma.org.uk

BMA COVID-19 guidance
We continue to regularly update our toolkit for GPs and practices, which includes a large range of topics relating to COVID-19. There is also guidance on the following topics:
Model terms of engagement for a GP providing temporary COVID-19 services

·         Guidance on risk assessments which includes specific information for practices.

For further information, see the BMA’s COVID-19 Webpage with all the latest guidance including links to the BMA’s COVID-19 ethical guidance and priorities for easing lockdown.

See this week’s GP bulletin here. 

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