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LMC weekly update 20 March 2020

Coronavirus (COVID-19) update
On Monday, the Prime Minister and CMO announced that the UK has entered the ‘rapid spread’ stage, and has introduced a number of new measures on social distancing:

  • People living with someone with minor symptoms should self-isolate for 14 days, and living alone to isolate for 7 days.
  • People should stop all unnecessary social contact with others
  • Avoid all but necessary travel and work from home where possible
  • By this weekend, the most vulnerable (those over 70, those with pre-existing conditions, and pregnant women) to practise even stricter social distancing over the next 12 weeks.
  • The objectives of these measures are to suppress the curve and stop it overwhelming the NHS and protecting the vulnerable.

This has led to an extraordinarily busy and challenging week for everyone as we do our best to respond to this unprecedented situation.

NHSE/I published its latest letter of preparedness yesterday, which outlines the actions that are being taken related to general practice. It includes important areas outlining what routine work can be stopped. We have however a number of concerns which we have raised directly with NHSE/I and government, including with the Health Minister, Jo Churchill, today.

We have produced guidance to help support practices on deciding what they should be doing now. Our advice is that practices should prioritise the urgent needs of their patients and do so in a safe way that protects the workforce. The NHSE/I letter provides guarantees of payments for 2019/20 QOF which will be based on either 18/19 or 19/20, whichever is greater, and provides similar guarantees for 2020/21. It also highlights a range of areas of routine work that can be stopped.  This is just the first step and it is likely that this will need to be extended once it becomes clear how long the current crisis lasts for, including the need for a recovery period.

PPE and GP pressures
We remain particularly concerned about lack of appropriate PPE for primary care providers and are working with NHS England and other stakeholders to get this sorted urgently. Today I raised this directly with the health minister, Jo Churchill MP, and stressed the urgency of getting adequate PPE to practices and giving practitioners confidence that the PPE they receive and use is appropriate. The Minister responded that this was a government priority, that they understood the concerns of healthcare workers and were trying to respond as quickly as possible.  This is an issue the BMA will continue to push for a resolution to as a matter of urgency.

In relation to the need for increased COVID-19 testing and prioritisation for healthcare workers, there was also agreement with DHSC outlining their commitment to significantly increasing the number of tests being carried out in order to help healthcare workers and patients to have the reassurance they need.

Read the BMA statement calling for reliable supply of proper PPE for HCWs here.

Read the updated NHSEI Standard Operating Procedure for General Practice here

NHSE/I has also published a letter to NHS about next steps on NHS response to COVID-19 this week in which they stated that they would ensure that all GP practices in 2020/21 continue to be paid at rates that assume they would have continued to perform at the same levels from the beginning of the outbreak as they had done previously, including for the purposes of QOF, DES and LES payments.

Following our request last week, the CQC has written to all providers in England informing them that as of 16 March they are stopping routine CQC inspections. Read the full letter here

The Welsh Government released a statement last week suspending non-urgent work and relaxation of GP contract. Read the BMA response to the statement here.

The attached letter from Welsh Government has guidance to practices regarding PPE and the appropriateness of the stock currently distributed. Phil White, GPC Wales Chair, was quoted in Wales online about the concerns about some GPs note having received any PPE.

The Scottish Government has published the attached supporting guidance for general practice.

COVID-19 prescribing and supply issues
As set out the NHSE/I letter of preparedness (5 March), practices are reminded not to increase the quantities they prescribe but to put patients on electronic repeat dispensing 13x23 day supplies to manage supply issues.

Appraisal and revalidation
NHS England has sent out the attached letter, which confirms that any doctors who are due to revalidate before the end of September will have their revalidation date deferred for one year.  Appraisals have been suspended until further notice.

Online isolation notes - providing proof of coronavirus absence from work

Online isolation notes via NHS111 online, for patients that are self isolating, have now been launched. An isolation note can be obtained without contacting a doctor, this will reduce the pressure on GP surgeries and prevent people needing to leave their homes. The notes can be accessed through the NHS website and NHS 111 online.

COVID-19: retired doctors returning to work
The Government is calling upon health professionals who have recently left clinical practice to help tackle the coronavirus outbreak in the UK. This BMA guidance aimed at doctors who choose to return to work. The GMC  is contacting around 15,000 fully qualified and experienced doctors of good standing with a UK address, who left the register or gave up their licence to practise in the last three years.

Serological testing letter (England)
PHE has sent out the attached letter to a small number of practices whose patients have tested negative for the COVID-19, asking for their assistance in obtaining a further blood sample from patients for serological testing. This is a specific and very limited project in this unprecedented situation and will enable PHE and those they work with to use those who have now recovered to help understand the condition better, develop a vaccine and help us all fight this infection better.


The BMA COVID-19 webpage is updated daily with guidance and links to official information:
 

The BMA has published FAQs on your contract terms and conditions which will be updated regularly. See also the COVID-19 ‘update page’ with links to BMA priorities, guidance and news.
 

We continue to raise issues that need to be addressed with the relevant organisations, and will continue to disseminate information as it becomes available.

If BMA members have any specific concerns or issues related to COVID-19 please contact the BMA’s advisers on 0300 123 1233 and support@bma.org.uk.

Wellbeing
At times of crisis it is also vital that we all look after our emotional as well as physical health and the BMA has a range of wellbeing services including 24/7 counselling, available to ALL doctors and medical students (not just BMA members).free of charge.

The World Health Organisation has also published guidance on

Mental Health and Psychosocial Considerations During COVID-19 Outbreak
 

Media

Chaand Nagpaul, BMA Chair of Council, appeared on Sky’s Sophy Ridge programme, BBC Newsnight and BBC Radio four where he raised concerns about lack of supplies of PPE and priority testing for HCP staff. This was also reported by The Telegraph, The i, The Mirror, Financial Times (subscription required) and Medscape. He was also interviewed on. David Wrigley, GP and Deputy Chair of BMA Council, was quoted in the Guardian about PPE and in GP online about testing for frontline staff.

PCN DES
As highlighted above, NHS England released a letter yesterday relating to contract changes in England due to the escalating crisis we are facing. GPC England has produced guidance about what practices can stop and other measures that practices and PCNs can take to focus on managing the current situation.

The PCN DES has been changed considerably in response to this emergency. It still supports practices to work in PCNs, and this is now more important than ever. The funding streams remain guaranteed, crucially to support workforce expansion and support for CDs who will be taking a key leadership role during this current crisis. The service specifications have been delayed or can be delayed due to COVID-19 taking priority. The IIF has been abandoned for at least 6 months, if not for longer, in favour of providing the equivalent funding for PCNs to use to support their COVID-19 related activity. We will be engaged with NHS England over the coming days as the situation develops to ensure any further changes required are implemented.

Practices still have until the end of May to confirm their sign up to the DES. As the situation is so different from last week when the special conference of English LMCs was held we would now encourage practices to do this as early as possible to ensure funding flows and collaborative working arrangements are in place during this extremely challenging period. We are aware that some CCGs have asked for earlier confirmation, and where possible we would encourage practices to respond, but the final deadline will be 31 May.  However the DES does remain voluntary.

With the recent changes the PCN DES Specification is still being finalised but will be released very soon so you will be able to then see the detail of what has changed.

In view of the dramatic changes since last week, after careful thought and checking with GPC England, we believe that postponing, for the moment, the survey we were planning to do on asking practices about signing up to the PCN DES is the right thing to do for the profession at this time. We will revisit this decision when the situation becomes clearer and ascertain the most appropriate time to circulate the detailed survey that we were planning to do.

National data opt-out
Given that the health and social care system will face significant pressures in the coming month due to the Covid-19 outbreak, NHSX and NHS Digital have made the decision to extend the compliance deadline for the national data opt-out and the final date for submission of the Data Security and Protection Toolkit (DSPT) to 30 September 2020. In addition NHSX has produced some Covid-19 IG guidance

Pensions tax annual allowance
As mentioned last week, NHSE/I have written to all GP contract holders and performers (including Locums) in England. The letter gives eligible clinicians assurance that they can undertake any combination of clinical roles for the NHS during the 2019/20 tax year without suffering any financial loss as a result of the annual allowance pensions tax, subject to using the Scheme Pays mechanism. This includes any additional work related to the response to coronavirus. Read the letter here and BMA guidance here

GP pressures
The latest general practice data from NHS England shows that before the COVID-19 outbreak, the monthly appointment count continued to climb this January (15% higher than December 2019) despite no increase in the number of fully qualified FTE GPs. 30,000 more GP appointments occurred in January 2020 than the same month last year. This scale-up in appointments, without corresponding increases in workforce means that GPs in 2020 are working under more pressure than ever – this is likely to only be exacerbated by the worrying onset of COVID-19. Read more about what the data shows about the changing nature of general practice on the  general practice pressures page

GP contract Roadshows (England)
The GPC England executive team have now presented GP contract details for 20-21 at a number of contract roadshow events across England.  All of the other planned events have now been cancelled due to the developing Covid-19 situation, but you can now access the roadshow presentation, with a commentary from me, on the contract page of our website.

LMC UK Conference 2020 – message from LMC UK Conference Chair, Mark Corcoran
After consulting with the GPDF and the BMA I have today taken the unfortunate but necessary decision formally to cancel this year's UK Conference of LMCs. I am sure you all understand why. Given current circumstances and the uncertainty going forward, it is unlikely that we will able to reschedule for any time later this year, so the next conference is likely to be May 2021. We will announce that date as soon as we possibly can.

On behalf of the UK conference agenda committee I would like to thank you all for the time and effort which went into crafting the motions you submitted. I will liaise with the chair of GPC UK in relation to how some of the key themes from those motions can be taken forward by GPC.

I know that many of you will also have questions in relation to the elections, which would have been held at conference, and I am working closely with the GPC Representation Policy Lead and the GPC secretariat on a solution. We will update you in due course.

I would also like to take this opportunity to thank you for your exceptional work on behalf of the profession and our patients during this national health emergency.

Finally, I refer you to the below message from the GPDF/BMA regarding expenses:
 -------------
Where there are unrefundable costs, or cancellation fees, we will reimburse these. 

  • For Representatives of LMCs this should be by an invoice to the GPDF;  this may be sent electronically to mail@gpdf.org.uk with a scan of the relevant item(s) but please use a file size less than 1MB
     
  • For GPC members and others claiming from the BMA using Concur in the usual way

    Any claims should be received by 31 May.

See this week’s GP bulletin here

See the sessional GPs bulletin here

See this week’s BMA COVID-19 bulletin here.

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