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LMC weekly update - 22 January, 2021

Contract agreement for 2021/22 (England) 

At our meeting yesterday GPC England supported the agreement we have secured with NHSE/I for minimal contract changes for 2021/22 whilst retaining the significant increases in funding already planned. Some of the previous agreements due to start in April will be delayed. This is to give practices support and stability through the continued pandemic and whilst practices are playing such a significant role in the COVID-19 vaccination programme. Some of these changes will be implemented throughout 2021/22 depending on the pandemic, and will be agreed later in the year. Practices will then be provided with adequate time to prepare. 

The full details are available on our website, but in summary, from April: 

  • Funding increases previously agreed will be honoured 
  • Funding increase to global sum to allow a 2.1% uplift in pay 
  • QOF will be largely the same as for 2020/21 with some amendments to cancer and SMI domains to assist with the impact of the pandemic, and changes to vaccinations and immunisations as previously planned to continue with the move to an item of service payment arrangement for childhood vaccinations – these will see additional funding go into QOF 
  • QI modules from 20/21 to be repeated and slightly amended and the work already done will count towards this 
  • The core digital offer to patients has been defined, largely based on how practices are already operating due to the pandemic 
  • New ARRS roles will come on stream, with additional funding being made available to enable mental health practitioners to be part of the PCN workforce  
  • London weighting can be paid as part of ARRS max reimbursement amounts 
  • IIF 2020/12 indicators will remain unchanged. GPCE and NHSEI will have further discussion on other planned indicators for 2021/22, as the length and impact of the pandemic becomes clearer, utilising the additional investment to the IIF 
  • No new PCN service specifications from April (will be phased in later in the year with dates to be agreed depending on the pandemic), and current PCN services to receive minor amendments 
  • GPC England and NHSE/I will discuss the introduction (in-year) of a new enhanced service related to obesity and weight management 

Full details are available on the website and further guidance will be provided in due course, but we hope that this will provide practices with some stability during this challenging time. Read our press statement here 

PCN DES ballot results (England) 

In November, the LMC England conference passed the following resolution: Conference notes that the BMA GPC (GP committee) England has never secured a robust democratic mandate for the PCN DES and so again asks the GPC England to secure a firm mandate from the entire profession by means of ballot before negotiating any extension or changes to the PCN DES for the year 2021 / 2022. 

As a result GPCE have completed a ballot, with the question based on the motion: “Prior to any further negotiations, extension or changes for 2021/22, do you give GPC England a mandate for the PCN directed enhanced service? 

The result of the ballot was: 

Yes: 80% (3,619) 

No: 20% (915) 

Total number responding: 4,534 

This outcome provides a clear mandate from the profession for the PCN DES, and GPC England will therefore continue to negotiate on this, seeking improvements and further developing it, as part of the whole GP contract, for the benefit of practices and our patients. Read more here 

This was reported by GPonline and Pulse, where I commented: “We are glad that the profession has spoken so clearly, giving GPC England a clear mandate for the PCN directed enhanced service and telling us that we should continue negotiating this important contract on behalf of grassroots GPs throughout the country.” 

GPC England meeting 

GPC England met yesterday to discuss the 2021/22 contract agreement, the PCN DES ballot results, and the COVID vaccination programme.  

I was pleased that Rachel Ali gave her first regular update following her appointment as the Committee’s first gender diversity champion. This was one of the key proposals of GPC’s Gender Task and Finish Group. There were update reports from the sessional GPs committee, GP trainees committee and GPC policy leads. These focused on a number of recent developments including pay and contracts, premises, well-being, and education and training issues. The GPC Executive and Policy Lead update from the meeting is available here for your information. 

Other items on the agenda included an update on the planned BMA submission to the DDRB, and a discussion on the BMA response to the integrated care systems proposals being made by NHSE/I. The response highlighted the critical role of LMCs must play in representing all GPs in any new structures and the committee raised concerns about how they may be implemented. 

Scottish GPC meeting 

SGPC met yesterday and discussed a number of issues, including the agreement reached with the Scottish Government on the next steps for the GMS contract in Scotland. The committee heard in more detail about the timescale by which responsibility for services outlined in the contract will be written out of GMS regulation and will transfer to the HSCPs. Transitionary Services will be introduced to compensate practices who are still required to temporarily deliver such services until the HSCP is in a position to provide them. SGPC also discussed the progress of the Covid vaccination programme and concerns about the pace of supplies reaching practices, along with appraisal and ongoing changes to urgent care in Scotland. 

COVID-19 vaccination programme  

From this week, people aged 70 and over and those clinically extremely vulnerable to COVID-19 can be invited to get their vaccinations as the roll out of the vaccination for the next 2 priority groups begins. Vaccinating the first two groups (care home residents and staff, and those aged 80 and over and frontline health and care staff) will remain the priority, but vaccination sites which have enough supply and capacity for vaccinating further people are allowed to offer vaccinations to the next 2 cohorts. We have however raised with NHSE/I our concerns about the way invitation letters are being sent to patients, and that these are not coordinated with local practice group sites, causing potential confusion for some patients and unnecessary travelling to more remote vaccination centres. 

NHS England has made it clear that vaccines should not be wasted, and sites should have reserve lists that they can use to make every effort to invite patients or healthcare professionals to ensure that they can make full use of any unused vaccines rather than have any go to waste. We have also added a section on vaccine supply to the BMA’s advice webpage on healthcare worker vaccination and are encouraging members to anonymously report any concerns about this via our feedback portal.  

Following last week’s announcement about additional funding to support the rapid delivery of vaccinations to care home staff and residents, NHSE/I has now published Process for the payment of Item of Service fees and Care Home Supplement payments to PCN groupings (log in required, so document is also attached). We have raised concerns about the complexity of this process but 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 £2500 per PCN grouping) of funding support. 

There have been some concerns about the availability of the COVID vaccine for private patients. The easiest way for private patients to access the vaccination programme is to temporarily register with an NHS practice involved in the vaccination programme. If they have not got an NHS number they will be provided with one as part of the registration process. We would encourage practices to do this for private patients and for local vaccination sites to make the bookings. However if a patient does not want to do this if they have ever had any contact with an NHS service they should still receive a vaccination letter via the national database.  

Read our guidance on the COVID-19 vaccination programme which includes information about the added funding to support rapid care home vaccination, and other recent information about how to administer the vaccine, and further support to enable practices to prioritise vaccine delivery. 

NHSE/I’s guidance for primary care about the COVID-19 vaccination programme is available here 

The latest data report of the number of COVID-19 vaccinations provided by the NHS in England, show that as of 20 January, a total of 4,419,704 have received an NHS vaccination since 7 December when vaccinations began.  

The BMA is tracking the rollout of both first and second dose vaccination against COVID-19, as we campaign for rapid vaccine distribution to doctors. Thank you to all who have participated so far – we found that while most UK doctors have now received a vaccination, there is variation by country and grade, and one in 10 are yet to receive a first dose. See the results here 

PM praises GPs 

We were pleased to hear the Prime Minister and Chief Medical Officer praising GPs and their teams in the COVID-19 press conference last week. The Prime Minister said, “A massive thank you...they’ve now stood up the vaccination on top of everything else...we should all be enormously grateful for what they have done.” Read more on the BMA’s GP twitter account 

Securing enhanced and suitable PPE 

In light of the continued spread of the new more transmissible variant of COVID-19, as well as growing evidence of aerosol transmission of the virus in non-AGP settings, the BMA is determined to ensure that every doctor is properly protected with adequate and suitable PPE. That’s why the BMA has written to Public Health England asking for an urgent review of their PPE guidance.  

As we reported last week, the Government has extended the provision of free COVID-19 PPE for all health, social care and public sector workers, until at least the end of June. Read the BMA’s updated PPE guidance and the guidance for practices on reducing COVID-19 transmission and PPE

BMA joins calls for emergency legislation to protect medics from 'unlawful killing' cases 

The BMA has co-signed a letter calling for emergency legislation to protect healthcare workers from 'inappropriate' legal action over Covid-19 treatment decisions. The story was covered by Sky News and BBC News. The letter, organised by the MPS and signed by other health organisations and addressed to Matt Hancock, reads: "With the chief medical officers now determining that there is a material risk of the NHS being overwhelmed within weeks, our members are worried that not only do they face being put in this position but also that they could subsequently be vulnerable to a criminal investigation by the police." 

Judicial Review against Northamptonshire safeguarding partners (safeguarding fees) 

The BMA made an application for Judicial Review against the Northamptonshire safeguarding partners, which was heard in May 2020. We argued that they had failed to discharge various statutory obligations in publishing their Local Safeguarding Arrangements Plan 2019-2021, because it did not specify what sum the Defendants had budgeted to meet the cost of GPs work on safeguarding cases, including the production of safeguarding reports and attendance at safeguarding conferences. 

Judgement in the Judicial Review brought by the BMA was handed down in July 2020. Unfortunately the Judge found against us and dismissed the application for Judicial review. The Judge reached a different conclusion to us about the correct interpretation of the Children Act 2004 and in particular, sections 16E and 16F. He interpreted those sections narrowly, as only requiring safeguarding partners to ‘make arrangements to enable themselves, when they exercise their individual safeguarding functions, to work together’. He held therefore, that they did not have a bearing on how safeguarding partners discharge related safeguarding obligations arising under different legal provisions. 

We were advised that there were sufficient, if limited grounds for appeal and an application was made. We have now heard that we were unfortunately unsuccessful in the appeal. The judicial review cannot now be taken any further. 

However, in reaching his original decision, the judge said that safeguarding partners can reasonably be expected to agree suitable arrangements to pay GPs, and if they don’t, GPs may well take legal action to force them to. Although this is much the same position we were in before we started the JR, it helps us that it is confirmed in a High Court judgment which at the same time dismisses the main legal arguments that local authorities would rely on to say GPs have to provide the work for free.  

LMCs are therefore asked to consider the possibility of finding some suitable test cases to challenge non-payment for these services. Please contact Greg Lewis, Senior Policy Advisor, on glewis@bma.org.uk 

Payments during suspension - SoS Determination (England) 

GPC is aware of a case where a GP has been asked to refund to the NHS a significant sum of money, that had allegedly been wrongly paid during a period of suspension. The payment was made under the Secretary of State’s Determination: Payments to Medical Practitioners suspended from the Performers List and there is nothing to suggest the interpretation of the Determination by NHSE/I was anything other than correct. However, the original payment was mistakenly made on the GP’s profits and not their drawings. The Determination sets out that entitlement is based on an individual’s normal monthly payments where they practise as an individual and in the case of partnerships, 90% of the normal monthly drawings from the partnership account. NHSE/I were correct in the re-interpretation of the Determination, payment Is based on drawings not profit, often a much lower sum, but not the one on which tax is payable. 

It has been suggested this amounts to discrimination against contractors when compared to other GPs and hospital doctors. The purpose of this update is to ensure members are aware of the consequences of this interpretation and the impact it might have on them if they receive payments when suspended.  

LMC UK Conference 2021 

This year’s annual LMC UK Conference will be held on virtually on 12 and 13 May.  LMCs have been sent an email with information on how to submit motions (deadline for submitting motions is midday Friday 19 February 2021) and how to register (applications must be submitted by Friday 26 March 2021). More information will be provided nearer the time on how to access the virtual conference, and will be added to the LMC page on the BMA website. For further information please email info.lmcconference@bma.org.uk 

LMC England Conference resolutions 

The virtual England LMC Conference took place on 27 November 2020.  This document which details the conference resolutions, election results and motions lost, has now been updated to include the voting statistics for each motion. All of the votes were quorate. 

GPC regional elections 

Nominations are opening at 12pm on Friday 22 January for seats to the General Practitioners Committee (GPC) in the following regions: 

  • Norfolk/Suffolk/Great Yarmouth & Waveney 
  • Enfield & Haringey/Camden & Islington/ Barnet/Kensington & Chelsea/Westminster 
  • Merton, Sutton & Wandsworth/Kingston & Richmond 
  • Sefton/Liverpool/Wirral 
  • Salford & Trafford/Manchester/Stockport 
  • Durham/Cleveland 
  • Northern Ireland 
  • Grampian/Highland/Orkney/Shetland/Western Isles 
  • Glasgow & Clyde 
  • Forth Valley/Fife /Lothian/Tayside 
  • Somerset/N & E Devon 
  • E Sussex/W Sussex 
  • Derbys/ Notts 
  • Gwent/Bro Taf/Morgannwg 
  • Herefordshire/Worcs/Warks/Coventry 
  • Birmingham/Solihull 
  • Barnsley/Doncaster/Rotherham/Sheffield* 

*This is a by-election and is for a two-year term only from 2021-23. The next meeting of GPC UK is Thursday 18 March – if you are standing in this election please hold this date in your diary.  

These seats are for a three-year term, 2021-24 sessions, subject to governance structure review.  

Nominations are also opening on 12pm on Friday 22 January to the below seat on GPC UK – this seat is for a three-year term from 2021-24: 

  • Prison GP representative 

Please note that in previous years there was a requirement that only GPs who paid the voluntary level could nominate themselves for election. That requirement has now been removed. 

To submit your nomination please visit https://elections.bma.org.uk/. The deadline for nominations is 12pm Friday 12 February. Voting will take place from 12pm 19 February to 12 March for the by-election and 19 March for all other seats.  

For any questions relating to the role or GPC please contact info.gpc@bma.org.uk 

If you have any queries regarding the election process, please contact elections@bma.org.uk

Meeting on public health restructuring for public health doctors working outside of PHE (England) 

Following discussions at the last joint Public Health Medicine Consultative Committee (PHMC) and with the ADPH, the Faculty of Public Health (FPH) has agreed to host a joint meeting with the BMA on Thursday 28 January 2021, 14:00 - 15:30 on the restructuring of public health in England.

This meeting is primarily for public health doctors working in the English system outside of Public Health England, and also relevant to GPs with a special interest in Public Health. You can register your free place here. When registering, you will be asked to enter your Faculty membership ID if you have one.  If you have any difficulties registering or are unable to attend but would like to ask a question, please contact the PHMC on info.phmc@bma.org.uk  

BMA COVID-19 guidance 

Read our COVID-19 toolkit for GPs and practices, which includes updates in the COVID-19 vaccination programme section and protecting clinically extremely vulnerable (CEV) patients section. There is also guidance on the following topics: 

COVID-19 media  

I have been quoted extensively in a range of national and regional media this week, speaking about the vaccine rollout. My comments were covered in the Mail OnlineBBC OnlineEvening StandardYorkshire Post, among others, which were in response to reports that areas such as the North East and Yorkshire were having vaccine supplies reduced to allow for more supplies to be distributed to other areas where vaccine coverage had not been as great. I have been absolutely clear that the Government needed to be far more honest and transparent about vaccine supplies and to provide clear justification about where they were being sent. I was also interviewed on BBC Look North (from 4m42s) and ITV Calendar. I’ve also been interviewed for BBC Look North again today. 

I spoke to BBC 5Live (around 10.20pm) and appeared on Good Morning Britain on Tuesday speaking about the challenges of the vaccine rollout. I said that the urgency of the vaccine rollout was very clear and emphasised the efforts of GPs so far and “It’s a bit frustrating where vaccine deliveries change. It means practices are having to reorganise clinics and rebook those clinics, often about a 1,000 people at a time and that's a real burden on practices. Practices want to provide vaccinations to their patients as quickly as possible.” 

On Sunday, I was interviewed live by BBC News about the possibility of all adults in the UK being offered the first dose by September. While this is welcome news, it is vital to stay focused on the task at hand and make sure the vulnerable and healthcare workers are protected first. I also spoke to BBC Radio London (around 7.10am) and BBC 5Live (around 9am) on the same topic. 

The Guardian and Metro reported on a record number of vaccinations done in one day (343,000) and that ministers refuse to reveal how much stock is in the system, despite concerns about supply issues, to which I commented: “Unfortunately, we are hearing of supply issues which are impacting the speed of the rollout of the vaccine. Despite having the staff and resources available, some GP-led sites are not able to vaccinate patients at the rate at which they could if they had continued access to the vaccine. As well as accelerating the delivery of supplies to ready and willing sites across the country, the Government needs to be honest both with the public and practices about what supplies are available. 

The Financial Times (paywall) reported that hundreds of thousands of patients without access to a car will struggle to reach their nearest vaccination centre as the 'postcode lottery' risks exacerbating income, ethnic and geographic divides. I commented that the ability to set up vaccination sites had in some cases been “limited by geography”, with rural areas in particular finding it harder to find suitable locations. Speaking on the vaccine supply issue I said: “We want to be able to plan ahead so we know in nine weeks’ time we’ll have vaccine so we can book people in. We’re not there yet because the NHS isn’t providing us with long-term projections around vaccine availability. We’re working from hand to mouth at the moment.” 

Chaand Nagpaul, BMA’s Chair of Council, has spoken live to BBC News and Radio 4 News about reports of vaccine wastage and said that the issue is not widespread and that the BMA is only aware of a very small amount of problems, most of which have now been resolved. He also gave a written statement on this to the Telegraph and Pulse, saying: "Reports of vaccination sites feeling pressured to discard unused doses of the Pfizer vaccine are extremely concerning. This is absolutely unacceptable and morally wrong. Any wasted dose would deny a real person the chance to be protected from serious illness or even death." This was also covered by the Mirror

Brian McGregor, GPC member, also highlighted the issue in the Telegraph and the Mirror where he said that NHS England had told his local CCG to dispose of unused vaccine doses, and claimed they had been warned the would be "performance managed" on the issue. He said: "They control our contracts, payments, vaccine supply, regulation, and can make life unbearable." Robert Morley, GPC member, was also quoted saying: "This is ridiculous, bordering on the criminal, to actually be wasting vaccines when you have the worst global healthcare crisis for a century." 

GPC member Gaurav Gupta was interviewed on BBC Radio Kent (from 2hrs 18mins) speaking about NHS pressures in the region. He said: “We are used to having extra pressure in the winter time but this year has been compounded by the number of patients who are Covid positive – this is completely unheard of." He was also interviewed on BBC South East (from 3mins) on the vaccine rollout in Kent. 

BMA Northern Ireland has released a statement in advance of an expected surge of admissions for COVID-19 in Northern Ireland saying that medical staff will face pressures unlike any they have faced before, and the BMA is deeply concerned about the long term impact on doctors mental health and the impact on the health service. The statement was picked up across the majority of news outlets in Northern Ireland, including Belfast telegraphIrish NewsNews LetterBBC News NIUTV News online, and Belfast Live.  NI Chair of Council, Tom Black, was also interviewed on Good Morning Ulster show (2:23:16) and BBC Radio Foyle Breakfast (1:24:25). He was also interviewed in the Sunday Life about the effects of long covid on doctors, and by News Letter about the new strain of covid-19 found in Brazil and what could happen if it established itself in NI. 

NIGPC chair Alan Stout was interviewed in the Belfast Telegraph about concerns over St Patrick’s Day parties being organised during the ongoing pandemic.  The interview was then highlighted in the paper’s editorial. 

NI GPC chair and deputy chair Alan Stout and Frances O’Hagan were interviewed across several BBC news outlets about concerns over the delays in supplies of the Oxford-AstraZeneca vaccine. Dr O'Hagan was interviewed on BBC Newsline (from 5.38) and in a BBC News NI online article, telling patients: "As soon as we get the vaccine, we will get it to you." Dr Stout was interviewed on Talk Back (from 12:49). 

David Bailey, Chair BMA Welsh Council, spoke on BBC Wales (from 3m45s) about supply issues where he said: “Any vaccines that we’ve got in Wales need to be got out as quickly as possible, if that means people in mass vaccination centres will be underemployed for a couple of weeks when we exhaust our supply then so be it. It still means all of those vaccines are starting to protect Welsh patients.” Phil White, Chair of GPC Wales, appeared on BBC Radio Cymru (from 10m54s) to talk about the disappointing comments from the First Minister on slowing vaccination rollout. 

Read the latest GP bulletin here 

Read the latest Sessional GPs bulletin here 

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