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LMC weekly update - 3 July, 2020

Faulty PPE

MHRA have advised a product recall notice to practices and care homes with safety warnings, notices for destruction and distribution stoppages for more than 85 million Cardinal Surgical masks and 3m and Cardinal respirators in the PIPP stockpile since it was deployed in March. This comes despite repeated assurances by Public Health England, NHS England and the Department of Health and Social Care, that all PPE products had been rigorously tested and are safe for use.

This is an unacceptable situation that has put healthcare workers at risk and now could leave some practices without any face masks to use, therefore potentially having a major impact on patient care. We have raised our serious concerns about this with NHSE/I. They have responded to say that they have not supplied any Cardinal masks since May and are working through a replacement plan with the wholesalers who supplied primary care.  Practices can obtain PPE supplies via their LRFs (who have good supplies) and the Portal that can be delivered within 48 hours. Find out how to register and contact the Portal Customer services team here

If doctors and health and care workers have been supplied with, and worn, faulty, re-dated masks, this is clearly a dereliction of duty to ensure the safety of NHS staff and patients. Wearing substandard PPE places doctors at risk of becoming infected and also spreading the illness to patients and nothing short of 100% fit for purpose PPE should have been supplied from the outset. Read the full BMA statement here

This was reported by Sky NewsChannel 4 News, PulseTelegraph, and  Nursing Notes,

New to Partnership Payment Scheme (England)

The New to Partnership Payment Scheme was launched on 1 July and will apply to all new clinical partners from 1 April 2020. The partnership model, which gives GPs based in communities the autonomy to lead and advocate for their patients, is the foundation of general practice, and vital for its survival and sustainability. However, in recent years the number of partners in England has been steadily falling and it was clear to us that action needed to be taken to attract and equip GPs to take on partnership. This scheme, secured through our recent contract negotiations, follows the Partnership Review and shows faith in GPs and the partnership model – backed with additional investment – so that new partners can have the confidence in taking on this important role.

There are still wider issues facing partners – and those considering becoming partners - that need urgent attention, which includes cutting back on bureaucracy and regulation, and empowering GPs as leaders enabled to shape sustainable services with the necessary resources in their area. Recent months have shown practices overhauling systems to ensure patients receive high quality care during the pandemic, and GPs must be trusted to continue this leadership and deliver the best for their patients and communities for the long term. This was reported by GPonline and Pulse

Lapse of the emergency GMS regulations (England)

The emergency regulations relating to general practice, which were part of the NHS response to the COVID-19 pandemic, lapsed on 1 July. We have been in discussion with NHSE/I about what the arrangements will be for the rest of the year as we are clearly a long way from the end of the pandemic and need to be prepared for a second wave or impact of local outbreaks as we are already seeing. We are seeking urgent clarification of this so that practices can plan for the months ahead and will provide an update as soon as we can.

Social distancing guidelines

Following the PM’s announcement last week about the change in the guidance on social distancing, we are working through the implications of this with NHSE/I and the impact it will have on services.

From 4 July, the guidance will change from ‘Stay 2 metres apart’ to ‘Where it is possible to keep 2 metres apart people should’, it also advises people to keep a social distance of ‘one metre plus’, meaning in areas where it is not possible to keep 2 metres apart such as in public transport and some working environments, they should remain at a minimum one metre apart, while also taking physical steps to reduce the risk of transmission. The government guidance continues to state that businesses should maintain 2 metre distancing wherever possible. This would apply to practices who should continue to apply social distancing. I have done an interview for Sky News today on these changes.

The BMA has written to the Secretary of State for Health and Social Care to express concerns over the lack of clarity in the Westminster government’s plans to ease lockdown and calling on government ministers to produce clear and consistent guidance on social distancing.

The BMA has also called for the Government to be more open and transparent with local COVID-19 data and about how regional spikes will be managed in the future, following the announcement of a reintroduction of lockdown measures in and around Leicester due to increasing levels of infection in the city. This was reported by the BBCBBC OnlineThe GuardianThe Independent, MetroMirrorHuffington PostTelegraphEvening Standard and MSN

Read more in the BMA statement calling for consistent guidance on social distancing

COVID-19 risk assessments

Last week we were disturbed by the results of the latest BMA tracker survey which found that more than a third of BAME doctors in the UK are still not being given access to potentially life-saving COVID-19 risk assessments – nearly two months after NHS England issued recommendations that risk assessments should be carried out for all staff as a precautionary measure.

In response to my letter to Simon Stevens earlier this month and our lobbying on these issues, NHSE/I have issued a letter which sets out that CCGs should commission an occupational health service to support practices with this risk assessment process.  We do not believe practices should be expected to pay for this, and it should be made freely available as soon as possible through local OH capacity, or by commissioning more to complement existing OH services via this Dynamic Purchasing Solution, if additional capacity or access outside normal working hours is needed. CCGs are asked to assure that this is happening comprehensively and speedily in their areas.

Read the BMA’s guidance on risk assessments which includes specific information for practices.

Shielding update

We have updated our guidance on shielding following the announcement that the guidance for clinically extremely vulnerable people who are currently shielding from coronavirus, will be eased in two stages – on 6th July and 1st August.

These patients will be sent a letter advising them to continue with the care/treatment arrangements currently in place. More detailed advice will be provided by the Government as the changes in advice come into effect, and unless there is a significant rise in COVID-19 cases the shielding programme is expected to be paused on 31 July.

The shielded patients list will continue to be maintained after August so that it can be used again in the future if necessary. Work is also being done to develop a new predictive risk tool which could lead to an updated list in the future.

We have heard of situations where individuals, employers, businesses or insurance companies have been suggesting that shielding patients obtain a letter from their GP to engage in certain activities, including having their hair cut. There is no requirement or necessity for such letters and patients and others should follow the government guidance relating to social distancing and other necessary precautions.

Read the Government’s guidance on shielding for patients and the letter to the NHS on shielding

Trust GPs to lead: learning from the response to COVID-19 within general practice in England

Our report Trust GPs to lead: learning from the response to COVID-19 within general practice in England, which was published last week, explores and highlights the scale of extra work being taken on by GPs during the pandemic, which was also highlighted in the BMA’s latest tracker survey.

I have joined a ministerial working group on renewal and recovery in general practice, set up by Jo Churchill MP, Parliamentary Under-Secretary of State for Health and Social Care.  This is also linked to the contract agreement for a government review to reduce unnecessary bureaucracy impacting general practice. The BMA will be submitting evidence to the review and participating in the ongoing discussions. The final recommendations will be agreed by the ministerial working group to take forward. Read more here 

Scottish GPC newsletter

Please see attached the latest newsletter from Scottish GPC, which includes updates on an update from the latest SGPC meeting, COVID-19, negotiation issues and contracts, IT, and LMC update.

COVID-19 has rewritten the rulebook for how the NHS operates

I have written a feature in the HSJ (log in required) highlighting how the pandemic saw general practice rapidly responding to enable the needs of patients to be met safely. The NHS has had to adapt significantly since the start of COVID-19, with general practice leading the way, and now most patients will have recognised the changes made over the last few months – all of which have been done more easily due to the reduced bureaucracy and increased autonomy for practices.

Pandemic Medicines Delivery Service extension

NHS England/NHS Improvement have now announced that the Pandemic Medicines Delivery Service will be extended until 31 July 2020. This new commission will be under the same terms of the current scheme with the same claims processes in place. Their letter announces that pharmacies and dispensing doctors across England will be required to ensure shielded patients can receive a home delivery of their medicines until 31 July 2020. Read the service specification and guidance here

GP appointment data (England)

NHS Digital has published the appointment data in England for May 2020, which show that there has been a significant reduction in appointments to non-COVID period in April and May. However we know that the reality on the ground is quite different with many seeing an initial drop in appointments at the start of the pandemic, but now experiencing a significant increase back to historic levels or in some cases over pre-COVID levels as practices manage delayed presentations.

Survey on digital primary care and COVID

The inSIGHT study is an international project that aims to understand the impact of COVID-19 on the use of digital-first technologies in primary care, and they would like to hear from GPs. The inSIGHT project is led by the Institute of Global Health Innovation at Imperial College London, involving collaborators from 17 organisations worldwide. Take the survey here

Annual GP recruitment drive (England)

Applications for GP specialty training open on the 28 July–13 August 2020. Please ‘like’ and follow the #Choose GP Facebook page to keep up to date, and forward this informationto anyone who may be thinking about career options. Visit the GP National Recruitment Office for more information. Health Education England has a number of GP and trainee volunteers who can help with local or general enquiries. Email Daryl at gprecruitment@hee.nhs.uk to be put in touch with them.

HEE thanks all GPs and trainees who responded to the call for volunteers willing to be contacted by doctors considering GP training - your support is very much appreciated.

Performers List processes associated with GP Registrars and professional standards (England)

Please find attached PLAN 07 that provides formal notification from NHSE/I confirming the joint agreement with Health Education England that GPRs due to start training in August 2020 are exempt from the requirement to be included in the England Medical Performers List. 

Self Care Forum Coronavirus Innovations Award

Every year the Self Care Forum invites submission of examples of good practice and innovation, to be celebrated during Self Care Week, and be given a £500. This year they are asking for examples of good practice and innovations in self care that have been implemented during the pandemic and which have made a difference to individuals and the community. Closing date for admissions is 31st July 2020. More information about the award and an application form can be found here

Mental health and wellbeing

The BMA’s latest tracker survey revealed high levels of exhaustion and stress amongst doctors. The BMA continues to offer wellbeing services and confidential 24/7 counselling and peer support for all doctors and medical students, as well as their partners and dependents, on 0330 123 1245. For hard copies of our Wellbeing poster, please email wellbeingsupport@bma.org.uk

Read the BMA’s report on the mental health and wellbeing of the medical workforce which sets out ten recommendations to be addressed to protect staff during the pandemic and in the future.

BMA COVID-19 guidance

We continue to regularly update our toolkit for GPs and practices, which includes a large range of topics relating to COVID-19. There is also guidance on the following topics:

For further information, see the BMA’s COVID-19 Webpage with all the latest guidance including links to the BMA’s COVID-19 ethical guidance and priorities for easing lockdown.

Thanking your colleagues on 5 July

The NHS as we know it would be nothing without the hard work and dedication of its staff, so the BMA is encouraging you to use the NHS’s 72nd anniversary on 5 July to recognise the colleagues who have been supporting you during the pandemic– by tagging them in a photo or a message of thanks on social media. If you also tag the BMA (@theBMA on TwitterInstagram and Facebook) we can make sure it’s seen by as many people as possible.

See this week’s GP bulletin here.

Read the Sessional GPs newsletter here

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