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LMC weekly update - 4 December, 2020

COVID-19 vaccination programme specifications and guidance (England) 

Following the agreement between GPC England and NHSE/I for general practice to play a leading role in the delivery of the COVID-19 vaccination programme, we have been negotiating the detail of the Enhanced Service Specifications, which have now been re-published to include modifications following discussion with MHRA and to ensure patients from non-participating practices can be provided vaccinations, alongside a letter that responds to many of the issues raised by practices and highlighted at the recent LMC England conference.  This does though continue to be a very fluid and fast changing situation as more information becomes available about vaccine availability and the logistics of delivery.  NHSE/I have provided further information this evening, including details on the first wave of vaccinations and a collaborative agreement. All details can be seen here. 
 

Practices are asked to sign up to this Enhanced Service by Monday 7 December, and will be provided at least 10 days’ notice of the first vaccines becoming available. Whilst the timeline is very short, this is because practices need to be ready to deliver vaccinations in the very near future, particularly with the approval this week of the first COVID-19 vaccination by the MHRA. 

NHSE/I have this evening published more information about the first practices to deliver covid vaccinations. Yesterday they asked CCGs for approximately 280 practice group sites to be the ‘Wave 1’ providers and selection of these sites will largely be based on the areas where there are the highest number of people aged 80 or more, and where the sites are ready to start within those timescales.  Those practices should now know that they have been put forward as potential sites and this will then be confirmed next week. We expect these sites to be fully supported by their local systems to enable the successful delivery of this first wave of vaccinations. We will also offer them all the support necessary. 

These initial sites should receive a box of 975 Pfizer BioNTech vaccines on or close to 14th December, to enable them to start vaccinating from the following day. Following the regulatory requirements set by MHRA they will need to use the vaccine within 3.5 days, not the previously suggested 5 days, and so need to ensure patients are invited to attend within that timescale.  All patients will need to be offered a second appointment 21 days afterwards for their second vaccination. Vaccines are being held back nationally to ensure they are available to provide this second dose. 

NHSEI will be writing to sites identified as part of Wave 1 on Monday, setting out full details of vaccine supply dates, delivery of other consumables and equipment to the site, and the process for assuring readiness before delivery of vaccines. This will include a delivery of IT equipment necessary to deliver the programme and a fridge for each site. Access to necessary training will be provided and sites will be given full support to mobilise within the timescale. 

The short timescale for delivery of this vaccine means that practices will need to re-prioritise and postpone other activities, such as non-essential health checks and reviews, in order to focus on the Covid-19 vaccination programme, particularly with the short period in which the vaccine will need to be used. Practice vaccination teams will need to work in core hours and therefore cannot be available for other more routine activity at the same time. We believe that patients will appreciate this prioritisation and that CCGs and NHSE/I must support practices in doing this. 

Sir Simon Stevens said earlier this week that around 1000 GP group sites had indicated their willingness to take part in the programme. Once the vaccine becomes more widely available these other community sites will be able to start vaccinating.  They will also be given at least 10 days notice of this. It is therefore important for practices not involved in the first wave to continue to review the enhanced service specification and indicate to their CCG as soon as possible their decision about involvement in this programme. 

The COVID-19 Vaccination Collaboration Agreement has been published today and can be found here. This is designed to support the delivery of the CVP by setting out the responsibilities and relationships between collaborating practices. GPC England has had legal support to scrutinise the document and is satisfied that it is fit for purpose, being in line with other similar collaboration agreements already in place. 

Wessex LMC have shared an excellent presentation about the vaccinations from Professor Saul Faust, the lead investigator for the Southampton arm of the Oxford AstraZeneca trial. To watch it - click here 

PHE Guidance for healthcare professionals delivering the COVID-19 vaccine 

Public Health England has published guidance for healthcare professionals who will deliver the COVID-19 vaccine which includes information about the vaccines (as they become available), vaccine recommendations and eligibility, contraindications and precautions, and vaccine administration issues. 

PHE has also published a new COVID-19 chapter in the Green Book which has guidance on the vaccine, provisional priority groups, advice on high risk groups and on potential adverse effects, which current evidence suggests are mild and short-term.  

GPC guidance on the COVID-19 vaccine programme (England) 

Our guidance page about the COVID-19 vaccination programme has been updated to and has FAQs throughout to answer questions from practices. We continue to update this regularly, as and when new information becomes available, so please refer back to this guidance page.  

We have also published guidance on how practices can utilise extra workforce to deliver the COVID-19 vaccine programme. Members of staff already qualified to provide vaccinations are likely to be the main part of the workforce administering vaccine in general practice, and most of the programme should be delivered by staff other than GPs, who will be more useful in other areas. 

The BMA are also calling for the prioritisation of those at the greater risk, including those with underlying health conditions and those of a BAME background, when vaccinations are rolled out.  Read the full statement here 

COVID-19 vaccine media 

Following  the news that the Health Secretary, Matt Hancock, had confirmed an initial order of 800,000 doses of the Pfizer vaccine was on its way from Belgium – with around five million to arrive by the end of the year, I said: "Today is a significant step towards overcoming Covid-19 and GPs share in the optimism of the rest of the nation as a future beyond the pandemic comes more clearly into sight. Practices have responded rapidly in recent weeks to put in place arrangements so that they are ready to deliver vaccinations once they are made available.” Read the full BMA press statement here. The comments have been covered in The Times, The i and the The Mirror. I was also interviewed by GP online and BBC Look North. I did interviews for a number of local radio stations including BBC Radio Somerset, Radio London, Radio Newcastle, Radio Hereford and Worcester, Radio Merseyside, Radio Shropshire and 3 Counties Radio. There have also been a number of interviews and quotes by BMA spokespeople on regional and national media, including Times Radio (2hrs 4mins), BBC Sussex (2hrs 15mins), BBC York (2hrs 09mins), BBC Somerset (1hr 05mins), BBC SpotlightGuardianIndependent and Mirror

BMA NI Council chair, Tom Black, was interviewed on BBC Foyle’s Breakfast Show (from 1hr38min), about the Pfizer vaccine approval where he said the vaccine 'was very good news' adding: "The sooner we get this in and start vaccinating the better." NI GPC chair, Alan Stout, was interviewed on  Good Morning Ulster (from 2hrs) on the Pfizer covid vaccine and what part general practice may play in the roll-out of a local vaccine programme. The interview was also carried by BBC News NI online.  Tom Black and GPC chair Alan Stout were also interviewed – can listen to the interviews at TalkBack (14:32), Newsline (05:23), UTV Live (1:50), Radio Foyle lunchtime news (11:30) and Q Radio News

The Telegraph (paywall) has published an article highlighting concerns over GP funding for the Covid vaccine after concerns have been raised that some surgeries may refuse to sign up. In response to this I said that I was hopeful that all practices would sign up, but acknowledged that significant uncertainties over the specifics of the roll-out plan remain. I also called on the Government to suspend safety inspections by the CQC, as well as various bureaucratic duties, while the roll-out takes place. 

Christmas and New Year period (England) 

As highlighted in the NHSE/I primary care bulletin this week, general practices are not expected to open for delivery of core services over the weekend and bank holidays for this coming Christmas and New Year period. Local commissioners and primary care providers can therefore continue to plan on the basis of their planned cover arrangements.  

This followed the concerns that we had raised of the importance of all those working in general practice needing time off during the Christmas bank holiday to rest after the difficult year we've had. 

Guidance for clinically extremely vulnerable people (England) 

As of 2 December, lockdown has ended in England and returned to a regionally differentiated three-tiered system. Due to this, the government has sent a letter this week with updated guidance to all clinically extremely vulnerable (CEV) people on the Shielded Patient List. 

In each tier, there is a set of rules that everyone in that area must follow. The letter, which sets out the new guidance, no longer advises CEV people to stay away from work or school, but does suggest limiting the number of social interactions. Read the government’s guidance for clinically extremely vulnerable people at each local tier.  

The DHSC has also announced that people on the CEV list and those in residential and nursing care homes will receive free winter supply of Vitamin D to help support general health, in particular bone and muscle health, during the winter months, which is even more important for those that have been shielding and may not have been able to obtain enough vitamin D from sunlight.  

NHS Digital has published letter templates for high-risk patients for use by GPs when notifying patients newly identified as clinically extremely vulnerable from COVID-19. 

We have also updated our guidance aboutclinically extremely vulnerable people

Joint letter on next steps for the GP contract in Scotland 

Ahead of the Scottish LMC Conference, held today, Andrew Buist, Chair of GPC Scotland, and Jeane Freeman MSP, the Cabinet Secretary for Health and Sport, have written a letter setting out the next steps for the GMS Contract in Scotland for 2021/22 and beyond. The Cabinet Secretary spoke at the conference today and praised the significant contribution that GPs and their practice teams had made over the last year. This is the third health minister to speak at the national LMC conferences in recent weeks. 

Joint message on COVID-19, the easing of lockdown and winter pressures (Scotland) 

BMA Scotland and the Academy of Royal Medical Colleges and Faculties in Scotland have published a joint statement on COVID-19, the easing of lockdown and winter pressures. The statement raises significant concerns about the how the five-day period over Christmas may impact upon Covid-19 infection rates. Read the statement here 

Accessing your GP animation  

To support general practice, the NHSE/I has created an animation to help explain to the public how they can continue to access GP services, including how to get in contact, the different ways care may be delivered, and how face-to-face appointments have changed.  

CQC review of the use of do not resuscitate decisions during COVID-19  

The CQC has produced a briefing clarifying how it will be undertaking a DHSC requested review of the use of ‘do not resuscitate’ decisions during COVID-19 (made after 17 March 2020).  

Some practices have already raised concerns regarding CQC ‘spot checks’ or communications from CCGs. Please note that these reviews are not CQC practice inspections and reports of review visits will not be published. If CQC do find examples in records which raise concerns about the way DNACPR decisions were made it will feed this back to the practice and to the CCG. CQC will also provide information to its local CQC inspection team as part of their routine monitoring. 


As you may recall, we recently wrote to Matt Hancock calling for an immediate suspension of all CQC inspections and reviews of general practice (other than those required for serious safety issues) for the duration of the pandemic to enable practices to focus on other priorities, not least the COVID-19 vaccination programme.  This was also reported by BBC news online

Conference of England LMCs 2020
The virtual England LMC Conference took place last Friday, 27 November 2020.  This document details the conference resolutions, election results and motions lost. 

You can watch my speech to the conference here and the webcast of the conference is available here. All of these, including the agenda, are also available on the BMA website

Watch some edited highlights from the conference on the BMA GP twitter page  

The BMJ reported on the motion which calledfor partners to receive same pay rise as salaried colleagues. 

Cameron Fund Christmas Appeal 

This year and subsequent years will be difficult for the Cameron Fund, which is the only medical benevolent fund that solely supports GPs and their dependents, as the Fund faces increased pressure from those affected by the COVID crisis and a reduced income from investments. As such, they have launched a Christmas appeal to try and raise more money for the Fund to be able to help more GPs in need. Read more in the letter from Dr Ian Winterton, Cameron Fund Treasurer and on the Cameron Fund website 

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.  

Institute of General Practice Management 

A new organisation representing Practice Managers has now been formed and is called Institute of General Practice Management. A website is currently being designed by Wessex LMCs and there is currently a Facebook page (Institute of General Practice Management) and twitter @TheIGPM. The next webinar for all PMs is on Wednesday 16th December at 5.00 p.m. – all this information is on the Facebook page and twitter. 

Integrated Care Systems consultation (England) 

Following the publication of the NHSE/I consultation last week about the next steps for ICSs, which raises some fundamental issues about how the NHS will be structured and work in the future, I was quoted in an article by the BMJ: I said that the changes offered an opportunity to “undo some of the damage” caused by the 2012 NHS reforms, but warned, “This must not be done in a way that is counter productive, and we have serious concerns about the risk of vertical integration, which would lead to an end to the independent contractor model for general practice.” I also stressed the crucial role that LMCs should play in enabling the voice of all GPs to be heard at all levels within a regional structure.

Parental leave webinar and workshop 

We will be hosting a workshop for GPs on parental leave next week, 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 

Pulse reported how this year GPs have had to be more dedicated and adaptable than ever, taking on new ways of remote working and run outdoor or socially distanced clinics, often with smaller teams due to staff self-isolating. The article refers to my speech at last week’s LMC England Conference where I said that GPs have shown ‘great bravery and determination’ this past year, putting patient safety first while also witnessing colleagues tragically unable to survive the virus, and far from closing, practices remained open, and are now delivering more appointments than a year ago, all while contending with the devastating impact of the pandemic.’ 

Alan Stout ,chair of Northern Ireland GPC, was interviewed on BBC Newsline about primary care’s involvement in the roll out of the Covid vaccination programme, which was subsequently picked up by BBC News NI online and the Good Morning Ulster programme. NIGPC deputy chair Frances O’Hagan was also interviewed on Saturday’s BBC Newsline.

See this week’s GP bulletin here.  

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