Changes to QOF and IIF
NHSE/I published a letter today announcing changes to QOF and IIF and changes to the COVID vaccination DES. More detail and operational guidance on these changes will be forthcoming in days to come.
Given today’s announcement on QOF and IIF, I hope it will become possible for practices to consider how they may be able to support the national vaccination effort whilst continuing to clinically prioritise patients who need them. I recognise the significant unprecedented challenges you are all facing at present and know that you will do your best in the days and weeks to come, as you have been doing these past 20 months. Thank you for all that you are doing for your patients, for your communities. Read our press statement.
Secretary of State for Health and Social Care, Sajid Javid, has written a thank you letter to Primary Care, thanking them for their efforts on the COVID-19 Vaccination Program.
Additional funding for COVID vaccination programme – but more support is needed (England)
Following the identification of the COVID-19 omicron variant, the government have accepted JCVI advice to widen the age range for vaccine eligibility to include all 18-39 year olds and to shorten the time from last vaccination to booster to three months.
In addition, 12 to 15 year olds can now receive a second dose of the Pfizer-BioNTech COVID-19 vaccine, no sooner than 12 weeks after the first dose. Severely immunosuppressed individuals who have received three primary doses, should also be offered a booster dose.
To support the quicker and larger roll-out of boosters, NHSE/I announced earlier this week that there will be some additional funding to support PCN Groupings to step up capacity by:
· Increasing the Item of Service (IoS) fee for COVID-19 vaccinations to £15 from 1 December to 31 January (Mondays to Saturdays)
· Increasing IoS fee to £20 for vaccinations administered on Bank Holidays and Sundays from 1 December to 31 January
· Increasing the supplement for vaccination of housebound patients to £30 from £20 between 1 December and 31 December backdated to 16 September
Although we welcome additional funding being made available, we remain concerned about the high workload and lack of workforce capacity in general practice. Given today’s announcement on QOF and IIF, I hope it will become possible for practices to consider how they may be able to support the national vaccination effort.
At this critical time in the fight against COVID-19, GPs and their teams want to do all they can to protect and look after their communities, focusing on those most in need.
This means finely balancing the clear national priority to deliver booster vaccinations to as many people as possible with ensuring that people who need care and treatment from their GP practice and the wider NHS continue to receive it.
If practices physically do not have the staff or time to dedicate additional time to the vaccine programme because they are also focused on other contractually required work it will do little to help. With a finite number of staff and hours in the day there is a limit to what practices can safely do.
We hope that these changes, by removing some of the more bureaucratic and target-based requirements within practices’ contracts, will create capacity to step up delivery of the vaccination programme to quickly protect as many as possible from COVID-19. Read our press statement
I spoke about this at length in the press, including in the Telegraph where I said: “What general practice needs right now, is to be trusted to lead their teams, delivering care to those who need it the most. We’re asking for a high-trust, low bureaucracy system.” I was also interviewed on BBC Radio 4's Today Programme (listen at 48m40s) and on BBC Radio 5 Live (listen at 2h55m) about the Covid booster campaign and pressures in general practice. This was also covered by MailOnline, Pulse, GPonline, the Times, the BBC (online), Daily Mail (also here and here), Pulse, and on BBC Radio London. The BMJ also ran an article about the need for extra staff in general practice and capacity to deliver accelerated booster programme.
Dr Brian McGregor, BMA Yorkshire regional council chair was interviewed on the topic on BBC Radio York (listen at 1h09m33s), and Dr George Rae, BMA North East regional council chair was interviewed on BBC Radio Tees (listen at 1h14m30s).
Pulse reported on my Tweets, where I said: ‘I have written to NHSE/I to offer the full support and force of general practice in the face of an evolving threat to the nation.’ It also reported on Tweets by former GPC chair, Dr Richard Vautrey, where he said that GPs ‘should be urgently freed up to focus on the patients who need them most’ and ‘step up delivery of [Covid vaccine] to quickly protect as many as possible from [Omicron]’.
New COVID-19 Omicron variant – new measures and booster programme extension
Following the reports of a new COVID-19 Omicron variant, last week the BMA called for mandatory mask-wearing and social distancing in indoor crowded spaces, and that public buildings, offices and hospitality venues have adequate ventilation to disperse the virus as much as possible.
The Prime Minister then announced that new targeted measures in England to prevent the spread of the new variant would be introduced on Tuesday 30 November, including mandatory mask wearing in shops and on public transport. The public was also encouraged to ensure they get vaccinated, to help protect themselves and others.
A CAS alert has been sent out to healthcare workers, with advice to continue to follow the national Infection prevention and control for seasonal respiratory infections in health and care settings for winter 2021 to 2022 guidance, wearing face masks for staff and face masks/coverings for all patients and visitors within health and care settings over the winter period.
It also recommends that physical distancing should be at least 1 metre, increasing whenever feasible to 2 metres across all health and care setting, and that it should remain at 2 metres where patients with suspected or confirmed respiratory infection are being cared for or managed. Read the BMA statement here
Following the Prime Minister’s announcement of new infection control measures in response to the emergence of the new Omicron Covid variant, the BMA issued a statement calling for mandatory mask wearing to extend to all public indoor and enclosed spaces, which featured across media.
I was interviewed by Radio News Hub and featured on news bulletins across the country.
BMA report: Weathering the storm
The BMA published a report, Weathering the storm: vital actions to minimise pressure on UK health services this winter, last week.
The report outlines practical recommendations for stemming the winter crisis that health services across the UK are facing. These include calling on political leaders to have honest conversations with the public about the immediate challenges facing health services so that patients and the public alike have the best information possible about how to access safe and appropriate care
The report calls for urgent and immediate action by government and health service leaders and asks them to do more to:
1. Communicate honestly with patients and the public about health service pressures
2. Retain existing staff and maximise workforce capacity
3. Promote responsible public health policies to keep people safe and healthy and help manage demand on services
4. Direct resources to where they are needed most to manage health service demand
Access the report and read more here
Joint statement on Inclisiran
Although the BMA is supportive of innovation of new drugs, we have serious concerns about how this particularly drug is being introduced. In particular we have raised issues about where the long-term responsibility lies when prescribing this drugs, and the lack of clarity about where doctors and patients can turn if there are concerns or problems.
There is also an issue of capacity the lack of clear resources to support the additional work required and how the impact that introducing new treatment plans will have on teams that are already stretched to their limits. We have raised these concerns with NICE and NHSE/I.
This guidance aims to advise practices that may want to prescribe these drugs of our concerns and that they should only do so if they feel comfortable. Read the statement here
Integrated care systems – primary care (England)
The BMA continues to lobby on a range of issues relating to the Health and Care Bill, including strengthening the involvement of general practice, and the role of LMCs. As part of this we have co-signed a letter with other representative bodies for primary care, to Ministers and the Health and Care Bill Committee, asking for a commitment from Ministers in Committee that:
· The government honours its commitment for primary care to be represented and involved in decision-making at all levels of the Integrated Care Systems (ICS) including strategic decision-making forums through formalised roles for GPs, dentists, pharmacists, primary eye care and primary hearing care audiologists in Integrated Care Partnerships (ICPs)
· These roles are remunerated to ensure parity of availability and voice with NHS Trusts, NHS staff, social care and public health colleagues in strategic thinking and decision-making
· That existing statutory Local Representative Committees, such as LMCs, have the right put forward nominations for those roles
· Transparency and accountability - ICBs and ICPs to be under duty to explain in writing in public when they choose not to heed advice from local primary care bodies.
A briefing outlining what collectively we want government to do has also been sent to Ministers.
The resolutions and election results from the Annual Conference of England LMCs 2021, which was held last week, have now been published. Watch recordings of the event:
Read more about the event here: Local medical committees (bma.org.uk)
There was coverage by Pulse and GPonline of a motion calling on the BMA to negotiate a new GP contract and coverage in GPonline of a motion asking for better primary care representation on ICS boards. There was also coverage in GPonline of a debate on GP wellbeing that saw delegates sharing harrowing personal accounts of attacks on staff in their surgeries.
Scottish LMC Conference 2021
The Scottish LMC conference was held today (virtually). Unfortunately I was unable to attend the day as originally planned. The conference was attended by the Cabinet Secretary for Health and Social Care Humza Yousaf. I understand that as one would expect, there was excellent debate, the day was expertly chaired by conference chair Dr Denise Mcfarlane. You can read Chair of SGPC Dr Andrew Buist conference speech. You can read the agenda here.
Sustainability payments for GP practices in Scotland
The Scottish Government has announced a £15 million sustainability payments for all GP practices in Scotland for 2021, with a further payment of £15m in 2022-23, following successful negotiations with Scottish GPC. The funding will need to be used to support:
· Extra internal GP sessions (including face-to-face appointments)
· Extra non-core hours
· Additional administrative time and practice manager time
· Additional practice nurse time
· Practice organised cover for PLT for reflection, learning and innovation
· External GP locum sessions
· Any other purpose connected with the provision of GP services
Read the blog about it by Chair of Scottish GPC, Dr Andrew Buist.
GPC Wales GP contract agreement 2021/22
GPC Wales has agreed changes to the GP contract for 2021/22 with Welsh Government and NHS Wales this week. The changes include:
· a 3% pay uplift for GPs and all practice staff1
· continued investment for the implementation of the ‘Access to In-hours GP Services’
· commitment to improve access to and from primary care
· in-year funding to alleviate winter pressures
· data legislative reform to de-risk general practice
· protected Learning Time and funding of Care Navigation Training
Supporting general practice
Read about how we are campaigning against abuse of GPs and their staff on our Support Your Surgery campaign page, which includes a number of resources that practices can use.
NHSE/I has now also published materials and guidance for use in primary care settings to encourage patients to treat NHS staff with respect.
I was interviewed in The Times (also in print), where I said that the BMA wants to work with the government despite the threat of industrial action, and that: "There has been a breakdown in discussion and understanding. I know that solutions come from talking, even if you’re in conflict, they come from talking or respectful conversations that look to find solutions. I want to say I’m sorry that things are as bad as they are. But that is despite us trying hard to do our very best." I also called on the Health Secretary to find a way to "put a protective ring around" patients who needed urgent support this winter.
The BMJ reported on the Indicative Ballot, and the fact that it showed that over half of general practices in England would be willing to withdraw from primary care networks in response to the government’s “rescue package” for the profession.
Chair of GPC Wales, Dr Phil White, featured on BBC 1 Wales - Breakfast (listen from 5:35) and in news bulletins throughout the day highlighting the demands on general practice and warning that "something will have to give" if GPs are required to assist with the booster roll-out.
BMA Scotland has welcomed the announcement by the First Minister, Nicola Sturgeon, of a £30 million fund to help GPs offer more appointments as part of a “significant down payment” of extra money for the Scottish NHS. This was reported by the National
NI GPC chair Dr Alan Stout joined a panel of experts on BBC The View to discuss the new omicron variant (listen from 9:56).
Read the BMA’s GP bulletin here.
Read my twitter page Dr Farah Jameel (@DrFJameel) / Twitter