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LMC weekly update - 27 November 2020

2020 Conference of England LMCs 

As many of you will be aware, the 2020 Conference of England LMC was held today, 27 November, as a virtual event. Rachel McMahon chaired the conference, support by deputy chair Shaba Nabi, who was also elected as chair of Conference of England LMCs for 2021.  

In my opening speech I thanked and commended GPs for having stepped up at this time of national crisis and for responding to the COVID-19 pandemic with such speed and effectiveness. I praised the hard work and diligence of our colleagues across primary care over the last nine months, while criticising the Government for being “behind the curve” with delayed guidance, limited initiatives and inadequate funding. 

I noted that with the daunting covid vaccination programme facing us there can be no better people to succeed in this task which the whole nation is depending on. Once a safe and effective vaccine is available, our practice teams will work to the best of their considerable ability to protect our patients as quickly as practically possible.  And whilst we may have super-powers we cannot be in two places at once and so we will need the help of everyone, we’ll need to be able to prioritise the rest of our workload and crucially we’ll need the understanding of our patients in doing so. We will need all hands to the pump. 

The event was webcast via this link and a recording of the event and the resolutions will be published on the website as soon as possible after the event. They are also available here. Read the agenda here . GPonline has reported on my speech 

Welsh LMC conference update 

I attended the annual conference of Welsh LMCs last weekend, which was chaired by Nimish Shah.  Phil White, chair of GPC Wales, gave a report to conference and thanked GPs for their continued dedication to their local communities and how rapidly the profession reacted early on, whilst maintaining a high-quality service throughout a global pandemic.  

The health minister had addressed and been welcomed by the NI LMC conference two weeks ago, and similarly Vaughan Gething MS, the Minister for Health and Social Care, was welcomed to the Welsh LMC conference and thanked GPs and staff for “dedication and commitment” shown when caring for people in Wales during the pandemic, and acknowledged the “unprecedented challenges” faced by the health and social care system.   

Motions debated included: access and remote consultations, clusters, pandemic response, digital and enhanced services, immunisation, workforce, workload and sustainability, primary and secondary care interface.  A full report from the conference and the resolutions are available here

COVID-19 vaccination programme guidance (England) 

NHSE/I has published a letter about the outcome of general practice site designation processto provide commissioners and practices with more information to help with planning. This follows on from a letter that NHSE/I sent to NHS Trusts last week, outlining the wider COVID-19 vaccination deployment strategy and operational readiness for mass immunisation sites. 

The letter sets out that NHSE/I aims to give all designated sites at least 10 days’ notice of the first vaccines becoming available to ensure sites can be prepared and clinics arranged. It also suggests practices may wish to use this opportunity to invite the extended flu vaccination programme cohort of 50-64 year olds to their single designated site, to test arrangements. 

In addition, NHSE/I has published FAQs on their FutureNHS platform (sign in required) based on the information known at present about eligible cohorts, appointment booking, administration of the vaccine, workforce and funding, to help answer any question that practices may have. We also expect that the COVID-19 vaccination programme specifications will be published imminently. 

Practices have stepped up to the challenge of putting in place arrangements at an unprecedented speed and should be commended for doing so. It's been vital to be prepared for all possible options and once the regulatory process is complete we will have greater clarity and be able to finalise plans. The difficulties with storing and moving the Pfizer vaccine make the delivery of this particularly challenging.  As a result it may be that initial vaccination plans of priority groups including care homes residents and healthcare staff will depend on the specific vaccinations available. 

Please see our recent guidance about the COVID-19 vaccination programme which has FAQs throughout to answer some of the questions that we know practices must have, and we will regularly update it when new information is available. 

Public Health England have produced two videos in which Wei Shen, chair of the Joint Committee on Vaccination and Immunisation, explaining the vaccine prioritisation and the rationale for the age-based approach. The videos can be found on the Public Health England twitter page. 

COVID-19 winter plan and exiting lockdown (England) 

Last week, the BMA launched a ‘blueprint’ for leaving lockdown, to help save lives and prevent the collapse of health services this winter, outlining major reforms for England to sustainably control the spread of COVID-19. 

Earlier this week, the Prime Minister set out the COVID-19 winter plan and announced the return to a three-tiered system when England ends lockdown next week on 2 December. He also confirmed that that mass testing will be introduced in all England's tier three areas, the highest alert level. In response to this, Chaand Nagpaul, BMA council chair, said: 


“The Government has had nearly a month to devise a realistic plan to halt the spread of Covid-19, in order to protect people’s health and prevent the NHS facing collapse. Worryingly, the Prime Minister has revealed a plan that is full of risks and threatens to undo the progress and undermine the difficult sacrifices the public have made in that time. 

The Prime Minister says the new measures are tougher than October when in reality many are far more relaxed, at a time when infection rates and covid-related hospitalisations and deaths remain high. For doctors and NHS staff who are already working under incredible pressure, the potential impact on NHS services is deeply worrying.” Read the full BMA statement here 

The full COVID-19 winter plan is available here and information about the local restriction tiers 

Guidance for clinically extremely vulnerable people 

From Wednesday 2 December, once the current national restrictions in England are replaced with a regionally differentiated approach of the country, the government is planning to communicate updated guidance with all c.2.3m people on the Shielded Patient List (SPL) via letter The government has provided specific guidance for clinically extremely vulnerable people at each local tier. This letter should be published on Saturday 28 November on the GOV.UK website. Letters may start arriving with patients from Saturday 28 November, and throughout all of next week (w/c 30 November). 

Media 

Responding to initial reports over the weekend, I appeared on BBC News, saying that the suggestion of tightening Tier restrictions is a good thing, but that we must have a proper plan in place before we consider relaxing any rules over Christmas. I also spoke to BBC 5Live (around 7.10am) BBC West Midlands (around 8am) and was interviewed by BBC Radio Humberside where I voiced scepticism about the efficacy of the previous Tier system, making it clear that we must avoid returning to arrangements that "don't work and put everybody at risk" and reiterated that the BMA advocates replacing the 'rule of six' with a 'rule of two (households)'. 

There was also general reporting of the BMA’s Exit Strategy including in the GuardianHuff PostITV Newsthe HeraldAsian Imagethe NationalDaily Telegraph  

New two-week circuit breaker for Northern Ireland  

Northern Ireland Executive has agreed to introduce a two-week circuit breaker to slow the spread of Coronavirus in the community and protect the health service. The new restrictions will cover two weeks from November 27 until December 11.

Tom Black, Chair of the BMA's council in Northern Ireland, took part in interviews about the new two-week circuit breaker announced by the Northern Ireland Executive late last week. On Friday, he spoke to BBC Radio Four World at One programme (30:45), the Nolan Show (1:19:35), Irish NewsIrish TimesRTE online newsDaily mail onlinei NewsBBC Newsline 

COVID-19 select committee: digitalisation of physical health services and impact on wellbeing 

Farah Jameel, GPC England executive team member, gave oral evidence to the Lords’ COVID-19 select committee this week, regarding the digitalisation of physical health services and the impact on our future wellbeing. Alongside other panellists from the King’s Fund, HealthWatch and Staffordshire’s STP, Dr Jameel talked about the increasing role digital technology has had in healthcare delivery – catalysed by the COVID-19 pandemic – and some of the risks and opportunities that should be considered in order to ensure patients receive the right care, at the right time, via the right medium. Watch Dr Jameel giving evidence to the committee here 

Integrated Care Systems consultation (England) 

The NHSE/I has published a consultation inviting comments on the next steps for ICSs (Integrated Care Systems).  The consultation raises some fundamental issues about how the NHS will be structured and work in the future and invites a discussion about how ICSs could be embedded in legislation or guidance. It signals an intent to make significant changes to CCGs and move the focus from competition to provider collaboration. The BMA will be carefully considering this and its implications. Read more about the proposals here  

GP trainees mileage payment 

NHS Employers and the BMA have published joint guidance for the reimbursement of home to principle place of work mileage for trainees in a GP practice. The guidance will provide the necessary information for employing organisations on operationalising the current provisions in the absence of an updated version of the terms and conditions. This is applicable to both back dated and future claims. 

QOF system suppliers update (England) 

As practices will be aware QOF 2020/21 has been revised to reflect the impact of COVID-19 on general practice. We recognise that practices need to reprioritise aspects of care not related to COVID-19 and the QOF requirements have been modified for 2020/21 to support this and to help release capacity in general practice. Practices and commissioners have been asked to work together to confirm that any population stratification is clinically appropriate for their local population. 

Clinical system suppliers have recently updated QOF indicators and prompts. In some instances, this may have impacted on practices’ records of progress to date. Practices should be reassured that the indicators affected by this update are those that are subject to income protection as outlined in 2020/21 QOF guidance. Practices are not expected to re-code or re-review patients for indicators affected by this system update, unless there is a clinical need to do so. 

Local funding protection – template letter for LMCs (England) 

We know some local authorities have advised they will be expecting practices to maintain pre-pandemic levels of service in order to receive agreed payments through Q3 and Q4 of this financial year – GPC England does not believe this is appropriate. The government, through NHS England, recognises the need for practices to prioritise their workload, and has protected their core income to allow them to do this. Local Authorities must follow suit. We also know some local authorities are using unnecessarily bureaucratic process for practices to claim supplier relief – again this is not appropriate. The funding must be protected and paid from the outset. 

In response to this emerging issue we have produced a letter which can be sent to relevant local authorities, urging them to reconsider this position and guarantee income protection for these services for the remainder of the financial year. 

We hope that this will be useful to LMCs and can contribute to ensuring that there is one less issue for practices to be concerned about over the difficult coming months. 

GP appointment data (England) 

The latest appointment data for October was published yesterday. There were nearly 1.6 million more appointments in October than September, and October also had the highest number of appointments of any month in 2020 (28,236,193), and the highest since October 2019. There were 1.8million more face-to-face appointments in October than September and the highest number since February. 

This data continues to show that general practice remains open and is delivering a high number of appointments during the second wave of the pandemic. 

Government spending review 

This week, the Chancellor announced funding plans for the NHS during his spending review speech. The announcements fall short of what is needed to improve GP practices/ estates and expand the GP workforce. Read our briefing on the announcements.  

GMC State of medical education and practice in the UK 

The GMC has released it’s annual survey findings in it’s State of medical education and practice in the UK report. Last year they looked at general practice in detail. This year, not surprisingly, they have found that 80% of GPs said they were working remotely more often, with fewer face-to-face consultations. Of concern, 34% reported seeing situations where patient safety or care was compromised. However, 59% felt the pandemic has had a positive impact on the speed of implementing change. 38% of GPs responding said they were satisfied or very satisfied in their day-to-day work, up from just 20% in 2019. 

RCGP call for suspension of GP appraisal during the Covid-19 pandemic 

The Royal College of GPs’ Council has passed a motion to call for suspension of GP appraisal for the duration of the Covid-19 pandemic. Although the College was pleased to see the introduction of a ‘lighter touch’ approach to appraisal, they remain concerned that many GPs simply do not have the capacity to engage even with a simpler process.  Read the full statement here 

Parental leave webinar and workshop 

We will be hosting a webinar and a workshop for GPs on parental leave on: 

2 December from 12.30pm – 2.00pm – Webinar - 'GP Maternity and Parental leave Guide: launch and introduction to the guide’. Register here 

9 December from 12.30pm – 2.30pm – Workshop - ‘GP maternity’. Register here 

If you would like to submit questions in advance to be covered at either session, please contact Christopher Scott via cscott@bma.org.uk  

COVID-19 media 

Gaurav Gupta, GPC policy lead for premises and finance and Kent representative, spoke to BBC Kent on Monday about the COVID vaccine and NHS spending. Listen to the interview here (starts at 7am).  

GP online reported that GP practices in England can use their share of a £150m Covid capacity fund to hire locums, helping ease staffing pressures. In response to this I said: "The whole intent of the £150 million is to provide support direct to practices with minimum bureaucracy to help them through the tough winter ahead. There should not be bureaucratic hurdles. I think we should trust practices to use it as best they can to expand their workforce - it can be GPs or practice staff, and they can use it for locums."  

In a look back at key news events from 2016, the Yorkshire Post (print only) quoted my response to a survey of GPs which found that 80 per cent felt their workload was 'unmanageable or excessive', and that this was negatively impacting on patient care. I said: "The Government has to fund an expansion of services. Failure to do so will result in the failure of the NHS as a whole." 

See this week’s GP bulletin here.  

Read the latest Sessional GPs newsletter here 

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