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LMC weekly update 22 May, 2020

GPC England meeting update

GPC England held its first ever virtual meeting yesterday. The meeting began with heartfelt tributes to the many GPs and other healthcare workers who have lost their lives during the COVID-19 crisis.

There was a detailed discussion regarding the many issues which have arisen and been addressed by GPCE over the last few months during the COVID-19 crisis. We also considered our strategy for the next stages of the pandemic, and in particular what changes made during the last few months should be retained, what should be stopped, and what elements could be brought back when capacity and the new environment we will be working in the for the foreseeable future allows.

 We considered other important matters, including agreeing to establish a gender diversity champion for GPC England. The establishment of that role was one of the recommendations of the GPC Gender Task and Finish Group, which I established to make recommendations to improve the gender balance of the committee. The GPC England gender diversity champion will work in collaboration with their counterparts on the nation GPCs to promote and champion the central importance of gender equality, diversity and inclusion issues to the committee and its work. They would also have an important ambassadorial role in promoting good practice in those areas to LMCs. Committee members also raised the importance of extending this role to focus on wider diversity and inclusivity issues.

The committee also spent time debating a paper regarding how GP practices can develop, and can be helped to develop, environmentally responsible policies. That work aligns with a wider BMA workstream in line with 2019 ARM policy to campaign and cooperate to deliver carbon neutrality by 2030. It is vital that GPCE, and general practice more widely, continues to lead in this important area.

Primary Care Network Contract DES 2020/21 (England)

Over the last three months, and following the Special LMC Conference, GPC England has been raising issues relating to the PCN DES with NHSE/I, particularly in the light of the COVID-19 pandemic and as many practices are in the process of making decisions about whether to sign up. NHSE/I has responded in a letter outlining gratitude to the many thousands of GPs and practice staff who have worked tirelessly to transform their services in response to the pandemic and noting that the DES was modified to provide greater support to practices working together in their areas. They will continue to keep the DES under close review in response to the pandemic and they believe PCNs have enormous potential to support the sustainability and resilience of general practice, and to improve delivery of care to patients.

Importantly it confirms the DES is clear that contract management will be supportive and collaborative and, in the rare circumstances that remedial actions are needed, NHSE/I expects CCGs to focus on the DES itself rather than other elements of the practice’s core contract. However they also made clear that should a practice opt out of the DES they will lose their Network Participation Payment of £1.76 per patient from their core practice contract, as well as their entitlements to funding and the workforce employed through the DES. CCGs will not be permitted to offer the service to those practices – or their associated Federation – on better terms through a local scheme as they will be expected to commission an alternative provider.  

Their latest figures suggest 96% of practices have either signed up to the DES or expressed their intention to do so, with 74 practices (1%) having informed their CCG that they have decided not to participate.

BMA survey of the profession

The BMA has now published the results of the latest, and fourth, tracker survey, which show that the majority of doctors have no confidence in being able to manage patient demand in the coming weeks and that caring for those with COVID-19 has severely impacted the treatment and care available for other patients.

Last month the Government insisted that before lockdown was eased, the NHS must be able to cope. These results clearly show that doctors on the frontline feel this is not the case.

The lowest level of confidence is for managing demand in the community, in particular for care homes, with 69% saying they are not very or not at all confident of being able to do this. In terms of patients being able to have tests, scans and other diagnostic type treatment, around 60% of doctors said they had little or no confidence that demand could be properly managed.

This was reported by FT (log in required) and the Independent

Immigration health surcharge for overseas healthcare workers

The BMA has welcomed the announcement that the Government is going to scrap the immigration health surcharge for overseas healthcare workers. Chaand Nagpaul, BMA council chair, said: “This announcement is long overdue but is testament to the BMA’s persistent lobbying for this surcharge, unfair to so many NHS workers from overseas, to be abolished. This is without a doubt a moral victory and brings huge relief to those facing bills of up to thousands of pounds – as well as the insult of having to pay for the very services they are working so hard to provide.” Read the statement here

Care homes

As we reported last week, following our lobbying of government, care homes are now being supported to do virtual consultations. Practices should continue provide proactive support for care home residents with suspected or confirmed COVID-19 through remote monitoring, or face-to-face assessment where clinically appropriate.

The Government have published an updated COVID-19: care home support package, as well as a new operational model to help pharmacy and medicines teams implement the NHSEI guidance Primary Care and Community Health Support for Care Homes.

Remote consultations for learning disability health checks

Providing support to people with learning disabilities is an important part of general practice activity, which includes offering the opportunity for an annual health check. NHSEI have confirmed that, with regards to health checks for people with a learning disability, where this cannot be delivered safely face to face or where the patient has other medical conditions which require them to shield or socially isolate, the review could be conducted remotely. Decisions about the best way to conduct a health check should be made on an individual basis, taking in to account the challenges some patients might have with this. Our toolkit for practices now also includes an FAQ for locum doctors working remotely.

Home working and distribution of high-risk work

Many practices now have some access to remote working and it is appropriate for clinical staff to make use of this where possible to reduce risk to staff and patients. For those situations where a face to face appointment is required then this should be arranged equitably between all clinical staff and based upon risk assessment where indicated. Read more in the our toolkit

BMA Risk assessment guidance

The BMA has been lobbying government to take urgent steps to address the need to protect Black, Asian and minority ethnic (BAME) communities from COVID-19, as was highlighted in the ONS data published last week, which showed that those with BAME background are more likely to die from the virus. The BMA has written to Sir Simon Stevens this week to address these concerns and the need for more practical advice, to practices, on risk assessment. The letter also highlights that the great local variation in the use of and approach to risk assessments, and that occupational health services are not available to most staff in primary care. Read the BMA guidance on risk assessments. This follows on from the publication of FOM Risk Reduction Framework for NHS staff at risk of COVID-19 and NHS Employers guidance on risk assessment for staff

New coronavirus life assurance scheme

On 27 April a new life assurance scheme was introduced covering health and social care workers during the COVID-19 pandemic. Details of the scheme have now been published by NHS Business Service Authority - scheme rules including guidance for claimants and employers can be found here. This payment is in addition to Death in Service (DiS) benefits linked to the pension schemes. We are aware of outstanding issues around DiS benefits, particularly for locum GPs, and continue to lobby on those.

Testing (UK)

Anyone over 5 who has symptoms of COVID-19 (a high temperature, a new, continuous cough, or a loss or change to their sense of smell or taste) can now access antigen testing.Practices in England, Scotland and Northern Ireland should direct symptomatic patients to the NHS website, for further information on how to access the test online. People in Wales can ask for a home test kit here.

If there are any questions about a test that has been booked, you can call the customer contact centre from 7am to 11pm. In England and Wales – call 119 free, and in Scotland and Northern Ireland call 0300 303 2714. Read more here

I commented on testing in The Guardian, highlighting the problem of false negative tests.

GP and practice COVID-19 toolkit

We continue to update our toolkit for GPs and practices, which should help to answer many of the questions we have been getting on a large range of topics relating to COVID-19. Last week we added a section for locum doctors working remotely, and also flagged the section on reducing COVID-19 transmission, in relation to social distancing within GP practices. The guidance also suggests clarity must be given to healthcare workers about the future contractual position and plans to restore training and career development. Read more here

Bank holiday Monday 25 May (England)

NHSE/I have confirmed that GP practices in England are not expected to open outside the normal bank holiday cover arrangements for the upcoming Whitsun Bank Holiday, 25 May.  Pharmacies are also not expected to open, as they did at Easter and on 8 May 2020. 

Temporary residents and travelling patients (England)

GPC England has issued new guidance on the use of remote consultations as a way for practices across the country to support colleagues working in practices in tourist areas who may face a large increase in visitors this summer. Patients are now much more likely to contact their own practice by phone or video rather than having to temporarily register with another practice. Read the guidance here

Domestic abuse during COVID-19: advice for NHS staff (England)

There has been a concerning increase in domestic abuse cases during the pandemic, and the Home Office have launched a national campaign to raise awareness of the support available. NHSEI has sent a letter with advice for NHS staff on dealing with domestic abuse during pandemic, which lists a number of resources that may be useful for NHS staff in signposting to specific support teams.

The DHSC has also launched a resource that looks at how health professionals can support patients who are experiencing domestic abuse. The document helps health staff to identify potential victims, initiate sensitive routine enquiry, respond effectively to disclosures of abuse. 

BMA paper on principles for restarting non-COVID care

The BMA has published a paper on the Ten principles for how the NHS should approach restarting ‘non-Covid care’. The paper warns that healthcare leaders should be ‘realistic and cautious’ about restarting shelved, non-treatment NHS work and re-balancing COVID-19 and non-COVID-19 capacity. The principles suggest that managers should take a realistic and cautious approach, that there must be adequate PPE for HCWs, and that decisions about staffing levels and redeployment must be safe and measures must be taken to safeguard staff wellbeing.

Welsh Government’s lockdown exit plan (Wales)

The Welsh Government has published Unlocking our society and economy – continuing the conversation’, which sets out a traffic light system for lifting lockdown in Wales, with phased reductions in the lockdown across different parts of daily life. Most areas are now in ‘Red’ with others still in lockdown. This includes a series of ‘circuit breakers’ that will trigger the re-imposition of measures if the growth of COVID-19 becomes unacceptable and could not be controlled by ‘test, trace and protect’. Read the BMA statement by David Bailey, Chair of BMA Wales Council, here

Scottish route map to easing lockdown (Scotland)

The Scottish Government published the Scottish ‘Route map’ to easing lockdown yesterday, in which a “careful relaxation” of lockdown measures will begin on May 28. More outdoor activity will be allowed, letting people sit in parks with people from one other household while observing social distancing. Non-contact outdoor activities will resume, along with allowing people to travel a short distance to take part in recreation, and schools will reopen from 11 August. BMA Scotland welcomes the cautious approach to restarting NHS services in Scotland – read the statement here

COVID-19 media

NIGPC chair Alan Stout was interviewed on the BBC Radio 5 Nolan Show discussing care home COVID infection and death rates for the Belfast Trust.  The interview is at the 03:30 part of the recording.

Dr Phil White, GPC Wales Chair, was appeared on BBC Radio Wales’ Jason Mohammad COVID phone in (listen from 8mins).

Referrals (England)

GP online reported that GP practices are under increasing pressure, with patient demand rising, while some hospitals continue to refuse referrals, despite being told to begin restoring non-COVID-19 services, including routine procedures, as part of the second-phase response to the pandemic. In response to this I said that blocked referrals 'continues to be a concern' for GPs and that some areas could only make urgent referrals, as I called for trusts to create a safe referral system to reduce patient anxiety and ease workload for GPs.

Restoration of cervical smear services

NHSE/I and Public Health England have published guidance on the restoration of cervical smear services, following the advice to step up urgent services which includes screening. The document provides guidance to NHSEI regional public health commissioning teams to support conversations with providers of NHS Cervical Screening Programme services to ensure that they are restored in a consistent, safe way. Read the guidance here

Premises update – NHSPS and NHSE/I engagement (England)

Last week, GPC premises policy lead, Gaurav Gupta, and deputy, Ian Hume, met for the first time with the recently appointed CEO and COO of NHS Property Services (NHSPS). Initial dialogue was constructive, and the group have resolved to meet regularly to escalate and troubleshoot operational concerns relating to COVID-19, as well as ongoing issues raised by members. The leads also met with NSHE/I for an update on the Premises Review, and to set expectations regarding engagement and consultation as more of the review workstreams get underway.

Serious shortage protocol for Fluoxetine 40mg capsules

The DHSC have issued a Serious Shortage Protocol (SSP) for fluoxetine 40mg capsules, which came into effect on 20 May, and will expire on 20 July 2020. The SSP will enable community pharmacists in England, Wales and Northern Ireland to supply patients with 2 x fluoxetine 20mg capsules.

NHS Confederation webinar (England)

NHS Confederation will be holding a webinar ‘The PCN DES: a discussion for the undecided’ on Wednesday 27th May 12.30-1.30pm. This will focus on issues relating to the DES and offer an opportunity for questions to be raised. They have also published a briefing regarding the PCN DES. Register for the webinar here

NHS Digital national GP data extraction to support COVID-19 planning and research

The DPN for the GPES Data extraction for pandemic planning and research (COVID-19) was uploaded last week, which will allow data to be collected using GPES to be made available for approved uses through NHS Digital’s Data Access Request Service in accordance with robust information governance standards and consultation with the BMA and RCGP.

As of 19 May, 54% of practices have participated in the extract, which represents 3815 practices (from a total of 7013). If you haven’t already registered, the DPN can be found here. NHSD have asked all practices to try to register by 27 May with extractions taking place on a fortnightly basis.

An opportunity to join a virtual ‘Doctors' Mess’ 

Former GPC member and London GP, Dr Rebecca Viney, has developed a twice-weekly confidential meeting place to talk, share, offload and give space to plan and prioritise in small virtual break out rooms. It began in April 2020 and now meets every Tuesday at 15.30-16.30 and Thursday 18:30 – 19:30. See more information in the attached flyer – or email direct to contactdoctorsmess@gmail.com 

BMA COVID-19 webpage and guidance

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

·         General practice toolkit

·         Model terms of engagement for a GP providing temporary COVID-19 services

·         Terms and conditions for sessional GPs

·         BMA’s COVID-19 ethical guidance

 

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

As part of Mental Health Awareness Week this week, the BMA has published a report on the mental health and wellbeing of the medical workforce - now and beyond COVID-19, which sets out ten recommendations to be addressed to protect staff now and in the future. Read more here

The BMA continue to offer wellbeing services and confidential 24/7 counselling and peer support for all doctors and medical students, regardless of BMA membership, as well as their partners and dependents, on 0330 123 1245.

If practices or LMCs would like hard copies of our Wellbeing poster, with tips for doctors supporting each other during the crisis, please email wellbeingsupport@bma.org.uk.

Other COVID 19 resources

BMJ – news and resources

RCGP COVID-19 information

NHSE/I daily primary care bulletins on COVID-19

NHSE/I COVID-19 webinars

COVID-19 Google Drive resource

Primary Care Pathways COVID-19 resource centre

NICE resources on COVID-19   

Diploma of Legal Medicine

The Faculty of Forensic & Legal Medicine of the Royal College of Physicians offer a Diploma of Legal Medicine (DLM), which would be appropriate for LMC secretaries and officials as well as Practice Managers and Medical Advisers, interested in medicolegal issue. For more information, please see the attached letter and flyer, which can be distributed as you wish.

​See this week’s GP bulletin here

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